The Dimension of Titania Nanotubes Influences Implant Success for Osteoclastogenesis and Osteogenesis Patients

Effect of the Sr-Fe layered double hydroxide coating based on the microenvironment response on implant osseointegration in osteoporotic rats

Osteoporosis is a disease that manifests itself as an abnormality of bone metabolism and is characterized by low bone mass and destruction of the bone microstructure. Since bone resorption occurs more rapidly than new bone formation, osteoporosis leads to reduced orthopedic implant stability. From a microenvironmental point of view, the rationale for this outcome is that osteoclasts are overactive in the bone tissue of patients with osteoporosis, and the large amount of H+ they produce leads to local chronic acidosis, which promotes bone mineral loss. Therefore, we designed a weakly alkaline layered double hydroxide (LDH) coating to modulate the pathologically acidic microenvironment and the osteogenic-osteoclastic coupling by releasing Sr2+. We prepared Sr-Fe LDH coatings on pure titanium implants using a hydrothermal method in this study and characterized the material using SEM, AFM, XRD, XPS, EDS, ICP, pH acidimeter, etc. We found that the coatings had good nanomorphology and were able to efficiently neutralize H+ as well as steadily release Sr2+ for up to 21 days. In vitro, the coating not only significantly promoted the adhesion, proliferation, and differentiation of osteoblasts, but also inhibited the differentiation of osteoclasts at the same time. In addition, in animal experiments, the coating significantly improved the mechanical stability of the implant in osteoporotic rats, increasing Sr-Fe LDH@Ti maximal push-out force by 72.2% compared to Ti. At the same time, the coating was effective in reversing the osteoporotic state, resulting in a 58.5% increase in BV/TV (%), and a 12.4% increase in Tb. N (1 mm-1), a 31.6% increase in Tb. Th (μm), and a 30.9% increase in BA (%). Our results suggest that this Sr-Fe LDH nanocoating material with acid-neutralizing, as well as long-term Sr2+-releasing capabilities, is a novel and effective orthopedic implant coating material under osteoporotic conditions.

Evaluating the cell migration potential of TiO2 nanorods incorporated in a Ti6Al4V scaffold: A multiscale approach

Improvement of cell migration by the nano-topographical modification of implant surface can directly or indirectly accelerate wound healing and osseointegration between bone and implant. Therefore, modification of the implant surface was done with TiO2 nanorod (NR) arrays to develop a more osseointegration-friendly implant in this study. Modulating the migration of a cell, adhered to a scaffold, by the variations of NR diameter, density and tip diameter in vitro is the primary objective of the study. The fluid structure interaction method was used, followed by the submodelling technique in this multiscale analysis. After completing a simulation over a global model, fluid structure interaction data was applied to the sub-scaffold finite element model to predict the mechanical response over cells at the cell-substrate interface. Special focus was given to strain energy density at the cell interface as a response parameter due to its direct correlation with the migration of an adherent cell. The results showed a huge rise in strain energy density after the addition of NRs on the scaffold surface. It also highlighted that variation in NR density plays a more effective role than the variation in NR diameter to control cell migration over a substrate. However, the effect of NR diameter becomes insignificant when the NR tip was considered. The findings of this study could be used to determine the best nanostructure parameters for better osseointegration.

Nanotopographical cues for regulation of macrophages and osteoclasts: emerging opportunities for osseointegration

Nanotopographical cues of bone implant surface has direct influences on various cell types during the establishment of osseointegration, a prerequisite of implant bear-loading. Given the important roles of monocyte/macrophage lineage cells in bone regeneration and remodeling, the regulation of nanotopographies on macrophages and osteoclasts has arisen considerable attentions recently. However, compared to osteoblastic cells, how nanotopographies regulate macrophages and osteoclasts has not been properly summarized. In this review, the roles and interactions of macrophages, osteoclasts and osteoblasts at different stages of bone healing is firstly presented. Then, the diversity and preparation methods of nanotopographies are summarized. Special attentions are paid to the regulation characterizations of nanotopographies on macrophages polarization and osteoclast differentiation, as well as the focal adhesion-cytoskeleton mediated mechanism. Finally, an outlook is indicated of coordinating nanotopographies, macrophages and osteoclasts to achieve better osseointegration. These comprehensive discussions may not only help to guide the optimization of bone implant surface nanostructures, but also provide an enlightenment to the osteoimmune response to external implant.

