A novel characteristic of porous titanium oxide implants

A review on in vitro/in vivo response of additively manufactured Ti-6Al-4V alloy

Bone replacement using porous and solid metallic implants, such as Ti-alloy implants, is regarded as one of the most practical therapeutic approaches in biomedical engineering. The bone is a complex tissue with various mechanical properties based on the site of action. Patient-specific Ti-6Al-4V constructs may address the key needs in bone treatment for having customized implants that mimic the complex structure of the natural tissue and diminish the risk of implant failure. This review focuses on the most promising methods of fabricating such patient-specific Ti-6Al-4V implants using additive manufacturing (AM) with a specific emphasis on the popular subcategory, which is powder bed fusion (PBF). Characteristics of the ideal implant to promote optimized tissue-implant interactions, as well as physical, mechanical/chemical treatments and modifications will be discussed. Accordingly, such investigations will be classified into 3B-based approaches (Biofunctionality, Bioactivity, and Biostability), which mainly govern native body response and ultimately the success in implantation.

Effects of Plasma Treatment on the Bioactivity of Alkali-Treated Ceria-Stabilised Zirconia/Alumina Nanocomposite (NANOZR)

Zirconia ceramics such as ceria-stabilized zirconia/alumina nanocomposites (nano-ZR) are applied as implant materials due to their excellent mechanical properties. However, surface treatment is required to obtain sufficient biocompatibility. In the present study, we explored the material surface functionalization and assessed the initial adhesion of rat bone marrow mesenchymal stem cells, their osteogenic differentiation, and production of hard tissue, on plasma-treated alkali-modified nano-ZR. Superhydrophilicity was observed on the plasma-treated surface of alkali-treated nano-ZR along with hydroxide formation and reduced surface carbon. A decreased contact angle was also observed as nano-ZR attained an appropriate wettability index. Treated samples showed higher in vitro bovine serum albumin (BSA) adsorption, initial adhesion of bone marrow and endothelial vascular cells, high alkaline phosphatase activity, and increased expression of bone differentiation-related factors. Furthermore, the in vivo performance of treated nano-ZR was evaluated by implantation in the femur of male Sprague-Dawley rats. The results showed that the amount of bone formed after the plasma treatment of alkali-modified nano-ZR was higher than that of untreated nano-ZR. Thus, induction of superhydrophilicity in nano-ZR via atmospheric pressure plasma treatment affects bone marrow and vascular cell adhesion and promotes bone formation without altering other surface properties.

Titanium Implants Coated with a Bifunctional Molecule with Antimicrobic Activity: A Rabbit Study

Background: Various surface treatments have been tested for titanium implants aiming at increasing their surface biocompatibility and their biological characteristics, but also the efficiency of the implant surface will have to be improved to drastically decrease peri-implantite and mucosite. In fact, the peri-implantitis and peri-implant mucositis have a high incidence in clinical practice. The nanofabrication techniques that offer the possibility to achieve the implant surface that reduces bacterial colonization could influence the osteointegration. The aim of this research was to evaluate the bone response to titanium implants coated with a bifunctional molecule with antimicrobic activity consisting of a combination of silver ions covalently bound to titanium dioxide nanoparticles. Methods: A total of 36 implants were inserted into 18 older New Zealand white male rabbits. They had two different surfaces. The implants Control group was characterized by an acid-etched and sandblasted surface treatment, and the Test implants had an acid-etched and sandblasted surface coated with a silver ion covalently bound to titanium dioxide nanoparticles in the solution. Results: No statistically significant difference of the bone density was evidenced between Control and Test implants at two weeks (p-value = 0.623), four weeks (p-value = 0.339), and eight weeks (p-value = 0.461). Moreover, no statistically significant difference of the bone-implant contact percentage was evidenced between Control and Test implants at two weeks (p-value = 0.938), four weeks (p-value = 0.307), and eight weeks (p-value = 0.294). The effectiveness of the present investigation demonstrated no adverse effects on osseointegration, and no statistically significant differences were observed in the bone density and percentage of bone-implant contact between Test and Control implants at all the experimental time points (two, four, and eight weeks). Conclusions: Titanium implants coated with the silver-anatase solution bind very well to the bone and did not have an adverse effect on the bone tissue in a rabbit model. These facts suggest possible clinical applications for the silver composition.

Biomedical Waste Management by Using Nanophotocatalysts: The Need for New Options

Biomedical waste management is getting significant consideration among treatment technologies, since insufficient management can cause danger to medicinal service specialists, patients, and their environmental conditions. The improvement of waste administration protocols, plans, and policies are surveyed, despite setting up training programs on legitimate waste administration for all healthcare service staff. Most biomedical waste substances do not degrade in the environment, and may also not be thoroughly removed through treatment processes. Therefore, the long-lasting persistence of biomedical waste can effectively have adverse impact on wildlife and human beings, as well. Hence, photocatalysis is gaining increasing attention for eradication of pollutants and for improving the safety and clearness of the environment due to its great potential as a green and eco-friendly process. In this regard, nanostructured photocatalysts, in contrast to their regular counterparts, exhibit significant attributes such as non-toxicity, low cost and higher absorption efficiency in a wider range of the solar spectrum, making them the best candidate to employ for photodegradation. Due to these unique properties of nanophotocatalysts for biomedical waste management, we aim to critically evaluate various aspects of these materials in the present review and highlight their importance in healthcare service settings.

