Electrochemical Deposition of Nanostructured Hydroxyapatite Coating on Titanium with Enhanced Early Stage Osteogenic Activity and Osseointegration

Crystallographic plane-induced selective mineralization of nanohydroxyapatite on fibrous-grained titanium promotes osteointegration and biocorrosion resistance

The (002) crystallographic plane-oriented hydroxyapatite (HA) and anatase TiO2 enable favorable hydrophilicity, osteogenesis, and biocorrosion resistance. Thus, the crystallographic plane control in HA coating and crystalline phase control in TiO2 is vital to affect the surface and interface bioactivity and biocorrosion resistance of titanium (Ti) implants. However, a corresponding facile and efficient fabrication method is absent to realize the HA(002) mineralization and anatase TiO2 formation on Ti. Herein, we utilized the predominant Ti(0002) plane of the fibrous-grained titanium (FG Ti) to naturally form anatase TiO2 and further achieve a (002) basal plane oriented nanoHA (nHA) film through an in situ mild hydrothermal growth strategy. The formed FG Ti-nHA(002) remarkably improved hydrophilicity, mineralization, and biocorrosion resistance. Moreover, the nHA(002) film reserved the microgroove-like topological structure on FG Ti. It could enhance osteogenic differentiation through promoted contact guidance, showing one order of magnitude higher expression of osteogenic-related genes. On the other hand, the nHA(002) film restrained the osteoclast activity by blocking actin ring formation. Based on these capacities, FG Ti-nHA(002) improved new bone growth and binding strength in rabbit femur implantation, achieving satisfactory osseointegration within 2 weeks.

Evaluation of the In Vitro Behavior of Electrochemically Deposited Plate-like Crystal Hydroxyapatite Coatings

The purpose of coatings is to protect or enhance the functionality of the substrate material, irrespective of the field in which the material was designed. The use of coatings in medicine is rapidly expanding with the objective of enhancing the osseointegration ability of metallic materials such as titanium. The aim of this study was to obtain biomimetic hydroxyapatite (HAp)-based coatings on titanium by using the pulsed galvanostatic method. The morphology of the HAp-based coatings revealed the presence of very thin and wide plate-like crystals, grown perpendicular to the Ti substrate, while the chemical composition highlighted a Ca/P ratio of 1.66, which is close to that of stoichiometric HAp (1.67). The main phases and chemical bonds identified confirmed the presence of the HAp phase in the developed coatings. A roughness of 228 nm and a contact angle of approx. 17° were obtained for the HAp coatings, highlighting a hydrophilic character. In terms of biomineralization and electrochemical behavior, it was shown that the HAp coatings have significantly enhanced the titanium properties. Finally, the in vitro cell tests carried out with human mesenchymal stem cells showed that the Ti samples coated with HAp have increased cell viability, extracellular matrix, and Ca intracellular deposition when compared with the uncoated Ti, indicating the beneficial effect.

Structure-optimized and microenvironment-inspired nanocomposite biomaterials in bone tissue engineering

Critical-sized bone defects represent a significant clinical challenge due to their inability to undergo spontaneous regeneration, necessitating graft interventions for effective treatment. The development of tissue-engineered scaffolds and regenerative medicine has made bone tissue engineering a highly viable treatment for bone defects. The physical and biological properties of nanocomposite biomaterials, which have optimized structures and the ability to simulate the regenerative microenvironment of bone, are promising for application in the field of tissue engineering. These biomaterials offer distinct advantages over traditional materials by facilitating cellular adhesion and proliferation, maintaining excellent osteoconductivity and biocompatibility, enabling precise control of degradation rates, and enhancing mechanical properties. Importantly, they can simulate the natural structure of bone tissue, including the specific microenvironment, which is crucial for promoting the repair and regeneration of bone defects. This manuscript provides a comprehensive review of the recent research developments and applications of structure-optimized and microenvironment-inspired nanocomposite biomaterials in bone tissue engineering. This review focuses on the properties and advantages these materials offer for bone repair and tissue regeneration, summarizing the latest progress in the application of nanocomposite biomaterials for bone tissue engineering and highlighting the challenges and future perspectives in the field. Through this analysis, the paper aims to underscore the promising potential of nanocomposite biomaterials in bone tissue engineering, contributing to the informed design and strategic planning of next-generation biomaterials for regenerative medicine.

