Cytotoxicity of commercial and novel binary titanium alloys with and without a surface-reaction layer

Zirconia Dental Implants as a Different Alternative to Titanium: A Literature Review

Aim

This article aims to provide an overview of the scientific evidence comparing zirconium dental implants with titanium implants.

Materials and Methods

A comprehensive literature review was conducted using the MEDLINE database accessed through PubMed and Scopus. The search included the keywords "dental implant," "zirconia dental implant," and "titanium dental implant" without any date restrictions.

Results

The review examined research articles focusing on the physical and chemical characteristics of titanium and zirconia dental implants. Additionally, studies investigating the strength and translucency of zirconia, as well as the osseointegration of both materials, were analyzed. However, no conclusive evidence demonstrating the superiority of either material was found in the current literature.

Conclusion

Taking into account the findings of this narrative study, no significant differences were identified between zirconium and titanium dental implants. Further scientific research is required to establish a definitive recommendation regarding the use of one material over the other.

Titanium Alloys for Dental Implants: A Review

The topic of titanium alloys for dental implants has been reviewed. The basis of the review was a search using PubMed, with the large number of references identified being reduced to a manageable number by concentrating on more recent articles and reports of biocompatibility and of implant durability. Implants made mainly from titanium have been used for the fabrication of dental implants since around 1981. The main alloys are so-called commercially pure titanium (cpTi) and Ti-6Al-4V, both of which give clinical success rates of up to 99% at 10 years. Both alloys are biocompatible in contact with bone and the gingival tissues, and are capable of undergoing osseointegration. Investigations of novel titanium alloys developed for orthopaedics show that they offer few advantages as dental implants. The main findings of this review are that the alloys cpTi and Ti-6Al-4V are highly satisfactory materials, and that there is little scope for improvement as far as dentistry is concerned. The conclusion is that these materials will continue to be used for dental implants well into the foreseeable future.

Cytotoxicity of orthodontic temporary anchorage devices on human periodontal ligament fibroblasts in vitro

Objectives

The objective of this study is to test cytotoxicity of four brands of commercially available orthodontic temporary anchorage devices (TADs).

Setting and sample population

Twenty-four (six for each brand, i.e., Aarhus [AO]; Dual top [RMO]; Vector TAS [ORMCO]; and Unitek TAD [3M UNITEK]) TADs were tested.

Materials and methods

Twenty-four (six for each brand, i.e., Aarhus [AO]; Dual top [RMO]; Vector TAS [ORMCO]; and Unitek TAD [3M UNITEK]) TADs were individually incubated in complete cell culture medium and shaken at a rate of 1.5 rpm at 37°C for 30 days to extract possible toxic substances in conditioned media (CM). To test cytotoxicity, human periodontal ligament fibroblasts were cultured and exposed to the CM for 24 hr, followed by the examinations of morphological changes, cell viability (MTT assay), and cell damage (lactate dehydrogenase [LDH] assay).

Results

No morphological changes were observed in any of the four brands of TADs compared with the negative control. LDH assay showed that none of the four brands of TADs caused significant cell damage after CM treatment compared with the negative control (P > .05). No significant differences were found between any of the four brands of TADs (P > .05). MTT assay showed similar results as did the LDH assay, except for a statistically significant difference found in the TADs from 3M UNITEK compared with the negative control (P = .047).

Conclusions

According to the International Standard Organization standards, except for the TAD from 3M, none of the other three brands of commercially available TADs (from AO, RMO, and ORMCO) exhibited significant cytotoxicity, suggesting their safe clinical applications.

Fabrication of multifunctional titanium surfaces by producing hierarchical surface patterns using laser based ablation methods

Textured implant surfaces with micrometer and sub-micrometer features can improve contact properties like cell adhesion and bacteria repellency. A critical point of these surfaces is their mechanical stability during implantation. Therefore, strategies capable to provide both biocompatibility for an improved implant healing and resistance to wear for protecting the functional surface are required. In this work, laser-based fabrication methods have been used to produce hierarchical patterns on titanium surfaces. Using Direct Laser Writing with a nanosecond pulsed laser, crater-like structures with a separation distance of 50 µm are produced on unpolished titanium surfaces. Directly on this texture, a hole-like pattern with 5 µm spatial period is generated using Direct Laser Interference Patterning with picosecond pulses. While the smaller features should reduce the bacterial adhesion, the larger geometry was designed to protect the smaller features from wear. On the multifunctional surface, the adherence of E. Coli bacteria is reduced by 30% compared to the untreated reference. In addition, wear test performed on the multiple-scale patterns demonstrated the possibility to protect the smaller features by the larger craters. Also, the influence of the laser treatment on the growth of a titanium oxide layer was evaluated using Energy Dispersive X-Ray Spectroscopy analysis.

