Modulation of bone ingrowth of rabbit femur titanium implants by in vivo axial micromechanical loading

The role of angiogenesis in implant dentistry part I: Review of titanium alloys, surface characteristics and treatments

Background

Angiogenesis plays an important role in osseointegration process by contributing to inflammatory and regenerative phases of surrounding alveolar bone. The present review evaluated the effect of titanium alloys and their surface characteristics including: surface topography (macro, micro, and nano), surface wettability/energy, surface hydrophilicity or hydrophobicity, surface charge, and surface treatments of dental implants on angiogenesis events, which occur during osseointegration period.

Material and Methods

An electronic search was performed in PubMed, MEDLINE, and EMBASE databases via OVID using the keywords mentioned in the PubMed and MeSH headings regarding the role of angiogenesis in implant dentistry from January 2000-April 2014.

Results

Of the 2,691 articles identified in our initial search results, only 30 met the inclusion criteria set for this review. The hydrophilicity and topography of dental implants are the most important and effective surface characteristics in angiogenesis and osteogenesis processes. The surface treatments or modifications of dental implants are mainly directed through the enhancement of biological activity and functionalization in order to promote osteogenesis and angiogenesis, and accelerate the osseointegration procedure.

Conclusions

Angiogenesis is of great importance in implant dentistry in a manner that most of the surface characteristics and treatments of dental implants are directed toward creating a more pro-angiogenic surface on dental implants. A number of studies discussed the effect of titanium alloys, dental implant surface characteristic and treatments on agiogenesis process. However, clinical trials and in-vivo studies delineating the mechanisms of dental implants, and their surface characteristics or treatments, action in angiogenesis processes are lagging.

Key words:Angiogenesis, dental implant, osseointergration.

Biological characterization of a new silicon based coating developed for dental implants

Taking into account the influence of Si in osteoblast cell proliferation, a series of sol-gel derived silicon based coating was prepared by controlling the process parameters and varying the different Si-alkoxide precursors molar rate in order to obtain materials able to release Si compounds. For this purpose, methyltrimethoxysilane (MTMOS) and tetraethyl orthosilicate (TEOS) were hydrolysed together and the sol obtained was used to dip-coat the different substrates. The silicon release ability of the coatings was tested finding that it was dependent on the TEOS precursor content, reaching a Si amount value around ninefolds higher for coatings with TEOS than for the pure MTMOS material. To test the effect of this released Si, the in vitro performance of developed coatings was tested with human adipose mesenchymal stem cells finding a significantly higher proliferation and mineralization on the coating with the higher TEOS content. For in vivo evaluation of the biocompatibility, coated implants were placed in the tibia of the rabbit and a histological analysis was performed. The evaluation of parameters such as the bone marrow state, the presence of giant cells and the fibrous capsule proved the biocompatibility of the developed coatings. Furthermore, coated implants seemed to produce a qualitatively higher osteoblastic activity and a higher number of bone spicules than the control (uncoated commercial SLA titanium dental implant).

Direct Radial LMHF Microvibration Induced Bone Formation and Promoted Implant Osseointegration

BACKGROUND

Mechanical loading is known to play an important role in bone remodeling.

PURPOSE

This study aimed to evaluate the effect of direct low-magnitude high-frequency (LMHF) microvibration on dental implant bone formation and osseointegration.

MATERIALS AND METHODS

Titanium implants were installed in rabbit tibiae. The implants in the left legs were loaded with mechanical vibration (15 μm) at 10, 20, 30, and 40 Hz (10, 20, 30, and 40 Hz groups, respectively) for 30 minutes every day. The implants on the right legs were used as a sham control and did not receive a vibration load.

RESULTS

After 20 days, the 10, 20, and 30 Hz groups showed significantly greater newly formed bone volume, density, ratio of the bone surface area to the trabecular bone surface area, and ratio of the bone surface area in direct contact with osteoclasts versus the total bone surface area in the region of interest compared with the sham control group, especially the 20 Hz group. However, the 40 Hz group did not.

CONCLUSIONS

In conclusion, the application of direct LMHF (10, 20, or 30 Hz) vibration on the implants promoted bone formation and osseointegration, especially at 20 Hz; however, the use of 40 Hz did not result in any significant improvement.