Photofunctionalization as a suitable approach to improve the osseointegration of implants in animal models-A systematic review and meta-analysis

OBJECTIVES

To determine whether photofunctionalization influences dental implant osseointegration.

MATERIAL AND METHODS

Data on osseointegration rates were extracted from 8 databases, based on bone-to-implant contact (BIC) and pushout tests. Internal validity was accessed through the SYRCLE risk of bias tool for animal experimental studies. Meta-analyses were performed for investigation of the influence of photofunctionalization on implant osseointegration, with a random effect and a confidence interval of 95%. The certainty of evidence was accessed through the GRADE approach.

RESULTS

Thirty-four records were identified, and 10 were included in the meta-analysis. Photofunctionalized implants showed higher mean values for BIC in rabbits (MD 6.92 [1.01, 12.82], p = .02), dogs (MD 23.70 [10.23, 37.16], p = .001), rats (MD 20.93 [12.91, 28.95], p < .0001), and in the pooled BIC analyses (MD 14.23 [7.80, 20.66], p < .0001) compared to those in control implants in the overall assay. Conversely, at late healing periods, the pooled BIC meta-analyses showed no statistically significant differences (p > .05) for photofunctionalized and control implants at 12 weeks of follow-up. For pushout analysis, photofunctionalized implants presented greater bone strength integration (MD 19.92 [13.88, 25.96], p < .0001) compared to that of control implants. The heterogeneity between studies ranged from "not important" to "moderate" for rabbits I²  = 24%, dogs I²  = 0%, rats I²  = 0%, and pooled BIC (I²  = 49%), while considerable heterogeneity was observed for pushouts (I²  = 90%).

CONCLUSION

Photofunctionalization improves osseointegration in the initial healing period of implants, as summarized from available data from rabbit, dog, and rat in vivo models.

Influence of Titanium Oxide Pillar Array Nanometric Structures and Ultraviolet Irradiation on the Properties of the Surface of Dental Implants-A Pilot Study

Aim: Titanium implants are commonly used as replacement therapy for lost teeth and much current research is focusing on the improvement of the chemical and physical properties of their surfaces in order to improve the osseointegration process. TiO₂, when it is deposited in the form of pillar array nanometric structures, has photocatalytic properties and wet surface control, which, together with UV irradiation, provide it with superhydrophilic surfaces, which may be of interest for improving cell adhesion on the peri-implant surface. In this article, we address the influence of this type of surface treatment on type IV and type V titanium discs on their surface energy and cell growth on them. Materials and methods: Samples from titanium rods used for making dental implants were used. There were two types of samples: grade IV and grade V. In turn, within each grade, two types of samples were differentiated: untreated and treated with sand blasting and subjected to double acid etching. Synthesis of the film consisting of titanium oxide pillar array structures was carried out using plasma-enhanced chemical vapor deposition equipment. The plasma was generated in a quartz vessel by an external SLAN-1 microwave source with a frequency of 2.45 GHz. Five specimens from each group were used (40 discs in total). On the surfaces to be studied, the following determinations were carried out: (a) X-ray photoelectron spectroscopy, (b) scanning electron microscopy, (c) energy dispersive X-ray spectroscopy, (d) profilometry, (e) contact angle measurement or surface wettability, (f) progression of contact angle on applying ultraviolet irradiation, and (g) a biocompatibility test and cytotoxicity with cell cultures. Results: The application of ultraviolet light decreased the hydrophobicity of all the surfaces studied, although it did so to a greater extent on the surfaces with the studied modification applied, this being more evident in samples manufactured in grade V titanium. In samples made in grade IV titanium, this difference was less evident, and even in the sample manufactured with grade IV and SLA treatment, the application of the nanometric modification of the surface made the surface optically less active. Regarding cell growth, all the surfaces studied, grouped in relation to the presence or not of the nanometric treatment, showed similar growth. Conclusions. Treatment of titanium oxide surfaces with ultraviolet irradiation made them change temporarily into superhydrophilic ones, which confirms that their biocompatibility could be improved in this way, or at least be maintained.

A wear-resistant TiO2 nanoceramic coating on titanium implants for visible-light photocatalytic removal of organic residues

An effective treatment for peri-implantitis is to completely remove all the bacterial deposits from the contaminated implants, especially the organic residues, to regain biocompatibility and re-osseointegration, but none of the conventional decontamination treatments has achieve this goal. The photocatalytic activity of TiO₂ coating on titanium implants to degrade organic contaminants has attracted researchers' attention recently. But a pure TiO₂ coating only responses to harmful ultraviolet light. Additionally, the poor coating mechanical properties are unable to protect the coating integrity versus initial mechanical decontamination. To address these issues, a unique TiO₂ nanoceramic coating was fabricated on titanium substrates through an innovative plasma electrolytic oxidation (PEO) based procedure, which showed a disordered layer with oxygen vacancies on the outmost part. As a result, the coating could decompose methylene blue, rhodamine B, and pre-adsorbed lipopolysaccharide (LPS) under visible light. Additionally, the coating showed two-fold higher hardness than untreated titanium and excellent wear resistance against steel decontamination instruments, which could be attributed to the specific micro-structure, including the densely packed nanocrystals and good metallurgical combination. Moreover, the in vitro response of MG63 cells confirmed that the coating had comparable biocompatibility and osteoconductivity to untreated titanium substrates. This study provides a unique coating technique as well as a photocatalytic cleaning strategy to enhance decontamination of titanium dental implants, which will favour the development of peri-implantitis treatments. STATEMENT OF SIGNIFICANCE: The treatment of peri-implantitis is based on the complete removal of bacterial deposits, especially the organic residues, but conventional decontamination treatments are hard to achieve it. The photocatalytic activity of TiO₂ coating on titanium implants to degrade organic contaminants provides a promising strategy for deeper decontamination, but its nonactivation to visible light and poor mechanical properties have limited its application. To address these issues, a unique TiO₂ nanoceramic coating was fabricated on titanium substrates based on plasma electrolytic oxidation. The coating showed enhanced visible-light photocatalytic activity, excellent wear resistance and satisfied biocompatibility. Based on this functional coating, it is promising to develop a more efficient strategy for deep decontamination of implant surface, which will favour the development of peri-implantitis treatments.

