Fatigue life of bioactive titanium dental implants treated by means of grit-blasting and thermo-chemical treatment

OBJECTIVE

This study focuses on the fatigue behavior of titanium dental implants as-received, with a grit-blasted surface and with a new bioactive surface treatment (2Steps).

BACKGROUND

The 2Step process consists of (1) an initial grit-blasting process to produce a micro-rough surface, followed by (2) a combined thermo-chemical treatment that produces a potentially bioactive surface, that is, that can form an apatitic layer when exposed to biomimetic conditions in vitro. The 2Step treatment produced micro-rough and apatitic coating implants.

METHODS

Residual stresses were determined by means of X-ray diffraction. The fatigue tests were carried out at 37°C on 500 dental implants, and the S-N curve was determined. The fatigue-crack nucleation for the different treatments was analyzed.

RESULTS

The fatigue tests show that the grit-blasting process improves the fatigue life. This is a consequence of the layer of compressive residual stresses that the treatment generates in titanium surfaces. Dental implants that had its surfaced prepared with the 2Step procedure (grit-blasting and thermo-chemical treatment) had its fatigue life decreased by 10% due to the incorporation of oxygen to the surface and the relaxation of the compressive residual stress produced by the heat treatment.

CONCLUSIONS

Thermo-chemical treatment is an excellent compromise between the improvement of bioactive and mechanical long-life behaviors.

Influence of the microstructure on electrochemical corrosion and nickel release in NiTi orthodontic archwires

The aim of this work was to determine the influence of the present phases and the chemical composition on the corrosion behavior and the nickel ion release of the NiTi orthodontic archwires. Eight Ni-Ti archwires from six commercial brands, in the as-received condition, were studied. The chemical composition, roughness, microstructure and the proportion of the phases as well as the corrosion behavior were analyzed for each archwire. The nickel ion release was characterized in artificial saliva immersion settings ranging up to 4 weeks. The results show that the presence of the martensitic phase improves corrosion resistance and significantly decreases Ni release into exterior medium in comparison with the austenitic specimens. In spite of the partial loss of superelasticity produced in the martensitic phase, it could be of great interest for biomedical applications, as it could minimize sensitization and allergies and improve biocompatibility and corrosion resistance of NiTi shape memory alloys.

Friction coefficients and wear rates of different orthodontic archwires in artificial saliva

The aim of this paper is to analyze the influence of the nature of the orthodontic archwires on the friction coefficient and wear rate against materials used commonly as brackets (Ti-6Al-4V and 316L Stainless Steel). The materials selected as orthodontic archwires were ASI304 stainless steel, NiTi, Ti, TiMo and NiTiCu. The array archwire's materials selected presented very similar roughness but different hardness. Materials were chosen from lower and higher hardness degrees than that of the brackets. Wear tests were carried out at in artificial saliva at 37 °C. Results show a linear relationship between the hardness of the materials and the friction coefficients. The material that showed lower wear rate was the ASI304 stainless steel. To prevent wear, the wire and the brackets have high hardness values and in the same order of magnitude.

Reduction of Ni release and improvement of the friction behaviour of NiTi orthodontic archwires by oxidation treatments

This work studies NiTi orthodontic archwires that have been treated using a new oxidation treatment for obtaining Ni-free surfaces. The titanium oxide on the surface significantly improves corrosion resistance and decreases nickel ion release, while barely affecting transformation temperatures. This oxidation treatment avoids the allergic reactions or toxicity in the surrounding tissues produced by the chemical degradation of the NiTi. In the other hand, the lack of low friction coefficient for the NiTi superelastic archwires makes difficult the optimal use of these materials in Orthodontic applications. In this study, the decrease of this friction coefficient has been achieved by means of oxidation treatment. Transformation temperatures, friction coefficient and ion release have been determined.

Wilson maxillary curve analyzed by CBCT. A study on normocclusion and malocclusion individuals

The anatomy of dental compensation curve in the frontal plane described by George H. Wilson is one of the occlusal determinants of orthodontic treatment. However, there is few published comparing malocclusion and normocclusion individuals.

OBJECTIVES

The aim of this study is to compare the curve of Wilson at first and second maxillary molars, normocclusion pattern and malocclusion pattern, with and without bilateral posterior crossbite, using angular references in CBCT studies.

