Chemical modification of metallic implant surfaces with biofunctional proteins (Part 2). Corrosion resistance of a chemically modified NiTi alloy

A review of the latest developments in rotary NiTi technology and root canal preparation

The introduction of nickel-titanium (NiTi) mechanical instruments dramatically changed clinical endodontics over the last few decades. Before NiTi, it was necessary to use more instruments to create an ideal root canal shape, and many approaches, sequences and techniques were developed over the years. Recently, NiTi endodontic instruments have undergone a series of changes brought about by modifications in design, surface treatments, and thermal treatments to improve their root canal preparation outcomes and reduce associated canal preparation risks during root canal treatment. Heat treatment is one of the most fundamental approaches to improving the fatigue resistance and flexibility of NiTi endodontic instruments. In addition, new kinematics have been developed to offer greater safety and efficiency. This narrative review describes the general properties and manufacturing of NiTi instruments, and the mechanical system evolution of NiTi instruments.

Titanium and titanium alloys in dentistry: current trends, recent developments, and future prospects

Many implant materials have been used in various dental applications depending on their efficacy and availability. A dental implant must possess the required characteristics, such as biocompatibility, corrosion & wear resistance, adequate mechanical properties, osseointegration, etc., to ensure its safe and optimum use. This review analyzes various aspects of titanium (Ti) and Ti alloys, including properties, manufacturing processes, surface modifications, applications as dental implants, and limitations. In addition, it also presents a perception of recent advances in Ti-based implant materials and the futuristic development of innovative dental implants.

Inhibition of initial bacterial adhesion on titanium surfaces by lactoferrin coating

Because dental implant abutments are located at transmucosal sites, their surface should inhibit bacterial accumulation to prevent peri-implantitis. The authors examined the effects of human lactoferrin (LF), an antibacterial protein present in saliva, as an antibacterial coating on the titanium surface and evaluated its effects before and after mucin-containing artificial saliva (AS) incubation. In the control group, titanium disks were soaked in distilled water, whereas in the LF group, titanium disks were soaked in LF solution to coat the disks. In the control-AS and LF-AS groups, half of the control and LF disks were incubated with AS. To confirm LF adsorption, the fluorescence intensity of fluorescein isothiocyanate-labeled LF was measured. The LF and LF-AS groups showed significantly higher intensity than the control and control-AS groups (P < 0.01). There was no significant difference between the LF and LF-AS groups (P > 0.05). The amount of adhered Streptococcus gordonii significantly increased by incubation with AS (P < 0.01) and significantly decreased by adsorption of LF (P < 0.01). There was no interaction between the two factors, LF adsorption and AS incubation (P = 0.561). These results suggest that the adsorbed LF inhibited bacterial adhesion following AS incubation. According to qualitative LIVE/DEAD analysis, viable bacteria appeared to be decreased in the presence of LF and SEM observation indicated that altered morphologies increased in LF and LF-AS groups. These results suggest that the adsorbed LF remained on the titanium surface after incubation with AS, and the remaining LF inhibited bacterial adhesion and exhibited bactericidal effects. Therefore, the adsorption of LF on the abutment material appears to be effective in preventing peri-implantitis.

Biomimetic coatings for bone tissue engineering of critical-sized defects

The repair of critical-sized bone defects is still challenging in the fields of implantology, maxillofacial surgery and orthopaedics. Current therapies such as autografts and allografts are associated with various limitations. Cytokine-based bone tissue engineering has been attracting increasing attention. Bone-inducing agents have been locally injected to stimulate the native bone-formation activity, but without much success. The reason is that these drugs must be delivered slowly and at a low concentration to be effective. This then mimics the natural method of cytokine release. For this purpose, a suitable vehicle was developed, the so-called biomimetic coating, which can be deposited on metal implants as well as on biomaterials. Materials that are currently used to fill bony defects cannot by themselves trigger bone formation. Therefore, biological functionalization of such materials by the biomimetic method resulted in a novel biomimetic coating onto different biomaterials. Bone morphogenetic protein 2 (BMP-2)-incorporated biomimetic coating can be a solution for a large bone defect repair in the fields of dental implantology, maxillofacial surgery and orthopaedics. Here, we review the performance of the biomimetic coating both in vitro and in vivo.