Effects of an Erbium:Yttrium-Aluminum-Garnet Laser and Ultrasonic Scaler on Titanium Dioxide-Coated Titanium Surfaces Contaminated With Subgingival Plaque: An In Vitro Study to Assess Post-Treatment Biocompatibility With Osteogenic Cells

BACKGROUND

Effects of conventional ultrasonic scaler versus an erbium:yttrium-aluminum-garnet (Er:YAG) laser on titanium surfaces contaminated with subgingival plaque from patients with peri-implantitis are evaluated in terms of: 1) plaque and biocorroded titanium oxide coating removal; 2) surface change induction; and 3) residual biocompatibility toward osteoblasts.

METHODS

Subgingival plaque-coated titanium disks with a moderately rough surface were fixed with ethanol and treated with an ultrasonic scaler (metal tip) or Er:YAG laser (20.3 or 38.2 J/cm²) in non-contact mode. Fluorescent detection of residual plaque was performed. Disk surface morphology was evaluated by scanning electron microscopy. Viability, attachment, proliferation, and differentiation of Saos-2 osteoblasts on new and treated disks were assayed by propidium iodide/DNA stain assay and confocal microscopic analysis of cytoskeleton, Ki67, expression of osteopontin and alkaline phosphatase, and formation of mineralized nodules.

RESULTS

Both methods resulted in effective debridement of treated surfaces, the plaque area being reduced to 11.7% with the ultrasonic scaler and ≤0.03% with the Er:YAG laser (38.2 J/cm²). Ultrasound-treated disks showed marked surface changes, incomplete removal of the titanium dioxide (TiO₂) layer, and scanty plaque aggregates, whereas the Er:YAG laser (38.2 J/cm²) completely stripped away the plaque and TiO₂ layer, leaving a micropitted surface. Both treatments maintained a good biocompatibility of surfaces to Saos-2 osteoblasts. Air-water cooling kept disk temperature below the critical threshold of 47°C.

CONCLUSION

This study shows that an ultrasonic scaler with metal tip is less efficient than high-energy Er:YAG irradiation to remove the plaque and TiO₂ layer on anodized disks, although both procedures appear capable of restoring an adequate osseoconductivity of treated surfaces.

Photofunctionalization of Dental Implants

After dental implants are manufactured there can be a loss of biological activity that may be reactivated by exposure to ultraviolet (UV) radiation, that is, photofunctionalization. The titanium surface is energy conditioned by UV radiation. This imparts a slight positive surface energy and hydrophilicity to the titanium dental implant surface. This conditioning renews biological activity lost after a shelf life of as little as 2 weeks. The UV radiation has chemical and biological effects on the osseous-implant interface. Photofunctionization for as little as 15 minutes accelerates healing and increases bone to implant contact. The most effective time exposure and UV wave length are in need of identification to produce a surface most conducive for osseointegration.

Fabrication of a micro-nano structure on steel surface and surface wetting

Micro-shot peening (MSP) was combined with subsequent anodization to produce a micro-nano structure on a carbon steel surface.

Ultraviolet-C irradiation to titanium implants increases peri-implant bone formation without impeding mineralization in a rabbit femur model

OBJECTIVES

Volume and bone quality of peri-implant supporting bone, in particular, at implant neck region, as well as bone-implant contact ratio, is important for long-term stability of implants. Ultraviolet-C (UVC) irradiation is known to enhance the osseointegration capability of titanium implants. However, the histological determination was performed only on a rat model, but not pre-clinical animal model such as a rabbit model. The purpose of this study was to determine the effects of UVC irradiation on titanium implants on the volume and mineral density of peri-implant supporting bone formation in a rabbit femur model.

MATERIALS AND METHODS

Acid-etched pure titanium screw implants with or without 3 mW/cm2 UVC irradiation for 48 h were placed in rabbit femur diaphyses. Peri-implant bone tissue formation was analyzed at 3 and 8 weeks post-operatively by histology and micro-CT-based bone morphometry after calibration with hydroxyl apatite phantoms.

RESULTS

UVC pre-irradiated implants accumulated a higher density of cells and thicker and longer bone tissue attachments that continued into the inner basic lamellae of the surface of existing cortical bone at 3 and 8 weeks than the implants without irradiation. Although the bone mineral density around both implants was equivalent to that of the existing cortical bone, bone volume was greater with UVC pre-irradiation in two-thirds or more of the apical region throughout the observation period.

CONCLUSIONS

These results indicate that UVC treatment increased the volume of cortical-like bone tissue in the coronal region of titanium implants without deterioration of bone mineral density.

