Corrosion resistance and biocompatibility of a new porous surface for titanium implants

Advanced Antimicrobial and Anti-Infective Strategies to Manage Peri-Implant Infection: A Narrative Review

Despite reductions in bacterial infection and enhanced success rate, the widespread use of systemic antibiotic prophylaxis in implant dentistry is controversial. This use has contributed to the growing problem of antimicrobial resistance, along with creating significant health and economic burdens. The basic mechanisms that cause implant infection can be targeted by new prevention and treatment methods which can also lead to the reduction of systemic antibiotic exposure and its associated adverse effects. This review aims to summarize advanced biomaterial strategies applied to implant components based on anti-pathogenic mechanisms and immune balance mechanisms. It emphasizes that modifying the dental implant surface and regulating the early immune response are promising strategies, which may further prevent or slow the development of peri-implant infection, and subsequent failure.

Hydrogels: An overview of its classifications, properties, and applications

The review paper starts with the introduction to hydrogels along with broad literature survey covering different modes of synthesis including high energy radiation methods. After that, paper covered broad classification of the hydrogels depending upon the basis of their source of origin, method of synthesis, type of cross-linking present and ionic charges on bound groups. Another advanced category response triggered hydrogels, which includes pH, temperature, electro, and light and substrate responsive hydrogels was also studied. Presented paper summarises chemical structure, properties, and synthesis of different kinds of hydrogels. Main focus was given to the preparation super absorbents such as: Semi-interpenetrating networks (semi-IPNs), Interpenetrating networks (IPNs) and cross-linked binary graft copolymers (BGCPs). The weak mechanical properties and easy degradation limit the uses of bio-based -hydrogels in biomedical field. Their properties can be improved through different chemical and physical methods. These methods were also discussed in the current research paper. Also, it includes development of hydrogels as controlled drug delivery devices, as implants and biomaterials to replace malfunctioned body parts along with their use in several other applications listed in the literature. Literature survey on the application of hydrogels in different fields like biomedical, nano-biotechnology, tissue engineering, drug delivery and agriculture was also carried out.

Strontium Functionalization of Biomaterials for Bone Tissue Engineering Purposes: A Biological Point of View

Strontium (Sr) is a trace element taken with nutrition and found in bone in close connection to native hydroxyapatite. Sr is involved in a dual mechanism of coupling the stimulation of bone formation with the inhibition of bone resorption, as reported in the literature. Interest in studying Sr has increased in the last decades due to the development of strontium ranelate (SrRan), an orally active agent acting as an anti-osteoporosis drug. However, the use of SrRan was subjected to some limitations starting from 2014 due to its negative side effects on the cardiac safety of patients. In this scenario, an interesting perspective for the administration of Sr is the introduction of Sr ions in biomaterials for bone tissue engineering (BTE) applications. This strategy has attracted attention thanks to its positive effects on bone formation, alongside the reduction of osteoclast activity, proven by in vitro and in vivo studies. The purpose of this review is to go through the classes of biomaterials most commonly used in BTE and functionalized with Sr, i.e., calcium phosphate ceramics, bioactive glasses, metal-based materials, and polymers. The works discussed in this review were selected as representative for each type of the above-mentioned categories, and the biological evaluation in vitro and/or in vivo was the main criterion for selection. The encouraging results collected from the in vitro and in vivo biological evaluations are outlined to highlight the potential applications of materials’ functionalization with Sr as an osteopromoting dopant in BTE.

