Biocompatibility of dental implants coated with hydroxyapatite using pulsed Er:YAG laser deposition

We aimed to improve the biocompatibility and osteoinductive potential of Ti implants using a simulated intraoral hydroxyapatite (HAp) coating. We devised a novel surface treatment for aggressive induction of osteoblast adhesion and bone regeneration on the implant surface. A thin α-tricalcium phosphate (α-TCP) film was deposited on the implant surface using a pulsed Er:YAG laser. The coating was converted to HAp through artificial saliva immersion, which was confirmed using scanning electron microscopy (SEM) and X-ray diffraction (XRD). SEM showed needle-like HAp crystals on the Ti disks and sandblasted implant surfaces after immersion in artificial saliva for 96 h. Microcomputed tomography and histological evaluation 4 and 8 weeks after implantation into beagle dog mandibles showed that the HAp-coated implant was biocompatible and exhibited superior osteoinduction compared to that of sandblasted implants. Coating the implant surface with HAp using an Er:YAG laser has potential as a new method of the implant-surface debridement.

The effects of HAp coating layer on mechanical and optical properties at bonding interface of high-performance polymers

PURPOSE

The effect of hydroxyapatite (HAp) coating layer on mechanical and optical properties at bonding interface of high-performance polymers (HPPs) used in computer-aided design (CAD)/computer-aided manufacture (CAM) technology was investigated in this in vitro study.

MATERIALS AND METHODS

Two hundred-twenty specimens were divided into two material groups (n = 110): polyetheretherketone (PEEK, KERA® starPEEK) and polyetherketoneketone (PEKK, Pekkton® ivory). For mechanical testing, each group was divided into five surface pretreatment subgroups and a control group (n = 10): HAp coating (1%,3%, 5%, and 10% concentrations) and sandblasting with 110-μm Al₂O₃ particles. For optical testing, each group was divided into five subgroups (n = 10): HAp coating (1%, 3%, 5%, and 10% concentrations) and control. The effects of the HAp coating on the optical changes and shear bond strength (SBS) of the specimens were investigated. Data was statistically analyzed by one-way ANOVA and Tukey's post-hoc test. Failure modes and surface properties of the specimens were examined by scanning electron microscopy (SEM) and coupled electron dispersive spectroscopy (EDS).

RESULTS

Average translucency and color change values increased with increasing HAp coating concentration in HPPs. As a result of the data, statistically significant differences were observed in terms of the effect of the HAp coating on SBS of HPPs (p < 0.05). Failure modes were examined, and mixed failure mode was observed.

CONCLUSION

HAp coating can contribute to the improvement of both the optical properties and bond strength of the HPPs to resin composite.

CLINICAL SIGNIFICANCE

Adhesion and color problems of high performance polymers are still under discussion. In order to solve these problems, generally focused on surface modifications of these polymers, but the effect of the HAp coating has not been investigated.

Clinical results at 10 years of minimum follow-up with the ABG 2 hip arthroplasty, matched with ceramic-on-ceramic bearings

Introduction: The current study aimed as a primary goal is to assess the results of a ceramic-on-ceramic (CoC) bearing hip system matched with ABG (Anatomic Benoist Girard) 2 components in terms of survivorship. Secondary objectives addressed specifically ceramic-related complications as well as specific patterns at the bone-implant interface. Material and methods: This is a retrospective bicentric continuous series involving 147 patients (95 males vs. 52 females) who underwent ABG 2 arthroplasties with CoC bearings. One hundred and twenty-five hips were closely followed-up at a mean period of 11.3 years. Results and discussion: With a mean follow-up of 11.3 years, nine cases (5.7%) underwent revision surgery, four caused by acetabular aseptic loosening, three by deep infections, one ceramic head fracture, and one femoro-acetabular impingement. The global survivorship was 92.2% at 12.7 years. The Harris Hip Score (HHS) mean scores increased post-operatively from 50.1 up to 96.1 points (p < 0.001). All stems featured patterns of radiological osseous integration onto the hydroxyapatite (HA)-coated zones. No radiological wear or osteolysis of ceramic bearings was demonstrated however, five patients reported hip squeaking using this bearing. This study demonstrated excellent results at mid-term follow-up in patients younger than 70 years of age using cementless ABG 2 components coupled with CoC bearings with no increase in complication rate.

