Antimicrobial and Osseointegration Properties of Nanostructured Titanium Orthopaedic Implants

3D printing metal implants in orthopedic surgery: Methods, applications and future prospects

Background

Currently, metal implants are widely used in orthopedic surgeries, including fracture fixation, spinal fusion, joint replacement, and bone tumor defect repair. However, conventional implants are difficult to be customized according to the recipient's skeletal anatomy and defect characteristics, leading to difficulties in meeting the individual needs of patients. Additive manufacturing (AM) or three-dimensional (3D) printing technology, an advanced digital fabrication technique capable of producing components with complex and precise structures, offers opportunities for personalization.

Methods

We systematically reviewed the literature on 3D printing orthopedic metal implants over the past 10 years. Relevant animal, cellular, and clinical studies were searched in PubMed and Web of Science. In this paper, we introduce the 3D printing method and the characteristics of biometals and summarize the properties of 3D printing metal implants and their clinical applications in orthopedic surgery. On this basis, we discuss potential possibilities for further generalization and improvement.

Results

3D printing technology has facilitated the use of metal implants in different orthopedic procedures. By combining medical images from techniques such as CT and MRI, 3D printing technology allows the precise fabrication of complex metal implants based on the anatomy of the injured tissue. Such patient-specific implants not only reduce excessive mechanical strength and eliminate stress-shielding effects, but also improve biocompatibility and functionality, increase cell and nutrient permeability, and promote angiogenesis and bone growth. In addition, 3D printing technology has the advantages of low cost, fast manufacturing cycles, and high reproducibility, which can shorten patients' surgery and hospitalization time. Many clinical trials have been conducted using customized implants. However, the use of modeling software, the operation of printing equipment, the high demand for metal implant materials, and the lack of guidance from relevant laws and regulations have limited its further application.

Conclusions

There are advantages of 3D printing metal implants in orthopedic applications such as personalization, promotion of osseointegration, short production cycle, and high material utilization. With the continuous learning of modeling software by surgeons, the improvement of 3D printing technology, the development of metal materials that better meet clinical needs, and the improvement of laws and regulations, 3D printing metal implants can be applied to more orthopedic surgeries.

The translational potential of this paper

Precision, intelligence, and personalization are the future direction of orthopedics. It is reasonable to believe that 3D printing technology will be more deeply integrated with artificial intelligence, 4D printing, and big data to play a greater role in orthopedic metal implants and eventually become an important part of the digital economy. We aim to summarize the latest developments in 3D printing metal implants for engineers and surgeons to design implants that more closely mimic the morphology and function of native bone.

The current status of stimuli-responsive nanotechnologies on orthopedic titanium implant surfaces

With the continuous innovation and breakthrough of nanomedical technology, stimuli-responsive nanotechnology has been gradually applied to the surface modification of titanium implants to achieve brilliant antibacterial activity and promoted osteogenesis. Regarding to the different physiological and pathological microenvironment around implants before and after surgery, these surface nanomodifications are designed to respond to different stimuli and environmental changes in a timely, efficient, and specific way/manner. Here, we focus on the materials related to stimuli-responsive nanotechnology on titanium implant surface modification, including metals and their compounds, polymer materials and other materials. In addition, the mechanism of different response types is introduced according to different activation stimuli, including magnetic, electrical, photic, radio frequency and ultrasonic stimuli, pH and enzymatic stimuli (the internal stimuli). Meanwhile, the associated functions, potential applications and developing prospect were discussion.

The combined effects of binder addition and different sintering methods on the mechanical properties of bovine hydroxyapatite

Hydroxyapatite (HA) from bovine bones has been used as a biomaterial in dentistry due to its biocompatibility and bioactivity. However, dense HA bioceramics still present inadequate properties for applications that require high mechanical performance, such as infrastructure. Microstructural reinforcements and control of ceramic processing steps are methods to improve these shortcomings. The present study assessed the effects of polyvinyl butyral (PVB) addition in combination with two sintering methodologies (2-step and conventional), on the mechanical properties of polycrystalline bovine HA bioceramics. The samples were divided into four groups (with 15 samples per group): conventional sintering with binder (HBC) and without binder (HWC) and 2-step sintering with (HB2) and without binder (HW2). HA was extracted from bovine bones, turned into nanoparticles in a ball mill, and subjected to uniaxial and isostatic pressing into discs, according to ISO 6872 standards. All groups were characterized by x-ray diffractometry (XRD), differential thermal analysis (DTA) and Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and relative density. Besides, mechanical analyses (biaxial flexural strength (BFS) and modulus of elasticity) were also performed. The characterization results demonstrated that adding agglutinants or the sintering method did not affect HA's chemical and structural characteristics. Even so, the HWC group showed the highest mechanical values for BFS and modulus of elasticity being 109.0 (98.0; 117.0) MPa and 105.17 ± 14.65 GPa, respectively. The HA ceramics submitted to conventional sintering and without the addition of binders achieved better mechanical properties than the other groups. The impacts of each variable were discussed and correlated to the final microstructures and mechanical properties.

Modelling the role of membrane mechanics in cell adhesion on titanium oxide nanotubes

Titanium surface treated with titanium oxide nanotubes was used in many studies to quantify the effect of surface topography on cell fate. However, the predicted optimal diameter of nanotubes considerably differs among studies. We propose a model that explains cell adhesion to a nanostructured surface by considering the deformation energy of cell protrusions into titanium nanotubes and the adhesion to the surface. The optimal surface topology is defined as a geometry that gives the membrane a minimum energy shape. A dimensionless parameter, the cell interaction index, was proposed to describe the interplay between the cell membrane bending, the intrinsic curvature, and the strength of cell adhesion. Model simulation shows that an optimal nanotube diameter ranging from 20 nm to 100 nm (cell interaction index between 0.2 and 1, respectively) is feasible within a certain range of parameters describing cell membrane adhesion and bending. The results indicate a possibility to tune the topology of a nanostructural surface in order to enhance the proliferation and differentiation of cells mechanically compatible with the given surface geometry while suppressing the growth of other mechanically incompatible cells.

Antibacterial Nanostructured Surfaces Modulate Protein Adsorption, Inflammatory Responses, and Fibrous Capsule Formation

The present study interrogates the interaction of highly efficient antibacterial surfaces containing sharp nanostructures with blood proteins and the subsequent immunological consequences, processes that are of key importance for the fate of every implantable biomaterial. Studies with human serum and plasma pointed to significant differences in the composition of the protein corona that formed on control and nanostructured surfaces. Quantitative analysis using liquid chromatography-mass spectrometry demonstrated that the nanostructured surface attracted more vitronectin and less complement proteins compared to the untreated control. In turn, the protein corona composition modulated the adhesion and cytokine expression by immune cells. Monocytes produced lower amounts of pro-inflammatory cytokines and expressed more anti-inflammatory factors on the nanostructured surface. Studies using an in vivo subcutaneous mouse model showed reduced fibrous capsule thickness which could be a consequence of the attenuated inflammatory response. The results from this work suggest that antibacterial surface modification with sharp spike-like nanostructures may not only lead to the reduction of inflammation but also more favorable foreign body response and enhanced healing, processes that are beneficial for most medical devices implanted in patients.