Tissue Integration and Biological Cellular Response of SLM-Manufactured Titanium Scaffolds

Background: SLM (Selective Laser Melting)–manufactured Titanium (Ti) scaffolds have a significant value for bone reconstructions in the oral and maxillofacial surgery field. While their mechanical properties and biocompatibility have been analysed, there is still no adequate information regarding tissue integration. Therefore, the aim of this study is a comprehensive systematic assessment of the essential parameters (porosity, pore dimension, surface treatment, shape) required to provide the long-term performance of Ti SLM medical implants. Materials and methods: A systematic literature search was conducted via electronic databases PubMed, Medline and Cochrane, using a selection of relevant search MeSH terms. The literature review was conducted using the preferred reporting items for systematic reviews and meta-analysis (PRISMA). Results: Within the total of 11 in vitro design studies, 9 in vivo studies, and 4 that had both in vitro and in vivo designs, the results indicated that SLM-generated Ti scaffolds presented no cytotoxicity, their tissue integration being assured by pore dimensions of 400 to 600 µm, high porosity (75–88%), hydroxyapatite or SiO2–TiO2 coating, and bioactive treatment. The shape of the scaffold did not seem to have significant importance. Conclusions: The SLM technique used to fabricate the implants offers exceptional control over the structure of the base. It is anticipated that with this technique, and a better understanding of the physical interaction between the scaffold and bone tissue, porous bases can be tailored to optimize the graft’s integrative and mechanical properties in order to obtain structures able to sustain osseous tissue on Ti.

Corrosion of Metallic Biomaterials: A Review

Metallic biomaterials are used in medical devices in humans more than any other family of materials. The corrosion resistance of an implant material affects its functionality and durability and is a prime factor governing biocompatibility. The fundamental paradigm of metallic biomaterials, except biodegradable metals, has been "the more corrosion resistant, the more biocompatible." The body environment is harsh and raises several challenges with respect to corrosion control. In this invited review paper, the body environment is analysed in detail and the possible effects of the corrosion of different biomaterials on biocompatibility are discussed. Then, the kinetics of corrosion, passivity, its breakdown and regeneration in vivo are conferred. Next, the mostly used metallic biomaterials and their corrosion performance are reviewed. These biomaterials include stainless steels, cobalt-chromium alloys, titanium and its alloys, Nitinol shape memory alloy, dental amalgams, gold, metallic glasses and biodegradable metals. Then, the principles of implant failure, retrieval and failure analysis are highlighted, followed by description of the most common corrosion processes in vivo. Finally, approaches to control the corrosion of metallic biomaterials are highlighted.

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.

Biocompatibility and Degradation of a Low Elastic Modulus Ti-35Nb-3Zr Alloy: Nanosurface Engineering for Enhanced Degradation Resistance

In this study, the biocompatibility and degradation behavior of a low elastic modulus Ti-35Nb-3Zr alloy were investigated and compared with that of the conventional orthopedic and dental implant materials, i.e., commercially pure titanium (Cp-Ti) and Ti-6Al-4V alloy. The biocompatibility test results suggested that cells proliferate equally well on Ti-35Nb-3Zr and Cp-Ti. The degradation rates of Cp-Ti and Ti-6Al-4V were ∼68% (p < 0.05) and ∼84% (p < 0.05) lower as compared to Ti-35Nb-3Zr, respectively. Interestingly, the passive current density (i_{pass (1000mv)}) of the Ti-35Nb-3Zr alloy was ∼29% lower than that of Cp-Ti, which suggests that the alloying elements in the Ti-35Nb-3Zr alloy have contributed to its passivation behavior. Nanosurface engineering of the Ti-35Nb-3Zr alloy, i.e., a two-step electrochemical process involving anodization (producing nanoporous layer) and calcium phosphate (CaP) deposition, decreased the degradation rate of the alloy by ∼83% (p < 0.05), and notably, it was similar to the conventional Ti-6Al-4V alloy. Hence, it can be suggested that the nanosurface-engineered low elastic modulus Ti-35Nb-3Zr alloy is a promising material for orthopedic and dental implant applications.

