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Abuhajar E, Salim NA, Satterthwaite JD, Silikas N, Anweigi LM. Effect of bioceramic powder abrasion on different implant surfaces. J Prosthodont 2024. [PMID: 38594924 DOI: 10.1111/jopr.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE Bioceramic coatings have been shown to promote bone repair, which aids in the early integration of implants. This study aimed to evaluate the influence of air abrasion with a bioceramic abrasive on the surface characteristics of different implant materials and surfaces. The dissolution of the applied treatment from the surfaces over 3 weeks was also assessed. MATERIALS AND METHODS Discs of three alloys used for dental implants were studied and compared: two types of commercially pure titanium (CpTi)/ (CpTi SLActive) and titanium-zirconia (TiZr). The tested surfaces were: CpTi control (CpC), sandblasted (SB), sandblasted and acid-etched (SBE), and CpTi SLActive®, (TiZr) Roxolid®. Three discs from each group underwent air abrasion with apatite bioceramic powders, 95% hydroxyapatite (HA)/5% calcium oxide (CaO), and 90% hydroxyapatite (HA)/10% calcium oxide (CaO). The treated discs were surface characterized by optical profilometry to obtain surface roughness, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS) to compare element weight percentages of titanium, calcium, and phosphate. Dissolution was assessed using inductively coupled plasma optic emission spectrometry (ICP-OES). RESULTS Bioceramic powders were deposited on all tested surfaces leading to changes in surface characteristics. The only statistically significant differences between the material groups for surface roughness were found with 95% HA/5% CaO powder in the Sp and Rp parameters (p = 0.03 and 0.04, respectively). There were no significant differences in the Ca and P wt% between all groups and powders 95% HA/5% CaO and 90% HA/10% CaO (p = 0.14, 0.18, and p = 0.15, 0.12, respectively). A non-uniform dispersion of the treatment on the surface layer was visible on all treated surfaces. The bioceramic powder continued to dissolute from the tested surfaces for 3 weeks. CONCLUSION Bioceramic abrasion modifies implant surface characteristics, although the change in surface characteristics resulting from such treatment was not influenced by the implant material or surface treatment. Air abrasion with hydroxyapatite and calcium oxide bioceramics leaves powder deposits on the treated implant surfaces that could potentially influence the healing of implants affected by peri-implantitis.
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Affiliation(s)
- Eman Abuhajar
- Faculty of Medicine, Dentistry and Oral Surgery, University of Tripoli, Tripoli, Libya
| | - Nesreen A Salim
- Prosthodontic Department, School of Dentistry, The University of Jordan, Consultant in Fixed and Removable Prosthodontics, The University of Jordan Hospital, Amman, Jordan
| | - Julian D Satterthwaite
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Nick Silikas
- School of Dentistry, The University of Manchester, Manchester, UK
| | - Lamyia M Anweigi
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
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Dorozhkin SV. There Are over 60 Ways to Produce Biocompatible Calcium Orthophosphate (CaPO4) Deposits on Various Substrates. JOURNAL OF COMPOSITES SCIENCE 2023; 7:273. [DOI: 10.3390/jcs7070273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
A The present overview describes various production techniques for biocompatible calcium orthophosphate (abbreviated as CaPO4) deposits (coatings, films and layers) on the surfaces of various types of substrates to impart the biocompatible properties for artificial bone grafts. Since, after being implanted, the grafts always interact with the surrounding biological tissues at the interfaces, their surface properties are considered critical to clinical success. Due to the limited number of materials that can be tolerated in vivo, a new specialty of surface engineering has been developed to desirably modify any unacceptable material surface characteristics while maintaining the useful bulk performance. In 1975, the development of this approach led to the emergence of a special class of artificial bone grafts, in which various mechanically stable (and thus suitable for load-bearing applications) implantable biomaterials and artificial devices were coated with CaPO4. Since then, more than 7500 papers have been published on this subject and more than 500 new publications are added annually. In this review, a comprehensive analysis of the available literature has been performed with the main goal of finding as many deposition techniques as possible and more than 60 methods (double that if all known modifications are counted) for producing CaPO4 deposits on various substrates have been systematically described. Thus, besides the introduction, general knowledge and terminology, this review consists of two unequal parts. The first (bigger) part is a comprehensive summary of the known CaPO4 deposition techniques both currently used and discontinued/underdeveloped ones with brief descriptions of their major physical and chemical principles coupled with the key process parameters (when possible) to inform readers of their existence and remind them of the unused ones. The second (smaller) part includes fleeting essays on the most important properties and current biomedical applications of the CaPO4 deposits with an indication of possible future developments.
