Hydroxyapatite coating of titanium implants using hydroprocessing and evaluation of their osteoconductivity

Improvement of absorbability, osteoconductivity, and strength of a β-tricalcium phosphate spacer for opening wedge high tibial osteotomy: clinical evaluations with 106 patients

BACKGROUND

An ideal synthetic spacer for medial opening wedge high tibial osteotomy (MOWHTO) has not yet been developed. The authors have developed a new β-tricalcium phosphate (β-TCP) spacer with 60% porosity (N-CP60) by modifying the micro- and macro-pore structures of a conventional β-TCP spacer (CP60) that is widely used in clinical practice. The purpose of this study was to compare the absorbability, osteoconductivity, and in vivo strength of the N-CP60 spacer with those of the CP60 spacer, when used in MOWHTO.

METHODS

First, the porosity, diameter distribution of macro- and micropores, and compressive strength of each β-TCP block were examined using methodology of biomaterial science. Secondly, a clinical study was performed using a total of 106 patients (106 knees) with MOWHTO, who were followed up for 18 months after surgery. In these knees, the N-CP60 and CP-60 spacers were implanted into 49 tibias and 57 tibias, respectively. The absorbability and osteoconductivity were radiologically evaluated by measuring the area of the implanted spacer remaining unabsorbed and assessing with the Hemert's score, respectively. The incidence of cracking in the implanted spacers was determined using computed radiography. Statistical comparisons were made with non-parametric tests. The significance level was set at p = 0.05.

RESULTS

The N-CP60 and CP60 blocks had almost the same porosity (mean, 61.0% and 58.7%, respectively). The diameter of macropores was significantly larger (p < 0.0001) in the N-CP60 block than in the CP60 block, while the diameter of micropores was significantly smaller (p = 0.019) in the N-CP60 block. The ultimate strength of the N-CP60 block (median, 36.8 MPa) was significantly greater (p < 0.01) than that of the CP60 block (31.6 MPa). As for the clinical evaluations, the absorption rate of the N-CP60 spacer at 18 months after implantation (mean, 48.0%) was significantly greater (p < 0.001) than that of the CP60 spacer (29.0%). The osteoconductivity of the N-CP60 spacer was slightly but significantly higher (p = 0.0408) than that of the CP60 spacer only in zone 1. The incidence of in vivo cracking of the posteriorly located N-CP60 spacer at one month (mean, 75.5%) was significantly lower (p = 0.0035) than that of the CP60 spacer (91.2%).

CONCLUSIONS

The absorbability, osteoconductivity, and compressive strength of the new N-CP60 spacer were significantly improved by modifying the macro- and micro-pore structures, compared with the conventional CP60 spacer. The N-CP60 spacer is more clinically useful than the CP60 spacer.

TRIAL REGISTRATION NUMBER

H29-0002.

Hydroxyapatite-based dental inserts: Microstructure, mechanical properties, bonding efficiency and fracture resistance of molars with occlusal restorations

This study aimed to (1) comparatively analyze properties of Sr- and Mg-substituted hydroxyapatite (HAP)-based dental inserts; (2) evaluate insert bonding to restorative materials, and (3) evaluate the effect of doped HAP inserts on fracture resistance (FR) of human molars with large occlusal restorations. By ion-doping with Sr or Mg, 3 insert types were obtained and characterized using XRD, SEM, Vickers hardness and fracture toughness. Shear bond strength (SBS) was determined between acid etched or unetched inserts and following materials: Maxcem cement (Kerr); Filtek Z250 (3M) bonded with Single Bond Universal (SBU; 3M) or Clearfil Universal (Cf; Kuraray). Modified Class I cavities were prepared in 16 intact molars and restored using insert + composite or composite only (control) (n = 8/group). FR of restored molars was determined by static load until fracture upon thermal cycling. Fracture toughness was similar between Sr/Mg-doped inserts (0.94-1.04 MPam-1/2 p = .429). Mg-doped inserts showed greater hardness (range 4.78-5.15 GPa) than Sr6 inserts (3.74 ± 0.31 GPa; p < .05). SBS for SBU and Cf adhesives (range 7.19-15.93 MPa) was higher than for Maxcem (range 3.07-5.95 MPa) (p < .05). There was no significant difference in FR between molars restored with insert-containing and control restorations (3.00 ± 0.30 kN and 3.22 ± 0.42 kN, respectively; p > .05). HAP-based inserts doped with Mg/Sr had different composition and mechanical properties. Adhesive bonding to inserts resulted in greater bond strength than cementation, which may be improved by insert acid-etching. Ion-doped HAP inserts did not affect FR of restored molars. In conclusion, HAP-based dental inserts may potentially replace dentin in large cavities, without affecting fracture resistance of restored teeth.

Effect of Er:YAG Pulsed Laser-Deposited Hydroxyapatite Film on Titanium Implants on M2 Macrophage Polarization In Vitro and Osteogenesis In Vivo

In a previous study, we successfully coated hydroxyapatite (HAp) onto titanium (Ti) plates using the erbium-doped yttrium aluminum garnet pulsed-laser deposition (Er:YAG-PLD) method. In this study, we performed further experiments to validate the in vitro osteogenic properties, macrophage polarization, and in vivo osseointegration activity of HAp-coated Ti (HAp-Ti) plates and screws. Briefly, we coated a HAp film onto the surfaces of Ti plates and screws via Er:YAG-PLD. The surface morphological, elemental, and crystallographic analyses confirmed the successful surface coating. The macrophage polarization and osteogenic induction were evaluated in macrophages and rat bone marrow mesenchymal stem cells, and the in vivo osteogenic properties were studied. The results showed that needle-shaped nano-HAp promoted the early expression of osteogenic and immunogenic genes in the macrophages and induced excellent M2 polarization properties. The calcium deposition and osteocalcin production were significantly higher in the HAp-Ti than in the uncoated Ti. The implantation into rat femurs revealed that the HAp-coated materials had superior osteoinductive and osseointegration activities compared with the Ti, as assessed by microcomputed tomography and histology. Thus, HAp film on sandblasted Ti plates and screws via Er:YAG-PLD enhances hard-tissue differentiation, macrophage polarization, and new bone formation in tissues surrounding implants both in vitro and in vivo.

