Antimicrobial and osteogenic effect of Ag-implanted titanium with a nanostructured surface

Biocompatible Nanostructured Silver-Incorporated Implant Surfaces Show Effective Antibacterial, Osteogenic, and Anti-Inflammatory Effects in vitro and in Rat Model

Introduction

Titanium (Ti) and its alloys are widely utilized in endosseous implants. However, their clinical efficacy is marred by complications arising from bacterial infections owing to their inadequate antibacterial properties. Consequently, enhancing the antibacterial attributes of implant surfaces stands as a pivotal objective in the realm of implantable materials research.

Methods

In this study, we employed sequential anodization and plasma immersion ion implantation (PIII) technology to fabricate a silver-embedded sparsely titania nanotube array (SNT) on the near-β titanium alloy Ti-5Zr-3Sn-5Mo-15Nb (TLM) implants. The surface characteristics, antimicrobial properties, biocompatibility, and osteogenic activity of the silver-nanomodified SNT implant (SNT Ag) surface, alongside peri-implant inflammatory responses, were meticulously assessed through a combination of in vitro and in vivo analyses.

Results

Compared with polished TLM and SNT, the silver-embedded SNT (SNT Ag) surface retained the basic shape of nanotubes and stably released Ag+ at the ppm level for a long time, which demonstrated an effective inhibition and bactericidal activity against Staphylococcus aureus (SA) while maintaining ideal cytocompatibility. Additionally, the subtle modifications in nanotubular topography induced by silver implantation endowed SNT Ag with enhanced osteogenic activity and mitigated inflammatory capsulation in soft tissue peri-implants in a rat model.

Conclusion

Incorporating a silver-embedded SNT array onto the implant surface demonstrated robust antibacterial properties, impeccable cytocompatibility, exceptional osteogenic activity, and the potential to prevent inflammatory encapsulation around the implant site. The Silver-PIII modification strategy emerges as a highly promising approach for surface applications in endosseous implants and trans-gingival implant abutments.

Metronidazole and Ketoprofen-Loaded Mesoporous Magnesium Carbonate for Rapid Treatment of Acute Periodontitis In Vitro

In the clinical pharmacological treatment of acute periodontitis, local periodontal administration is expected to be preferable to systemic administration. However, the action of the active medicine component is hindered and diminished by the limitation of drug solubility, which does not provide timely relief of the enormous pain being suffered by patients. This study aimed to develop a mesoporous magnesium carbonate (MMC) medicine loading system consisting of MMC, metronidazole (MET), and ketoprofen (KET), which was noted as MET-KET@MMC. A solvent evaporation process was utilized to load MET and KET in MMC. Scanning electron microscopy, nitrogen sorption, thermogravimetric analysis, and X-ray diffraction were performed on the MET-KET@MMC. The rapid drug release properties were also investigated through the drug release curve. The rapid antiseptic property against Porphyromonas gingivalis (P. gingivalis) and the rapid anti-inflammatory property (within 1 min) were analyzed in vitro. The cytotoxicity of MET-KET@MMC was tested in direct contact with human gingival cells and human oral keratinocytes. Crystallizations of MET and KET were completely suppressed in MMC. As compared to crystalline MET and KET, MMC induced higher apparent solubility and rapid drug release, resulting in 8.76 times and 3.43 times higher release percentages of the drugs, respectively. Over 70.11% of MET and 85.97% of KET were released from MMC within 1 min, resisting bacteria and reducing inflammation. MET-KET@MMC nanoparticles enhanced the solubility of drugs and possess rapid antimicrobial and anti-inflammatory properties. The MET-KET@MMC is a promising candidate for the pharmacotherapy of acute periodontitis with drugs, highlighting a significant clinical potential of MMC-based immediate drug release systems.

The effect of strontium content on physicochemical and osteogenic property of Sr/Ag-containing TiO2 microporous coatings

Strontium (Sr) is the most common element introduced into TiO₂ coatings to strengthen the osteogenic property of titanium implants. However, the optimal Sr content and its effect on osteogenic and physicochemical properties of the coatings need to be clarified. In the current study, TiO₂ microporous coatings with different contents of Sr (9.64-21.25 wt %) and silver (Ag) (0.38-0.75 wt %) were prepared via micro-arc oxidation technique. Sr contents did not change physicochemical properties of the coatings, including surface microstructure, micropore size and distribution, phase composition, roughness and hydrophilicity. Meanwhile, higher Sr contents (18.23-21.25 wt %) improved cytocompatibility, proliferation and alkaline phosphatase (ALP) activity of preosteoblasts, even the coatings underwent 30 days' PBS immersion. Furthermore, higher Sr contents facilitated preosteoblast growth and spreading, which are essential for their proliferation and osteogenic differentiation. Therefore, it is promising to incorporate higher Sr content (18.23-21.25 wt %) within TiO₂ microporous coatings to improve their osteogenic capability.

Single-Step Process for Titanium Surface Micro- and Nano-Structuring and In Situ Silver Nanoparticles Formation by Ultra-Short Laser Patterning

Ultra-short laser (USL)-induced surface structuring combined with nanoparticles synthesis by multiphoton photoreduction represents a novel single-step approach for commercially pure titanium (cp-Ti) surface enhancement. Such a combination leads to the formation of distinct topographical features covered by nanoparticles. The USL processing of cp-Ti in an aqueous solution of silver nitrate (AgNO3) induces the formation of micron-sized spikes surmounted by silver nanoparticles (AgNPs). The proposed approach combines the structuring and oxidation of the Ti surface and the synthesis of AgNPs in a one-step process, without the use of additional chemicals or a complex apparatus. Such a process is easy to implement, versatile and sustainable compared to alternative methodologies capable of obtaining comparable results. Antimicrobial surfaces on medical devices (e.g., surgical tools or implants), for which titanium is widely used, can be realized due to the simultaneous presence of AgNPs and micro/nano-structured surface topography. The processed surfaces were examined by means of a scanning electron microscope (SEM), energy-dispersive X-ray spectroscopy (EDX), atomic force microscopy (AFM) and Raman spectroscopy. The surface morphology and the oxidation, quality and quantity of AgNPs were analyzed in relation to process parameters (laser scanning speed and AgNO3 concentration), as well as the effect of AgNPs on the Raman signal of Titanium oxide.

