In vitro fibroblast and pre-osteoblastic cellular responses on laser surface modified Ti–6Al–4V

Study on Surface Roughness, Morphology, and Wettability of Laser-Modified Powder Metallurgy-Processed Ti-Graphite Composite Intended for Dental Application

In this study, the surface laser treatment of a new type of dental biomaterial, a Ti-graphite composite, prepared by low-temperature powder metallurgy, was investigated. Different levels of output laser power and the scanning speed of the fiber nanosecond laser with a wavelength of 1064 nm and argon as a shielding gas were used in this experiment. The surface integrity of the machined surfaces was evaluated to identify the potential for the dental implant's early osseointegration process, including surface roughness parameter documentation by contact and non-contact methods, surface morphology assessment by scanning electron microscopy, and surface wettability estimation using the sessile drop technique. The obtained results showed that the surface roughness parameters attributed to high osseointegration relevance (Rsk, Rku, and Rsm) were not significantly influenced by laser power, and on the other hand, the scanning speed seems to have the most prevalent effect on surface roughness when exhibiting statistical differences in all evaluated profile roughness parameters except Rvk. The obtained laser-modified surfaces were hydrophilic, with a contact angle in the range of 62.3° to 83.2°.

Fibroblasts Adhesion to Laser-Modified Titanium Surfaces-A Systematic Review

OBJECTIVE

Laser treatment has been recently introduced in many fields of implant dentistry. The systematic review tried to address the question: "How does laser modification of titanium surface influence fibroblast adhesion?".

METHODS

An electronic search of the PubMed and Scopus databases was performed. The following keywords were used: (laser) AND (fibroblast) AND (titanium) AND (implant OR disc) AND (proliferation OR adhesion). Initially, 136 studies were found. Ten studies met the inclusion criteria and were included in the review. All studies chosen to be included in the review were considered to have a low risk of bias.

RESULTS

Studies included in the review varied with laser parameters or ways of observing fibroblast behavior. Studies showed that fibroblasts tend to take different shapes and create extensions on modified surfaces and that their metabolic activity is more intense. One study concentrated on laser application and showed that three-directional laser application is the most successful in terms of fibroblast adhesion. Studies which concentrated more on laser parameters showed that too low energy density (lower or equal to 0.75 J/cm2) does not influence fibroblast adhesion. Increasing the energy density over 0.75 J/cm2 causes better cell adhesion of fibroblasts to the laser-modified sample. One included study focused on increasing titanium surface wettability, which also positively influenced cell adhesion.

CONCLUSION

The studies included in the review proved a positive effect of laser-modified titanium surfaces on fibroblast adhesion. However, the application of an appropriate laser energy dose is crucial.

Surgical treatment for upper cervical deformity with atlantoaxial joint dislocation using individualized 3D printing occipitocervical fusion instrument: A case report and literature review

To introduce a novel technique of using individualized 3D printing occipitocervical fusion instrument (3D-OCF) for the treatment of upper cervical deformity with atlantoaxial joint dislocation.The surgery for deformity of the craniocervical junction area is a challenge in the field of spine. If the surgical deviation is too large to injure the spinal cord or vertebral artery, it will cause catastrophic damage to the patient. Therefore, it is controversial whether these patients should undergo surgical treatment. We provide a novel surgical approach for the challenging upper cervical surgery through 3D-OCF and a typical patient.We present a 54-year-old female patient, who suffered from dizziness and numbness in her limbs for 8 months. After the patient was admitted, we performed the three-dimensional CT scan, modeled using Mimics software 17.0, and designed customized occipitocervical fusion instrument. Besides, we repeatedly perform simulated surgery based on 3D-printed models before surgery.The operative time was 142 minutes and the intraoperative blood loss was 700 mL. X-ray showed reduction of atlantoaxial dislocation and accurate position of internal fixation. The patient's symptoms were significantly relieved: the sensation of dizziness and numbness of limbs was obviously relieved, and the sense of banding in chest, abdomen, and ankle was disappeared. At the last follow-up, imaging showed that 3D-OCF had bone-integration and Syringomyelia was disappeared. The patient's cervical JOA (Japanese Orthopaedic Association) score increased from 10 points to 17 points.Individualized 3D-OCF can improve the safety and accuracy of upper cervical surgery, reduce the operative time and the number of fluoroscopy. Our study provides a novel surgical approach for the challenging upper cervical surgery.