Chances and limitations of nanosized titanium dioxide practical application in view of its physicochemical properties

Nanotechnology is a field of science that is nowadays developing in a dynamic way. It seems to offer almost endless opportunities of contribution to many areas of economy and human activity, in general. Thanks to nanotechnology, the so-called nanomaterials can be designed. They present structurally altered materials, with their physical, chemical and biological properties entirely differing from properties of the same materials manufactured in microtechnology. Nanotechnology creates a unique opportunity to modify the matter at the level of atoms and particles. Therefore, it has become possible to obtain items displaying new, useful properties, i.e. self-disinfecting and self-cleaning surfaces. Those surfaces are usually covered by a thin layer of a photocatalyst. The role of the photocatalyst is most of the time performed by the nanosized titanium dioxide (nano-TiO2). Excitation of nano-TiO2 by ultraviolet radiation initiates advanced oxidation processes and reactions leading to the creation of oxygen vacancies that bind water particles. As a result, photocatalytic surfaces are given new properties. Those properties can then be applied in a variety of disciplines, such as medicine, food hygiene, environmental protection or building industry. Practically, the applications include inactivation of microorganisms, degradation of toxins, removing pollutants from buildings and manufacturing of fog-free windows or mirrors.

Osseointegration: hierarchical designing encompassing the macrometer, micrometer, and nanometer length scales

OBJECTIVE

Osseointegration has been a proven concept in implant dentistry and orthopedics for decades. Substantial efforts for engineering implants for reduced treatment time frames have focused on micrometer and most recently on nanometer length scale alterations with negligible attention devoted to the effect of both macrometer design alterations and surgical instrumentation on osseointegration. This manuscript revisits osseointegration addressing the individual and combined role of alterations on the macrometer, micrometer, and nanometer length scales on the basis of cell culture, preclinical in vivo studies, and clinical evidence.

METHODS

A critical appraisal of the literature was performed regarding the impact of dental implant designing on osseointegration. Results from studies with different methodological approaches and the commonly observed inconsistencies are discussed.

RESULTS

It is a consensus that implant surface topographical and chemical alterations can hasten osseointegration. However, the tailored combination between multiple length scale design parameters that provides maximal host response is yet to be determined.

SIGNIFICANCE

In spite of the overabundant literature on osseointegration, a proportional inconsistency in findings hitherto encountered warrants a call for appropriate multivariable study designing to ensure that adequate data collection will enable osseointegration maximization and/or optimization, which will possibly lead to the engineering of endosteal implant designs that can be immediately placed/loaded regardless of patient dependent conditions.

Biofilm formation on titanium implants counteracted by grafting gallium and silver ions

Biofilm-associated infections remain the leading cause of implant failure. Thanks to its established biocompatibility and biomechanical properties, titanium has become one of the most widely used materials for bone implants. Engineered surface modifications of titanium able to thwart biofilm formation while endowing a safe anchorage to eukaryotic cells are being progressively developed. Here surfaces of disks of commercial grade 2 titanium for bone implant were grafted with gallium and silver ions by anodic spark deposition. Scanning electron microscopy of the surface morphology and energy dispersive X-ray spectroscopy were used for characterization. Gallium-grafted titanium was evaluated in comparison with silver-grafted titanium for both in vivo and in vitro antibiofilm properties and for in vitro compatibility with human primary gingival fibroblasts. Surface-modified materials showed: (i) homogeneous porous morphology, with pores of micrometric size; (ii) absence of cytotoxic effects; (iii) ability to support in vitro the adhesion and spreading of gingival fibroblasts; and (iv) antibiofilm properties. Although both silver and gallium exhibited in vitro strong antibacterial properties, in vivo gallium was significantly more effective than silver in reducing number and viability of biofilm bacteria colonies. Gallium-based treatments represent promising titanium antibiofilm coatings to develop new bone implantable devices for oral, maxillofacial, and orthopedic applications.

A review on the wettability of dental implant surfaces II: Biological and clinical aspects

Dental and orthopedic implants have been under continuous advancement to improve their interactions with bone and ensure a successful outcome for patients. Surface characteristics such as surface topography and surface chemistry can serve as design tools to enhance the biological response around the implant, with in vitro, in vivo and clinical studies confirming their effects. However, the comprehensive design of implants to promote early and long-term osseointegration requires a better understanding of the role of surface wettability and the mechanisms by which it affects the surrounding biological environment. This review provides a general overview of the available information about the contact angle values of experimental and of marketed implant surfaces, some of the techniques used to modify surface wettability of implants, and results from in vitro and clinical studies. We aim to expand the current understanding on the role of wettability of metallic implants at their interface with blood and the biological milieu, as well as with bacteria, and hard and soft tissues.

The effects of different wavelength UV photofunctionalization on micro-arc oxidized titanium

Many challenges exist in improving early osseointegration, one of the most critical factors in the long-term clinical success of dental implants. Recently, ultraviolet (UV) light-mediated photofunctionalization of titanium as a new potential surface treatment has aroused great interest. This study examines the bioactivity of titanium surfaces treated with UV light of different wavelengths and the underlying associated mechanism. Micro-arc oxidation (MAO) titanium samples were pretreated with UVA light (peak wavelength of 360 nm) or UVC light (peak wavelength of 250 nm) for up to 24 h. UVC treatment promoted the attachment, spread, proliferation and differentiation of MG-63 osteoblast-like cells on the titanium surface, as well as the capacity for apatite formation in simulated body fluid (SBF). These biological influences were not observed after UVA treatment, apart from a weaker effect on apatite formation. The enhanced bioactivity was substantially correlated with the amount of Ti-OH groups, which play an important role in improving the hydrophilicity, along with the removal of hydrocarbons on the titanium surface. Our results showed that both UVA and UVC irradiation altered the chemical properties of the titanium surface without sacrificing its excellent physical characteristics, suggesting that this technology has extensive potential applications and merits further investigation.