Photothermal-Controlled Release of IL-4 in IL-4/PDA-Immobilized Black Titanium Dioxide (TiO2) Nanotubes Surface to Enhance Osseointegration: An In Vivo Study

Host immune response has gradually been accepted as a critical factor in achieving successful implant osseointegration. The aim of this study is to create a favorable immune microenvironment by the dominant release of IL-4 during the initial few days after implant insertion to mitigate early inflammatory reactions and facilitate osseointegration. Herein, the B-TNT/PDA/IL-4 substrate was established by immobilizing an interleukin-4 (IL-4)/polydopamine (PDA) coating on a black TiO₂ nanotube (B-TNT) surface, achieving on-demand IL-4 release under near infrared (NIR) irradiation. Gene Ontology (GO) enrichment analyses based on high-throughput DNA microarray data revealed that IL-4 addition inhibited osteoclast differentiation and function. Animal experiment results suggested that the B-TNT/PDA/IL-4+Laser substrate induced the least inflammatory, tartrate-resistant acid phosphatase, inducible nitric oxide synthase and the most CD163 positive cells, compared to the Ti group at 7 days post-implantation. In addition, 28 days post-implantation, micro-computed tomography results showed the highest bone volume/total volume, trabecular thickness, trabecular number and the lowest trabecular separation, while Hematoxylin-eosin and Masson-trichrome staining revealed the largest amount of new bone formation for the B-TNT/PDA/IL-4+Laser group. This study revealed the osteoimmunoregulatory function of the novel B-TNT/PDA/IL-4 surface by photothermal release of IL-4 at an early period post-implantation, thus paving a new way for dental implant surface modification.

The Calcium Phosphate Modified Titanium Implant Combined With Platelet-Rich Plasma Treatment Promotes Implant Stabilization in an Osteoporotic Model

ABSTRACT

Osteoporosis as a kind of systemic bone metabolic disease has become one of the most prevalent diseases among the middle- and old-age, characterized with low bone mass and disruptive osseous microenvironment. The poor bone condition both in quantity and quality makes it daunting for osteoporotic patients who are submitted to dental implantation, joint replacement therapy, or orthopedic surgery. Since calcium phosphate (CaP) and platelet-rich plasma (PRP) treatment, all have improving the effect on bone regeneration. Inspired by this fact, the authors introduced a kind of novel implant with CaP modified surface by HPT (hydrothermal & pressure) treatment in this study. After producing, the authors tested its physicochemical properties through scanning electron microscopy (SEM), X-ray diffraction (XRD), X-ray photoelectron spectroscope (XPS) and contact-angle measurement. Then the authors desired to investigate the effect of this CaP-modified implant on bone regeneration and stabilization maintenance combined with PRP treatment by establishing an osteoporotic rat model. After 3 months of surgery, the authors collected all the specimens and evaluated new bone formation by micro-computed tomography (micro-CT) analysis, biomechanical test, and histologic assessment. All the results in vivo experiment showed the CaP modified implant combined with PRP treatment could improve the osteoinductive effect under osteoporotic condition, leading to better maintenance for stabilization between bone and implant interface, which might be rendered as a promising clinical method for osteoporotic patients when they receive orthopedic surgeries.

The State of the Art and Prospects for Osteoimmunomodulatory Biomaterials

The critical role of the immune system in host defense against foreign bodies and pathogens has been long recognized. With the introduction of a new field of research called osteoimmunology, the crosstalk between the immune and bone-forming cells has been studied more thoroughly, leading to the conclusion that the two systems are intimately connected through various cytokines, signaling molecules, transcription factors and receptors. The host immune reaction triggered by biomaterial implantation determines the in vivo fate of the implant, either in new bone formation or in fibrous tissue encapsulation. The traditional biomaterial design consisted in fabricating inert biomaterials capable of stimulating osteogenesis; however, inconsistencies between the in vitro and in vivo results were reported. This led to a shift in the development of biomaterials towards implants with osteoimmunomodulatory properties. By endowing the orthopedic biomaterials with favorable osteoimmunomodulatory properties, a desired immune response can be triggered in order to obtain a proper bone regeneration process. In this context, various approaches, such as the modification of chemical/structural characteristics or the incorporation of bioactive molecules, have been employed in order to modulate the crosstalk with the immune cells. The current review provides an overview of recent developments in such applied strategies.