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Affiliation(s)
- Sergey V. Dorozhkin
- Faculty of Physics, M.V. Lomonosov Moscow State University, Leninskie Gory 1-2, Moscow 119991, Russia
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Prezas PR, Soares MJ, Borges JP, Silva JC, Oliveira FJ, Graça MPF. Bioactivity Enhancement of Plasma-Sprayed Hydroxyapatite Coatings through Non-Contact Corona Electrical Charging. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:1058. [PMID: 36985952 PMCID: PMC10058569 DOI: 10.3390/nano13061058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/05/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Atmospheric plasma spray (APS) remains the only certified industrial process to produce hydroxyapatite (Hap) coatings on orthopaedic and dental implants intended for commercialization. Despite the established clinical success of Hap-coated implants, such as hip and knee arthroplasties, a concern is being raised regarding the failure and revision rates in younger patients, which are increasing rapidly worldwide. The lifetime risk of replacement for patients in the 50-60 age interval is about 35%, which is significantly higher than 5% for patients aged 70 or older. Improved implants targeted at younger patients are a necessity that experts have been alerted to. One approach is to enhance their bioactivity. For this purpose, the method with the most outstanding biological results is the electrical polarization of Hap, which remarkably accelerates implant osteointegration. There is, however, the technical challenge of charging the coatings. Although this is straightforward on bulk samples with planar faces, it is not easy on coatings, and there are several problems regarding the application of electrodes. To the best of our knowledge, this study demonstrates, for the first time, the electrical charging of APS Hap coatings using a non-contact, electrode-free method: corona charging. Bioactivity enhancement is observed, establishing the promising potential of corona charging in orthopedics and dental implantology. It is found that the coatings can store charge at the surface and bulk levels up to high surface potentials (>1000 V). The biological in vitro results show higher Ca2+ and P5+ intakes in charged coatings compared to non-charged coatings. Moreover, a higher osteoblastic cellular proliferation is promoted in the charged coatings, indicating the promising potential of corona-charged coatings when applied in orthopedics and dental implantology.
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Affiliation(s)
- Pedro R. Prezas
- I3N and Physics Department, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Manuel J. Soares
- I3N and Physics Department, University of Aveiro, 3810-193 Aveiro, Portugal
| | - João P. Borges
- I3N-CENIMAT, New University of Lisbon, 1099-085 Lisbon, Portugal
| | - Jorge C. Silva
- I3N-CENIMAT, New University of Lisbon, 1099-085 Lisbon, Portugal
| | - Filipe J. Oliveira
- CICECO and Materials Engineering Department, University of Aveiro, 3810-193 Aveiro, Portugal
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Surface, Subsurface and Tribological Properties of Ti6Al4V Alloy Shot Peened under Different Parameters. MATERIALS 2020; 13:ma13194363. [PMID: 33008035 PMCID: PMC7579628 DOI: 10.3390/ma13194363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/22/2022]
Abstract
Ti6Al4V alloy was shot peened by using stainless-steel shots with different sizes (0.09–0.14 mm (S10) and 0.7–1.0 mm (S60)) for two durations (5 and 15 min) using a custom-designed peening system. The shot size was the main parameter modifying the roughness (0.74 µm for S10 vs. 2.27 µm for S60), whereas a higher peening time slightly increased roughness. Hardness improved up to approximately 35% by peening with large shots, while peening time was insignificant in hardness improvement. However, longer peening duration with large shots led to an unwanted formation of micro-cracks and delamination on the peened surfaces. After dry sliding wear tests, the mass loss of peened samples (S60 for 15 min) was 25% higher than that of un-peened samples, while the coefficient of friction decreased by 12%. Plastically deformed regions and micro-scratches were observed on the worn surfaces, which corresponds to mostly adhesive and abrasive wear mechanisms. The present study sheds light on how surface, subsurface and tribological properties of Ti6Al4V vary with shot peening and peening parameters, which paves the way for the understanding of the mechanical, surface, and tribological behavior of shot peened Ti6Al4V used in both aerospace and biomedical applications.
