Materials for endosseous dental implants

Surface modification strategies to reinforce the soft tissue seal at transmucosal region of dental implants

Soft tissue seal around the transmucosal region of dental implants is crucial for shielding oral bacterial invasion and guaranteeing the long-term functioning of implants. Compared with the robust periodontal tissue barrier around a natural tooth, the peri-implant mucosa presents a lower bonding efficiency to the transmucosal region of dental implants, due to physiological structural differences. As such, the weaker soft tissue seal around the transmucosal region can be easily broken by oral pathogens, which may stimulate serious inflammatory responses and lead to the development of peri-implant mucositis. Without timely treatment, the curable peri-implant mucositis would evolve into irreversible peri-implantitis, finally causing the failure of implantation. Herein, this review has summarized current surface modification strategies for the transmucosal region of dental implants with improved soft tissue bonding capacities (e.g., improving surface wettability, fabricating micro/nano topographies, altering the surface chemical composition and constructing bioactive coatings). Furthermore, the surfaces with advanced soft tissue bonding abilities can be incorporated with antibacterial properties to prevent infections, and/or with immunomodulatory designs to facilitate the establishment of soft tissue seal. Finally, we proposed future research orientations for developing multifunctional surfaces, thus establishing a firm soft tissue seal at the transmucosal region and achieving the long-term predictability of dental implants.

The past forty-three years of dental implantology literature. A global mapping and scientometric analysis

PURPOSE

The aim of this research is to make a scientometric analysis of the dental implantology literature and to present the results in a more understandable way to the reader by visualizing them with maps.

METHODS

The dental implantology literature was accessed through the Web of Science database. Scientometric data was obtained with Citespace 6.1 software, co-citation, clustering analysis, citation burst, and mapping analyzes were performed. Scimago Graphica software was used for additional visualizations.

RESULTS

A total of 35,704 articles were included in the analysis. There were 88,616 authors, 72,333 institutes, 142 countries/regions, and 3,265 journals contributing to the dental implantology literature. The United States was first with 7,334 publications and 225,868 citations. The literature between 1980 and 2023 was divided into 19 different clusters, and the literature between 2000 and 2023 was divided into 16 different clusters.

CONCLUSIONS

Key themes in the field include the use of autogenous bone, advancements in implant surface technology, and the use of platform switching and intraoral scanners. Emerging topics of interest include esthetic considerations in the treatment of the anterior region, stress distribution, the use of zirconia, and the impact of implant treatment on oral health-related quality of life. With similar scientometric analysis studies to be done in the future, the progress of the literature can be followed on the basis of evidence.

Comparing the mechanical properties, microstructure, texture and in-vitro degradation behavior of TNTZ/nano-fluorapatite composite and TNTZ bioalloy

The present study deals with (i) the fabrication of the composite surface layer of Ti-29Nb-13Ta-4.6Zr/nano-fluorapatite through friction stir processing, (ii) clarifying the correlation of microstructure and texture with in-vitro degradation behavior and bioactivity of fabricated nano-biocomposite, and (iii) comparing the mechanical and functional properties of nano composite whit those obtained for TNTZ bio-alloy. The results indicated that increasing the number of deformation passes effectively refines the microstructure, leading to the average grain sizes of less than 5 μm. The texture of the material was also evolved in the presence of the nano particles where the grains reorient along <111> direction in contrast to the <101>-oriented grains in the starting microstructure. In-vitro bioactivity of the processed samples was measured after being immersed in simulated body fluid solution for various duration up to 30 days. Enhanced corrosion resistance and bio-mineralization of nanocomposite surface layer was discussed relying on the occurrence of grain refinement, substructure development and evolution of texture components along <101> direction. Assessment of the mechanical properties of the fabricated composites and as-received material also indicated the positive effect of the applied processing route and the presence of nano particles.

Comparison of the different voxel sizes in the estimation of peri-implant fenestration defects using cone beam computed tomography: an ex vivo study

Background

To examine the influence of voxel sizes to detect of peri-implant fenestration defects on cone beam computed tomography (CBCT) images.

Materials and methods

This study performed with three sheep heads both maxilla and mandible and two types of dental implant type 1 zirconium implant (Zr⁴⁰) (n = 6) and type 2 titanium implant (Ti²²) (n = 10). A total of 14 peri-implant fenestrations (8 buccal surfaces, 6 palatal/lingual surface) were created while 18 surfaces (8 buccal, 10 palatal/lingual) were free of fenestrations. Three observers have evaluated the images of fenestration at each site. Images obtained with 0.75 mm³, 0.100 mm³, 0.150 mm³, 0.200 mm³, and 0.400 mm³ voxel sizes. For intra- and inter-observer agreements for each voxel size, Kappa coefficients were calculated.

