In vitro reaction of human osteoblasts on alumina-toughened zirconia

Surface Modifications for Zirconia Dental Implants: A Review

Zirconia-based bioceramic is a potential material for dental implants developed and introduced in dentistry 30 years ago. However, some limitations still exist for zirconia implants caused by several factors, such as manufacturing difficulties, low-temperature degradation (LTD), long-term stability, and clinical experience. Several studies validated that some subtle changes on the zirconia surface might significantly impact its mechanical properties and osseointegration. Thus, attention was paid to the effect of surface modification of zirconia implants. This review generally summarizes the surface modifications of zirconia implants to date classified as physical treatment, chemical treatment, and surface coating, aiming to give an overall perspective based on the current situation. In conclusion, surface modification is an effective and essential method for zirconia implant application. However, before clinical use, we need more knowledge about these modification methods.

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.

Ca-P spots modified zirconia by liquid precursor infiltration and the effect on osteoblast-like cell responses

Ca-P spots modified zirconia by liquid precursor infiltration and the cell responses were investigated. Pre-sintered zirconia specimens were immersed in Ca-P precursor solution. After dense sintering, scanning electron microscopy showed Ca-P spots were formed on the zirconia and anchored with zirconia substrates. The distribution density was increased with the extension of immersion time. Energy dispersive spectrometer confirmed the stoichiometric Ca/P ratio was about 1.67. After hydrothermal treatment, Ca-P spots turned into rod crystals where diffraction peaks of tricalcium phosphate and hydroxyapatite were detected by X-ray diffraction, and Ca²⁺ and PO₄^3- release decreased slightly (p>0.05). There was no significant decrease on three-point bending strength (p>0.05). Osteoblast-like MC3T3-E1 cells attached and spread well and showed higher proliferation on Ca-P spots modified zirconia (p<0.05), though its initial alkaline phosphatase activity was not significant high (p>0.05). In conclusion, Ca-P liquid precursor infiltration is a potential method to modify the zirconia ceramics for improving bioactivity.

Surface Characterization and Cell Adhesion of Different Zirconia Treatments: An in vitro Study

AIM

The aim of this study was to characterize the surface of zirconia subjected to different treatments and evaluate its effect on cell adhesion and proliferation.

MATERIALS AND METHODS

A total of 80 zirconia disks were divided into four groups (n = 20) according to the surface treatments used: group I: as-sintered (AS), no surface treatment applied; group II: abrasion treatment applied using Rocatec (ROC; 3M ESPE) system with silica-coated alumina powder of grit size 110 μm; group III: erbium, chromium:yttrium, scandium, gallium, garnet (Er, Cr:YSGG) laser (LAS; BIOLASE) was used at a frequency of 20 Hz and output power of 3 W; and group IV: specimens were subjected to the selective infiltration etching (SIE) technique. Surface characterization was evaluated for the different groups (roughness, hardness, and morphology), and cell behavior (adhesion and proliferation) was tested (a = 0.05).

RESULTS

The ROC group reported a significant increase in surface roughness (2.201 ± 0.352) and Vickers hardness (1758 ± 16.6) compared with the other surface treatments. The SIE surface-treated group reported a significantly higher number of cells (64.5 ± 2.6 and 53.5 ± 2.2 respectively) compared with the other surface-treated groups.

CONCLUSION

The SIE is a promising surface treatment for zirconia that significantly enhances cell adhesion and osseointegration.

CLINICAL SIGNIFICANCE

The SIE treatment of zirconia implants may help in a faster and better osseointegration.

Osseointegration of zirconia dental implants in animal investigations: A systematic review and meta-analysis

OBJECTIVE

To determine the osseointegration rate of zirconium dioxide (ZrO₂) dental implants in preclinical investigations.

DATA

Data on the osseointegration rate was extracted considering the bone to implant contact (BIC), removal torque analysis (RTQ) and push-in tests. Meta analyses were conducted using multilevel multivariable mixed-effects linear regression models. The Šidák method was used in case of multiple testing.