In vitro biocompatibility of orthodontic miniscrews with human gingival fibroblast and SAOS-2 osteoblast cultures

PURPOSE

Miniscrews are an important choice for orthodontic anchorage. Yet reports on failures do exist, and attempts have been made to elucidate the causes. Clinical outcomes may be compromised not only by the mechanical implications of miniscrew design and the location of anchorage but also by poor biocompatibility. Hence, this study deals with the surface roughness and elemental composition of miniscrews and how these properties may affect the in vitro biocompatibility of four commercially available miniscrews.

METHODS

Most of the currently available miniscrews are made of TiAl6V4, an alloy widely considered to be biocompatible. The samples tested in this study included four similarly dimensioned TiAl6V4 products from different manufacturers: tomas® by Dentaurum, OrthoEasy® by Forestadent®, Dual Top™ by Jeil Medical/Promedia, and LOMAS by Mondeal®. The surface properties of these products were characterized by scanning electron microscopy (SEM) and energy-dispersive X‑ray spectroscopy (EDX). Cytotoxicity was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and agar overlay assays according to ISO 10993-5.

RESULTS

The miniscrew products were found to show variations in surface-finish quality pertaining to topography and chemical composition, with the latter departing slightly from the manufacturers' specifications. MTT assays yielded rates of cell culture viability in excess of 90%, and agar overlay assays did not reveal decoloration beyond the specimen outlines in any of the experimental groups tested.

CONCLUSIONS

The four miniscrew products exhibited some minor, but statistically significant, differences in microtopography, alloy composition, and biological inertness. Cytotoxicity testing revealed that all four products should be considered non-cytotoxic, thus, ruling out poor biocompatibility as a cause of miniscrew failure.

Laser Surface Pattering of Titanium for Improving the Biological Performance of Dental Implants

Direct laser interference patterning (DLIP) is used to produce periodic line-like patterns on titanium surfaces. An Nd:YAG laser operating at 532 nm wavelength with a pulse duration of 8 ns is used for the laser patterning process. The generated periodic patterns with spatial periods of 5, 10, and 20 µm are produced with energy densities between 0.44 and 2.6 J cm^-2 with a single laser pulse. With variation of energy density, different shapes of the arising topography are observed due to the development of the solidification front of the molten material at the maxima positions. Characterization of the surface chemistry shows that the DLIP treatment enhances the content of nitrogen of the titanium reactive layer from 3.9% up to 23.4%. The structural analysis near the titanium surface shows no changes in microstructure after the laser treatment. Contact angles between 65° and 79° are measured on both structured and turned reference surfaces. Cell viability of human osteoblasts on line-like patterned surfaces after 7 d in cultivation medium is 16% higher compared to the grit-blasted and acid-etched references. Finally, the possibility of patterning complex 3D dental implants is shown.

Effect of temperature variation on the cytotoxicity of cast dental alloys and commercially pure titanium

Cell culture system has been used to evaluate alloy cytotoxicity under different environments, testing the extracts, but the effect of temperature variation on the cytotoxicity of dental alloys has not been analyzed. Objective: The aim of the present study was to investigate if temperature variation could affect dental alloy cytotoxicity, testing alloy extracts in an epithelial cell culture system. Material and methods: Discs of Ni-Cr, Co-Cr-Mo, Ni-Cr-Ti, Ti-6Al-4V and commercially pure titanium (cp Ti) were cast by arc melting, under argon atmosphere, injected by vacuum-pressure. Discs were immersed in artificial saliva and subjected to different temperatures: 37°C and thermocycling (37°C/5°C/37°C/55°C/37°C). After thermocycling, extracts were put in a subconfluent culture during 6 h, and the number of cells and their viability were used to evaluate cytotoxicity in these temperatures. For each alloy, data from temperature conditions were compared by Student's t-test (α=0.05). Results: The cytotoxicity tests with alloy/metal extracts showed that Ni-Cr, Co-Cr-Mo, Ti-6Al-4V and cp Ti extracts (p>0.05) did not affect cell number or cell viability, while Ni-Cr-Ti (p<0.05) extract decreased cell number and viability when the alloy was subjected to thermocycling. Conclusion: Within the limitations of the present study, the Ni-Cr-Ti alloy had cell number and viability decreased when subjected to temperature variation, while the other alloys/metal extracts did not show these results.