Biomineral-Based Composite Materials in Regenerative Medicine

Regenerative medicine aims to address substantial defects by amplifying the body's natural regenerative abilities and preserving the health of tissues and organs. To achieve these goals, materials that can provide the spatial and biological support for cell proliferation and differentiation, as well as the micro-environment essential for the intended tissue, are needed. Scaffolds such as polymers and metallic materials provide three-dimensional structures for cells to attach to and grow in defects. These materials have limitations in terms of mechanical properties or biocompatibility. In contrast, biominerals are formed by living organisms through biomineralization, which also includes minerals created by replicating this process. Incorporating biominerals into conventional materials allows for enhanced strength, durability, and biocompatibility. Specifically, biominerals can improve the bond between the implant and tissue by mimicking the micro-environment. This enhances cell differentiation and tissue regeneration. Furthermore, biomineral composites have wound healing and antimicrobial properties, which can aid in wound repair. Additionally, biominerals can be engineered as drug carriers, which can efficiently deliver drugs to their intended targets, minimizing side effects and increasing therapeutic efficacy. This article examines the role of biominerals and their composite materials in regenerative medicine applications and discusses their properties, synthesis methods, and potential uses.

Characterization, mechanical properties, corrosion behavior and bone-like apatite formation ability of fluorine substituted hydroxyapatite coating

Hydroxyapatite (HA) is a non-bioceramic commonly used in human implants in the form of coatings, which are limited in their application by mechanical and wear resistance properties, as well as biodegradability. In this study, fluorine substituted hydroxyapatite (FHA) coatings were prepared on Ti-6Al-4V surfaces by plasma spraying method using a mixture of calcium fluoride and hydroxyapatite powders. The prepared coatings were characterized by X-ray diffraction and fourier transform infrared (FTIR) spectroscopy at different levels of calcium fluoride (3 wt%, 6 wt%, 9 wt%, and 12 wt%). The biocompatibility of the coatings was evaluated by in vitro mineralization experiments. Experimental results showed that at 9 wt% of calcium fluoride, the prepared FHA coatings had better mechanical properties, with improved bond strength (28.2 MPa). The X-ray diffraction patterns of the coatings reflect the fluorine substitution during the spraying process and the 9FHA has the highest crystallinity according to the XRD analysis, which is closely related to the biological activity of the coating. In addition, Potentiodynamic polarisation showed that the sample coated with the 9FHA coating had the highest Ecorr and lowest Icorr, indicating the best corrosion resistance. The FHA coating exhibits faster apatite deposition in simulated body fluid, and the efficiency of apatite deposition increases with the increase of CaF2.

Spectral Analysis of Strontium-Doped Calcium Phosphate/Chitosan Composite Films

Strontium-doped calcium phosphate/chitosan films were synthetized on silicon substrates using the radio-frequency magnetron sputtering technique and the matrix-assisted pulsed laser evaporation technique. The deposition conditions associated with the radio-frequency magnetron sputtering discharge, in particular, include the high temperature at the substrate, which promotes the formation of strontium-doped tetra calcium phosphate layers. The physical and chemical processes associated with the deposition of chitosan on strontium-doped calcium phosphate layers were investigated using Fourier Transform Infrared Spectroscopy, Energy Dispersive X-ray Spectroscopy, and Scanning Electron Microscopy. Mass spectrometry coupled with laser induced ablation of the composite films proved to be a useful tool in the detection of the molecular ions characteristic to chitosan chemical structure.