A polydopamine-assisted strontium-substituted apatite coating for titanium promotes osteogenesis and angiogenesis via FAK/MAPK and PI3K/AKT signaling pathways

Early osteointegration is essential for biomedical implants. Surface modifications can significantly compensate for an implant's lack of biocompatibility and osteo-differentiation. They can also be designed to promote angiogenesis in order to assist osteogenesis and ultimately facilitate bone regeneration. In this study, a polydopamine-assisted strontium-substituted apatite coating (Ti@PDA + SrHA) was fabricated on a multifunctional titanium implant to induce both angiogenic and osteogenic abilities for rapid osseointegration. Polydopamine and Sr-substituted hydroxyapatite were coated on the implant through biomineralization. The in vitro results showed that Ti@PDA + SrHA improved cell adhesion and increased the proliferation of rat bone marrow-derived mesenchymal stem cells (rBMSCs) and human umbilical vein endothelial cells (HUVECs). Ti@PDA + SrHA upregulated the expression of ALP activity and osteogenic genes in rBMSCs and elevated angiogenic genes in both rBMSCs and HUVECs. Mechanically, the FAK/MAPK signaling pathway was activated in rBMSCs, and the PI3K/AKT signaling pathway was activated in both rBMSCs and HUVECs. Consistent with these findings, Ti@PDA + SrHA accelerated new bone formation and rapid osseointegration in the femoral condyle implantation study with good stability. Overall, we fabricated a multifunctional biocompatible implant with better angiogenic and osteogenic performance compared to the non-coated implant.

Fabrication of customized Ti6AI4V heterogeneous scaffolds with selective laser melting: Optimization of the architecture for orthopedic implant applications

Orthopedic implants with heterogeneous porous structures were known as ideal bone osteointegration. This research introduced the selective laser melting (SLM), finite element analysis (FEA), and a hydrothermal process (HT) for manufacturing a three-level heterogeneous porous structure. The macroporous structure was designed via CAD and micropores were tuned via laser power regulation. A nano-size layer of hydroxyapatite crystals was coated by an HT process. The mechanical properties were reinforced via a core-shell structure with core reinforcement. The existence of micropores and nano-hydroxyapatite coating enhanced the in vitro proliferation of preosteoblasts and osteogenic cellular behaviors of rBMSCs. Thus, the three-level heterogeneous porous titanium implants could inspire researchers with potential clue of cyto-implant interaction mechanism, therefore building ideal orthopedic implants with accelerated osteointegration. STATEMENT OF SIGNIFICANCE: Porous structures of titanium implants play an important role in bone tissue regeneration; The geometrical environment influence cell behaviour and bone tissue ingrowth in all macro-/micro-/nanoscale. In this study, a novel method to fabricate heterogeneous scaffolds and its macro-/micro-/nanoscopic structures were studied. A CAD model was used to obtain the macroscopic structure and the insufficient laser power was introduced for porous microstructure. Therefore, a layer of nano hydroxyapatite was coated via hydrothermal process. Cytoproliferation and cytodifferentiation results indicated that a integrity of regular/irregular, macro-/micro-/nanoscale porous structure had advance in recruiting stem cells and promoting differentiation. This research is beneficial to the development of bone implants with better bone regeneration ability.

Enhanced corrosion resistance, antibacterial properties, and biocompatibility by hierarchical hydroxyapatite/ciprofloxacin-calcium phosphate coating on nitrided NiTi alloy

Multi-functional hierarchical coatings are deposited on the nitrided NiTi alloy. The nitrided layer is first deposited by nitrogen plasma immersion ion implantation and a middle layer containing porous hydroxyapatite and ciprofloxacin (Cip) is produced before the top calcium phosphate coating is deposited by the sol-gel method. The thicknesses of the coating and nitrided intermediate layer are about 1.54 μm and 160 nm, respectively and Cip penetrates to a depth of about 530 nm. Calcium phosphate reduces surface defects resulting in a surface roughness of 17 ± 2 nm compared to 34 ± 5 nm of the porous hydroxyapatite coating. The corrosion resistance is improved due to reduced defects and localized corrosion as manifested by the decrease in the Ni²⁺ release rate by 11.6% from 0.0198 to 0.0175 mg L^-1 cm^-2. The bacterial resistance against E. coli is also improved by about 88 times on account of Cip release and good biocompatibility is confirmed by proliferation of MC3T3 cells. This multi-functional hierarchical coating has large potential in orthopedic and dental applications.

