Surface Modification of Biomedical Titanium Alloy: Micromorphology, Microstructure Evolution and Biomedical Applications

Cold atmospheric plasma treated 3D printed polylactic acid film; application in thin film solid phase microextraction of anticancer drugs

Tyrosine Kinase Inhibitors (TKIs) represent a pharmacological category of targeted therapeutics deployed for the treatment of malignant pathologies. Considering the side effects of this class of drugs for humans, therapeutic drug monitoring (TDM) becomes important. Here, a novel and specific methodology is introduced for the quantification of two TKIs (dasatinib and erlotinib) in human plasma samples. Furthermore, this study investigates the successful application of 3D printer technology in analytical sample preparation methods. Employing a fused deposition modeling (FDM) 3D printer and polylactic acid (PLA) filament, adsorbent films were designed and produced to be utilized in thin film microextraction. The 3D printed polylactic acid film surface was modified using cold atmospheric plasma (CAP) as a fast, clean and dry surface modification method with low consumption of chemicals and energy. Subsequently, FESEM, AFM, ATR-FTIR, and WCA analysis studies were employed to effectively assess the efficacy of the plasma surface modification method for the 3D printed films. After the optimization of the plasma modification and extraction methods, human plasma samples were studied for the effectiveness of the aforementioned approach. So, the selected 3D printed films with excellent microextraction efficiency have been found to be effective in sample preparation of biological samples. The linear dynamic range (LDR), limit of detection (LOD) and limit of quantification (LOQ) were obtained 0.10-20 μgL-1, 0.03 μgL-1and 0.1 μgL-1 for dasatinib and 1.0-500 μgL-1, 0.3 μgL-1, and 1 μgL-1 for erlotinib. The results obtained indicate that the developed method proves to be successful in the effective separation of anticancer drugs.

A Knowledge Transfer Framework for General Alloy Materials Properties Prediction

Biomedical metal implants have many applications in clinical treatment. Due to a variety of application requirements, alloy materials with specific properties are being designed continuously. The traditional alloy properties testing experiment is faced with high-cost and time-consuming challenges. Machine learning can accurately predict the properties of materials at a lower cost. However, the predicted performance is limited by the material dataset. We propose a calculation framework of alloy properties based on knowledge transfer. The purpose of the framework is to improve the prediction performance of machine learning models on material datasets. In addition to assembling the experiment dataset, the simulation dataset is also generated manually in the proposed framework. Domain knowledge is extracted from the simulation data and transferred to help train experiment data by the framework. The high accuracy of the simulation data (above 0.9) shows that the framework can effectively extract domain knowledge. With domain knowledge, the prediction performance of experimental data can reach more than 0.8. And it is 10% higher than the traditional machine learning method. The explanatory ability of the model is enhanced with the help of domain knowledge. In addition, five tasks are applied to show the framework is a general method.

Progress in partially degradable titanium-magnesium composites used as biomedical implants

Titanium-magnesium composites have gained increasing attention as a partially degradable biomaterial recently. The titanium-magnesium composite combines the bioactivity of magnesium and the good mechanical properties of titanium. Here, we discuss the limitations of conventional mechanically alloyed titanium-magnesium alloys for bioimplants, in addition we summarize three suitable methods for the preparation of titanium-magnesium composites for bioimplants by melt: infiltration casting, powder metallurgy and hot rotary swaging, with a description of the advantages and disadvantages of all three methods. The titanium-magnesium composites were comprehensively evaluated in terms of mechanical properties and degradation behavior. The feasibility of titanium-magnesium composites as bio-implants was reviewed. In addition, the possible future development of titanium-magnesium composites was discussed. Thus, this review aims to build a conceptual and practical toolkit for the design of titanium-magnesium composites capable of local biodegradation.

Additively manufactured metallic biomaterials

Metal additive manufacturing (AM) has led to an evolution in the design and fabrication of hard tissue substitutes, enabling personalized implants to address each patient's specific needs. In addition, internal pore architectures integrated within additively manufactured scaffolds, have provided an opportunity to further develop and engineer functional implants for better tissue integration, and long-term durability. In this review, the latest advances in different aspects of the design and manufacturing of additively manufactured metallic biomaterials are highlighted. After introducing metal AM processes, biocompatible metals adapted for integration with AM machines are presented. Then, we elaborate on the tools and approaches undertaken for the design of porous scaffold with engineered internal architecture including, topology optimization techniques, as well as unit cell patterns based on lattice networks, and triply periodic minimal surface. Here, the new possibilities brought by the functionally gradient porous structures to meet the conflicting scaffold design requirements are thoroughly discussed. Subsequently, the design constraints and physical characteristics of the additively manufactured constructs are reviewed in terms of input parameters such as design features and AM processing parameters. We assess the proposed applications of additively manufactured implants for regeneration of different tissue types and the efforts made towards their clinical translation. Finally, we conclude the review with the emerging directions and perspectives for further development of AM in the medical industry.