Recent Advances in Copper-Doped Titanium Implants

Titanium (Ti) and its alloys have been extensively used as implant materials in clinical practice due to their high corrosion resistance, light weight and excellent biocompatibility. However, the insufficient intrinsic osteogenic capacity of Ti and its alloys impedes bone repair and regeneration, and implant-related infection or inflammation remains the leading cause of implant failure. Bacterial infections or inflammatory diseases constitute severe threats to human health. The physicochemical properties of the material are critical to the success of clinical procedures, and the doping of Cu into Ti implants has been confirmed to be capable of enhancing the bone repair/regeneration, angiogenesis and antibacterial capability. This review outlines the recent advances in the design and preparation of Cu-doped Ti and Ti alloy implants, with a special focus on various methods, including plasma immersion implantation, magnetron sputtering, galvanic deposition, microarc oxidation and sol-gel synthesis. More importantly, the antibacterial and mechanical properties as well as the corrosion resistance and biocompatibility of Cu-doped Ti implants from different methods are systematically reviewed, and their prospects and limitations are also discussed.

Corrosion resistance, nano-mechanical properties, and biocompatibility of Mg-plasma-implanted and plasma-etched Ta/TaN hierarchical multilayered coatings on the nitrided AZ91 Mg alloy

A tantalum/tantalum nitride (Ta/TaN) multilayered coating is deposited on plasma-nitridedAZ91 Mg alloy. The top TaN layer undergoes O₂+ Ar plasma etching to improve the antibacterial properties and Mg plasma immersion ion implantation (MgPIII) is performed to enhance the biocompatibility and wound healing capability. A uniform, compact, homogeneous, and columnar nanostructured MgPIII and plasma-etched TaN layer with a cluster size of about 17 nm, surface roughness of 0.28 nm, and needle morphology is observed. Although, plasma etching increases the corrosion current density (i_corr) from 0.02 to 0.19 µA cm^-2due to larger surface roughness and different potentials between sharp points and smooth points, MgPIII decreasesi_corrfrom 0.19 to 0.02 µA cm^-2besides a more positive corrosion potential. The amounts of Mg⁺²released to the simulated body fluid (SBF) diminishes from 89.63 ± 0.54 to 60.30 ± 0.47 mg l^-1cm^-2indicating improved corrosion resistance. Under fever conditions (40 °C),i_corrdecreases by 63%, but the open circuit potential does not change due to the constant chemical composition of the surface as well as thicker double layer and less defects, as confirmed by the larger amount of Mg⁺²of 71.49 ± 0.22 mg l^-1cm^-2leached to the SBF. In the self-healing process which occurs via the reactions between the tantalum intermediate layer and electrolytes and penetrating ions through the defects as well as formation of oxide compounds, creation and propagation of defects are deterred as shown the 24 h destructive polarization test in SBF. The combination of plasma etching and MgPIII enhance not only the bacterial resistance and biocompatibility of the super-hard TaN layer by providing the rougher surface on TaN-P-Mg, but also the nano-mechanical properties and anticorrosion properties. As a result, the hardness increases by 7%, elastic modulus decreases by 19%, and the stiffness increases by 21%.

Antibacterial Liquid Metals: Biofilm Treatment via Magnetic Activation

Antibiotic resistance has made the treatment of biofilm-related infections challenging. As such, the quest for next-generation antimicrobial technologies must focus on targeted therapies to which pathogenic bacteria cannot develop resistance. Stimuli-responsive therapies represent an alternative technological focus due to their capability of delivering targeted treatment. This study provides a proof-of-concept investigation into the use of magneto-responsive gallium-based liquid metal (LM) droplets as antibacterial materials, which can physically damage, disintegrate, and kill pathogens within a mature biofilm. Once exposed to a low-intensity rotating magnetic field, the LM droplets become physically actuated and transform their shape, developing sharp edges. When placed in contact with a bacterial biofilm, the movement of the particles resulting from the magnetic field, coupled with the presence of nanosharp edges, physically ruptures the bacterial cells and the dense biofilm matrix is broken down. The antibacterial efficacy of the magnetically activated LM particles was assessed against both Gram-positive and Gram-negative bacterial biofilms. After 90 min over 99% of both bacterial species became nonviable, and the destruction of the biofilms was observed. These results will impact the design of next-generation, LM-based biofilm treatments.

Tunable morphological changes of asymmetric titanium nanosheets with bactericidal properties

HYPOTHESIS

Titanium and titanium alloys are often the most popular choice of material for the manufacture of medical implants; however, they remain susceptible to the risk of device-related infection caused by the presence of pathogenic bacteria. Hydrothermal etching of titanium surfaces, to produce random nanosheet topologies, has shown remarkable ability to inactivate pathogenic bacteria via a physical mechanism. We expect that systematic tuning of the nanosheet morphology by controlling fabrication parameters, such as etching time, will allow for optimisation of the surface pattern for superior antibacterial efficacy.