SOURCES

An electronic screening of the literature (MEDLINE/Pubmed, Cochrane Library and Embase) and a supplementary manual search were performed. Animal investigations with a minimum sample size of 3 units evaluating implants made of zirconia (ZrO₂) or its composites (ZrO₂>50vol.%) were included.

STUDY SELECTION

The search provided 4577 articles, and finally 54 investigations were included and analyzed. Fifty-two studies included implants made from zirconia, 4 zirconia composite implants and 37 titanium implants. In total, 3435 implants were installed in 954 animals.

CONCLUSIONS

No significant influence of the evaluated bulk materials on the outcomes of interest could be detected. When comparing different animal models, significant differences for the evaluated variables could be found. These results might be of interest for the design of further animal investigations.

A Novel Technique for the Connection of Ceramic and Titanium Implant Components Using Glass Solder Bonding

Both titanium and ceramic materials provide specific advantages in dental implant technology. However, some problems, like hypersensitivity reactions, corrosion and mechanical failure, have been reported. Therefore, the combining of both materials to take advantage of their pros, while eliminating their respective cons, would be desirable. Hence, we introduced a new technique to bond titanium and ceramic materials by means of a silica-based glass ceramic solder. Cylindrical compound samples (Ø10 mm × 56 mm) made of alumina toughened zirconia (ATZ), as well as titanium grade 5, were bonded by glass solder on their end faces. As a control, a two-component adhesive glue was utilized. The samples were investigated without further treatment, after 30 and 90 days of storage in distilled water at room temperature, and after aging. All samples were subjected to quasi-static four-point-bending tests. We found that the glass solder bonding provided significantly higher bending strength than adhesive glue bonding. In contrast to the glued samples, the bending strength of the soldered samples remained unaltered by the storage and aging treatments. Scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) analyses confirmed the presence of a stable solder-ceramic interface. Therefore, the glass solder technique represents a promising method for optimizing dental and orthopedic implant bondings.

Zirconium ions up-regulate the BMP/SMAD signaling pathway and promote the proliferation and differentiation of human osteoblasts

Zirconium (Zr) is an element commonly used in dental and orthopedic implants either as zirconia (ZrO2) or in metal alloys. It can also be incorporated into calcium silicate-based ceramics. However, the effects of in vitro culture of human osteoblasts (HOBs) with soluble ionic forms of Zr have not been determined. In this study, primary culture of human osteoblasts was conducted in the presence of medium containing either ZrCl4 or Zirconium (IV) oxynitrate (ZrO(NO3)2) at concentrations of 0, 5, 50 and 500 µM, and osteoblast proliferation, differentiation and calcium deposition were assessed. Incubation of human osteoblast cultures with Zr ions increased the proliferation of human osteoblasts and also gene expression of genetic markers of osteoblast differentiation. In 21 and 28 day cultures, Zr ions at concentrations of 50 and 500 µM increased the deposition of calcium phosphate. In addition, the gene expression of BMP2 and BMP receptors was increased in response to culture with Zr ions and this was associated with increased phosphorylation of SMAD1/5. Moreover, Noggin suppressed osteogenic gene expression in HOBs co-treated with Zr ions. In conclusion, Zr ions appear able to induce both the proliferation and the differentiation of primary human osteoblasts. This is associated with up-regulation of BMP2 expression and activation of BMP signaling suggesting this action is, at least in part, mediated by BMP signaling.

Zirconium ions up-regulate the BMP/SMAD signaling pathway and promote the proliferation and differentiation of human osteoblasts

