The use of nickel-titanium alloy in orthopedic surgery in China

Nitinol Type Alloys General Characteristics and Applications in Endodontics

A very extensive literature review presents the possibilities and needs of using, in endodontics, the alloys commonly known as nitinol. Nitinol, as the most modern group of engineering materials used to develop root canals, is equilibrium nickel and titanium alloys in terms of the elements’ atomic concentration, or very similar. The main audience of this paper is engineers, tool designers and manufacturers, PhD students, and students of materials and manufacturing engineering but this article can also certainly be used by dentists. The paper aims to present a full material science characterization of the structure and properties of nitinol alloys and to discuss all structural phenomena that determine the performance properties of these alloys, including those applied to manufacture the endodontic tools. The paper presents the selection of these alloys’ chemical composition and processing conditions and their importance in the endodontic treatment of teeth. The results of laboratory studies on the analysis of changes during the sterilization of endodontic instruments made of nitinol alloys are also included. The summary of all the literature analyses is an SWOT analysis of strengths, weaknesses, opportunities, and threats, and is a forecast of the development strategy of this material in a specific application such as endodontics.

What Are the Chances of Resilon to Dominate the Market Filling Materials for Endodontics?

This paper is a literature review with additional virtual analyses of the authors’ own experimental research results. Knowledge from various areas was synergistically combined, appropriately for concurrent engineering, presenting several possible methodological approaches used in research, optimizing the selection of engineering materials and the conditions of their application with particular application in endodontics. Particular attention was paid to the theoretical aspects of filling material strengths, weaknesses, opportunities, and threats SWOT analysis. Attention was paid to the original concepts of Sustainable Dentistry Development in conjunction with Dentistry 4.0, which includes endodontics as an important element. The dentists’ actions, among others, in conservative dentistry, along with endodontics, requires close cooperation with engineers and the enginering sciences. Methods of root canal preparation were described, together with selected tools, including those made of nitinol. Principles concerning the process of cleaning and shaping the pulp complex are presented. The importance of obturation methods, including the Thermo-Hydraulic-Condensation THC technique, and the selection of filling materials with the necessary sealants for the success of endodontic treatment are discussed. The experimental studies were carried out in vitro on human teeth removed for medical reasons, except for caries, for which two groups of 16 teeth were separated. After the root canal was prepared, it was filled with studs and pellets of a filling material based on polyester materials, which has gained the common trade name of resilon or, less frequently, RealSeal (SybronEndo) with an epiphany sealant. The teeth for the first group were obturated by cold lateral condensation. In the second case the obturation was performed using the Thermo-Hydraulic-Condensation technique using System B and Obtura III. The experimental leakage testing was done using a scanning electron microscope SEM and a light stereoscopic microscope LSM, as typical research tools used in materialography. The research results, in a confrontation with the data taken from the literature studies, do not indicate the domination of resilon in endodontics.

Shape Memory Alloy Expandable Pedicle Screw to Enhance Fixation in Osteoporotic Bone: Primary Design and Finite Element Simulation

The properties of shape memory alloys, specifically the equiatomic intermetallic NiTi, are unique and significant in that they offer simple and effective solutions for some of the biomechanical issues encountered in orthopedics. Pedicle screws, used as an anchoring point for the implantation of spinal instrumentations in the spinal fracture and deformity treatments, entail the major drawback of loosening and backing out in osteoporotic bone. The strength of the screw contact with the surrounding bone diminishes as the bone degrades due to osteoporosis. The SMArtTM pedicle screw design is developed to address the existing issue in degraded bone. It is based on the interaction of bi-stable shape memory-superelastic elements. The bi-stable assembly acts antagonistically and consists of an external superelastic tube that expands the design protrusions when body temperature is attained; also an internal shape memory wire, inserted into the tube, retracts the assembly while locally heated to above the body temperature. This innovative bi-stable solution augments the pull-out resistance while still allowing for screw removal. The antagonistic wire-tube assembly was evaluated and parametrically analyzed as for the interaction of the superelastic tube and shape memory wire using a finite element model developed in COMSOL Multiphysics®. The outcomes of the simulation suggest that shape memory NiTi inserts on the SMArtTM pedicle screw can achieve the desired antagonistic functionality of expansion and retraction. Consequently, a parametric analysis was conducted over the effect of different sizes of wires and tubes. The dimensions for the first sample of this innovative pedicle screw were determined based on the results of this analysis.