Results

Intra- and inter-observer kappa values were the highest for 0.150 mm³, and the lowest in 0.75 mm³ and 0.400 mm³ voxel sizes for all types of implants. The highest area under the curve (AUC) values were found higher for the scan mode of 0.150 mm³, whereas lower AUC values were found for the voxel size for 0.400 mm³. Titanium implants had higher AUC values than zirconium with the statistical significance for all voxel sizes (p ≤ 0.05).

Conclusion

A voxel size of 0.150 mm³ can be used to detect peri-implant fenestration bone defects. CBCT is the most reliable diagnostic tool for peri-implant fenestration bone defects.

Titanium salts tested in reconstructed human skin with integrated MUTZ-3-derived Langerhans cells show an irritant rather than a sensitizing potential

BACKGROUND

The nature of clinically related adverse reactions to titanium is still unknown.

OBJECTIVE

To determine whether titanium salts have irritant or sensitizing potential in a reconstructed human skin (RHS) model with integrated Langerhans cells (LCs).

METHODS

RHS-LCs (ie, reconstructed epidermis) containing primary differentiated keratinocytes and CFSE⁺ CD1a⁺ -LCs generated from the MUTZ-3 cell line on a primary fibroblast-populated collagen hydrogel (dermis) were topically exposed to titanium(IV) bis(ammonium lactato)dihydroxide (TiALH). LC migration and plasticity were determined.

RESULTS

TiALH resulted in CFSE⁺ CD1a⁺ -LC migration out of the epidermis. Neutralizing antibodies to CCL5 and CXCL12 showed that LC migration was CCL5 and not CXCL12 mediated. LCs accumulating within the dermis after TiALH exposure were CFSE⁺ Lang⁺ CD68⁺ which is characteristic of a phenotypic switch of MUTZ-LC to a macrophage-like cell. Furthermore, TiALH did not result in increased interleukin (IL)-1β or CCR7 messenger RNA (mRNA) in the dermis, but did result in increased IL-10 mRNA. In addition, monocultures of MUTZ-LCs failed to increase LC maturation biomarkers CD83, CD86, and CXCL-8 when exposed to noncytotoxic concentrations of four different titanium salts.

CONCLUSION

These results classify titanium salts as irritants rather than sensitizers and indicate that titanium implant-related complaints could be due to localized irritant-mediated inflammation arising from leachable agents rather than a titanium metal allergy.

Biomimetic in vitro test system for evaluation of dental implant materials

OBJECTIVES

Before application in dental practice, novel dental materials are tested in vitro and in vivo to ensure safety and functionality. However, transferability between preclinical and clinical results is often limited. To increase the predictive power of preclinical testing, a biomimetic in vitro test system that mimics the wound niche after implantation was developed.

METHODS

First, predetermined implant materials were treated with human blood plasma, M2 macrophages and bone marrow stromal stem cells. Thereby, the three-dimensional wound niche was simulated. Samples were cultured for 28 days, and subsequently analyzed for metabolic activity and biomineralization. Second test level involved a cell-infiltrated bone substitute material for an osseointegration assay to measure mechanical bonding between dental material and bone. Standard and novel dental materials validated the developed test approach.

RESULTS

The developed test system for dental implant materials allowed quantification of biomineralization on implant surface and assessment of the functional stability of mineralized biomaterial-tissue interface. Human blood plasma, M2 macrophages and bone marrow stromal stem cells proved to be crucial components for predictive assessment of implant materials in vitro. Biocompatibility was demonstrated for all tested materials, whereas the degree of deposited mineralized extracellular matrix and mechanical stability differed between the tested materials. Highest amount of functional biomineralization was determined to be on carbon-coated implant surface.

SIGNIFICANCE

As an ethical alternative to animal testing, the established in vitro dental test system provides an economic and mid-throughput evaluation of novel dental implant materials or modifications thereof, by applying two successive readout levels: biomineralization and osseointegration.

Wear and Corrosion Interactions at the Titanium/Zirconia Interface: Dental Implant Application

PURPOSE

Dental implants have been shown to have predictable success, but esthetic complications often arise. To reduce tissue shadowing from titanium, zirconia abutments may be used; however, the literature suggests that the use of zirconia leads to greater destruction of the implant interface that may result in biological complications such as titanium tattoos and heavy metal toxicity. Previous studies have examined the mechanical aspects of this implant/abutment relationship, but they have not accounted for the corrosive degradation that also takes place in the dynamic environment of the oral cavity. This study investigated the combined effect of both wear and corrosion on the materials at the implant and abutment interface.