Ultrasonic aqueous synthesis of corrosion resistant hydroxyapatite coating on magnesium alloys for the application of long-term implant

For the orthopedic application, the promising biodegradable magnesium alloys gained increasing attention. In order to improve the interface bonding strength and corrosion resistance of magnesium alloys, a novel ultrasonic aqueous synthesis approach was performed to produce hydroxyapatite coating on biodegradable magnesium alloys. The effect of ultrasonic time on the composition, microstructure, interface bonding strength and corrosion resistance of HA coated magnesium alloys were investigated. A dense and crack-free HA coating was synthesized by only ultrasonic cavitation for 1 h in the aqueous solution containing Ca²⁺ and PO₄^3- ions and the coating was constituted of bamboo leaf-like HA staggered irregularly, which endowed magnesium alloy with a sufficient interface bonding strength of 18.1 ± 2.2 MPa. The electrochemical performance and mineralization ability of the coated magnesium alloys were carried out in the simulated body fluids. Compared with bare magnesium samples, the coated samples presented excellent corrosion resistance and could rapidly induce apatite formation after only three days of immersion in the simulated body fluid (SBF). Moreover, in the immersion test of 90 days, HA coatings could provide a long-term protection for magnesium alloy substrate, indicating that ultrasonic aqueous synthesized HA coating could be acted as a promising modified biomaterial on magnesium alloys for the orthopedic application.

Limb lengthening and deformity correction in children with abnormal bone

Flexible intramedullary nailing (FIN) provides multiple advantages in limb lengthening and progressive deformity correction in combination with external fixation. The article presents brief literature review and authors' experience in limb lengthening of abnormal bone (Ollier's disease, fibrous dysplasia, osteogenesis imperfecta). Titanium and, especially, hydroxyapatite-coated bent elastic nails in combination with external fixator are appropriate in limb lengthening of abnormal bone in children. FIN left in situ after lengthening procedure and external frame removal should be applied for long-term reinforcement of lengthened bone in patients with abnormal bone (metabolic bone disorders, skeletal dysplasias with compromised bone tissue development). The FIN respects bone biology, which is mandatory for good bone consolidation. Osteoactive properties of intramedullary elastic implants are favorable for bone formation and as well as for stable position of nails without risks of migration in long-term follow-up.

Ion-substituted calcium phosphate coatings by physical vapor deposition magnetron sputtering for biomedical applications: A review

Coatings based on ion-substituted calcium phosphate (Ca-P) have attracted great attention in the scientific community over the past decade for the development of biomedical applications. Among such Ca-P based structures, hydroxyapatite (HA) has shown significant influence on cell behaviors including cell proliferation, adhesion, and differentiation. These cell behaviors determine the osseointegration between the implant and host bone and the biocompatibility of implants. This review presents a critical analysis on the physical vapor deposition magnetron sputtering (PVDMS) technique that has been used for ion-substituted Ca-P based coatings on implants materials. The effect of PVDMS processing parameters such as discharge power, bias voltage, deposition time, substrate temperature, and post-heat treatment on the surface properties of ion-substituted Ca-P coatings is elucidated. Moreover, the advantages, short comings and future research directions of Ca-P coatings by PVDMS have been comprehensively analyzed. It is revealed that the topography and surface chemistry of amorphous HA coatings influence the cell behavior, and ion-substituted HA coatings significantly increase cell attachment but may result in a cytotoxic effect that reduces the growth of the cells attached to the coating surface areas. Meanwhile, low-crystalline HA coatings exhibit lower rates of osteogenic cell proliferation as compared to highly crystalline HA coatings developed on Ti based surfaces. PVDMS allows a close reproduction of bioapatite characteristics with high adhesion strength and substitution of therapeutic ions. It can also be used for processing nanostructured Ca-P coatings on polymeric biomaterials and biodegradable metals and alloys with enhanced corrosion resistance and biocompatibility. STATEMENT OF SIGNIFICANCE: Recent studies have utilized the physical vapor deposition magnetron sputtering (PVDMS) for the deposition of Ca-P and ion-substituted Ca-P thin film coatings on orthopedic and dental implants. This review explains the effect of PVDMS processing parameters, such as discharge power, bias voltage, deposition time, substrate temperature, and post-heat treatment, on the surface morphology and crystal structure of ion-substituted Ca-P and ion-substituted Ca-P thin coatings. It is revealed that coating thickness, surface morphology and crystal structure of ion-substituted Ca-P coatings via PVDMS directly affect the biocompatibility and cell responses of such structures. The cell responses determine the osseointegration between the implant and host bone and eventually the success of the implants.