Selective Laser Melted Titanium Alloy for Transgingival Components: Influence of Surface Condition on Fibroblast Cell Behavior

PURPOSE

To mechanically characterize and assess the biological properties of Ti6Al4V surfaces obtained by Selective Laser Melting in order to determine whether this process is conceivable for production of implant-supported prostheses and particularly trans-gingival components. As-built and polished surfaces were studied in comparison with components obtained by computer numerical control machining technology in order to consider whether the properties are in the same range as the conventional method currently used.

MATERIALS AND METHODS

Cylindrical specimens of Ti6Al4V (n = 6) were built with Selective Laser Melting for the characterization of mechanical properties according to ISO 22674 and discs (n = 12) were fabricated in the same conditions for cytotoxicity evaluation. Discs (n = 12) of Ti6Al4V were also obtained by computer numerical control machining as control. Half of the number of discs (n = 6) from each process were polished, to simulate the laboratory protocol for polishing of transmucosal components and half of the discs remained unaltered (as-built). Surface roughness measurements of disc specimens (as-built and polished) were compared with computer numerical control milling specimens (as-built and polished). Proliferation of human gingival fibroblasts on Ti6Al4V surfaces was also assessed for each condition. Viability and cell morphology were then evaluated qualitatively. Ra and Sa data were compared using Student's t-test (α = 0.05) and metabolic activity data were compared using Kruskal-Wallis statistical test (α = 0.05).

RESULTS

Selective Laser Melting specimens showed elongation at break greater than 2% and 0.2% yield strength better than 500MPa which complied with ISO 22674 standards. Although Selective Laser Melting samples displayed significantly increased roughness on as-built surfaces compared to computer numerically controlled milling samples (p < 0.05), no statistically significant difference was observed after mechanical polishing (p = 0.279). Regarding metabolic activity, no statistical difference was observed between groups at day 3 (p > 0.05) and fibroblasts showed a viability higher than 97% on all discs. Cell shapes on polished samples suggested moderate adhesion compared to unpolished samples.

CONCLUSION

With the manufacturing parameters selected in this study, Selective Laser Melting of Ti6Al4V appeared to be compatible with a prosthetic application type 4 according to ISO 22674. Surfaces obtained, followed by recommended postprocessing provided components with equivalent biological properties compared to computer numerical control machining technology.

Empirical and theoretical insights into the structural effects of selenite doping in hydroxyapatite and the ensuing inhibition of osteoclasts

The use of ions as therapeutic agents has the potential to minimize the use of small-molecule drugs and biologics for the same purpose, thus providing a potentially more economic and less adverse means of treating, ameliorating or preventing a number of diseases. Hydroxyapatite (HAp) is a solid compound capable of accommodating foreign ions with a broad range of sizes and charges and its properties can dramatically change with the incorporation of these ionic additives. While most ionic substitutes in HAp have been monatomic cations, their lesser atomic weight, higher diffusivity, chaotropy and a lesser residence time on surfaces theoretically makes them prone to exert a lesser influence on the material/cell interaction than the more kosmotropic oxyanions. Selenite ion as an anionic substitution in HAp was explored in this study for its ability to affect the short-range and the long-range crystalline symmetry and solubility as well as for its ability to affect the osteoclast activity. We combined microstructural, crystallographic and spectroscopic analyses with quantum mechanical calculations to understand the structural effects of doping HAp with selenite. Integration of selenite ions into the crystal structure of HAp elongated the crystals along the c-axis, but isotropically lowered the crystallinity. It also increased the roughness of the material in direct proportion with the content of the selenite dopant, thus having a potentially positive effect on cell adhesion and integration with the host tissue. Selenite in total acted as a crystal structure breaker, but was also able to bring about symmetry at the local and global scales within specific concentration windows, indicating a variety of often mutually antagonistic crystallographic effects that it can induce in a concentration-dependent manner. Experimental determination of the lattice strain coupled with ab initio calculations on three different forms of carbonated HAp (A-type, B-type, AB-type) demonstrated that selenite ions initially substitute carbonates in the crystal structure of carbonated HAp, before substituting phosphates at higher concentrations. The most energetically favored selenite-doped HAp is of AB-type, followed by the B-type and only then by the A-type. This order of stability was entailed by the variation in the geometry and orientation of both the selenite ion and its neighboring phosphates and/or carbonates. The incorporation of selenite in different types of carbonated HAp also caused variations of different thermodynamic parameters, including entropy, enthalpy, heat capacity, and the Gibbs free energy. Solubility of HAp accommodating 1.2 wt% of selenite was 2.5 times higher than that of undoped HAp and the ensuing release of the selenite ion was directly responsible for inhibiting RAW264.7 osteoclasts. Dose-response curves demonstrated that the inhibition of osteoclasts was directly proportional to the concentration of selenite-doped HAp and to the selenite content in it. Meanwhile, selenite-doped HAp had a significantly less adverse effect on osteoblastic K7M2 and MC3T3-E1 cells than on RAW264.7 osteoclasts. The therapeutically promising osteoblast vs. osteoclast selectivity of inhibition was absent when the cells were challenged with undoped HAp, indicating that it is caused by selenite ions in HAp rather than by HAp alone. It is concluded that like three oxygens building the selenite pyramid, the coupling of (1) experimental materials science, (2) quantum mechanical modeling and (3) biological assaying is a triad from which a deeper understanding of ion-doped HAp and other biomaterials can emanate.

