Enhanced osteoconductivity of micro-structured titanium implants (XiVE S CELLplus™) by addition of surface calcium chemistry: a histomorphometric study in the rabbit femur

Improved Biocompatibility and Osseointegration of Nanostructured Calcium-Incorporated Titanium Implant Surface Treatment (XPEED®)

Surface treatment of implants facilitates osseointegration, with nanostructured surfaces exhibiting accelerated peri-implant bone regeneration. This study compared bone-to-implant contact (BIC) in implants with hydroxyapatite (HA), sand-blasted and acid-etched (SLA), and SLA with calcium (Ca)-coated (XPEED®) surfaces. Seventy-five disk-shaped grade 4 Ti specimens divided into three groups were prepared, with 16 implants per group tested in New Zealand white rabbits. Surface characterization was performed using X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM), digital microscopy, and a contact angle analyzer. Cell viability, proliferation, and adhesion were assessed using MC3T3-E1 cells. Apatite formation was evaluated using modified simulated body fluid (m-SBF) incubation. After 4 weeks of healing, the outcomes reviewed were BIC, bone area (BA), removal torque tests, and histomorphometric evaluation. A microstructure analysis revealed irregular pores across all groups, with the XPEED group exhibiting a nanostructured Ca-coated surface. Surface characterization showed a crystalline CaTiO3 layer on XPEED surfaces, with evenly distributed Ca penetrating the implants. All surfaces provided excellent environments for cell growth. The XPEED and SLA groups showed significantly higher cell density and viability with superior osseointegration than HA (p < 0.05); XPEED exhibited the highest absorbance values. Thus, XPEED surface treatment improved implant performance, biocompatibility, stability, and osseointegration.

Synergistic Amelioration of Osseointegration and Osteoimmunomodulation with a Microarc Oxidation-Treated Three-Dimensionally Printed Ti-24Nb-4Zr-8Sn Scaffold via Surface Activity and Low Elastic Modulus

Biomaterial scaffolds, including bone substitutes, have evolved from being primarily a biologically passive structural element to one in which material properties such as surface topography and chemistry actively direct bone regeneration by influencing stem cells and the immune microenvironment. Ti-6Al-4V(Ti6Al4V) implants, with a significantly higher elastic modulus than human bone, may lead to stress shielding, necessitating improved stability at the bone-titanium alloy implant interface. Ti-24Nb-4Zr-8Sn (Ti2448), a low elastic modulus β-type titanium alloy devoid of potentially toxic elements, was utilized in this study. We employed 3D printing technology to fabricate a porous scaffold structure to further decrease the structural stiffness of the implant to approximate that of cancellous bone. Microarc oxidation (MAO) surface modification technology is then employed to create a microporous structure and a hydrophilic oxide ceramic layer on the surface and interior of the scaffold. In vitro studies demonstrated that MAO treatment enhances the proliferation, adhesion, and osteogenesis capabilities on the scaffold surface. The chemical composition of the MAO-Ti2448 oxide layer is found to enhance the transcription and expression of osteogenic genes in bone mesenchymal stem cells (BMSCs), potentially related to the enrichment of Nb2O5 and SnO2 in the oxide layer. The MAO-Ti2448 scaffold, with its synergistic surface activity and low stiffness, significantly activates the anti-inflammatory macrophage phenotype, creating an immune microenvironment that promotes the osteogenic differentiation of BMSCs. In vivo experiments in a rabbit model demonstrated a significant improvement in the quantity and quality of the newly formed bone trabeculae within the scaffold under the contact osteogenesis pattern with a matched elastic modulus. These trabeculae exhibit robust connections to the external structure of the scaffold, accelerating the formation of an interlocking structure between the bone and implant and providing higher implantation stability. These findings suggest that the MAO-Ti2448 scaffold has significant potential as a bone defect repair material by regulating osteoimmunomodulation and osteogenesis to enhance osseointegration. This study demonstrates an optional strategy that combines the mechanism of reducing the elastic modulus with surface modification treatment, thereby extending the application scope of β-type titanium alloy.