Tantalum implanted entangled porous titanium promotes surface osseointegration and bone ingrowth

Porous Ti is considered to be an ideal graft material in orthopaedic and dental surgeries due to its similar spatial structures and mechanical properties to cancellous bone. In this work, to overcome the bioinertia of Ti, Ta-implanted entangled porous titanium (EPT) was constructed by plasma immersion ion implantation &deposition (PIII&D) method. Ca-implanted and unimplanted EPTs were investigated as control groups. Although no difference was found in surface topography and mechanical performances, both Ca- and Ta-implanted groups had better effects in promoting MG-63 cell viability, proliferation, differentiation, and mineralization than those of unimplanted group. The expression of osteogenic-related markers examined by qRT-PCR and western blotting was upregulated in Ca- and Ta-implanted groups. Moreover, Ta-implanted EPT group could reach a higher level of these effects than that of Ca-implanted group. Enhanced osseointegration of both Ca- and Ta-implanted EPT implants was demonstrated through in vivo experiments, including micro-CT evaluation, push-out test, sequential fluorescent labeling and histological observation. However, the Ta-implanted group possessed more stable and continuous osteogenic activity. Our results suggest that Ta-implanted EPT can be developed as one of the highly efficient graft material for bone reconstruction situations.

Surface Modifications and Their Effects on Titanium Dental Implants

This review covers several basic methodologies of surface treatment and their effects on titanium (Ti) implants. The importance of each treatment and its effects will be discussed in detail in order to compare their effectiveness in promoting osseointegration. Published literature for the last 18 years was selected with the use of keywords like titanium dental implant, surface roughness, coating, and osseointegration. Significant surface roughness played an important role in providing effective surface for bone implant contact, cell proliferation, and removal torque, despite having good mechanical properties. Overall, published studies indicated that an acid etched surface-modified and a coating application on commercial pure titanium implant was most preferable in producing the good surface roughness. Thus, a combination of a good surface roughness and mechanical properties of titanium could lead to successful dental implants.

Metallic ion content and damage to the DNA in oral mucosa cells patients treated dental implants

The aim of this study was to assess the potential genotoxicity of dental implants, evaluating biomarkers of DNA damage (micronuclei and/or nuclear buds), cytokinetic defects (binucleated cells) and the presence of trace metals in gingival cells of patients with implants, comparing these with a control group. A total of 60 healthy adults (30 patients with dental implants and 30 control patients without) were included in the study. Medical and dental histories were made for each including life-style factors. Genotoxicity effects were assessed by micronucleus assays in the gingival epithelial cells of each patient; 1,000 epithelial cells were analyzed, evaluating the frequency of micronucleated cells and other nuclear anomalies. The concentration of metals (Al(27), Ag(107), Co (59), Cr (52), Cu(63), Fe(56), Sn(118), Mn(55), Mo(92), Ni(60), Pb(208), Ti(47)) were assayed by means of coupled plasma-mass spectrophotometry (ICP-MS). The frequency of micronuclei in the patient group with implants was higher than in the control group but without statistically significant differences (P > 0.05). Similar results were found for binucleated cells and nuclear buds (P > 0.05). For metals assayed by ICP-MS, significant differences were found for Ti(47) (P ≤ 0.045). Univariate analysis identified a significant association between the presence of micronuclei and age. Dental implants do not induce DNA damage in gingival cells, the slight effects observed cannot be indicated as biologically relevant.

Removing bacteria from rough surface titanium discs with chlorhexidine and additional brushing with dentifrice

OBJECTIVES

This in vitro study was conducted: (i) to evaluate the effect of using cotton pellets soaked with chlorhexidine (CHX) on titanium surface roughness; (ii) to assess the removal of Porphyromonas gingivalis (P. gingivalis) from resorbable blast material (RBM) titanium surfaces using CHX pellets; and (iii) to evaluate the effects of additional brushing on bacterial removal efficiency.

MATERIALS AND METHODS

RBM titanium discs were treated with CHX-soaked cotton pellets, and change in surface roughness was measured using confocal microscopy. After the titanium discs were incubated with P. gingivalis for 2 days, the discs were cleaned with CHX pellets for 40 s. The quantity of remaining adherent bacteria was measured using crystal violet assay. Additional brushing was performed with dentifrice for a total of 40 s, and bacterial removal efficiency with brushing and dentifrice was evaluated using crystal violet assay and scanning electron microscopy.