Surface Modified Techniques and Emerging Functional Coating of Dental Implants

Dental implants are widely used in the field of oral restoration, but there are still problems leading to implant failures in clinical application, such as failed osseointegration, marginal bone resorption, and peri-implantitis, which restrict the success rate of dental implants and patient satisfaction. Poor osseointegration and bacterial infection are the most essential reasons resulting in implant failure. To improve the clinical outcomes of implants, many scholars devoted to modifying the surface of implants, especially to preparing different physical and chemical modifications to improve the osseointegration between alveolar bone and implant surface. Besides, the bioactive-coatings to promote the adhesion and colonization of ossteointegration-related proteins and cells also aim to improve the osseointegration. Meanwhile, improving the anti-bacterial performance of the implant surface can obstruct the adhesion and activity of bacteria, avoiding the occurrence of inflammation related to implants. Therefore, this review comprehensively investigates and summarizes the modifying or coating methods of implant surfaces, and analyzes the ossteointegration ability and anti-bacterial characteristics of emerging functional coatings in published references.

Treatment of massive iliac chondrosarcoma with personalized three-dimensional printed tantalum implant: a case report and literature review

Although customized three-dimensional tantalum implants have been used to treat a large variety of diseases, few reports have described the application of such implants to reconstruct large pelvic bone defects after the removal of massive tumors. We herein describe a 30-year-old woman with a 9-year history of a massive low-grade chondrosarcoma in the pelvic bone. After removal of a solid 12- × 8- × 6-cm tumor with clear margins, we used a customized three-dimensional printed tantalum implant to fill the large pelvic bone defect and performed hip arthroplasty in a one-step surgery. The patient's postoperative recovery was uneventful. She started walking 1 month after surgery, and she developed no tumor recurrence, instrumentation failure, or implant loosening during the 12-month follow-up period. This report describes the successful application of a customized three-dimensional printed implant to reconstruct a massive pelvic bone defect. Satisfactory functional recovery was achieved with no apparent complications. The methodology of the current case may benefit orthopedic and oncologic surgeons in designing treatment strategies for similar cases.

Magnesium doping on TiN coatings affects mesenchymal stem cell differentiation and proliferation positively in a dose-dependent manner

BACKGROUND

In vitro evaluation of cell-surface interactions for hard tissue implants have mostly been done using osteoblasts. However, when an implant is placed in the body, mesenchymal stem cells (MSCs) play a major role in new bone formation. Therefore, using MSCs in cell-surface investigations may provide more reliable information on the prediction of in vivo behavior of implants.

OBJECTIVE

In this study, Mg doped TiN coatings ((Ti,Mg)N) were prepared and tested for their effect on MSC differentiation and mineralization.

METHODS

MSCs were isolated from rat bone marrow (rBMSCs) and seeded onto bare Ti, TiN and Mg containing (Ti,Mg)N surfaces. Cell proliferation, osteogenic differentiation (collagen type 1, alkaline phosphatase activity), calcium phosphate deposition (von Kossa staining, Scanning Electron Microscopy) analysis were conducted.