In vivo study of conductive 3D printed PCL/MWCNTs scaffolds with electrical stimulation for bone tissue engineering

Critical bone defects are considered one of the major clinical challenges in reconstructive bone surgery. The combination of 3D printed conductive scaffolds and exogenous electrical stimulation (ES) is a potential favorable approach for bone tissue repair. In this study, 3D conductive scaffolds made with biocompatible and biodegradable polycaprolactone (PCL) and multi-walled carbon nanotubes (MWCNTs) were produced using the extrusion-based additive manufacturing to treat large calvary bone defects in rats. Histology results show that the use of PCL/MWCNTs scaffolds and ES contributes to thicker and increased bone tissue formation within the bone defect. Angiogenesis and mineralization are also significantly promoted using high concentration of MWCNTs (3 wt%) and ES. Moreover, scaffolds favor the tartrate-resistant acid phosphatase (TRAP) positive cell formation, while the addition of MWCNTs seems to inhibit the osteoclastogenesis but present limited effects on the osteoclast functionalities (receptor activator of nuclear factor κβ ligand (RANKL) and osteoprotegerin (OPG) expressions). The use of ES promotes the osteoclastogenesis and RANKL expressions, showing a dominant effect in the bone remodeling process. These results indicate that the combination of 3D printed conductive PCL/MWCNTs scaffold and ES is a promising strategy to treat critical bone defects and provide a cue to establish an optimal protocol to use conductive scaffolds and ES for bone tissue engineering.

Biofunctional Elements Incorporated Nano/Microstructured Coatings on Titanium Implants with Enhanced Osteogenic and Antibacterial Performance

Bone fracture is prevalent among athletes and senior citizens and may require surgical insertion of bone implants. Titanium (Ti) and its alloys are widely used in orthopedics due to its high corrosion resistance, good biocompatibility, and modulus compatible with natural bone tissues. However, bone repair and regrowth are impeded by the insufficient intrinsic osteogenetic capability of Ti and Ti alloys and potential bacterial infection. The physicochemical properties of the materials and nano/microstructures on the implant surface are crucial for clinical success and loading with biofunctional elements such as Sr, Zn, Cu, Si, and Ag into nano/microstructured TiO2 coating has been demonstrated to enhance bone repair/regeneration and bacterial resistance of Ti implants. In this review, recent advances in biofunctional element-incorporated nano/microstructured coatings on Ti and Ti alloy implants are described and the prospects and limitations are discussed.

The Anatase Phase of Nanotopography Titania with Higher Roughness Has Better Biocompatibility in Osteoblast Cell Morphology and Proliferation

Previous studies have concluded that surface-modified titanium oxide (titania, TiO2) surface properties promote osteoblast cell morphology and proliferation. To screen a suitable structured titania coating with the best biocompatibility to be used in dental implants, five titania films (two amorphous, one rutile, and two anatases) with different surfaces were successfully synthesized on polished titanium by radio frequency (RF) magnetron sputtering. We applied atomic force microscopy (AFM) and X-ray diffraction (XRD) to depict the formulations. Furthermore, MC3T3-E1, the mouse osteoblast precursor cell, was used to assess cell proliferation and observe morphologic changes at the film surface. The data indicated that the overall number of MC3T3-E1 cells on anatase films was significantly higher as compared with cells on rutile and amorphous films. Meanwhile, the actin filaments of the cells grown on the anatase phase films were well defined and fully spread. In addition, the film with higher roughness had enhanced biocompatibility than that with lower roughness. The results showed that the crystal phase and titania coated roughness had a greater influence on the biocompatibility of nanostructured titania film. The higher the roughness of the anatase phase was, the better bioactivity for the morphology and proliferation of osteoblast. This is a good surface-modified biological material and may have a good application prospect in dental implants.

Drug Delivery Systems Based on Titania Nanotubes and Active Agents for Enhanced Osseointegration of Bone Implants

TiO2 nanotubes (TNTs) are attractive nanostructures for localized drug delivery. Owing to their excellent biocompatibility and physicochemical properties, numerous functionalizations of TNTs have been attempted for their use as therapeutic agent delivery platforms. In this review, we discuss the current advances in the applications of TNT-based delivery systems with an emphasis on the various functionalizations of TNTs for enhancing osteogenesis at the bone-implant interface and for preventing implant-related infection. Innovation of therapies for enhancing osteogenesis still represents a critical challenge in regeneration of bone defects. The overall concept focuses on the use of osteoconductive materials in combination with the use of osteoinductive or osteopromotive factors. In this context, we highlight the strategies for improving the functionality of TNTs, using five classes of bioactive agents: growth factors (GFs), statins, plant derived molecules, inorganic therapeutic ions/nanoparticles (NPs) and antimicrobial compounds.