Zirconium (Zr) is an element commonly used in dental and orthopedic implants either as zirconia (ZrO2) or in metal alloys. It can also be incorporated into calcium silicate-based ceramics. However, the effects of in vitro culture of human osteoblasts (HOBs) with soluble ionic forms of Zr have not been determined. In this study, primary culture of human osteoblasts was conducted in the presence of medium containing either ZrCl4 or Zirconium (IV) oxynitrate (ZrO(NO3)2) at concentrations of 0, 5, 50 and 500 µM, and osteoblast proliferation, differentiation and calcium deposition were assessed. Incubation of human osteoblast cultures with Zr ions increased the proliferation of human osteoblasts and also gene expression of genetic markers of osteoblast differentiation. In 21 and 28 day cultures, Zr ions at concentrations of 50 and 500 µM increased the deposition of calcium phosphate. In addition, the gene expression of BMP2 and BMP receptors was increased in response to culture with Zr ions and this was associated with increased phosphorylation of SMAD1/5. Moreover, Noggin suppressed osteogenic gene expression in HOBs co-treated with Zr ions. In conclusion, Zr ions appear able to induce both the proliferation and the differentiation of primary human osteoblasts. This is associated with up-regulation of BMP2 expression and activation of BMP signaling suggesting this action is, at least in part, mediated by BMP signaling.

Surface modifications of dental ceramic implants with different glass solder matrices: in vitro analyses with human primary osteoblasts and epithelial cells

Ceramic materials show excellent esthetic behavior, along with an absence of hypersensitivity, making them a possible alternative implant material in dental surgery. However, their surface properties enable only limited osseointegration compared to titanium implants. Within this study, a novel surface coating technique for enhanced osseointegration was investigated biologically and mechanically. Specimens of tetragonal zirconia polycrystal (TZP) and aluminum toughened zirconia (ATZ) were modified with glass solder matrices in two configurations which mainly consisted of SiO2, Al2O3, K2O, and Na2O. The influence on human osteoblastic and epithelial cell viability was examined by means of a WST-1 assay as well as live/dead staining. A C1CP-ELISA was carried out to verify procollagen type I production. Uncoated/sandblasted ceramic specimens and sandblasted titanium surfaces were investigated as a reference. Furthermore, mechanical investigations of bilaterally coated pellets were conducted with respect to surface roughness and adhesive strength of the different coatings. These tests could demonstrate a mechanically stable implant coating with glass solder matrices. The coated ceramic specimens show enhanced osteoblastic and partly epithelial viability and matrix production compared to the titanium control. Hence, the new glass solder matrix coating could improve bone cell growth as a prerequisite for enhanced osseointegration of ceramic implants.

Response of osteoblast-like cells to zirconia with different surface topography

The objective of this study was to clarify the effect of surface topography on osteoblast-like cell behavior on yttria stabilized tetragonal zirconia polycrystals (TZP). Mirror-polished; blasted with 50- or 150-µm alumina (SB50 and SB150); and SB150 acid-etched with hydrofluoric acid (SB150E) were prepared on TZP. Initial attachment, proliferation and differentiation of MC3T3-E1 were evaluated. The scanning electron microscopy and Sdr (developed interfacial area ratio) values indicated that both micro- and nano-topographies produced on the SB150E surfaces. Although no clear differences were observed in initial cell attachment among specimens, the proliferation rate and expression of ALP activity on the SB150E specimens was significantly higher than that on the other specimens. These results indicate that the creation of micro- and nano-topographies on TZP by surface treatment offers a promising method of enhancing the proliferation and differentiation of MC3T3-E1 cells.

Influence of surface topography and surface physicochemistry on wettability of zirconia (tetragonal zirconia polycrystal)

Surface modification technologies are available for tetragonal zirconia polycrystal (TZP) to enhance its bioactivity and osseointegration capability. The surface wettability of an implant material is one of the important factors in the process of osseointegration, possibly regulating protein adsorption, and subsequent cell behavior. The aim of this study was to clarify the effect of topographical or physicochemical modification of TZP ceramics on wettability to determine the potential of such treatment in application to implants. Several types of surface topography were produced by alumina blasting and acid etching with hydrofluoric acid; surface physicochemistry was modified with oxygen (O(2)) plasma, ultraviolet (UV) light, or hydrogen peroxide treatment. The obtained specimens were also subjected to storage under various conditions to evaluate their potential to maintain superhydrophilicity. The results showed that surface modification of surface topography or physicochemistry, especially of blast/acid etching as well as O(2) plasma and UV treatment, greatly increased the surface wettability, resulting in superhydrophilicity. X-ray photoelectron spectroscopy revealed that a remarkable decrease in carbon content and the introduction of hydroxyl groups were responsible for the observed superhydrophilicity. Furthermore, superhydrophilicity was maintained, even after immersion in an aqueous solution, an important consideration in the clinical application of this technology.