A review on in vitro/in vivo response of additively manufactured Ti-6Al-4V alloy

Bone replacement using porous and solid metallic implants, such as Ti-alloy implants, is regarded as one of the most practical therapeutic approaches in biomedical engineering. The bone is a complex tissue with various mechanical properties based on the site of action. Patient-specific Ti-6Al-4V constructs may address the key needs in bone treatment for having customized implants that mimic the complex structure of the natural tissue and diminish the risk of implant failure. This review focuses on the most promising methods of fabricating such patient-specific Ti-6Al-4V implants using additive manufacturing (AM) with a specific emphasis on the popular subcategory, which is powder bed fusion (PBF). Characteristics of the ideal implant to promote optimized tissue-implant interactions, as well as physical, mechanical/chemical treatments and modifications will be discussed. Accordingly, such investigations will be classified into 3B-based approaches (Biofunctionality, Bioactivity, and Biostability), which mainly govern native body response and ultimately the success in implantation.

A Novel Nanostructured Surface on Titanium Implants Increases Osseointegration in a Sheep Model

BACKGROUND

A nanostructured titanium surface that promotes antimicrobial activity and osseointegration would provide the opportunity to create medical implants that can prevent orthopaedic infection and improve bone integration. Although nanostructured surfaces can exhibit antimicrobial activity, it is not known whether these surfaces are safe and conducive to osseointegration.

QUESTIONS/PURPOSES

Using a sheep animal model, we sought to determine whether the bony integration of medical-grade, titanium, porous-coated implants with a unique nanostructured surface modification (alkaline heat treatment [AHT]) previously shown to kill bacteria was better than that for a clinically accepted control surface of porous-coated titanium covered with hydroxyapatite (PCHA) after 12 weeks in vivo. The null hypothesis was that there would be no difference between implants with respect to the primary outcomes: interfacial shear strength and percent intersection surface (the percentage of implant surface with bone contact, as defined by a micro-CT protocol), and the secondary outcomes: stiffness, peak load, energy to failure, and micro-CT (bone volume/total volume [BV/TV], trabecular thickness [Tb.Th], and trabecular number [Tb.N]) and histomorphometric (bone-implant contact [BIC]) parameters.

METHODS

Implants of each material (alkaline heat-treated and hydroxyapatite-coated titanium) were surgically inserted into femoral and tibial metaphyseal cancellous bone (16 per implant type; interference fit) and in tibial cortices at three diaphyseal locations (24 per implant type; line-to-line fit) in eight skeletally mature sheep. At 12 weeks postoperatively, bones were excised to assess osseointegration of AHT and PCHA implants via biomechanical push-through tests, micro-CT, and histomorphometry. Bone composition and remodeling patterns in adult sheep are similar to that of humans, and this model enables comparison of implants with ex vivo outcomes that are not permissible with humans. Comparisons of primary and secondary outcomes were undertaken with linear mixed-effects models that were developed for the cortical and cancellous groups separately and that included a random effect of animals, covariates to adjust for preoperative bodyweight, and implant location (left/right limb, femoral/tibial cancellous, cortical diaphyseal region, and medial/lateral cortex) as appropriate. Significance was set at an alpha of 0.05.

RESULTS

The estimated marginal mean interfacial shear strength for cancellous bone, adjusted for covariates, was 1.6 MPa greater for AHT implants (9.3 MPa) than for PCHA implants (7.7 MPa) (95% CI 0.5 to 2.8; p = 0.006). Similarly, the estimated marginal mean interfacial shear strength for cortical bone, adjusted for covariates, was 6.6 MPa greater for AHT implants (25.5 MPa) than for PCHA implants (18.9 MPa) (95% CI 5.0 to 8.1; p < 0.001). No difference in the implant-bone percent intersection surface was detected for cancellous sites (cancellous AHT 55.1% and PCHA 58.7%; adjusted difference of estimated marginal mean -3.6% [95% CI -8.1% to 0.9%]; p = 0.11). In cortical bone, the estimated marginal mean percent intersection surface at the medial site, adjusted for covariates, was 11.8% higher for AHT implants (58.1%) than for PCHA (46.2% [95% CI 7.1% to 16.6%]; p < 0.001) and was not different at the lateral site (AHT 75.8% and PCHA 74.9%; adjusted difference of estimated marginal mean 0.9% [95% CI -3.8% to 5.7%]; p = 0.70).

CONCLUSION

These data suggest there is stronger integration of bone on the AHT surface than on the PCHA surface at 12 weeks postimplantation in this sheep model.

CLINICAL RELEVANCE

Given that the AHT implants formed a more robust interface with cortical and cancellous bone than the PCHA implants, a clinical noninferiority study using hip stems with identical geometries can now be performed to compare the same surfaces used in this study. The results of this preclinical study provide an ethical baseline to proceed with such a clinical study given the potential of the alkaline heat-treated surface to reduce periprosthetic joint infection and enhance implant osseointegration.

Analytical review on the biocompatibility of surface-treated Ti-alloys for joint replacement applications

INTRODUCTION

With the advancement of joint replacements such as total hip replacement (THR), Titanium (Ti) and its alloys are widely used as implant materials. The bearing surface of Ti improves the longevity of implants. In this perception, researchers design a Ti-alloy that increases the wear and corrosion resistance to enhance osteogenesis and mechanical stability.

AREAS COVERED

: This paper is dedicated to finding the major causes of the failure of THR. Further, this paper provides an overview of the application of metallic alloys and their influencing factors that influence biocompatibility. The most contributing part of this paper focuses on the post-treatment impact on Ti-alloys biocompatibility.

EXPERT OPINION

This paper revealed and discussed that Ti alloys' biocompatibility for orthopedic applications mainly depends on antibacterial activities that decide tissue-implant compatibility. Therefore, performing surface treatment enhances the biocompatibility of Ti alloys. It was also observed that more water contact angle (WCA) induces bacterial growth and enhances cell adhesion. In contrast, the treated surface increases the antibacterial activities at lower WCA. Surface heat treatment with sintering or micro-arc oxidation achieves suitable antibacterial or antimicrobial activities.

Antibacterial Adhesion Strategy for Dental Titanium Implant Surfaces: From Mechanisms to Application

Dental implants are widely used to restore missing teeth because of their stability and comfort characteristics. Peri-implant infection may lead to implant failure and other profound consequences. It is believed that peri-implantitis is closely related to the formation of biofilms, which are difficult to remove once formed. Therefore, endowing titanium implants with anti-adhesion properties is an effective method to prevent peri-implant infection. Moreover, anti-adhesion strategies for titanium implant surfaces are critical steps for resisting bacterial adherence. This article reviews the process of bacterial adhesion, the material properties that may affect the process, and the anti-adhesion strategies that have been proven effective and promising in practice. This article intends to be a reference for further improvement of the antibacterial adhesion strategy in clinical application and for related research on titanium implant surfaces.

Antibiotic-Loaded Hyperbranched Polyester Embedded into Peptide-Enriched Silk Fibroin for the Treatment of Orthopedic or Dental Infections

The development of innovative osteoconductive matrices, which are enriched with antibiotic delivery nanosystems, has the invaluable potential to achieve both local contaminant eradication and the osseointegration of implanted devices. With the aim of producing safe, bioactive materials that have osteoconductive and antibacterial properties, novel, antibiotic-loaded, functionalized nanoparticles (AFN)-based on carboxylic acid functionalized hyperbranched aliphatic polyester (CHAP) that can be integrated into peptide-enriched silk fibroin (PSF) matrices with osteoconductive properties-were successfully synthesized. The obtained AFNPSF sponges were first physico-chemically characterized and then tested in vitro against eukaryotic cells and bacteria involved in orthopedic or oral infections. The biocompatibility and microbiological tests confirmed the promising characteristics of the AFN-PSF products for both orthopedic and dental applications. These preliminary results encourage the establishment of AFN-PSF-based preventative strategies in the fight against implant-related infections.