A review on magnesium alloys for biomedical applications

Magnesium (Mg) and Mg alloys are considered as potential candidates for biomedical applications because of their high specific strength, low density, and elastic modulus, degradability, good biocompatibility and biomechanical compatibility. However, the rapid corrosion rate of Mg alloys results in premature loss of mechanical integrity, limiting their clinical application in load-bearing parts. Besides, the low strength of Mg alloys restricts their further application. Thus, it is essential to understand the characteristics and influencing factors of mechanical and corrosion behavior, as well as the methods to improve the mechanical performances and corrosion resistance of Mg alloys. This paper reviews the recent progress in elucidating the corrosion mechanism, optimizing the composition, and microstructure, enhancing the mechanical performances, and controlling the degradation rate of Mg alloys. In particular, the research progress of surface modification technology of Mg alloys is emphasized. Finally, the development direction of biomedical Mg alloys in the future is prospected.

Study on Corrosion Resistance and Biological Properties of the Double Glow Plasma Nb-Zr Biological Implantation Alloying Layers

In order to improve the corrosion resistance of implant materials and understand the corrosion mechanisms, we prepared a biomedical Nb-Zr alloying layer on 316L stainless steel using double-layer glow plasma surface-alloying technology and investigated the effects of gas pressures on its surface structure, mechanical properties, and corrosion behavior. In particular, the surface states of the substrate and alloying layers were investigated using 3D confocal micrographs, the water contact angle, and UV reflectance, which aims to study the effect of the surface quality on corrosion resistance and discuss the corrosion mechanisms. The results show that the working pressure has an effect on the current density, the sputtering amount of the alloying elements, and the diffusion process of the alloying elements during glow discharge. The Nb-Zr alloying layer prepared under a pressure of 40 Pa had a uniform and dense surface structure, and the distribution was island-like. A Nb-Zr alloying layer with a thickness of 15 μm was successfully obtained, including the diffusion layer and the deposition layer. Simultaneously, the elements Nb and Zr were gradually distributed along the depth, and a high Nb concentration formed in the Nb-Zr alloying layer. The solid solution formed by Zr in the Nb layer significantly improved the microhardness and corrosion resistance of the substrate. The Nb-Zr alloying layer prepared under a pressure of 40 Pa had the lowest corrosion current density and excellent corrosion resistance, which originated from the passive film formed by the Nb-Zr alloying layer that could inhibit the invasion of corrosive ions and improve the corrosion resistance. In addition, the Nb-Zr alloying layer could promote cell proliferation during long-term use and had good biocompatibility. Our study provides an efficient, high-quality processing method for the surface modification of biomedical metallic materials to form thicker Nb-Zr alloying layers as a cost-effective alternative to bulk Nb-based alloys.

Engineering Multifunctional Hydrogel-Integrated 3D Printed Bioactive Prosthetic Interfaces for Osteoporotic Osseointegration

3D printed porous titanium alloy implants is an advanced orthopedic material for joint replacement. However, the high risk of aseptic loosening and periprosthetic infection is difficult to avoid, and the declined autophagy of osteoporosis-derived bone marrow mesenchymal stem cells (OP-BMSCs) further severely impairs the osseointegration under the osteoporotic circumstance. It is thus becoming urgently significant to develop orthopedic materials with autophagy regulation and antibacterial bioactivity. In this regard, a novel class of multifunctional hydrogel-integrated 3D printed bioactive prosthetic interfaces is engineered for in situ osseointegration in osteoporosis. The hydrogel is fabricated from the dynamic crosslinking of synthetic polymers, natural polymers, and silver nanowires to deliver autophagy-regulated rapamycin. Therefore, the resultant soft material exhibits antibacterial ability, biocompatibility, degradability, conductive, self-healing, and stimuli-responsive abilities. In vitro experiments demonstrate that the hydrogel-integrated 3D printed bioactive prosthetic interfaces can restore the declined cellular activities of OP-BMSCs by upregulating the autophagy level and show excellent antibacterial activity against S. aureus and MRSA. More remarkably, the multifunctional 3D printed bioactive prosthetic interfaces significantly improve osseointegration and inhibit infection in osteoporotic environment in vivo. This study provides an efficient strategy to develop novel prosthetic interfaces to reduce complications after arthroplasty for patients with osteoporosis.

A Critical Review of Additive Manufacturing Techniques and Associated Biomaterials Used in Bone Tissue Engineering

With the ability to fabricate complex structures while meeting individual needs, additive manufacturing (AM) offers unprecedented opportunities for bone tissue engineering in the biomedical field. However, traditional metal implants have many adverse effects due to their poor integration with host tissues, and therefore new material implants with porous structures are gradually being developed that are suitable for clinical medical applications. From the perspectives of additive manufacturing technology and materials, this article discusses a suitable manufacturing process for ideal materials for biological bone tissue engineering. It begins with a review of the methods and applicable materials in existing additive manufacturing technologies and their applications in biomedicine, introducing the advantages and disadvantages of various AM technologies. The properties of materials including metals and polymers, commonly used AM technologies, recent developments, and their applications in bone tissue engineering are discussed in detail and summarized. In addition, the main challenges for different metallic and polymer materials, such as biodegradability, anisotropy, growth factors to promote the osteogenic capacity, and enhancement of mechanical properties are also introduced. Finally, the development prospects for AM technologies and biomaterials in bone tissue engineering are considered.