New bone formation and microstructure assessed by combination of confocal laser scanning microscopy and differential interference contrast microscopy

Bone is a mineralized connective tissue that is continuously and microstructurally remodeled. Altered bone formation and microstructure arise in pathological bone conditions such as osteoporosis, osteonecrosis, fracture repair, and Paget disease of bone. A proper and objective assessment of bone formation and microstructure will provide insight into the understanding of bone pathogenesis and remodeling. Here, new bone formation ex vitro and its microstructure were evaluated in in vivo multiple sequential polychrome-labeled samples using confocal laser scanning microscopy (CLSM), which generated clearer and more reliable images of thick bone sections than conventional fluorescence microscopy (CFM). Intriguingly, fine details of the bone microstructural features, including the mineralization fronts, quiescent versus active osteons, and Volkmann's channel, were elucidated using CLSM, which defines the relationship between morphological changes and function, when combined with differential interference contrast microscopy. Furthermore, CLSM provided objective evaluations of bone formation, such as the ratio of labeled areas of new bone formation in a rabbit model when compared with CFM. Altogether, new bone formation and its microstructure can be evaluated more adequately using a combination of CLSM and DIC microscopies.

Investigation of creep mechanical characteristics of femoral prostheses by simulated hip replacement

In order to provide creep mechanical parameters for the clinical application of both traditional and reserved anatomy femoral artificial joint replacements, simulated hip replacement femoral stress relaxation and creep experiments were performed. Twenty-four corpse femoral specimens were obtained, with 8 specimens being randomly assigned to the control group and 8 specimens being randomly assigned to the traditional prosthesis group. Our results showed that the retaining femoral neck prosthesis and traditional prosthesis groups have different stress relaxation and creep mechanical properties.

In vitro cytotoxicity and in vivo osseointergration properties of compression-molded HDPE-HA-Al2O3 hybrid biocomposites

The aim of this study was to investigate the in vivo biocompatibility in terms of healing of long segmental bone defect in rabbit model as well as in vitro cytotoxicity of eluates of compression-molded High density polyethylene (HDPE)-hydroxyapatite (HA)-aluminum oxide (Al2O3) composite-based implant material. Based on the physical property in terms of modulus and strength properties, as reported in our recent publication, HDPE-40 wt % HA and HDPE-20 wt % HA-20 wt % Al2O3 hybrid composites were used for biocompatibility assessment. Osteoblasts cells were cultured in conditioned media, which contains varying amount of composite eluate (0.01, 0.1, and 1.0 wt %). In vitro, the eluates did not exhibit any significant negative impact on proliferation, mineralization or on morphology of human osteoblast cells. In vivo, the histological assessment revealed neobone formation at the bone/implant interface, characterized by the presence of osteoid and osteoblasts. The observation of osteoclastic activity indicates the process of bone remodeling. No inflammation to any noticeable extent was observed at the implantation site. Overall, the combination of in vitro and in vivo results are suggestive of potential biomedical application of compression-molded HDPE- 20 wt % HA- 20 wt % Al2O3 composites to heal long segmental bone defects without causing any toxicity of bone cells.

Early tissue response to citric acid-based micro- and nanocomposites

Composites based on calcium phosphates and biodegradable polymers are desirable for orthopedic applications because of their potential to mimic bone. Herein, we describe the fabrication, characterization, and in vivo response of novel citric acid-based microcomposites and nanocomposites. Poly(1,8-octanediol-co-citrate) (POC) was mixed with increasing amounts of hydroxyapatite (HA) nanoparticles or microparticles (up to 60 wt %), and the morphology and mechanical properties of the resulting composites were assessed. To investigate tissue response, nanocomposites, microcomposites, POC, and poly(L-lactide) were implanted in osteochondral defects in rabbits and harvested at 6 weeks for histological evaluation. Scanning electron microscopy confirmed increased surface roughness of microcomposites relative to nanocomposites. The mechanical properties of both types of composites increased with increasing amounts of HA (8-328 MPa), although nanocomposites with 60 wt % HA displayed the highest strength and stiffness. Based on tissue-implant interfacial assessments, all implants integrated well with the surrounding bone and cartilage with no evidence of inflammation. Both nanocomposites and microcomposites supported bone remodeling; however, nanocomposites induced more trabecular bone formation at the tissue-implant interface. The mechanical properties of citric acid-based composites are within the range of human trabecular bone (1-1524 MPa, 211 ± 78 MPa mean modulus), and tissue response was dependent on the size and content of HA, providing new perspectives of design and fabrication criteria for orthopedic devices such as interference screws and fixation pins.