Titanium or Biodegradable Osteosynthesis in Maxillofacial Surgery? In Vitro and In Vivo Performances

Osteosynthesis systems are used to fixate bone segments in maxillofacial surgery. Titanium osteosynthesis systems are currently the gold standard. However, the disadvantages result in symptomatic removal in up to 40% of cases. Biodegradable osteosynthesis systems, composed of degradable polymers, could reduce the need for removal of osteosynthesis systems while avoiding the aforementioned disadvantages of titanium osteosyntheses. However, disadvantages of biodegradable systems include decreased mechanical properties and possible foreign body reactions. In this review, the literature that focused on the in vitro and in vivo performances of biodegradable and titanium osteosyntheses is discussed. The focus was on factors underlying the favorable clinical outcome of osteosyntheses, including the degradation characteristics of biodegradable osteosyntheses and the host response they elicit. Furthermore, recommendations for clinical usage and future research are given. Based on the available (clinical) evidence, biodegradable copolymeric osteosyntheses are a viable alternative to titanium osteosyntheses when applied to treat maxillofacial trauma, with similar efficacy and significantly lower symptomatic osteosynthesis removal. For orthognathic surgery, biodegradable copolymeric osteosyntheses are a valid alternative to titanium osteosyntheses, but a longer operation time is needed. An osteosynthesis system composed of an amorphous copolymer, preferably using ultrasound welding with well-contoured shapes and sufficient mechanical properties, has the greatest potential as a biocompatible biodegradable copolymeric osteosynthesis system. Future research should focus on surface modifications (e.g., nanogel coatings) and novel biodegradable materials (e.g., magnesium alloys and silk) to address the disadvantages of current osteosynthesis systems.

Advances and Prospects in Antibacterial-Osteogenic Multifunctional Dental Implant Surface

In recent years, dental implantation has become the preferred protocol for restoring dentition defects. Being the direct contact between implant and bone interface, osseointegration is the basis for implant exerting physiological functions. Nevertheless, biological complications such as insufficient bone volume, poor osseointegration, and postoperative infection can lead to implant failure. Emerging antibacterial-osteogenic multifunctional implant surfaces were designed to make up for these shortcomings both during the stage of forming osseointegration and in the long term of supporting the superstructure. In this mini-review, we summarized the recent antibacterial-osteogenic modifications of the dental implant surface. The effects of these modifications on biological performance like soft tissue integration, bone osteogenesis, and immune response were discussed. In addition, the clinical findings and prospects of emerging antibacterial-osteogenic implant materials were also discussed.

Nanomechanical tribological characterisation of nanostructured titanium alloy surfaces using AFM: A friction vs velocity study

Medical-grade titanium alloys used for orthopaedic implants are at risk from infections and complications such as wear and tear. We have recently shown that hydrothermally etched (HTE) nanostructures (NS) formed on the Ti6AlV4 alloy surfaces impart enhanced anti-bacterial activity which results in inhibited formation of bacterial biofilm. Although these titanium alloy nanostructures may resist bacterial colonisation, their frictional properties are yet to be understood. Orthopaedic devices are encapsulated by bone and muscle tissue. Contact friction between orthopaedic implant surfaces and these host tissues may trigger inflammation, osteolysis and wear. To address these challenges, we performed simulation of the contact behaviour between a smooth control Ti6Al4V alloy and HTE surfaces against a hardwearing SiO₂ sphere using Atomic Force Microscopy (AFM) in Lateral Force Microscopy mode. The friction study was evaluated in both air and liquid environments at high (5 Hz) and low (0.5 Hz) scan velocities. Lower scan velocities demonstrated opposing friction force changes between the two mediums, with friction stabilising at higher velocities. The friction measured on the NS alloy surfaces was reduced by ~20% in air and ~80% in phosphate buffered saline, in comparison to the smooth control surface, displaying a non-linear behaviour of the force applied by the AFM tip. Changes in friction values and cantilever scan velocities on different substrates are discussed with respect to the Stribeck curve. Reduced friction on nanostructured surfaces may improve wear resistance and aid osseointegration.

Nanostructured Titanium Implant Surface Facilitating Osseointegration from Protein Adsorption to Osteogenesis: The Example of TiO2 NTAs

Titanium implants have been widely applied in dentistry and orthopedics due to their biocompatibility and resistance to mechanical fatigue. TiO₂ nanotube arrays (TiO₂ NTAs) on titanium implant surfaces have exhibited excellent biocompatibility, bioactivity, and adjustability, which can significantly promote osseointegration and participate in its entire path. In this review, to give a comprehensive understanding of the osseointegration process, four stages have been divided according to pivotal biological processes, including protein adsorption, inflammatory cell adhesion/inflammatory response, additional relevant cell adhesion and angiogenesis/osteogenesis. The impact of TiO₂ NTAs on osseointegration is clarified in detail from the four stages. The nanotubular layer can manipulate the quantity, the species and the conformation of adsorbed protein. For inflammatory cells adhesion and inflammatory response, TiO₂ NTAs improve macrophage adhesion on the surface and induce M2-polarization. TiO₂ NTAs also facilitate the repairment-related cells adhesion and filopodia formation for additional relevant cells adhesion. In the angiogenesis and osteogenesis stage, TiO₂ NTAs show the ability to induce osteogenic differentiation and the potential for blood vessel formation. In the end, we propose the multi-dimensional regulation of TiO₂ NTAs on titanium implants to achieve highly efficient manipulation of osseointegration, which may provide views on the rational design and development of titanium implants.

Current Knowledge on Biomaterials for Orthopedic Applications Modified to Reduce Bacterial Adhesive Ability

A significant challenge in orthopedics is the design of biomaterial devices that are able to perform biological functions by substituting or repairing various tissues and controlling bone repair when required. This review presents an overview of the current state of our recent research into biomaterial modifications to reduce bacterial adhesive ability, compared with previous reviews and excellent research papers, but it is not intended to be exhaustive. In particular, we investigated biomaterials for replacement, such as metallic materials (titanium and titanium alloys) and polymers (ultra-high-molecular-weight polyethylene), and biomaterials for regeneration, such as poly(ε-caprolactone) and calcium phosphates as composites. Biomaterials have been designed, developed, and characterized to define surface/bulk features; they have also been subjected to bacterial adhesion assays to verify their potential capability to counteract infections. The addition of metal ions (e.g., silver), natural antimicrobial compounds (e.g., essential oils), or antioxidant agents (e.g., vitamin E) to different biomaterials conferred strong antibacterial properties and anti-adhesive features, improving their capability to counteract prosthetic joint infections and biofilm formation, which are important issues in orthopedic surgery. The complexity of biological materials is still far from being reached by materials science through the development of sophisticated biomaterials. However, close interdisciplinary work by materials scientists, engineers, microbiologists, chemists, physicists, and orthopedic surgeons is indeed necessary to modify the structures of biomaterials in order to achieve implant integration and tissue regeneration while avoiding microbial contamination.

Novel Titanium Nanospike Structure Using Low-Energy Helium Ion Bombardment for the Transgingival Part of a Dental Implant

AIM(S)

The aim of the study was to fabricate a nanospike surface on a titanium alloy surface using a newly established method of low-energy helium ion bombardment. Various methods to achieve nanospike formation on titanium have been introduced recently, and their antibacterial properties have been mainly investigated with respect to Escherichia coli and Staphylococcus aureus. Oral pathogens such as Porphyromonas gingivalis play an important role in the development of peri-implantitis. For that reason, the antibacterial properties of the novel, nanostructured titanium surface against P. gingivalis were assessed, and a possible effect on the viability of gingival fibroblasts was evaluated.