Recent Advancements in Materials and Coatings for Biomedical Implants

Metallic materials such as stainless steel (SS), titanium (Ti), magnesium (Mg) alloys, and cobalt-chromium (Co-Cr) alloys are widely used as biomaterials for implant applications. Metallic implants sometimes fail in surgeries due to inadequate biocompatibility, faster degradation rate (Mg-based alloys), inflammatory response, infections, inertness (SS, Ti, and Co-Cr alloys), lower corrosion resistance, elastic modulus mismatch, excessive wear, and shielding stress. Therefore, to address this problem, it is necessary to develop a method to improve the biofunctionalization of metallic implant surfaces by changing the materials’ surface and morphology without altering the mechanical properties of metallic implants. Among various methods, surface modification on metallic surfaces by applying coatings is an effective way to improve implant material performance. In this review, we discuss the recent developments in ceramics, polymers, and metallic materials used for implant applications. Their biocompatibility is also discussed. The recent trends in coatings for biomedical implants, applications, and their future directions were also discussed in detail.

Effect of Surface Tooling Techniques of Medical Titanium Implants on Bacterial Biofilm Formation In Vitro

The aim of this study was to assess the biofilm formation of Streptococcus mutans, Staphylococcus aureus, Enterococcus faecalis, and Escherichia coli on titanium implants with CAD-CAM tooling techniques. Twenty specimens of titanium were studied: Titanium grade 2 tooled with a Planmeca CAD-CAM milling device (TiGrade 2), Ti6Al4V grade 5 as it comes from CAD-DMLS device (computer aided design-direct metal laser sintering device) (TiGrade 5), Ti6Al4V grade 23 as it comes from a CAD-CAM milling device (TiGrade 23), and CAD-DMLS TiGrade 5 polished with an abrasive disc (TiGrade 5 polished). Bacterial adhesion on the implants was completed with and without saliva treatment to mimic both extraoral and intraoral surgical methods of implant placement. Five specimens/implant types were used in the bacterial adhesion experiments. Autoclaved implant specimens were placed in petri plates and immersed in saliva solution for 30 min at room temperature and then washed 3×with 1 ×PBS. Bacterial suspensions of each strain were made and added to the specimens after saliva treatment. Biofilm was allowed to form for 24 h at 37 °C and the adhered bacteria was calculated. Tooling techniques had an insignificant effect on the bacterial adhesion by all the bacterial strains studied. However, there was a significant difference in biofilm formation between the saliva-treated and non-saliva-treated implants. Saliva contamination enhanced S. mutans, S. aureus, and E. faecalis adhesion in all material types studied. S. aureus was found to be the most adherent strain in the saliva-treated group, whereas E. coli was the most adherent strain in the non-saliva-treated group. In conclusion, CAD-CAM tooling techniques have little effect on bacterial adhesion. Saliva coating enhances the biofilm formation; therefore, saliva contamination of the implant must be minimized during implant placement. Further extensive studies are needed to evaluate the effects of surface treatments of the titanium implant on soft tissue response and to prevent the factors causing implant infection and failure.

Influence of Femtosecond Laser Modification on Biomechanical and Biofunctional Behavior of Porous Titanium Substrates

Bone resorption and inadequate osseointegration are considered the main problems of titanium implants. In this investigation, the texture and surface roughness of porous titanium samples obtained by the space holder technique were modified with a femtosecond Yb-doped fiber laser. Different percentages of porosity (30, 40, 50, and 60 vol.%) and particle range size (100–200 and 355–500 μm) were compared with fully-dense samples obtained by conventional powder metallurgy. After femtosecond laser treatment the formation of a rough surface with micro-columns and micro-holes occurred for all the studied substrates. The surface was covered by ripples over the micro-metric structures. This work evaluates both the influence of the macro-pores inherent to the spacer particles, as well as the micro-columns and the texture generated with the laser, on the wettability of the surface, the cell behavior (adhesion and proliferation of osteoblasts), micro-hardness (instrumented micro-indentation test, P–h curves) and scratch resistance. The titanium sample with 30 vol.% and a pore range size of 100–200 μm was the best candidate for the replacement of small damaged cortical bone tissues, based on its better biomechanical (stiffness and yield strength) and biofunctional balance (bone in-growth and in vitro osseointegration).

Bioprinting of cell-laden hydrogels onto titanium alloy surfaces to produce a bioactive interface

The surface of metal implants serves as a powerful signaling cue for cells. Its properties play an essential role in stabilizing the bone-implant interface and facilitating the early osseointegration by encouraging bone deposition on the surface. However, effective strategies to deliver cells to the metal surfaces are yet to be explored. Here, we use a bioprinting process called reactive jet impingement (ReJI) to deposit high concentrations (4×10⁷  cells/mL) of mesenchymal stromal cells (MSCs) within hydrogel matrices directly onto the titanium alloy metal surfaces that vary in surface roughness and morphology. In this proof of concept study, we fabricate cell-hydrogel-metal systems with the aim of enhancing bioactivity through delivering MSCs in hydrogel matrices at the bone-implant interface. Our results show that the deposition of high cell concentrations encourages quick cell-biomaterial interactions at the hydrogel-metal surface interface, and cell morphology is influenced by the surface type. Cells migrate from the hydrogels and deposit mineralized matrix rich in calcium and phosphorus on the titanium alloy surfaces. We demonstrate that ReJI bioprinting is a promising tool to deliver cells in a three-dimensional (3D) environment before implantation that can be used when developing a new generation of medical devices for bone tissue engineering. This article is protected by copyright. All rights reserved.