EXPERIMENTS

Using time-dependent hydrothermal processing of bulk titanium, we fabricated bactericidal nanosheets with variable nanoedge morphologies according to a function of etching time. A systematic study was performed to compare the bactericidal efficiency of nanostructured titanium surfaces produced at 0.5, 1, 2, 3, 4, 5, 6, 24 and 60 h of hydrothermal etching.

FINDINGS

Titanium surfaces hydrothermally treated for a period of 6 h were found to achieve maximal antibacterial efficiency of 99 ± 3% against Gram-negative Pseudomonas aeruginosa and 90 ± 9% against Gram-positive Staphylococcus aureus bacteria, two common human pathogens. These surfaces exhibited nanosheets with sharp edges of approximately 10 nm. The nanotopographies presented in this work exhibit the most efficient mechano-bactericidal activity against both Gram-negative and Gram-positive bacteria of any nanostructured titanium topography reported thus far.

Antibacterial and Cytocompatible Nanoengineered Silk-Based Materials for Orthopedic Implants and Tissue Engineering

Many postsurgical complications stem from bacteria colony formation on the surface of implants, but the usage of antibiotic agents may cause antimicrobial resistance. Therefore, there is a strong demand for biocompatible materials with an intrinsic antibacterial resistance not requiring extraneous chemical agents. In this study, homogeneous nanocones were fabricated by oxygen plasma etching on the surface of natural, biocompatible Bombyx mori silk films. The new hydroxyl bonds formed on the surface of the nanopatterned film by plasma etching increased the surface energy by around 176%. This hydrophilic nanostructure reduced the bacterial attachment by more than 90% for both Gram-negative (Escherichia coli) and Gram-positive (Staphylococcus aureus) bacteria and at the same time improved the proliferation of osteoblast cells by 30%. The nanoengineered substrate and pristine silk were cultured for 6 h with three different bacteria concentrations of 10⁷, 10⁵, and 10³ CFU mL^-1 and the cell proliferation on the nanopatterned samples was significantly higher due to limited bacteria attachment and prevention of biofilm formation. The concept and materials described here reveal a promising alternative to produce biomaterials with an inherent biocompatibility and bacterial resistance simultaneously to mitigate postsurgical infections and minimize the use of antibiotics.

Investigation of silver nanoparticles on titanium surface created by ion implantation technology

Objectives: Using dental Ti implants has become a well-accepted and used method for replacing missing dentition. It has become evident that in many cases peri-implant inflammation develops. The objective was to create and evaluate the antibacterial effect of silver nanoparticle (Ag-NP) coated Ti surfaces that can help to prevent such processes if applied on the surface of dental implants.

Methods: Annealing I, Ag ion implantation by the beam of an Electron Cyclotron Resonance Ion Source (ECRIS), Ag Physical Vapor Deposition (PVD), Annealing II procedures were used, respectively, to create a safely anchored Ag-NP layer on 1x1 cm² Grade 2 titanium samples. The antibacterial effect was evaluated by culturing Staphylococcus aureus (ATCC 29213) on the surfaces of the samples for 8 hours, and comparing the results to that of glass as control and of pure titanium samples. Alamar Blue assay was carried out to check cytotoxicity.

Results: It was proved that silver nanoparticles were present on the treated surfaces. The average diameter of the particles was 58 nm, with a 25 nm deviation and Gaussian distribution, the the filling factor was 25%. Antibacterial evaluation revealed that the nanoparticle covered samples had an antibacterial effect of 64.6% that was statistically significant. Tests also proved that the nanoparticles are safely anchored to the titanium surface and are not cytotoxic.

Conclusion: Creating a silver nanoparticle layer can be an option to add antibacterial features to the implant surface and to help in the prevention of peri-implant inflammatory processes. Recent studies demonstrated that silver nanoparticles can induce pathology in mammal cells, thus safe fixation of the particles is essential to prevent them from getting into the circulation.

In vitro study on cytocompatibility and osteogenesis ability of Ti-Cu alloy

Titanium implants easily suffer bacteria-related infections in clinic due to their inherent lack of self-protection ability. Therefore, a novel Ti-Cu alloy with good antibacterial activity has been developed as a new kind of implant material. This study focuses on a systematic evaluation of both cytocompatibility and osteogenesis activity of the Ti-Cu alloy in vitro. It was revealed that an addition of 5% Cu into pure Ti would not cause any negative effect on osteoblasts adhesion, proliferation and apoptosis cultured with Ti-Cu alloy. In addition, Ti-Cu alloy could significantly promote the osteogenic differentiation of MG 63 cells by upregulating the osteogenesis-related gene expressions including alkaline phosphatase (ALP), Collagen I (Colla I), osteopontin (OPN) and osteocalcin (OCN). These promising results suggest that the Ti-Cu alloy has great potential to be used as a multi-functional titanium implant for clinical applications.

The antibacterial effect of non-thermal atmospheric pressure plasma treatment of titanium surfaces according to the bacterial wall structure

Titanium is commonly used as a biomaterial for dental implants. In this study, we investigated the antibacterial properties of titanium samples following treatment with a non-thermal atmospheric pressure plasma jet (NTAPPJ) on bacteria with two different cell wall structures, including gram-positive and gram-negative bacteria. The hydrophilicity and surface energy of titanium surfaces were significantly increased after NTAPPJ treatment without altering topographical features. Changes in the chemical composition and reductive potential were observed on the NTAPPJ-treated titanium surfaces. The adhesion and biofilm formation rate of bacteria were significantly reduced on the NTAPPJ-treated titanium surfaces compared with the untreated samples, which was confirmed by fluorescent imaging. Regarding the comparison between gram-positive and gram-negative bacteria, both adhesion and the biofilm formation rate were significantly lower for gram-negative bacteria than gram-positive bacteria on samples treated for longer durations with the NTAPPJ. Transmission electron microscopy imaging showed a comparably more disruptive membrane structure of gram-negative bacteria than gram-positive bacteria on the NTAPPJ-treated surfaces. Our results indicated that the NTAPPJ treatment could be useful for preventing bacterial adhesion and biofilm formation on titanium dental implant surfaces, while the reductive potential on surfaces treated by the NTAPPJ could cause oxidation of bacteria, which could be more sensitive to gram-negative bacteria due to differences in the cell wall structure.