MATERIALS AND METHODS

Helium sputtering was employed for developing titanium surfaces with nanospikes of 500 nm (ND) in height; commercially available smooth-machined (MD) and sandblasted and acid-etched titanium disks (SLA) were used as controls. Surface structure characterization was performed through scanning electron microscopy (SEM) and atomic force microscopy (AFM). Following incubation with P. gingivalis, antibacterial properties were determined via conventional culturing and SEM. Additionally, the viability of human gingival fibroblasts (HGFs) was tested through MTT assay, and cell morphology was assessed through SEM.

RESULTS

SEM images confirmed the successful establishment of a nanospike surface with required heights, albeit with heterogeneity. AFM images of the 500 nm nanospike surface revealed that the roughness is dominated by large-scale hills and valleys. For frame sizes of 5 × 5 μm and smaller, the average roughness is dominated by the height of the titanium spikes. ND successfully induces dysmorphisms within P. gingivalis cultures following the incubation period, while conventional culturing reveals a 17% and 20% reduction for ND compared to MD and SLA, respectively. Moreover, the nanospike surfaces did not affect the viability of human growth fibroblasts despite their sharp surface.

CONCLUSION(S)

This study successfully developed a novel titanium-nanospike-based structuration technique for titanium surfaces. In addition, the nanospikes did not hinder gingival fibroblast viability. Enhanced antimicrobial effects for such a novel nanospike-based resurfacing technique can be achieved through further optimizations for nanospike spacing and height parameters.

The Bumpy Road to Stem Cell Therapies: Rational Design of Surface Topographies to Dictate Stem Cell Mechanotransduction and Fate

Cells sense and respond to a variety of physical cues from their surrounding microenvironment, and these are interpreted through mechanotransductive processes to inform their behavior. These mechanisms have particular relevance to stem cells, where control of stem cell proliferation, potency, and differentiation is key to their successful application in regenerative medicine. It is increasingly recognized that surface micro- and nanotopographies influence stem cell behavior and may represent a powerful tool with which to direct the morphology and fate of stem cells. Current progress toward this goal has been driven by combined advances in fabrication technologies and cell biology. Here, the capacity to generate precisely defined micro- and nanoscale topographies has facilitated the studies that provide knowledge of the mechanotransducive processes that govern the cellular response as well as knowledge of the specific features that can drive cells toward a defined differentiation outcome. However, the path forward is not fully defined, and the "bumpy road" that lays ahead must be crossed before the full potential of these approaches can be fully exploited. This review focuses on the challenges and opportunities in applying micro- and nanotopographies to dictate stem cell fate for regenerative medicine. Here, key techniques used to produce topographic features are reviewed, such as photolithography, block copolymer lithography, electron beam lithography, nanoimprint lithography, soft lithography, scanning probe lithography, colloidal lithography, electrospinning, and surface roughening, alongside their advantages and disadvantages. The biological impacts of surface topographies are then discussed, including the current understanding of the mechanotransductive mechanisms by which these cues are interpreted by the cells, as well as the specific effects of surface topographies on cell differentiation and fate. Finally, considerations in translating these technologies and their future prospects are evaluated.

A Two-Step Approach to Tune the Micro and Nanoscale Morphology of Porous Niobium Oxide to Promote Osteointegration

We present a two-step surface modification process to tailor the micro and nano morphology of niobium oxide layers. Niobium was firstly anodized in spark regime in a Ca- and P-containing solution and subsequently treated by acid etching. The effects of anodizing time and applied potential on the surface morphology is investigated with SEM and AFM, complemented by XPS compositional analysis. Anodizing with a limiting potential of 250 V results in the fast growth of oxide layers with a homogeneous distribution of micro-sized pores. Cracks are, however, observed on 250 V grown layers. Limiting the anodizing potential to 200 V slows down the oxide growth, increasing the anodizing time needed to achieve a uniform pore coverage but produces fracture-free oxide layers. The surface nano morphology is further tuned by a subsequent acid etching process that leads to the formation of nano-sized pits on the anodically grown oxide surface. In vitro tests show that the etching-induced nanostructure effectively promotes cell adhesion and spreading onto the niobium oxide surface.

Superhydrophilic multifunctional nanotextured titanium dental implants: in vivo short and long-term response in a porcine model

Current clinical demand in dental implantology is for a multifunctional device with optimum mechanical properties, improved biocompatibility and bioactivity, and having differential interactions with cells and pathogenic agents. This would minimise bacterial infection, biofilm formation and modulate inflammation, leading to a fast and durable osseointegration. The present study intends to establish the multifunctional behaviour of surface modified titanium dental implants that are superhydrophilic, with unique micro-nano or nanoscale topographies, developed by a facile hydrothermal technique. Here, the short and long-term performances of these textured implants are tested in a split mouth design using a porcine model, in pre- and post-loaded states. Quantitative and qualitative analyses of the bone implant interphase are performed through μ-CT and histology. Parameters that evaluate bone mineral density, bone contact volume and bone implant contact reveal enhanced bone apposition with better long-term response for the nano and micro-nano textured surfaces, compared to the commercial microtextured implant. Concurrently, the nanoscale surface features on implants reduced bacterial attachment by nearly 90% in vivo, outperforming the commercial variant. This preclinical evaluation data thus reveal the superiority of nano/micro-nano textured designs for clinical application and substantiate their improved osseointegration and reduced bacterial adhesion, thus proposing a novel dental implant with multifunctional characteristics.

Electrochemical Behaviour of Ti and Ti-6Al-4V Alloy in Phosphate Buffered Saline Solution

The electrochemical behavior of commercially pure titanium (CP Ti) and Ti-6Al-4V (Grade 5) alloy in phosphate buffered saline solution (PBS, pH = 7.4) at 37 °C (i.e., in simulated physiological solution in the human body) was examined using open circuit potential measurements, linear and potentiodynamic polarization and electrochemical impedance spectroscopy methods. After the impedance measurements and after potentiodynamic polarization measurements, the surface of the samples was investigated by scanning electron microscopy, while the elemental composition of oxide film on the surface of each sample was determined by EDS analysis. The electrochemical and corrosion behavior of CP Ti and Ti-6Al-4V alloys is due to forming a two-layer model of surface oxide film, consisting of a thin barrier-type inner layer and a porous outer layer. The inner barrier layer mainly prevents corrosion of CP Ti and Ti-6Al-4V alloy, whose thickness and resistance increase sharply in the first few days of exposure to PBS solution. With longer exposure times to the PBS solution, the structure of the barrier layer subsequently settles, and its resistance increases further. Compared to Ti-6Al-4V alloy, CP Ti shows greater corrosion stability.

Skin adhesion to the percutaneous component of direct bone anchored systems: systematic review on preclinical approaches and biomaterials

Nowadays, direct bone anchored systems are an increasingly adopted approach in the therapeutic landscape for amputee patients. However, the percutaneous nature of these devices poses a major challenge to obtain a stable and lasting proper adhesion between the implant surface and the skin. A systematic review was carried out in three databases (PubMed, Scopus, Web of Science) to provide an overview of the innovative strategies tested with preclinical models (in vitro and in vivo) in the last ten years to improve the skin adhesion of direct bone anchored systems. Fifty five articles were selected after screening, also employing PECO question and inclusion criteria. A modified Cochrane RoB 2.0 tool for the in vitro studies and the SYRCLE tool for in in vivo studies were used to assess the risk of bias. The evidence collected suggests that the implementation of porous percutaneous structures could be one of the most favorable approach to improve proper skin adhesion, especially in association with bioactive coatings, as hydroxyapatite, and exploiting the field of nanostructure. Some issues still remain open as (a) the identification and characterization of the best material/coating association able to limit the shear stresses at the interface and (b) the role of keratinocyte turnover on the skin/biomaterial adhesion and integration processes.