Bio-Piezoelectric Ceramic Composites for Electroactive Implants-Biological Performance

Barium titanate (BaTiO3) piezoelectric ceramic may be a potential alternative for promoting osseointegration due to its piezoelectric properties similar to bone electric potentials generated in loading function. In this sense, the aim of this in vitro study was to evaluate the cellular response of human osteoblasts and gingival fibroblasts as well as the impact on S. oralis when in contact with BaTiO3 functionalized zirconia implant surfaces with piezoelectric properties. Zirconia discs with BaTiO3 were produced and contact poling (piezo activation) was performed. Osteoblasts (hFOB 1.19), fibroblasts (HGF hTERT) and S. oralis were culture on discs. Cell viability and morphology, cell differentiation markers, bacterial adhesion and growth were evaluated. The present study suggests that zirconia composite surfaces with the addition of piezoelectric BaTiO3 are not cytotoxic to peri-implant cells. Also, they seem to promote a faster initial osteoblast differentiation. Moreover, these surfaces may inhibit the growth of S. oralis by acting as a bacteriostatic agent over time. Although the piezoelectric properties do not affect the cellular inflammatory profile, they appear to enable the initial adhesion of bacteria, however this is not significant over the entire testing period. Furthermore, the addition of non-poled BaTiO3 to zirconia may have a potential reduction effect on IL-6 mediated-inflammatory activity in fibroblasts.

Hydroxyapatite Double Substituted with Zinc and Silicate Ions: Possibility of Mechanochemical Synthesis and In Vitro Properties

In this study, the mechanochemical synthesis of substituted hydroxyapatite (HA) containing zinc and silicon ions having a chemical formula of Ca_10-xZn_x(PO₄)_6-x(SiO₄)_x(OH)_2-x, where x = 0.2, 0.6, 1.0, 1.5, and 2.0, was carried out. The synthesized materials were characterized by powder X-ray diffraction, Fourier transform infrared spectroscopy, transmission electron microscopy, and inductively coupled plasma spectroscopy. We found that HA co-substituted with zinc and silicate formed up to x = 1.0. At higher concentrations of the substituents, the formation of large amounts of an amorphous phase was observed. The cytotoxicity and biocompatibility of the co-substituted HA was studied in vitro on Hek293 and MG-63 cell lines. The HA co-substituted with zinc and silicate demonstrated high biocompatibility; the lowest cytotoxicity was observed at x = 0.2. For this composition, good proliferation of MG-63 osteoblast-like cells and an increased solubility compared with that of HA were detected. These properties allow us to recommend the synthesized material for medical applications, namely, for the restoration of bone tissue and manufacture of biodegradable implants.

Effect of Hydroxyapatite/β-Tricalcium Phosphate on Osseointegration after Implantation into Mouse Maxilla

In our previous study we established an animal model for immediately placed implants using mice and clarified that there were no significant differences in the chronological healing process at the bone-implant interface between immediately and delayed placed implants blasted with hydroxyapatite (HA)/β-tricalcium phosphate (β-TCP) (ratio 1:4). This study aimed to analyze the effects of HA/β-TCP on osseointegration at the bone-implant interface after immediately placed implants in the maxillae of 4-week-old mice. Right maxillary first molars were extracted and cavities were prepared with a drill and titanium implants, blasted with or without HA/β-TCP, were placed. The fixation was followed-up at 1, 5, 7, 14, and 28 days after implantation, and the decalcified samples were embedded in paraffin and prepared sections were processed for immunohistochemistry using anti-osteopontin (OPN) and Ki67 antibodies, and tartrate-resistant acid phosphatase histochemistry. The undecalcified sample elements were quantitatively analyzed by an electron probe microanalyzer. Bone formation occurred on the preexisting bone surface (indirect osteogenesis) and on the implant surface (direct osteogenesis), indicating that osseointegration was achieved until 4 weeks post-operation in both of the groups. In the non-blasted group, the OPN immunoreactivity at the bone-implant interface was significantly decreased compared with the blasted group at week 2 and 4, as well as the rate of direct osteogenesis at week 4. These results suggest that the lack of HA/β-TCP on the implant surface affects the OPN immunoreactivity on the bone-implant interface, resulting in decreased direct osteogenesis following immediately placed titanium implants.

Hydroxyapatite-coated gelatin microribbon scaffolds induce rapid endogenous cranial bone regeneration in vivo

Hydroxyapatite (HA) has a composition similar to mineral bone and has been used for coating macroporous scaffolds to enhance bone formation. However, previous macroporous scaffolds did not support minimally invasive delivery. Our lab has reported on gelatin-based microribbon (μRB) shaped hydrogels, which combine injectability with macroporosity and support cranial bone formation in an immunocompromised mouse model. However, gelatin alone was not sufficient to support cranial bone formation in immunocompetent animals. To overcome this challenge, here we evaluated two methods to incorporate HA into gelatin μRB scaffolds using either modified simulated body fluid (mSBF) or commercially available HA nanoparticles (HAnp). HA incorporation and distribution were characterized using scanning electron microscopy and energy-dispersive X-ray spectroscopy. While both methods enhanced MSC osteogenesis and mineralization, the mSBF method led to undesirable reduction in mechanical properties. HAnp-coated μRB scaffolds were further evaluated in an immunocompetent mouse cranial defect model. Acellular HAnp-coated gelatin μRB scaffolds induced rapid and robust endogenous cranial bone regeneration as shown by MicroCT imaging and histology. Co-delivery with exogenous MSCs led to later bone resorption accompanied by increased osteoclast activity. In summary, our results demonstrate the promise of gelatin μRBs with HAnps as a promising therapy for cranial bone regeneration without the need for exogenous cells or growth factors.