Corrosion resistance and antibacterial properties of hydroxyapatite coating induced by gentamicin-loaded polymeric multilayers on magnesium alloys

As a result of their good biocompatibility, bioactivity, and mechanical properties, magnesium (Mg) alloys have received considerable attention as next generation biodegradable implants. Herein, in order to achieve a proper degradation rate and good antibacterial ability, we reported a novel hydroxyapatite coating induced by gentamicin (GS)-loaded polymeric multilayers for the surface treatment of the Mg alloy. The coating was characterized by X-ray diffraction, fourier transform infrared spectroscopy and scanning electron microscopy. The as-prepared hydroxyapatite coating showed the compact morphology and a well-crystallized apatite structure. This coating could improve the adhesion strength and reduce the corrosion rate of the substrate in simulated body fluid solution. Meanwhile, the drug release and antibacterial experiments demonstrated that the GS loaded specimen revealed a significant antimicrobial performance toward Staphylococcus aureus and had a prolonged release profile of GS, which would be helpful to the long-term bactericidal activity of the Mg implant. This coating showed acceptable biocompatibility via MTT assay and Live/dead staining. Thus, the multilayers-hydroxyapatite coated Mg alloy could improve the corrosion resistance and biocompatibility while delivering vital drugs to the site of implantation.

Is there any difference between tapered titanium stems with similar geometry and hydroxyapatite coating?

PURPOSE

Several tapered stems with similar geometry and extensive hydroxyapatite coating have recently been introduced. It is not clear, however, whether they share the same design or whether they exhibit any difference that might affect their clinical performances. In this study, we analysed five tapered stems fully coated with hydroxyapatite to establish whether they exhibit similar geometric features and may therefore be used indifferently when a cementless stem is indicated.

METHODS

The length of the stem, the coronal and sagittal diameters, the length of the stem shoulder and the metadiaphyseal angle were measured. The ratio between the proximal and distal coronal diameters of the stem and that between the proximal and distal cross-sectional areas were calculated as a flare index and tapered index, respectively.

RESULTS

The proximal coronal diameter ranged between 24.9 and 28 mm in the smaller size and between 34 and 38.4 mm in the largest sizes. The proximal sagittal diameter ranged between 10.2 and 11.8 in the smallest size and between 14.4 and 17.2 in the largest. A significant difference was found between stems of different brands in the flare index, tapered index, length of stem shoulder and metadiaphyseal angle.

CONCLUSIONS

Lookalike tapered stems with extensive HA coating actually exhibit significant differences in several geometric features potentially affecting their clinical performances. As a result, these stems should not be used indifferently, but rather they should be selected on the basis of the femoral morphology of the operated patient.

Improved osteoblast adhesion and osseointegration on TiO2 nanotubes surface with hydroxyapatite coating

To improve initial osteoblast adhesion and subsequent osseointegration, TiO₂ nanotubes layer was constructed on the titanium (Ti) surface by anodic oxidation (AO), with an additional hydroxyapatite (HA) coating to form the AO/HA surface. Tests on in vitro cellular activity displayed that the AO surface, especially the AO/HA surface, promoted initial adhesion, proliferation and differentiation of osteoblast cells. The modified AO and AO/HA surfaces further presented an up-regulated gene expression of osteogenic and adhesion markers collagen type 1 (COL), osteopontin (OPN), osteocalcin (OCN) and vinculin. In addition, in vivo experiments with a rat model demonstrated that the AO surface, particularly the AO/HA surface, achieved earlier osseointegration and a superior bone bonding ability compared with Ti. Our study shed light on a synergistic role played by nanotopography and HA in promoting osteoblast adhesion, proliferation, differentiation and osseointegration, thus suggesting a promising method for better modifying the implant surface.