Hydroxyapatite coatings versus osseointegration in dental implants: A systematic review

STATEMENT OF PROBLEM

Knowledge of the effectiveness of hydroxyapatite coatings on the surface of titanium dental implants is lacking because of difficulties in standardizing their thickness, roughness, and effect on osseointegration. The selection of articles describing this coating in osseointegration will be of great relevance to implant dentistry.

PURPOSE

This systematic review aimed to answer the question, "How effective is hydroxyapatite on titanium surfaces for osseointegration?"

MATERIAL AND METHODS

The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines were followed, and the protocol was registered on the international prospective register of systematic reviews (PROSPERO) database (CRD42023422601). The PubMed, Scopus, Web of Science, and Embase databases were searched, and articles were selected manually in 2 steps by 2 blinded investigators according to the previously selected eligibility criteria. The risk of bias was assessed using the systematic review center for laboratory animal experimentation (SYRCLE) tool.

RESULTS

Initially, 671 results were found. After analysis of eligibility criteria and full reading, 15 articles were included in the present review. Of these, 12 reported favorable osseointegration results for hydroxyapatite-coated surfaces, and 3 found no significant long-term difference between the coated and uncoated groups.

CONCLUSIONS

Hydroxyapatite surface treatment is effective in the osseointegration of titanium dental implants because it favors the absorption of proteins, adhesion, and proliferation of bone cells when obtained by methods that ensure proper adhesion. (J Prosthet Dent xxxx;xxx:xxx-xxx).

Development of Hydroxyapatite Coatings for Orthopaedic Implants from Colloidal Solutions: Part 1-Effect of Solution Concentration and Deposition Kinetics

This study introduces and explores the use of supersaturated solutions of calcium and phosphate ions to generate well-defined hydroxyapatite coatings for orthopaedic implants. The deposition of hydroxyapatite is conducted via several solutions of metastable precursors that precipitate insoluble hydroxyapatite minerals at a substrate-solution interface. Solutions of this nature are intrinsically unstable, but this paper outlines process windows in terms of time, temperature, concentration and pH in which coating deposition is controlled via the stop/go reaction. To understand the kinetics of the deposition process, comparisons based on ionic strength, particle size, electron imaging, elemental analyses and mass of the formed coating for various deposition solutions are carried out. This comprehensive dataset enables the measurement of deposition kinetics and identification of an optimum solution and its reaction mechanism. This study has established stable and reproducible process windows, which are precisely controlled, leading to the successful formation of desired hydroxyapatite films. The data demonstrate that this process is a promising and highly repeatable method for forming hydroxyapatites with desirable thickness, morphology and chemical composition at low temperatures and low capital cost compared to the existing techniques.

Electrodeposited Zinc Coatings for Biomedical Application: Morphology, Corrosion and Biological Behaviour

The improvement of biodegradable metals is currently an active and promising research area for their capabilities in implant manufacturing. However, controlling their degradation rate once their surface is in contact with the physiological media is a challenge. Surface treatments are in the way of addressing the improvement of this control. Zinc is a biocompatible metal present in the human body as well as a metal widely used in coatings to prevent corrosion, due to its well-known metal protective action. These two outstanding characteristics make zinc coating worthy of consideration to improve the degradation behaviour of implants. Electrodeposition is one of the most practical and common technologies to create protective zinc coatings on metals. This article aims to review the effect of the different parameters involved in the electrochemical process on the topography and corrosion characteristics of the zinc coating. However, certainly, it also provides an actual and comprehensive description of the state-of-the-art of the use of electrodeposited zinc for biomedical applications, focusing on their capacity to protect against bacterial colonization and to allow cell adhesion and proliferation.

