The corrosion and biological behaviour of titanium alloys in the presence of human lymphoid cells and MC3T3-E1 osteoblasts

Titanium corrosion products from dental implants and their effect on cells and cytokine release: A review

INTRODUCTION

Titanium is considered to be an inert material owing to the ability of the material to form a passive titanium oxide layer. However, once the titanium oxide layer is lost, it can lead to exposure of the underlying titanium substructure and can undergo corrosion.

SUMMARY

The article explores the role of titanium ions and particles from dental implants on cells, cytokine release, and on the systemic redistribution of these particles as well as theories proposed to elucidate the effects of these particles on peri-implant inflammation based on evidence from in-vitro, human, and animal studies. Titanium particles and ions have a pro-inflammatory and cytotoxic effect on cells and promote the release of pro-inflammatory mediators like cytokines. Three theories to explain etiopathogenesis have been proposed, one based on microbial dysbiosis, the second based on titanium particles and ions and the third based on a synergistic effect between microbiome and titanium particles on the host.

CONCLUSION

There is clear evidence from in-vitro and limited human and animal studies that titanium particles released from dental implants have a detrimental effect on cells directly and through the release of pro-inflammatory cytokines. Future clinical and translational studies are required to clarify the role of titanium particles and ions in peri-implant inflammation and the etiopathogenesis of peri-implantitis.

Immunotoxicity of stainless-steel nanoparticles obtained after 3D printing

This study aims to investigate the in vitro effects of nanoparticles (NPs) produced during the selective laser melting (SLM) of 316 L stainless steel metal powder on the immune response in a human blood model. Experimental data did not reveal effect on viability of 316 L NPs for the tested doses. Functional immune assays showed a significant immunosuppressive effect of NPs. There was moderate stimulation (117%) of monocyte phagocytic activity without significant changes in phagocytic activity and respiratory burst of granulocytes. A significant dose-dependent increase in the levels of the pro-inflammatory cytokine TNF-a was found in blood cultures treated with NPs. On the contrary, IL-8 chemokine levels were significantly suppressed. The levels of the pro-inflammatory cytokine IL-6 were reduced by only a single concentration of NPs. These new findings can minimise potential health risks and indicate the need for more research in this area.

Influence of implant diameter on implant survival rate and clinical outcomes in the posterior area: a systematic review and meta-analysis

OBJECTIVE

The aim of the present systematic review was to test the hypothesis that the diameter of implants inserted in the posterior area affects implant survival rate, prosthetic survival rate and peri-implant parameters (bleeding on probing (BoP), marginal bone loss (MBL), pocket probing depth (PPD)).

MATERIALS AND METHODS

An electronic search of studies published until December 2021 was done on three databases (Pubmed, Scopus, Cochrane) independently by two authors. Clinical trials comparing implant survival rate, BoP, MBL and PPD among narrow diameter implants (NDI: ≥ 3.0 mm to < 3.75 mm) and regular diameter implants (RDI ≥ 3.75 mm to < 5 mm) were included. Data were independently extracted by two reviewers. Risk of bias was evaluated according to the Cochrane risk-of-bias tool for randomized studies and to the Joanna Briggs Institute Critical Appraisal tools for non-randomized ones. A pair-wise meta-analysis was conducted on the included studies.

RESULTS

Seven articles were included out of the 4291 identified from the digital research. Overall, a total of 939 implants were inserted (319 NDI, 620 RDI). Only one study was judged at serious risk of bias. No statistically significant difference was found in implant survival rate (risk ratio 1.01 (95% CI [0.98 to 1.04], P = 0.67)) while the difference was significant for BoP (mean difference 2.89 (95% CI [0.30 to 5.48] mm, P = 0.03)) with higher values for NDI. Higher MBL was identified among regular diameter implants (mean difference -0.15 mm (95% CI [-0.32 to 0.01 mm], P = 0.07). No statistically significant differences were identified for prosthetic survival and PPD.

CONCLUSIONS

No differences were found in implant survival rate between narrow and regular implants. A higher BoP was identified among narrow implants, but there was no higher bone loss. It is not possible to draw definitive conclusions about the use of narrow-diameter implants in the posterior region.