Oral Keratinocyte Responses to Nickel-based Dental Casting Alloys In Vitro

Adverse reactions of oral mucosa to nickel-based dental casting alloys are probably due to corrosion metal ion release. We exposed H400 oral keratinocytes to two Ni-based dental alloys (Matchmate and Dsign10) as well as NiCl 2 (1—40 μg/mL Ni2+). Alloy derived Ni2+ media concentrations were determined. Direct culture on both alloys resulted in inhibited growth with a greater effect observed for Dsign10 (higher ion release). Indirect exposure of cells to conditioned media from Dsign10 negatively affected cell numbers (~64% of control by 6 days) and morphology while Matchmate-derived media did not. Exposure to increasing NiCl2 negatively affected cell growth and morphology, and the Granulocyte-macrophage colony-stimulating factor (GM-CSF) transcript was significantly up-regulated in cells following direct and indirect exposure to Dsign10. NiCl2 exposure up-regulated all cytokine transcripts at 1 day. At day 6, IL-1β and IL-8 transcripts were suppressed while GM-CSF and IL-11 increased with Ni2+ dose. Accumulation of Ni2+ ions from alloys in oral tissues may affect keratinocyte viability and chronic inflammation.

Silicon carbide coating of nitinol stents to increase antithrombogenic properties and reduce nickel release

BACKGROUND

The use of stents in the superficial femoral artery is still limited by the number of restenoses. Influencing factors include thrombus formation and smooth muscle cell proliferation as well as motion stress. A reduction of thrombogenicity can be achieved by passive coating with silicon carbide, which induces less thrombus formation due to its semiconducting properties.

METHODS AND MATERIALS

Self-expanding peripheral stents with and without silicon carbide coating were examined in a chandler loop model. Assessed parameters included thrombocyte count, beta-thromboglobulin (TG), thrombin-antithrombin (TAT) III complex, and polymorphonuclear elastase. Nickel release was quantified at Days 1, 3, and 223 using graphite furnace atomic absorption spectrometry. To visualize thrombus formation on the surface, scanning electron microscopy was conducted.

RESULTS

The tests showed a superiority of the coated stents regarding beta-TG (484.0+/-180.2 IU/l vs 2189.1+/-898.9 IU/l) as well as formation of TAT III complex (16.0+/-19.1 microg/l vs 458.3+/-761.0 microg/l). Scanning electron microscopy revealed a nearly absent thrombus formation on the coating. Nickel release was reduced by more than 90% at all time points.

CONCLUSIONS

In the provided in vitro setting, silicon carbide coating applied to self-expanding peripheral stents showed an advantage regarding thrombogenicity. The passive barrier resulted in a limited release of nickel from the alloy itself. These features seem promising for the use in the peripheral vasculature.

Antifouling properties of poly(methyl methacrylate) films grafted with poly(ethylene glycol) monoacrylate immersed in seawater

Biofouling of all structures immersed in seawater constitutes an important problem, and many strategies are currently being developed to tackle it. In this context, our previous work shows that poly(ethylene glycol) monoacrylate (PEGA) macromonomer grafted on preoxidized poly(methyl methacrylate) (PMMAox) films exhibits an excellent repellency against the bovine serum albumin used as a model protein. This study aims to evaluate the following: (1) the prevention of a marine extract material adsorption by the modified surfaces and (2) the antifouling property of the PEGA-g-PMMAox substrates when immersed in natural seawater during two seasons (season 1: end of April-beginning of May 2007, and season 2: end of October-beginning of November 2007). The antifouling performances of the PEGA-g-PMMAox films are investigated for different PEG chain lengths and macromonomer concentrations into the PEGA-based coatings. These two parameters are followed as a function of the immersion time, which evolves up to 14 days. The influence of the PEGA layer on marine compounds (proteins and phospholipids) adsorption is evidenced by time-of-flight secondary ion mass spectrometry (ToF-SIMS) and X-ray photoelectron spectroscopy (XPS). It was found that the antifouling efficiency of the PEGA-grafted surfaces increases with both PEGA concentration and PEG chain length.

