Improving fretting corrosion resistance of CoCrMo alloy with TiSiN and ZrN coatings for orthopedic applications

Total hip replacement is the most effective treatment for late stage osteoarthritis. However, adverse local tissue reactions (ALTRs) have been observed in patients with modular total hip implants. Although the detailed mechanisms of ALTRs are still unknown, fretting corrosion and the associated metal ion release from the CoCrMo femoral head at the modular junction has been reported to be a major factor. The purpose of this study is to increase the fretting corrosion resistance of the CoCrMo alloy and the associated metal ion release by applying hard coatings to the surface. Cathodic arc evaporation technique (arc-PVD) was used to deposit TiSiN and ZrN hard coatings on CoCrMo substrates. The morphology, chemical composition, crystal structures and residual stress of the coatings were characterized by scanning electron microscopy, energy dispersive X-ray spectroscopy, and X-ray diffractometry. Hardness, elastic modulus, and adhesion of the coatings were measured by nano-indentation, nano-scratch test, and the Rockwell C test. Fretting corrosion resistance tests of coated and uncoated CoCrMo discs against Ti6Al4V spheres were conducted on a four-station fretting testing machine in simulated body fluid at 1Hz for 1 million cycles. Post-fretting samples were analyzed for morphological changes, volume loss and metal ion release. Our analyses showed better surface finish and lower residual stress for ZrN coating, but higher hardness and better scratch resistance for TiSiN coating. Fretting results demonstrated substantial improvement in fretting corrosion resistance of CoCrMo with both coatings. ZrN and TiSiN decreased fretting volume loss by more than 10 times and 1000 times, respectively. Both coatings showed close to 90% decrease of Co ion release during fretting corrosion tests. Our results suggest that hard coating deposition on CoCrMo alloy can significantly improve its fretting corrosion resistance and could thus potentially alleviate ALTRs in metal hip implants.

Processing and properties of Na-doped porous calcium polyphosphates - Mechanical properties and in vitro degradation characteristics

Porous calcium polyphosphate (CPP) is being investigated for use as a biodegradable bone substitute and for repair of osteochondral defects. The necessary requirements for these applications, particularly in load-bearing sites, include sufficient strength to withstand functional forces prior to bone ingrowth and substitution of the initial porous CPP template with new bone and cartilage (for osteochondral implants) in a timely and efficacious manner. The present study explored the effects of Na⁺ doping and processing to form porous structures of both higher strength and faster degradation than previously reported for 'pure' (non-doped) CPP structures of similar geometry. Compressive and tensile strengths were determined before and after 30-day in vitro degradation (PBS, pH 7.1 at 37 °C) and degradation rates assessed. Scanning electron microscopy (SEM), x-ray diffraction (XRD) and solid state nuclear magnetic resonance (³¹P SS NMR) were used to evaluate 'pure' and Na-doped CPP samples before and after degradation. The results indicated that the different processing protocols required to prepare samples of similar volume % porosity (a 2-step procedure with a Step-1 sintering temperatures equal to 575 °C being used with the Na-doped samples versus a 585 °C Step-1 treatment for 'pure' CPP) resulted in an approximate 1.5- to 2-fold increase in strength (tensile & compressive respectively) and 2-fold increase in degradation rate of Na-doped CPP compared with 'pure' CPP. This difference was attributed to the different Step-1 sintering temperatures used for sample processing.

Sol gel-derived hydroxyapatite films over porous calcium polyphosphate substrates for improved tissue engineering of osteochondral-like constructs

Integration of in vitro-formed cartilage on a suitable substrate to form tissue-engineered implants for osteochondral defect repair is a considerable challenge. In healthy cartilage, a zone of calcified cartilage (ZCC) acts as an intermediary for mechanical force transfer from soft to hard tissue, as well as an effective interlocking structure to better resist interfacial shear forces. We have developed biphasic constructs that consist of scaffold-free cartilage tissue grown in vitro on, and interdigitated with, porous calcium polyphosphate (CPP) substrates. However, as CPP degrades, it releases inorganic polyphosphates (polyP) that can inhibit local mineralization, thereby preventing the formation of a ZCC at the interface. Thus, we hypothesize that coating CPP substrate with a layer of hydroxyapatite (HA) might prevent or limit this polyP release. To investigate this we tested both inorganic or organic sol-gel processing methods, asa barrier coating on CPP substrate to inhibit polyP release. Both types of coating supported the formation of ZCC in direct contact with the substrate, however the ZCC appeared more continuous in the tissue formed on the organic HA sol gel coated CPP. Tissues formed on coated substrates accumulated comparable quantities of extracellular matrix and mineral, but tissues formed on organic sol-gel (OSG)-coated substrates accumulated less polyP than tissues formed on inorganic sol-gel (ISG)-coated substrates. Constructs formed with OSG-coated CPP substrates had greater interfacial shear strength than those formed with ISG-coated and non-coated substrates. These results suggest that the OSG coating method can modify the location and distribution of ZCC and can be used to improve the mechanical integrity of tissue-engineered constructs formed on porous CPP substrates.

STATEMENT OF SIGNIFICANCE

Articular cartilage interfaces with bone through a zone of calcified cartilage. This study describes a method to generate an "osteochondral-like" implant that mimics this organization using isolated deep zone cartilage cells and a sol-gel hydroxyapatite coated bone substitute material composed of calcium polyphosphate (CPP). Developing a layer of calcified cartilage at the interface should contribute to enhancing the success of this "osteochondral-like" construct following implantation to repair cartilage defects.

Hydrophilic Polyurethane Elastomers for Hemiarthroplasty: A Preliminary in Vitro Wear Study

Polyurethane surface layers with visco-elastic properties similar to natural articular cartilage are proposed for use with single component joint replacement prostheses in which the implant is intended to bear against a natural cartilage surface. Preliminary in vitro experiments were performed to study the effect of fluid film lubrication on the wear of the polyurethane. The results suggest the possibility of designing a metallic prosthesis with a polyurethane surface layer for hemiarthroplasty such that a fluid film will be formed to protect both surfaces during implant functioning.

Engineering of hyaline cartilage with a calcified zone using bone marrow stromal cells

OBJECTIVE

In healthy joints, a zone of calcified cartilage (ZCC) provides the mechanical integration between articular cartilage and subchondral bone. Recapitulation of this architectural feature should serve to resist the constant shear force from the movement of the joint and prevent the delamination of tissue-engineered cartilage. Previous approaches to create the ZCC at the cartilage-substrate interface have relied on strategic use of exogenous scaffolds and adhesives, which are susceptible to failure by degradation and wear. In contrast, we report a successful scaffold-free engineering of ZCC to integrate tissue-engineered cartilage and a porous biodegradable bone substitute, using sheep bone marrow stromal cells (BMSCs) as the cell source for both cartilaginous zones.

DESIGN

BMSCs were predifferentiated to chondrocytes, harvested and then grown on a porous calcium polyphosphate substrate in the presence of triiodothyronine (T3). T3 was withdrawn, and additional predifferentiated chondrocytes were placed on top of the construct and grown for 21 days.