MATERIAL AND METHODS

We analyzed 10 cases of malocclusion with bilateral posterior crossbite, 10 cases of malocclusion without bilateral posterior crossbite and 10 cases with non orthodontic normocclusion (patients who underwent cone beam study for other reasons than orthodontic). All of them were adults, more than 19 years. Angular variables from left and right axis (line connecting the occlusal and furcation groove) of first and second molars towards a perpendicular to the frontal palate were measured. There was carried out an Anova test, Bonferroni analysis and Levene's statistics.

RESULTS

The descriptive analysis of the results shows an average values of total maxillary curve of Wilson for first molars (sum of left and right angle) of 8.1° for normocclusion group, 0.4° for the malocclusion pattern with bilateral posterior crossbite and 16.9° for the malocclusion pattern without this alteration. The mean differences was statistical significant (P<0,042) between between malocclusion pattern groups with and without crossbite .

CONCLUSION

The curve of Wilson, measured at maxillary first molars in patients with bilateral posterior crossbite is more concave than the other groups, suggesting no dentoalveolar compensations.

Development of Biomimetic NiTi Alloy: Influence of Thermo-Chemical Treatment on the Physical, Mechanical and Biological Behavior

A bioactive layer, free of nickel, has been performed for its greater acceptability and reliability in clinical applications for NiTi shape memory alloys. In the first step, a safe barrier against Ni release has been produced on the surface by means of a thicker rutile/anastase protective layer free of nickel. In the second step, a sodium alkaline titanate hydrogel, which has the ability to induce apatite formation, has been performed from oxidized surface. An improvement of host tissue–implant integration has been achieved in terms of Ni ions release and the bioactivity of the treated NiTi alloys has been corroborated with both in vitro and in vivo studies. The transformation temperatures (A_s, A_f, M_s, and M_f), as well as the critical stresses (σ^β⇔M), have been slightly changed due to this surface modification. Consequently, this fact must be taken into account in order to design new surface modification on NiTi implants.

Long-term stability of surgical-orthodontic correction of class III malocclusions with long-face syndrome

Objectives: In the first place, to evaluate skeletal changes of the maxilla and mandible induced by surgical-orthodontic correction of malocclusions class III with long-face syndrome and secondly, to analyze the stability of these skeletal changes in the long term (more than 6 years). Design of Study: A retrospective, unicentric and longitudinal study of 19 patients who had undergone surgical and orthodontic therapy for class III skeletal malocclusion with long-face syndrome was undertaken. A cephalometric analysis based on 8 angle measurements, and statistical analyses at three different points in time (before orthodontic treatment, after orthognathic surgery and after a retention period of at least 6 years) were carried out. Results: The changes produced following surgery show that, with the exception of the maxillary plane and the facial axis, all other variables presented changes of great statistical difference. Conclusions: Skeletal changes after orthodontic-surgical correction present maxillary advance, mandibular regression and mandibular anterorotation. The angles that represent the mandibular vertical position (ramus angle, goniac angle and mandibular plane angle) showed statistically significant relapses and no stability in contrast to the facial axis.

Key words:Long term results, stability, relapse, orthognathic surgery, class III, long face.

Corrosion and corrosion-fatigue behavior of cp-Ti and Ti-6Al-4V laser-marked biomaterials

The aim of this work was to determine the influence of laser surface modification treatments on mechanical and electrochemical behavior in Ti and Ti-6Al-4V implants. For each metal, different samples were laser modified simulating the markings according to the international requirements. (It is necessary in each metallic biomaterial to mark the serial, batch and company numbers.) Microstructural changes produced by this treatment were observed: (a) the melting zone with small grain sizes and martensitic structures in above-mentioned metals and (b) the heat-affected zone (HAZ) with alpha phase in cp-Titanium with bigger grain sizes and Widmanstatten structure in Ti-6Al-4V. Positive tensile residual stress was determined by means X-ray analysis in the zones marked by laser. Furthermore, corrosion behavior was studied in a simulated body fluid at 37°C. Pitting was observed in different zones near the HAZ and the results showed a decrease of the corrosion resistance in the laser treated samples. Residual stresses and the martensitic microstructures favoured the decrease of the corrosion-fatigue life around 20% of both metals under physiological conditions.