Zeolite Socony Mobil-Five Coating on Ti-24 Nb-4 Zr-7.9 Sn Promotes Biocompatibility and Osteogenesis In Vitro and In Vivo

The aim of this study was to evaluate the biocompatibility and osteogenic potential of a Zeolite Socony Mobil-5 (ZSM-5) coating on a Ti-24 Nb-4 Zr-7.9 Sn (Ti-2448) surface. ZSM-5-modified Ti-2448 (ZSM-5/Ti-2448) and Ti-2448 (control) groups were employed. The physical and chemical properties of the two types of samples were evaluated by scanning electron microscopy, Fourier-transform infrared spectroscopy, nitrogen adsorption/desorption, and contact angle methods. The surface of the ZSM-5/Ti-2448 was rougher than that of the original Ti-2448, while the contact angle of the ZSM-5/Ti-2448 was smaller than that of Ti-2448. In addition, the ZSM-5/Ti-2448 largely increased the specific surface area and introduced silanol groups. A bone-like apatite layer could be formed on the surface of ZSM-5/Ti-2448 after 14 days of incubation in a simulated body fluid. ZSM-5/Ti-2448 was not cytotoxic. The number and alkaline phosphatase (ALP) activity of osteoblasts on ZSM-5/Ti-2448 were significantly higher than those on Ti-2448 surfaces, obtained in vitro using 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide and ALP activity assays. Few inflammatory cells were observed around ZSM-5/Ti-2448 after insertion into the femurs of Japanese white rabbits after 4, 12, and 26 weeks through hematoxylin-eosin staining. The average gray scale of transforming growth factor-β1 (TGF-β1) on ZSM-5/Ti-2448 peaked earlier than that on Ti-2448, according to immunohistochemical staining. These results indicate that ZSM-5/Ti-2448 has a good biocompatibility and improved early osteogenic potential compared to a noncoated Ti-2448.

Impact of exogenous metal ions on peri-implant bone metabolism: a review

The development of effective methods to promote the osseointegration of dental implants by surface modification is an area of intense research in dental materials science. Exogenous metal ions present in the implant and surface modifications are closely related to the bone metabolism around the implant. In the complex oral microenvironment, the release of metal ions caused by continuous corrosion of dental implants has an unfavorable impact on the surrounding tissue, and then affects osseointegration, leading to bad results such as loosening and falling off in the late stage of the implant. Besides, these ions can even be distributed in distant tissues and organs. Currently, surface modification techniques are being developed that involve different processing technologies including the introduction of exogenous metal ions with different properties onto the surface of implants to improve performance. However, most metal elements have some level of biological toxicity and can only be used within a safe concentration range to exert the optimum biological effects on recipients. In this paper, we review the adverse effects of metal ions on osseointegration and highlight the emerging applications for metal elements in improving the performance of dental implants.

Surface modification for osseointegration of Ti6Al4V ELI using powder mixed sinking EDM

Biomedical implant rejection due to micromotion and inflammation around an implant leads to osteolysis and eventually has an implant failure because of poor osseointegration. To enhance osseointegration, the implant surface modification both at the nano and micro-scale levels is preferred to result in an enhanced interface between the body tissue and implant. The present study focuses on the modification of the surface of Titanium (α+β) ELI medical grade alloy using powder-mixed electric discharge machining (PMEDM). Pulse current, on/off time, and various silicon carbide (SiC) powder concentrations are used as input parameters to comprehend desired surface modifications. Powder concentration is considered as the most important factor to control surface roughness and recast layer depth. A significant decrease in surface fracture density and roughness is observed using a 20 g/l concentration of SiC particles. Elemental mapping analysis has confirmed the migration of Si and the generation of promising surface texture and chemistry. Oxides and carbides enriched surface improved the microhardness of the re-solidified layer from 320 HV to 727 HV. Surface topology reveals nano-porosity (50-200 nm) which enhances osseointegration due to the absorption of proteins especially collagen to the surface.

Current perspectives regarding the application and incorporation of silver nanoparticles into dental biomaterials

INTRODUCTION

The key idea of nanotechnology is to construct and preserve functional structures by means of exploiting atoms and molecules. Nanotechnology has proven to be crucial in pharmacological medicine, tissue engineering, clinical diagnosis, long term conservation of biological tissues in a cryogenic state, protein detection, tumor destruction and magnetic resonance imaging.The aim of this paper is to review the literature on the specific characteristics of nanostructured materials, their applications and advantages that they bring to dentistry.