Total hip arthroplasty using a short-stemmed femoral component in the presence of a proximal femoral fixation device - a case report

A patient previously treated by cannulated screws fixation of a femoral neck fracture and plate and screw fixation of an ipsilateral shaft fracture presented for a total hip arthroplasty due to femoral head avascular necrosis. The cortical bone at the previous fracture site was weak and damage on the proximal femur was considered likely during removal of the plate. We were also concerned that a periprosthetic fracture might occur during or after the insertion of a conventional femoral stem. We used a short-stemmed femoral component for total hip arthroplasty in this patient, to avoid the risk of potential complications.

Mechanisms of fluid-flow-induced matrix production in bone tissue engineering

Matrix production by tissue-engineered bone is enhanced when the growing tissue is subjected to mechanical forces and/or fluid flow in bioreactor culture. Cells deposit collagen and mineral, depending upon the mechanical loading that they receive. However, the molecular mechanisms of flow-induced signal transduction in bone are poorly understood. The hyaluronan (HA) glycocalyx has been proposed as a potential mediator of mechanical forces in bone. Using a parallel-plate flow chamber the effects of removal of HA on flow-induced collagen production and NF-κB activation in MLO-A5 osteoid osteocytes were investigated. Short periods of fluid flow significantly increased collagen production and induced translocation of the NF-κB subunit p65 to the cell's nuclei in 65 per cent of the cell population. Enzymatic removal of the HA coat and antibody blocking of CD44 (a transmembrane protein that binds to HA) eliminated the fluid-flow-induced increase in collagen production but had no effect on the translocation of p65. HA and CD44 appear to play roles in transducing the flow signals that modulate collagen production over long-term culture but not in the short-term flow-induced activation of NF-κB, implying that multiple signalling events are initiated from the commencement of flow. Understanding the mechanotransduction events that enable fluid flow to stimulate bone matrix production will allow the optimization of bioreactor design and flow profiles for bone tissue engineering.

Use of rapidly mineralising osteoblasts and short periods of mechanical loading to accelerate matrix maturation in 3D scaffolds

MLO-A5 cells are a fully differentiated osteoblastic cell line with the ability to rapidly synthesise mineralised extracellular matrix (ECM). We used MLO-A5 cells to develop a system for studying the mechanical modulation of bone matrix formation in 3D using a cyclic compressive loading stimulus. Polyurethane (PU) open cell foam scaffolds were seeded with MLO-A5 cells under static conditions and loaded in compression at 1 Hz, 5% strain in a sterile fluid-filled chamber. Loading was applied for only 2 h per day on days 5, 10 and 15 of culture and cell-seeded scaffolds were assayed on days 10, 15 and 20 of culture. Collagen content as assayed by Sirius red was significantly (2 fold) higher at days 15 and 20 in loaded samples compared with static controls. Calcium content as assayed by alizarin red was significantly (4 fold) higher by day 20. The number of viable cells as assayed by MTS was higher in loaded samples at day 10 but there was no difference by days 15 and 20. Loaded samples also had higher stiffness in compression by the end of the experiment. The mRNA expression of type I collagen, osteopontin and osteocalcin was higher, after a single bout of loading, in loaded than in non-loaded samples as assayed by RT-PCR. In conclusion, mineralisation by fully differentiated osteoblasts, MLO-A5s, was shown to be highly sensitive to mechanical loading, with short bouts of mechanical loading having a strong effect on mineralised matrix production. The 3D system developed will be useful for systematic investigation of the modulators of in vitro matrix mineralisation by osteoblasts in mechanobiology and tissue engineering studies.