Preparation and characterization of TiO 2 ‐coated polymerization of methyl methacrylate (PMMA) for biomedical applications: In vitro study

Low surface energy and hydrophobicity of polymethyl methactylate (PMMA) are the main disadvantages of this biomaterial. The aim of this study was to investigate the effects of a new coating process on the surface characteristics and properties of PMMA. A combination of temperature and pressure was used for deposition of titanium dioxide (TiO₂) on the surface of PMMA. The PMMA coated with TiO₂ thin films and prepared by sputtering and non-coated PMMA were considered as control groups. The surface wettability, functional group, and roughness were determined by contact angle measurement, Fourier transform Infrared spectroscopy (FTIR), and 3D laser scanning digital microscopy, respectively. The flexural strength of coated and non-coated samples was measured using three-point bending test. The cell proliferation, attachment, and viability were determined using 3-(4,5-dimethyldiazol-2-yl)-2,5-diphenyl tetrazolium bromide, live and dead assay, scanning electron microscope (SEM), and DAPI (4',6-diamidino-2-phenylindole) staining. The antifungal activity of TiO₂ was also determined by examining the biofilm attachment of Candida albicans. The obtained results showed that TiO₂ was successfully coated on PMMA. The contact angle measurement shows a significant increase of hydrophilicity in TiO₂-coated PMMA. FTIR and roughness analysis revealed no loss of TiO₂ from coated specimens following sonication. The cell viability after 7 days culturing on TiO2-coated specimens was more than the cell viability on the control groups. SEM images and DAPI staining showed that the total number of the cells increased after 7 days of seeding on TiO₂-coated group, whereas it decreased gradually in both control groups. C. albicans attachment also decreased by 63% to 77% on the coated PMMA surface. Overall, this research suggested a new way for developing surface energy of PMMAs for biomedical applications.

Electrical Impedance of Surface Modified Porous Titanium Implants with Femtosecond Laser

The chemical composition and surface topography of titanium implants are essential to improve implant osseointegration. The present work studies a non-invasive alternative of electrical impedance spectroscopy for the characterization of the macroporosity inherent to the manufacturing process and the effect of the surface treatment with femtosecond laser of titanium discs. Osteoblasts cell culture growths on the titanium surfaces of the laser-treated discs were also studied with this method. The measurements obtained showed that the femtosecond laser treatment of the samples and cell culture produced a significant increase (around 50%) in the absolute value of the electrical impedance module, which could be characterized in a wide range of frequencies (being more relevant at 500 MHz). Results have revealed the potential of this measurement technique, in terms of advantages, in comparison to tiresome and expensive techniques, allowing semi-quantitatively relating impedance measurements to porosity content, as well as detecting the effect of surface modification, generated by laser treatment and cell culture.

Implant-bone-interface: Reviewing the impact of titanium surface modifications on osteogenic processes in vitro and in vivo

Titanium is commonly and successfully used in dental and orthopedic implants. However, patients still have to face the risk of implant failure due to various reasons, such as implant loosening or infection. The risk of implant loosening can be countered by optimizing the osteointegration capacity of implant materials. Implant surface modifications for structuring, roughening and biological activation in favor for osteogenic differentiation have been vastly studied. A key factor for a successful stable long-term integration is the initial cellular response to the implant material. Hence, cell-material interactions, which are dependent on the surface parameters, need to be considered in the implant design. Therefore, this review starts with an introduction to the basics of cell-material interactions as well as common surface modification techniques. Afterwards, recent research on the impact of osteogenic processes in vitro and vivo provoked by various surface modifications is reviewed and discussed, in order to give an update on currently applied and developing implant modification techniques for enhancing osteointegration.

Analytical Compliance Equations of Generalized Elliptical-Arc-Beam Spherical Flexure Hinges for 3D Elliptical Vibration-Assisted Cutting Mechanisms

Elliptical vibration-assisted cutting technology has been widely applied in complicated functional micro-structured surface texturing. Elliptical-arc-beam spherical flexure hinges have promising applications in the design of 3D elliptical vibration-assisted cutting mechanisms due to their high motion accuracy and large motion ranges. Analytical compliance matrix formulation of flexure hinges is the basis for achieving high-precision positioning performance of these mechanisms, but few studies focus on this topic. In this paper, analytical compliance equations of spatial elliptic-arc-beam spherical flexure hinges are derived, offering a convenient tool for analysis at early stages of mechanism design. The mechanical model of a generalized flexure hinge is firstly established based on Castigliano's Second Theorem. By introducing the eccentric angle as the integral variable, the compliance matrix of the elliptical-arc-beam spherical flexure hinge is formulated. Finite element analysis is carried out to verify the accuracy of the derived analytical compliance matrix. The compliance factors calculated by the analytical equations agree well with those solved in the finite element analysis for the maximum error; average relative error and relative standard deviation are 8.25%, 1.83% and 1.78%, respectively. This work lays the foundations for the design and modeling of 3D elliptical vibration-assisted cutting mechanisms based on elliptical-arc-beam spherical flexure hinges.