Osteosphere Model to Evaluate Cell-Surface Interactions of Implantable Biomaterials

Successful biomaterials for bone tissue therapy must present different biocompatible properties, such as the ability to stimulate the migration and proliferation of osteogenic cells on the implantable surface, to increase attachment and avoid the risks of implant movement after surgery. The present work investigates the applicability of a three-dimensional (3D) model of bone cells (osteospheres) in the evaluation of osteoconductive properties of different implant surfaces. Three different titanium surface treatments were tested: machined (MA), sandblasting and acid etching (BE), and Hydroxyapatite coating by plasma spray (PSHA). The surfaces were characterized by Scanning Electron Microscopy (SEM) and atomic force microscopy (AFM), confirming that they present very distinct roughness. After seeding the osteospheres, cell–surface interactions were studied in relation to cell proliferation, migration, and spreading. The results show that BE surfaces present higher densities of cells, leaving the aggregates towards than titanium surfaces, providing more evidence of migration. The PSHA surface presented the lowest performance in all analyses. The results indicate that the 3D model allows the focal analysis of an in vitro cell/surfaces interaction of cells and surfaces. Moreover, by demonstrating the agreement with the clinical data observed in the literature, they suggest a potential use as a predictive preclinical tool for investigating osteoconductive properties of novel biomaterials for bone therapy.

Comparative Study of Physicochemical Properties and Biocompatibility (L929 and MG63 Cells) of TiN Coatings Obtained by Plasma Nitriding and Thin Film Deposition

Ti6Al4V is one of the most lightweight, mechanically resistant, and appropriate for biologically induced corrosion alloys. However, surface properties often must be tuned for fitting into biomedical applications, and therefore, surface modification is of paramount importance to carry on its use. This work compares the interaction between two different cell lines (L929 fibroblasts and osteoblast-like MG63) and medical grade Ti6Al4V after surface modification by plasma nitriding or thin film deposition. We studied the adhesion of these two cell lines, exploring which trends are consistent for cell behavior, correlating with osseointegration and in vivo conditions. Modified surfaces were analyzed through several physicochemical characterization techniques. Plasma nitriding led to a more pronounced increase in surface roughness, a thicker aluminum-free layer, made up of diverse titanium nitride phases, whereas thin film deposition resulted in a single-phase pure titanium nitride layer that leveled the ridged topography. The selective adhesion of osteoblast-like cells over fibroblasts was observed in nitrided samples but not in thin film deposited films, indicating that the competitive cellular behavior is more pronounced in plasma nitrided surfaces. The obtained coatings presented an appropriate performance for its use in biomedical-aimed applications, including the possibility of a higher success rate in osseointegration of implants.

Anodizing/Anaphoretic Electrodeposition of Nano-Calcium Phosphate/Chitosan Lactate Multifunctional Coatings on Titanium with Advanced Corrosion Resistance, Bioactivity, and Antibacterial Properties

The aim of this work was to investigate corrosion resistivity, bioactivity, and antibacterial activity of novel nano-amorphous calcium phosphate (ACP) potentially multifunctional composite coatings with and without chitosan oligosaccharide lactate (ChOL), ACP + ChOL/TiO₂ and ACP/TiO₂ ACP + ChOL/TiO₂, respectively, on the titanium substrate. The coatings were obtained by new single-step in situ anodization of the substrate to generate TiO₂ and the anaphoretic electrodeposition process of ACP and ChOL. The obtained coatings were around 300 ± 15 μm thick and consisted of two phases, namely, TiO₂ and hybrid composite phases. Both ACP/TiO₂ and ACP + ChOL/TiO₂ have improved corrosion stability, whereas the ACP + ChOL/TiO₂ coating showed better corrosion stability. It was shown that at the very start of the deposition process, the formation of the ChOL/TiO₂ layer takes place predominantly, which is followed by the inclusion of ChOL into ACP with simultaneous growth of TiO₂. This deposition mechanism resulted in the formation of strongly bonded uniform stable coating with high corrosion resistance. In vitro bioactivity was investigated by immersion of the samples in simulated body fluid (SBF). There is in-bone-like apatite formation on both ACP/TiO₂ and ACP + ChOL/TiO₂ surfaces upon immersion into SBF, which was proven by X-ray diffraction and Fourier transform infrared spectroscopy. While ACP/TiO₂ shows no antibacterial activity, ACP + ChOL/TiO₂ samples exhibited three- to fourfold decreases in the number of Staphylococcus aureus and Pseudomonas aeruginosa, respectively, after 420 min. The probable mechanism is binding ChOL with the bacterial cell wall, inhibiting its growth, altering the permeability of the cell membrane, and leading to bacterial death.

An Overview of RNA-Based Scaffolds for Osteogenesis

Tissue engineering provides new hope for the combination of cells, scaffolds, and bifactors for bone osteogenesis. This is achieved by mimicking the bone's natural behavior in recruiting the cell's molecular machinery for our use. Many researchers have focused on developing an ideal scaffold with specific features, such as good cellular adhesion, cell proliferation, differentiation, host integration, and load bearing. Various types of coating materials (organic and non-organic) have been used to enhance bone osteogenesis. In the last few years, RNA-mediated gene therapy has captured attention as a new tool for bone regeneration. In this review, we discuss the use of RNA molecules in coating and delivery, including messenger RNA (mRNA), RNA interference (RNAi), and long non-coding RNA (lncRNA) on different types of scaffolds (such as polymers, ceramics, and metals) in osteogenesis research. In addition, the effect of using gene-editing tools-particularly CRISPR systems-to guide RNA scaffolds in bone regeneration is also discussed. Given existing knowledge about various RNAs coating/expression may help to understand the process of bone formation on the scaffolds during osseointegration.

Low-Temperature Hydrothermal Synthesis of Novel 3D Hybrid Nanostructures on Titanium Surface with Mechano-bactericidal Performance

Titanium is extensively employed in modern medicines as orthopedic and dental implants, but implant failures frequently occur because of bacterial infections. Herein, three types of 3D nanostructured titanium surfaces with nanowire clusters (NWC), nanowire/sheet clusters (NW/SC) and nanosheet clusters (NSC), were fabricated using the low-temperature hydrothermal synthesis under normal pressure, and assessed for the sterilization against two common human pathogens. The results show that the NWC and NSC surfaces merely display good bactericidal activity against Escherichia coli, whereas the NW/SC surface represents optimal bactericidal efficiency against both Escherichia coli (98.6 ± 1.23%) and Staphylococcus aureus (69.82 ± 2.79%). That is attributed to the hybrid geometric nanostructure of NW/SC, i.e., the pyramidal structures of ∼23 nm in tip diameter formed with tall clustered wires, and the sharper sheets of ∼8 nm in thickness in-between these nanopyramids. This nanostructure displays a unique mechano-bactericidal performance via the synergistic effect of capturing the bacteria cells and penetrating the cell membrane. This study proves that the low-temperature hydrothermal synthesized hybrid mechano-bactericidal titanium surfaces provide a promising solution for the construction of bactericidal biomedical implants.