Progress in Surface Modification of Titanium Implants by Hydrogel Coatings

Although titanium and titanium alloys have become the preferred materials for various medical implants, surface modification technology still needs to be strengthened in order to adapt to the complex physiological environment of the human body. Compared with physical or chemical modification methods, biochemical modification, such as the introduction of functional hydrogel coating on implants, can fix biomolecules such as proteins, peptides, growth factors, polysaccharides, or nucleotides on the surface of the implants, so that they can directly participate in biological processes; regulate cell adhesion, proliferation, migration, and differentiation; and improve the biological activity on the surface of the implants. This review begins with a look at common substrate materials for hydrogel coatings on implant surfaces, including natural polymers such as collagen, gelatin, chitosan, and alginate, and synthetic materials such as polyvinyl alcohol, polyacrylamide, polyethylene glycol, and polyacrylic acid. Then, the common construction methods of hydrogel coating (electrochemical method, sol-gel method and layer-by-layer self-assembly method) are introduced. Finally, five aspects of the enhancement effect of hydrogel coating on the surface bioactivity of titanium and titanium alloy implants are described: osseointegration, angiogenesis, macrophage polarization, antibacterial effects, and drug delivery. In this paper, we also summarize the latest research progress and point out the future research direction. After searching, no previous relevant literature reporting this information was found.

Elastin-like recombinamer-mediated hierarchical mineralization coatings on Zr-16Nb-xTi (x = 4,16 wt%) alloy surfaces improve biocompatibility

The biocompatibility of biomedical materials is vital to their applicability and functionality. However, modifying surfaces for enhanced biocompatibility using traditional surface treatment techniques is challenging. We employed a mineralizing elastin-like recombinamer (ELR) self-assembling platform to mediate mineralization on Zr-16Nb-xTi (x = 4,16 wt%) alloy surfaces, resulting in the modification of surface morphology and bioactivity while improving the biocompatibility of the material. We modulated the level of nanocrystal organization by adjusting the cross-linker ratio. Nanoindentation tests revealed that the mineralized configuration had nonuniformity with respect to Young's modulus and hardness, with the center areas having higher values (5.626 ± 0.109 GPa and 0.264 ± 0.022 GPa) compared to the edges (4.282 ± 0.327 GPa and 0.143 ± 0.023 GPa). The Scratch test results indicated high bonding strength (2.668 ± 0.117 N) between the mineralized coating and the substrate. Mineralized Zr-16Nb-xTi (x = 4,16 wt%) alloys had higher viability compared to untreated alloys, which exhibited high cell viability (>100 %) after 5 days and high alkaline phosphatase activity after 7 days. Cell proliferation assays indicated that MG 63 cells grew faster on mineralized surfaces than on untreated surfaces. Scanning electron microscopy imaging confirmed that the cells adhered and spread well on mineralized surfaces. Furthermore, hemocompatibility test results revealed that all mineralized samples were non-hemolytic. Our results demonstrate the viability of employing the ELR mineralizing platform to improve alloy biocompatibility.

Effects of Micro-Arc Oxidation Discharge Parameters on Formation and Biomedical Properties of Hydroxyapatite-Containing Flower-like Structure Coatings

The micro-arc oxidation (MAO) process was used to prepare hydroxyapatite-containing flower-like structure coatings on commercially pure titanium substrates with various values of the applied voltage (330, 390, 450 V), applied current (0.4, 0.5, 0.6 A), and duration time (1, 3, 5 min). It was found that the surface morphology of the coatings was determined primarily by the applied voltage. A voltage of 330 V yielded a flower-like/plate-like structure, while voltages of 390 V and 450 V produced a flower-like structure and a porous morphology, respectively. The applied current and duration time mainly affected the coating formation speed and petal size of the flower-like structures, respectively. The coatings prepared using voltages of 330 V and 390 V (0.6 A, 5 min) both contained Ti, TiO₂-A (anatase), TiO₂-R (rutile), DCPD (CaHPO₄·2H₂O, calcium hydrogen phosphate), and hydroxyapatite (HA). However, the latter coating contained less DCPD and had a higher HA/DCPD ratio and a Ca/P ratio closer to the ideal value of HA. The coating prepared with a voltage of 450 V consisted mainly of Ti, TiO₂-A, TiO₂-R, and CaTiO₃. For the coatings prepared with a voltage of 390 V, the flower-like structures consisted mainly of HA-containing compounds. DCPD plate-like structures were observed either between the HA-containing flower-like structures (330 V samples) or within the flower-like structures themselves (390 V samples). The coating surfaces with flower-like/plate-like or flower-like structures had a greater roughness, which increased their hydrophilicity and resulted in superior bioactivity (SBF immersion) and biocompatibility (MG-63 cell culture). The optimal biomedical performance was found in the 390 V coating due to its flower-like structure and high HA/DCPD ratio.