Evaluation of carbon nanotubes-hydroxyapatite nanocomposites as bioactive implant coats radiated by near infrared laser

This study aimed to evaluate carbon nanotubes-hydroxyapatite nanocomposites as bioactive titanium implant coats and to assess the effect of near-infrared radiation on these nanocomposites. Carbon nanotubes were acid-functionalized, and hydroxyapatite was prepared by the wet-chemical precipitation method. Both precursors were used to prepare the carbon nanotubes-hydroxyapatite nanocomposites in two concentrations of hydroxyapatite (0.5 and 1 wt.%). The formed nanocomposites were characterized and used to coat silanized titanium discs and cylinders. Half the specimens of each group were radiated by near-infrared laser, then wettability and shear bond strength were tested for all specimens. Bioactivity was tested by monitoring the formation of calcium phosphate compounds after soaking in simulated body fluid. A significant increase in wettability and bond strength was found in the radiated coats compared to the non-radiated ones with the 1% hydroxyapatite group showing the highest values followed by 0.5% hydroxyapatite then the carbon nanotubes group. The two-way ANOVA test showed that both the difference in material and the laser treatment have had a statistically significant contribution to the increase in wettability and bond strength. The radiated groups also contributed to the formation of more calcium phosphate crystals of larger sizes and higher degrees of crystallinity.

Biodegradable Poly(D-L-lactide-co-glycolide) (PLGA)-Infiltrated Bioactive Glass (CAR12N) Scaffolds Maintain Mesenchymal Stem Cell Chondrogenesis for Cartilage Tissue Engineering

Regeneration of articular cartilage remains challenging. The aim of this study was to increase the stability of pure bioactive glass (BG) scaffolds by means of solvent phase polymer infiltration and to maintain cell adherence on the glass struts. Therefore, BG scaffolds either pure or enhanced with three different amounts of poly(D-L-lactide-co-glycolide) (PLGA) were characterized in detail. Scaffolds were seeded with primary porcine articular chondrocytes (pACs) and human mesenchymal stem cells (hMSCs) in a dynamic long-term culture (35 days). Light microscopy evaluations showed that PLGA was detectable in every region of the scaffold. Porosity was greater than 70%. The biomechanical stability was increased by polymer infiltration. PLGA infiltration did not result in a decrease in viability of both cell types, but increased DNA and sulfated glycosaminoglycan (sGAG) contents of hMSCs-colonized scaffolds. Successful chondrogenesis of hMSC-colonized scaffolds was demonstrated by immunocytochemical staining of collagen type II, cartilage proteoglycans and the transcription factor SOX9. PLGA-infiltrated scaffolds showed a higher relative expression of cartilage related genes not only of pAC-, but also of hMSC-colonized scaffolds in comparison to the pure BG. Based on the novel data, our recommendation is BG scaffolds with single infiltrated PLGA for cartilage tissue engineering.

Osteocytes Influence on Bone Matrix Integrity Affects Biomechanical Competence at Bone-Implant Interface of Bioactive-Coated Titanium Implants in Rat Tibiae

Osseointegration is a prerequisite for the long-term success of implants. Titanium implants are preferred for their biocompatibility and mechanical properties. Nonetheless, the need for early and immediate loading requires enhancing these properties by adding bioactive coatings. In this preclinical study, extracellular matrix properties and cellular balance at the implant/bone interface was examined. Polyelectrolyte multilayers of chitosan and gelatin or with chitosan and Hyaluronic acid fabricated on titanium alloy using a layer-by-layer self-assembly process were compared with native titanium alloy. The study aimed to histologically evaluate bone parameters that correlate to the biomechanical anchorage enhancement resulted from bioactive coatings of titanium implants in a rat animal model. Superior collagen fiber arrangements and an increased number of active osteocytes reflected a significant improvement of bone matrix quality at the bone interface of the chitosan/gelatin-coated titan implants over chitosan/hyaluronic acid-coated and native implants. Furthermore, the numbers and localization of osteoblasts and osteoclasts in the reparative and remodeling phases suggested a better cellular balance in the chitosan/Gel-coated group over the other two groups. Investigating the micro-mechanical properties of bone tissue at the interface can elucidate detailed discrepancies between different promising bioactive coatings of titanium alloys to maximize their benefit in future medical applications.

Evaluation of Ti/Al alloy coated with biogenic hydroxyapatite as an implant device in dogs' femur bones

The main target of the present research was a full assessment of the toxicity effects and biocompatibility of a Ti/Al-alloy device coated with biogenic hydroxyapatite (bHA) when implanted in dogs in comparison with those of an uncoated Ti/Al-alloy device. The coating of the alloy was carried out using controlled high-velocity suspension flame spray (HVSFS) technique. Both coated and uncoated devices were implanted in dogs' femur bones for different time periods (45 days and 90 days). Bone-formation ability and healing were followed up, and blood analysis was performed, at Time zero (immediately post surgery), and then at 3 days, 45 days, and 90 days post surgery. Bone mineral density checks, radiological scans of the femur bone, and histological analysis were also conducted. The in-vivo study results proved that implantation of a device made from bHA-coated Ti/Al alloy in dogs' femur bones is completely safe. This is due to the high osteoconductivity of the coated alloy, which enables the formation of new bone and a full connection between new and original bone material. At 90 days post surgery, the coated alloy had been completely digested within the original bone; thus, it appeared as a part of the femur bone and not as a foreign body. Both the scanning electron microscopy with energy-dispersive X-ray and histology analysis findings affirmed the results. Furthermore, the blood tests indicated no toxicity effects during the 90 days of implantation.