Zinc- and strontium- co-incorporated nanorods on titanium surfaces with favorable material property, osteogenesis, and enhanced antibacterial activity

Early infection and peri-implantitis after implant restoration are major reasons for dental implant failure. Implant-associated infections are majorly attributed to biofilm formation. In this study, co-incorporated zinc- (Zn-) and strontium- (Sr-) nanorod coating on sandblasted and acid-etched (SLA) titanium (SLA-Zn/Sr) was fabricated by hydrothermal synthesis. It was aimed at promoting osteogenesis while inhibiting biofilm formation. The nanorod-like particles (φ 30-50 nm) were found to be evenly formed on SLA-Zn/Sr (Zn: 1.49 ± 0.16 wt%; Sr: 21.69 ± 2.74 wt%) that was composed of well-crystallized ZnTiO₃ and SrTiO₃ phases. With a sufficient interface bonding strength (42.00 ± 3.00 MPa), SLA-Zn/Sr enhanced the corrosion resistance property of titanium. Besides, SLA-Zn/Sr promoted the cellular initial adhesion, proliferation and osteogenic differentiation of rBMSCs in vitro while inhibiting the adhesion of Staphylococcus aureus and Porphyromonas gingivalis . In addition, through down-regulating icaA gene expression, this novel surface reduced the secretion of polysaccharide intercellular adhesion (reduced by 87.9% compared to SLActive) to suppress the S. aureus biofilm formation. We, therefore, propose a new chemical modification on titanium for multifunctional implant material development. Due to the Zn/Sr co-doping in coating, material properties, early osteogenic effect and antibacterial ability of titanium can be simultaneously enhanced, which has the potential to be applied in dental implantation in the future.

Synergistic Effect of rhBMP-2 Protein and Nanotextured Titanium Alloy Surface to Improve Osteogenic Implant Properties

One of the major limitations during titanium (Ti) implant osseointegration is the poor cellular interactions at the biointerface. In the present study, the combined effect of recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) and nanopatterned Ti6Al4V fabricated with Directed irradiation synthesis (DIS) is investigated in vitro. This environmentally-friendly plasma uses ions to create self-organized nanostructures on the surfaces. Nanocones (≈36.7 nm in DIS 80°) and thinner nanowalls (≈16.5 nm in DIS 60°) were fabricated depending on DIS incidence angle and observed via scanning electron microscopy. All samples have a similar crystalline structure and wettability, except for sandblasted/acid-etched (SLA) and acid-etched/anodized (Anodized) samples which are more hydrophilic. Biological results revealed that the viability and adhesion properties (vinculin expression and cell spreading) of DIS 80° with BMP-2 were similar to those polished with BMP-2, yet we observed more filopodia on DIS 80° (≈39 filopodia/cell) compared to the other samples (<30 filopodia/cell). BMP-2 increased alkaline phosphatase activity in all samples, tending to be higher in DIS 80°. Moreover, in the mineralization studies, DIS 80° with BMP-2 and Anodized with BMP-2 increased the formation of calcium deposits (>3.3 fold) compared to polished with BMP-2. Hence, this study shows there is a synergistic effect of BMP-2 and DIS surface modification in improving Ti biological properties which could be applied to Ti bone implants to treat bone disease.

Nanoparticles and Nanostructured Surface Fabrication for Innovative Cranial and Maxillofacial Surgery

A novel strategy to improve the success of soft and hard tissue integration of titanium implants is the use of nanoparticles coatings made from basically any type of biocompatible substance, which can advantageously enhance the properties of the material, as compared to its similar bulk material. So, most of the physical methods approaches involve the compaction of nanoparticles versus micron-level particles to yield surfaces with nanoscale grain boundaries, simultaneously preserving the chemistry of the surface among different topographies. At the same time, nanoparticles have been known as one of the most effective antibacterial agents and can be used as effective growth inhibitors of various microorganisms as an alternative to antibiotics. In this paper, based on literature research, we present a comprehensive review of the mechanical, physical, and chemical methods for creating nano-structured titanium surfaces along with the main nanoparticles used for the surface modification of titanium implants, the fabrication methods, their main features, and the purpose of use. We also present two patented solutions which involve nanoparticles to be used in cranioplasty, i.e., a cranial endoprosthesis with a sliding system to repair the traumatic defects of the skull, and a cranial implant based on titanium mesh with osteointegrating structures and functional nanoparticles. The main outcomes of the patented solutions are: (a) a novel geometry of the implant that allow both flexible adaptation of the implant to the specific anatomy of the patient and the promotion of regeneration of the bone tissue; (b) porous structure and favorable geometry for the absorption of impregnated active substances and cells proliferation; (c) the new implant model fit 100% on the structure of the cranial defect without inducing mechanical stress; (d) allows all kinds of radiological examinations and rapid osteointegration, along with the patient recover in a shorter time.

Titanium for Orthopedic Applications: An Overview of Surface Modification to Improve Biocompatibility and Prevent Bacterial Biofilm Formation

Titanium and its alloys have emerged as excellent candidates for use as orthopedic biomaterials. Nevertheless, there are often complications arising after implantation of orthopedic devices, most notably prosthetic joint infection and aseptic loosening. To ensure that implanted devices remain functional in situ, innovation in surface modification has attracted much attention in the effort to develop orthopedic materials with optimal characteristics at the biomaterial-tissue interface. This review will draw together metallurgy, surface engineering, biofilm microbiology, and biomaterial science. It will serve to appreciate why titanium and its alloys are frequently used orthopedic biomaterials and address some of the challenges facing these biomaterials currently, including the significant problem of device-associated infection. Finally, the authors shall consolidate and evaluate surface modification techniques employed to overcome some of these issues by offering a unique perspective as to the direction in which research is headed from a broad, interdisciplinary point of view.

Nanointeraction: The profound influence of nanostructured and nano-drug delivery biomedical implant surfaces on cell behavior

Nanostructured surfaces feature promising biological properties on biomaterials attracting large interest at basic research, implant industry development, and bioengineering applications. Thou, nanoscale interactions at a molecular and cellular level are not yet completely understood and its biological and clinical implications need to be further elucidated. As follows, the aim of this comprehensive review was to evaluate nanostructured surfaces at biomedical implants focusing on surface development, nanostructuration, and nanoengineered drug delivery systems that can induce specific cell interactions in all relevant aspects of biological, reparative, anti-bacterial, anti-inflammatory and clinical processes. The methods and the physio-chemical properties involved in nanotopography performance, the main cellular characteristics involved at surface/cell interaction, and a summary of results and outlooks reported in studies applying nanostructured surfaces and nano-drug delivery systems is presented. The future prospects and commercial translation of this developing field, particularly concerning multifunctional nanostructured surfaces and its clinical implications are further discussed. At a cellular level, nanostructured biomedical implant surfaces can enhance osteogenesis by targeting osteoblasts, osteocytes, and mesenchymal cells, stimulate fibroblast/epithelial cells proliferation and adherence, inhibit bacterial cell proliferation and biofilm accumulation, and act as immune-modulating surfaces targeting macrophages and reducing pro-inflammatory cytokine expression. Moreover, several methodological options to create drug-delivery systems on metallic implant surfaces are available, however, the clinical translation is yet incomplete. The efficiency of which nanostructured/nano-delivery surfaces may target specific cell interactions and favor clinical outcomes needs to be further elucidated in pre-clinical and clinical studies, along with engineering solutions for commercial translation and approval of controlling agencies.

The Biomaterials of Total Shoulder Arthroplasty: Their Features, Function, and Effect on Outcomes

The materials that are used in total shoulder arthroplasty (TSA) implants have been carefully chosen in an attempt to minimize hardware-related complications. The 2 main metal alloys used in TSA implants are Ti-6Al-4V (titanium-aluminum-vanadium) and CoCrMo (cobalt-chromium-molybdenum). Ti alloys are softer than CoCr alloys, making them less wear-resistant and more susceptible to damage, but they have improved osseointegration and osteoconduction properties. Although controversial, metal allergy may be a concern in patients undergoing TSA and may lead to local tissue reaction and aseptic loosening. Numerous modifications to polyethylene, including cross-linking, minimizing oxidation, and vitamin E impregnation, have been developed to minimize wear and reduce complications. Alternative bearing surfaces such as ceramic and pyrolytic carbon, which have strong track records in other fields, represent promising possibilities to enhance the strength and the durability of TSA prostheses.