Surface properties and biocompatibility of sandblasted and acid-etched titanium-zirconium binary alloys with various compositions

Ti-Zr alloys have been investigated as an alternative to commercially pure Ti (c.p.Ti). According to our previous studies on the mechanical properties of Ti-Zr alloys, a Zr proportion in the range of 30-50 mol% has competitive advantages over Ti-10Zr and c.p.Ti. The aim of this study is to evaluate the biological response to Ti-Zr alloys with different compositions and their surface characteristics. Alloy surfaces are modified by sandblasting and sulfuric acid etching. As a result, similar surface structures are observed for c.p.Ti, Ti-10Zr, and Ti-30Zr, whereas Ti-50Zr does not form a micro-rough structure by the same treatment process. No significant difference is found in the viability of cells on c.p.Ti, Ti-10Zr, and Ti-30Zr, whereas lower cell attachment levels are detected on Ti-50Zr. In summary, Ti-30Zr reliably forms a micro-rough structure, which provides one evidence for its application in a new dental implant material.

A Pilot Study with Randomised Controlled Design Comparing TiZr Alloy Dental Implants to Ti Implants

Objectives

Evidence on the clinical performance of recently introduced dental implants in titanium-zirconium alloy is sparse. The aim of the present pilot study with randomized controlled design is to compare changes in supporting structures around dental titanium-zirconium alloy implants to commercially pure titanium implants.

Material and Methods

The present material includes consecutive patients referred to a specialist clinic in Sweden. Two patient groups treated with dental implants in two different materials - titanium (Ti) and titanium-zirconium (TiZr) - were defined after block randomisation for smoking. In total, 40 implants installed in 21 patients were available for one-year follow-up. Marginal bone level, soft tissue height and width of keratinised mucosa were registered at baseline and at one-year follow-up.

Results

At implant level, the test group (TiZr) yielded significant marginal bone loss (P < 0.001) after one year. Additionally, marginal bone loss after one year was significantly higher for TiZr implants (P < 0.001) as compared to traditional Ti implants. Soft tissue dimensions were stable throughout the evaluation time for both implant materials.

Conclusions

One-year results indicate more pronounced initial marginal bone loss for dental implants in titanium-zirconium alloy as compared to implants made of commercially pure titanium.

Development and properties of dental Ti-Zr binary alloys

In this study, two medium Zr-containing Ti-based alloys with commercially pure titanium as control were systematically investigated to assess their potential biomedical application. After samples subjected to TMP and CR, it was found that the Zr addition significantly affected the microstructure, phase constitutions, mechanical properties and cytocompatibility. The microstructural results showed that increasing Zr concentrations resulted in more refined grains. Furthermore, Zr changed the phase constitution: CR Ti-20Zr was formed by the single α-phase while CR Ti-30Zr alloy was formed by the coexistence of α and deformation-induced FCC phases. The P-type FCC phase was dominant and more prone to occur than the B-type one. The mechanical tests demonstrated that the increasing Zr content led to a simultaneous increase in micro-hardness, strength and plasticity of CR samples due to the combined effects of solution strengthening, work hardening and the FCC phase. The SEM fractography indicated that the brittle fracture of CR Ti-20Zr due to deformation twins and ductile fracture of CR Ti-30Zr because of FCC phase. Furthermore, Ti-Zr alloys presented comparable cytocompatibility to the CP-Ti control based on cell viability, proliferation and intracellular O^2- content of MSCs. Specifically, alkaline phosphatase activity in BMSCs were significantly higher for grain refined CR Ti-30Zr. Considering all these results, CR Ti-30Zr alloy exhibited the optimal comprehensive performance to be potential dental materials.

Implant Soft-Tissue Attachment Using 3D Oral Mucosal Models-A Pilot Study

PURPOSE

The aim of this study was to investigate soft-tissue attachment to different metal, ceramic, and polymer implant surfaces using an inflamed, three-dimensional (3D), tissue-engineered, human oral mucosal model, as well as multiple-endpoint qualitative and quantitative biological approaches.

METHODS

Normal human oral fibroblasts, OKF6/TERT-2 keratinocytes and THP-1 monocytes were cultured, and full-thickness, 3D oral mucosal models were engineered inside tissue culture inserts. Sand-blasted and acid-etched (SLA) and machined (M) titanium-zirconium alloy (TiZr; commercially known as Roxolid; Institut Straumann AG, Switzerland), ceramic (ZrO2), and polyether ether ketone (PEEK) rods (Ø 4 mm × 8 mm) were inserted into the center of tissue-engineered oral mucosa following a Ø 4mm punch biopsy. Inflammation was simulated with addition of the lipopolysaccharide (LPS) of Escherichia coli (E. coli) and tumor necrosis factor (TNF)-alpha to the culture medium. Implant soft-tissue attachment was assessed using histology, an implant pull-test with PrestoBlue assay, and scanning electron microscopy (SEM).