Enhanced bone healing in porous Ti implanted rabbit combining bioactive modification and mechanical stimulation

To improve the bone healing efficiency of porous titanium implants, desired biological properties of implants are mandatory, involving bioactivity, osteoconductivity, osteoinductivity and a stable environment. In this study, bare porous titanium (abbr. pTi) with the porosity of 70% was fabricated by vacuum diffusion bonding of titanium meshes. Hydroxyapatite-coated pTi (abbr. Hap-pTi) was obtained by successively subjecting pTi to alkali heat treatment, pre-calcification and simulated body fluid. Both pTi and Hap-pTi were respectively implanted into the tibia defect model (ϕ10 mm × 6 mm) in New Zealand white rabbits, then subjected to non-invasively axial compressive loads at high-magnitude low-frequency (HMLF), which were denoted as F-pTi and F-Hap-pTi, respectively. Bone repairing efficiencies were analyzed by postoperative X-ray examination, optical observation and HE staining after 14 and 30 days of implantation. ALP and OCN contents in serum were also examined at 30 days. Results showed that the sham group and sham group with mechanical stimulation (abbr. F-sham) preferably caused bone fractures. Qualitatively, Hap-pTi reduced the risk of bone fractures and enhanced bone healing slightly more effectively compared to bared pTi. However, both Hap-pTi combined with mechanical stimulation and F-pTi in the case of bioactive modification could result in a higher bone healing efficiency (F-Hap-pTi). The molecular signaling investigation of ALP and OCN contents in serum further revealed a probable synergistic effect of Hap coating coupling with HMLF compression on improving bone repairing efficiency. It provides a candidate of clinically applicable therapy for osseous defects.

Universal and biocompatible hydroxyapatite coating induced by phytic acid-metal complex multilayer

As the basic component of natural bone in the human body, hydroxyapatite is widely used in orthopedic, dental, and bone implants, especially as a surface coating to improve osteoconductivity and osseointeration of materials. Several methods have been used for hydroxyapatite coating, including plasma spraying, laser pulse deposition, and electrophoretic and electrochemical deposition. However, these methods require expensive instruments and involve complex operations. Thus, it is highly desirable to develop a feasible, simple, cheap, and universal method to prepare hydroxyapatite coatings. In this work, we develop a method for hydroxyapatite coating on various materials by a phytic acid-metal complex multilayer. The abundant phosphate moieties on phytic acid not only work for chemical modification of a wide range of materials but also for further the formation of hydroxyapatite. The formed crystals improve the biocompatibility and osteogenic ability of MG63 cells. This method is simple, cheap, and novel, and can be utilized in biomedical applications such as orthopedic, dental, and bone implants.

Hydroxyapatite-coated implant: Clinical prognosis assessment via a retrospective follow-up study for the average of 3 years

PURPOSE

This research evaluated clinical outcomes of two types of hydroxyapatite (HA)-coated implants: OT (Osstem TS III-HA, Osstem implant Co., Busan, Korea) and ZM (Zimmer TSV-HA, Zimmer dental, Carlsbad, USA).

MATERIALS AND METHODS

The research was conducted on 303 implants (89 of OT, 214 of ZM), which were placed from January 16, 2010 to December 20, 2012. The prognosis was evaluated in terms of success rates, survival rates, annual marginal bone loss, and implant stability quotients (ISQ). The samples were classified into immediate, early, conventional, and delayed groups according to the loading time.

RESULTS

Overall, there were no significant differences between OT and ZM in success rates, survival rates, and annual marginal bone loss, except for the result of secondary stability. OT showed 77.83 ± 8.23 ISQ, which was marginally higher than 76.09 ± 6.90 ISQ of ZM (P<.05). In terms of healing periods, only immediate loading showed statistically significant differences (P<.05). Differences between OT and ZM were observed in terms of two indices, the annual marginal bone loss (0.17 ± 0.58 mm/year < 0.45 ± 0.80 mm/year) and secondary stability (84.36 ± 3.80 ISQ > 82.48 ± 3.69 ISQ) (P<.05). OT and ZM did not have any statistically significant differences in early, conventional, and delayed loading (P>.05).