Biocompatibility evaluation of antibacterial Ti-Ag alloys with nanotubular coatings

BACKGROUND

Implant-related infection is a major problem postsurgery. As an alternative to a localized antibiotic release system, we used Ag to fabricate Ti-Ag alloys with nanotubular coatings (TiAg-NTs). Ag has excellent antibacterial properties, but its biological toxicity is a concern. Therefore, we performed biological experiments both in vitro and in vivo to evaluate the biocompatibility of TiAg-NTs with different concentrations of Ag (1%, 2%, and 4%).

METHODS

For in vitro experiments, cytocompatibility, including cell attachment, viability, and proliferation, was tested, and genes and proteins related to osteogenic differentiation were also evaluated. For in vivo assays, the rat femoral condylar insertion model was used, and micro-computed tomography (micro-CT) and histological analysis were conducted to analyze bone formation around implants at 1, 2, and 4 weeks after surgery.

RESULTS

Both in vitro and in vivo results indicate that Ti2%Ag-NT showed comparable cytocompatibility with commercially pure Ti (cp-Ti), and it could achieve good osseointegration with the surrounding bone tissue.

CONCLUSION

We thus believe that Ti2%Ag-NT is a potential biomaterial for orthopedics.

Effects on cytotoxicity and antibacterial properties of the incorporations of silver nanoparticles into the surface coating of dental alloys

The aim of this study was to research the changes in cytotoxicity and antibacterial properties after silver nanoparticles (AgNPs) were incorporated into the surface coating of dental alloys. AgNPs were attached to cobalt chromium alloys and pure titanium using a hydrothermal method, according to the reaction: AgNO₃+NaBH₄→ Ag+1/2H₂+1/2B₂H₆+NaNO₃. A 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay was used to evaluate the cytotoxicity of the alloys when in contact with osteogenic precursor cells (MC3T3-E1) from mice and mesenchymal stem cells (BMSC) from rats. The antibacterial properties of dental alloys incorporating three different concentrations (10, 4, and 2 μmol/L) of AgNPs were tested on Staphylococcus aureus (SA) and Streptococcus mutans (MS). High cytotoxicity values were observed for all dental alloys that contained 0% of AgNPs (the control groups). The incorporation of AgNPs reduced cytotoxicity values. No significant difference was observed for antibacterial performance when comparing dental alloys containing AgNPs to the respective control groups. The results demonstrated that the cobalt chromium alloys and pure titanium all had cytotoxicity to MC3T3-E1 and BMSC and that the incorporation of AgNPs could reduce this cytotoxicity. The concentrations of AgNPs adopted in this study were found to have no antibacterial action against SA or MS.

Potential antibacterial mechanism of silver nanoparticles and the optimization of orthopedic implants by advanced modification technologies

Infection, as a common postoperative complication of orthopedic surgery, is the main reason leading to implant failure. Silver nanoparticles (AgNPs) are considered as a promising antibacterial agent and always used to modify orthopedic implants to prevent infection. To optimize the implants in a reasonable manner, it is critical for us to know the specific antibacterial mechanism, which is still unclear. In this review, we analyzed the potential antibacterial mechanisms of AgNPs, and the influences of AgNPs on osteogenic-related cells, including cellular adhesion, proliferation, and differentiation, were also discussed. In addition, methods to enhance biocompatibility of AgNPs as well as advanced implants modifications technologies were also summarized.

Osteoinductivity and Antibacterial Properties of Strontium Ranelate-Loaded Poly(Lactic-co-Glycolic Acid) Microspheres With Assembled Silver and Hydroxyapatite Nanoparticles

Bone-related infection rates are 4–64% in long open bone fractures and nearly 1% in joint-related surgeries. Treating bone infections and infection-related bone loss is very important. The present study prepared strontium ranelate (SR)-loaded poly(lactic-co-glycolic acid) (PLGA) microspheres (PM) with assembled silver nanoparticles (AgNPs) and hydroxyapatite nanoparticles (HANPs) (SR-PM-Ag-HA) through a novel solid-in-oil nanosuspension (S/O/N) method to achieve osteoinductivity and antibacterial properties. We evaluated the microstructure, drug release, biocompatibility, osteoinductivity, and antibacterial activity in vitro. The microspheres showed a stable shape and size. The cumulative drug release reached a maximum of ∼90% after 22 days. All groups loaded with SR enhanced MC3T3-E1 cell proliferation to a greater degree than pure PM. The osteoinductivity behavior was investigated by ALP staining and real-time PCR of osteogenic differentiation marker genes. The antibacterial activity was evaluated using antibacterial ability and biofilm formation assays. SR-PM-Ag-HA greatly enhanced osteogenic differentiation and showed excellent antibacterial properties. These results indicated that SR-PM-Ag-HA could be biocompatible and suitable for drug delivery, osteoinduction, and antibiosis, and therefore, have potential applications in the treatment of bone-related infections and promotion of bone formation at infected sites.