Functional engineering strategies of 3D printed implants for hard tissue replacement

Three-dimensional printing technology with the rapid development of printing materials are widely recognized as a promising way to fabricate bioartificial bone tissues. In consideration of the disadvantages of bone substitutes, including poor mechanical properties, lack of vascularization and insufficient osteointegration, functional modification strategies can provide multiple functions and desired characteristics of printing materials, enhance their physicochemical and biological properties in bone tissue engineering. Thus, this review focuses on the advances of functional engineering strategies for 3D printed biomaterials in hard tissue replacement. It is structured as introducing 3D printing technologies, properties of printing materials (metals, ceramics and polymers) and typical functional engineering strategies utilized in the application of bone, cartilage and joint regeneration.

Surface coating of orthopedic implant to enhance the osseointegration and reduction of bacterial colonization: a review

The use of orthopedic implants in surgical technology has fostered restoration of physiological functions. Along with successful treatment, orthopedic implants suffer from various complications and fail to offer functions correspondent to native physiology. The major problems include aseptic and septic loosening due to bone nonunion and implant site infection due to bacterial colonization. Crucial advances in material selection in the design and development of coating matrixes an opportunity for the prevention of implant failure. However, many coating materials are limited in in-vitro testing and few of them thrive in clinical tests. The rate of implant failure has surged with the increasing rates of revision surgery creating physical and sensitive discomfort as well as economic burdens. To overcome critical pathogenic activities several systematic coating techniques have been developed offering excellent results that combat infection and enhance bone integration. This review article includes some more common implant coating matrixes with excellent in vitro and in vivo results focusing on infection rates, causes, complications, coating materials, host immune responses and significant research gaps. This study provides a comprehensive overview of potential coating technology, with functional combination coatings which are focused on ultimate clinical practice with substantial improvement on in-vivo tests. This includes the development of rapidly growing hydrogel coating techniques with the potential to generate several accurate and precise coating procedures.

Electrochemical deposition of lithium coating on titanium implant with enhanced early stage osseointegration

Recently, a large number of studies have reported that lithium (Li) displayed a positive effect on osteogenesis. However, only a few studies have investigated the Li-incorporated surfaces through electrochemical deposition. In this study, electrochemical deposition was conducted on a CHI600E electrochemical workstation. The characterization of electrochemical deposition (ECD) and ECD-Li surfaces were detected by field-emission scanning electron microscopy with energy-dispersive spectrometer. rBMSCs were cultured on two surfaces for subsequent adhesion, proliferation and live/dead assay. To evaluate the effects of Li-incorporated implants by electrochemical deposition on osseointegration in vivo, teeth extraction of two premolars and one first molar in bilateral mandible were performed on six male beagle dogs. After 3 months, ZDI and ZDI-Li implants were inserted into the bilateral mandible of each beagle dog. Micro Computed Tomography (Micro-CT) and hard tissue sectioning analysis were carried out to evaluate the osseointegration at 4- and 8-weeks post-implantation. Results showed that ECD-Li surface promoted adhesion and proliferation of BMSCs in the early stage. More importantly, through micro-CT analysis, the values of bone volume/total volume (BV/TV) (0.374 ± 0.015), bone-implant contact (BIC) (0.831 ± 0.025), and Tb.Th (0.412 ± 0.007) in ZDI-Li group was significantly higher than those of ZDI group (0.302 ± 0.009, 0.700 ± 0.023, 0.353 ± 0.001, p < .01) at 4 weeks. Similarly, ZDI-Li group manifested more bone contact with the implant surfaces at 4 weeks based on hard tissue sectioning analysis, whereas no significant difference was detected between two groups at 8 weeks. Therefore, incorporating Li into implant surface through ECD could enhance early osseointegration in vivo.