Ag-Based Synergistic Antimicrobial Composites. A Critical Review

The emerging problem of the antibiotic resistance development and the consequences that the health, food and other sectors face stimulate researchers to find safe and effective alternative methods to fight antimicrobial resistance (AMR) and biofilm formation. One of the most promising and efficient groups of materials known for robust antimicrobial performance is noble metal nanoparticles. Notably, silver nanoparticles (AgNPs) have been already widely investigated and applied as antimicrobial agents. However, it has been proposed to create synergistic composites, because pathogens can find their way to develop resistance against metal nanophases; therefore, it could be important to strengthen and secure their antipathogen potency. These complex materials are comprised of individual components with intrinsic antimicrobial action against a wide range of pathogens. One part consists of inorganic AgNPs, and the other, of active organic molecules with pronounced germicidal effects: both phases complement each other, and the effect might just be the sum of the individual effects, or it can be reinforced by the simultaneous application. Many organic molecules have been proposed as potential candidates and successfully united with inorganic counterparts: polysaccharides, with chitosan being the most used component; phenols and organic acids; and peptides and other agents of animal and synthetic origin. In this review, we overview the available literature and critically discuss the findings, including the mechanisms of action, efficacy and application of the silver-based synergistic antimicrobial composites. Hence, we provide a structured summary of the current state of the research direction and give an opinion on perspectives on the development of hybrid Ag-based nanoantimicrobials (NAMs).

A novel non-destructive technique for qualitative and quantitative measurement of dental erosion in its entirety by porosity and bulk tissue-loss

OBJECTIVE

To explore the potential of combining non-contact profilometry (NCP) and confocal laser scanning microscopy (CLSM) data to measure the entire erosive process non-destructively and to validate findings using inductively coupled plasma-atomic emission spectroscopy (ICP-AES), scanning electron microscopy (SEM) and surface microhardness (SMH) using the same samples throughout.

METHODS

Polished bovine enamel samples (n = 35) were divided into groups (7/group) with similar SMH values. Samples underwent individual erosive challenges (1 % citric acid, pH3.8) for 1, 5, 10, 15 or 30 min under stirring and aliquot extracts were analysed for Ca and P by ICP-AES. SMH was used to measure erosive softening. Profilometry was used to assess bulk volume loss (BVL). Images were captured by SEM. Samples were stained with rhodamine-B (0.1 mM, 24 h) and images captured by CLSM. Image processing was used to determine changes in fluorescent volume for the first 10 μm (ΔFV₁₀) for each enamel sample which were combined with BVL to calculate total lesion volume (TLV). ANOVA, linear regression and Pearson correlation analysis were used where applicable.

RESULTS

Surface softening, [Ca], [P], BVL and ΔFV_10μm increased with acid erosion duration which were significant by 10 min (P < .01). The Ca:P ratio increased to 1.57 then decreased after 5 min erosion suggesting a sub/surface phase change, which was observed by SEM and CLSM showing significant changes to the enamel surface and subsurface morphology with time. Combination of BVL and ΔFV₁₀ as TLV strengthened the significant correlations with [Ca], [P], and SMH (P < .01).

CONCLUSION

This novel combination of CLSM and NCP allows for concurrent non-destructive quantification of the entire erosive process by mineral loss, and qualitatively characterise microstructural changes during dental erosion.

Discovery of New Ti-Based Alloys Aimed at Avoiding/Minimizing Formation of α” and ω-Phase Using CALPHAD and Artificial Intelligence

In this work, we studied a Ti-Nb-Zr-Sn system for exploring novel composition and temperatures that will be helpful in maximizing the stability of β phase while minimizing the formation of α” and ω-phase. The Ti-Nb-Zr-Sn system is free of toxic elements. This system was studied under the framework of CALculation of PHAse Diagram (CALPHAD) approach for determining the stability of various phases. These data were analyzed through artificial intelligence (AI) algorithms. Deep learning artificial neural network (DLANN) models were developed for various phases as a function of alloy composition and temperature. Software was written in Python programming language and DLANN models were developed utilizing TensorFlow/Keras libraries. DLANN models were used to predict various phases for new compositions and temperatures and provided a more complete dataset. This dataset was further analyzed through the concept of self-organizing maps (SOM) for determining correlations between phase stability of various phases, chemical composition, and temperature. Through this study, we determined candidate alloy compositions and temperatures that will be helpful in avoiding/minimizing formation of α” and ω-phase in a Ti-Zr-Nb-Sn system. This approach can be utilized in other systems such as ω-free shape memory alloys. DLANN models can even be used on a common Android mobile phone.

Fabrication of Microporous Coatings on Titanium Implants with Improved Mechanical, Antibacterial, and Cell-Interactive Properties

The success of an orthopedic implant therapy depends on successful bone integration and the prevention of microbial infections. In this work, plasma electrolytic oxidation (PEO) was performed to deposit TiO₂ coatings enriched with Ca, P, and Ag on titanium to improve its surface properties and antibacterial efficacy while maintaining normal biological functions and thus to enhance the performance of orthopedic implants. After PEO treatment, the surface of Ti was converted to anatase and rutile TiO₂, hydroxyapatite, and calcium titanate phases. The presence of these crystalline phases was further increased with an increased Ag content in the coatings. The developed coatings also exhibited a more porous morphology with an improved surface wettability, roughness, microhardness, and frictional coefficient. In vitro antibacterial assays indicated that the Ag-doped coatings can significantly prevent the growth of both Staphylococcus aureus and Escherichia coli by releasing Ag⁺ ions, and the ability to prevent these bacteria was enhanced by increasing the Ag content in the coatings, resulting in a maximal 6-log reduction of E. coli and a maximal 5-log reduction of S. aureus after 24 h of incubation. Moreover, the in vitro cytocompatibility evaluation of the coatings showed that the osteoblast (MC3T3) cell integration on the PEO-based coatings was greatly improved compared to untreated Ti and no notable impact on their cytocompatibility was observed on increasing the amount of Ag in the coating. In conclusion, the coating with favorable physicochemical and mechanical properties along with controlled silver ion release can offer an excellent antibacterial performance and osteocompatibility and can thus become a prospective coating strategy to face current challenges in orthopedics.