CONCLUSION

OT (97.75%) and ZM (98.50%) showed relatively good outcomes in terms of survival rates. In general, OT and ZM did not show statistically significant differences in most indices (P>.05), although OT performed marginally better than ZM in the immediate loading and 1-stage surgery (P<.05).

Effects of polycaprolactone on alendronate drug release from Mg-doped hydroxyapatite coating on titanium

The scientific objective of this study was to understand the influence of PCL coating on alendronate drug release kinetics in vitro. Our hypothesis was PCL coating would minimize burst release of alendronate from plasma sprayed Mg-doped hydroxyapatite (HA) coated commercially pure titanium (CpTi) samples. In the US alone, over 44 million women and men aged 50 and older are affected by osteoporosis which can lead to replacement and/or revision surgeries. Alendronate is a widely-used drug for treating osteoporosis and would be an ideal drug to be loaded and released from these replacement systems. Initial burst release is a common phenomenon for the most drug loaded devices. To modulate the release kinetics, a biodegradable polymer, polycaprolactone (PCL), coating with slow degradable kinetics was employed. Samples with 2 and 4 wt% PCL showed about 34% and 26% release of alendronate within the first 24 h, respectively, compared to 75% burst release without any PCL coating. With the addition of a PCL coating, a controlled release kinetics of alendronate was achieved from HA coated titanium implants, which can potentially impact millions of patients worldwide having compromised bone due to osteoporosis.

Effect of doxycycline-treated hydroxyapatite surface on bone apposition: A histomophometric study in murine maxillae

Improved osseointegration of dental implants is imperative in clinic. Effect of doxycycline on promoting bone formation after implant placement was expected due to its inhibitory properties on inflammation and osteoclastogenesis. To evaluate new bone formation on the hydroxyapatite (HA)-coated implant surface, which was treated with doxycycline, in comparison with the untreated HA surface, half of the HA-coated implants were soaked in doxycycline solution (DOX group) whereas the other HA-coated implants were untreated (HA group). Eight weeks after extracting the maxillary first molars of 4-week-old male mice, the implants of both groups were placed at the extracted site. 4 and 8 weeks after surgery, the samples were evaluated radiologically and histomorphometrically. Bone-implant contact of DOX group was statistically higher than the one of HA group at 4 and 8 weeks. New bone area between the threads of the implants also statistically increased at 8 weeks in DOX group compared to HA group.

Osteogenesis ability of CAD/CAM porous zirconia scaffolds enriched with nano-hydroxyapatite particles

Background

The aim of this study was to evaluate osteogenesis ability of CAD/CAM porous zirconia scaffolds enriched with hydroxy apatite used to augment large boney defects in a dog model.

Methods

Surgical defects were made bilaterally on the lower jaw of 12 Beagle dogs. Cone beam CT images were used to create three dimensional images of the healed defects. Porous zirconia scaffolds were fabricated by milling custom made CAD/CAM blocks into the desired shape. After sintering, the pores of half of the scaffolds were filled with a nano-hydroxy apatite (HA) powder while the other half served as control. The scaffolds were inserted bilaterally in the healed mandibular jaw defects and were secured in position by resorbable fixation screws. After a healing time of 6 weeks, bone-scaffold interface was subjected to histomorphometric analysis to detect the amount of new bone formation. Stained histological sections were analyzed using a computer software (n=12, α=0.05). Mercury porosimetery was used to measure pore sizes, chemical composition was analyzed using energy dispersive x-ray analysis (EDX), and the crystal structure was identified using x-ray diffraction micro-analysis (XRD).

Results

HA enriched zirconia scaffolds revealed significantly higher volume of new bone formation (33% ± 14) compared to the controls (21% ± 11). New bone deposition started by coating the pore cavity walls and proceeded by filling the entire pore volume. Bone in-growth started from the surface of the scaffold and propagated towards the scaffold core. Islands of entrapped hydroxy apatite particles were observed in mineralized bone matrix.

Conclusions

Within the limitations of this study, hydroxy apatite enhanced osteogenesis ability of porous zirconia scaffolds.