Inhibition of Inflammatory Response and Promotion of Osteogenic Activity of Zinc-Doped Micro-Arc Titanium Oxide Coatings

An early and sustained immune response can lead to chronic inflammation after the implant is placed in the body. The implantable materials with immunomodulatory effects can reduce the body's immune response and promote the formation of ideal osseointegration between the implants and bone tissue. In this study, zinc-coated titanium micro-arc oxide coating was prepared on titanium surface by micro-arc oxidation. The physical properties, anti-inflammation, and osteogenesis of the material were evaluated. We have physically characterized the surface structure of the coatings by scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), and atomic force microscopy (AFM) and detected the release of Zn²⁺ from the coating surface by inductively coupled optical plasma emission spectrometry (ICP-OES). The BMSCs were inoculated on the surface of the coating, and the biocompatibility of the coating was evaluated by CCK-8 analysis and living and dead cell staining. The osteogenic effect of the layer on BMSCs was evaluated by alkaline phosphatase (ALP) assays, osteocalcin (OCN) immunofluorescence, and quantitative polymerase chain reaction (q-PCR). The survival status of RAW264.7 on the coating surface and the mRNA expression of the associated proinflammatory markers, tumor necrosis factor-α (TNF-α), cluster of differentiation 86 (CD86), and inducible nitric oxide (INOS) were detected by CCK-8 analysis and q-PCR. In parallel, the cell counting kit-8 (CCK-8) analysis and q-PCR screened and evaluated the effective concentration of Zn²⁺ anti-inflammatory in vitro. The results show that the coating has good physical characterization, and Zn is uniformly bound to the surface of titanium and shows stable release and good biocompatibility to BMSCs, downregulating the expression of inflammation-related genes promoting the bone formation of BMSCs. We have successfully prepared zinc-coated micro-arc titanium oxide coating on the titanium surface, which has good osteogenesis and great anti-inflammatory potential and provides a new way for osseointegration in the implant.

Strontium-loaded titanium implant with rough surface modulates osseointegration by changing sfrp4 in canonical and noncanonical Wnt signaling pathways

A rough morphology and strontium can activate the Wnt pathway to regulate bone mesenchymal stem cells (rBMSCs) osteogenic differentiation, but the mechanism remains unclear. We constructed smooth Ti (ST) surfaces, rough Ti (RT) surfaces subjected to hydrofluoric acid etching, strontium-loaded smooth Ti (ST-Sr) surfaces subjected to magnetron sputtering, and rough strontium-loaded Ti (RT-Sr) surfaces. We systematically studied the in vitro osteogenic differentiation of rBMSCs on these four surfaces by alkaline phosphatase measurement, Alizarin Red staining and PCR. We also investigated whether crosstalk of the canonical and noncanonical Wnt signaling pathways regulated by sfrp4, which is an inhibitor of canonical and noncanonical Wnt, is the underlying mechanism via PCR on rBMSCs in different stages of osteogenic differentiation. We confirmed the effect of sfrp4 through an in vivo sfrp4-siRNA test. The in vitro osteogenic differentiation of rBMSCs decreased in the order RT-Sr, RT, ST-Sr, and ST. Regarding the mechanism, rough morphology and strontium both enhanced the canonical Wnt pathway to promote osseointegration. Additionally, rough morphology can inhibit sfrp4 to activate the noncanonical Wnt pathway, and then, the activated noncanonical Wnt pathway can suppress the canonical Wnt pathway at the early stage of osteogenic differentiation. Strontium continuously enhanced sfrp4 to inhibit the canonical Wnt pathway instead of activating the noncanonical Wnt pathway. Interestingly, the effect of rough morphology on sfrp4 changed from inhibition to enhancement, and the enhancing effect of strontium on sfrp4 was gradually attenuated. The results of the in vivo sfrp4-siRNA test showed that osseointegration decreased in the order RT-Sr, RT-Sr-siRNA, and ST. Our results suggest that the lack of sfrp4 could suppress osseointegration, indicating that sfrp4 acts as a crucial regulatory molecule for the canonical and noncanonical Wnt pathways during the response of rBMSCs to rough morphology and strontium.