Assessment of the Functional Properties of 316L Steel Alloy Subjected to Ion Implantation Used in Biotribological Systems

Clinical trials conducted in many centres worldwide indicate that, despite advances made in the use of biomaterials for medical applications, tribocorrosive wear remains a significant issue. The release of wear residue into body fluids can cause inflammation and, as a result, implant failure. Surface modification is one of the methods used to improve the mechanical, tribological, and fatigue properties of biomaterials. In this article, the authors investigated the impact of ion implantation on improving the functional properties of implant surfaces. This paper presents morphology, geometric surface structure, hardness, and tribological test results for layers obtained by ion implantation with nitrogen and oxygen ions on alloy 316L. The surface morphology and thickness of the implanted layer were examined using scanning microscopy. Atomic force microscopy was used to evaluate the geometric structure of the surface. Instrumented indentation was used to measure nanohardness. Model tribo tests were carried out for reciprocating motion under conditions of dry friction and lubricated friction with Ringer’s solution. The tribological tests showed that the implanted samples had a lower wear than the reference samples. Nitrogen ion implantation increased the hardness of 316L steel by about 45% and increased it by about 15% when oxygen ions were used.

Effects of Surface Pretreatment of Titanium Substrates on Properties of Electrophoretically Deposited Biopolymer Chitosan/Eudragit E 100 Coatings

The preparation of the metal surface before coating application is fundamental in determining the properties of the coatings, particularly the roughness, adhesion, and corrosion resistance. In this work, chitosan/Eudragit E 100 (chit/EE100) were fabricated by electrophoretic deposition (EPD) and both their microstructure and properties were investigated. The present research is aimed at characterizing the effects of the surface pretreatment of titanium substrate, applied deposition voltage, and time on physical, mechanical, and electrochemical properties of coatings. The coating’s microstructure, topography, thickness, wettability, adhesion, and corrosion behavior were examined. The applied process parameters influenced the morphology of the coatings, which affected their properties. Coatings with the best properties, i.e., uniformity, proper thickness and roughness, hydrophilicity, highest adhesion to the substrate, and corrosion resistance, were obtained after deposition of chit/EE100 coating on nanotubular oxide layers produced by previous electrochemical oxidation.

Elastic-plastic properties of titanium and its alloys modified by fibre laser surface nitriding for orthopaedic implant applications

Laser nitriding is one of the most promising approaches to improve wear resistance of Ti alloy surfaces and may extend the use in orthopaedic implants. In this study, three types of Ti alloys, namely alpha commercially pure Ti ("TiG2"), alpha-beta Ti-6Al-4V ("TiG5"), and beta Ti-35.5Nb-7.3Zr-5.7Ta ("βTi"), were subjected to an open-air laser nitriding treatment. Essential elastic-plastic mechanical properties including elastic modulus, hardness, elastic energy, plasticity index, and hardness-to-elasticity ratio of the laser-treated Ti alloys were characterized using nanoindentation experiment. The results showed that the elastic modulus, hardness and elastic energy values of all Ti samples significantly increased in the nitrided layer compared to respective bare substrates for all three Ti materials. Across different Ti samples, βTi sustained its relatively lower elastic modulus, but presented comparable hardness, elastic energy, plasticity index, as well as hardness-to-elasticity ratio in the nitrided layer compared to the other two Ti alloys. Overall, amongst three medical grade Ti alloys in this study, βTi appeared as the most appealing candidate for joint replacement applications even solely in view of mechanical compatibility when combined with surface laser nitriding. Nevertheless, laser nitriding treatment in this study tended to cause a residual compressive stress on all Ti alloys as displayed by cracks developed in the nitrided layer and analyzed on βTi by X-ray diffraction (XRD) and further nanoindentation tests.

Polydopamine-assisted immobilization of silk fibroin and its derived peptide on chemically oxidized titanium to enhance biological activity in vitro

Biochemical modification can endow the surface of implants with superior biological activity. Herein, silk fibroin (SF) protein and its anionic derivative peptides (Cs) were covalently immobilized onto a titanium implant surface via a polydopamine layer. The successful conjugation of SF and Cs was revealed by X-ray photoelectron spectroscopy (XPS), field-emission scanning electron microscopy (FE-SEM), atomic force microscopy (AFM), and contact angle measurements. The addition of Cs prevented the conformational transition of silk fibroin to silk II. The deposition of apatite on its surface was significantly accelerated, and the bioactive composite coating was observed to enhance protein adsorption and cell proliferation. More importantly, it also promoted the osteogenic differentiation of bone marrow stem cells (BMSCs) for the quantitative and qualitative detection of alkaline phosphatase (ALP) and alizarin red (ARS). Overall, the stable performance and enhanced osteogenic property of the composite coating promote an extensive application for clinical titanium-based implants.

A review on alloy design, biological response, and strengthening of β-titanium alloys as biomaterials

From the past few years, developments of β-Ti alloys have been the subject of active research in the medical domain. The current paper highlights significant findings in the area of β-Ti alloy design, biological responses, strengthening mechanisms, and developing low-cost implants with a high degree of biocompatibility. It is evident that an astonishing demand for developing the low modulus-high strength implants can be fulfilled by synchronizing β stabilizer content and incorporating tailored thermo-mechanical techniques. Furthermore, the biological response of the implants is as important as the physical properties that regulate healing response; hence, the optimum selection of alloying elements plays a curial role for clinical success. The paper also presents the evolution of patents in this field from the year 2010 to 2020 showing the relevant innovations that may benefit a wide range of researchers.