Bioactivity and osteointegration of hydroxyapatite-coated stainless steel and titanium wires used for intramedullary osteosynthesis

A lot of research was conducted on the use of various biomaterials in orthopedic surgery. Our study investigated the effects of nanostructured calcium–phosphate coating on metallic implants introduced into the bone marrow canal. Stainless steel or titanium 2-mm wires (groups 1 and 2, respectively), and hydroxyapatite-coated stainless steel or titanium wires of the same diameter (groups 3 and 4, respectively) were introduced into the tibial bone marrow canal of 20 dogs (each group = 5 dogs). Hydroxyapatite coating was deposited on the wires with the method of microarc oxidation. Light microscopy to study histological diaphyseal transverse sections, scanning electron microscopy to study the bone marrow area around the implant and an X-ray electron probe analyzer to study the content of calcium and phosphorus were used to investigate bioactivity and osteointegration after a four weeks period. Osteointegration was also assessed by measuring wires’ pull-off strength with a sensor dynamometer. Bone formation was observed round the wires in the bone marrow canal in all the groups. Its intensity depended upon the features of wire surfaces and implant materials. Maximum percentage volume of trabecular bone was present in the bone marrow canals of group 4 dogs that corresponded to a mean of 27.1 ± 0.14%, while it was only 6.7% in group 1. The coating in groups 3 and 4 provided better bioactivity and osteointegration. Hydroxyapatite-coated titanium wires showed the highest degree of bone formation around them and greater pull-off strength. Nanostructured hydroxyapatite coating of metallic wires induces an expressed bone formation and provides osteointegration. Hydroxyapatite-coated wires could be used along with external fixation for bone repair enhancement in diaphyseal fractures, management of osteogenesis imperfecta and correction of bone deformities in phosphate diabetes.

Microstructural and surface modifications and hydroxyapatite coating of Ti-6Al-4V triply periodic minimal surface lattices fabricated by selective laser melting

Ti-6Al-4V Gyroid triply periodic minimal surface (TPMS) lattices were manufactured by selective laser melting (SLM). The as-built Ti-6Al-4V lattices exhibit an out-of-equilibrium microstructure with very fine α' martensitic laths. When subjected to the heat treatment of 1050°C for 4h followed by furnace cooling, the lattices show a homogenous and equilibrium lamellar α+β microstructure with less dislocation and crystallographic defects compared with the as-built α' martensite. The as-built lattices present very rough strut surfaces bonded with plenty of partially melted metal particles. The sand blasting nearly removed all the bonded metal particles, but created many tiny cracks. The HCl etching eliminated these tiny cracks, and subsequent NaOH etching resulted in many small and shallow micro-pits and develops a sodium titanate hydrogel layer on the surfaces of the lattices. When soaked in simulated body fluid (SBF), the Ti-6Al-4V TPMS lattices were covered with a compact and homogeneous biomimetic hydroxyapatite (HA) layer. This work proposes a new method for making Ti-6Al-4V TPMS lattices with a homogenous and equilibrium microstructure and biomimetic HA coating, which show both tough and bioactive characteristics and can be promising materials usable as bone substitutes.

A review of hydroxyapatite-based coating techniques: Sol-gel and electrochemical depositions on biocompatible metals

New promising techniques for depositing biocompatible hydroxyapatite-based coatings on biocompatible metal substrates for biomedical applications have continuously been exploited for more than two decades. Currently, various experimental deposition processes have been employed. In this review, the two most frequently used deposition processes will be discussed: a sol-gel dip coating and an electrochemical deposition. This study deliberates the surface morphologies and chemical composition, mechanical performance and biological responses of sol-gel dip coating as well as the electrochemical deposition for two different sample conditions, with and without coating. The review shows that sol-gel dip coatings and electrochemical deposition were able to obtain the uniform and homogeneous coating thickness and high adherent biocompatible coatings even in complex shapes. It has been accepted that both coating techniques improve bone strength and initial osseointegration rate. The main advantages and limitations of those techniques of hydroxyapatite-based coatings are presented. Furthermore, the most significant challenges and critical issues are also highlighted.