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Neary G, Blom AW, Shiel AI, Wheway G, Mansell JP. Development and biological evaluation of fluorophosphonate-modified hydroxyapatite for orthopaedic applications. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:122. [PMID: 30032456 DOI: 10.1007/s10856-018-6130-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/09/2018] [Indexed: 06/08/2023]
Abstract
There is an incentive to functionalise hydroxyapatite (HA) for orthopaedic implant use with bioactive agents to encourage superior integration of the implants into host bone. One such agent is (3S) 1-fluoro-3-hydroxy-4-(oleoyloxy) butyl-1-phosphonate (FHBP), a phosphatase-resistant lysophosphatidic acid (LPA) analogue. We investigated the effect of an FHBP-HA coating on the maturation of human (MG63) osteoblast-like cells. Optimal coating conditions were identified and cell maturation on modified and unmodified, control HA surfaces was assessed. Stress tests were performed to evaluate coating survivorship after exposure to mechanical and thermal insults that are routinely encountered in the clinical environment. MG63 maturation was found to be three times greater on FHBP-modified HA compared to controls (p < 0.0001). There was no significant loss of coating bioactivity after autoclaving (P = 0.9813) although functionality declined by 67% after mechanical cleaning and reuse (p < 0.0001). The bioactivity of modified disks was significantly greater than that of controls following storage for up to six months (p < 0.001). Herein we demonstrate that HA can be functionalised with FHBP in a facile, scalable manner and that this novel surface has the capacity to enhance osteoblast maturation. Improving the biological performance of HA in a bone regenerative setting could be realised through the simple conjugation of bioactive LPA species in the future. Depicted is a stylised summary of hydroxyapatite (HA) surface modification using an analogue of lysophosphatidic acid, FHBP. a HA surfaces are simply steeped in an aqueous solution of 2 μM FHBP. b The polar head group of some FHBP molecules react with available hydroxyl residues at the mineral surfaces forming robust HA-O-P bonds leaving acyl chain extensions perpendicular to the HA surface. These fatty acyl chains provide points of integration for other FHBP molecules to facilitate their self-assembly. This final surface finish enhanced the human osteoblast maturation response to calcitriol, the active vitamin D3 metabolite.
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Affiliation(s)
- Gráinne Neary
- Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Bristol, BS10 5NB, UK.
| | - Ashley W Blom
- Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Bristol, BS10 5NB, UK
| | - Anna I Shiel
- Department of Applied Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Gabrielle Wheway
- Department of Applied Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Jason P Mansell
- Department of Applied Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, UK.
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Dunne CF, Roche K, Janssen A, Zhong X, Burke M, Twomey B, Stanton KT. Ultrafine grain formation and coating mechanism arising from a blast coating process: A transmission electron microscopy analysis. SURF INTERFACE ANAL 2017. [DOI: 10.1002/sia.6324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Conor F. Dunne
- UCD School of Mechanical and Materials Engineering; University College Dublin; Belfield Dublin 4 Ireland
| | - Kevin Roche
- ENBIO Ltd, DCU Alpha Innovation Campus; Glasnevin Dublin 11 Ireland
| | - Arne Janssen
- Materials Performance Centre and Electron Microscopy Centre, School of Materials; The University of Manchester; Manchester UK
| | - Xiangli Zhong
- Materials Performance Centre and Electron Microscopy Centre, School of Materials; The University of Manchester; Manchester UK
| | - M.G. Burke
- Materials Performance Centre and Electron Microscopy Centre, School of Materials; The University of Manchester; Manchester UK
| | - Barry Twomey
- ENBIO Ltd, DCU Alpha Innovation Campus; Glasnevin Dublin 11 Ireland
| | - Kenneth T. Stanton
- UCD School of Mechanical and Materials Engineering; University College Dublin; Belfield Dublin 4 Ireland