Laser Nd:YAG patterning enhance human osteoblast behavior on zirconia implants

Zirconia has been regarded as a promising material for dental implants, and Nd:YAG laser treatment has been proposed as a potential strategy to improve its bioactivity. The main aim of the present study was to evaluate the in vitro behavior of human fetal osteoblasts in contact with laser-textured zirconia implant surfaces assessing the effect of different texture patterns, spacing between laser passes and number of laser passes. Zirconia discs were produced and treated with Nd:YAG laser according to test group variables: texture (microgrooves and micropillar array), distance between surface features (25 μm, 30 μm and 35 μm), and laser passes [1, 2, 4, and 8]. Untextured sandblasted and acid-etched zirconia discs (SBAE) were used as controls. Human osteoblasts (hFOB 1.19) were cultured for 14 days on test and control samples. Morphology and cellular adhesion were observed using scanning electron microscopy (SEM). Cell viability and proliferation were evaluated at 1, 3, 7, and 14 days using a commercial resazurin-based method. Collagen type I was evaluated at 3 days using ELISA. Alkaline phosphatase (ALP) activity was evaluated at 7 days using a colorimetric enzymatic technique. Group comparisons were tested using ANOVA or Mann-Whitney test (Tukey's post hoc) using statistical software, and significance was set at p < 0.05. Cell viability and proliferation increased over time for all groups with statistically higher values for laser-textured groups when compared with control at 7 and 14 days in culture (p < 0.05). Collagen type I levels were higher for study groups (p < 0.05) when compared with control group. No statistically differences were detected for ALP activity levels between texture and control groups (p > 0.05). The results suggest that laser-machined zirconia implant surfaces may benefit biological osteoblast response. However, the type of texture, spacing at the range of 25-35 μm, and number of laser passes did not seem to be relevant variables.

Gelatin-Based Microribbon Hydrogels Support Robust MSC Osteogenesis across a Broad Range of Stiffness

Scaffold macroporosity has been shown to be critical for promoting bone regeneration. Although injectable materials are preferred for minimally invasive delivery, conventional macroporous scaffolds were not injectable and do not support homogeneous cell encapsulation. We recently reported a gelatin-based microribbon (μRB) scaffold that offers macroporosity while also supporting homogeneous cell encapsulation. Compared to conventional gelatin hydrogels, macroporous gelatin μRB scaffolds demonstrated great advantage in enhancing mesenchymal stem cell (MSC)-based cartilage formation. However, whether gelatin-based μRBs support MSC osteogenesis and bone formation remains unknown. The goal of this study is to assess the potential of gelatin-based μRBs for supporting MSC-based osteogenesis and bone formation in vitro. Given recent evidence from the literature that osteogenesis is sensitive to substrate stiffness, we further investigate how varying μRB stiffness modulates MSC osteogenesis. We first determine the maximal stiffness range of gelatin μRBs that can be fabricated (13-57 kPa), which supports both retention of μRB shape and macroporosity within scaffolds after inter-cross-linking. Interestingly, varying μRB stiffness across a broad range of stiffness did not significantly impact osteogenesis, with all groups supporting upregulation of bone markers and extensive collagen deposition. All gelatin μRBs also supported a comparable level of cell spreading and upregulation of mechanosensing markers. However, soft μRB (13 kPa) scaffolds did not maintain structural integrity and condensed into a pellet over time. Both intermediate and stiff gelatin μRB-based scaffolds maintained their integrity and supported robust bone formation, leading to a more than 10-fold increase in the compressive moduli of engineered bone after 5 weeks of culture in osteogenic media. Incorporating hydroxyapatite (HA) nanoparticle coating onto the gelatin μRB surface further accelerated the maturation of MSCs into osteoblasts and mineralization. Together, these results validate that gelatin μRBs can support MSC osteogenesis across a broad range of stiffness and offers an injectable macroporous scaffold for enhancing stem-cell-based bone regeneration.

On the characterization of functionally graded biomaterial primed through a novel plaster mold casting process

The current work presents a novel plaster mold casting (PMC) process for fabricating functionally graded biodegradable materials (FGBMs) for orthopedics applications. According to the proposed route, the plaster molds were first prepared by using a hybrid and variable mixture of Plaster of Paris (PoP) and hydroxyapatite (HAP). Upon drying, molten magnesium (Mg) alloy was poured in the mold cavity and allowed to solidify. Various experiments have been conducted as per Taguchi based design of experimentation to study the effect of PoP_X/HAP proportion, mixing time, and baking times on mechanical, corrosion, and cytocompatibility performances of the resulting FGBM. It has been revealed by the scanning electron microscopy (SEM) that uniform layers of HAP particles were developed on the prepared specimens, revealed the novelty of the route. The mechanical properties, in case of surface hardness and impact strength, the optimum results were obtained with PoP(x = 90% by wt.) and HAP(y = 10% by wt.). Further, the corrosion investigations highlighted that the sample prepared with PoP(x = 70% by wt.) and HAP(y = 30% by wt.) proportion possessed excellent corrosion resistance. Moreover, the cytocompatibility analysis revealed that all the developed FGBM are substantially bioactive and promoted cell adhesion, proliferation, differentiation, and various other cytoplasmic activities. However, in this case, FGBM with PoP(x = 70% by wt.) and HAP(y = 30% by wt.) proportion was found superior. The overall results of the present work supported the developed FGBM components and involved the PMC route as a potential candidate for various orthopedics fabrications.

Mesenchymal stem cell interaction with Ti6Al4V alloy pre-exposed to simulated body fluid

Titanium and its alloys are widely used for substitution of hard tissues, especially in orthopaedic and dental surgery. Despite the benefit of the use of titanium for such applications, there are still questions which must be sorted out. Surface properties are crucial for cell adhesion, proliferation and differentiation. Mainly, micro/nanostructured surfaces positively influence osteogenic differentiation of human mesenchymal stem cells. Ti₆Al₄V is a biocompatible α + β alloy which is widely used in orthopaedics. The aim of this study was to investigate the interaction of the nanostructured and ground Ti₆Al₄V titanium alloys with simulated body fluid complemented by the defined precipitation of hydroxyapatite-like coating and to study the cytotoxicity and differentiation capacity of cells with such a modified titanium alloy. Nanostructures were fabricated using electrochemical oxidation. Human mesenchymal stem cells (hMSC) were used to evaluate cell adhesion, metabolic activity and proliferation on the specimens. The differentiation potential of the samples was investigated using PCR and specific staining of osteogenic markers collagen type I and osteocalcin. Our results demonstrate that both pure Ti₆Al₄V, nanostructured samples, and hydroxyapatite-like coating supported hMSC growth and metabolic activity. Nanostructured samples improved collagen type I synthesis after 14 days, while both nanostructured and hydroxyapatite-like coated samples enhanced collagen synthesis on day 21. Osteocalcin synthesis was the most enhanced by hydroxyapatite-like coating on the nanostructured surfaces. Our results indicate that hydroxyapatite-like coating is a useful tool guiding hMSC osteogenic differentiation.