MATERIALS AND METHODS

Using a simulated oral tribocorrosive environment, titanium (Ti) and zirconia (Zr) abutment materials were slid against titanium and Roxolid implant alloys. The four couplings (Ti/Ti, Ti/Rox, Zr/Ti, Zr/Rox) were selected for the tribocorrosion tests (N = 3). The testing was conducted for 25K cycles, and the coefficient of friction (CoF) and voltage evolution were recorded simultaneously. Following the tribocorrosion assays, the wear volume loss was calculated, and surface characterization was performed. Statistical analysis was completed using a one-way ANOVA followed by post-hoc Bonferroni comparisons.

RESULTS

Zr/Ti groups had the highest CoF (1.1647), and Ti/Ti had the lowest (0.5033). The Zr/Ti coupling generated significantly more mechanical damage than the Ti/Ti group (p = 0.021). From the corrosion aspect, the Ti/Ti groups had the highest voltage drop (0.802 V), indicating greater corrosion susceptibility. In comparison, the Zr/Roxolid group had the lowest voltage drop (0.628 V) and significantly less electrochemical degradation (p = 0.019). Overall, the Ti/Ti group had the largest wear volume loss (15.1 × 10⁷ μm³ ), while the Zr/Ti group had the least volume loss (2.26 × 10⁷ μm³ ). Both zirconia couplings had significantly less wear volume than the titanium couplings (p < 0.001).

CONCLUSIONS

This study highlights the synergistic interaction between wear and corrosion, which occurs when masticatory forces combine with the salivary environment of the oral cavity. Overall, the zirconia groups outperformed the titanium groups. In fact, the titanium groups generated 5 to 6 times more wear to the implant alloys as compared with the zirconia counterparts. The best performing group was Zr/Ti, and the worst performing group was Ti/Ti.

Bio-functionalization of grade V titanium alloy with type I human collagen for enhancing and promoting human periodontal fibroblast cell adhesion - an in-vitro study

Surface modification of medical grade V titanium alloy (Ti-6Al-4V) with biomolecules is an important and vital step for tailoring it for various biomedical applications. Present study investigates theinfluence of type I human collagen (T1HC) bio-conjugation through a three stage process. Polished grade V titanium alloy discs were functionalizedwith free OH group by means of controlled heat and alkali treatment followed by coating of 3-aminopropyltriethoxy (APTES) silane couplingagent. T1HC were bio-conjugated through 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide hydrochloride N-hydroxysuccinimide (EDCNHS)coupling reaction. At each stage, grade V titanium alloy surfaces were characterized by atomic force microscopy (AFM), scanning electronmicroscopy (SEM), Fourier transform infrared spectroscopy (FTIR) and Xrayphotoelectron spectroscopy (XPS). FTIR and XPS studies confirms thecovalent attachment of APTES with titanium alloy surface while terminalamine groups of APTES remained free for further attachment of T1HCthrough covalent bond. Aqueous stability of bio-conjugated titanium discsat various pH and time intervals (i.e. at pH of 5.5, 6.8 and 8.0 at timeinterval of 27 and 48h) confirmed the stability of T1HC bioconjugated collagen on titanium surface. Further human periodontalfibroblast cell line (HPdlF) culture revealed enhanced adhesion on theT1HC bio-conjugated surface compared to the polystyrene and polishedgrade V titanium alloy surfaces.

Optimizing Connective Tissue Integration on Laser-Ablated Implant Abutments

Focused Clinical Question: The integration of connective tissue (CT) to a laser-ablated abutment with a microgrooved surface at the apical millimeter (LL) has been documented in both animal and human studies. How should the healing be influenced to optimize the CT integration on abutment surfaces? Summary: When smooth machined titanium (ST) abutments were placed, epithelial attachment was found on abutments, but no CT integration was noted. On LL abutments, a zone of epithelial attachment and CT integration was noted. When an ST abutment was switched for an LL abutment, the soft tissue was inconsistent; however, when an LL abutment was placed after the removal of a prior LL abutment, CT integration was observed. Conclusions: Consistent CT integration was observed on LL abutment surfaces after implant placement. Switching LL abutments with new LL abutments consistently led to CT integration. This was not consistent when an ST abutment was switched for an LL abutment. Plaque and gingival indices were comparable between teeth and abutments. Probing depth (PD) was lower around teeth. There was no difference in PD between abutments. CT integration on LL abutments was optimized by initial healing occurring on an LL abutment or by creation of a CT wound before insertion of the abutment.

Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty

Background:

Inflammatory responses to wear debris cause osteolysis that leads to aseptic prosthesis loosening and hip arthroplasty failure. Although osteolysis is usually associated with aseptic loosening, it is rarely seen around stable implants. Aseptic implant loosening is a simple radiologic phenomenon, but a complex immunological process. Particulate debris produced by implants most commonly causes osteolysis, and this is called particle-associated periprosthetic osteolysis (PPO).