Protruding Nanostructured Surfaces for Antimicrobial and Osteogenic Titanium Implants

Protruding nanostructured surfaces have gained increasing interest due to their unique wetting behaviours and more recently their antimicrobial and osteogenic properties. Rapid development in nanofabrication techniques that offer high throughput and versatility on titanium substrate open up the possibility for better orthopaedic and dental implants that deter bacterial colonisation while promoting osteointegration. In this review we present a brief overview of current problems associated with bacterial infection of titanium implants and of efforts to fabricate titanium implants that have both bactericidal and osteogenic properties. All of the proposed mechano-bactericidal mechanisms of protruding nanostructured surfaces are then considered so as to explore the potential advantages and disadvantages of adopting such novel technologies for use in future implant applications. Different nanofabrication methods that can be utilised to fabricate such nanostructured surfaces on titanium substrate are briefly discussed.

Hollow cathode plasma nitriding of medical grade Ti6Al4V: A comprehensive study

Ti6Al4V used in biomedical applications still has several surface-related problems, such as poor bone compatibility and low wear resistance. In this work, the formation of a protective layer of titanium nitride obtained by plasma treatment in hollow cathode was studied, and the best experimental conditions were verified by a statistical factorial design of experiments. The samples were characterized in terms of their physical and chemical properties, correlating the effects of time (min) and temperature (°C). An achieved ideal condition was further analysed in terms of in vitro cytotoxicity, micro-abrasion, and electrochemical properties. The carried-out assessment has shown that nitrided condition has an improvement in wettability, microhardness, along with TixNy formation and roughness increment, when compared to pristine condition.

Ultrafast Laser Processing of Nanostructured Patterns for the Control of Cell Adhesion and Migration on Titanium Alloy

Femtosecond laser texturing is a promising surface functionalization technology to improve the integration and durability of dental and orthopedic implants. Four different surface topographies were obtained on titanium-6aluminum-4vanadium plates by varying laser processing parameters and strategies: surfaces presenting nanostructures such as laser-induced periodic surface structures (LIPSS) and ‘spikes’, associated or not with more complex multiscale geometries combining micro-pits, nanostructures and stretches of polished areas. After sterilization by heat treatment, LIPSS and spikes were characterized to be highly hydrophobic, whereas the original polished surfaces remained hydrophilic. Human mesenchymal stem cells (hMSCs) grown on simple nanostructured surfaces were found to spread less with an increased motility (velocity, acceleration, tortuosity), while on the complex surfaces, hMSCs decreased their migration when approaching the micro-pits and preferentially positioned their nucleus inside them. Moreover, focal adhesions of hMSCs were notably located on polished zones rather than on neighboring nanostructured areas where the protein adsorption was lower. All these observations indicated that hMSCs were spatially controlled and mechanically strained by the laser-induced topographies. The nanoscale structures influence surface wettability and protein adsorption and thus influence focal adhesions formation and finally induce shape-based mechanical constraints on cells, known to promote osteogenic differentiation.

The effects of local and intraperitoneal zinc treatments on maxillofacial fracture healing in rabbits

OBJECTIVE

This study aimed to determine whether administration of topical and intraperitoneal zinc for maxillofacial fractures has any impact on the bone healing process.

MATERIAL AND METHOD

Thirty-two New Zealand rabbits were randomly assigned to four groups of eight each. The first group was the control group; fracture lines were fixed using titanium microplates and no medication was administered. The second group received fixations using zinc-coated titanium microplates. A single dose of 3 mg/kg zinc was administered intraperitoneally to the third group following fixations with titanium microplates. A single dose of 3 mg/kg zinc was administered intraperitoneally to the fourth group following fixations with zinc-coated titanium microplates. Zinc coating on to the titanium microplates was achieved using the physical vapor deposition technique. A fracture line was created in the nasal bones of all subjects and fixed with five-hole flat microplates and three 5-mm micro screws. All work groups were sacrificed at the end of the sixth week.

RESULTS

Histological examination showed that the number of osteoblasts were significantly higher in zinc-coated group (Group 2) than zinc uncoated, control group (Group 1), (415.6 ± 46.7 vs 366.3 ± 11.8) (p < 0.001). It was observed that intraperitoneal zinc treatment alone (Group 3) did not significantly increase in the osteoblast count compared to zinc un-coated group (Group 1), (390.6 ± 83.2 vs 366.3 ± 11.8), (p = 0.341). The immunoreactivity scores for IGF-1 were significantly higher in the zinc-coated group compared to control group (Group 2 vs 1), (9.3 ± 2.8 vs 3.7 ± 1.9) (p < 0.05). It was observed that intraperitoneal zinc treatment did not cause a significant difference in the aspect of IGF-1 for zinc-coated groups (Group 2 vs 4) (9.3 ± 2.8 vs 9.6 ± 2.2) (p = 0.791). The difference in the immunoreactivity score among whole groups for TGF-β was not statistically significant (Group 1 vs 2, 3.2 ± 1.7 vs 4.4 ± 2.3, p = 0.256; Group 1 vs 3, 3.2 ± 1.7 vs 3.8 ± 2.8, p = 0.524; Group 1 vs 4, 3.2 ± 1.7 vs 2.8 ± 1.3, p = 0.717; Group 2 vs 3, 4.4 ± 2.3, vs 3.8 ± 2.8, p = 0.610; Group 2 vs 4, 4.4 ± 2.3, vs 2.8 ± 1.3, p = 0.124; Group 3 vs 4, 3.8 ± 2.8, vs 2.8 ± 1.3, p = 0.311).

CONCLUSION

The local use of titanium microplates coated with zinc by PVD technique was found effective for fracture healing. Zinc coating of titanium microplates used in fracture treatment can accelerate fracture healing. It may be concluded that clinical studies should be performed now in order to explore if comparable results can be achieved in humans.

Electrochemical Evaluation of the Compact and Nanotubular Oxide Layer Destruction under Ex Vivo Ti6Al4V ELI Transpedicular Screw Implantation

Nano-engineered implants are a promising orthopedic implant modification enhancing bioactivity and integration. Despite the lack of destruction of an oxide layer confirmed in ex vivo and in vivo implantation, the testing of a microrupture of an anodic layer initiating immune-inflammatory reaction is still underexplored. The aim of this work was to form the compact and nanotubular oxide layer on the Ti6Al4V ELI transpedicular screws and electrochemical detection of layer microrupture after implantation ex vivo by the Magerl technique using scanning electron microscopy and highly sensitive electrochemical methods. For the first time, the obtained results showed the ability to form the homogenous nanotubular layer on an Ti6Al4V ELI screw, both in α and β-phases, with favorable morphology, i.e., 35 ÷ 50 ± 5 nm diameter, 1500 ± 100 nm height. In contrast to previous studies, microrupture and degradation of both form layers were observed using ultrasensitive electrochemical methods. Mechanical stability and corrosion protection of nanotubular layer were significantly better when compared to compact oxide layer and bare Ti6Al4V ELI.

Effects of ZnO/TiO2 nanoparticle and TiO2 nanotube additions to dense polycrystalline hydroxyapatite bioceramic from bovine bones

OBJECTIVES

A bovine dense hydroxyapatite ceramic (HA) was produced as new biomaterial, however, the production of a material with consistently high flexural strength remains challenging. The objective of this study was to evaluate the effects of ZnO nanoparticles, TiO₂ nanoparticles, and TiO₂ nanotubes (1%, 2%, and 5% by weight) on the microstructure and flexural strength of a bovine dense hydroxyapatite ceramic (HA).