Titanium and its alloys are widely used for substitution of hard tissues, especially in orthopaedic and dental surgery.

Novel chitosan/agarose/hydroxyapatite nanocomposite scaffold for bone tissue engineering applications: comprehensive evaluation of biocompatibility and osteoinductivity with the use of osteoblasts and mesenchymal stem cells

Background

Nanocomposites produced by reinforcement of polysaccharide matrix with nanoparticles are widely used in engineering of biomaterials. However, clinical applications of developed novel biomaterials are often limited due to their poor biocompatibility.

Purpose

The aim of this work was to comprehensively assess biocompatibility of highly macroporous chitosan/agarose/nanohydroxyapatite bone scaffolds produced by a novel method combining freeze-drying with a foaming agent. Within these studies, blood plasma protein adsorption, osteoblast (MC3T3-E1 Subclone 4 and hFOB 1.19) adhesion and proliferation, and osteogenic differentiation of mesenchymal stem cells derived from bone marrow and adipose tissue were determined. The obtained results were also correlated with materials' surface chemistry and wettability to explain the observed protein and cellular response.

Results

Obtained results clearly showed that the developed nanocomposite scaffolds were characterized by high biocompatibility and osteoconductivity. Importantly, the scaffolds also revealed osteoinductive properties since they have the ability to induce osteogenic differentiation (Runx2 synthesis) in undifferentiated mesenchymal stem cells. The surface of biomaterials is extremely hydrophilic, prone to protein adsorption with the highest affinity toward fibronectin binding, which allows for good osteoblast adhesion, spreading, and proliferation.

Conclusion

Produced by a novel method, macroporous nanocomposite biomaterials have great potential to be used in regenerative medicine for acceleration of the bone healing process.

Risk Mitigation in Preventing Adventitious Agent Contamination of Mammalian Cell Cultures

Industrial-scale mammalian cell culture processes have been contaminated by viruses during the culturing phase. Although the historical frequency of such events has been quite low, the impact of contamination can be significant for the manufacturing company and for the supply of the product to patients. This chapter discusses sources of adventitious agent contamination risk in a cell culture process, provides a semiquantitative assessment of such risks, and describes potential process barriers that can be used to reduce contamination risk. High-temperature, short-time (HTST) heat treatment is recommended as the process barrier of choice, when compatible with the process. A case study assessing the compatibility of HTST heat treatment with a cell culture medium is presented, and lessons learned are shared from our experiences over many years of developing and implementing virus barriers in mammalian cell culture processes. Graphical Abstract.

Surface modification of titanium with hydroxyapatite layer induced by phase-transited lysozyme coating

Surface modification of titanium with a hydroxyapatite (HAP) coating can improve the bioactivity of pristine titanium. The traditional techniques for coating HAP on titanium involve nonmild treatments using strong bases or acids or high temperatures. In this study, the coating of HAP was carried out by a novel methodology called phase-transited lysozyme-assisted hydroxyapatite formation (PAH); in this process of biomimetic mineralization, the abundant functional carboxyl groups of phase-transited lysozyme (PTL) were responsible for the nucleation of HAP crystals by concentrating Ca²⁺ ions at the interface between PTL and CaCl₂ solution and for the subsequent growth of HAP crystals occurring in simulated body fluid (SBF). In vitro and in vivo experiments verified that the surface of titanium modified with the HAP/PTL-Ti multilayer was endowed with improved biocompatibility and osteoinductivity compared with those of pristine titanium. Therefore, PAH is a simple, rapid, low-cost and green process for the surface modification of titanium with an HAP coating and thus will be a promising methodology for the surface modification of titanium implants.

Antiviral activity of multifunctional composite based on TiO2-modified hydroxyapatite

An antiviral activity of TiO₂-modified hydroxyapatite composite (HA/TiO₂) had been investigated. The HA/TiO₂ composite (HA50:Ti50) was prepared by a solid state reaction method followed by calcination at 650 °C for 2 h. Phase formations and morphologies of the obtained HA/TiO₂ composite powders were determined using XRD and SEM. XRD result confirmed that HA/TiO₂ composite was successfully prepared. SEM revealed small crystals of anatase TiO₂ embedded in larger HA crystals. A strong antiviral activity against H1N1 Influenza A Virus was observed at 0.5 mg/ml concentration of the composite under the UV irradiation for 60 min. It showed the highest rate of reducing virus titer approximately more than 2 log/h. Results obtained from this study indicated that HA/TiO₂ composite could be a promising material to be used as antimicrobial filtration applications such as in face masks.

Comparison of phosphorus recovery from incineration and gasification sewage sludge ash

Incineration of sewage sludge is a common practice in many western countries. Gasification is an attractive option because of its high energy efficiency and flexibility in the usage of the produced gas. However, they both unavoidably produce sewage sludge ashes, a material that is rich in phosphorus, but which is commonly landfilled or used in construction materials. With current uncertainty in phosphate rock supply, phosphorus recovery from sewage sludge ashes has become interesting. In the present work, ashes from incineration and gasification of the same sewage sludge were compared in terms of phosphorus extractability using electrodialytic (ED) methods. The results show that comparable recovery rates of phosphorus were achieved with a single ED step for incineration ashes and a sequential combination of two ED steps for gasification ashes, which was due to a higher influence of iron and/or aluminium in phosphorus solubility for the latter. A product with lower level of metallic impurities and comparable to wet process phosphoric acid was eventually obtained from gasification ashes. Thus, gasification becomes an interesting alternative to incineration also in terms of phosphorus separation.