The relationship between substrate morphology and biological performances of nano-silver-loaded dopamine coatings on titanium surfaces

Biomedical device-associated infection (BAI) and lack of osseointegration are the main causes of implant failure. Therefore, it is imperative for implants not only to depress microbial activity and biofilm colonization but also to prompt osteoblast functions and osseointegration. As part of the coating development for implants, the interest of in vitro studies on the interaction between implant substrate morphology and the coating's biological performances is growing. In this study, by harnessing the adhesion and reactivity of bioinspired polydopamine, nano-silver was successfully anchored onto micro/nanoporous as well as smooth titanium surfaces to analyse the effect of substrate morphology on biological performances of the coatings. Compared with the smooth surface, a small size of nano-silver and high silver content was found on the micro/nanoporous surface. More mineralization happened on the coating on the micro/nanoporous structure than on the smooth surface, which led to a more rapid decrease of silver release from the micro/nanoporous surface. Antimicrobial tests indicated that both surfaces with resulting coating inhibit microbial colonization on them and growth around them, indicating that the coating eliminates the shortcoming of the porous structure which render the implant extremely susceptible to BAI. Besides, the multiple osteoblast responses of nano-silver-loaded dopamine coatings on both surfaces, i.e. attachment, proliferation and differentiation, have deteriorated, however the mineralized surfaces of these coatings stimulated osteoblast proliferation and differentiation, especially for the micro/nanoporous surface. Therefore, nano-silver-loaded dopamine coatings on micro/nanoporous substratum may not only reduce the risk of infection but also facilitate mineralization during the early post-operative period and then promote osseointegration owing to the good osteoblast-biocompatibility of the mineralized surface. These results clearly highlight the influence of the substrate morphology on the biological performances of implant coating.

An effective treatment of experimental osteomyelitis using the antimicrobial titanium/silver-containing nHP66 (nano-hydroxyapatite/polyamide-66) nanoscaffold biomaterials

Effective treatment of osteomyelitis remains a formidable clinical challenge. The rapid emergence of multidrug-resistant bacteria has renewed interest in developing antimicrobial biomaterials using antiseptic silver ions to treat osteomyelitis. However, inadequate local retention and severe cytotoxic effects have limited the clinical use of ionic silver for bone grafts. We recently developed novel porous nano-hydroxyapatite/polyamide 66 (nHP66)-based nanoscaffold materials containing varied concentrations of silver ions (Ag⁺) (TA-nHAPA66) and oxidized titanium (TiO₂), which was added as a second binary element to enhance antibacterial activity and biocompatibility. In this study, we establish a large cohort of rabbit model of experimental osteomyelitis and investigate the in vivo antimicrobial and therapeutic effects of TA-nHP66 biomaterials and their in vivo silver release kinetics. We find the TA-nHP66 scaffolds exhibit potent antibacterial activities against E. coli and S. aureus, support cell adhesion and cell proliferation of pre-osteoblasts, and stimulate osteogenic regulator/marker expression. Moreover, the TA2-nHP66 scaffold exerts potent antibacterial/anti-inflammation effects in vivo and promotes bone formation at the lesion site of osteomyelitis. We further demonstrate that TA2-nHP66 exhibits excellent biosafety profile without apparent systemic toxicities. Therefore, the TA-nHP66 scaffold biomaterials may be further explored as an effective adjuvant therapy for infected bone defects and/or osteomyelitis debridement.

Antibacterial abilities and biocompatibilities of Ti-Ag alloys with nanotubular coatings

Purpose

To endow implants with both short- and long-term antibacterial activities without impairing their biocompatibility, novel Ti–Ag alloy substrates with different proportions of Ag (1, 2, and 4 wt% Ag) were generated with nanotubular coverings (TiAg-NT).

Methods

Unlike commercial pure Ti and titania nanotube, the TiAg-NT samples exhibited short-term antibacterial activity against Staphylococcus aureus (S. aureus), as confirmed by scanning electron microscopy and double staining with SYTO 9 and propidium iodide. A film applicator coating assay and a zone of inhibition assay were performed to investigate the long-term antibacterial activities of the samples. The cellular viability and cytotoxicity were evaluated through a Cell Counting Kit-8 assay. Annexin V-FITC/propidium iodide double staining was used to assess the level of MG63 cell apoptosis on each sample.

Results

All of the TiAg-NT samples, particularly the nanotube-coated Ti–Ag alloy with 2 wt% Ag (Ti2%Ag-NT), could effectively inhibit bacterial adhesion and kill the majority of adhered S. aureus on the first day of culture. Additionally, the excellent antibacterial abilities exhibited by the TiAg-NT samples were sustained for at least 30 days. Although Ti2%Ag-NT had less biocompatibility than titania nanotube, its performance was satisfactory, as demonstrated by the higher cellular viability and lower cell apoptosis rate obtained with it compared with those achieved with commercial pure Ti. The Ti1%Ag-NT and Ti4%Ag-NT samples did not yield good cell viability.

Conclusion

This study indicates that the TiAg-NT samples can prevent biofilm formation and maintain their antibacterial ability for at least 1 month. Ti2%Ag-NT exhibited better antibacterial ability and biocompatibility than commercial pure Ti, which could be attributed to the synergistic effect of the presence of Ag (2 wt%) and the morphology of the nanotubes. Ti2%Ag-NT may offer a potential implant material that is capable of preventing implant-related infection.