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Mendoza-Arnau A, Vallecillo-Capilla MF, Cabrerizo-Vílchez MÁ, Rosales-Leal JI. Topographic characterisation of dental implants for commercial use. Med Oral Patol Oral Cir Bucal 2016; 21:e631-6. [PMID: 27475680 PMCID: PMC5005103 DOI: 10.4317/medoral.20333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/22/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To characterize the surface topography of several dental implants for commercial use. MATERIAL AND METHODS Dental implants analyzed were Certain (Biomet 3i), Tissue Level (Straumann), Interna (BTI), MG-InHex (MozoGrau), SPI (Alphabio) and Hikelt (Bioner). Surface topography was ascertained using a confocal microscope with white light. Roughness parameters obtained were: Ra, Rq, Rv, Rp, Rt, Rsk and Rku. The results were analysed using single-factor ANOVA and Student-Neuman-Keuls (p<0.05) tests. RESULTS Certain and Hikelt obtained the highest Ra and Rq scores, followed by Tissue Level. Interna and SPI obtained lower scores, and MG-InHex obtained the lowest score. Rv scores followed the same trend. Certain obtained the highest Rp score, followed by SPI and Hikelt, then Interna and Tissue Level. MG-InHex obtained the lowest scores. Certain obtained the highest Rt score, followed by Interna and Hikelt, then SPI and Tissue Level. The lowest scores were for MG-InHex. Rsk was negative (punctured surface) in the MG-InHex, SPI and Tissue Level systems, and positive (pointed surface) in the other systems. Rku was higher than 3 (Leptokurtic) in Tissue Level, Interna, MG-InHex and SPI, and lower than 3 (Platykurtic) in Certain and Hikelt. CONCLUSIONS The type of implant determines surface topography, and there are differences in the roughness parameters of the various makes of implants for clinical use.
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Affiliation(s)
- A Mendoza-Arnau
- University of Granada, School of Dentistry, Campus de Cartuja s/n, 18071-Granada, Spain,
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Calcium orthophosphate deposits: Preparation, properties and biomedical applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 55:272-326. [PMID: 26117762 DOI: 10.1016/j.msec.2015.05.033] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/21/2015] [Accepted: 05/08/2015] [Indexed: 01/12/2023]
Abstract
Since various interactions among cells, surrounding tissues and implanted biomaterials always occur at their interfaces, the surface properties of potential implants appear to be of paramount importance for the clinical success. In view of the fact that a limited amount of materials appear to be tolerated by living organisms, a special discipline called surface engineering was developed to initiate the desirable changes to the exterior properties of various materials but still maintaining their useful bulk performances. In 1975, this approach resulted in the introduction of a special class of artificial bone grafts, composed of various mechanically stable (consequently, suitable for load bearing applications) implantable biomaterials and/or bio-devices covered by calcium orthophosphates (CaPO4) to both improve biocompatibility and provide an adequate bonding to the adjacent bones. Over 5000 publications on this topic were published since then. Therefore, a thorough analysis of the available literature has been performed and about 50 (this number is doubled, if all possible modifications are counted) deposition techniques of CaPO4 have been revealed, systematized and described. These CaPO4 deposits (coatings, films and layers) used to improve the surface properties of various types of artificial implants are the topic of this review.
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Dunne CF, Gibbons J, FitzPatrick DP, Mulhall KJ, Stanton KT. On the fate of particles liberated from hydroxyapatite coatings in vivo. Ir J Med Sci 2015; 184:125-33. [PMID: 25576323 DOI: 10.1007/s11845-014-1243-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/21/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Hydroxyapatite (HA) has been used as a coating for orthopaedic implants for over 30 years to help promote the fixation of orthopaedic implants into the surrounding bone. However, concerns exist about the fate of the hydroxyapatite coating and hydroxyapatite particles in vivo, especially in the wake of recent concerns about particulates from metal-on-metal bearings. METHODS Here, we assess the mechanisms of particle detachment from coated orthopaedic devices as well as the safety and performance concerns and biomedical implications arising from the liberation of the particles by review of the literature. FINDINGS The mechanisms that can result in the detachment of the HA coating from the implant can be mechanical or biochemical, or both. Mechanical mechanisms include implant insertion, abrasion, fatigue and micro-motion. Biochemical mechanisms that contribute to the liberation of HA particles include dissolution into extra-cellular fluid, cell-mediated processes and crystallisation of amorphous phases. The form the particles take once liberated is influenced by a number of factors such as coating method, the raw powder morphology, processing parameters, coating thickness and coating structure. CONCLUSIONS This review summarises and discusses each of these factors and concludes that HA is a safe biomimetic material to use as a coating and does not cause any problems in particulate form if liberated as debris from an orthopaedic implant.