RESULTS

This protocol yielded two distinct zones: hyaline cartilage that accumulated proteoglycans and collagen type II, and calcified cartilage adjacent to the substrate that additionally accumulated mineral and collagen type X. Constructs with the calcified interface had comparable compressive strength to native sheep osteochondral tissue and higher interfacial shear strength compared to control without a calcified zone.

CONCLUSION

This protocol improves on the existing scaffold-free approaches to cartilage tissue engineering by incorporating a calcified zone. Since this protocol employs no xenogeneic material, it will be appropriate for use in preclinical large-animal studies.

Porous calcium polyphosphate as load-bearing bone substitutes: in vivo study

Porous calcium polyphosphate (CPP) is being investigated for fabrication of novel biodegradable bone substitutes. In this study, porous CPP implants formed by conventional CPP powder packing and using a two-step sinter/anneal process was used to form 20 and 30 vol % porous samples displaying relatively high strength. These were implanted in rabbit femoral condyle sites to study their ability for secure fixation in prepared sites through bone ingrowth. Porous implants of 20 and 30 vol % porosity and displaying compressive strengths ~80 and 35 MPa, respectively, were used. Bone ingrowth sufficient to allow secure implant fixation was observed by 6 weeks (~19% bone ingrowth per available pore space for the 30 vol % and 13% for the 20 vol % porous implants). The results of the in vivo study suggest the potential usefulness of porous CPP as biodegradable bone substitutes/augments in high load-bearing skeletal regions.

Inorganic polyphosphate stimulates cartilage tissue formation

Clinical utilization of tissue-engineered cartilage constructs has been limited by their inferior mechanical properties compared to native articular cartilage. A number of strategies have been investigated to increase the accumulation of major extracellular matrix components within in vitro-formed cartilage, including the administration of growth factors and mechanical stimulation. In this study, the anabolic effect of inorganic polyphosphates, a linear polymer of orthophosphate residues linked by phosphoanhydride bonds, was demonstrated in both chondrocyte cultures and native articular cartilage cultured ex vivo. Compared to untreated controls, polyphosphate treatment of three-dimensional primary chondrocyte cultures induced increased glycosaminoglycan and collagen accumulation in a concentration- and chain length-dependent manner. This effect was transient, because chondrocytes express exopolyphosphatases that hydrolyze polyphosphate. The anabolic effect of polyphosphates was accompanied by a lower rate of DNA increase within the chondrocyte cultures treated with inorganic polyphosphate. Inorganic polyphosphate enhances cartilage matrix accumulation and is a promising approach to improve the quality of tissue-engineered cartilage constructs.

The incorporation of a zone of calcified cartilage improves the interfacial shear strength between in vitro-formed cartilage and the underlying substrate

A major challenge for cartilage tissue engineering remains the proper integration of constructs with surrounding tissues in the joint. Biphasic osteochondral constructs that can be anchored in a joint through bone ingrowth partially address this requirement. In this study, a methodology was devised to generate a cell-mediated zone of calcified cartilage (ZCC) between the in vitro-formed cartilage and a porous calcium polyphosphate (CPP) bone substitute in an attempt to improve the mechanical integrity of that interface. To do so, a calcium phosphate (CaP) film was deposited on CPP by a sol-gel process to prevent the accumulation of polyphosphates and associated inhibition of mineralization as the substrate degrades. Cartilage formed in vitro on the top surface of CaP-coated CPP by deep-zone chondrocytes was histologically and biochemically comparable to that formed on uncoated CPP. Furthermore, the mineral in the ZCC was similar in crystal structure, morphology and length to that formed on uncoated CPP and native articular cartilage. The generation of a ZCC at the cartilage-CPP interface led to a 3.3-fold increase in the interfacial shear strength of biphasic constructs. Improved interfacial strength of these constructs may be critical to their clinical success for the repair of large cartilage defects.

Mechanical characteristics of solid-freeform-fabricated porous calcium polyphosphate structures with oriented stacked layers

This study addresses the mechanical properties of calcium polyphosphate (CPP) structures formed by stacked layers using a powder-based solid freeform fabrication (SFF) technique. The mechanical properties of the 35% porous structures were characterized by uniaxial compression testing for compressive strength determination and diametral compression testing to determine tensile strength. Fracture cleavage surfaces were analyzed using scanning electron microscopy. The effects of the fabrication process on the microarchitecture of the CPP samples were also investigated. Results suggest that the orientation of the stacked layers has a substantial influence on the mechanical behavior of the SFF-made CPP samples. The samples with layers stacked parallel to the mechanical compressive load are 48% stronger than those with the layers stacked perpendicular to the load. However, the samples with different stacking orientations are not significantly different in tensile strength. The observed anisotropic mechanical properties were analyzed based on the physical microstructural properties of the CPP structures.

Fabrication of a biodegradable calcium polyphosphate/polyvinyl-urethane carbonate composite for high load bearing osteosynthesis applications

The formation of biodegradable implants for use in osteosynthesis has been a major goal of biomaterials research for the past 2-3 decades. Self-reinforced polylactide systems represent the most significant success of this research to date, however, with elastic constants up to 12-15 GPa at best, they fail to provide the initial stiffness required of devices for stabilizing fractures of major load-bearing bones. Our research has investigated the use of calcium polyphosphate (CPP), an inorganic polymer in combination with polyvinyl-urethane carbonate (PVUC) organic polymers for such applications. Initial studies indicated that composite samples formed as interpenetrating phase composites (IPC) exhibited suitable as-made strength and stiffness, however, they displayed a rapid loss of properties when exposed to in vitro aging. An investigation to determine the mechanism of this accelerated in vitro degradation for the IPCs as well as to identify possible design changes to overcome this drawback was undertaken using a model IPC system. It was found that strong interfacial strength and minimal swelling of the PVUC are very important for obtaining and maintaining appropriate mechanical properties in vitro.

Matrix accumulation by articular chondrocytes during mechanical stimulation is influenced by integrin-mediated cell spreading

We have shown previously that cyclic compression of newly forming bioengineered cartilage in vitro results in improved tissue formation via changes in expression of matrix metalloproteases, such as, MT1-MMP (membrane type metalloprotease), and increased synthesis of matrix molecules. Several studies have suggested an association between MT1-MMP and integrins, which are known to influence cell shape. Thus, the objectives of this study were to determine the effect of compressive mechanical stimulation on cell shape and the role of integrins and MT1-MMP in mediating these changes and influencing matrix accumulation. Bovine articular chondrocytes were grown on the surface of a porous ceramic substrate for 72 h and then cyclically compressed for 30 min. Scanning electron microscopy and morphometric analysis demonstrated that compression induced a rapid, transient increase in chondrocyte spreading by 10 min, followed by a retraction to prestimulated size within 6 h. This was associated with increased accumulation of newly synthesized proteoglycans, as determined by quantification of radioisotope incorporation. Blocking the alpha5beta1 integrin, or its beta1 subunit, inhibited cell spreading and resulted in a partial inhibition of compression-induced increase in matrix accumulation. Knockdown of MT1-MMP expression partially inhibited cell retraction and resulted in a reduced matrix accumulation as well. These results suggest that chondrocyte spreading and retraction following cyclic compression in vitro regulates matrix accumulation. Understanding the mechanisms that regulate chondrocyte mechanotransduction may ultimately lead to the design of improved repair tissue for cartilage damage. (c) 2010 Wiley Periodicals, Inc. J Biomed Mater Res, 2010.