Effect of Fluoride Content of Mouthwashes on Superelastic Properties of NiTi Orthodontic Archwires

The influence of sodium fluoride (NaF) concentration in mouthwashes on the properties of superelastic NiTi orthodontic wires has been studied. In this work, 55.8%Ni and 44.2%Ti (in weight) wires were introduced in commercial mouthwashes with different NaF contents (0, 130, 200 and 380 ppm). The release of Ni²⁺ and Ti⁴⁺ ions was by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) at 1, 4, 7 and 14 days. Superelastic orthodontic wires present at oral temperature the austenitic phase which is transformed into a plastic phase (martensite) by cooling. The temperatures at which this occurs are influenced by the chemical composition. The release of ions from the wire will produce variations in the temperatures and stresses of the stress-induced martensitic transformation. M_s, M_f, A_s, A_f were determined by Differential Scanning Calorimeter (DSC). The transformation stresses (austenite to stress induce martensite) were determined with a servo-hydraulic testing machine at 37 °C. The surfaces for the different times and mouthwash were observed by Scanning Electron Microscope (SEM). The release of Ni²⁺ in mouthwashes with 380 ppm NaF concentrations reaches 230,000 ppb in 14 days and for Ti⁴⁺ 175,000 ppb. When NaF concentrations are lower than 200 ppm the release of Ni and Ti ions is around 1500 ppb after 14 days. This variation in compositions leads to variations in M_s from 27 °C to 43.5 °C in the case of higher NaF concentration. The increasing immersion time and NaF concentrations produce a decrease of Ni in the wires, increasing M_s which exceed 37 °C with the loss of superelasticity. In the same way, the stresses (tooth position corrective) decrease from 270 MPa to 0 MPa due to the martensitic phase. The degradation can produce the growth of precipitates rich in Ti (Ti₂Ni). These results are of great interest in the orthodontic clinic in order to avoid the loss of the therapeutic properties of superelastic NiTi due to long immersion in fluoride mouthwashes.

Effect of oral bacteria on the mechanical behavior of titanium dental implants

PURPOSE

This study sought to determine whether the mechanical properties of titanium dental implants changed after exposure to bacteria.

MATERIALS AND METHODS

Two strains of bacteria (Streptococcus sanguinis and Lactobacillus salivarius) were used in the study. The adhesive properties of the two strains were investigated as follows. Titanium implants were placed in bacteria broth, seeded with the two bacteria strains, and left in the broth for 1 or 3 months. Another group of titanium implants was immersed in artificial saliva at 37°C for 3 months. Ten implants in each group were tested in 37°C artificial saliva to evaluate their mechanical flexural strength and fatigue life.

RESULTS

The bacterial cultures grew quickly on titanium surfaces. After 1 month of bacteria culture in vitro, the bacteria had produced corrosion pits on the titanium surfaces. After 3 months of bacterial culture, a 7% decrease in the flexural strength of the implant samples and a decrease of 15% in the number of cycles to failure by fatigue were seen versus implants not exposed to bacteria.

CONCLUSIONS

These results demonstrate that, in physiologic conditions in vitro, bacteria have the capacity to produce a pitting corrosion phenomenon on exposed titanium surfaces, leading to a significant deterioration in the mechanical properties of the implant. It is therefore logical to conclude that bacteria may produce corrosion that reduces the useful life of dental implants.

Bacteriostatic Poly Ethylene Glycol Plasma Coatings for Orthodontic Titanium Mini-Implants