Response of osteoblast-like cells cultured on zirconia to bone morphogenetic protein-2

Purpose

The aim of this study was to compare osteoblast behavior on zirconia and titanium under conditions cultured with bone morphogenetic protein-2.

Methods

MC3T3-E1 cells were cultured on sandblasted zirconia and sandblasted/etched titanium discs. At 24 hours after seeding MC3T3-E1, the demineralized bone matrix (DBM) gel alone and the DBM gel with bone morphogenetic protein-2 (BMP-2) were added to the culture medium. The surface topography was examined by confocal laser scanning microscopy. Cellular proliferation was measured at 1, 4, and 7 days after gel loading. Alkaline phosphatase activity was measured at 7 days after gel loading. The mRNA expression of ALPase, bone sialoprotein, type I collagen, runt-related transcription factor 2 (Runx-2), osteocalcin, and osterix were evaluated by real-time polymerase chain reaction at 4 days and 7 days.

Results

At 1, 4, and 7 days after loading the DBM gel alone and the DBM gel with BMP-2, cellular proliferation on the zirconia and titanium discs was similar and that of the groups cultured with the DBM gel alone and the DBM gel with BMP-2 was not significantly different, except for titanium with BMP-2 gel. ALPase activity was higher in the cells cultured with BMP-2 than in the other groups, but there was no difference between the zirconia and titanium. In ALPase, bone sialoprotein, osteocalcin, Runx-2 and osterix gene expression, that of cells on zirconia or titanium with BMP-2 gel was much more highly increased than titanium without gel at day 7. The gene expression level of cells cultured on zirconia with BMP-2 was higher than that on titanium with BMP-2 at day 7.

Conclusions

The data in this study demonstrate that the osteoblastic cell attachment and proliferation of zirconia were comparable to those of titanium. With the stimulation of BMP-2, zirconia has a more pronounced effect on the proliferation and differentiation of the osteoblastic cells compared with titanium.

In vivo performance of zirconia and titanium implants: a histomorphometric study in mini pig maxillae

OBJECTIVES

To compare the bone tissue response to surface-modified zirconia (ZrO2 ) and titanium implants.

METHODS

Cylindrical low-pressure injection moulded zirconia (ZrO2 ) implants were produced with an acid-etched surface. Titanium implants with identical shape, sandblasted and acid-etched surface (SLA) served as controls. Eighteen adult miniature pigs received both implant types in the maxilla 6 months after extraction of the canines and incisors. The animals were euthanized after 4, 8 and 12 weeks and 16 zirconia and 18 titanium implants with the surrounding tissue were retrieved, embedded in methylmethacrylate and stained with Giemsa-Eosin. The stained sections were digitized and histomorphometrically analysed with regard to peri-implant bone density (bone volume/total volume) and bone-implant contact (BIC) ratio. Statistical analysis was performed using Mann-Whitney' U-test.

RESULTS

Histomorphometrical analysis showed direct osseous integration for both materials. ZrO2 implants revealed mean peri-implant bone density values of 60.4% (SD ± 9.9) at 4 weeks, 65.4% (SD ± 13.8) at 8 weeks, and 63.3% (SD ± 21.5) at 12 weeks after implantation, whereas Ti-SLA implants demonstrated mean values of 61.1% (SD ± 6.2), 63.6% (SD ± 6.8) and 68.2% (SD ± 5.8) at corresponding time intervals. Concerning the BIC ratio, the mean values for ZrO(2) ranged between 67.1% (SD ± 21.1) and 70% (SD ± 14.5) and for Ti-SLA between 64.7% (SD ± 9.4) and 83.7% (SD ± 10.3). For the two parameters investigated, no significant differences between both types of implants could be detected at any time point.

CONCLUSION

The results indicate that there was no difference in osseointegration between ZrO2 implants and Ti-SLA controls regarding peri-implant bone density and BIC ratio.