Surface modification of titanium manufactured through selective laser melting inhibited osteoclast differentiation through mitogen-activated protein kinase signaling pathway

Selective laser melting used in manufacturing custom-made titanium implants becomes more popular. In view of the important role played by osteoclasts in peri-implant bone resorption and osseointegration, we modified selective laser melting-manufactured titanium surfaces using sandblasting/alkali-heating and sandblasting/acid-etching, and investigated their effect on osteoclast differentiation as well as their underlying mechanisms. The properties of the surfaces, including elements, roughness, wettability and topography, were analyzed. We evaluated the proliferation and morphology of primary mouse bone marrow-derived monocytes, as well as induced osteoclasts derived from bone marrow-derived monocytes, on samples. Then, osteoclast differentiation was determined by the tartrate-resistant acid phosphatase activity assay, calcitonin receptors immunofluorescence staining and the expression of osteoclast-related genes. The results showed that sandblasting/alkali-heating established nanonet structure with the lowest water contact angle, and both sandblasting/alkali-heating and sandblasting/acid-etching significantly decreased surface roughness and heterogeneity compared with selective laser melting. Surface modifications of selective laser melting-produced titanium altered bone marrow-derived monocyte morphology and suppressed bone marrow-derived monocyte proliferation and osteoclastogenesis in vitro (sandblasting/alkali-heating>sandblasting/acid-etching>selective laser melting). These surface modifications reduced the activation of extracellular signal-regulated kinase and c-Jun N-terminal kinases compared to native-selective laser melting. Sandblasting/alkali-heating additionally blocked tumor necrosis factor receptor-associated factor 6 recruitment. The results suggested that sandblasting/alkali-heating and sandblasting/acid-etching modifications on selective laser melting titanium could inhibit osteoclast differentiation through suppressing extracellular signal-regulated kinase and c-Jun N-terminal kinase phosphorylation in mitogen-activated protein kinase signaling pathway and provide a promising technique which might reduce peri-implant bone resorption for optimizing native-selective laser melting implants.

Current Advances in Immunomodulatory Biomaterials for Bone Regeneration

Biomaterials with suitable surface modification strategies are contributing significantly to the rapid development of the field of bone tissue engineering. Despite these encouraging results, utilization of biomaterials is poorly translated to human clinical trials potentially due to lack of knowledge about the interaction between biomaterials and the body defense mechanism, the "immune system". The highly complex immune system involves the coordinated action of many immune cells that can produce various inflammatory and anti-inflammatory cytokines. Besides, bone fracture healing initiates with acute inflammation and may later transform to a regenerative or degenerative phase mainly due to the cross-talk between immune cells and other cells in the bone regeneration process. Among various immune cells, macrophages possess a significant role in the immune defense, where their polarization state plays a key role in the wound healing process. Growing evidence shows that the macrophage polarization state is highly sensitive to the biomaterial's physiochemical properties, and advances in biomaterial research now allow well controlled surface properties. This review provides an overview of biomaterial-mediated modulation of the immune response for regulating key bone regeneration events, such as osteogenesis, osteoclastogenesis, and inflammation, and it discusses how these strategies can be utilized for future bone tissue engineering applications.

Nanochannelar Topography Positively Modulates Osteoblast Differentiation and Inhibits Osteoclastogenesis

Based on previously reported findings showing reduced foreign body reactions on nanochannelar topography formed on TiZr alloy, this study explores the in vitro effects of such a nanostructured surface on cells relevant for implant osseointegration, namely osteoblasts and osteoclasts. We show that such nanochannelar surfaces sustain adhesion and proliferation of mouse pre-osteoblast MC3T3-E1 cells and enhance their osteogenic differentiation. Moreover, this specific nanotopography inhibits nuclear factor kappa-B ligand (RANKL)-mediated osteoclastogenesis. The nanochannels’ dual mode of action on the bone-derived cells could contribute to an enhanced bone formation around the bone implants. Therefore, these results warrant further investigation for nanochannels’ use as surface coatings of medical implant materials.