Modeling wear of cast Ti alloys

The wear behavior of Ti-based alloys was analyzed by considering the elastic-plastic fracture of individual alloys in response to the relevant contact stress field. Using the contact stresses as the process driving force, wear was computed as the wear rate or volume loss as a function of hardness and tensile ductility for Ti-based cast alloys containing an alpha, alpha+beta or beta microstructure with or without the intermetallic precipitates. Model predictions indicated that wear of Ti alloys increases with increasing hardness but with decreasing fracture toughness or tensile ductility. The theoretical results are compared with experimental data to elucidate the roles of microstructure in wear and contrasted against those in grindability.

Initial cytotoxicity of novel titanium alloys

We assessed the biological response to several novel titanium alloys that have promising physical properties for biomedical applications. Four commercial titanium alloys [Super-TIX(R) 800, Super-TIX(R) 51AF, TIMETAL(R) 21SRx, and Ti-6Al-4V (ASTM grade 5)] and three experimental titanium alloys [Ti-13Cr-3Cu, Ti-1.5Si and Ti-1.5Si-5Cu] were tested. Specimens (n = 6; 5.0 x 5.0 x 3.0 mm(3)) were cast in a centrifugal casting machine using a MgO-based investment and polished to 600 grit, removing 250 mum from each surface. Commercially pure titanium (CP Ti: ASTM grade 2) and Teflon (polytetrafluoroethylene) were used as positive controls. The specimens were cleaned and disinfected, and then each cleaned specimen was placed in direct contact with Balb/c 3T3 fibroblasts for 72 h. The cytotoxicity [succinic dehydrogenase (SDH) activity] of the extracts was assessed using the MTT method. Cytotoxicity of the metals tested was not statistically different compared to the CP Ti and Teflon controls (p > 0.05). These novel titanium alloys pose cytotoxic risks no greater than many other commonly used alloys, including commercially pure titanium. The promising short-term biocompatibility of these Ti alloys is probably due to their excellent corrosion resistance under static conditions, even in biological environments.

Effect of commercial mouthwashes on the corrosion resistance of Ti-10Mo experimental alloy

The purpose of this work was to evaluate the effect of three commercial mouthwashes on the corrosion resistance of Ti-10Mo experimental alloy. Experiments were made at 37.0 +/- 0.5 degrees C in a conventional three-compartment double wall glass cell containing commercial mouthwashes. Three mouthwashes with different active ingredients were tested: (I) 0.05% sodium fluoride + 0.03% triclosan; (II) 0.5 g/l cetylpyridinium chloride + 0.05% sodium fluoride; (III) 0.12% chlorohexidine digluconate. The assessment of the individual effect of active ingredients was studied by using 0.05% sodium fluoride. Commercially pure titanium (CP Ti) was used as control. Microstructures from Ti-10Mo experimental alloy and CP Ti were also evaluated using optical microscopy. Ti-10Mo as-cast alloy shows the typical rapidly cooled dendrites microstructure (beta phase) while CP Ti has exhibited a metastable martensitic microstructure. Electrochemical behavior of dental materials here studied was more affected by mouthwash type than by Ti alloy composition or microstructure. In both alloys passivation phenomenon was observed. This process may be mainly related to Ti oxides or other Ti species present in spontaneously formed film. Small differences in passive current densities values may be connected with changes in film porosity and thickness. Protective characteristics of this passive film are lower in 0.05% sodium fluoride + 0.03% triclosan mouthwash than in the other two mouthwashes tested.

Increased transglutaminase activity was associated with IL-6 release in cultured human gingival fibroblasts exposed to dental cast alloys

Molecular mechanisms underlying gingival and periodontal inflammation caused by dental alloys are still poorly understood. Recently, it has been demonstrated that tissue transglutaminase can be involved in inflammatory cell response. The aim of this study was to evaluate effects of exposure to orthodontic materials on transglutaminase in cultured human gingival fibroblasts. The incubation with Ni-Ti heat-activated (T3) or Ni-Ti super-elastic (T4), and with Ni-Cr-Co (T2) alloys produced respectively 2.5-fold and 8-fold increases in IL-6 release compared with control cultures. Transglutaminase activity was significantly increased in cells exposed to T3 and T4 alloys (about 170% of control; p < 0.05), where it was mainly localized close to inner part of cell membrane. The exposure to T3 and T4 specimens significantly up-regulated also tTG expression compared with control cultures. These data first show an association between IL-6 release and tissue transglutaminase increases, suggesting that TGase-mediated reactions may play a major role in periodontal inflammation.