METHOD

We conducted an electronic scientific database research that included PubMed, Cochrane and Medline. The following keywords were used: nanotechnology, nanodentistry and silver nanoparticles. Initially 1650 original articles were retrieved from the these mentioned international databases, which were screened in detail. We included literature reviews that dealt with the comprehensive applications of nanostructured particles and silver nanoparticles in particular, in all fields of contemporary dentistry. Case reports, clinical trials, editorials and opinion letters were excluded in the first phase of our research. Fifty two articles met all the selection criteria and were ultimately selected and reviewed.

RESULTS

Nanotechnology deals with the production of various types of nanomaterials with potential applications in the field of biomedicine. Silver nanoparticles have the capacity to eliminate dental caries producing bacteria or repair teeth enamel with signs of dental decay. Nanodentistry will allow better oral health by use of nanostructured materials. Treatment opportunities that nanotechnology has to offer in contemporary dentistry include local anesthesia, permanent treatment of dental hypersensitivity, orthodontic and oral health care with nanorobotic dentifrice.

CONCLUSION

The studies that we reviewed are largely in favor of nanotechnology and nanostructured materials, highlighting their qualities and enhancements they bring to the field of dentistry. Although many of these products that benefit from silver nanoparticles properties are still expensive and exclusive, we can foresee major improvements and demand regarding dental biomaterials with nanoparticles incorporated in the near future.

Osseointegration of standard and mini dental implants: a histomorphometric comparison

Background

Mini dental implants (MDIs) are becoming increasingly popular for rehabilitation of edentulous patients because of their several advantages. However, there is a lack of evidence on the osseointegration potential of the MDIs. The objective of the study was to histomorphometrically evaluate and compare bone apposition on the surface of MDIs and standard implants in a rabbit model.

Methods

Nine New Zealand white rabbits were used for the study to meet statistical criteria for adequate power. Total 18 3M^™ESPE^™ MDIs and 18 standard implants (Ankylos^® Friadent, Dentsply) were inserted randomly into the tibia of rabbits (four implants per rabbit); animals were sacrificed after a 6-week healing period. The specimens were retrieved en bloc and preserved in 10% formaldehyde solution. Specimens were prepared for embedding in a light cure acrylic resin (Technovit 9100). The most central sagittal histological sections (30–40 μm thick) were obtained using a Leica SP 1600 saw microtome. After staining, the Leica DM2000 microscope was used, the images were captured using Olympus DP72 camera and associated software. Bone implant contact (BIC) was measured using Infinity Analyze software.

Results

All implants were osseointegrated. Histologic measures show mineralized bone matrix in intimate contact with the implant surface in both groups. The median BIC was 58.5 % (IQR 8.0) in the MDI group and 57.0 % (IQR 5.5) in the control group (P > 0.05; Mann-Whitney test). There were no statistical differences in osseointegration at 6 weeks between MDIs and standard implants in rabbit tibias.

Conclusions

Based on these results, it is concluded that osseointegration of MDIs is similar to that of standard implants.

Customized SmartPeg for measurement of resonance frequency of mini dental implants

Background

One-piece narrow diameter implants (NDIs) have been recommended as “Single-tooth replacements in the anterior zones, single posterior, multiple-unit fixed dental prosthesis (FDP), edentulous jaws to be rehabilitated with FDP, and edentulous jaws rehabilitation with overdentures in situations with reduced mesiodistal space or reduced ridge width.” (ITI consensus 2013). Since NDIs can be immediately loaded, it is important to be able to carry out stability testing. We developed and validated a customized SmartPeg for this type of implant to measure the Implant Stability Quotient (ISQ). The ISQ of mini dental implants (MDIs) was measured and compared with the stability of standard and in a rabbit model.

Objective

The aim of the study is to test the feasibility of a customized SmartPeg for resonance frequency measurement of single-piece mini dental implants and to compare primary stability of a standard and the mini dental implant (3M™ESPE™ MDI) in a rabbit model after 6 weeks of healing.

Methods

Eight New Zealand white rabbits were used for the study. The protocol was approved by the McGill University Animal Ethics Review Board. Sixteen 3M™ESPE™ MDI and equal number of standard implants (Ankylos® Friadent, Dentsply) were inserted into the tibia/femur of the rabbits and compared. Each rabbit randomly received two 3M™ESPE™ MDI and two Ankylos® implants in each leg. ISQ values were measured with the help of an Osstell ISQ device using custom-made SmartPegs for the MDIs and implant-specific SmartPegs™ (Osstell) for the Ankylos®. Measurements were obtained both immediately following implant placement surgery and after a 6-week healing period. Each reading was taken thrice and their average compared using Wilcoxon matched pairs signed-rank tests.