Titanium mini-implants are used as anchorage for orthodontic tooth movements. However, these implants present problems due to the infection of surrounding tissues. The aim of this work was to obtain a polyethylene glycol (PEG) layer by plasma in order to achieve a bacteriostatic surface. Titanium surfaces were activated by argon plasma and, after, by PEG plasma with different powers (100, 150 and 200 W) for 30 and 60 min. The roughness was determined by white light interferometer microscopy and the wettability was determined by the contact angle technique. Surface chemical compositions were characterized by X-ray photoelectron spectroscopy (XPS) and cytocompatibility and cell adhesion studies were performed with fibroblast (hFFs) and osteoblast (SAOS-2) cells. Bacterial cultures with Spectrococcus Sanguinis and Lactobacillus Salivarius were performed, and bacterial colonization was determined. The results showed that plasma treatments do not affect the roughness. Plasma makes the surfaces more hydrophilic by decreasing the contact angles from 64.2° for titanium to 5.2° for argon-activated titanium, with values ranging from 12° to 25° for the different PEG treatments. The plasma has two effects: the cleaning of the surface and the formation of the PEG layer. The biocompatibility results were, for all cases, higher than 80%. The polymerization treatment with PEG reduced the adhesion of hFFs from 7000 to 6000 and, for SAOS-2, from 14,000 to 6500, for pure titanium and those treated with PEG, respectively. Bacterial adhesion was also reduced from 600 to 300 CFU/mm² for Spetrococcuns Sanguinis and from 10,000 to 900 CFU/mm² for Lactobacillus Salivarius. The best bacteriostatic treatment corresponded to PEG at 100 W and 30 s. As a consequence, the PEG coating would significantly prevent the formation of bacterial biofilm on the surface of titanium mini-implants.

Effect of Fluoride Content of Mouthwashes on the Metallic Ion Release in Different Orthodontics Archwires

Metal ion release studies were carried out on three of the most commonly used orthodontic wires in the clinic: austenitic stainless steel, Ti-Mo, and superelastic NiTi, using three mouthwashes with different fluoride concentrations: 130, 200, and 380 ppm. Immersions were carried out in these mouthwashes at 37 °C for 1, 4, 7, and 14 days, and the ions released were determined by inductively coupled plasma-mass spectrometry (ICP-MS). All wires were observed by scanning electron microscopy (SEM). The results showed a moderate ion release in the stainless steel wires, with nickel and chromium values of 500 and 1000 ppb in the worst conditions for the wires: concentrations of 380 ppm fluoride and 14 days of immersion. However, in the Ti-Mo and NiTi alloys, an abrupt change in release was observed when the samples were immersed in 380 ppm fluoride concentrations. Titanium releases in Ti-Mo wires reached 200,000 ppb, creating numerous pits on the surface. Under the same conditions, the release of Ni and Ti ions from the superelastic wires also exceeded 220,000 ppb and 180,000 ppb, respectively. This release of ions causes variations in the chemical composition of the wires, causing the appearance of martensite plates in the austenitic matrix after 4 days of immersion. This fact causes it to lose its superelastic properties at a temperature of 37 °C. In the case of immersion in 380 ppm mouthwashes for more than 7 days, rich-nickel precipitates can be seen. These embrittle the wire and lose all tooth-correcting properties. It should be noted that the release of Ni ions can cause hypersensitivity in patients, particularly women. The results indicate that the use of mouthwashes with a high content of fluoride should not be recommended with orthodontic archwires.

Five-year follow-up evaluation of the noncemented press-fit titanium hip-joint endoprosthesis

A series of 260 noncemented total hip arthroplasties with a titanium alloy stem and fixation by the Zweymüller press-fit and an Endler polyethylene threaded cup was reviewed in detail. The minimum follow-up period was 48 months and the maximum 72 months, with an average of 60 months. A scale from zero to five points was applied to evaluate pain, mobility, and motion for a total possible accumulation of 15 points. The global results of the different etiologic groups (arthrosis, femoral head necrosis, rheumatoid arthritis, and subcapital hip fractures) have been very good and good (12-15 points) in 67.5% of the cases and fairly good and bad in 32.3%. These results have been better in femoral head necrosis than in arthrosis or rheumatoid arthritis, but not as good in subcapital hip fractures. The age groups below 60 had better results than the above 60 groups. The Singh index higher than 3 was correlated with better-than-average results. The polyethylene cup migrated horizontally (more than 4 mm) in 7.6% of the cases and vertically (more than 5 mm) in 10%. The non-evolutionary cortical remodelation of the femur does not influence the results. Prosthetic stem sinking less than 4 mm has been found in 62% of the cases, from 4 to 9 mm in 21%, and greater than 9 mm in 6%. No alterations with clinical consequences attributable to stress-shielding have been detected.