Calcification of cartilage formed in vitro on calcium polyphosphate bone substitutes is regulated by inorganic polyphosphate

A major challenge to the successful clinical application of bioengineered cartilage remains its integration to surrounding tissues upon implantation. One way to address this consists of generating biphasic constructs composed of articular cartilage formed in vitro on the top surface and integrated with the porous sub-surface of a bone substitute material - in the case of this study, calcium polyphosphate (CPP). To improve the mechanical integrity of the cartilage-bone substitute interface, attempts have been made to generate a zone of calcified cartilage (ZCC) within the CPP-cartilage interface, thereby mimicking the native joint architecture. The purpose of this work was to establish the effects of the degradation products of CPP on cartilage calcification in order to explain the observed positioning of a ZCC away from the interface junction. It was determined that polyphosphate released from the CPP accumulates within in vitro-grown cartilage and inhibits cartilage calcification in a concentration and chain length (i.e. molecular weight) dependent manner. It was found that this effect is transient as chondrocytes express exopolyphosphatases which hydrolyze polyphosphate to release orthophosphate. Hence, the generation of biphasic constructs with a properly located ZCC will require tailoring of CPP substrates with lower degradation rates or the upregulation of exopolyphosphatases by chondrocytes.

Effect of circumferential constraint on nucleus pulposus tissue in vitro

BACKGROUND CONTEXT

Degeneration of the intervertebral disc (IVD) involves structural changes in the annulus fibrosus (AF), which could alter the mechanical forces imposed on the nucleus pulposus (NP) tissue. This could contribute to degenerative changes that occur in the NP.

PURPOSE

The purpose of the study was to determine whether circumferential constraint affects anabolic and catabolic gene expression, biochemical composition, and mechanical properties of NP tissue.

STUDY DESIGN

Nucleus pulposus cells were isolated from bovine caudal IVD and allowed to form tissue for a period of two weeks. The effect of no, intermediate, or high circumferential constraint on biochemical composition (cellularity and proteoglycan and collagen synthesis), gene expression, and compressive mechanical properties was evaluated.

RESULTS

Increasing the rigidity of circumferential constraint surrounding in vitro formed NP tissue resulted in decreased gene expression of aggrecan and type II collagen and increased expression of MMP-1 and ADAMTS-5. This was associated with decreased accumulation of extracellular matrix and a deterioration of the compressive mechanical properties of the tissue.

CONCLUSIONS

As increased circumferential constraint can have a significant negative effect on the composition and quality of NP tissue and this raises the possibility that the AF may contribute to the degenerative or age-related alterations that occur in the NP. Further study in a functional spinal unit is required to validate this.

"Biologic width"and crestal bone remodeling with sintered porous-surfaced dental implants: a study in dogs

PURPOSE

The aim of this study was to obtain histometric measurements of bone and peri-implant mucosal tissue contact with implants of 2 sintered porous-surfaced designs. The "short-collar" design had a collar height (smooth coronal region) of 0.75 mm, while the "long-collar" model had a smooth coronal region of 1.8 mm.

MATERIALS AND METHODS

Implants (2 per side) were placed in healed mandibular extraction sites of 4 beagle dogs using a submerged technique. After 4 weeks of healing, they were uncovered and used to support fixed partial dentures for a 9-month period. After sacrifice, specimens were retrieved and nondemineralized sections were examined histometrically to determine the most coronal bone-to-implant contact (first BIC) using the microgap as a reference and standard mucosal parameters of "biologic width."

RESULTS

Significant (P = .001) differences in first BIC were found between designs (1.97 mm for long-collar versus 1.16 mm for short-collar implants) for posteriorly located implants but not for anteriorly located ones (1.21 mm versus 1.38 mm; P = .40). If crestal bone loss involved sintered surface, fibrous connective tissue ingrowth was observed to replace lost bone. No significant differences in peri-implant mucosal measurements (total peri-implant mucosal thickness; length of the epithelial component of this mucosa, and thickness of the connective tissue component) were detected between implant designs.

CONCLUSIONS

Results suggest that "biologic width" accommodation drives initial crestal bone loss with sintered porous-surfaced implants. Histometric data obtained for bone contact showed no significant differences between the long- and short-collar implant designs.

Substrate architecture and fluid-induced shear stress during chondrocyte seeding: role of alpha5beta1 integrin

Chondrocyte behaviour has been shown previously to be influenced by the architecture of the substrate on which the cells are grown. Chondrocytes cultured on fully porous titanium alloy substrates showed greater spreading and more matrix accumulation when compared to cells grown on porous-coated substrates with solid bases. We hypothesized that these features developed because of differences in fluid-induced shear stresses due to substrate architecture and that integrins mediate these responses. Computational fluid dynamics analyses predicted that cells on fully porous substrates experience time-dependent shear stresses that differ from those experienced by cells on porous-coated substrates with solid bases where media flow-through is restricted. To validate this model, the seeding protocol was modulated to affect fluid flow and this affected cell spreading and matrix accumulation as predicted. Integrin blocking experiments revealed that alpha5beta1 integrins regulated cell shape under these two conditions and when cell spreading was prevented the increased accumulation of collagen and proteoglycans by chondrocytes seeded on fully porous substrates did not occur. Identifying the substrate-induced mechanical and molecular mechanisms that influence chondrocyte behaviour and tissue formation may ultimately lead to the formation of a tissue that more closely resembles natural articular cartilage.

AP-1 DNA binding activity regulates the cartilage tissue remodeling process following cyclic compression in vitro

Generating bioengineered cartilage yields tissue with physical qualities inferior to that of native tissue. Application of cyclic compression (30 min, 1 kPa, 1 Hz) to cartilage cells (chondrocytes) seeded on calcium polyphosphate substrates significantly increases the accumulation of collagens and proteoglycans by 24 hours, thus improving the tissue generated. The mechanism for this increase is not fully known but seems to follow a remodeling pathway of sequential catabolic and anabolic changes. The initial catabolic event involves increased transcription of matrix metalloproteinase (MMP)-3 and MMP-13 two hours after the end of cyclic compression. As MMP-3 and MMP-13 promoters contain activating protein-1 (AP-1) DNA binding sites, we investigated the effect of inhibiting DNA binding through the use of modified decoy oligodeoxynucleotides (ODN). Mechanical stimulation in the presence of the ODN blocked AP-1 DNA binding as detected by electrophoretic mobility shift assay and prevented the increased transcription of MMP-3 and MMP-13. As well the increased accumulation of collagens and proteoglycans by 24 hours in mechanically stimulated samples was prevented. The data suggests that the mechano-induction of MMP-3 and MMP-13 may be regulated at the AP-1 DNA binding site and that upregulation of these metalloproteases is a necessary component of the matrix remodeling initiated by cyclic compression.

A pilot study to assess the performance of a partially threaded sintered porous-surfaced dental implant in the dog mandible

PURPOSE

The purpose of this study was to compare patterns of crestal bone remodeling with 2 sintered porous-surfaced dental implant designs during a 14-month functional period.