Objective:

The objective of this review is to outline the features of particle-associated periprosthetic osteolysis to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome.

Methods:

A thorough literature search was performed using available databases, including Pubmed, to cover important research published covering particle-associated PPO.

Results:

Although osteolysis causes bone resorption, clinical, animal, and in vitro studies of particle bioreactivity suggest that particle-associated PPO represents the culmination of several biological reactions of many cell types, rather than being caused solely by the osteoclasts. The biological activity is highly dependent on the characteristics and quantity of the wear particles.

Conclusion:

Despite advances in total hip arthroplasty (THA), particle-associated PPO and aseptic loosening continue to be major factors that affect prosthetic joint longevity. Biomarkers could be exploited as easy and objective diagnostic and prognostic targets that would enable testing for osteolysis after THA. Further research is needed to identify new biomarkers in PPO. A comprehensive understanding of the underlying biological mechanisms is crucial for developing new therapeutic interventions to reverse or suppress biological responses to wear particles.

A Critical Review of Dental Implant Materials with an Emphasis on Titanium versus Zirconia

The goal of the current publication is to provide a comprehensive literature review on the topic of dental implant materials. The following paper focuses on conventional titanium implants and more recently introduced and increasingly popular zirconia implants. Major subtopics include the material science and the clinical considerations involving both implant materials and the influence of their physical properties on the treatment outcome. Titanium remains the gold standard for the fabrication of oral implants, even though sensitivity does occur, though its clinical relevance is not yet clear. Zirconia implants may prove to be promising in the future; however, further in vitro and well-designed in vivo clinical studies are needed before such a recommendation can be made. Special considerations and technical experience are needed when dealing with zirconia implants to minimize the incidence of mechanical failure.

Release of titanium ions from an implant surface and their effect on cytokine production related to alveolar bone resorption

Although interest in peri-implant mucositis and peri-implantitis has recently been increasing, the mechanisms driving these diseases remain unknown. Here, the effects of titanium ions on the inflammation and bone resorption around an implant were investigated. First, the accumulated amount of Ti ions released into gingival and bone tissues from an implant exposed to sodium fluoride solution was measured using inductively coupled plasma mass spectrometry. Next, the cellular responses in gingival and bone tissues to Ti ions and/or Porphyromonas gingivalis-lipopolysaccharide (P. gingivalis-LPS) were assessed using a rat model. More Ti ions were detected in the gingival tissues around an implant after treatment with sodium fluoride (pH 4.2) than in its absence, which suggests that the fluoride corroded the implant surface under salivary buffering capacity. The injection of Ti ions (9ppm) significantly increased the mRNA expression and protein accumulation of chemokine (C-C motif) ligand 2, as well as the ratio of receptor activator of nuclear factor-κB ligand to osteoprotegerin, in rat gingival tissues exposed to P. gingivalis-LPS in a synergistic manner. In addition, the enhanced localization of toll-like receptor 4, which is an LPS receptor, was observed in gingival epithelium loaded with Ti ions (9ppm). These data suggest that Ti ions may be partly responsible for the infiltration of monocytes and osteoclast differentiation by increasing the sensitivity of gingival epithelial cells to microorganisms in the oral cavity. Therefore, Ti ions may be involved in the deteriorating effects of peri-implant mucositis, which can develop into peri-implantitis accompanied by alveolar bone resorption.

An evidence-based systematic review of vanadium by the Natural Standard Research Collaboration

An evidence-based systematic review of vanadium by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

Surface contaminants inhibit osseointegration in a novel murine model

Surface contaminants, such as bacterial debris and manufacturing residues, may remain on orthopedic implants after sterilization procedures and affect osseointegration. The goals of this study were to develop a murine model of osseointegration in order to determine whether removing surface contaminants enhances osseointegration. To develop the murine model, titanium alloy implants were implanted into a unicortical pilot hole in the mid-diaphysis of the femur and osseointegration was measured over a five week time course. Histology, backscatter scanning electron microscopy and X-ray energy dispersive spectroscopy showed areas of bone in intimate physical contact with the implant, confirming osseointegration. Histomorphometric quantification of bone-to-implant contact and peri-implant bone and biomechanical pullout quantification of ultimate force, stiffness and work to failure increased significantly over time, also demonstrating successful osseointegration. We also found that a rigorous cleaning procedure significantly enhances bone-to-implant contact and biomechanical pullout measures by two-fold compared with implants that were autoclaved, as recommended by the manufacturer. The most likely interpretation of these results is that surface contaminants inhibit osseointegration. The results of this study justify the need for the development of better detection and removal techniques for contaminants on orthopedic implants and other medical devices.