RESULTS

Inflamed, full-thickness, 3D human oral mucosal models with inserted implants were successfully engineered and histologically characterized. The implant pull-test with PrestoBlue assay showed higher viability of the tissue that remained attached to the TiZr-SLA surface compared to the other test groups. This difference was statistically significant (p < 0.05). SEM analysis showed evidence of epithelial cell attachment on different implant surfaces.

CONCLUSIONS

The inflamed, 3D, oral mucosal model has the potential to be used as a suitable in vitro test system for visualization and quantification of implant soft-tissue attachment. The results of our study indicate greater soft tissue attachment to TiZr-SLA compared to TiZr-M, ceramic, and PEEK surfaces.

On the Future Design of Bio-Inspired Polyetheretherketone Dental Implants

Polyetheretherketone (PEEK) is a promising implant material because of its excellent mechanical characteristics. Although this polymer is a standard material in spinal applications, PEEK is not in use in the manufacturing of dental implants, where titanium is still the most-used material. This may be caused by its relative bio-inertness. By the use of various surface modification techniques, efforts have been made to enhance its osseointegrative characteristics to enable the polymer to be used in dentistry. In this feature paper, the state-of-the-art for dental implants is given and different surface modification techniques of PEEK are discussed. The focus will lie on a covalently attached surface layer mimicking natural bone. The usage of such covalently anchored biomimetic composite materials combines many advantageous properties: A biocompatible organic matrix and a mineral component provide the cells with a surrounding close to natural bone. Bone-related cells may not recognize the implant as a foreign body and therefore, may heal and integrate faster and more firmly. Because neither metal-based nor ceramics are ideal material candidates for a dental implant, the combination of PEEK and a covalently anchored mineralized biopolymer layer may be the start of the desired evolution in dental surgery.

Biological characterization of surface-treated dental implant materials in contact with mammalian host and bacterial cells: titanium versus zirconia

Early-colonizing oral bacterial adhesion and mammal cell proliferation were similar on surface-treated titanium and zirconia.

Evaluation of corrosion resistance of implant-use Ti-Zr binary alloys with a range of compositions

Although titanium-zirconium (Ti-Zr) alloy has been adopted for clinical applications, the ideal proportion of Zr in the alloy has not been identified. In this study, we investigated the biocompatibility of Ti-Zr alloy by evaluating its corrosion resistance to better understand whether there is an optimal range or value of Zr proportion in the alloy. We prepared pure Ti, Ti-30Zr, Ti-50Zr, Ti-70Zr, and pure Zr (mol% of Zr) samples and subjected them to anodic polarization and immersion tests in a lactic acid + sodium chloride (NaCl) solution and artificial saliva. We observed pitting corrosion in the Ti-70Zr and Zr after exposure to both solutions. After the immersion test, we found that pure Ti exhibited the greatest degree of dissolution in the lactic acid + NaCl solution, with the addition of Zr dramatically reducing Ti ion dissolution, with the reduction ultimately exceeding 90% in the case of the Ti-30Zr. Hence, although the localized corrosion resistance under severe conditions was compromised when the Zr content was more than 70%, metal ion release reduced owing to Zr addition and the corresponding formation of a stable passive layer. The results suggest that Ti-30Zr or a Zr proportion of less than 50% would offer an ideal level of corrosion resistance for clinical applications. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 73-79, 2018.

The effect of C content on the mechanical properties of Ti-Zr coatings

In this study, Ti-Zr and Ti-Zr-C coatings were deposited at room temperature via pulsed-DC magnetron sputtering. A 70Ti-30Zr at% target and a 99.99% graphite plate were used to deposit samples. In order to modify C content, coatings were deposited at different target powers such as 50, 75 and 100 W. Changes on the structure, microstructure and mechanical properties due to C addition were studied. Results indicate that the as-deposited coatings were partly crystalline and that an increment on C content stabilized α' phase and inhibited the appearance of ω precipitates. Therefore, Ti-Zr-C alloys with C>1.9 at% showed only α' phase whereas the others alloys exhibited α'+ω structures. Hardness values from 12.94 to 34.31 GPa were obtained, whereas the elastic modulus was found between 181.84 and 298 GPa. Finally, a high elastic recovery ratio (0.69-0.87) was observed as a function of composition. The overall properties of these coatings were improved due to C content increment, martensitic α' phase and nanocrystalline grain size (10-16 nm).