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Affiliation(s)
- C F Dunne
- UCD School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
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Dunne CF, Twomey B, Kelly C, Simpson JC, Stanton KT. Hydroxyapatite and fluorapatite coatings on dental screws: effects of blast coating process and biological response. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:5347. [PMID: 25578701 DOI: 10.1007/s10856-014-5347-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 08/03/2014] [Indexed: 06/04/2023]
Abstract
This paper describes the deposition of hydroxyapatite (HA) and fluorapatite (FA) onto titanium dental screws using a novel ambient temperature coating technique named CoBlast. The process utilises a coating medium and a blast medium sprayed simultaneously at the substrate surface. The blast medium was a sintered apatite (sHA) and two particles sizes (<106 and <180 µm) were used to assess their influence on the coating process. The influence of the coating process on the coating composition, coating adhesion, screw morphology and screw microstructure was examined. XRD analysis revealed the coating crystallinity was the same as the original HA and FA feedstock powders. Examining the screw's morphology, the threads of the CoBlasted screws exhibited rounding compared to the unmodified screw. This is due to the abrasive nature of the CoBlast process. The degree of rounding was more significant for the screws blasted with the 180 µm sHA than the 106 µm sHA. The blast media particle size significantly influences the surface roughness of both the substrate and coating and the microstructure of the substrate. The screws did not exhibit any loss of coating after insertion into a model bone material, indicating that the coating was strongly adhered to the substrate. There was no statistically significant difference in cell attachment and cell morphology on the unmodified substrates compared to the coated substrates. In conclusion, the CoBlast process can be used to deposit HA and FA onto complex geometries such as dental screws. The choice of blast medium particle size influences the screws morphology. The coating process does not negatively impact on the cell attachment and morphology in vitro.
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Affiliation(s)
- Conor F Dunne
- UCD School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
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Shi XH, Wang SL, Zhang YM, Wang YC, Yang Z, Zhou X, Lei ZY, Fan DL. Hydroxyapatite-coated sillicone rubber enhanced cell adhesion and it may be through the interaction of EF1β and γ-actin. PLoS One 2014; 9:e111503. [PMID: 25386892 PMCID: PMC4227678 DOI: 10.1371/journal.pone.0111503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 10/01/2014] [Indexed: 01/09/2023] Open
Abstract
Silicone rubber (SR) is a common soft tissue filler material used in plastic surgery. However, it presents a poor surface for cellular adhesion and suffers from poor biocompatibility. In contrast, hydroxyapatite (HA), a prominent component of animal bone and teeth, can promote improved cell compatibility, but HA is an unsuitable filler material because of the brittleness in mechanism. In this study, using a simple and economical method, two sizes of HA was applied to coat on SR to counteract the poor biocompatibility of SR. Surface and mechanical properties of SR and HA/SRs confirmed that coating with HA changes the surface topology and material properties. Analysis of cell proliferation and adhesion as well as measurement of the expression levels of adhesion related molecules indicated that HA-coated SR significantly increased cell compatibility. Furthermore, mass spectrometry proved that the biocompatibility improvement may be related to elongation factor 1-beta (EF1β)/γ-actin adjusted cytoskeletal rearrangement.
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Affiliation(s)
- Xiao-hua Shi
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Shao-liang Wang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Yi-ming Zhang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Yi-cheng Wang
- Department of Plastic and Cosmetic Surgery, Chongqing Armed Police Corps Hospital, Chongqing, 400061, People's Republic of China
| | - Zhi Yang
- Department of War Trauma care, Hainan branch of PLA General Hospital, Sanya, Hainan, 572013, People's Republic of China
| | - Xin Zhou
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Ze-yuan Lei
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Dong-li Fan
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing, 400037, People's Republic of China
- * E-mail:
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