Progress in TiO2 nanotube coatings for biomedical applications: a review

Titanium dioxide nanotubes (TNTs) have drawn wide attention and been extensively applied in the field of biomedicine, due to their large specific surface area, good corrosion resistance, excellent biocompatibility, and enhanced bioactivity. This review describes the preparation of TNTs and the surface modification that entrust the nanotubes with better antibacterial property and enhanced osteoblast adhesion, proliferation, and differentiation. Considering the contact between TNTs' surface and surrounding tissues after implantation, the interactions between TNTs (with properties including their diameter, length, wettability, and crystalline phase) and proteins, platelets, bacteria, and cells are illustrated. The state of the art in the applications of TNTs in dentistry, orthopedic implants, and cardiovascular stents are introduced. In particular, the application of TNTs in biosensing has attracted much attention due to its ability for the rapid diagnosis of diseases. Finally, the difficulties and challenges in the practical application of TNTs are also discussed.

Modulation of Osteoclast Interactions with Orthopaedic Biomaterials

Biomaterial integration in bone depends on bone remodelling at the bone-implant interface. Optimal balance of bone resorption by osteoclasts and bone deposition by osteoblasts is crucial for successful implantation, especially in orthopaedic surgery. Most studies examined osteoblast differentiation on biomaterials, yet few research has been conducted to explore the effect of different orthopaedic implants on osteoclast development. This review covers, in detail, the biology of osteoclasts, in vitro models of osteoclasts, and modulation of osteoclast activity by different implant surfaces, bio-ceramics, and polymers. Studies show that surface topography influence osteoclastogenesis. For instance, metal implants with rough surfaces enhanced osteoclast activity, while smooth surfaces resulted in poor osteoclast differentiation. In addition, surface modification of implants with anti-osteoporotic drug further decreased osteoclast activity. In bioceramics, osteoclast development depended on different chemical compositions. Strontium-incorporated bioceramics decreased osteoclast development, whereas higher concentrations of silica enhanced osteoclast activity. Differences between natural and synthetic polymers also modulated osteoclastogenesis. Physiochemical properties of implants affect osteoclast activity. Hence, understanding osteoclast biology and its response to the natural microarchitecture of bone are indispensable to design suitable implant interfaces and scaffolds, which will stimulate osteoclasts in ways similar to that of native bone.

M2 macrophages contribute to osteogenesis and angiogenesis on nanotubular TiO2 surfaces

The monocyte/macrophage system plays an essential role in the host response and the fate of endosseous implanted materials. Macrophage behavior was thought to be regulated by nanostructured titanium which has been considered as a very promising candidate for dental implants. However, there is little known for subsequent effects of these activated macrophages on osteogenesis and angiogenesis which were essential for bone integration. Here we presented two different dimensions of titanium nanotubes generated by anodic oxidation at 10 V (NT 10) and 20 V (NT 20), respectively. The behavior of macrophages on the surfaces was evaluated, and their conditioned medium (CM) was collected to stimulate MC3T3 and HUVECs, with commercially pure titanium (cp Ti) as control. We found that NT 20 induced macrophage activation similar to the anti-inflammatory M2 macrophage state with the enhanced expression of IL-10 and ARG, while NT 10 was associated with M1 macrophage phenotype characterized by high levels of IL-1β, iNOS and TNF-α. Furthermore, the osteogenic capacity of MC3T3 in CM from NT 20 was enhanced (NT 20 > NT 10 ≈ cp Ti) and the tube formation capacity of HUVECs was promoted in CM from nanotubular surfaces with increasing tube dimensions (NT 20 > NT 10 > cp Ti). Our data suggest that dental implants with the large nanotube dimension surface could result in a favorable osteoimmunomodulatory microenvironment for the establishment of osseointegration.

TiO2 nanorod arrays modified Ti substrates promote the adhesion, proliferation and osteogenic differentiation of human periodontal ligament stem cells