Nanomedicine: Photo-activated nanostructured titanium dioxide, as a promising anticancer agent

The multivariate condition of cancer disease has been approached in various ways, by the scientific community. Recent studies focus on individualized treatments, minimizing the undesirable consequences of the conventional methods, but the development of an alternative effective therapeutic scheme remains to be held. Nanomedicine could provide a solution, filling this gap, exploiting the unique properties of innovative nanostructured materials. Nanostructured titanium dioxide (TiO₂) has a variety of applications of daily routine and of advanced technology. Due to its biocompatibility, it has also a great number of biomedical applications. It is now clear that photo-excited TiO₂ nanoparticles, induce generation of pairs of electrons and holes which react with water and oxygen to yield reactive oxygen species (ROS) that have been proven to damage cancer cells, triggering controlled cellular processes. The aim of this review is to provide insights into the field of nanomedicine and particularly into the wide context of TiO₂-NP-mediated anticancer effect, shedding light on the achievements of nanotechnology and proposing this nanostructured material as a promising anticancer photosensitizer.

Surface Modification Techniques of Titanium and its Alloys to Functionally Optimize Their Biomedical Properties: Thematic Review

Depending on the requirements of specific applications, implanted materials including metals, ceramics, and polymers have been used in various disciplines of medicine. Titanium and its alloys as implant materials play a critical role in the orthopedic and dental procedures. However, they still require the utilization of surface modification technologies to not only achieve the robust osteointegration but also to increase the antibacterial properties, which can avoid the implant-related infections. This article aims to provide a summary of the latest advances in surface modification techniques, of titanium and its alloys, specifically in biomedical applications. These surface techniques include plasma spray, physical vapor deposition, sol-gel, micro-arc oxidation, etc. Moreover, the microstructure evolution is comprehensively discussed, which is followed by enhanced mechanical properties, osseointegration, antibacterial properties, and clinical outcomes. Future researches should focus on the combination of multiple methods or improving the structure and composition of the composite coating to further enhance the coating performance.

Research Progress of Titanium-Based High Entropy Alloy: Methods, Properties, and Applications

With the continuous progress and development in the biomedicine field, metallic biomedical materials have attracted the considerable attention of researchers, but the related procedures need to be further developed. Since the traditional metal implant materials are not highly compatible with the human body, the modern materials with excellent mechanical properties and proper biocompatibility should be developed urgently in order to solve any adverse reactions caused by the long-term implantations. The advent of the high-entropy alloy (HEA) as an innovative and advanced idea emerged to develop the medical implant materials through the specific HEA designs. The properties of these HEA materials can be predicted and regulated. In this paper, the progression and application of titanium-based HEAs, as well as their preparation and biological evaluation methods, are comprehensively reviewed. Additionally, the prospects for the development and use of these alloys in implant applications are put forward.

Two-Step Laser Post-Processing for the Surface Functionalization of Additively Manufactured Ti-6Al-4V Parts

Laser powder bed fusion (LPBF) is one of the additive manufacturing methods used to build metallic parts. To achieve the design requirements, the LPBF process chain can become long and complex. This work aimed to use different laser techniques as alternatives to traditional post-processes, in order to add value and new perspectives on applications, while also simplifying the process chain. Laser polishing (LP) with a continuous wave laser was used for improving the surface quality of the parts, and an ultrashort pulse laser was applied to functionalize it. Each technique, individually and combined, was performed following distinct stages of the process chain. In addition to removing asperities, the samples after LP had contact angles within the hydrophilic range. In contrast, all functionalized surfaces presented hydrophobicity. Oxides were predominant on these samples, while prior to the second laser processing step, the presence of TiN and TiC was also observed. The cell growth viability study indicated that any post-process applied did not negatively affect the biocompatibility of the parts. The presented approach was considered a suitable post-process option for achieving different functionalities in localized areas of the parts, for replacing certain steps of the process chain, or a combination of both.

Interleukin-4 assisted calcium-strontium-zinc-phosphate coating induces controllable macrophage polarization and promotes osseointegration on titanium implant

Titanium (Ti) and its alloys are believed to be promising scaffold materials for dental and orthopedic implantation due to their ideal mechanical properties and biocompatibility. However, the host immune response always causes implant failures in the clinic. Surface modification of the Ti scaffold is an important factor in this process and has been widely studied to regulate the host immune response and to further promote bone regeneration. In this study, a calcium-strontium-zinc-phosphate (CSZP) coating was fabricated on a Ti implant surface by phosphate chemical conversion (PCC) technique, which modified the surface topography and element constituents. Here, we envisioned an accurate immunomodulation strategy via delivery of interleukin (IL)-4 to promote CSZP-mediated bone regeneration. IL-4 (0 and 40 ng/mL) was used to regulate immune response of macrophages. The mechanical properties, biocompatibility, osteogenesis, and anti-inflammatory properties were evaluated. The results showed that the CSZP coating exhibited a significant enhancement in surface roughness and hydrophilicity, but no obvious changes in proliferation or apoptosis of bone marrow mesenchymal stem cells (BMMSCs) and macrophages. In vitro, the mRNA and protein expression of osteogenic related factors in BMMSCs cultured on a CSZP coating, such as ALP and OCN, were significantly higher than those on bare Ti. In vivo, there was no enhanced bone formation but increased macrophage type 1 (M1) polarization on the CSZP coating. IL-4 could induce M2 polarization and promote osteogenesis of BMMSCs on CSZP in vivo and in vitro. In conclusion, the CSZP coating is an effective scaffold for BMMSCs osteogenesis, and IL-4 presents the additional advantage of modulating the immune response for bone regeneration on the CSZP coating in vivo.