Results

The median ISQ and interquartile range (IQR) values were 53.3 (8.3) at insertion and 60.5 (5.5) at 6 weeks for the 3M™ESPE™MDI and, respectively, 58.5 (4.75) and 65.5 (9.3) for the Ankylos® implant. These values also indicate that both types of implants achieved primary and secondary stability, and this is supported by histological data. ISQ values of both 3M™ESPE™ MDI and Ankylos® increased significantly from the time of insertion to 6 weeks post-insertion (p < 0.05).

Conclusions

The new custom-made SmartPeg is suitable for measuring the Implant Stability Quotient of 3M™ESPE™MDIs. The primary stability of 3M™ESPE™MDIs is similar to the primary stability attained by standard implants in the rabbit tibia.

Histomorphometric and histologic evaluation of titanium-zirconium (aTiZr) implants with anodized surfaces

The choice of implant surface has a significant influence on osseointegration. Modification of TiZr surface by anodization is reported to have the potential to modulate the osteoblast cell behaviour favouring more rapid bone formation. The aim of this study is to investigate the effect of anodizing the surface of TiZr discs with respect to osseointegration after four weeks implantation in sheep femurs. Titanium (Ti) and TiZr discs were anodized in an electrolyte containing DL-α-glycerophosphate and calcium acetate at 300 V. The surface characteristics were analyzed by scanning electron microscopy, electron dispersive spectroscopy, atomic force microscopy and goniometry. Forty implant discs with thickness of 1.5 and 10 mm diameter (10 of each-titanium, titanium-zirconium, anodized titanium and anodized titanium-zirconium) were placed in the femoral condyles of 10 sheep. Histomorphometric and histologic analysis were performed 4 weeks after implantation. The anodized implants displayed hydrophilic, porous, nano-to-micrometer scale roughened surfaces. Energy dispersive spectroscopy analysis revealed calcium and phosphorous incorporation into the surface of both titanium and titanium-zirconium after anodization. Histologically there was new bone apposition on all implanted discs, slightly more pronounced on anodised discs. The percentage bone-to-implant contact measurements of anodized implants were higher than machined/unmodified implants but there was no significant difference between the two groups with anodized surfaces (P > 0.05, n = 10). The present histomorphometric and histological findings confirm that surface modification of titanium-zirconium by anodization is similar to anodised titanium enhances early osseointegration compared to machined implant surfaces.

Modulating macrophage polarization with divalent cations in nanostructured titanium implant surfaces

Nanoscale topographical modification and surface chemistry alteration using bioactive ions are centrally important processes in the current design of the surface of titanium (Ti) bone implants with enhanced bone healing capacity. Macrophages play a central role in the early tissue healing stage and their activity in response to the implant surface is known to affect the subsequent healing outcome. Thus, the positive modulation of macrophage phenotype polarization (i.e. towards the regenerative M2 rather than the inflammatory M1 phenotype) with a modified surface is essential for the osteogenesis funtion of Ti bone implants. However, relatively few advances have been made in terms of modulating the macrophage-centered early healing capacity in the surface design of Ti bone implants for the two important surface properties of nanotopography and and bioactive ion chemistry. We investigated whether surface bioactive ion modification exerts a definite beneficial effect on inducing regenerative M2 macrophage polarization when combined with the surface nanotopography of Ti. Our results indicate that nanoscale topographical modification and surface bioactive ion chemistry can positively modulate the macrophage phenotype in a Ti implant surface. To the best of our knowledge, this is the first demonstration that chemical surface modification using divalent cations (Ca and Sr) dramatically induces the regenerative M2 macrophage phenotype of J774.A1 cells in nanostructured Ti surfaces. In this study, divalent cation chemistry regulated the cell shape of adherent macrophages and markedly up-regulated M2 macrophage phenotype expression when combined with the nanostructured Ti surface. These results provide insight into the surface engineering of future Ti bone implants that are harmonized between the macrophage-governed early wound healing process and subsequent mesenchymal stem cell-centered osteogenesis function.