Antibacterial effect of copper-bearing titanium alloy (Ti-Cu) against Streptococcus mutans and Porphyromonas gingivalis

Formation of bacterial biofilms on dental implant material surfaces (titanium) may lead to the development of peri-implant diseases influencing the long term success of dental implants. In this study, a novel Cu-bearing titanium alloy (Ti-Cu) was designed and fabricated in order to efficiently kill bacteria and discourage formation of biofilms, and then inhibit bacterial infection and prevent implant failure, in comparison with pure Ti. Results from biofilm based gene expression studies, biofilm growth observation, bacterial viability measurements and morphological examination of bacteria, revealed antimicrobial/antibiofilm activities of Ti-Cu alloy against the oral specific bacterial species, Streptococcus mutans and Porphyromonas gingivalis. Proliferation and adhesion assays with mesenchymal stem cells, and measurement of the mean daily amount of Cu ion release demonstrated Ti-Cu alloy to be biocompatible. In conclusion, Ti-Cu alloy is a promising dental implant material with antimicrobial/antibiofilm activities and acceptable biocompatibility.

Antibacterial Activity of Silver Doped Titanate Nanowires on Ti Implants

A nanostructured film composed of one-dimensional titanate nanowires (TNWs) was employed as a carrier of Ag nanoparticles and chitosan (CS) to improve the surface antibacterial activity and biocompatibility of titanium implants. A TNWs film was produced on a Ti substrate by an alkali hydrothermal reaction and subsequently doped by Ag nanoparticles through an ultraviolet light chemical reduction. The CS nanofilm was deposited on the Ag nanoparticles through a spin-assisted layer by layer assembly method. The results disclosed that Ag nanoparticles were successfully carried by TNWs and homogeneously distributed on the entire surface. Moreover, a CS nanofilm was also successfully deposited on the Ag nanoparticles. Antibacterial tests showed that the samples modified with a higher initial concentration of AgNO3 solution exhibited better antibacterial activity, and that a CS nanofilm could further improve the antibacterial activity of the TNWs. Cell viability and ALP tests revealed that the release of Ag(+) was detrimental for the growth, proliferation, and differentiation of MC3T3, and that CS could lower the negative effects of Ag gradually as the incubation time increased.

Antimicrobial technology in orthopedic and spinal implants

Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines orthopedic implant antimicrobial technology, its current applications and supporting evidence, and clinically promising future directions.

Antibacterial Surface Design of Titanium-Based Biomaterials for Enhanced Bacteria-Killing and Cell-Assisting Functions Against Periprosthetic Joint Infection

Periprosthetic joint infection (PJI) is one of the formidable and recalcitrant complications after orthopedic surgery, and inhibiting biofilm formation on the implant surface is considered crucial to prophylaxis of PJI. However, it has recently been demonstrated that free-floating biofilm-like aggregates in the local body fluid and bacterial colonization on the implant and peri-implant tissues can coexist and are involved in the pathogenesis of PJI. An effective surface with both contact-killing and release-killing antimicrobial capabilities can potentially abate these concerns and minimize PJI caused by adherent/planktonic bacteria. Herein, Ag nanoparticles (NPs) are embedded in titania (TiO2) nanotubes by anodic oxidation and plasma immersion ion implantation (PIII) to form a contact-killing surface. Vancomycin is then incorporated into the nanotubes by vacuum extraction and lyophilization to produce the release-killing effect. A novel clinical PJI model system involving both in vitro and in vivo use of methicillin-resistant Staphylococcus aureus (MRSA) ST239 is established to systematically evaluate the antibacterial properties of the hybrid surface against planktonic and sessile bacteria. The vancomycin-loaded and Ag-implanted TiO2 nanotubular surface exhibits excellent antimicrobial and antibiofilm effects against planktonic/adherent bacteria without appreciable silver ion release. The fibroblasts/bacteria cocultures reveal that the surface can help fibroblasts to combat bacteria. We first utilize the nanoarchitecture of implant surface as a bridge between the inorganic bactericide (Ag NPs) and organic antibacterial agent (vancomycin) to achieve total victory in the battle of PJI. The combination of contact-killing and release-killing together with cell-assisting function also provides a novel and effective strategy to mitigate bacterial infection and biofilm formation on biomaterials and has large potential in orthopedic applications.

Antimicrobial Drugs in Fighting against Antimicrobial Resistance

The outbreak of antimicrobial resistance, together with the lack of newly developed antimicrobial drugs, represents an alarming signal for both human and animal healthcare worldwide. Selection of rational dosage regimens for traditional antimicrobial drugs based on pharmacokinetic/pharmacodynamic principles as well as development of novel antimicrobials targeting new bacterial targets or resistance mechanisms are key approaches in tackling AMR. In addition to the cellular level resistance (i.e., mutation and horizontal gene transfer of resistance determinants), the community level resistance (i.e., bilofilms and persisters) is also an issue causing antimicrobial therapy difficulties. Therefore, anti-resistance and antibiofilm strategies have currently become research hotspot to combat antimicrobial resistance. Although metallic nanoparticles can both kill bacteria and inhibit biofilm formation, the toxicity is still a big challenge for their clinical applications. In conclusion, rational use of the existing antimicrobials and combinational use of new strategies fighting against antimicrobial resistance are powerful warranties to preserve potent antimicrobial drugs for both humans and animals.