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A chemical conversion calcium-strontium-zinc-phosphate (CSZP) coating is prepared on titanium.

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The CSZP coating exhibits micellar lamellar crystal morphology in micro-nano scale.

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The CSZP coating has an optimal topography and element composition for osteogenesis.

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Interleukin-4 assisted CSZP coating can obtain better osteoimmunomodulation properties.

Electrodeposited Biocoatings, Their Properties and Fabrication Technologies: A Review

Coatings deposited under an electric field are applied for the surface modification of biomaterials. This review is aimed to characterize the state-of-art in this area with an emphasis on the advantages and disadvantages of used methods, process determinants, and properties of coatings. Over 170 articles, published mainly during the last ten years, were chosen, and reviewed as the most representative. The most recent developments of metallic, ceramic, polymer, and composite electrodeposited coatings are described focusing on their microstructure and properties. The direct cathodic electrodeposition, pulse cathodic deposition, electrophoretic deposition, plasma electrochemical oxidation in electrolytes rich in phosphates and calcium ions, electro-spark, and electro-discharge methods are characterized. The effects of electrolyte composition, potential and current, pH, and temperature are discussed. The review demonstrates that the most popular are direct and pulse cathodic electrodeposition and electrophoretic deposition. The research is mainly aimed to introduce new coatings rather than to investigate the effects of process parameters on the properties of deposits. So far tests aim to enhance bioactivity, mechanical strength and adhesion, antibacterial efficiency, and to a lesser extent the corrosion resistance.

The Effect of Various Surface Treatments of Ti6Al4V on the Growth and Osteogenic Differentiation of Adipose Tissue-Derived Stem Cells

The physical and chemical properties of the material surface, especially its roughness and wettability, have a crucial effect on the adhesion, proliferation, and differentiation of cells. The aim of this study is to select the most appropriate surface modifications of Ti6Al4V implants for pre-colonization of the implants with adipose tissue-derived stem cells (ASCs) in order to improve their osseointegration. We compared the adhesion, growth, and osteogenic differentiation of rat ASCs on Ti6Al4V samples modified by methods commonly used for preparing clinically used titanium-based implants, namely polishing (PL), coating with diamond-like carbon (DLC), brushing (BR), anodizing (AND), and blasting (BL). The material surface roughness, measured by the Ra and Rq parameters, increased in the following order: PL < DLC ˂ BR ˂ AND ˂ BL. The water drop contact angle was in the range of 60–74°, with the exception of the DLC-coated samples, where it was only 38°. The cell number, morphology, mitochondrial activity, relative fluorescence intensity of osteogenic markers RUNX2, type 1 collagen, and osteopontin, the calcium consumption by the cells and the alkaline phosphatase activity depended on the surface roughness rather than on the surface wettability of the materials. Materials with a surface roughness of several tens of nanometers (Ra 60–70 nm), i.e., the BR and AND samples, supported a satisfactory level of cell proliferation. At the same time, they achieved the highest level of osteogenic cell differentiation. These surface modifications therefore seem to be most suitable for pre-colonization of Ti6Al4V implants with stem cells pre-differentiated toward osteoblasts, and then for implanting them into the bone tissue.

The Toxicity Phenomenon and the Related Occurrence in Metal and Metal Oxide Nanoparticles: A Brief Review From the Biomedical Perspective

Thousands of different nanoparticles (NPs) involve in our daily life with various origins from food, cosmetics, drugs, etc. It is believed that decreasing the size of materials up to nanometer levels can facilitate their unfavorable absorption since they can pass the natural barriers of live tissues and organs even, they can go across the relatively impermeable membranes. The interaction of these NPs with the biological environment disturbs the natural functions of cells and its components and cause health issues. In the lack of the detailed and comprehensive standard protocols about the toxicity of NPs materials, their control, and effects, this review study focuses on the current research literature about the related factors in toxicity of NPs such as size, concentration, etc. with an emphasis on metal and metal oxide nanoparticles. The goal of the study is to highlight their potential hazard and the advancement of green non-cytotoxic nanomaterials with safe threshold dose levels to resolve the toxicity issues. This study supports the NPs design along with minimizing the adverse effects of nanoparticles especially those used in biological treatments.

Crystallized TiO2 Nanosurfaces in Biomedical Applications

Crystallization alters the characteristics of TiO2 nanosurfaces, which consequently influences their bio-performance. In various biomedical applications, the anatase or rutile crystal phase is preferred over amorphous TiO2. The most common crystallization technique is annealing in a conventional furnace. Methods such as hydrothermal or room temperature crystallization, as well as plasma electrolytic oxidation (PEO) and other plasma-induced crystallization techniques, present more feasible and rapid alternatives for crystal phase initiation or transition between anatase and rutile phases. With oxygen plasma treatment, it is possible to achieve an anatase or rutile crystal phase in a few seconds, depending on the plasma conditions. This review article aims to address different crystallization techniques on nanostructured TiO2 surfaces and the influence of crystal phase on biological response. The emphasis is given to electrochemically anodized nanotube arrays and their interaction with the biological environment. A short overview of the most commonly employed medical devices made of titanium and its alloys is presented and discussed.