Effect of weight-bearing on bone-bonding behavior of strontium-containing hydroxyapatite bone cement

The purpose of this study was to investigate and compare the chemical composition and nanomechanical properties at the bone-cement interface under non-weight-bearing and weight-bearing conditions, in order to understand the effect of weight-bearing on the bone-bonding behavior of strontium-containing hydroxyapatite (Sr-HA) cement. In one group, Sr-HA cement was injected into rabbit ilium (under non-weight-bearing conditions). Unilateral hip replacement was performed with Sr-HA cement (under weight-bearing conditions) in the other group. Six months later, scanning electron microscopy (SEM) with energy-dispersive X-ray (EDX) analysis and nanoindentation tests were conducted on the interfaces between cancellous bone and the Sr-HA cement. The nanoindentation results revealed two different transitional behaviors under different conditions. nder weight-bearing conditions, both the Young modulus and hardness at the interface were considerably higher than those at either the Sr-HA cement or cancellous bone. On the contrary, under non-weight-bearing conditions, both the Young modulus and hardness values at the interface were lower than those at the cancellous bone, but were higher than the Sr-HA cement. In addition, EDX results showed that the calcium and phosphorus contents at the interface under weight-bearing conditions were considerably higher than those under non-weight-bearing conditions. The differences in chemical composition and nanomechanical properties at the cement-bone interface under two different conditions indicate that weight-bearing produces significant effects on the bone-bonding behavior of the Sr-HA cement.

Nanomechanical properties of alginate-recovered chondrocyte matrices for cartilage regeneration

Tissue-engineered cartilage constructs designed for in-vivo applications intuitively should mimic the mechanical properties of native cartilage. The objective of the present work was to characterize the nanomechanical properties of alginate-recovered chondrocyte matrices as a function of ex-vivo incubation time. Chondrocytes isolated from the articular cartilage of the mature bovine metacarpophalangeal joints were cultured with alginate hydrogel to allow for the formation of extracellular matrices. The recovered chondral constructs after 2, 4, 8, and 12 weeks of ex-vivo incubation were analysed using nanoindentation with atomic force microscopy to determine their mechanical properties. Chondral constructs had average Young's moduli of 123±22 kPa, 174±31 kPa, 373±40 kPa, and 564±79 kPa after incubation for 2, 4, 8, and 12 weeks respectively, indicating the gradual attainment of mechanical stiffness. This escalating trend of micromechanical properties as a function of increasing ex-vivo incubation time suggests that chondral constructs via a tissue-engineering approach are capable of elaborating extracellular matrices and increase mechanical stiffness. The relationship between Young's modulus and incubation time of the chondral constructs is useful in the design and fabrication of tissue-engineered cartilage constructs.

Continuing differentiation of human mesenchymal stem cells and induced chondrogenic and osteogenic lineages in electrospun PLGA nanofiber scaffold

Nanofibers have recently gained substantial interest for potential applications in tissue engineering. The objective of this study was to determine whether electrospun nanofibers accommodate the viability, growth, and differentiation of human mesenchymal stem cells (hMSCs) as well as their osteogenic (hMSC-Ob) and chondrogenic (hMSC-Ch) derivatives. Poly(d,l-lactide-co-glycolide) (PLGA) beads with a PLA:PGA ratio of 85:15 were electrospun into non-woven fibers with an average diameter of 760+/-210 nm. The average Young's modulus of electrospun PLGA nanofibers was 42+/-26 kPa, per nanoindentation with atomic force microscopy (AFM). Human MSCs were seeded 1-4 weeks at a density of 2 x 10(6)cells/mL in PLGA nanofiber sheets. After 2 week culture on PLGA nanofiber scaffold, hMSCs remained as precursors upon immunoblotting with hKL12 antibody. SEM taken up to 7 days after cell seeding revealed that hMSCs, hMSC-Ob and hMSC-Ch apparently attached to PLGA nanofibers. The overwhelming majority of hMSCs was viable and proliferating in PLGA nanofiber scaffolds up to the tested 14 days, as assayed live/dead tests, DNA assay and BrdU. In a separate experiment, hMSCs seeded in PLGA nanofiber scaffolds were differentiated into chodrogenic and osteogenic cells. Histological assays revealed that hMSCs continuously differentiated into chondrogenic cells and osteogenic cells after 2 week incubation in PLGA nanofibers. Taken together, these data represent an original investigation of continuous differentiation of hMSCs into chondrogenic and osteogenic cells in PLGA nanofiber scaffold. Consistent with previous work, these findings also suggest that nanofibers may serve as accommodative milieu for not only hMSCs, but also as a 3D carrier vehicle for lineage specific cells.