RESULTS

The changes in surface roughness after treatment were observed by confocal microscopy. Statistically significant decrease in surface roughness was seen in CHX 40-s group (p < 0.05). Cleaning with CHX-soaked pellets resulted in significant decrease in remaining adherent bacteria. Brushing the bacteria-incubated discs with dentifrice reduced adhering bacteria. There were fewer bacteria left on the CHX-pre-treated discs compared with the brushing-only group, but there were no significant differences when compared with the brushing-only group (p > 0.05).

CONCLUSIONS

This study clearly showed that burnishing with CHX influenced the RBM titanium surface, and burnishing with CHX pellets and brushing with dentifrice were efficient in removing bacteria from the contaminated titanium surface.

Biomaterials for tissue engineering

Biomaterials serve as an integral component of tissue engineering. They are designed to provide architectural framework reminiscent of native extracellular matrix in order to encourage cell growth and eventual tissue regeneration. Bone and cartilage represent two distinct tissues with varying compositional and mechanical properties. Despite these differences, both meet at the osteochondral interface. This article presents an overview of current biomaterials employed in bone and cartilage applications, discusses some design considerations, and alludes to future prospects within this field of research.

The synthesis and spectroscopic characterization of nano calcium fluorapatite using tetra-butylammonium fluoride

Pure homogeneous nano sized biocompatible fluorapatite (FAp) particles were synthesized by a wet chemical procedure using water soluble tetra-butylammonium fluoride (TBAF) without using high temperatures and any purification processes. Combination of the Bragg's law and the plane-spacing equation for the two high intensity lines, namely, (002) and (300), gives a=9.3531 Å, c=6.8841 Å, confirms the identity of the highly crystalline synthetic material as well as its purity. The effect of various pH's in crystal formation and on their size was also evaluated. The calculated crystallinities were excellent with a rate around 5.0. The synthesized nano FAp was fully characterized by spectroscopic techniques (XRD, SEM, EDS, BET, FT-IR and ICP-AES). The nitrogen adsorption-desorption isotherm showed a type IV diagram and calculation of the surface area was investigated as well.

In vitro biocompatibility and mechanical performance of titanium doped high calcium oxide metaphosphate-based glasses

This study challenged to produce phosphate-based glasses (PBG) for the treatment of osseous defects. The glasses contained, among other components, 40 mol% CaO and 1–5 mol% TiO₂. The mechanical performance and in vitro biocompatibility using both human osteosarcoma and primary osteoblasts were carried out. Incorporation of TiO₂ into PBG had no significant effect on strength and modulus. These glasses encouraged attachment and maintained high viability of osteosarcoma cells similar to the positive control surface. Cells grown directly (on glasses) or indirectly (in the presence of glass extracts) showed similar proliferation pattern to the positive control cells with no significant effect of TiO₂ detected. Increasing TiO₂ content, however, has a profound effect on cytoskeleton organization and spreading and maturation of primary osteoblasts. It is believed that TiO₂ might have acted as a chemical cue-modulating cells response, and hence the substrates supported maturation/mineralization of the primary osteoblasts.

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.

Retention of mechanical properties and cytocompatibility of a phosphate-based glass fiber/polylactic acid composite