Nanostructure coating on titanium (Ti) implants is well known as a cue for directing osteoblast behavior and function. However, effects of nanostructure coatings on dental stem cells have been rarely explored. In this work, assembled TiO₂ nanorod arrays (TNRs) were fabricated on the polished Ti substrates using hydrothermal and sintering methods. The adhesion, morphology, proliferation and osteogenic differentiation of human periodontal ligament stem cells (PDLSCs) seeded onto TNRs substrates were evaluated. Ti substrates were used as control. Rougher TNRs showed better hydrophilicity and protein adsorption capacity compared with Ti control. When seeded on TNRs substrates, PDLSCs exhibited more stretched morphology and higher proliferation rate. Cytoskeletal F-actin expression was markedly promoted for PDLSCs cultured on TNRs substrates under osteogenic induction. Alkaline phosphatase (ALP) activity and mineral deposition were also enhanced by TNRs. Moreover, osteogenesis-related markers of ALP, runt related transcription factor 2 (Runx2) and osteopontin (OPN) of PDLSCs cultured on TNRs substrates were significantly up-regulated at both gene and protein levels when compared to Ti substrates. In conclusion, the unique structure of TNRs provided a biocompatible platform for modulating morphology and function of PDLSCs. The promotion of osteogenic differentiation indicated that the surface modification of implants with TNRs may improve the osteogenic activity of implants and the bone-implant integration in future clinical applications.

Silver-loaded nanotubular structures enhanced bactericidal efficiency of antibiotics with synergistic effect in vitro and in vivo

Antibiotic-resistant bacteria have become a major issue due to the long-term use and abuse of antibiotics in treatments in clinics. The combination therapy of antibiotics and silver (Ag) nanoparticles is an effective way of both enhancing the antibacterial effect and decreasing the usage of antibiotics. Although the method has been proved to be effective in vitro, no in vivo tests have been carried out at present. Herein, we described a combination therapy of local delivery of Ag and systemic antibiotics treatment in vitro in an infection model of rat. Ag nanoparticle-loaded TiO₂ nanotube (NT) arrays (Ag-NTs) were fabricated on titanium implants for a customized release of Ag ion. The antibacterial properties of silver combined with antibiotics vancomycin, rifampin, gentamicin, and levofloxacin, respectively, were tested in vitro by minimum inhibitory concentration (MIC) assay, disk diffusion assay, and antibiofilm formation test. Enhanced antibacterial activity of combination therapy was observed for all the chosen bacterial strains, including gram-negative Escherichia coli (ATCC 25922), gram-positive Staphylococcus aureus (ATCC 25923), and methicillin-resistant Staphylococcus aureus (MRSA; ATCC 33591 and ATCC 43300). Moreover, after a relative short (3 weeks) combinational treatment, animal experiments in vivo further proved the synergistic antibacterial effect by X-ray and histological and immunohistochemical analyses. These results demonstrated that the combination of Ag nanoparticles and antibiotics significantly enhanced the antibacterial effect both in vitro and in vivo through the synergistic effect. The strategy is promising for clinical application to reduce the usage of antibiotics and shorten the administration time of implant-associated infection.

Antibacterial Behavior of Additively Manufactured Porous Titanium with Nanotubular Surfaces Releasing Silver Ions

Additive manufacturing (3D printing) has enabled fabrication of geometrically complex and fully interconnected porous biomaterials with huge surface areas that could be used for biofunctionalization to achieve multifunctional biomaterials. Covering the huge surface area of such porous titanium with nanotubes has been already shown to result in improved bone regeneration performance and implant fixation. In this study, we loaded TiO2 nanotubes with silver antimicrobial agents to equip them with an additional biofunctionality, i.e., antimicrobial behavior. An optimized anodizing protocol was used to create nanotubes on the entire surface area of direct metal printed porous titanium scaffolds. The nanotubes were then loaded by soaking them in three different concentrations (i.e., 0.02, 0.1, and 0.5 M) of AgNO3 solution. The antimicrobial behavior and cell viability of the developed biomaterials were assessed. As far as the early time points (i.e., up to 1 day) are concerned, the biomaterials were found to be extremely effective in preventing biofilm formation and decreasing the number of planktonic bacteria particularly for the middle and high concentrations of silver ions. Interestingly, nanotubes not loaded with antimicrobial agents also showed significantly smaller numbers of adherent bacteria at day 1, which may be attributed to the bactericidal effect of high aspect ratio nanotopographies. The specimens with the highest concentrations of antimicrobial agents adversely affected cell viability at day 1, but this effect is expected to decrease or disappear in the following days as the rate of release of silver ions was observed to markedly decrease within the next few days. The antimicrobial effects of the biomaterials, particularly the ones with the middle and high concentrations of antimicrobial agents, continued until 2 weeks. The potency of the developed biomaterials in decreasing the number of planktonic bacteria and hindering the formation of biofilms make them promising candidates for combating peri-operative implant-associated infections.