MATERIALS AND METHODS

Two root-form press-fit dental implants were evaluated in healed extraction sites in dog mandibles. The standard (control) design was a press-fit implant with a 2-mm machined collar; the remainder of the implant had a sintered porous surface. The test or "hybrid" design had 3 coronal machined threads instead of a machined collar; the remainder of the implant had a sintered porous surface.

RESULTS

Standardized radiographs indicated significantly less crestal bone loss (0.82 to 0.93 mm versus 1.45 to 1.5 mm) with the hybrid design and a slower approach toward an apparent steady state (12 to 14 months for the hybrid versus 7 months for the standard design). Morphometric assessment of back-scattered scanning electron micrographs confirmed that crestal bone loss was significantly less for the hybrid design on all but the lingual implant aspect.

CONCLUSION

The addition of coronal threads to an implant relying on a sintered porous surface geometry for its long-term osseointegration reduced the extent of crestal bone loss compared to a machined collar region.

Membrane type-1 matrix metalloproteinase is induced following cyclic compression of in vitro grown bovine chondrocytes

OBJECTIVE

To determine if membrane type-1 matrix metalloproteinase (MT1-MMP) will respond to cyclic compression of chondrocytes grown in vitro and the regulatory mechanisms underlying this response.

METHODS

Cyclic compression (30min, 1kPa, 1Hz) was applied to bovine chondrocytes (6-9-month-old animals) grown on top of a biodegradable substrate within 3 days of initiating culture. Luciferase assays using bovine articular chondrocytes were undertaken to demonstrate the mechanosensitivity of MT1-MMP. Semi-quantitative reverse-transcription polymerase chain reaction (RT-PCR) and western blot analysis were used to establish the time course of gene and protein upregulation in response to cyclic compression. The regulation of MT1-MMP was assessed by electrophoretic mobility shift assays, RT-PCR and western blot analysis. As well, an MT1-MMP decoy oligonucleotide and an extracellular signal-regulated kinase 1/2 (ERK1/2) pharmacological inhibitor were utilized to further characterize MT1-MMP regulation.

RESULTS

After cyclic compression, MT1-MMP showed a rapid and transient increase in gene expression. Elevated protein levels were detected within 2h of stimulation which returned to baseline by 6h. During cyclic compression, phosphorylation of the mitogen activated protein kinase ERK1/2 increased significantly. This was followed by increased gene and protein expression of the transcription factor; early growth factor-1 (Egr-1) and Egr-1 binding to the MT1-MMP promoter. Blocking Egr-1 DNA binding with a decoy MT1-MMP oligonucleotide, downregulated MT1-MMP gene expression. The ERK1/2 inhibitor U0126 also reduced Egr-1 DNA binding activity to MT1-MMP promoter sequences and subsequent transcription of MT1-MMP.

CONCLUSIONS

These data suggest that cyclic compression of chondrocytes in vitro upregulates MT1-MMP via ERK1/2 dependent activation of Egr-1 binding. Delineation of the regulatory pathways activated by mechanical stimulation will further our understating of the mechanisms influencing tissue remodeling.

Formation of biphasic constructs containing cartilage with a calcified zone interface

The zone of calcified cartilage is the mineralized region of articular cartilage that anchors the hyaline cartilage to the subchondral bone and serves to disperse mechanical forces across this interface. In an attempt to mimic this zonal organization, we have developed the methodology to form biphasic constructs composed of cartilaginous tissue anchored to the top surface of a bone substitute (porous calcium polyphosphate, CPP) with a calcified interface. To accomplish this, chondrocytes were selectively isolated from the deep zone of bovine articular cartilage, placed on top of the CPP substrate, and grown in the presence of beta-glycerophosphate (10 mM, beta-GP). By 8 weeks, cartilage tissue had formed with two zones: a calcified region adjacent to the CPP substrate and a hyaline-like zone above. Little or no mineralization occurred in the absence of beta-GP. The mineral that formed in vitro was identified as hydroxyapatite, similar in composition and crystal size to that found in vivo. The tissue stiffness was seven times greater, and the interfacial shear properties at the cartilage-CPP interface were at least two times greater in the presence of this mineralized zone within the in vitro-formed cartilage than in tissue lacking a mineral zone. In conclusion, developing a biphasic construct with a calcified zone at the tissue-biomaterial interface resulted in significantly better cartilage load-bearing (compressive) properties and interfacial shear strength, emphasizing the importance of the presence of a mineralized zone in bioengineered cartilage. Because failure due to shear occurred at the cartilage-CPP interface instead of the tidemark, as occurs with osteochondral tissue, further study is required to optimize this system so that it more closely mimics the native tissue.

Multi-axial mechanical stimulation of tissue engineered cartilage: review

The development of tissue engineered cartilage is a promising new approach for the repair of damaged or diseased tissue. Since it has proven difficult to generate cartilaginous tissue with properties similar to that of native articular cartilage, several studies have used mechanical stimuli as a means to improve the quantity and quality of the developed tissue. In this study, we have investigated the effect of multi-axial loading applied during in vitro tissue formation to better reflect the physiological forces that chondrocytes are subjected to in vivo. Dynamic combined compression-shear stimulation (5% compression and 5% shear strain amplitudes) increased both collagen and proteoglycan synthesis (76 +/- 8% and 73 +/- 5%, respectively) over the static (unstimulated) controls. When this multi-axial loading condition was applied to the chondrocyte cultures over a four week period, there were significant improvements in both extracellular matrix (ECM) accumulation and the mechanical properties of the in vitro-formed tissue (3-fold increase in compressive modulus and 1.75-fold increase in shear modulus). Stimulated tissues were also significantly thinner than the static controls (19% reduction) suggesting that there was a degree of ECM consolidation as a result of long-term multi-axial loading. This study demonstrated that stimulation by multi-axial forces can improve the quality of the in vitro-formed tissue, but additional studies are required to further optimize the conditions to favour improved biochemical and mechanical properties of the developed tissue.

Osteochondral defect repair using a novel tissue engineering approach: sheep model study

Porous calcium polyphosphate (CPP) constructs of desired density were formed by sintering CPP powders. Articular cartilage was formed on these constructs in cell culture over an 8-week period with the resulting cartilage layer forming on the CPP surface and within the near surface pores thereby mechanically anchoring the cartilage to the CPP. The biphasic constructs so formed were implanted in sheep femoral condyle sites and left for short-term periods (3 to 4 months) or longer periods (9 months). Implant fixation within the condyle sites was achieved through bone ingrowth into the inferior CPP pores. The properties and characteristics of the as-in vitro-formed, short- and long-term implanted tissues were compared. The results indicated that such implants might be useful for repair of small subchondral defects.

Low-power laser stimulation of tissue engineered cartilage tissue formed on a porous calcium polyphosphate scaffold

BACKGROUND AND OBJECTIVE

Forming cartilage tissue in vitro that resembles native tissue is one of the challenges of cartilage tissue engineering. The aim of this study was to determine whether low-power laser stimulation would improve the formation of cartilage tissue in vitro.