Polymers prepared from polylactic acid (PLA) have found a multitude of uses as medical devices. The main advantage of having a material that degrades is so that an implant would not necessitate a second surgical event for removal. In addition, the biodegradation may offer other advantages. In this study, fibers produced from a quaternary phosphate-based glass (PBG) in the system 50P(2)O(5)-40CaO-5Na(2)O-5Fe(2)O(3) (nontreated and heat-treated) were used to reinforce the biodegradable polymer, PLA. Fiber properties were investigated, along with the mechanical and degradation properties and cytocompatibility of the composites produced. Retention of mechanical properties overtime was also evaluated. The mean fiber strength for the phosphate glass fibers was 456 MPa with a modulus value of 51.5 GPa. Weibull analysis revealed a shape and scale parameter value of 3.37 and 508, respectively. The flexural strength of the composites matched that for cortical bone; however, the modulus values were lower than those required for cortical bone. After 6 weeks of degradation in deionized water, 50% of the strength values obtained was maintained. The composite degradation properties revealed a 14% mass loss for the nontreated and a 10% mass loss for the heat-treated fiber composites. It was also seen that by heat-treating the fibers, chemical and physical degradation occurred much slower. The pH profiles also revealed that nontreated fibers degraded quicker, thus correlating well with the degradation profiles. The in vitro cell culture experiments revealed both PLA (alone) and the heat-treated fiber composites maintained higher cell viability as compared to the nontreated fiber composites. This was attributed to the slower degradation release profiles of the heat-treated composites as compared to the nontreated fiber composites. SEM analyses revealed a porous structure after degradation, and it is clear that there are possibilities here to tailor the distribution of porosity within polymer matrices.

Implanting hydroxyapatite-coated porous titanium with bone morphogenetic protein-2 and hyaluronic acid into distal femoral metaphysis of rabbits

OBJECTIVE

To assess the osseointegration capability of hydroxyapatite-coated porous titanium with bone morphogenetic protein-2 (BMP-2) and hyaluronic acid to repair defects in the distal femur metaphysis in rabbits.

METHODS

Porous titanium implants were made by sintering titanium powder at high temperature, which were coated with hydroxyapatite by alkali and heat treatment and with BMP-2 combined with bone regeneration materials. And hyaluronic acid was further used as delivery system to prolong the effect of BMP-2. The implants were inserted into the metaphysis of the distal femur of rabbits. The animals were killed at 6, 12 and 24 weeks to accomplish histological and biomechanical analyses.

RESULTS

According to the result of histological analysis, the osseointegration in BMP-2 group was better than that of the HA-coated porous titanium group. In push-out test, all the samples had bigger shear stress as time passed by. There was statistical difference between the two groups in 6 and 12 weeks but not in 24 weeks.

CONCLUSION

Hydroxyapatite-coated porous titanium with BMP-2 and hyaluronic acid has a good effect in repairing defects of distal femur in rabbits, which is a fine biotechnology for future clinical application.

Effect of increasing titanium dioxide content on bulk and surface properties of phosphate-based glasses

There is an ingoing need for more effective and less costly bone substitute materials. In a previous study, addition of titanium dioxide (TiO2) up to 5 mol.% was shown to be effective in controlling glass degradation, and this was reflected in enhanced gene expression and bone-forming capacity of phosphate-based glasses. In the current study, incorporation of the maximum possible amount of TiO2 has been attempted in order to further improve the biological response of these glasses. This report describes the physical, surface properties and short-term response of an osteoblast cell line (MG63) on phosphate glasses doped with the maximum possible TiO2 content. The results showed that a maximum of 15 mol.% TiO2 can be incorporated into the ternary formulations while maintaining their amorphous nature; such incorporation was associated with a significant increase in density and glass transition temperature. On crystallization, X-ray diffraction analysis showed the presence of TiP2O7 and NaCa(PO3)3 as the main phases for all TiO2-containing glasses, while beta-(CaP2O6) was only detected for 10 and 15 mol.% TiO2 glasses. The degradation rate, however, was significantly reduced by an order of magnitude with incorporation of 10 and 15 mol.% TiO2, and this was reflected in the released ions. This change in the bulk properties, produced with TiO2 incorporation, was also associated with a significant change in the hydrophilicity and surface reactivity of these glasses. Even though the addition of TiO2 reduced the hydrophilicity and the surface free energy of these glasses compared to TiO2 free composition, TiO2-containing glasses still have a significantly reactive surface layer compared to Thermanox. Generally glasses with 5-15 mol.% TiO2 supported MG63 cell growth and maintained high cell viability for up to 7 days culture, which is comparable to Thermanox. Based on the results obtained from this study, TiO2-containing phosphate glasses are promising substrates for bone tissue engineering applications.