In vitro evaluation of biocompatibility of Ti-Mo-Sn-Zr superelastic alloy

Shape memory alloys (SMAs) including superelastic alloys have unique properties such as shape memory and superelasticity, thus they are recognized as very useful biomaterials. These properties are very advantageous for medical use, and actually the SMA wires have been widely used in medical field. However, biocompatibility of nickel-titanium (Ni-Ti) alloy, which is the only practical SMA at present, has been questioned because of its high nickel content. The aim of this study was to evaluate the biocompatibility of a newly developed Ni-free Ti-based SMA for medical use. The newly developed SMA made of Ti-Mo-Sn-Zr system was processed into a disk of 15.1 mm in diameter. Pure titanium of the same shape was prepared as control. All the disk surfaces were polished using emery papers, #120, #400, and #600. Scanning electron microscopy and a 3D optics profiler were used to evaluate the surface of the materials. In vitro evaluations included colony examination for evaluation of the cell cytotoxicity, DNA quantification for the cell proliferation, Alamar blue assay for metabolic activity, FDA staining for the live cell imaging, and cell cycle analysis, using Chinese hamster fibroblastic V-79 cells and mouse osteoblastic MC3T3-E1 cells. In colony examination and DNA quantification, there was no significant difference between the Ti-Mo-Sn-Zr and the pure titanium. In FDA staining, cultured cells on the Ti-Mo-Sn-Zr alloy showed the same biocompatibility as those on the pure titanium. The present results suggest that the newly developed Ti-Mo-Sn-Zr alloy showed the high biocompatibility comparable to pure titanium and can be used as efficient biomaterial for medical use.

Influence of albumin on the electrochemical behaviour of Zr in phosphate buffered saline solutions

The corrosion behaviour of Zr in phosphate buffered saline (PBS) solutions with various concentrations (0-4 g L(-1)) of albumin was studied by electrochemical techniques and surface analysis. Addition of albumin to PBS solutions moved the open circuit potential (OCP) to less nobler direction. OCP, polarization resistance and impedance increased and the corrosion current decreased over immersion duration. At early stages of immersion, the resistance was increased with the concentration of albumin because of the high adsorption kinetics of albumin on metal. After the long term immersion, the resistance in PBS without albumin was higher than PBS with albumin owing to the anodic dissolution effect of albumin on metal. According to the analysis of effective capacitances, a normal distribution of time-constants was proposed to estimate the surface film on Zr. A corrosion mechanism of Zr in PBS with different albumin was proposed based on electrochemical analysis.

Reduced toxicity and superior cellular response of preosteoblasts to Ti-6Al-7Nb alloy and comparison with Ti-6Al-4V

There are serious concerns on the toxicity of vanadium in Ti-6Al-4V alloy. In this regard, we describe the biological footprint of Ti-6Al-4V and compare with a viable alternate Ti-6Al-7Nb alloy, in terms of novel experimentation pertaining to cellular activity that include qualitative and quantitative analysis of Feret's diameter of cells, area, and perimeter, and proteins-actin, vinculin, and fibronectin. Interestingly, Ti-6Al-7Nb was characterized by superior cell attachment, proliferation, viability, morphology, and spread, which were significantly different from Ti-6Al-4V alloy. Additionally, immunofluorescence studies demonstrated stronger vinculin signals associated with actin stress fibers in the outer regions of the cells and cellular extensions in Ti-6Al-7Nb alloy. These striking observations suggest enhanced cell-substrate interaction and activity on the surface of niobium-containing titanium alloy. The significant differences in the cellular response between the two alloys clearly point to the determining role of alloying element (Nb versus V) in a conclusive manner. Based on this study, next generation of titanium alloys is proposed to focus on niobium-containing alloy.

A Review of Titanium Zirconium (TiZr) Alloys for Use in Endosseous Dental Implants

Dental implants made from binary titanium-zirconium (TiZr) alloys have shown promise as a high strength, yet biocompatible alternative to pure titanium, particularly for applications requiring small diameter implants. The aim of this review is to summarize existing literature reporting on the use of binary TiZr alloys for endosseous dental implant applications as tested in vitro, in animals and clinically. And furthermore to show that TiZr is “at least as good as” pure titanium in terms of biocompatibility and osseointergration. From the twelve papers that met the inclusion criteria, the current literature confirms that TiZr alloys produce small diameter implants with a strength up to 40% higher than conventional, cold-worked, grade IV titanium implants, and with a corrosion resistance and biocompatibility that is at least as good as pure titanium. The surface structure of TiZr is compatible with established surface treatments proven to aid in the osseointegration of titanium implants. Furthermore, binary TiZr alloys have been shown to achieve good osseointegration and high success rates both in animal and in clinical studies.