RESULTS

Differentiation towards osteoblast lineage was significantly improved with the increment in Mg presence. Collagen type I deposition, mineralization, and the ALP activity were higher on high Mg containing (>10 at% Mg) surfaces but differentiation of rBMSCs were found to be delayed.

CONCLUSIONS

Mg presence affected rBMSCs proliferation and differentiation positively in a dose-dependent manner. However, high Mg amounts delayed both proliferation and differentiation.

[Clinical application of three-dimensional printed metal prosthesis in joint surgery]

Objective

To summarize the application progress of three-dimensional (3D) printed metal prosthesis in joint surgery.

Methods

The related literature was extensively reviewed. The effectiveness of 3D printed metal prosthesis in treatment of joint surgery diseases were discussed and summarized, including the all key issues in prosthesis transplantation such as prosthesis stability, postoperative complications, bone ingrowth, etc.

Results

3D printed metal prosthesis has good matching degree, can accurately reconstruct and restore joint function, reduce operation time, and achieve high patient satisfaction in short- and medium-term follow-up. Its application in joint surgery has made good progress.

Conclusion

The personalized microporous structure prostheses of different shapes produced by 3D printing can solve the problem of poor personalized matching of joints for special patients existing in traditional prostheses. Therefore, 3D printing technology is full of hope and will bring great potential to the reform of orthopedic practice in the future.

Proliferation of Osteoblasts on Laser-Modified Nanostructured Titanium Surfaces

Nanostructured titanium has become a useful material for biomedical applications such as dental implants. Certain surface properties (grain size, roughness, wettability) are highly expected to promote cell adhesion and osseointegration. The aim of this study was to compare the biocompatibilities of several titanium materials using human osteoblast cell line hFOB 1.19. Eight different types of specimens were examined: machined commercially pure grade 2 (cpTi2) and 4 (cpTi4) titanium, nanostructured titanium of the same grades (nTi2, nTi4), and corresponding specimens with laser-treated surfaces (cpTi2L, cpTi4L, nTi2L, nTi4L). Their surface topography was evaluated by means of scanning electron microscopy. Surface roughness was measured using a mechanical contact profilometer. Specimens with laser-treated surfaces had significantly higher surface roughness. Wettability was measured by the drop contact angle method. Nanostructured samples had significantly higher wettability. Cell proliferation after 48 hours from plating was assessed by viability and proliferation assay. The highest proliferation of osteoblasts was found in nTi4 specimens. The analysis of cell proliferation revealed a difference between machined and laser-treated specimens. The mean proliferation was lower on the laser-treated titanium materials. Although plain laser treatment increases surface roughness and wettability, it does not seem to lead to improved biocompatibility.

Additive manufacturing technique-designed metallic porous implants for clinical application in orthopedics

Traditional metallic scaffold prostheses, as vastly applied implants in clinical orthopedic operations, have achieved great success in rebuilding limb function. However, mismatch of bone defects and additional coating requirements limit the long-term survival of traditional prostheses. Recently, additive manufacturing (AM) has opened up unprecedented possibilities for producing complicated structures in prosthesis shapes and microporous surface designs of customized prostheses, which can solve the drawback of traditional prostheses mentioned above. This review presents the most commonly used metallic additive manufacturing techniques, the microporous structure design of metallic scaffolds, and novel applications of customized prostheses in the orthopedic field. Challenges and future perspectives on AM fabricated scaffolds are also summarized.

Effect of the Heat-Treated Ti6Al4V Alloy on the Fibroblastic Cell Response

Two heat treatments were carried out below (Ti6Al4V₈₀₀) and above (Ti6Al4V₁₀₅₀) Ti6Al4V beta-phase transformation temperature (980 °C), with the purpose of studying the effect of microstructure on the adhesion and proliferation of fibroblast cells, as well as their electrochemical behavior. These alloys were seeded with 10,000 L929 fibroblast cells and immersed for 7 days in the cell culture at 37 °C, pH 7.40, 5% CO₂ and 100% relative humidity. Cell adhesion was characterized by Scanning Electron Microscopy (SEM) and Electrochemical Impedance Spectroscopy (EIS) techniques. Polygonal and elongated cell morphology was observed independent of Ti6Al4V microstructure. Besides, C, O, P, S, Na and Cl signals were detected by Energy Dispersive X-Ray Spectroscopy (EDX), associated with the synthesis of organic compounds excreted by the cells, including protein adsorption from the medium. In certain areas on Ti6Al4V and Ti6Al4V₈₀₀ alloys, cells were agglomerated (island type), likely related to the globular microstructure; meanwhile, larger cellular coverage is shown for Ti6Al4V₁₀₅₀ alloy, forming more than one layer on the surface, where only Ca was recorded. Impedance diagrams showed a similar passive behavior for the different Ti6Al4V alloys, mainly due to TiO₂ overlaying the contribution of the organic compounds excreted by fibroblast cells.