Bioactive Coatings Loaded with Osteogenic Protein for Metallic Implants

Osteoconductive and osteoinductive coatings represent attractive and tunable strategies towards the enhanced biomechanics and osseointegration of metallic implants, providing accurate local modulation of bone-to-implant interface. Composite materials based on polylactide (PLA) and hydroxyapatite (HAp) are proved beneficial substrates for the modulation of bone cells' development, being suitable mechanical supports for the repair and regeneration of bone tissue. Moreover, the addition of osteogenic proteins represents the next step towards the fabrication of advanced biomaterials for hard tissue engineering applications, as their regulatory mechanisms beneficially contribute to the new bone formation. In this respect, laser-processed composites, based on PLA, Hap, and bone morphogenetic protein 4(BMP4), are herein proposed as bioactive coatings for metallic implants. The nanostructured coatings proved superior ability to promote the adhesion, viability, and proliferation of osteoprogenitor cells, without affecting their normal development and further sustaining the osteogenic differentiation of the cells. Our results are complementary to previous studies regarding the successful use of chemically BMP-modified biomaterials in orthopedic and orthodontic applications.

A state-of-the-art review of the fabrication and characteristics of titanium and its alloys for biomedical applications

Abstract

Commercially pure titanium and titanium alloys have been among the most commonly used materials for biomedical applications since the 1950s. Due to the excellent mechanical tribological properties, corrosion resistance, biocompatibility, and antibacterial properties of titanium, it is getting much attention as a biomaterial for implants. Furthermore, titanium promotes osseointegration without any additional adhesives by physically bonding with the living bone at the implant site. These properties are crucial for producing high-strength metallic alloys for biomedical applications. Titanium alloys are manufactured into the three types of α, β, and α + β. The scientific and clinical understanding of titanium and its potential applications, especially in the biomedical field, are still in the early stages. This review aims to establish a credible platform for the current and future roles of titanium in biomedicine. We first explore the developmental history of titanium. Then, we review the recent advancement of the utility of titanium in diverse biomedical areas, its functional properties, mechanisms of biocompatibility, host tissue responses, and various relevant antimicrobial strategies. Future research will be directed toward advanced manufacturing technologies, such as powder-based additive manufacturing, electron beam melting and laser melting deposition, as well as analyzing the effects of alloying elements on the biocompatibility, corrosion resistance, and mechanical properties of titanium. Moreover, the role of titania nanotubes in regenerative medicine and nanomedicine applications, such as localized drug delivery system, immunomodulatory agents, antibacterial agents, and hemocompatibility, is investigated, and the paper concludes with the future outlook of titanium alloys as biomaterials.

Graphic abstract

Plasma Spray vs. Electrochemical Deposition: Toward a Better Osteogenic Effect of Hydroxyapatite Coatings on 3D-Printed Titanium Scaffolds

Surface modification of three-dimensional (3D)-printed titanium (Ti) scaffolds with hydroxyapatite (HA) has been a research hotspot in biomedical engineering. However, unlike HA coatings on a plain surface, 3D-printed Ti scaffolds have inherent porous structures that influence the characteristics of HA coatings and osteointegration. In the present study, HA coatings were successfully fabricated on 3D-printed Ti scaffolds using plasma spray and electrochemical deposition, named plasma sprayed HA (PSHA) and electrochemically deposited HA (EDHA), respectively. Compared to EDHA scaffolds, HA coatings on PSHA scaffolds were smooth and continuous. In vitro cell studies confirmed that PSHA scaffolds have better potential to promote bone mesenchymal stem cell adhesion, proliferation, and osteogenic differentiation than EDHA scaffolds in the early and late stages. Moreover, in vivo studies showed that PSHA scaffolds were endowed with superior bone repair capacity. Although the EDHA technology is simpler and more controllable, its limitation due to the crystalline and HA structures needs to be improved in the future. Thus, we believe that plasma spray is a better choice for fabricating HA coatings on implanted scaffolds, which may become a promising method for treating bone defects.