Cytocompatibility and early osseointegration of nanoTiO2-modified Ti-24 Nb-4 Zr-7.9 Sn surfaces

This study aimed to evaluate the cytocompatibility and early osseointegration of Ti-24 Nb-4 Zr-7.9 Sn (Ti-2448) surfaces that were modified with a nanoscale TiO2 coating. The coating was fabricated using a hydrothermal synthesis method to generate nanoTiO2/Ti-2448. The surface characteristics of the samples were evaluated using scanning electron microscopy (SEM), energy dispersive spectrometry (EDS) and X-ray diffraction (XRD). The cytotoxicity of the fabricated nanoTiO2/Ti-2448 was determined using MTT assays. The proliferation and alkaline phosphatase (ALP) activity of MC3T3-E1 osteoblasts cultured on nanoTiO2/Ti-2448 were compared with those cultured on Ti-2448. Disk-shaped implants were placed in Wistar rats. The histological sections were stained with haematoxylin and eosin (HE), and the histocompatibility was analysed at 4 and 12weeks post-implantation. Cylindrical implants were embedded in Japanese white rabbits, and the histological sections were stained with HE and anti-TGF-β1 to evaluate the histocompatibility and early osseointegration at 4, 12 and 26weeks post-implantation. NanoTiO2/Ti-2448 exhibited a rougher surface than did Ti-2448. NanoTiO2/Ti-2448 was determined to be non-cytotoxic. More osteoblasts and higher ALP activity were observed for nanoTiO2/Ti-2448 than Ti-2448 (p<0.05). Few inflammatory cells were detected around nanoTiO2/Ti-2448, and the expression of TGF-β1 on nanoTiO2/Ti-2448 peaked at earlier time than that on Ti-2448. The results indicate that the cytocompatibility and early osseointegration were enhanced by the nanoTiO2 coating.

Nanotechnology and its application in dentistry

Nanotechnology influences almost every facet of everyday life from security to medicine. The concept of nanotechnology is that when one goes down to the bottom of things, one can discover unlimited possibilities and potential of the basic particle. In nanotechnology, analysis can be made to the level of manipulating atoms, molecules and chemical bonds between them. The growing interest in the dental applications of nanotechnology is leading to the emergence of a new field called nanodentistry. An electronic database search that included PubMed, MedLine, and Cochrane library was conducted. Key words used in the search are nanotechnology dentistry and applications. Language limitation was set as articles reviewed were only those written and published in English language. We did not search the gray literature. Initially, 52 articles were retrieved from the database, and articles considered were those published from 2008 to 2013. Eight articles that met the selection criteria were eventually selected and reviewed.

The relative effect of surface strontium chemistry and super-hydrophilicity on the early osseointegration of moderately rough titanium surface in the rabbit femur

OBJECTIVE

It is unclear whether surface bioactive chemistry or hydrophilicity plays a more dominant role in the osseointegration of micro-structured titanium implants having the same surface topography at the micrometer and submicrometer scales. To understand their comparative effect on enhancing the early osseointegration of micro-rough-surfaced implants, this study compared the bone healing-promoting effect of surface strontium (Sr) chemistry that has been shown in numerous studies to super-hydrophilicity in the early osseointegration of moderately rough-surfaced clinical oral implants (SLA(®) implant) in rabbit cancellous bone.

MATERIAL AND METHODS

Hydrothermal treatment was performed to incorporate Sr ions into the surface of clinical SLA implants (SLA/Sr implant). The surface characteristics were evaluated by using field emission-scanning electron microscopy, X-ray photoelectron spectroscopy and optical profilometry. Twenty screw implants (10 control and 10 experimental) were placed in the femoral condyles of 10 New Zealand White rabbits. The early osseointegration of the SLA/Sr implant was compared with a chemically modified super-hydrophilic SLA implant (SLActive(®) implant) by histomorphometric and resonance frequency analysis after 2 weeks of implantation.

RESULTS

The SLA/Sr and SLActive implants exhibited an identical surface topography and average R(a) values at the micron and submicron scales. The SLA/Sr implant displayed a high amount of surface Sr content (15.6 at.%). There was no significant difference in the implant stability quotient (ISQ) values between the two groups. However, histomorphometric analysis revealed a significantly higher bone-to-implant contact percentage in the SLA/Sr implants compared with the SLActive implants in rabbit cancellous bone (P < 0.01).

CONCLUSION

The results indicate that the surface Sr chemistry surpasses the effect of super-hydrophilicity in promoting the early bone apposition of moderately rough Ti surface in cancellous bone.