A Comparative Study of 660 nm Low-Level Laser and Light Emitted Diode in Proliferative Effects of Fibroblast Cells

Introduction: In recent years, low-power lasers have been widely used in medicine. With the introduction of affordable light emitted diode (LED), clinical application of LED light has become more and more popular. However, some researchers believe that due to lack of coherence of the LED light, it can be different in terms of biological effects, in comparison with laser. In this study, the biological effects of low-level laser (LLL) to those of LED light are compared and discussed. Methods: Human skin fibroblast cell line Hu02 was irradiated with LLL and LED light with a wavelength of 660 nm, power output of 35 mW and in continuous mode and the control group was not irradiated. The biological effects were compared through analysis of cell proliferation, production of reactive oxygen species (ROS) within the cell and rate of cell division. Results: Our findings showed that production of ROS within the cell was linearly increased both in the LED and laser light irradiated cells. However, laser light is more incremental in comparison to LED light. The MTT results showed that laser light at low energy density (less than 5 J/cm²) increased the rate of cell proliferation after 24 hours. Although, the rate of cell division was increased in energy density of 1 J/cm² compared to the control group, this increase was not statistically significant. Discussion: The findings indicated that the coherence properties of laser light provided more energy for the cells, and in a constant energy density, laser light created more oxidative stresses in comparison with LED light.

In vitro biological outcome of laser application for modification or processing of titanium dental implants

There are numerous functions for laser in modern implant dentistry including surface treatment, surface coating, and implant manufacturing. As laser application may potentially improve osseointegration of dental implants, we systematically reviewed the literature for in vitro biological responses to laser-modified or processed titanium dental implants. The literature was searched in PubMed, ISI Web, and Scopus, using keywords "titanium dental implants," "laser," "biocompatibility," and their synonyms. After screening the 136 references obtained, 28 articles met the inclusion criteria. We found that Nd:YAG laser was the most commonly used lasers in the treatment or processing of titanium dental implants. Most of the experiments used cell attachment and cell proliferation to investigate bioresponses of the implants. The most commonly used cells in these assays were osteoblast-like cells. Only one study was conducted in stem cells. These in vitro studies reported higher biocompatibility in laser-modified titanium implants. It seems that laser radiation plays a vital role in cell response to dental implants; however, it is necessary to accomplish more studies using different laser types and parameters on various cells to offer a more conclusive result.

Osteoblast Cell Response on the Ti6Al4V Alloy Heat-Treated

In an effort to examine the effect of the microstructural changes of the Ti6Al4V alloy, two heat treatments were carried out below (Ti6Al4V₈₀₀) and above (Ti6Al4V₁₀₅₀) its β-phase transformation temperature. After each treatment, globular and lamellar microstructures were obtained. Saos-2 pre-osteoblast human osteosarcoma cells were seeded onto Ti6Al4V alloy disks and immersed in cell culture for 7 days. Electrochemical assays in situ were performed using OCP and EIS measurements. Impedance data show a passive behavior for the three Ti6Al4V alloys; additionally, enhanced impedance values were recorded for Ti6Al4V₈₀₀ and Ti6Al4V₁₀₅₀ alloys. This passive behavior in culture medium is mostly due to the formation of TiO₂ during their sterilization. Biocompatibility and cell adhesion were characterized using the SEM technique; Ti6Al4V as received and Ti6Al4V₈₀₀ alloys exhibited polygonal and elongated morphology, whereas Ti6Al4V₁₀₅₀ alloy displayed a spherical morphology. Ti and O elements were identified by EDX analysis due to the TiO₂ and signals of C, N and O, related to the formation of organic compounds from extracellular matrix. These results suggest that cell adhesion is more likely to occur on TiO₂ formed in discrete α-phase regions (hcp) depending on its microstructure (grains).