Titanium ion induces necrosis and sensitivity to lipopolysaccharide in gingival epithelial-like cells

Gingival epithelial-like cells (GE-1) were cultured and used to examine the cellular responses of gingival tissues to varying concentrations of titanium (Ti) ions. Titanium ions at concentrations of more than 13 ppm significantly decreased the viability of GE-1 cells and increased LDH release from the cells into the supernatant, but had no significant effect on their caspase 3 activity. These data suggest that a high concentration of Ti ions induced necrosis of the GE-1 cells. Titanium ions at a concentration of 5 ppm significantly increased the level of CCL2 mRNA expression in GE-1 cells exposed to lipopolysaccharide derived from Porphyromonas gingivalis in a synergistic manner. Moreover, the mRNA expression levels of TLR-4 and ICAM-1 in GE-1 cells loaded with Ti ions at 9 ppm were significantly enhanced as compared with those in GE-1 cells without Ti stimulation. We suggest that Ti ions are in part responsible for monocyte infiltration in the oral cavity by elevating the sensitivity of gingival epithelial cells to microorganisms. Taken together, these data indicate that Ti ions may be involved in cytotoxicity and inflammation at the interfaces of dental implants and gingival tissue.

Impact of titanium ions on osteoblast-, osteoclast- and gingival epithelial-like cells

PURPOSE

To investigate the effects of titanium (Ti) ions on the cell viability, the cell differentiation and the gene expressions related to bone resorption including Receptor Activator of NF-kappaB Ligand (RANKL) and Osteoprotegerin (OPG) in the tissues around dental implants, the osteoblast-, osteoclast-, and gingival epithelial-like cells were exposed to Ti ions.

METHODS

An MTS assay was carried out to evaluate the viabilities of osteoblast-like MC3T3-E1, osteoclast-like RAW264.7 and epithelial cell-like GE-1 cells. The gene expressions in these cells were analyzed by the use of RT-PCR and real-time quantitative RT-PCR.

RESULTS

Ti ions in the concentration range 1-9 ppm had little effect on the viabilities of MC3T3-E1, RAW264.7 and GE-1, whereas 20 ppm Ti ions significantly decreased the viabilities of all cells. Analyses of RT-PCR and real-time quantitative RT-PCR data revealed that Ti ions at 9 ppm remarkably inhibited the expressions of Runx2, Osterix and type I collagen in MC3T3-E1. In RAW264.7, Ti ions showed no effects on the levels of mRNAs for TRAP and cathepsin K enhanced by RANKL. Ti ions at the range of 1-9 ppm showed no effects on the levels of mRNAs for RANKL and OPG in GE-1, while Ti ions at 9 ppm enhanced the expression of these genes in MC3T3-E1.

CONCLUSIONS

These results, taken together, suggested that Ti ions show the biological effects, both on the viabilities of osteoblast and osteoclast and on the differentiation of either the osteoblastic or osteoclastic cells, which may influence the prognosis of dental implants.

Polysaccharide-protein surface modification of titanium via a layer-by-layer technique: Characterization and cell behaviour aspects

To improve the surface biocompatibility of titanium films, a layer-by-layer (LBL) self-assembly technique, based on the polyelectrolyte-mediated electrostatic adsorption of chitosan (Chi) and gelatin (Gel), was used leading to the formation of multilayers on the titanium thin film surfaces. The film growth was initialized by deposition of one layer of positively charged poly(ethylene imine) (PEI). Then the thin film was formed by the alternate deposition of negatively charged Gel and positively charged Chi utilizing electrostatic interactions. The LBL film growth was monitored by several techniques. The chemical composition, surface topography as well as wettability were investigated by using X-ray photoelectron spectroscopy (XPS), atomic force microscopy (AFM), confocal laser scanning microscopy (CLSM) and water contact angle measurement, respectively. Quantitative XPS analysis showed the alternative change of C/N ratio after four sequential cycles coating of Ti/PEI/Gel/Chi/Gel, which indicated the discrete layer structure of coatings. Uncoated titanium (control sample) displayed a smooth surface morphology (root mean square (RMS) roughness was around 2.5 nm). A full coverage of coating with Gel/Chi layers was achieved on the titanium surface only after the deposition layers of PEI/(Gel/Chi)2. The PEI/Gel/(Chi/Gel)3 layer displayed a rough surface morphology with a tree-like structure (RMS roughness is around 82 nm). These results showed that titanium films could be modified with Chi/Gel which may affect the biocompatibility of the modified titanium films. To confirm this hypothesis, cell proliferation and cell viability of osteoblasts on LBL-modified titanium films as well as control samples were investigated in vitro. The proliferation of osteoblasts on modified titanium films was found to be greater than that on control (p<0.05) after 1 and 7 days culture, respectively. Cell viability measurement showed that the Chi/Gel-modified films have higher cell viability (p<0.05) than the control. These data suggest that Chi/Gel were successfully employed to surface engineer titanium via LBL technique, and enhanced its cell biocompatibility. The approach presented here may be exploited for fabrication of titanium-based implant surfaces.