STUDY DESIGN/MATERIALS AND METHODS

Bovine articular chondrocytes were seeded on the top surface of porous calcium polyphosphate substrates. After 2 days, laser stimulation was applied daily at a wavelength of 650 nm using a laser diode with energy densities of either 1.75 or 3 J/cm(2) for 4 weeks. Proteoglycan and collagen synthesis and matrix content were determined. Cartilage tissue morphology was evaluated histologically.

RESULTS

Histologically, there was no difference in the appearance or cellularity of the tissues that formed in the presence or absence of laser stimulation at either dosage. There were no differences in DNA content between treated and untreated constructs and live-dead assay confirmed that this treatment was not toxic to the cells. Laser stimulation at 3 J/cm(2) enhanced matrix synthesis resulting in significantly more tissue formation than laser stimulation at 1.75 J/cm(2) or untreated cultures.

CONCLUSION

Short exposures to low-power laser stimulation using a laser diode with 3 J/cm(2) dose improves cartilage tissue formation.

Threaded versus porous-surfaced implants as anchorage units for orthodontic treatment: three-dimensional finite element analysis of peri-implant bone tissue stresses

PURPOSE

A 3-dimensional finite element model was developed to investigate the cause of different crestal bone loss patterns observed around sintered porous-surfaced and machined (turned) threaded dental implants used for orthodontic anchorage in a previously reported animal study.

MATERIALS AND METHODS

Twenty-noded structural solid elements with parabolic interpolation between nodes were used for modeling the bone-implant interface zone. A 3-N traction force acting between either 2 porous-surfaced or 2 machined threaded implants placed in canine premolar mandibular sites and bone profiles observed at initiation and 22 weeks of orthodontic loading were modeled.

RESULTS

Higher maximum stresses in peri-implant bone next to the coronal region of the implants were predicted with the machined threaded implants at both the initial and final time points, with the values 20% greater than those predicted after the 22-week loading period. These values were approximately 200% greater than those predicted for the porous-surfaced implants, for which a more uniform stress distribution was predicted.

DISCUSSION

The finite element model results indicated that the observed greater retention of crestal bone next to the porous-surfaced implants was attributable to lower peak stresses developing in crestal peri-implant bone with this design, which decreased the probability of bone loss related to local overstressing and bone microfracture.

CONCLUSION

The predicted lower stresses were a result of the more uniform transfer of force from implant to bone with the porous-surfaced implants, which was a consequence of the interlocking of bone and implant possible with this design.

Heterotopic Bone Formation Around Sintered Porous-Surfaced Ti-6Al-4V Implants Coated with Native Bone Morphogenetic Proteins

PURPOSE

Coating endosseous dental implants with growth factors such as bone morphogenetic proteins (BMPs) may be one way to accelerate and/or enhance the quality of osseointegration. The purpose of this study was to investigate in the murine muscle pouch model whether sintered porous-surfaced titanium alloy implants coated with BMPs would lead to heterotopic bone formation around and within the implant surface geometry.

MATERIALS

Porous-surfaced dental implants were coated with partially purified native human BMPs, with or without a carrier of Poloxamer 407 (BASF Corp., Parsippany, NJ), placed in gelatin capsules and implanted into the hindquarter muscles of mice. Mice were euthanized after 28 days. Sections of retrieved specimens were subsequently prepared for morphometric analysis of bone formation using backscatter electron microscopic images.

RESULTS

Human BMPs, either with or without the carrier of Poloxamer 407, led to bone formation within and outside of the sintered porous implant surface. When the sintered implant surface region was subdivided into inner and outer halves, similar levels of bone ingrowth and contact were seen in the 2 halves. Evidence of bone formation to the depth of the solid implant core (i.e., the deepest level possible) also was seen.

DISCUSSION AND CONCLUSIONS

Sintered porous-surfaced dental implants can be used as substrate for partially purified BMPs in the murine muscle pouch model. With the addition of these osteoinductive factors, the porous implant surface supported bone formation within the surface porosity provided, in some instances, all the way to the solid implant core. The addition of growth factors to a sintered porous surface may be an efficient method for altering locally the healing sequence and quality of bone associated with osseointegration of bone-interfacing implants.

Differential regulation of matrix degrading enzymes in a TNFalpha-induced model of nucleus pulposus tissue degeneration

Intervertebral disc degeneration occurs commonly and is linked to persistent back pain and the development of disc herniation. The mechanisms responsible for tissue catabolism have not yet been fully elucidated. Previously we characterized an in vitro model of TNFalpha-induced nucleus pulposus degeneration, which demonstrates decreased expression of matrix macromolecules, increased expression of matrix degrading enzymes, and the activation of aggrecanase-mediated proteoglycan degradation [Seguin, C.A., Pilliar, R.M., Roughley, P.J., and Kandel, R.A. 2005. Tumor necrosis factor-alpha modulates matrix production and catabolism in nucleus pulposus tissue. Spine 30: 1940-1948]. This study explores the intracellular pathways activated during TNFalpha-induced matrix degradation. We demonstrate that in nucleus pulposus cells, the p38 and JNK pathways regulate induction of MMP-1 and -3; p38, JNK, and NF-kappaB regulate the induction of MMP-13; and ERK regulates the up-regulation of MT1-MMP mRNA in response to TNFalpha. Induction of ADAMTS-4 and -5 mRNA occurred downstream of NF-kappaB activation. Depletion of tissue proteoglycans was mediated by ERK and NF-kappaB-dependent "aggrecanase" activity, suggesting MT1-MMP and ADAMTS-4 and -5 as effectors of TNFalpha-induced tissue catabolism.

Substrate porosity enhances chondrocyte attachment, spreading, and cartilage tissue formation in vitro

Tissue engineering is being explored as a new approach to treat damaged cartilage. As the biomaterial used may influence tissue formation, the effects of substrate geometry on chondrocyte behavior in vitro were examined. Articular chondrocytes were isolated and cultured on the surface of smooth, rough, porous-coated, and fully porous Ti-6Al-4V substrates. The percentage of chondrocytes that attached to each substrate at 24 h was determined. After 24 and 72 h, chondrocytes were visualized by scanning electron microscopy and cell areas were measured. Collagen and proteoglycan accumulation within the first 24 h was determined by incorporation with [3H]-proline and [35S]-SO4, respectively. Chondrocyte attachment as well as matrix accumulation was enhanced as substrate surface area increased. Cell areas on the fully porous substrate were over four times greater than on any other substrate by 72 h in culture. After 8 weeks in culture, a continuous layer of cartilaginous tissue formed only on the surface of the fully porous substrate. This suggests that fully porous Ti-6Al-4V substrates provide the conditions that favor cartilage tissue formation by influencing cell attachment and extent of cell spreading. Understanding how substrate porosity influences chondrocyte behavior may help identify methods to further enhance cartilage tissue formation in vitro.