Smart intramedullary rod for correction of pediatric bone deformity: a preliminary study

We were interested in determining if a smart intramedullary rod made of nitinol shape-memory alloy is capable of correcting deformed immature long bones. Because of limitations in our study design the process was reversed in that we examined the smart rod's ability to create a deformity rather than to correct one. Smart rods of different lengths and diameters were heat-treated to resume a radius of curvature of 30 to 110 mm. The low and high temperature phases of the smart rods were set, respectively, at 0 degrees C to 4 degrees C and 36 degrees C to 38 degrees C. The preshaped smart intramedullary rods were implanted in the cooled martensite phase in the medullary canal of the tibia in eight rabbits, where they restored their austenite form, causing a continuous bending force. On a weekly basis anteroposterior and lateral radiographs of the surgically treated tibia and the contralateral tibia were obtained for comparison. Rabbits were euthanized 6 weeks after surgery and computed tomography scans of both tibias were used for image analysis. Smart rods with a larger radius of curvature showed only minimal signs of remodeling; however, rods with a radius of curvature of 50 and 70 mm generated enough force history to create bone remodeling and deformation. The amount of bone deformation was highly magnified when unicortical corticotomy on the tension side was done. Based on this preliminary study the technology of the smart intramedullary rod may provide a valuable alternative method to correct pediatric skeletal deformities.

Porous titanium-nickel for intervertebral fusion in a sheep model: part 2. Surface analysis and nickel release assessment

Porous titanium-nickel (PTN) devices represent an alternative to traditional cage implants. PTN materials possess an interconnecting network of pores with capillarity properties that may promote bone ingrowth, long-term fixation, and intervertebral fusion without the need for bone grafting. However, their considerable surface area and nickel content may elicit concerns over sensitization potential. Therefore, PTN surface corrosion and nickel release resistance must be carefully studied. To evaluate this possibility, a PTN interbody fusion device (IFD) was compared to a conventional nonporous cage made of TiAlV, a well-known biocompatible biomaterial, in a sheep model. PTN and TiAlV IFDs were inserted at two non-contiguous lumbar sites for 3, 6, and 12 months postsurgery. Their surface was then evaluated by scanning electron microscopy (SEM) combined with backscattered electron analysis (BSE). No evidence of surface corrosion was observed either pre- or postimplantation, regardless of device type. Dosage of nickel ions was also performed with the use of inductively coupled plasma-mass spectrometry (ICP-MS). Blood nickel levels were observed to be within acceptable levels at all postinstrumentation times. Nickel content in PTN-adjacent tissue, as well as in detoxification and remote organs, was equivalent both in PTN-treated and control sheep. Therefore, porous titanium-nickel demonstrated resistance to both in vivo surface corrosion and nickel ion release and compared very well with a conventional titanium implant in the course of a 12-month sheep study.

Bone modeling controlled by a nickel-titanium shape memory alloy intramedullary nail

Nitinol (NiTi) shape memory metal alloy makes it possible to prepare functional implants that apply a continuous bending force to the bone. The purpose of this study was to find out if bone modeling can be controlled with a functional intramedullary NiTi nail. Pre-shaped intramedullary NiTi nails (length 26 mm, thickness 1.0-1.4 mm) with a curvature radius of 25-37 mm were implanted in the cooled martensite form in the medullary cavity of the right femur in eight rats, where they restored their austenite form, causing a bending force. After 12 weeks, the operated femurs were compared with their non-operated contralateral counterpairs. Anteroposterior radiographs demonstrated significant bowing, as indicated by the angle between the distal articular surface and the long axis of the femur (p = 0.003). Significant retardation of longitudinal growth and thickening of operated femurs were also seen. Quantitative densitometry showed a significant increase in the average cross-sectional cortical area (p = 0.001) and cortical thickness (p = 0.002), which were most obvious in the mid-diaphyseal area. Cortical bone mineral density increased in the proximal part of the bone and decreased in the distal part. Polarized light microscopy of the histological samples revealed that the new bone induced by the functional intramedullary nail was mainly woven bone. In conclusion, this study showed that bone modeling can be controlled with a functional intramedullary nail made of nickel-titanium shape memory alloy.