Vitroceramic interface deposited on titanium substrate by pulsed laser deposition method

Pulsed laser deposition (PLD) method was used to obtain biovitroceramic thin film coatings on titanium substrates. The composition of the targets was selected from SiO2-CaO-P2O5-(CaF2) systems and the corresponding masses were prepared using the sol-gel method. The depositions were performed in oxygen atmosphere (100mTorr), while the substrates were heated at 400°C. The PLD deposited films were analysed through different experimental techniques: X-ray diffraction, scanning (SEM, EDX) and transmission (HRTEM, SAED) electron microscopy and infra-red spectroscopy coupled with optical microscopy. They were also biologically tested by in vitro cell culture and the contact angle was determined. The bioevaluation results indicate a high biocompatibilty of the obtained materials, demonstrating their potential use for biomedical applications.

A systemic study on key parameters affecting nanocomposite coatings on magnesium substrates

Nanocomposite coatings offer multiple functions simultaneously to improve the interfacial properties of magnesium (Mg) alloys for skeletal implant applications, e.g., controlling the degradation rate of Mg substrates, improving bone cell functions, and providing drug delivery capability. However, the effective service time of nanocomposite coatings may be limited due to their early delamination from the Mg-based substrates. Therefore, the objective of this study was to address the delamination issue of nanocomposite coatings, improve the coating properties for reducing the degradation of Mg-based substrates, and thus improve their cytocompatibility with bone marrow derived mesenchymal stem cells (BMSCs). The surface conditions of the substrates, polymer component type of the nanocomposite coatings, and post-deposition processing are the key parameters that contribute to the efficacy of the nanocomposite coatings in regulating substrate degradation and bone cell responses. Specifically, the effects of metallic surface versus alkaline heat-treated hydroxide surface of the substrates on coating quality were investigated. For the nanocomposite coatings, nanophase hydroxyapatite (nHA) was dispersed in three types of biodegradable polymers, i.e., poly(lactic-co-glycolic acid) (PLGA), poly(l-lactic acid) (PLLA), or poly(caprolactone) (PCL) to determine which polymer component could provide integrated properties for slowest Mg degradation. The nanocomposite coatings with or without post-deposition processing, i.e., melting, annealing, were compared to determine which processing route improved the properties of the nanocomposite coatings most significantly. The results showed that optimizing the coating processes addressed the delamination issue. The melted then annealed nHA/PCL coating on the metallic Mg substrates showed the slowest degradation and the best coating adhesion, among all the combinations of conditions studied; and, it improved the adhesion density of BMSCs. This study elucidated the key parameters for optimizing nanocomposite coatings on Mg-based substrates for skeletal implant applications, and provided rational design guidelines for the nanocomposite coatings on Mg alloys for potential clinical translation of biodegradable Mg-based implants.

STATEMENT OF SIGNIFICANCE

This manuscript describes the systemic optimization of nanocomposite coatings to control the degradation and bioactivity of magnesium for skeletal implant applications. The key parameters influencing the integrity and functions of the nanocomposite coatings on magnesium were identified, guidelines for the optimization of the coatings were established, and the benefits of coating optimization were demonstrated through reduced magnesium degradation and increased bone marrow derived mesenchymal stem cell (BMSC) adhesion in vitro. The guidelines developed in this manuscript are valuable for the biometal field to improve the design of bioresorbable implants and devices, which will advance the clinical translation of magnesium-based implants.

An Investigation on the Wear Resistance and Fatigue Behaviour of Ti-6Al-4V Notched Members Coated with Hydroxyapatite Coatings

In this study, surface properties of Ti-6Al-4V alloy coated with hydroxyapatite coatings were investigated. Wear resistance and fatigue behaviour of samples with coating thicknesses of 10 and 50 µm as well as uncoated samples were examined. Wear experiments demonstrated that the friction factor of the uncoated titanium decreased from 0.31 to 0.06, through a fluctuating trend, after 50 cycles of wear tests. However, the friction factor of both the coated samples (10 and 50 µm) gradually decreased from 0.20 to 0.12 after 50 cycles. At the end of the 50th cycle, the penetration depth of the 10 and 50 µm coated samples were 7.69 and 6.06 µm, respectively. Fatigue tests showed that hydroxyapatite coatings could improve fatigue life of a notched Ti-6Al-4V member in both low and high cycle fatigue zones. It was understood, from fractography of the fracture surfaces, that the fatigue zone of the uncoated specimens was generally smaller in comparison with that of the coated specimens. No significant difference was observed between the fatigue life of coated specimens with 10 and 50 µm thicknesses.

A novel photocrosslinkable and cytocompatible chitosan coating for Ti6Al4V surfaces

BACKGROUND

In this work, chitosan (CH) was used to produce a novel coating for Ti6Al4V, the most widely used alloy in orthopedic implants, so as to improve the biological tissue response at the metallic surface.

METHODS

The Ti6Al4V surface was sandblasted with alumina particles. CH was chemically modified, via carbodiimide chemistry, using lactobionic and 4-azidebenzoic acid to make it soluble at physiological pH and photocrosslinkable, respectively. The reaction was verified by FTIR, NMR and UV/vis spectroscopy. Ti6Al4V surfaces were coated with solutions of the modified CH and exposed to UV light, causing polymer crosslinking and formation of a hydrogel on the surface. The crosslinking reaction was monitored by FTIR at different exposure times. Coating morphology was observed by SEM. The coating's cytocompatibility was determined in vitro through the culture of rat bone marrow mesenchymal stem cells, using an MTT assay, with their morphology assessed by SEM.