Bactercline(®)-coated implants: Clinical results up to 1 year after loading from a controlled clinical trial

BACKGROUND

Titanium dioxide exists in three different crystal lattices, anatase, rutile, and brookite. Anatase coating releases, under ultraviolet (UV) irradiation, free radicals such as ·OH, O2 (-), HO2 (-), and H2O2. This potent oxidizing power characteristically results in the lysis of bacteria and other organic substances. The purpose of this study was to evaluate the bone response to implants made of titanium alloy or coated with a new combination of anatase and Bactercline(®) product.

MATERIALS AND METHODS

In the period between July 2009 and June 2010, 26 patients (10 females and 16 males; median age 51 ± 11 years, min. 27 years, max. 72 years) were operated and 62 implants were inserted. Lost fixtures and peri-implant bone resorption were considered as predictors of clinical outcomes. Pearson χ(2)-test was used. Prosthesis and implant failures, any complications after loading, and peri-implant marginal bone-level changes were assessed by a masked assessor. All patients were followed up to 1 year after loading.

RESULTS

No implant was lost. Average bone resorption around implant was 0.33 mm (both for 25 standard and 37 Bactercline-coated implants), and thus no statistical difference was detected.

CONCLUSION

These results shown that no adverse effects on osseo-integration were present.

Photocatalytically induced hydrophilicity influences bone remodelling at longer healing periods: a rabbit study

OBJECTIVES

Previously, we have reported that photocatalytically active hydrophilicity of the anatase titanium dioxide (TiO₂) nanoparticles coated onto commercially pure titanium discs presented significantly improved hydrophilicity after ultraviolet irradiation. As hydrophilicity has shown enhancement of osseointegration, the in vivo responses were of great interest. The aim of this study was to evaluate whether or not the photo-activated hydrophilicity generated at the time of implant placement has an effect on the longer healing periods for osseointegration.

MATERIALS AND METHODS

Photocatatytically active nanostructured TiO₂ powder (Degussa P-25), which consists of approximately 80% anatase and 20% rutile, was spin-coated onto commercially pure titanium discs and was heat-treated thereafter. These P25-coated discs were irradiated with ultraviolet (UV) light for the test (+UV) group, and non-irradiated discs were prepared for the control (-UV) group. Both groups of discs were placed in the rabbits' tibiae. After 12 weeks of healing period, histological analysis and gene expression analysis using real-time RT-PCR were performed.

RESULTS

From the histological analyses, there were no specific differences between -UV and +UV groups. However, from the gene expression analysis, ALP, RUNX-2 and IL-10 were significantly upregulated for the +UV group compared with the -UV group.

CONCLUSIONS

The biologically enhancing effect to photocatalytically activated surfaces remained even after 12 weeks of healing time in terms of genetic responses.

Plasma treatment maintains surface energy of the implant surface and enhances osseointegration

The surface energy of the implant surface has an impact on osseointegration. In this study, 2 surfaces: nonwashed resorbable blasting media (NWRBM; control) and Ar-based nonthermal plasma 30 days (Plasma 30 days; experimental), were investigated with a focus on the surface energy. The surface energy was characterized by the Owens-Wendt-Rabel-Kaelble method and the chemistry by X-ray photoelectron spectroscopy (XPS). Five adult beagle dogs received 8 implants (n = 2 per surface, per tibia). After 2 weeks, the animals were euthanized, and half of the implants (n = 20) were removal torqued and the other half were histologically processed (n = 20). The bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) were evaluated on the histologic sections. The XPS analysis showed peaks of C, Ca, O, and P for the control and experimental surfaces. While no significant difference was observed for BIC parameter (P > 0.75), a higher level for torque (P < 0.02) and BAFO parameter (P < 0.01) was observed for the experimental group. The surface elemental chemistry was modified by the plasma and lasted for 30 days after treatment resulting in improved biomechanical fixation and bone formation at 2 weeks compared to the control group.

Structural influence from calcium phosphate coatings and its possible effect on enhanced bone integration

OBJECTIVE

The aim of this review was to summarize our present knowledge about calcium phosphate (CaP) coatings on implants with respect to their topographical appearance at micrometer as well as nanometer level and also the reported influence on bone healing.

MATERIAL AND METHODS

The PubMed database was used with the key words - surface roughness, CaP coating, implant, bone integration, clinical studies, experimental studies - used in different combinations. Only in vivo studies were taken into consideration.

CONCLUSIONS

A significantly improved healing capacity associated with CaP-coated implants is often reported, but individual importance of the several modes of surface changes introduced, deliberately or not, is usually very difficult to interpret. Several studies claim this difference to be due to altered chemistry, but in many the result may equally well be dependent on the surface topography. The few studies that have been published indicate that nanometer structures have an impact on early bone healing. However, the optimal size and distribution of nanometer-sized particles or pores applied on implant surfaces is still unknown, as are the evaluation effects of micrometer roughness. Improved surface characterization is needed if we are to reveal effects dependent on isolated nanometer alterations.