An overview of nickel-titanium alloys used in dentistry

The nickel-titanium alloy Nitinol has been used in the manufacture of endodontic instruments in recent years. Nitinol alloys have greater strength and a lower modulus of elasticity compared with stainless steel alloys. The super-elastic behaviour of Nitinol wires means that on unloading they return to their original shape following deformation. These properties are of interest in endodontology as they allow construction of root canal instruments that utilize these favourable characteristics to provide an advantage when preparing curved canals. This review aims to provide an overview of Nitinol alloys used in dentistry in order for its unique characteristics to be appreciated.

In vitro biocompatibility assessment of a nickel-titanium alloy using electron microscopy in situ end-labeling (EM-ISEL)

Shape memory nickel-titanium (NiTi) alloys are potential candidates for biomedical applications. However, their equiatomic composition (50 wt% Ni) is controversial, and concerns have been raised about their biocompatibility level because of the carcinogenicity potential. The relative in vitro genotoxicity of NiTi therefore was evaluated and compared to commercially pure titanium (cpTi), 316L stainless steel (SS 316L), and positive and negative controls. To do so, human peripheral blood lymphocytes were cultured in semiphysiological medium that previously had been exposed to the biomaterials. The electron microscopy in situ end-labeling (EM-ISEL) assay then was performed in order to provide quantification of in vitro chromatin DNA single-stranded breaks (SSBs). Chromosomes and nuclei were harvested and exposed to exonuclease III, which amplifies DNA lesions at 3' ends of breaks. After random priming, incorporation of biotin-dUTP was labeled by immunogold binding, which then was detected using electron microscopy. Cellular chromatin exposed to the positive control demonstrated a significantly stronger immunogold labeling than when it was exposed to NiTi, cpTi, SS 316L extracts, or the untreated control. Moreover, gold particle counts, whether in the presence of NiTi, cpTi, or the negative control medium, were not statistically different. NiTi genocompatibility therefore presents promising prescreening results towards its biocompatibility approval.

Biocompatibility of nickel-titanium shape memory metal and its corrosion behavior in human cell cultures

Nickel-titanium alloy (Nitinol) is a metallic biomaterial that has a unique thermal shape memory, superelasticity, and high damping properties. Nitinol is potentially very useful in orthopedic surgery, for example. At present, there are not enough confirmative biocompatibility data available on Nitinol. The aim of our study was to clarify the primary cytotoxicity and corrosion rate of Nitinol in human cell cultures. Comparisons were made with stainless steel (Stst), titanium (Ti), composite material (C), and control cultures with no test discs. Human osteoblasts (OB) and fibroblasts (FB) were incubated for 10 days with test discs of equal size, 6 x 7 mm. The cultures were photographed and the cells counted. Samples from culture media were collected on days 2, 4, 6, and 8, and the analysis of metals in the media was done using flameless atomic absorption spectrophotometry. The proliferation of FB was 108% (Nitinol), 134% (Ti) (p < 0.02), 107% (Stst), and 48% (C)(p < 0.0001) compared to the control cultures. The proliferation of OB was 101% (Nitinol), 100% (Ti), 105% (Stst), and 54% (C) (p < 0.025) compared to the controls. Initially, Nitinol released more nickel (129-87 micrograms/L) into the cell culture media than Stst (7 micrograms/L), but after 2 days the concentrations were about equal (23-5 micrograms/L versus 11-1 micrograms/L). The titanium concentrations from both Nitinol and Ti samples were all < 20 micrograms/L. We conclude that Nitinol has good in vitro biocompatibility with human osteoblasts and fibroblasts. Despite the higher initial nickel dissolution, Nitinol induced no toxic effects, decrease in cell proliferation, or inhibition on the growth of cells in contact with the metal surface.

An evaluation of nitinol and stainless steel files used by dental students during a laboratory proficiency exam

Eighty-one dental students instrumented two curved canals in acrylic blocks with the use of stainless steel files in one block and nitinol files in the other. Overlay tracings were made of photographs taken before and after instrumentation of the acrylic blocks and differences between the tracings were measured along the canal walls. The canals instrumented with nitinol files were shaped better than those instrumented with stainless steel files; working length was maintained more often without ledging the canal walls and with less zipping of the apical foramen.