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.

Histological and three-dimensional evaluation of osseointegration to nanostructured calcium phosphate-coated implants

Nanostructures on implant surfaces have been shown to enhance osseointegration; however, commonly used evaluation techniques are probably not sufficiently sensitive to fully determine the effects of this process. This study aimed to observe the osseointegration properties of nanostructured calcium phosphate (CaP)-coated implants, by using a combination of three-dimensional imaging and conventional histology. Titanium implants were coated with stable CaP nanoparticles using an immersion technique followed by heat treatment. Uncoated implants were used as the control. After topographical and chemical characterizations, implants were inserted into the rabbit femur. After 2 and 4weeks, the samples were retrieved for micro-computed tomography and histomorphometric evaluation. Scanning electron microscopy evaluation indicated that the implant surface was modified at the nanoscale by CaP to obtain surface textured with rod-shaped structures. Relative to the control, the bone-to-implant contact for the CaP-coated implant was significantly higher at 4weeks after the implant surgery. Further, corresponding 3-D images showed active bone formation surrounding the implant. 3-D quantification and 2-D histology demonstrated statistical correlation; moreover, 3-D quantification indicated a statistical decrease in bone density in the non-coated control implant group between 2 and 4weeks after the surgery. The application of 3-D evaluation further clarified the temporal characteristics and biological reaction of implants in bone.

The cytocompatibility and osseointegration of the Ti implants with XPEED® surfaces

OBJECTIVES

This study evaluated cytocompatibility and osseointegration of the titanium (Ti) implants with resorbable blast media (RBM) surfaces produced by grit-blasting or XPEED(®) surfaces by coating of the nanostructured calcium.

MATERIAL AND METHODS

Ti implants with XPEED(®) surfaces were hydrothermally prepared from Ti implants with RBM surfaces in a solution containing alkaline calcium. The surface characteristics were evaluated by using a scanning electron microscope (SEM) and surface roughness measuring system. Apatite formation was measured with SEM after immersion in modified-simulated body fluid and the amount of calcium released was measured by inductively coupled plasma optical emission. The cell proliferation was investigated by MTT assay and the cell attachment was evaluated by SEM in MC3T3-E1 pre-osteoblast cells. Thirty implants with RBM surfaces and 30 implants with XPEED(®) surfaces were placed in the proximal tibiae and in the femoral condyles of 10 New Zealand White rabbits. The osseointegration was evaluated by a removal torque test in the proximal tibiae and by histomorphometric analysis in the femoral condyles 4 weeks after implantation.

RESULTS

The Ti implants with XPEED(®) surfaces showed a similar surface morphology and surface roughness to those of the Ti implants with RBM surfaces. The amount of calcium ions released from the surface of the Ti implants with XPEED(®) surfaces was much more than the Ti implants with RBM surfaces (P < 0.05). The cell proliferation and cell attachment of the Ti implants showed a similar pattern to those of the Ti implants with RBM surfaces (P > 0.1). Apatite deposition significantly increased in all surfaces of the Ti implants with XPEED(®) surfaces. The removable torque value (P = 0.038) and percentage of bone-to-implant contact (BIC%) (P = 0.03) was enhanced in the Ti implants with XPEED(®) surfaces.

CONCLUSION

The Ti implants with XPEED(®) surfaces significantly enhanced apatite formation, removal torque value, and the BIC%. The Ti implants with XPEED(®) surfaces may induce strong bone integration by improving osseointegration of grit-blasted Ti implants in areas of poor quality bone.

Bone healing of commercial oral implants with RGD immobilization through electrodeposited poly(ethylene glycol) in rabbit cancellous bone