Healing of complement activating Ti implants compared with non-activating Ti in rat tibia

Recent studies have revealed that ozone ultraviolet (UVO) illumination of titanium (Ti) implants improves bone-implant anchorage by altering the physico-chemical and immune activating properties of the titanium dioxide (TiO(2)) layer. In the present rat tibia model, the authors compared the early events of inflammation and bone formation around UVO-treated Ti and complement activating immunoglobin g (IgG)-coated Ti. Machined Ti and machined Ti coated with a physical vapour-deposited Ti layer were used as references. Screw-shaped test and reference implants were implanted into rat tibia and harvested after 1, 7 and 28 days. Messenger RNA expression of implant adhered cells and peri-implant tissue ~250 μm from the surface were subsequently analysed with regard to IL-1β, TNF-α, osteocalcin, cathepsin K, BMP-2 and PDGF. Separate implants were retrieved after 7 and 28 days for removal torque measurements, and histological staining and histomorphometric analysis of bone area and bone-to-implant contact. While enhanced expression of inflammatory markers, TNF-α and IL-1β, was observed on IgG-coated surfaces throughout the observation time, UVO-treated surfaces indicated a significantly lower early inflammatory response. In the early phases (1 and 7 days), the UVO-treated surfaces displayed a significantly higher expression of osteoblast markers BMP-2 and osteocalcin. In summary, complement activating Ti implants elicited a stronger inflammatory response than UVO-treated Ti, with low complement activation during the first week of healing. In spite of this, the UVO-treated Ti induced only marginally more bone growth outside the implants.

In vitro characterization and osteoblast responses to nanostructured photocatalytic TiO2 coated surfaces

The aims of the study were to characterize a nanostructured photoactive titanium dioxide (TiO(2)) coating and to compare the cellular response of human osteoblasts before and after ultraviolet (UV) irradiation of the coating. A specific nanostructured TiO(2) powder (Degussa P-25), which consists of approximately 80% anatase and 20% rutile, was spin-coated onto commercially pure titanium discs, and was heat-treated thereafter. After topographical, chemical and photocatalytic property characterizations, human osteoblasts were cultured on the coated discs before and after UV irradiation. Cell morphology was evaluated by scanning electron microscopy (SEM), and cell viability was analysed by 3-(4,5-dimethylthiazol)-2,5-diphenyltetrazolium bromide (MTT) assay. From the contact angle analysis, the wettability significantly improved after UV irradiation. The cultured cells were flattened with numerous elongated lammellipodia; however, no morphological differences were indicated between -UV and +UV surfaces. The MTT assay analysis showed that -UV surface presented significantly higher viability compared to the +UV surface except for one cell population group at 3h where there were no differences. The nanostructured photoactive TiO(2) surface improved its hydrophilicity by UV irradiation, however no enhancing effect in cell response was confirmed at the time tested compared to the non-irradiated surface.

Accelerated bone formation on photo-induced hydrophilic titanium implants: an experimental study in the dog mandible

OBJECTIVES

The purpose of this study was to investigate the effect of photo-induced hydrophilic titanium dioxide (TiO₂) on serum fibronectin (sFN) attachment, and further to evaluate initial osseointegration responses in the dog mandibles.

MATERIALS AND METHODS

To apply the anatase TiO₂ film, plasma source ion implantation (PSII) method followed by annealing was employed for the titanium disks and implants, which were then illuminated with UV-A for 24 h for the experimental groups. Non-deposited titanium disks and implants were prepared for the control group. Surface characterization was performed using the interferometer and contact angle analyzer. The attachments of sFN were evaluated using fluorescence emission analysis. Thereafter both groups of implants were placed in the mandible of six beagle dogs. Bone response was investigated with histological and histomorphometrical analyses after periods of 2 and 4 weeks.

RESULTS

The experimental groups exhibited strong hydrophilicity under UV-A illumination and showed significant improvement in sFN attachment. And further, the experimental implants enhanced the bone formation with the bone-to-implant contact of 42.7% after 2 weeks of healing (control: 28.4%).

CONCLUSIONS

The combined applications of plasma fibronectin and PSII to produce hydrophilic titanium surfaces could accelerate early osseointegration.

Osseointegration of two different phosphate ion-containing titanium oxide surfaces in rabbit cancellous bone

OBJECTIVE

This study assessed the osseointegration of grit-blasted titanium (Ti) implants with a hydrophilic phosphate ion-incorporated oxide surface in rabbit cancellous bone, and compared its bone healing with commercially available phosphate-incorporated clinical implants obtained by micro-arc oxidation (TiUnite, TU implant).

MATERIAL AND METHODS

The hydrophilic phosphate-incorporated Ti surface (P implant) was produced by hydrothermal treatment on grit-blasted moderately rough-surfaced clinical implant. The TU surface was used as a control. The surface characteristics were evaluated by field emission-scanning electron microscopy, X-ray photoelectron spectroscopy, optical profilometry, and inductively coupled plasma-atomic emission spectroscopy (ICP-AES). Thirty-two threaded implants with lengths of 10 and 3.3 mm diameter (16 P implants and 16 TU implants) were placed in the femoral condyles of 16 New Zealand White rabbits. Histomorphometric analysis, removal torque tests, and surface analysis of the torque-tested implants were performed 4 weeks after implantation.

RESULTS

The P and TU implants displayed micro-rough surface features with similar Ra values at the micron-scale. ICP-AES analysis revealed that both the P and TU implants released phosphate ions into the solution. The torque-tested P and TU implants exhibited a considerable quantity of bone attached to the surface. The P implants exhibited significantly higher bone-implant contact percentages, both in terms of the all threads region and the total lateral length of implants compared with the TU implants (P < 0.01), but no statistical difference was found for the removal torque values.