Transforming growth factor-beta 1 (TGF-β1) prevents the age-dependent decrease in bone formation in human osteoblast/implant cultures

Titanium implants have been extensively used in orthopedic surgery and dentistry. Most of the patients who receive such implants are elderly with a compromised ability to heal and form new bone. By using an in vitro osteoblast/implant culture system, the potency of TGF-beta1 in enhancing mineralization of human osteoblast cultures from elderly subjects was investigated in this study. Primary human osteoblast (HOB) cells obtained from different age group human subjects [Young (Y), Middle (M), and Old (O)] were cultured on Ti alloy (Ti-6Al-4V) disks with or without continuous administration of 0.2 ng/mL TGF-beta1 in the medium for 2 or 4 weeks. TGF-beta1 significantly (p < 0.05) increased calcium content and the size of calcified nodules on implant disks in the O group, but had no effect on the Y or M groups. The number of calcified nodules was not different with or without TGF-beta1 in all age groups. As measured by Northern blot analysis and RT-PCR, TGF-beta1 significantly increased the expression of bone-specific extracellular matrix proteins, including alkaline phosphatase, Type I collagen, bone sialoprotein and osteocalcin, after both 2 and 4 weeks in the O group but not in the Y group. In conclusion, TGF-beta1 enhances mineralization on implant materials of osteoblast cultures from elderly human subjects.

Integrins as linker proteins between osteoblasts and bone replacing materials. A critical review

The adhesion of osteoblasts to substrates is mediated through proteins that have adsorbed to the substrate, providing integrins on the cell membrane with ligands to connect to. The integrins regulate cell behavior through bi-directional signaling pathways. This critical review has the purpose to consider the research that has been performed with osteoblasts, integrins, and bone replacing materials. Until now, most research has been done to investigate the integrin expression of osteoblasts in culture during cellular adhesion. However, it remains difficult to draw general conclusions from this research. Nevertheless, it can be concluded that the used substrates and protein or peptide coatings can influence the integrin expression and cellular behavior. Additional research has to be done to fully understand all the parameters involved in integrin expression, the adhesion of cells to substrates, and the subsequent cellular behavior. For this purpose, model substrates are under development. The signaling pathway is receiving more and more attention, but for biomaterial purposes, too little consideration is paid to the translation of the in vitro results to the in vivo situation, and to practical applications.

Electrostatic spray deposition (ESD) of calcium phosphate coatings, an in vitro study with osteoblast-like cells

Electrostatic spray deposition (ESD) is a recently developed technique to deposit a calcium phosphate (CaP) coating upon substrates. With this technique, an organic solvent containing calcium and phosphate is pumped through a nozzle. Between the nozzle and substrate a high voltage is applied. As a consequence, droplets coming out the nozzle disperse into a spray, and this spray is deposited upon the substrate. When the solvent has evaporated, a coating is formed on the substrate. ESD allows for a variation in coating composition and morphology. Titanium alloy (TiAl6V4) substrates were coated with a CaP layer using two different methods; radio frequency magnetron sputtering, and ESD. These surfaces were characterized with X-ray diffraction, Fourier transform infrared spectroscopy, an universal surface tester, scanning electron microscopy, and energy dispersive spectrometry. Subsequently, bone marrow cells were isolated from rat femora and cultured 1, 4, 8, 14 and 16 days. Cell proliferation, alkaline phosphatase activity, and osteocalcin concentration were assayed. RT-PCR was done for collagen type I and osteocalcin. SEM was also performed to observe cellular behaviour during culture. Two separate runs of the experiment were performed. In the first run, osteoblast-like cells on both CaP coatings showed similar results in all assays. In the second run, proliferation and osteogenic expression had increased on ESD coatings. On basis of these results, we conclude that the novel ESD coating behaved similar to, or even better than the known RF magnetron sputter coating. Thus, ESD could be a valid addition to already existing CaP coating processes.