Structure of Biocompatible Coatings Produced from Hydroxyapatite Nanoparticles by Detonation Spraying

Detonation-produced hydroxyapatite coatings were studied by scanning electron microscopy (SEM), X-ray powder diffraction (XRD), Raman spectroscopy, and electron paramagnetic resonance (EPR) spectroscopy. The source material for detonation spraying was a B-type carbonated hydroxyapatite powder. The coatings consisted of tetracalcium phosphate and apatite. The ratio depended slightly on the degree of crystallinity of the initial powder and processing parameters of the coating preparation. The tetracalcium phosphate phase was homogeneous; the apatite phase contained defects localized on the sixfold axis and consisted of hydroxyapatite and oxyapatite. Technological factors contributing to the transformation of hydroxyapatite powder structure during coating formation by detonation spraying are discussed.

Peptide aptamers: Novel coatings for orthopaedic implants

Current processes for coating titanium implants with ceramics involve very high energy techniques with associated high cost and disadvantages such as heterogeneity of the coatings, phase transformations and inability to coat complex structures. In order to address the above problems, we propose a biomimetic hydroxyapatite coating process with the use of peptides that can bind both on titanium surfaces and hydroxyapatite. The peptides enabled homogeneous coating of a titanium surface with hydroxyapatite. The hydroxyapatite-peptide sandwich coating showed no adverse effects on cell number or collagen deposition. This makes the sandwich coated titanium a good candidate for titanium implants used in orthopaedics and dentistry.

The Effect of Hydroxyapatite Coating on Long-term Results of Total Hip Arthroplasty with Hydroxyapatite-coated Anatomic Femoral Stem

Purpose

To evaluate the clinical and radiological results, as well as the survival rate, associated with total hip arthroplasty using a hydroxyapatite (HA)-coated anatomical femoral stem at a follow-up of ≥12 years.

Materials and Methods

From April 1992 to May 1997, 86 patients (102 hips) underwent total hip arthroplasty with a HA-coated ABG I (Anatomical Benoist Giraud; Howmedica) hip prosthesis. The average age at the time of surgery was 53.4 years and the mean duration of follow-up was 17.1 years (range, 12.1-21.0 years). The Harris hip score (HHS) and radiographic assessments of thigh pain were used to evaluate the clinical results. We observed osteointegration, cortical hypertrophy, reactive line, calcar resorption and osteolysis around the femoral stems. The survival rate of the femoral stems was evaluated by using the span of time to a revision operation for any reasons was defined as the end point.

Results

The mean HHS was 50.5 preoperatively and 84.2 at the time of last follow-up. Osteolysis only around the HA-coated proximal portion of the femoral stem was observed in 72 hips, cortical hypertrophy all around the distal portion of the femoral stem was observed in 38 hips, and calcar resorption was observed in 44 hips. A reactive line was observed in 13 hips, but was unrelated to component loosening. Stem revision operations were performed in 24 (23%) hips due to osteolysis (14 hips), fracture (5 hips) and infection (5 hips). The femoral stem survival rate was 75% over the mean duration of follow-up.

Conclusion

Total hip arthroplasty using a HA-coated anatomical femoral stem showed necessitated a high rate of revision operations due to osteolysis around the femoral stem in this long term follow-up study.

The differential regulation of osteoblast and osteoclast activity by surface topography of hydroxyapatite coatings

The behavior of bone cells is influenced by the surface chemistry and topography of implants and scaffolds. Our purpose was to investigate how the topography of biomimetic hydroxyapatite (HA) coatings influences the attachment and differentiation of osteoblasts, and the resorptive activity of osteoclasts. Using strategies reported previously, we directly controlled the surface topography of HA coatings on polycaprolactone discs. Osteoblasts and osteoclasts were incubated on HA coatings having distinct isotropic topographies with submicrometer and micro-scale features. Osteoblast attachment and differentiation were greater on more complex, micro-rough HA surfaces (Ra ~2 μm) than on smoother topographies (Ra ~1 μm). In contrast, activity of the osteoclast marker tartrate-resistant acid phosphatase was greater on smoother than on micro-rough surfaces. Furthermore, scanning electron microscopy revealed the presence of resorption lacunae exclusively on smoother HA coatings. Inhibition of resorption on micro-rough surfaces was associated with disruption of filamentous actin sealing zones. In conclusion, HA coatings can be prepared with distinct topographies, which differentially regulate responses of osteoblasts, as well as osteoclastic activity and hence susceptibility to resorption. Thus, it may be possible to design HA coatings that induce optimal rates of bone formation and degradation specifically tailored for different applications in orthopedics and dentistry.