METHODS

Discs (Ø=12.5mm; thickness=1.3mm) were prepared and subjected to X-ray diffraction (XRD), and observation with a field emission scanning electron microscope (FE-SEM), biaxial flexural strength (BFS) testing, and Vickers hardness (VH) testing. The BFS and VH data were subjected to ANOVA and Tukey post-hoc tests (α=0.05) and Weibull analysis.

RESULTS

The XRD showed that the addition of nanomaterials caused the formation of a secondary phase when 5% of the ZnO nanoparticles was used, or when all percentages of the TiO₂ nanoparticles/nanotubes were used, and the HA crystallographic planes were maintained. Differences were not observed between the higher BFS values obtained with pure HA and those obtained with the 5% addition of TiO₂ nanoparticles. However, the results were different compared with the other groups (α=0.05). The results obtained by Weibull analysis revealed that the 1%, 2%, and 5% addition of TiO₂ nanotubes, and the 1% and 2% addition of TiO₂ nanoparticles decreased the HA characteristic strength (σ₀), while the Weibull modulus (m) increased when 5% of TiO₂ nanoparticles, 1% and 2% of ZnO nanoparticles, and 2% of TiO₂ nanoparticles were added, but with no statistical difference from the pure HA. The 5% addition of ZnO₂ nanoparticles decreased the σ₀ without changing m. Moreover, the 5% addition of TiO₂ nanoparticles resulted in an m closest to that of pure HA. Regarding the VH results, the blend of HA with 1% and 2% addition of TiO₂ nanoparticles exhibited the higher values, which were similar between the different addition ratios (p=0.102). Moreover, the addition of 5% TiO₂ nanoparticles resulted in higher value compared with pure HA.

SIGNIFICANCE

This study demonstrated that the HA blend with 5% of TiO₂ nanoparticles has the greatest potential as a bovine HA dense bioceramic reinforcement.

Effects of calcium and phosphorus incorporation on the properties and bioactivity of TiO2 nanotubes

In this study, we investigate the formation of calcium and phosphorus-doped TiO₂ nanotubes, produced by potentiostatic anodization of Ti in viscous electrolyte-containing HF and Ca/P ions. Characterization of the produced oxide layer was conducted using scanning electron microscopy, glancing-angle X-ray diffraction, X-ray photoelectron spectroscopy, contact angle, and protein adsorption measurements. Adipose-derived stem cells were used to study material cytotoxicity, cell viability and proliferation, and cell morphology and growth. To evaluate the adipose-derived stem-cell differentiation, we investigated the expression of osteocalcin and osteopontin by cells as well as calcium mineralization. Results show that it was possible to produce a superhydrophilic titanium oxide nanotube layer with incorporation of Ca and P ions. The presence of Ca and P in the oxide layer not only improved the cell adhesion and proliferation but also stimulated the production of key marker proteins indicating differentiation of cells.

Bioactive Glass and Silicate-Based Ceramic Coatings on Metallic Implants: Open Challenge or Outdated Topic?

The overall success and long-term life of the medical implants are decisively based on the convenient osseointegration at the hosting tissue-implant interface. Therefore, various surface modifications and different coating approaches have been utilized to the implants to enhance the bone formation and speed up the interaction with the surrounding hosting tissues, thereby enabling the successful fixation of implants. In this review, we will briefly present the main metallic implants and discuss their biocompatibility and osseointegration ability depending on their chemical and mechanical properties. In addition, as the main goal of this review, we explore the main properties of bioactive glasses and silica-based ceramics that are used as coating materials for both orthopedic and dental implants. The current review provides an overview of these bioactive coatings, with a particular emphasis on deposition methods, coating adhesion to the substrates and apatite formation ability tested by immersion in Simulated Body Fluid (SBF). In vitro and in vivo performances in terms of biocompatibility, biodegradability and improved osseointegration are examined as well.

Mechanical testing of antimicrobial biocomposite coating on metallic medical implants as drug delivery system

Post-operative infection often occurs following orthopedic and dental implant placement requiring systemically administered antibiotics. However, this does not provide long-term protection. Over the last few decades, alternative methods involving slow drug delivery systems based on biodegradable poly-lactic acid and antibiotic loaded hydroxyapatite microspheres were developed to prevent post-operative infection. In this study, thermally anodised and untreated Ti6Al4V discs were coated with Poly-Lactic Acid (PLA) containing Gentamicin (Gm) antibiotic-loaded coralline Hydroxyapatite (HAp) are investigated. Following chemical characterization, mechanical properties of the coated samples were measured using nanoindentation and scratch tests to determine the elastic modulus, hardness and bonding adhesion between film and substrate. It was found that PLA biocomposite multilayered films were around 400nm thick and the influence and effect of the substrate were clearly observed during the nanoindentation studies with heavier loads. Scratch tests of PLA coated samples conducted at ~160nm depth showed the minimal difference in the measured friction between Gm and non Gm containing films. It is also observed that the hardness values of PLA film coated anodised samples ranged from 0.45 to 1.9GPa (dependent on the applied loads) against untreated coated samples which ranged from 0.28 to 0.8GPa.

The Fate of Osteoblast-Like MG-63 Cells on Pre-Infected Bactericidal Nanostructured Titanium Surfaces

Biomaterials that have been newly implanted inside the body are the substratum targets for a "race for the surface", in which bacterial cells compete against eukaryotic cells for the opportunity to colonize the surface. A victory by the former often results in biomaterial-associated infections, which can be a serious threat to patient health and can undermine the function and performance of the implant. Moreover, bacteria can often have a 'head start' if implant contamination has taken place either prior to or during the surgery. Current prevention and treatment strategies often rely on systemic antibiotic therapies, which are becoming increasingly ineffective due to a growing prevalence of antibiotic-resistant bacteria. Nanostructured surfaces that kill bacteria by physically rupturing bacterial cells upon contact have recently emerged as a promising solution for the mitigation of bacterial colonization of implants. Furthermore, these nanoscale features have been shown to enhance the adhesion and proliferation of eukaryotic cells, which is a key to, for example, the successful osseointegration of load-bearing titanium implants. The bactericidal activity and biocompatibility of such nanostructured surfaces are often, however, examined separately, and it is not clear to what extent bacterial cell-surface interactions would affect the subsequent outcomes of host-cell attachment and osseointegration processes. In this study, we investigated the ability of bactericidal nanostructured titanium surfaces to support the attachment and growth of osteoblast-like MG-63 human osteosarcoma cells, despite them having been pre-infected with pathogenic bacteria. MG-63 is a commonly used osteoblastic model to study bone cell viability, adhesion, and proliferation on the surfaces of load-bearing biomaterials, such as titanium. The nanostructured titanium surfaces used here were observed to kill the pathogenic bacteria, whilst simultaneously enhancing the growth of MG-63 cells in vitro when compared to that occurring on sterile, flat titanium surfaces. These results provide further evidence in support of nanostructured bactericidal surfaces being used as a strategy to help eukaryotic cells win the "race for the surface" against bacterial cells on implant materials.

Dental Implant Bioactive Surface Modifiers: An Update

Objectives:

Main purpose of this review was to present an update on various coating materials utilized in improving the surface chemistry of the dental implants.

Methods:

Literature search was carried out in various on-line databases such as PubMed, Medline, Google scholar, EBSCO, Wiley Science Library, and Saudi Digital Library using appropriate keywords (dental implant surface coatings, dental implant surface modifiers, and dental surface coatings).

Results:

Total of 569 studies were retrieved. All the relevant studies among them were reviewed and compiled.

Conclusion:

Current implant surface's biomimetic coatings offer many benefits compared to the traditional plasma sprayed coatings. Further incorporation of biomimetic coatings with various material has lead improvement in mechanical and biological properties of implants.