Corrosion behavior of cast titanium with reduced surface reaction layer made by a face-coating method

This study characterized the corrosion behavior of cast CP titanium made with a face-coating method. Wax patterns were coated with oxide slurry of Y(2)O(3) or ZrO(2) before investing with a MgO-based investment. Three surface preparations were tested: ground, sandblasted, and as-cast. Uncoated castings served as controls. Sixteen-hour open circuit potential (OCP) measurement, linear polarization and potentiodynamic cathodic polarization were performed in an aerated modified Tani-Zucchi synthetic saliva at 37 degrees C. Anodic polarization was conducted in the same deaerated medium. Polarization resistance (R(p)) and Tafel slopes were determined. Corrosion current density was calculated for each specimen. Results (n=4) were subjected to nonparametric statistical analysis (alpha=0.05). Cross sections of cast specimens were examined by optical microscopy. Energy dispersive spectroscopy (EDS) spot analysis was performed at various depths below the surface. The OCP stabilized within several hours for all the specimens. Apparent differences in anodic polarization behavior were observed among the different surfaces. A distinctive wide passive region followed by breakdown was seen on specimens with ground and sandblasted surfaces. There were no significant differences in the corrosion resistance among the control and the two face-coating groups for each group. The Mann-Whitney test showed significantly lower OCP and higher R(p) values for ground surfaces. The surface condition significantly affected the corrosion behavior more than the face coating methods. In most cases, specimens with as-cast surfaces exhibited the least corrosion resistance during the potentiodynamic anodic polarization.

Acid pretreatment of titanium implants

The purpose of this study was to evaluate the effectiveness of several methods of cleaning titanium surfaces as pretreatment for surface modifications by analyzing the chemical interaction of three acids, such as Na(2)S(2)O(8),H(2)SO(4) and HCl, followed by rinsing with acetone or ultrapure water. Chemical evaluation, using X-ray photoelectron spectroscopy (XPS), and mechanical evaluation, using nanoindentation, were employed. XPS revealed that an untreated Ti surface consisted of carbon- and nitrogen-containing contaminant and titanium oxide layer on metallic titanium substrate. The method involving the combination of 10 N HCl and acetone was the most effective of all the methods investigated. Such a combination most effectively reduced values of contamination parameters C/Ti and N/Ti, as well as the intensity of the titanium oxide component in Ti 2p spectra. Chlorine was barely detected from the surface treated with HCl in any concentration. Sulfur from the residual S(2)O(8)(2-) or SO(4)(2-), however, was detected from the samples treated with either Na(2)S(2)O(8) or H(2)SO(4). The S/Ti values depended on concentration of the acidic solution. In addition, nanoindentation measurements revealed that Young's modulus of the surface treated with 0.1-10 N HCl was not significantly different from that of an untreated surface (p > 0.05). Consequently, the HCl/acetone treatment is proposed as an excellent decontamination method for the surface preparation process of Ti.

Peptide-modified p(AAm-co-EG/AAc) IPNs grafted to bulk titanium modulate osteoblast behavior in vitro

Interpenetrating polymer networks (IPNs) of poly(acrylamide-co-ethylene glycol/acrylic acid) (p(AAm-co-EG/AAc) applied to model surfaces prevent protein adsorption and cell adhesion. Subsequently, IPN surfaces functionalized with the RGD cell-binding domain from rat bone sialoprotein (BSP) modulated bone cell adhesion, proliferation, and matrix mineralization. The objective of this study was to utilize the same biomimetic modification strategy to produce functionally similar p(AAm-co-EG/AAc) IPNs on clinically relevant titanium surfaces. Contact angle goniometry and X-ray photoelectron spectroscopy (XPS) data were consistent with the presence of the intended surface modifications. Cellular response was gauged by challenging the surfaces with primary rat calvarial osteoblast (RCO) surfaces in serum-containing media. IPN modified titanium and negative control (RGE-IPN) surfaces inhibit cell adhesion and proliferation, while RGD-modified IPNs on titanium supported osteoblast attachment and spreading. Furthermore, the latter surfaces supported significant mineralization despite exhibiting lower levels of proliferation than positive control surfaces. These results suggest that with the appropriate optimization, this approach may be practical for surface engineering of osseous implants.

Evaluation of the titanium Ti-6Al-7Nb alloy with and without plasma-sprayed hydroxyapatite coating on growth and viability of cultured osteoblast-like cells

BACKGROUND

Osseointegrated dental implants are currently recognized as a standard treatment method in dentistry. Titanium (Ti) and its alloys are the metals of choice for endosseous parts of currently available dental implants. Ti-6Al-4V is the most used Ti alloy, however; an improved version, Ti-6Al-7Nb, has been recently developed.