Use of the Sol–Gel Method for the Preparation of Coatings of Titanium Substrates with Hydroxyapatite for Biomedical Application

Hydroxyapatite (HA) was coated onto the surface of commercially pure titanium grade 4 (a material generally used for implant application) by a dip coating method using HA sol. Hydroxyapatite sol was synthesized via sol–gel using Ca(NO3)2∙4H2O and P2O5 as precursors. The surface of the HA coating was homogeneous, as determined by scanning electron microscopy (SEM), attenuated total reflectance Fourier transform infrared (ATR-FTIR), and X-ray diffraction (XRD), which allowed the materials to be characterized. The bioactivity of the synthesized materials and their efficiency for use as future bone implants was confirmed by observing the formation of a layer of hydroxyapatite on the surface of the samples soaked in a fluid simulating the composition of human blood plasma. To verify the biocompatibility of the obtained biomaterial, fibroblasts were grown on a glass surface and were tested for viability after 24 h. The results of the WST-8 analysis suggest that the HA systems, prepared by the sol–gel method, are most suitable for modifying the surface of titanium implants and improving their biocompatibility.

Study on the Cutting Performance of Micro Textured Tools on Cutting Ti-6Al-4V Titanium Alloy

Titanium alloys are widely used in various fields, but their machinability is poor because the chip would easily adhere to the tool surface during cutting, causing poor surface quality and tool wear. To improve the cutting performance of titanium alloy Ti-6Al-4V, experiments were conducted to investigate the effect of micro textured tool on the cutting performances. The cemented carbide tools whose rake faces were machined with line, rhombic, and sinusoidal groove textures with 10% area occupancy rates were adopted as the cutting tools. The effects of cutting depth and cutting speed on feed force and main cutting force were discussed based on experimental results. The results show that the cutting force produced by textured tools is less than that produced by non-textured tools. Under different cutting parameters, the best cutting performance can be obtained by using sinusoidal textured tools among the four types of tools. The wear of micro textured tools is significantly lower than that of non-textured tools, due to a continuous lubrication film between the chip and the rake face of the tool that can be produced because the micro texture can store and replenish lubricant. The surface roughness obtained using the textured tool is better than that using the non-textured tool. The surface roughness Ra can be reduced by 35.89% when using sinusoidal textured tools. This study is helpful for further improving the cutting performance of cemented carbide tools on titanium alloy and prolonging tool life.

Titania Nanofiber Scaffolds with Enhanced Biointegration Activity-Preliminary In Vitro Studies

The increasing need for novel bone replacement materials has been driving numerous studies on modifying their surface to stimulate osteogenic cells expansion and to accelerate bone tissue regeneration. The goal of the presented study was to optimize the production of titania-based bioactive materials with high porosity and defined nanostructure, which supports the cell viability and growth. We have chosen to our experiments TiO2 nanofibers, produced by chemical oxidation of Ti6Al4V alloy. Fibrous nanocoatings were characterized structurally (X-ray diffraction (XRD)) and morphologically (scanning electron microscopy (SEM)). The wettability of the coatings and their mechanical properties were also evaluated. We have investigated the direct influence of the modified titanium alloy surfaces on the survival and proliferation of mesenchymal stem cells derived from adipose tissue (ADSCs). In parallel, proliferation of bone tissue cells-human osteoblasts MG-63 and connective tissue cells - mouse fibroblasts L929, as well as cell viability in co-cultures (osteoblasts/ADSCs and fibroblasts/ADSCs has been studied. The results of our experiments proved that among all tested nanofibrous coatings, the amorphous titania-based ones were the most optimal scaffolds for the integration and proliferation of ADSCs, fibroblasts, and osteoblasts. Thus, we postulated these scaffolds to have the osteopromotional potential. However, from the co-culture experiments it can be concluded that ADSCs have the ability to functionalize the initially unfavorable surface, and make it suitable for more specialized and demanding cells.

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.

Impact of Electrocautery on Fatigue Life of Spinal Fusion Constructs-An In Vitro Biomechanical Study

Instrumentation failure in the context of spine surgery is attributed to cyclic loading leading to formation of fatigue cracks, which later propagate and result in rod fracture. A biomechanical analysis of the potential impact of electrocautery on the fatigue life of spinal implants has not been previously performed. The aim of this study was to assess the fatigue life of titanium (Ti) and cobalt-chrome (CoCr) rod-screw constructs after being treated with electrocautery. Twelve spinal constructs with CoCr and Ti rods were examined. Specimens were divided into four groups by rod material (Ti and CoCr) and application of monopolar electrocautery on the rods’ surface (control-group and electrocautery-group). Electrocautery was applied on each rod at three locations, then constructs were cyclically tested. Outcome measures were load-to-failure, total number of cycles-to-failure, and location of rod failure. Ti-rods treated with electrocautery demonstrated a significantly decreased fatigue life compared to non-treated Ti-rods. Intergroup comparison of cycles-to-failure revealed a significant mean decrease of almost 9 × 10⁵ cycles (p = 0.03). No CoCr-rods failed in this experiment. Electrocautery application on the surface of Ti-rods significantly reduces their fatigue life. Surgeons should exercise caution when using electrocautery in the vicinity of Ti-rods to mitigate the risk of rod failure.