Cyclic compressive mechanical stimulation induces sequential catabolic and anabolic gene changes in chondrocytes resulting in increased extracellular matrix accumulation

Overcoming the limited ability of articular cartilage to self-repair may be possible through tissue engineering. However, bioengineered cartilage formed using current methods does not match the physical properties of native cartilage. In previous studies we demonstrated that mechanical stimulation improved cartilage tissue formation. This study examines the mechanisms by which this occurs. Application of uniaxial, cyclic compression (1 kPa, 1 Hz, 30 min) significantly increased matrix metalloprotease (MMP)-3 and MMP-13 gene expression at 2 h compared to unstimulated cells. These returned to constitutive levels by 6 h. Increased MMP-13 protein levels, both pro- and active forms, were detected at 6 h and these decreased by 24 h. This was associated with tissue degradation as more proteoglycans and collagen had been released into the culture media at 6 h when compared to the unstimulated cells. This catabolic change was followed by a significant increase in type II collagen and aggrecan gene expression at 12 h post-stimulation and increased synthesis and accumulation of these matrix molecules at 24 h. Mechanical stimulation activated the MAP kinase pathway as there was increased phosphorylation of ERK1/2 and JNK as well as increased AP-1 binding. Mechanical stimulation in the presence of the JNK inhibitor, SP600125, blocked AP-1 binding preventing the increased gene expression of MMP-3 and -13 at 2 h and type II collagen and aggrecan at 12 h as well as the increased matrix synthesis and accumulation. Given the sequence of changes, cyclic compressive loading appears to initiate a remodelling effect involving MAPK and AP-1 signalling resulting in improved in vitro formation of cartilage.

A single application of cyclic loading can accelerate matrix deposition and enhance the properties of tissue-engineered cartilage

OBJECTIVE

Mechanical stimulation is a widely used method to enhance the formation and properties of tissue-engineered cartilage. While studies have evaluated the responsiveness of chondrocytes to mechanical stimuli, little is known about how much stimulation is actually required. Thus, the purpose of this study was to investigate the effect of a single application of cyclic loading to chondrocytes on the formation and properties of in vitro-formed tissue.

DESIGN

Isolated bovine articular chondrocytes were seeded on ceramic substrates in 3D culture and subjected to a single application of compressive cyclic loading at 1, 8 or 15 days after seeding. Once the time at which the chondrocytes were most sensitive to mechanical loading was determined, the effect of a single application on the synthesis and accumulation of matrix molecules as well as the mechanical properties of the in vitro-formed cartilage tissue was evaluated.

RESULTS

Chondrocytes were more responsive to cyclic loading applied early in culture. Cyclic forces applied 24 h after the cultures were established increased collagen and proteoglycan syntheses (48 +/- 11% and 49 +/- 11%, respectively). This single application of cyclic loading also increased the accumulation of collagen (stimulated: 207 +/- 20 microg, control: 173 +/- 9 microg) and proteoglycans (stimulated: 302 +/- 24 microg, control: 270 +/- 14 microg) as well as improved the mechanical properties of the in vitro-formed tissue (twofold increase in equilibrium stress and modulus) determined 4 weeks after the applied stimulus.

CONCLUSIONS

A single application of cyclic loading to chondrocytes early in culture increased matrix accumulation and enhanced the mechanical properties of the in vitro-formed tissue. This suggests that mechanical forces do not have to be applied intermittently over long periods of time to accelerate in vitro tissue formation.

Osteotome sinus elevation and simultaneous placement of porous-surfaced dental implants: a morphometric study in rabbits

The objective was to establish a model in rabbits in which to study the healing events associated with localized indirect osteotome-mediated maxillary sinus floor elevation in conjunction with simultaneous placement of sintered porous-surfaced dental implants. On one side of the maxilla of each of 28 rabbits, a sintered porous-surfaced titanium alloy press-fit implant was placed without the use of a bone graft material, while on the collateral side an implant was placed after first adding Bio-Oss graft particles to the osteotomy. Specimens were retrieved for morphometric assessment of bone contact and bone ingrowth of the porous implant surface after 2, 4, 6 and 8 weeks of healing. All implants became osseointegrated by bone ingrowth into the porous implant surface. While the addition of graft particles did not result in a statistically significant increase in the parameters measured, a trend for greater bone contact and particularly bone ingrowth at the apices of the implants was seen as healing time increased. The rabbit maxillary sinus can be used to study healing following placement of sintered porous-surfaced dental implants using the indirect sinus elevation procedure.

Influence of anionic monomer content on the biodegradation and toxicity of polyvinyl-urethane carbonate-ceramic interpenetrating phase composites

The objective of this study was to characterize a series of anionic biodegradable polymer resins for their compatibility in a biological environment, comparing them with respect to the influence of ionic function on enzyme catalyzed biodegradation when the polymers were incorporated into a porous calcium polyphosphate (CPP) 3-D structure to form an interpenetrating phase composite (IPC). The swelling behavior of the polymers was investigated by immersing the cured polymer resins in growth media at 37 degrees C. In vitro cytotoxicity of the polymer resins was assessed using a HeLa cell line. Cell viability increased when the amount of low molecular weight monomer was minimized. Despite observing that the addition of carboxylic acid groups into the polymer resin chains contributed to an improvement of the chemical bonding between the polymer and the CPP, the addition of high ionic content into the resin led to the greatest loss of bending strength for the samples incubated in phosphate buffer and cholesterol esterase enzyme solutions, when compared to their as made state. The increased degradation for the higher ionic component materials and their loss of physical strength was attributed to enhanced hydrolysis within the materials and by water transport deep within the composites, via the anionic components of the resin. The findings indicated that the introduction of anionic content must be optimized to promote increased mechanical performance for the CPP, balancing the features of polymer CPP bonding versus polymer swelling and cytotoxicity.

Formation of a nucleus pulposus-cartilage endplate construct in vitro

Intervertebral disc (IVD) degeneration is a common problem and treatment options for persistent symptomatic disease are limited. Tissue engineering is being explored for its ability to reconstitute the functional components of the IVD. The purpose of this study was to determine whether it was possible to form in vitro a triphasic construct consisting of nucleus pulposus (NP), cartilage endplate (CEP), and a porous calcium polyphosphate (CPP) bone substitute. Bovine articular chondrocytes were placed on the top surface of a porous CPP construct and allowed to form cartilage in vitro. Nucleus pulposus cells were then placed onto the in vitro-formed hyaline cartilage. At 24 h scanning electron microscopy demonstrated that the NP cells maintained their rounded morphology, similar to NP cells placed directly on porous CPP. At 8 weeks histological examination of the triphasic constructs by light microscopy showed that a continuous layer of NP tissue had formed and was fused to the underlying cartilage tissue, which itself was integrated with the porous CPP. The incorporation of the cartilage layer was beneficial to the construct by improving tissue attachment to the CPP, as demonstrated by increased peak load and increased energy required for failure during shear loading when compared to a biphasic construct composed of nucleus pulposus-bone substitute only. This study demonstrates that it is possible to generate a multi-component construct with the incorporation of a CEP-like layer resulting in improved bone substitute-to-IVD tissue interface characteristics.

Tumor necrosis factor-alpha modulates matrix production and catabolism in nucleus pulposus tissue

STUDY DESIGN

This study examines changes in the production of extracellular matrix molecules as well as the induction of tissue degradation in in vitro formed nucleus pulposus (NP) tissues following incubation with tumor necrosis factor (TNF)alpha.

OBJECTIVE

To characterize the response of NP cells to TNF-alpha, a proinflammatory cytokine present in herniated NP tissues.