METHODS

Rat osteoblast-like cells (osteo- 1 culture) were used to analyze the biocompatibility of Ti-6Al-7Nb alloy with and without hydroxyapatite (HA) coating. The cells were grown on culture Petri dishes on the top of either plain Ti-6Al-7Nb or HA-coated Ti-6Al-7Nb disks. Osteo-1 cells grown on plain culture dishes were used as controls. Growth and cell viability curves were obtained by scanning electron microscopy. For the growth and viability curves, 10(4) cells were seeded on 35 mm dishes. Cells from each group were counted, in triplicate at 3, 7, 11, and 15 days after seeding using the Trypan blue dye exclusion assay.

RESULTS

The cells grew as multiple layers on both Ti-6Al-7Nb substrates, showing extracellular matrix only when grown on HA-coated Ti-6Al-7Nb disks. The cells grown on HA-coated Ti-6Al-7Nb grew more slowly than the other 2 groups, with significantly smaller cell numbers than control cultures at the end of the experimental time. Additionally, the HA coated Ti-6Al-7Nb group presented smaller percentage of cell viability when compared to the control group. However, no significant differences were observed between the Ti groups.

CONCLUSIONS

The presence of HA on the Ti-6Al-7Nb surface impaired the cell growth and viability of osteo-1 cells. However, this coating improved the extracellular matrix formation. Thus, our cell viability and structural studies showed that Ti-6Al-7Nb with or without HA coating has relevant physical and biological properties as an implant material.

Histomorphological evaluation of loaded plate-form and root-form implants in Macaca mulatta monkeys

As part of a long-term evaluation of endosteal dental implants in primates, this paper describes the histological response to plate-form and root-form implants. Thirty-six primates received 48 mandibular distal abutment implants. After healing, the implants were restored with fixed partial dentures, which remained in function for two years. A subset of the group was ligated at the gingival sulcus to biologically stress tissues supporting the implants. Crestal bone height around implants was quantified using digital subtraction radiographic techniques. The ligated implants lost more crestal bone than non-ligated implants, as shown by ANOVA (P < 0.05). After retrieval, implants were embedded and sectioned for histomorphometric analysis including measurement of per cent osseointegration. Both plate-form and root-form non-ligated implants demonstrated about 60% osseointegration. When ligated, plate-form implants dropped to an average integration of only 34%, while root-form implants maintained 62% integration, a significant difference. These data show that in this primate model, plate-form and root-form implants maintained integration while in function for two years. When stressed with ligation, root-form implants maintained relative amounts of osseointegration, while per cent osseointegration of plate-form implants decreased.

Alloys for prosthodontic restorations

The numbers and types of alloys for prosthodontic restorations have increased dramatically over the past 25 years, making selection of an alloy for a given clinical situation difficult. Factors such as cost, the need for better strength, and worries about alloy corrosion have pressured the alloy market to change significantly. A number of properties--including yield strength, hardness, elastic modulus, microstructural phases, grain size, corrosion performance, coefficient of thermal expansion, oxide color, and melting range--are relevant to the proper selection of an alloy for a given clinical problem. In this article, a brief historical look at prosthodontic alloys and the nomenclature for alloys is followed by a discussion of the most important physical properties of alloys for clinical practice. A summary of the types of alloys available today and their classification is then presented. Finally, speculations about future trends for alloys are made, and simple guidelines are suggested to help dentists choose appropriate alloys for their practices. This review excludes implant alloys, dental amalgam, and alloys for orthodontic and endodontic applications.

Effect of ion modification of commonly used orthopedic materials on the attachment of human bone-derived cells

Biomaterials which combine optimum properties of strength and biocompatibility are desirable in improving the long-term performance of implantable medical devices. Our study is aimed at developing technology designed to alter the outer atomic layers of a material to give the desired compatibility with the tissue while retaining the properties of the bulk substratum. Materials used in this study were titanium vanadium alloy (Ti-6Al-4V) and cobalt chromium molybdenum alloy (Co-Cr). Soda lime glass discs and polyethylene terephthalate (PET) acted as controls. A cathode of either Ti-6Al-4V or Co-Cr was used to simultaneously deposit and implant identified substrata. The attachment of human bone-derived cells (HBDC) to various materials was determined using radiolabeling or colorimetric assays. Results show that HBDC adhere preferentially to the unmodified surfaces of Ti-6Al-4V and Ti-6Al-4V on glass compared to the unmodified Co-Cr surfaces and to that of the Co-Cr on glass. Depositing Ti-6Al-4V on Co-Cr gives significantly better attachment of HBDC than when depositing Co-Cr onto Ti-6Al-4V. While cellular attachment to the created surfaces reflects that of the cathodic materials, it is not identical to these materials. Ion deposition/implantation is capable of creating permanent surfaces which reflect the adhesion of source materials not bulk substrata.