Porous NiTi for bone implants: a review

NiTi foams are unique among biocompatible porous metals because of their high recovery strain (due to the shape-memory or superelastic effects) and their low stiffness facilitating integration with bone structures. To optimize NiTi foams for bone implant applications, two key areas are under active study: synthesis of foams with optimal architectures, microstructure and mechanical properties; and tailoring of biological interactions through modifications of pore surfaces. This article reviews recent research on NiTi foams for bone replacement, focusing on three specific topics: (i) surface modifications designed to create bio-inert porous NiTi surfaces with low Ni release and corrosion, as well as bioactive surfaces to enhance and accelerate biological activity; (ii) in vitro and in vivo biocompatibility studies to confirm the long-term safety of porous NiTi implants; and (iii) biological evaluations for specific applications, such as in intervertebral fusion devices and bone tissue scaffolds. Possible future directions for bio-performance and processing studies are discussed that could lead to optimized porous NiTi implants.

Gene expression of MC3T3-E1 cells on fibronectin-immobilized titanium using tresyl chloride activation technique

Fibronectin (FN) can be immobilized directly on titanium surfaces using tresyl chloride activation technique. The key advantage of tresyl chloride activation technique lies in its simplicity. In this study, we examined the cell attachment and gene expression of MC3T3-E1 cells on FN-immobilized titanium using GeneChip. Cells attached on FN-immobilized titanium at a higher rate than untreated titanium. FN altered the gene expression profile, whereby 62 genes were found to be up-regulated, while 56 genes were found to down-regulate to over twice the level on day 14. FN not only enhanced the expression levels of IBSP and OMD, but also decreased SULF1 mRNA level. Taken together, the immobilization of FN on tresylated titanium promoted early matrix mineralization and bone formation.

Modification of the titan surface with photoreactive gelatin to regulate cell attachment

Titan (TiO2) was modified with photoreactive gelatin in order to regulate the attachment of cells. Photoreactive gelatin, which was synthesized by the coupling reaction of gelatin with N-(4-azidobenzoyloxy) succinimide, was immobilized onto the n-octadecyltrimethoxysilane (ODS)-TiO2 or TiO2 surface by ultraviolet irradiation both in the absence and presence of a photo mask. In the absence of a photo mask, the modified titan surface was analyzed by measuring water contact angles and X-ray photoelectron spectroscopy (XPS). The result showed that ODS hydrophobilized the titan surface, and that the immobilization of gelatin affected the surface's hydrophilicity. XPS shows that titan was covered with organic material, including ODS and gelatin. With the photo mask in place, micropatterning of the gelatin was performed. This pattern was confirmed by optical microscopy and time-of-flight secondary ion-mass spectroscopy (TOF-SIMS). Monkey COS-7 epithelial cells were cultured on the unpattern- and pattern-immobilized plate. A significantly higher degree of cell attachment was found on the photoreactive gelatin-immobilized regions than on those that were not immobilized. It was concluded that the cellular pattern on titan was regulated by immobilized photoreactive gelatin.

Modified aminosilane substrates to evaluate osteoblast attachment, growth, and gene expression in vitro

Bone cell-substrate interactions are important to understand in the design, selection, and surface modification of bone implants. To gain insight into such interactions, substrates designed with surface species approximating the physiological environment of bone matrix were studied. Osteoblasts (Ob) grown on three such surfaces were used to evaluate cell-substrate effects on attachment, growth, and gene expression as compared with controls. Initial surface preparation consisted of coating glass slides with aminopropyltriethoxy silane (APTES), after which the coated slides were modified with collagen-rich extracellular matrix components obtained from normally mineralizing avian tendon: the tripeptide arginine-glycine-aspartic acid (arg-gly-asp), or a precipitate formed from a metastable solution containing inorganic ions normally found in blood (simulated body fluid). Each of the modified substrates, as well as the nonmodified (APTES) control, provided distinctly different physical (evidenced by differences in rms roughness) and chemical surfaces for seeding primary osteoblasts obtained from 14-day-old normal embryonic chickens. Cell responses to each of the substrates were evaluated over a 21-day period in terms of Ob growth and growth rate, alkaline phosphatase (ALP) activity, and gene expression of type I collagen (COL I), osteopontin (OPN), osteocalcin (OC), and bone sialoprotein (BSP). From these preliminary experiments, indications are that cell attachment and growth in this study possibly are independent processes, an assumption that compels the need for further studies. Collagen-rich matrix-modified substrates had a distinct advantage over others when cell growth rate, ALP activity, and gene expression were considered; cells on these substrates exhibited increased ALP activity and enhanced expression of BSP, OPN, and OC when compared with those of cells on APTES controls or other modified substrates. These results indicate that matrix-modified substrates such as those used in this study provide favorable templates for tissue generation, suggesting their potential in the design of surfaces for bone implants.