Impact of exogenous metal ions on peri-implant bone metabolism: a review

The development of effective methods to promote the osseointegration of dental implants by surface modification is an area of intense research in dental materials science. Exogenous metal ions present in the implant and surface modifications are closely related to the bone metabolism around the implant. In the complex oral microenvironment, the release of metal ions caused by continuous corrosion of dental implants has an unfavorable impact on the surrounding tissue, and then affects osseointegration, leading to bad results such as loosening and falling off in the late stage of the implant. Besides, these ions can even be distributed in distant tissues and organs. Currently, surface modification techniques are being developed that involve different processing technologies including the introduction of exogenous metal ions with different properties onto the surface of implants to improve performance. However, most metal elements have some level of biological toxicity and can only be used within a safe concentration range to exert the optimum biological effects on recipients. In this paper, we review the adverse effects of metal ions on osseointegration and highlight the emerging applications for metal elements in improving the performance of dental implants.

Enhancing Osseointegration of TC4 Alloy by Surficial Activation Through Biomineralization Method

Titanium (Ti) alloys have been applied to biomedical implants for a long time. Although Ti alloys are biocompatible, efforts have been continuously made to improve their bone conductivity and osteogenesis for enhancing their performance. Silk fibroin (SF) is a natural biomaterial with excellent biomedical and mechanical properties, and hydroxyapatite (HAP) nanocomposites derived from SF are promising for producing “artificial bone” owing to their biomedical applicability and strong mechanical functions. Therefore, we built an SF coating on the surface of Ti–6Al–4V alloy, and then the incubated SF-coated Ti alloy were immersed in simulated body fluid to induce mineral deposition of HAP on the alloys. The results from Scanning Electron Microscopy (SEM), X-ray Diffraction (XRD) analysis, and Attenuated Total Reflection–Fourier Transform Infrared Spectroscopy (ATR–FTIR) confirmed the deposition of a mineral layer on the SF film surface. The proliferation, adhesion, and differentiation of MG-63 were tested, along with the BMP-2, COX-2, and OPG expression and protein content in the MG-63. Both Ti + SF and Ti + SF + HAP groups exhibited significantly better performance than a control Ti group with regard to the cell adhesion, cell proliferation, and protein expression. Furthermore, the hybrid layer comprising HAP and SF delivered more significant improvement of the osseointegration than the SF alone. It is hoped that the proposed methods can be used for constructing modified surfaces on Ti alloys, as they endowed the implants with good osteogenic potential.

Current Challenges and Innovative Developments in Hydroxyapatite-Based Coatings on Metallic Materials for Bone Implantation: A Review

Biomaterials are in use for the replacement and reconstruction of several tissues and organs as treatment and enhancement. Metallic, organic, and composites are some of the common materials currently in practice. Metallic materials contribute a big share of their mechanical strength and resistance to corrosion properties, while organic polymeric materials stand high due to their biocompatibility, biodegradability, and natural availability. To enhance the biocompatibility of these metals and alloys, coatings are frequently applied. Organic polymeric materials and ceramics are extensively utilized for this purpose due to their outstanding characteristics of biocompatibility and biodegradability. Hydroxyapatite (HAp) is the material from the ceramic class which is an ultimate candidate for coating on these metals for biomedical applications. HAp possesses similar chemical and structural characteristics to normal human bone. Due to the bioactivity and biocompatibility of HAp, it is used for bone implants for regenerating bone tissues. This review covers an extensive study of the development of HAp coatings specifically for the orthopaedic applications that include different coating techniques and the process parameters of these coating techniques. Additionally, the future direction and challenges have been also discussed briefly in this review, including the coating of HAp in combination with other calcium magnesium phosphates that occur naturally in human bone.