RESULTS

The developed coating behaved as a hydrogel on the Ti6Al4V and was stable on the surface. FTIR and NMR confirmed the crosslinking mechanism, based on an arile ring expansion, and subsequent reaction with the CH amine groups. Furthermore, the coating was able to support cell proliferation and osteogenic differentiation.

CONCLUSIONS

UV crosslinking of CH is easy to apply and has potential for future metallic implant surface modifications. Due to its nature as a hydrogel, the coating could be used for further studies in the encapsulation of bioactive molecules to improve osteogenic potential at the tissue-implant interface.

Substituted hydroxyapatites with antibacterial properties

Reconstructive surgery is presently struggling with the problem of infections located within implantation biomaterials. Of course, the best antibacterial protection is antibiotic therapy. However, oral antibiotic therapy is sometimes ineffective, while administering an antibiotic at the location of infection is often associated with an unfavourable ratio of dosage efficiency and toxic effect. Thus, the present study aims to find a new factor which may improve antibacterial activity while also presenting low toxicity to the human cells. Such factors are usually implemented along with the implant itself and may be an integral part of it. Many recent studies have focused on inorganic factors, such as metal nanoparticles, salts, and metal oxides. The advantages of inorganic factors include the ease with which they can be combined with ceramic and polymeric biomaterials. The following review focuses on hydroxyapatites substituted with ions with antibacterial properties. It considers materials that have already been applied in regenerative medicine (e.g., hydroxyapatites with silver ions) and those that are only at the preliminary stage of research and which could potentially be used in implantology or dentistry. We present methods for the synthesis of modified apatites and the antibacterial mechanisms of various ions as well as their antibacterial efficiency.

Effects of functionalization of PLGA-[Asp-PEG]n copolymer surfaces with Arg-Gly-Asp peptides, hydroxyapatite nanoparticles, and BMP-2-derived peptides on cell behavior in vitro

Functionalization of polymer surfaces has been recognized as a valuable tool to improve their properties that significantly influence cellular behaviors, such as adhesion, proliferation, migration, and differentiation. In stem cell-mediated bone tissue engineering, surface multifunctionalization of polymeric scaffolds with cell-adhesive, osteoconductive, and osteoinductive biomolecules is a critical strategy to improve such properties. However, the traditional surface modification techniques such as physical deposition/adsorption, chemical modification, grafting, and plasma techniques have great limitations for immobilization of multiple bioactive molecules due to multistep procedures. Recently, a universal technique based on mussel-inspired self-polymerization of dopamine is developed for multifunctional coatings in a simple way. In our study, we used this newly developed technique to incorporate three biomolecules, cell adhesion-promoting (K)16 GRGDSPC peptides, osteoconductive hydroxyapatite (HAp) nanoparticles, and osteoinductive bone morphogenetic protein-2-derived P24 peptides, to functionalize poly(lactide-co-glycolide) (PLGA)-[Asp-PEG]n scaffolds, and the effects on biological behaviors of co-cultured rabbit-derived bone marrow stromal cells in vitro were investigated. The results showed (K)16 GRGDSPC, HAp, and P24 could be immobilized onto the scaffolds through predeposition of polydopamine (pDA) ad-layer, and the surface-modified scaffolds were noncytotoxic as well as the virgin scaffold. The pDA-assisted codeposition of (K)16 GRGDSPC, HAp, and P24 on the scaffold surfaces significantly promoted cell adhesion, proliferation, osteodifferentiation, and mineralization in vitro with synergistic effects. Taken together, the functionalized PLGA-[Asp-PEG]n polymeric scaffolds achieved significantly elevated affinity, osteoconductive and osteoinductive ability, and may be a potentially promising bone graft substitute for bone repair.

Small molecule stimulation enhances bone regeneration but not titanium implant osseointegration

The osteogenic and osseointegrative potential of a small molecule was examined to assess its usefulness in regenerative procedures. Purmorphamine was used to stimulate bone growth and repair in an in vitro cell-based assay and an in vivo chick embryo CAM-assay with and without the presence of an implant. Purmorphamine adhered to precipitated hydroxyapatite coating, could activate the sonic hedgehog pathway and thereby stimulated osteodifferentiation. Porous calcium phosphate beads were used to deliver this small molecule in vivo and showed that purmorphamine increased the trabecular bone to bone area significantly. The assay showed purmorphamine failed to induce any significant difference in osseointegration on titanium coated PTFE implants. This suggests that, while a small molecule can enhance osteogenesis and might be useful in regenerative procedures, it failed to enhance the osseointegration of a Ti coated implant, suggesting that this sort of stimulation might be useful for enhancing bone regeneration where bone loss due to disease exists, but not for enhancing early stability of an implant.

Manufacture of Accurate Titanium Cranio-Facial Implants with High Forming Angle Using Single Point Incremental Forming

One of the key application areas of Single Point Incremental Forming is in the manufacture of parts for bio-medical applications. This paper discusses the challenges associated with the manufacture of cranio-facial implants with extreme forming angles using medical grade titanium sheets. While on one hand, the failure wall angle is an issue of concern, the parts also need to be manufactured with accuracy at the edges where the implants fit into the human body. Systematic steps taken to overcome these challenges, using intelligent intermediate part design, feature analysis and compensation, are discussed. A number of case studies illustrating the manufacture of accurate parts in aluminium, stainless steel and titanium grade-2 alloy are discussed.

Hydroxylapatite nanoparticles: fabrication methods and medical applications

Hydroxylapatite (or hydroxyapatite, HAp) exhibits excellent biocompatibility with various kinds of cells and tissues, making it an ideal candidate for tissue engineering, orthopedic and dental applications. Nanosized materials offer improved performances compared with conventional materials due to their large surface-to-volume ratios. This review summarizes existing knowledge and recent progress in fabrication methods of nanosized (or nanostructured) HAp particles, as well as their recent applications in medical and dental fields. In section 1, we provide a brief overview of HAp and nanoparticles. In section 2, fabrication methods of HAp nanoparticles are described based on the particle formation mechanisms. Recent applications of HAp nanoparticles are summarized in section 3. The future perspectives in this active research area are given in section 4.