Corrosion Resistance and Surface Characterization of Electrolyzed Ti-Ni Alloy

Ti-Ni alloy has been increasingly applied to medical and dental devices, such as coronary stents and orthodontic wires. This alloy contains nickel, which is known to give rise to cytotoxicity, metal allergy, and carcinogenicity. Therefore, the purpose of this study was to improve the corrosion resistance of Ti-Ni alloy by electrolytic treatment, whereby investigation was carried out using different acidic electrolyte compositions. As a result, specimens electrolyzed with lactic acid, water, and glycerol were found to show higher corrosion potential and release lower amount of titanium and nickel ions than mechanical-polished specimens (p<0.05). With the electrolytic treatment, nickel concentration in the surface oxide layer of Ti-Ni alloy decreased, and the thickness of the surface oxide layer increased. Based on the results of this study, it was shown that electrolytic treatment with suitable electrolyte could improve the corrosion resistance of Ti-Ni alloy, which is effective to produce medical and dental devices that utilize shape memory effect or superelasticity with better biocompatibility.

Adsorption of albumin and IgG to porous and smooth titanium

The possibility to load submicrometer porous titanium surfaces with relatively small proteins, albumin and immunoglobulin G (IgG) was investigated. The loading ability is of interest due to the possibility of slow release of molecules from biomaterial surfaces, and may be important for the manipulation of wound healing around prostheses. Iodine-125 (125I) labeled albumin and IgG were adsorbed onto smooth and to porous titanium with a pore diameter of 200-300 nm. The smooth and porous surfaces were divided into three groups: hydrophilic, hydrophobic, or to amine-terminated silane (3-aminopropyltriethoxysilane) that bound proteins via glutaraldehyde. The protein solution pH and protein concentrations were varied, and the adsorption experiments made without or in the presence of calcium and magnesium ions. The adsorbed amounts were quantified with a gamma counter. Two to eleven times more proteins adsorbed onto porous than smooth surfaces and the adsorbed amounts increased with increasing protein concentration (0.1-10 mg/ml) during a constant incubation time. The elutability by sodium dodecyl sulphate (SDS) was incomplete on porous surfaces.

Preparation of alginic acid layers on stainless-steel substrates for biomedical applications

This study is concerned with the blood compatibility of alginic acid layers immobilized on gamma-aminopropyltriethoxysilane (gamma-APS)-grafted stainless-steel (SUS316L). The surfaces were characterized with contact angle measurement and X-ray photoelectron spectroscopy (XPS). The blood compatibility was evaluated in terms of platelet adhesion and blood clotting time. An in vitro platelet adhesion assay indicated that only a small number of platelets adhered to substrate surfaces modified with gamma-APS and subsequently with alginic acid. Moreover, alginic-acid-immobilized SUS316L substrates had little effect on the blood clotting time. This indicated that alginic-acid-immobilized SUS316L substrates do not adsorb some blood-clotting proteins or factors, or stimulate them.

Acid pretreatment of titanium implants

The purpose of this study was to evaluate the effectiveness of several methods of cleaning titanium surfaces as pretreatment for surface modifications by analyzing the chemical interaction of three acids, such as Na(2)S(2)O(8),H(2)SO(4) and HCl, followed by rinsing with acetone or ultrapure water. Chemical evaluation, using X-ray photoelectron spectroscopy (XPS), and mechanical evaluation, using nanoindentation, were employed. XPS revealed that an untreated Ti surface consisted of carbon- and nitrogen-containing contaminant and titanium oxide layer on metallic titanium substrate. The method involving the combination of 10 N HCl and acetone was the most effective of all the methods investigated. Such a combination most effectively reduced values of contamination parameters C/Ti and N/Ti, as well as the intensity of the titanium oxide component in Ti 2p spectra. Chlorine was barely detected from the surface treated with HCl in any concentration. Sulfur from the residual S(2)O(8)(2-) or SO(4)(2-), however, was detected from the samples treated with either Na(2)S(2)O(8) or H(2)SO(4). The S/Ti values depended on concentration of the acidic solution. In addition, nanoindentation measurements revealed that Young's modulus of the surface treated with 0.1-10 N HCl was not significantly different from that of an untreated surface (p > 0.05). Consequently, the HCl/acetone treatment is proposed as an excellent decontamination method for the surface preparation process of Ti.