Osteogenic response and osteoprotective effects in vivo of a nanostructured titanium surface with antibacterial properties

In implantology, as an alternative approach to the use of antibiotics, direct surface modifications of the implant addressed to inhibit bacterial adhesion and to limit bacterial proliferation are a promising tactic. The present study evaluates in an in vivo normal model the osteogenic response and the osteointegration of an anodic spark deposition nanostructured titanium surface doped with gallium (ASD + Ga) in comparison with two other surface treatments of titanium: an anodic spark deposition treatment without gallium (ASD) and an acid etching treatment (CTR). Moreover the study assesses the osteoprotective potential and the antibacterial effect of the previously mentioned surface treatments in an experimentally-induced peri-implantitis model. The obtained data points out a more rapid primary fixation in ASD and ASD + Ga implants, compared with CTR surface. Regarding the antibacterial properties, the ASD + Ga surface shows osteoprotective action on bone peri-implant tissue in vivo as well as an antibacterial effect within the first considered time point.

Performance evaluation of nanoclay enriched anti-microbial hydrogels for biomedical applications

A major factor contributing to the failure of orthopedic and orthodontic implants is post-surgical infection. Coating metallic implant surfaces with anti-microbial agents has shown promise but does not always prevent the formation of bacterial biofilms. Furthermore, breakdown of these coatings within the human body can cause release of the anti-microbial drugs in an uncontrolled or unpredictable fashion. In this study, we used a calcium alginate and calcium phosphate cement (CPC) hydrogel composite as the base material and enriched these hydrogels with the anti-microbial drug, gentamicin sulfate, loaded within a halloysite nanotubes (HNTs). Our results demonstrate a sustained and extended release of gentamicin from hydrogels enriched with the gentamicin-loaded HNTs. When tested against the gram-negative bacteria, the hydrogel/nanoclay composites showed a pronounced zone of inhibition suggesting that anti-microbial doped nanoclay enriched hydrogels can prevent the growth of bacteria. The release of gentamicin sulfate for a period of five days from the nanoclay-enriched hydrogels would supply anti-microbial agents in a sustained and controlled manner and assist in preventing microbial growth and biofilm formation on the titanium implant surface. A pilot study, using mouse osteoblasts, confirmed that the nanoclay enriched surfaces are also cell supportive as osteoblasts readily, proliferated and produced a type I collagen and proteoglycan matrix.

Hierarchical micro/nanostructured titanium with balanced actions to bacterial and mammalian cells for dental implants

A versatile strategy to endow dental implants with long-term antibacterial ability without compromising the cytocompatibility is highly desirable to combat implant-related infection. Silver nanoparticles (Ag NPs) have been utilized as a highly effective and broad-spectrum antibacterial agent for surface modification of biomedical devices. However, the high mobility and subsequent hazardous effects of the particles on mammalian cells may limit its practical applications. Thus, Ag NPs were immobilized on the surface of sand-blasted, large grit, and acid-etched (SLA) titanium by manipulating the atomic-scale heating effect of silver plasma immersion ion implantation. The silver plasma immersion ion implantation-treated SLA surface gave rise to both good antibacterial activity and excellent compatibility with mammalian cells. The antibacterial activity rendered by the immobilized Ag NPs was assessed using Fusobacterium nucleatum and Staphylococcus aureus, commonly suspected pathogens for peri-implant disease. The immobilized Ag NPs offered a good defense against multiple cycles of bacteria attack in both F. nucleatum and S. aureus, and the mechanism was independent of silver release. F. nucleatum showed a higher susceptibility to Ag NPs than S. aureus, which might be explained by the presence of different wall structures. Moreover, the immobilized Ag NPs had no apparent toxic influence on the viability, proliferation, and differentiation of rat bone marrow mesenchymal stem cells. These results demonstrated that good bactericidal activity could be obtained with very small quantities of immobilized Ag NPs, which were not detrimental to the mammalian cells involved in the osseointegration process, and promising for titanium-based dental implants with commercial SLA surfaces.

Antimicrobial properties of nanomolecules: potential candidates as antibiotics in the era of multi-drug resistance

OBJECTIVES

The emergence of multi-drug resistance among various microbial pathogens has been a cause of serious concern to the medical world, limiting the choice of antibiotics. Considering that it may take decades to synthesize new antimicrobial drugs that combat resistant pathogens, the search for alternatives to conventional antimicrobial agents has begun.

METHODS

In his paper we attempted to review the physico-chemical properties of nanoparticles, their modes of action and potential use in medicine and research with special reference to antimicrobial properties.

RESULTS

Nanomolecules and nanoparticles have in recent years been extensively studied for their utility not only as antibiotics but also as vehicles to carry antibiotics or other agents such as cancer chemotherapeutics to target sites and limit damage to host cells.

CONCLUSION

Nanomolecules were positively evaluated for their antimicrobial activities. Anti-biofilm activities of nanoparticles, utility of nanomaterials as carrier agents of drugs signifies their importance in medicine and research.

Antibacterial Activity of As-Annealed TiO2 Nanotubes Doped with Ag Nanoparticles against Periodontal Pathogens

It is important to develop functional transmucosal implant surfaces that reduce the number of initially adhering bacteria and they need to be modified to improve the anti-bacterial performance. Commercially pure Ti sheets were anodized in an electrolyte containing ethylene glycol, distilled water and ammonium fluoride at room temperature to produce TiO₂ nanotubes. These structures were then annealed at 450°C to transform them to anatase. As-annealed TiO₂ nanotubes were then treated in an electrolyte containing 80.7 g/L NiSO₄·7H₂O, 41 g/L MgSO₄·7H₂O, 45 g/L H₃BO₃, and 1.44 g/L Ag₂SO₄ at 20°C by the application of 9 V AC voltage for doping them with silver. As-annealed TiO₂ nanotubes and as-annealed Ag doped TiO₂ nanotubes were evaluated by SEM, FESEM, and XRD. Antibacterial activity was assessed by determining the adherence of A. actinomycetemcomitans, T. forsythia, and C. rectus to the surface of the nanotubes. Bacterial morphology was examined using an SEM. As-annealed Ag doped TiO₂ nanotubes revealed intense peak of Ag. Bacterial death against the as-annealed Ag doped TiO₂ nanotubes were detected against A. actinomycetemcomitans, T. forsythia, and C. rectus indicating antibacterial efficacy.