Geometry and cell density of rat craniofacial sutures during early postnatal development and upon in vivo cyclic loading

Cranial sutures are unique to skull bones and consist of multiple connective tissue cell lineages such as mesenchymal cells, fibroblast-like cells, and osteogenic cells, in addition to osteoclasts. Mechanical modulation of intramembranous bone growth in the craniofacial suture is not well understood, especially during postnatal development. This study investigated whether in vivo mechanical forces regulate sutural growth responses in postnatal rats. Cyclic compressive forces with a peak-to-peak magnitude of 300 mN and 4 Hz were applied to the maxilla in each of 17-, 23-and 32-day-old rats for 20 min/day over 5 consecutive days. Computerized histomorphometric analysis revealed that cyclic loading significantly increased the average geometric widths of the premaxillomaxillary suture (PMS) to 86 +/- 7 microm, 99 +/- 12 microm, and 149 +/- 30 microm, representing 32%, 50%, and 39% increases for P17, P23, and P32 in comparison with age-matched sham controls. For the nasofrontal suture (NFS), cyclic loading significantly increased the average sutural widths to 88 +/- 15 microm, 92 +/- 10 microm, and 100 +/- 14 microm, representing 33%, 24%, and 32% increases for P17, P23, and P32 relative to age-matched controls. The average PMS cell density upon cyclic loading was 10182 +/- 132 cells/mm(2), 9752 +/- 661 cells/mm(2), and 9521 +/- 628 cells/mm(2), representing 62%, 35%, and 30% increases for P17, P23, and P32 in comparison with age-matched controls. For the NFS, cyclic loading increased the average cell density to 9884 +/- 893 cells/mm(2), 9818 +/- 1091 cells/mm(2), 9355 +/- 661 cells/mm(2), representing 44%, 46% and 40% increases at P17, P23, and P32 respectively. Osteoblast-occupied sutural bone surface was significantly greater in cyclically loaded sutures for P17, P23, and P32 than corresponding controls for both the PMS and NFS. On the other hand, cyclic loading elicited significantly higher sutural bone surface populated by osteoclast-like cells by P17 and P23 days, but not P32 days, for the PMS. For the NFS, sutural osteoclast surface was significantly higher upon cyclic loading for P23 and P32 days, but not P17. The present data demonstrate that cyclic forces are potent stimuli for modulating postnatal sutural development, potentially by stimulating both osteogenesis and osteoclastogenesis. Cyclic loading may have clinical implications as novel mechanical stimuli for modulating craniofacial growth in patients suffering from craniofacial anomalies and dentofacial deformities.

Towards the limit of quantifying low-amplitude strains on bone and in coagulum around immediately loaded oral implants in extraction sockets

The purpose of this study was to quantify strains in coagulum around immediately loaded oral implants in extraction sockets at the ex vivo level. Bilateral maxillary premolar teeth of two fresh human cadavers were extracted and psi 4.1 x 12 mm Straumann TE implants were placed in the sockets of first and second premolars by utilizing mesio-distal and palatal anchorage, respectively. Installation torque value (ITV) of each implant was measured by a custom-made torque wrench and resonance frequency analyses (RFAs) were undertaken to determine intraosseous stability. Upon abutment connection, a gold coping allowing the placement of a miniature load cell to contact the underlying solid abutment was fabricated. A linear strain gauge was connected to the coping at a distance for strain measurements in coagulum around the implant neck in the extraction socket. Linear strain gauges were also bonded on the labial marginal bone of each extraction socket. Strain measurements were performed at a sample rate of 10 kHz simultaneously monitored from a computer connected to data acquisition system and under a maximum load of 100 N on each implant with or without human coagulum in the extraction socket. Low-amplitude strains were measured around immediate implants. The increase in load increased strains on labial marginal cortical bone around implants (P < 0.05). Bone strains were higher on the implant loaded, when coagulum was present in the bone defects (P < 0.05). Strains within coagulum around mesiodistally anchored implants were higher than palatally anchored implants (P < 0.05). The type of implant on anchorage and presence of coagulum has an impact mechanotransduction to buccal marginal bone around immediate implants.