Ex vivo PMA-induced respiratory burst and TNF-alpha secretion elicited from inflammatory cells on machined and porous blood plasma clot-coated titanium

The release of inflammatory mediators around implants and normal wounds may differ due to the presence of the solid surface. In this study, machined and sub-micron porous titanium implants with and without a 100 nm thick blood plasma clot were inserted subcutaneously in rat for 3 or 24 h. The cell recruitment to the interfaces, in vivo secretion of TNF-alpha and the ex vivo PMA-induced production of reactive oxygen species were subsequently investigated. The thin plasma clot coating gave rise to an increased ex vivo PMA-stimulated oxygen radical production by implant-associated cells at both implantation times, and an increased cell recruitment at 24 h. The total TNF-alpha secretion was highest at sham sites and plasma clot-coated porous titanium at 24 h. After 24 h, the cell-type pattern in the exudate around the porous plasma-coated implant was more similar to that found at sham sites than that adjacent to the non-coated implants. No differences were observed between the machined Ti and the machined sub-micron porous Ti.

In vitro preparation and ellipsometric characterization of thin blood plasma clot films on silicon

The wound-healing process around implants differs from that of a normal healing without the inserted material. In this work, the composition of a natural wound surface was mimicked through clotting of a thin human blood plasma film with approximate ellipsometric thickness of 100 nm onto differently pretreated silicon surfaces. Their stability was investigated by incubations in sodium dodecyl sulphate (SDS) solutions. The enzymatic clot degradation was induced through addition of human tissue plasminogen activator (t-PA) to the plasma and the surface protein remnants after the degradation were analyzed with polyclonal antibodies. The results show that the plasma films were not SDS resistant on hydrophilic silicon. However, stability was obtained after preparation on hydrophobic silicon or when albumin or fibrinogen was immobilized to silicon before the plasma incubations. Different surfaces bound different polyclonal antibodies after the clot film degradation. The methods indicate a simple means to improve or reestablish a normal tissue inflammatory response around biomaterials.

Surface modification using silanated poly(ethylene glycol)s

Surface-grafted poly(ethylene glycol) (PEG) molecules are known to prevent protein adsorption to the surface. The protein-repulsive property of PEG molecules are maximized by covalent grafting. We have synthesized silanated monomethoxy-PEG (m-PEG) for covalent grafting of PEG to surfaces with oxide layers. Two different trialkoxysilylated PEGs were synthesized and characterized. The first trialkoxysilylated PEG was prepared by direct coupling of m-PEG with 3-isocyanatopropyltriethoxysilane through a urethane bond (silanated PEG I). The other silanated PEG (silanated PEG II) containing a long hydrophobic domain between PEG and a silane domain was prepared by reacting m-PEG with 1,6-diisocyanatohexane and 10-undecen-1-ol in sequence before silylation with 3-mercaptopropyl trimethoxysilane. Silanated PEGs I and II were grafted onto glass, a model surface used in our study. The PEG-grafted glass surfaces were characterized by contact angle, X-ray photoelectron spectroscopy (XPS), and atomic force microscopy (AFM). Although contact angle did not change much as the bulk concentration of silanated PEG used for grafting increased from 0.1 to 20 mg/ml for both PEGs I and II, the surface atomic concentrations from XPS measurements showed successful PEG grafting. Surface PEG grafting increased concentration of surface carbon but decreased silicone concentration. The high resolution C1s spectra showed higher ether carbon with lower hydrocarbon compositions for the PEG-grafted surfaces compared to the control surface. AFM images showed that more PEG molecules were grafted onto the surface as the bulk concentration used for grafting was increased. AFM images of the dried surfaces showed that the surfaces were not completely covered by PEG molecules. After hydration, however, the surface appears to be covered completely probably due to the hydration of the grafted PEG chains. Glass surfaces modified with silanated PEGs reduced fibrinogen adsorption by more than 95% as compared with the control surface. Silanated PEGs provides a simple method for PEG grafting to the surface containing oxide layers.