Calcium and zinc containing bactericidal glass coatings for biomedical metallic substrates

The present work presents new bactericidal coatings, based on two families of non-toxic, antimicrobial glasses belonging to B₂O₃–SiO₂–Na₂O–ZnO and SiO₂–Na₂O–Al₂O₃–CaO–B₂O₃ systems. Free of cracking, single layer direct coatings on different biomedical metallic substrates (titanium alloy, Nb, Ta, and stainless steel) have been developed. Thermal expansion mismatch was adjusted by changing glass composition of the glass type, as well as the firing atmosphere (air or Ar) according to the biomedical metallic substrates. Formation of bubbles in some of the glassy coatings has been rationalized considering the reactions that take place at the different metal/coating interfaces. All the obtained coatings were proven to be strongly antibacterial versusEscherichia coli (>4 log).

Existence, release, and antibacterial actions of silver nanoparticles on Ag-PIII TiO₂ films with different nanotopographies

Nanotopographical TiO₂ films (including nanorod, nanotip, and nanowire topographies) were successfully fabricated on the metallic Ti surface via hydrothermal treatment and then underwent Ag plasma immersion ion implantation to incorporate Ag with TiO₂. The surface morphology, phase component, and chemical composition before and after Ag-PIII were characterized. In view of the potential clinical applications, both Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus were used to estimate their antimicrobial effect. The nanostructured TiO₂ films on a Ti surface exhibit a better bacteriostatic effect on both microbes compared to the pristine Ti. The nanotopographies of the TiO₂ films affect the nucleation, growth, and distribution of Ag nanoparticles in the films during Ag-PIII process. The Ag nanoparticles are completely embedded into the nanorod film while partially exposed out of the nanotip and nanowire films, which account for the significant differences in the release behaviors of Ag ions in vitro. However, no significant difference exists in their antimicrobial activity against both microbes. The antimicrobial actions of the Ag@TiO₂ system described here consist of two methods - the contact-killing action and the release-killing action. Nevertheless, based on the observed results, the contact-killing action should be regarded as the main method to destroy microbes for all the Ag plasma-modified TiO₂ nanofilms. This study provides insight to optimize the surface design of Ti-based implants to acquire more effective antimicrobial surfaces to meet clinical applications.

Surface modification of titanium substrates with silver nanoparticles embedded sulfhydrylated chitosan/gelatin polyelectrolyte multilayer films for antibacterial application

To develop Ti implants with potent antibacterial activity, a novel "sandwich-type" structure of sulfhydrylated chitosan (Chi-SH)/gelatin (Gel) polyelectrolyte multilayer films embedding silver (Ag) nanoparticles was coated onto titanium substrate using a spin-assisted layer-by-layer assembly technique. Ag ions would be enriched in the polyelectrolyte multilayer films via the specific interactions between Ag ions and -HS groups in Chi-HS, thus leading to the formation of Ag nanoparticles in situ by photo-catalytic reaction (ultraviolet irradiation). Contact angle measurement and field emission scanning electron microscopy equipped with energy dispersive X-ray spectroscopy were employed to monitor the construction of Ag-containing multilayer on titanium surface, respectively. The functional multilayered films on titanium substrate [Ti/PEI/(Gel/Chi-SH/Ag) n /Gel] could efficiently inhibit the growth and activity of Bacillus subtitles and Escherichia coli onto titanium surface. Moreover, studies in vitro confirmed that Ti substrates coating with functional multilayer films remained the biological functions of osteoblasts, which was reflected by cell morphology, cell viability and ALP activity measurements. This study provides a simple, versatile and generalized methodology to design functional titanium implants with good cyto-compatibility and antibacterial activity for potential clinical applications.

Magnesium ion implantation on a micro/nanostructured titanium surface promotes its bioactivity and osteogenic differentiation function

As one of the important ions associated with bone osseointegration, magnesium was incorporated into a micro/nanostructured titanium surface using a magnesium plasma immersion ion-implantation method. Hierarchical hybrid micro/nanostructured titanium surfaces followed by magnesium ion implantation for 30 minutes (Mg30) and hierarchical hybrid micro/nanostructured titanium surfaces followed by magnesium ion implantation for 60 minutes (Mg60) were used as test groups. The surface morphology, chemical properties, and amount of magnesium ions released were evaluated by field-emission scanning electron microscopy, energy dispersive X-ray spectroscopy, field-emission transmission electron microscopy, and inductively coupled plasma-optical emission spectrometry. Rat bone marrow mesenchymal stem cells (rBMMSCs) were used to evaluate cell responses, including proliferation, spreading, and osteogenic differentiation on the surface of the material or in their medium extraction. Greater increases in the spreading and proliferation ability of rBMMSCs were observed on the surfaces of magnesium-implanted micro/nanostructures compared with the control plates. Furthermore, the osteocalcin (OCN), osteopontin (OPN), and alkaline phosphatase (ALP) genes were upregulated on both surfaces and in their medium extractions. The enhanced cell responses were correlated with increasing concentrations of magnesium ions, indicating that the osteoblastic differentiation of rBMMSCs was stimulated through the magnesium ion function. The magnesium ion-implanted micro/nanostructured titanium surfaces could enhance the proliferation, spreading, and osteogenic differentiation activity of rBMMSCs, suggesting they have potential application in improving bone-titanium integration.