Immobilization of RGD peptides on titanium (Ti) surfaces enhances implant bone healing by promoting early osteoblastic cell attachment and subsequent differentiation by facilitating integrin binding. Our previous studies have demonstrated the efficacy of RGD peptide immobilization on Ti surfaces through the electrodeposition of poly(ethylene glycol) (PEG) (RGD/PEG/Ti), which exhibited good chemical stability and bonding. The RGD/PEG/Ti surface promoted differentiation and mineralization of pre-osteoblasts. This study investigated the in vivo bone healing capacity of the RGD/PEG/Ti surface for biomedical application as a more osteoconductive implant surface in dentistry. The RGD/PEG/Ti surface was produced on an osteoconductive implant surface, i.e. the grit blasted micro-rough surface of a commercial oral implant. The osteoconductivity of the RGD/PEG/Ti surface was compared by histomorphometric evaluation with an RGD peptide-coated surface obtained by simple adsorption in rabbit cancellous bone after 2 and 4 weeks healing. The RGD/PEG/Ti implants displayed a high degree of direct bone apposition in cancellous bone and achieved greater active bone apposition, even in areas of poor surrounding bone. Significant increases in the bone to implant contact percentage were observed for RGD/PEG/Ti implants compared with RGD-coated Ti implants obtained by simple adsorption both after 2 and 4 weeks healing (P<0.05). These results demonstrate that RGD peptide immobilization on a Ti surface through electrodeposited PEG may be an effective method for enhancing bone healing with commercial micro-rough surface oral implants in cancellous bone by achieving rapid bone apposition on the implant surface.

The effect of hierarchical micro/nanosurface titanium implant on osseointegration in ovariectomized sheep

Hydrofluoric etching and anodized hierarchical micro/nanotextured surface titanium implant was placed in mandibles of ovariectomized sheep for 12 weeks, and it showed improved osseointegration by resonance frequency analysis (RFA), microcomputed tomography (micro-CT) evaluation, histomorphometry, and biomechanical test.

INTRODUCTION

This study aimed to investigate the effects of micro/nanotextured titanium implant on osseointegration in ovariectomized (OVX) sheep.

METHODS

The hierarchical micro/nanotextured surface of titanium implant was fabricated by acid in 0.5% (w/v) hydrofluoric (HF) and anodized in HF acid electrolytes with a DC power of 20 V, and the machined surface implants with no treatment served as control group. The implants were placed in mandibles of OVX sheep, respectively. Twelve weeks after implantation, RFA, microcomputed tomography, histomorphometry, and biomechanical tests were applied to detect the osseointegration of the two groups.

RESULTS

The implant stability quotient (ISQ) values, the maximum pull-out forces, and the bone-implant contact (BIC) were 65.5 ± 6.3, 490.6 ± 72.7 N, and 58.31 ± 5.79% in the micro/nanogroup and 58.3 ± 8.9, 394.5 ± 54.5 N, and 46.85 ± 5.04% in the control group, respectively. There was no significant difference between the two groups in ISQ values (p > 0.05), but in the micro/nanogroup, the maximal pull-out force and the BIC were increased significantly (p < 0.05 or p < 0.01). Micro-CT analysis showed that the bone volume ratio and the trabecular number increased significantly (p < 0.01), and the trabecular separation decreased significantly (p < 0.05) in the micro/nanogroup.

CONCLUSION

Implant modification by HF acid etching and anodization to form a hierarchical micro/nanotextured surface could improve titanium implant osseointegration in OVX sheep 12 weeks after implantation.

Osseointegration of commercial microstructured titanium implants incorporating magnesium: a histomorphometric study in rabbit cancellous bone

OBJECTIVE

Recent studies have suggested that magnesium (Mg) ions exert a beneficial effect on implant osseointegration. This study assessed the osseointegration of nanoporous titanium (Ti) surface incorporating the Mg produced by hydrothermal treatment in rabbit cancellous bone to determine whether this surface would further enhance bone healing of moderately rough-surfaced implants in cancellous bone, and compared the result with commercially available micro-arc oxidized Mg-incorporated implants.

MATERIAL AND METHODS

The Mg-incorporated Ti surfaces (RBM/Mg) were obtained by hydrothermal treatment using an alkaline Mg-containing solution on grit-blasted moderately rough (RBM) implants. Untreated RBM and recently introduced Mg-incorporated microporous Ti implants produced by micro-arc oxidation (M) were used controls in this study. The surface characteristics were evaluated by scanning electron microscopy, X-ray photoelectron spectroscopy and optical profilometry. Twenty-four threaded implants with a length of 10 mm (eight RBM implants, eight RBM/Mg implants and eight M implants) were placed in the femoral condyles of 12 New Zealand White rabbits. Histomorphometric analysis was performed 4 weeks after implantation.