CONCLUSION

These results suggest that the phosphate-incorporated Ti oxide surface obtained by hydrothermal treatment achieves rapid osseointegration in cancellous bone by increasing the degree of bone-implant contact.

Accelerated photo-induced hydrophilicity promotes osseointegration: an animal study

BACKGROUND

In the previous in vitro study, fluoride-modified, anodized porous titanium was proven to have enhanced its photo-induced hydrophilicity, which induced the hyperactivation of initial cell response.

PURPOSE

The purpose of the present study was to investigate in vivo bone apposition during the early stages of osseointegration in rabbit tibiae.

MATERIALS AND METHODS

Anodized porous titanium implants (TiU, TiUnite®, Nobel Biocare AB, Göteborg, Sweden) were modified with 0.175 wt% ammonium hydrogen fluoride solution (NH(4) F-HF(2) ). Twenty-four hours prior to the experiments, the surface-modified implants were ultraviolet-irradiated (modTiU). Blinded and unpackaged TiU implants were used as controls. Thereafter, the implants were placed in the rabbit tibial metaphyses and histomorphometrically analyzed at 2 and 6 weeks after insertion.

RESULTS

ModTiU demonstrated a significantly greater degree of bone-to-metal contact than TiU after 2 and 6 weeks of healing.

CONCLUSION

The results proved that the enhanced photo-induced hydrophilicity of the NH(4) F-HF(2) -modified anodized implants promoted bone apposition during the early stages of osseointegration.

Protein adsorption to surface chemistry and crystal structure modification of titanium surfaces

Objectives

To observe the early adsorption of extracellular matrix and blood plasma proteins to magnesium-incorporated titanium oxide surfaces, which has shown superior bone response in animal models.

Material and Methods

Commercially pure titanium discs were blasted with titanium dioxide (TiO₂) particles (control), and for the test group, TiO₂ blasted discs were further processed with a micro-arc oxidation method (test). Surface morphology was investigated by scanning electron microscopy, surface topography by optic interferometry, characterization by X-ray photoelectron spectroscopy (XPS), and by X-ray diffraction (XRD) analysis. The adsorption of 3 different proteins (fibronectin, albumin, and collagen type I) was investigated by an immunoblotting technique.

Results

The test surface showed a porous structure, whereas the control surface showed a typical TiO₂ blasted structure. XPS data revealed magnesium-incorporation to the anodic oxide film of the surface. There was no difference in surface roughness between the control and test surfaces. For the protein adsorption test, the amount of albumin was significantly higher on the control surface whereas the amount of fibronectin was significantly higher on the test surface. Although there was no significant difference, the test surface had a tendency to adsorb more collagen type I.

Conclusions

The magnesium-incorporated anodized surface showed significantly higher fibronectin adsorption and lower albumin adsorption than the blasted surface. These results may be one of the reasons for the excellent bone response previously observed in animal studies.

Anodic oxidized nanotubular titanium implants enhance bone morphogenetic protein-2 delivery

Implant failure has been attributed to loosening of an implant from the host bone possibly due to poor osseointegration. One promising strategy for improving osseointegration is to develop a functional implant surface that promotes osteoblast differentiation. In this study, a titanium (Ti) surface was functionalized by an anodic oxidation process and was loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2). The following four groups of Ti surfaces were prepared: machined (M), anodized machined (MA), resorbable blast medium (RBM), and anodized RBM (RBMA). The surfaces were characterized by scanning electron microscopy and contact angle measurements. The results showed that a Ti oxide layer (TiO(2)) was observed in the anodized surfaces in the form of nanotubes, approximately 100 nm in diameter and 500 nm in length. The hydrophilic properties of the anodized surfaces were significantly improved. The adsorbed rhBMP-2 loaded on the nonanodized surfaces and lyophilized showed spherical particle morphology. However, the adsorbed rhBMP-2 showed a dispersed pattern over the anodized surfaces. The velocity of the rhBMP-2 released from the surfaces was measured to determine if the anodized surface can improve in delivery efficiency. The results showed that the release velocity of the rhBMP-2 from the anodized surfaces was sustained when compared with that of the nonanodized surfaces. In addition, the rhBMP-2 released from the surface was found to be bioactive according to the alkaline phosphatase activity and the level of calcium mineral deposition. These results suggest that the TiO(2) nanotubular structure formed by anodizing is a promising configuration for sustained rhBMP-2 delivery.

In vivo gene expression in response to anodically oxidized versus machined titanium implants

A quantitative polymerase chain reaction technique (qPCR) in combination with scanning electron microscopy was applied for the evaluation of early gene expression response and cellular reactions close to titanium implants. Anodically oxidized and machined titanium miniscrews were inserted in rat tibiae. After 1, 3, and 6 days the implants were unscrewed and the surrounding bone was retrieved using trephines. Both the implants and bone were analyzed with qPCR. A greater amount of cells, as indicated with higher expression of 18S, was detected on the oxidized surface after 1 and 6 days. Significantly higher osteocalcin (at day 6), alkaline phosphatase (at days 3 and 6), and cathepsin K (at day 3) expression was demonstrated for the oxidized surface. Higher expression of tumor necrosis factor-alpha (at day 1) and interleukin-1beta (at days 1 and 6) was detected on the machined surfaces. SEM revealed a higher amount of mesenchymal-like cells on the oxidized surface. The results show that the rapid recruitment of mesenchymal cells, the rapid triggering of gene expression crucial for bone remodeling and the transient nature of inflammation, constitute biological mechanisms for osseointegration, and high implant stability associated with anodically oxidized implants.