SUMMARY OF BACKGROUND DATA

TNF-alpha is a proinflammatory cytokine expressed by NP cells of degenerate intervertebral discs. It is implicated in the pain associated with disc herniation, although its role in intervertebral disc degeneration remains poorly understood.

METHODS

In vitro formed NP tissues were treated with TNF-alpha (up to 50 ng/mL) over 48 hours. Tissues were assessed for histologic appearance, proteoglycan and collagen contents, as well as proteoglycan and collagen synthesis. Reverse transcriptase polymerase chain reaction was used to determine the effect of TNF-alpha on NP cell gene expression. Proteoglycan degradation was assessed by immunoblot analysis.

RESULTS

At doses of 1-5 ng/mL, TNF-alpha induced multiple cellular responses, including: decreased expression of both aggrecan and type II collagen genes; decreases in the accumulation and overall synthesis of aggrecan and collagen; increased expression of MMP-1, MMP-3, MMP-13, ADAM-TS4, and ADAM-TS5; and induction of ADAM-TS dependent proteoglycan degradation. Within 48 hours, these cellular responses resulted in NP tissue with only 25% of its original proteoglycan content.

CONCLUSIONS

Because low levels of TNF-alpha, comparable to those present physiologically, induced NP tissue degradation, this suggests that TNF-alpha may contribute to the degenerative changes that occur in disc disease.

Peri-implant bone response to orthodontic loading: Part 1. A histomorphometric study of the effects of implant surface design

INTRODUCTION

Bone response to orthodontic loading was compared histomorphometrically around 2 different types of osseointegrated implants (porous surfaced and machined threaded) to determine their suitability for orthodontic anchorage.

METHODS

Five beagles each received 3 implants of each design in contralateral mandibular locations. After a 6-week initial healing period, abutments were placed, and, 1 week later, the 2 mesial implants on each side were orthodontically loaded for 22 weeks. All implants remained osseointegrated throughout orthodontic loading except for 1 threaded implant that loosened. Light miscroscopy and back-scattered scanning electron microscopy were used to compare responses around the 2 implant designs.

RESULTS

Porous-surfaced implants had higher marginal bone levels (P +/- .025) and less relative implant displacement than threaded implants.

CONCLUSIONS

Differences in implant surface design can lead to differences in peri-implant bone height and bone-to-implant contact. Porous-surfaced implants might be successful as orthodontic anchorage units.

Peri-implant bone response to orthodontic loading: Part 2. Implant surface geometry and its effect on regional bone remodeling

INTRODUCTION

Bone response to orthodontic loading was compared around 2 different types of osseointegrated implants (porous surfaced and machined threaded) to determine the effect of implant surface geometry on regional bone remodeling.

METHODS

Five beagles each received 3 implants of each design in contralateral mandibular extraction sites. After a 6-week initial healing period, abutments were placed, and, 1 week later, the 2 mesial implants on each side were orthodontically loaded for 22 weeks. All implants remained osseointegrated throughout orthodontic loading except for 1 threaded implant that loosened. Back-scattered scanning electron microscopy and fluorochrome bone labeling techniques were used to compare responses around the 2 types of implants.

RESULTS

The loaded, porous-surfaced implants had significantly higher marginal bone levels and greater bone-to-implant contact than did the machined-threaded implants.

CONCLUSIONS

Significant differences in peri-implant bone remodeling and bone formation in response to controlled orthodontic loading were observed for the 2 implant designs. Short, porous-surfaced implants might be more effective for orthodontic applications than machine-threaded implants.

Evaluating interface strength of calcium phosphate sol-gel-derived thin films to Ti6Al4V substrate

The interface shear strength of Ca-P thin films applied to Ti6Al4V substrates have been evaluated in this study using a substrate straining method--a shear lag model. The Ca-P films were synthesized using sol-gel methods from either an inorganic or organic precursor solution. Strong interface bonding was demonstrated for both film types. The films were identified as non-stoichiometric hydroxyapatite but with different Ca/P ratios. The Ca-P films were 1-1.5 microm thick and testing and analysis using the shear lag approach revealed a shear strength of approximately 347 and 280 MPa for Inorganic and Organic Route-formed films, respectively. Overall, the exceptional mechanical properties of Ca-P/Ti6Al4V system along with the inherent advantages of sol-gel processing support continued studies to utilize this technology for bone-interfacing implant surface modification.

Cementless implant fixation--toward improved reliability

Cementless implants offer the advantage of fixation by direct bone-to-implant osseointegration, thereby avoiding the use of a synthetic intermediary material (such as acrylic bone cement) of limited mechanical strength. Successful osseointegration, however, depends on several conditions being satisfied during the peri-implant bone healing period, including the need for limited early loading resulting in minimal relative movement at the implant-bone interface. Sintered porous- and plasma spray-coated implants represent the most common cementless orthopedic implants in current clinical use, although novel cast structures also are being investigated. All stand to benefit from surface modifications currently being explored to enhance osteoconductive or osteoinductive characteristics of the implants. The faster osseointegration that such modified surface designs potentially might offer would result in more reliable and convenient (from the patient perspective) cementless implants. Encouraging results of early animal-based studies exploring such modifications have been reported.

Tissue engineered nucleus pulposus tissue formed on a porous calcium polyphosphate substrate

STUDY DESIGN

This study describes the formation of nucleus pulposus tissue using a novel tissue engineering approach.

OBJECTIVES

To determine if a construct composed of nucleus pulposus tissue on the surface of a calcium polyphosphate substrate could be formed in vitro with properties similar to native nucleus pulposus tissue.

SUMMARY OF BACKGROUND DATA

There is no optimal treatment for the persistent pain associated with intervertebral disc degeneration. Disc replacement using artificial intervertebral discs has met with some success, and biologic transplantation is limited by the availability of donor tissues.

METHODS

Nucleus pulposus cells were isolated from bovine caudal intervertebral discs. Cells were seeded at high density on the upper surface of a porous bone substitute material (calcium polyphosphate) and maintained up to 6 weeks in culture. In vitro formed tissue was compared to native nucleus pulposus for histologic appearance, biochemical composition (tissue cellularity, proteoglycan and collagen accumulation), and compressive mechanical properties.

RESULTS

When maintained on the surface of a three-dimensional substrate, nucleus pulposus cells formed a continuous layer of tissue with a proteoglycan content equivalent to the native tissue. Although collagen accumulation attained only 26% than that of the native tissue, there was no difference in tissue stiffness, viscosity, or weight-bearing capacity of the in vitro formed tissue when compared with the native tissue.

CONCLUSION

Nucleus pulposus-like tissue formed in vitro on the surface of a calcium polyphosphate substrate resembles the native tissue in terms of proteoglycan content and compressive mechanical properties. These studies are the first step toward developing a functional spinal unit in vitro.

A Targeted Review of Study Outcomes With Short (≤7 mm) Endosseous Dental Implants Placed in Partially Edentulous Patients

BACKGROUND

Generally, threaded root-form endosseous dental implants are thought to perform poorly in short lengths (i.e., < 10 mm). However, whether modifications in implant surface geometry will improve performance of short threaded implants is less clear.