RESULTS

Hydrothermally treated and untreated grit-blasted implants displayed almost identical surface morphologies and R(a) values at the micron-scale. The RBM/Mg implants exhibited morphological differences compared with the RBM implants at the nano-scale, which displayed nanoporous surface structures. The Mg-incorporated implants (RBM/Mg and M) exhibited more continuous bone apposition and a higher degree of bone-to-implant contact (BIC) than the untreated RBM implants in rabbit cancellous bone. The RBM/Mg implants displayed significantly greater BIC% than untreated RBM implants, both in terms of the all threads region and the total lateral length of implants (P<0.05), but no statistical differences were found between the RBM/Mg and M implants except BIC% values in total lateral length.

CONCLUSION

These results indicate that a nanoporous Mg-incorporated surface may be effective in enhancing the osseointegration of moderately rough grit-blasted implants by increasing the degree of bone-implant contact in areas of cancellous bone.

Nanoscale surface modifications of medically relevant metals: state-of-the art and perspectives

Evidence that nanoscale surface properties stimulate and guide various molecular and biological processes at the implant/tissue interface is fostering a new trend in designing implantable metals. Cutting-edge expertise and techniques drawn from widely separated fields, such as nanotechnology, materials engineering and biology, have been advantageously exploited to nanoengineer surfaces in ways that control and direct these processes in predictable manners. In this review, we present and discuss the state-of-the-art of nanotechnology-based approaches currently adopted to modify the surface of metals used for orthopedic and dental applications, and also briefly consider their use in the cardiovascular field. The effects of nanoengineered surfaces on various in vitro molecular and cellular events are firstly discussed. This review also provides an overview of in vivo and clinical studies with nanostructured metallic implants, and addresses the potential influence of nanotopography on biomechanical events at interfaces. Ultimately, the objective of this work is to give the readership a comprehensive picture of the current advances, future developments and challenges in the application of the infinitesimally small to biomedical surface science. We believe that an integrated understanding of the in vitro and particularly of the in vivo behavior is mandatory for the proper exploitation of nanostructured implantable metals and, indeed, of all biomaterials.

Osteoblast response to magnesium ion-incorporated nanoporous titanium oxide surfaces

OBJECTIVE

This study investigated the surface characteristics and in vitro osteoconductivity of a titanium (Ti) surface incorporated with the magnesium ions (Mg) produced by hydrothermal treatment for future application as an endosseous implant surface.

MATERIAL AND METHODS

Mg-incorporated Ti oxide surfaces were produced by hydrothermal treatment using Mg-containing solution on two different microstructured surfaces--abraded minimally rough (Ma) or grit-blasted moderately rough (RBM) samples. The surface characteristics were evaluated using scanning electron microscopy, thin-film X-ray diffractometry, X-ray photoelectron spectroscopy, optical profilometry, and inductively coupled plasma atomic emission spectroscopy (ICP-AES). MC3T3-E1 pre-osteoblast cell attachment, proliferation, alkaline phosphatase (ALP) activity, and quantitative analysis of osteoblastic gene expression on Ma, RBM, Mg-incorporated Ma (Mg), and Mg-incorporated grit-blasted (RBM/Mg) Ti surfaces were evaluated.

RESULTS

Hydrothermal treatment produced an Mg-incorporated Ti oxide layer with nanoporous surface structures. Mg-incorporated surfaces showed surface morphologies and surface roughness values almost identical to those of untreated smooth or micro-rough surfaces at the micron scale. ICP-AES analysis showed Mg ions released from treated surfaces into the solution. Mg incorporation significantly increased cellular attachment (P=0 at 0.5 h, P=0.01 at 1 h) on smooth surfaces, but no differences were found on micro-rough surfaces. Mg incorporation further increased ALP activity in cells grown on both smooth and micro-rough surfaces at 7 and 14 days of culture (P=0). Real-time polymerase chain reaction analysis showed higher mRNA expressions of the osteoblast transcription factor gene (Dlx5), various integrins, and the osteoblast phenotype genes (ALP, bone sialoprotein and osteocalcin) in cells grown on micro-rough (RBM) and Mg-incorporated (Mg and RBM/Mg) surfaces than those on Ma surfaces. Mg incorporation further increased the mRNA expressions of key osteoblast genes and integrins (α1, α2, α5, and β1) in cells grown on both the smooth and the micro-rough surfaces.

CONCLUSION

These results indicate that an Mg-incorporated nanoporous Ti oxide surface produced by hydrothermal treatment may improve implant bone healing by enhancing the attachment and differentiation of osteoblastic cells.