Corrosion of phosphate-enriched titanium oxide surface dental implants (TiUnite) under in vitro inflammatory and hyperglycemic conditions

Endosseous dental implants use is increasing in patients with systemic conditions that compromise wound healing. Manufacturers recently have redesigned implants to ensure more reliable and faster osseointegration. One design strategy has been to create a porous phosphate-enriched titanium oxide (TiUnite) surface to increase surface area and enhance interactions with bone. In the current study, the corrosion properties of TiUnite implants were studied in cultures of monocytic cells and solutions simulating inflammatory and hyperglycemic conditions. Furthermore, to investigate whether placement into bone causes enough mechanical damage to alter implant corrosion properties, the enhanced surface implants as well as machined titanium implants were placed into human cadaver mandibular bone, the bone removed, and the corrosion properties measured. Implant corrosion behavior was characterized by open circuit potentials, linear polarization resistance, and electrical impedance spectroscopy. In selected samples, THP1 cells were activated with lipopolysaccharide prior to implant exposure to simulate an inflammatory environment. No significant differences in corrosion potentials were measured between the TiUnite implants and the machined titanium implants in previous studies. TiUnite implants exhibited lower corrosion rates in all simulated conditions than observed in PBS, and EIS measurements revealed two time constants which shifted with protein-containing electrolytes. In addition, the TiUnite implants displayed a significantly lower corrosion rate than the machined titanium implants after placement into bone. The current study suggests that the corrosion risk of the enhanced oxide implant is lower than its machined surface titanium implant counterpart under simulated conditions of inflammation, elevated dextrose concentrations, and after implantation into bone.

Role of Chloride Formed on Anodized Titanium Surfaces Against an Oral Microorganism

A modified titanium surface, anodized after being discharged in electrolytes, provides antibacterial activity against oral bacteria as well as osteoconductivity. However, the mechanism of this antibacterial effect against oral bacteria is still unclear. This study aims to investigate whether it is the chloride or the hydrophilicity properties of the anodized titanium, which is effective against the oral bacteria. Titanium plates are anodized in various electrolytes with or without chloride and are characterized. Then the survival of Streptococcus mutans on each specimen is evaluated. The results demonstrate that the peroxidation effects of HClO generated from the TiCl3 formed on the titanium surface anodized in various chloride solutions efficiently killed adherent S. mutans on the surface whereas the presence of hydrophilicity alone do not demonstrate antibacterial activity. This method of anodizing titanium surface in a chloride solution may provide a novel strategy for use in orthopedic or dental implant systems.

Photo-induced hydrophilicity enhances initial cell behavior and early bone apposition

OBJECTIVE

The anatase form of titanium dioxide (TiO(2)) exhibits photo-induced hydrophilicity when it is irradiated with ultraviolet (UV) light. In the present study, the effect of photo-induced hydrophilicity on initial cell behavior and bone formation was evaluated.

MATERIALS AND METHODS

Plasma source ion implantation method and post-annealing were employed for coating the anatase form of TiO(2) to the surface of the titanium disk and implant. Half of the disks and implants were illuminated with UV for 24 h beforehand, whereas the other halves were blinded and used as controls. Photo-induced hydrophilicity was confirmed by a static wettability assay. The effects of this hydrophilicity on cell behavior were evaluated by means of cell attachment, proliferation and morphology using pluripotent mesenchymal precursor C2C12 cells. Thereafter, bone formation around the hydrophilic implant inserted in the rabbit tibia was confirmed histomorphometrically.

RESULTS

The water contact angle of the photo-induced hydrophilic disk decreased markedly from 43.5 degrees to 0.5 degree. Cell attachment and proliferation on this hydrophilic disk showed significant improvement. The cell morphology on this hydrophilic disk was extremely flattened, with an elongation of the lamellipodia, whereas a round/spherical morphology was observed on the control disk. The photo-induced hydrophilic implant enhanced the bone formation with the bone-to-metal contact of 28.2% after 2 weeks of healing (control: 17.97%).

CONCLUSION

The photo-induced hydrophilic surface used in the current study improves the initial cell reactions and enhances early bone apposition to the implant.

Enhanced initial cell responses to chemically modified anodized titanium

BACKGROUND

Previously, we reported that anodized porous titanium implants have photocatalytic hydrophilicity. However, this effect was not always sufficient for the significant improvement of bone apposition.

PURPOSE

The purpose of this study was to improve the photocatalytic properties of porous titanium implants by the fluoride modification of the anodized titanium dioxide (TiO(2)), and to investigate the initial cell response to it.

MATERIALS AND METHODS

The ideal concentration of ammonium hydrogen fluoride (NH(4)F-HF(2)) used in this study was determined by a static water contact angle assay. The ideal concentration of NH(4)F-HF(2) was 0.175%, and experimental disks were treated with this concentration. A pluripotent mesenchymal cell line, C2C12, was cultured on the disks in order to investigate cell attachment, morphology, and proliferation.

RESULTS

Cell attachment after 30 minutes of culturing was significantly higher for the ultraviolet-irradiated, fluoride-modified anodized TiO(2) (p < .05), and the simultaneous scanning electron microscope observation showed a rather flattened and extended cell morphology. The proliferation rate after 24 hours was also significantly higher for the fluoride-modified anodized TiO(2).

CONCLUSION

Fluoride chemical modification enhances the hydrophilic property of the anodized TiO(2) and improves the initial cell response to it.