METHODS

The relationship between dental implant failure rates and their surface geometry, length, and location (maxilla versus mandible) was explored in the published literature. Using a MEDLINE search (1985 through 2001), studies were sought with the following criteria: 1) data suitable to calculate failure rates of implant lengths < or = 7 mm versus > 7 mm; 2) data separable into maxillary versus mandibular results; 3) criteria for "failure" clearly defined; and 4) minimal functional period of 2 years.

RESULTS

Twelve papers were identified as follows: eight with machined threaded implants, two with acid-treated threaded implants, and two with sintered porous-surfaced press-fit implants. The following results were found: 1) machined surface implants experienced greater failure rates than textured surface implants; 2) with the exception of sintered porous-surfaced implants, 7 mm long dental implants appear to have higher failure rates than those > 7 mm length; and 3) with textured surface implants, higher failure rates were more likely in the maxilla than in the mandible, but with machined surface implants there were no differences in failure rates between maxilla and mandible.

CONCLUSIONS

Dental implant surface geometry is a major determinant in how well these implants perform in short lengths, defined here as lengths of < or = 7 mm. While threaded implants show higher failure rates in short versus longer lengths, sintered porous-surfaced implants perform well in the defined "short" lengths. More studies are needed to better assess the performance of short, acid-washed threaded implants.

The effect of sol–gel-formed calcium phosphate coatings on bone ingrowth and osteoconductivity of porous-surfaced Ti alloy implants

Ti-6Al-4V implants formed with a sintered porous surface for implant fixation by bone ingrowth were prepared with or without the addition of a thin surface layer of calcium phosphate (Ca-P) formed using a sol-gel coating technique over the porous surface. The implants were placed transversely across the tibiae of 17 rabbits. Implanted sites were allowed to heal for 2 weeks, after which specimens were retrieved for morphometric assessment using backscattered scanning electron microscopy and quantitative image analysis. Bone formation along the porous-structured implant surface, was measured in relation to the medial and lateral cortices as an indication of implant surface osteoconductivity. The Absolute Contact Length measurements of endosteal bone growth along the porous-surfaced zone were greater with the Ca-P-coated implants compared to the non-Ca-P-coated implants. The Ca-P-coated implants also displayed a trend towards a significant increase in the area of bone ingrowth (Bone Ingrowth Fraction). Finally, there was significantly greater bone-to-implant contact within the sinter neck regions of the Ca-P-coated implants.

Effect of surface chemistry on the rate of osseointegration of sintered porous-surfaced Ti-6Al-4V implants

PURPOSE

The effect of adding a thin sol-gel-formed calcium phosphate (CaP) coating to sintered porous-surfaced titanium alloy (Ti-6Al-4V) implants on rates of initial bone ingrowth was investigated.

MATERIALS AND METHODS

Control implants (as manufactured) and similar implants with sol-gel CaP coatings were randomly placed in distal femoral rabbit condyles (1 implant/leg). After healing for 6, 9, 12, and 16 days, 8 of 10 rabbits in each time group were assessed for maximum implant pullout force (N) and interface stiffness (N/mm). Selected extracted implants also were examined by secondary electron imaging to characterize affected surfaces. The implants of the remaining 2 rabbits in each group were examined by backscattered scanning electron microscopy (BSEM).

RESULTS

Significantly greater pullout forces and interface stiffness were found for CaP-coated implants at 6 and 9 days. At 6 days, BSEM revealed bone ingrowth on CaP-coated implants but not on control implants. Secondary electron imaging and BSEM observations also suggested greater bone ingrowth with CaP-coated porous implants at 9, 12, and 16 days.

DISCUSSION

Sol-gel-formed CaP surface films significantly enhance rates of bone ingrowth into sintered porous-surfaced implants.

CONCLUSION

This surface treatment may have a number of clinical benefits, including shortening the period prior to functional loading of such implants and improving treatment outcomes in situations of poor bone quality and/or quantity. (More than 50 references).

Synthesis and characterization of a novel polymer-ceramic system for biodegradable composite applications

The objective of this study was to develop a biodegradable polymer resin that could be used for the fabrication of an interpenetrating phase composite (IPC) made of porous calcium polyphosphate (CPP) and an organic polymer resin. The resin was synthesized from a polycarbonate-based divinyl oligomer and monomers containing ionic groups. The physical and chemical properties of the polymer resin and polycarbonate-based divinyl oligomer were characterized by gel permeation chromatography, Fourier transform infrared spectroscopy, and swelling studies. The in vitro degradation of the polymer resins was assessed using cholesterol esterase in a buffer solution at 37 degrees C for 3 weeks. Scanning electron microscopy of the degraded samples indicated that the hydrolysis of the resin was catalyzed by the enzyme. The relative interfacial shear strength between the polymer resin and the CPP ceramic was studied using a microbond test. The addition of ionic groups into the polymer resin chains appeared to improve the chemical bonding between the polymer and the CPP. Preliminary mechanical properties of the IPC were investigated by determining bending strength using a three point bending test. The data showed a sevenfold increase in strength over that of the monolithic CPP, and the addition of more ionic groups into the resin led to a higher bending strength for the newly formed CPP/polycarbonate resin system. Sample cross sections of the IPC examined using scanning electron microscopy suggested that the resin had infiltrated almost all of the pores of the CPP. The results of this study indicate that the IPC could potentially be used for fabricating novel biodegradable load-bearing implants.

Long-term intermittent shear deformation improves the quality of cartilaginous tissue formed in vitro

The formation of cartilaginous tissue in vitro is a promising alternative to repair damaged articular cartilage. However, recent attempts to tissue-engineer articular cartilage that has similar properties to the native tissue have proven to be difficult. The in vitro-formed cartilaginous tissue typically has a similar proteoglycan content to native cartilage, but has a reduced collagen content and only a fraction of the mechanical properties. In this study, we investigated whether the intermittent application of cyclic shearing forces during tissue formation would improve the tissue quality. Chondrocyte cultures were stimulated at a 2% shear strain amplitude at a frequency of 1 Hz for 400 cycles every 2nd day. At one week, both collagen and proteoglycan synthesis increased (23+/-6% and 20+/-6%, respectively) over the unstimulated, static controls. At four weeks, an increased amount of tissue formed (stimulated: 1.85+/-0.08, unstimulated: 1.58+/-0.07 mg dry wt.). This tissue contained approximately 40% more collagen (stimulated: 511+/-23, unstimulated: 367+/-24 microg/construct) and 35% more proteoglycans (stimulated: 376+/-21, unstimulated: 279+/-26 microg/construct). Tissues that formed in the presence of shearing forces also displayed a 3-fold increase in compressive load-bearing capacity (stimulated: 16+/-5, unstimulated: 5+/-1 kPa max. equilibrium stress) and a 6-fold increase in stiffness (stimulated: 112+/-36, unstimulated: 20+/-6 kPa max. equilibrium modulus) compared to the static controls. These results demonstrate that intermittent application of dynamic shearing forces over a four-week period improves the quality of cartilaginous tissue formed in vitro. Interestingly, low amplitudes of shear stimulation for short periods of time (6 min of stimulation applied every 2nd day) produced these changes.