Management of tibial nonunion and osteoarthritis using a 3D-printed titanium cone: A case report

The use of customized 3D-printed structures has been gaining popularity in non-union management, as it allows for bypassing the defect while promoting osseointegration. Additionally, porous titanium implants minimize stress shielding due to their stiffness and elastic modulus being closer to that of bone. The interconnected channels increase the surface area and provide space for cell adhesion and proliferation. This study presents the case of a 62-year-old female patient with concomitant knee osteoarthritis recalcitrant aseptic atrophic nonunion in the tibial proximal metaphysis. Due to the small distance between the nonunion site and the joint line, nonunion treatment had to be included in the treatment plan, as it would result in a lack of mechanical stability of the tibial component, and techniques such as plating were not an option. A customized 3D-printed porous titanium cone was used to bypass the fracture site and support the stem used with the CCK prosthesis, allowing for simultaneous nonunion and osteoarthritis management.

Surface competition between osteoblasts and bacteria on silver-doped bioactive titanium implant

The rapid integration in the bone tissue and the prevention of bacterial infection are key for the success of the implant. In this regard, a silver (Ag)-doped thermochemical treatment that generate an Ag-doped calcium titanate layer on titanium (Ti) implants was previously developed by our group to improve the bone-bonding ability and provide antibacterial activity. In the present study, the biological and antibacterial potential of this coating has been further studied. In order to prove that the Ag-doped layer has an antibacterial effect with no detrimental effect on the bone cells, the behavior of osteoblast-like cells in terms of cell adhesion, morphology, proliferation and differentiation was evaluated, and the biofilm inhibition capacity was assessed. Moreover, the competition by the surface between cell and bacteria was carried out in two different co-culture methods. Finally, the treatment was applied to porous Ti implants to study in vivo osteointegration. The results show that the incorporation of Ag inhibits the biofilm formation and has no effect on the performance of osteoblast-like cells. Therefore, it can be concluded that the Ag-doped surface is capable of preventing bone bacterial infection and providing suitable osseointegration.

Subsidence and fusion performance of a 3D-printed porous interbody cage with stress-optimized body lattice and microporous endplates - a comprehensive mechanical and biological analysis

BACKGROUND CONTEXT

Cage subsidence remains a serious complication after spinal fusion surgery. Novel porous designs in the cage body or endplate offer attractive options to improve subsidence and osseointegration performance.

PURPOSE

To elucidate the relative contribution of a porous design in each of the two major domains (body and endplates) to cage stiffness and subsidence performance, using standardized mechanical testing methods, and to analyze the fusion progression via an established ovine interbody fusion model to support the mechanical testing findings.

STUDY DESIGN/SETTING

A comparative preclinical study using standardized mechanical testing and established animal model.

METHODS

To isolate the subsidence performance contributed by each porous cage design feature, namely the stress-optimized body lattice (vs. a solid body) and microporous endplates (vs. smooth endplates), four groups of cages (two-by-two combination of these two features) were tested in: (1) static axial compression of the cage (per ASTM F2077) and (2) static subsidence (per ASTM F2267). To evaluate the progression of fusion, titanium cages were created with a microporous endplate and internal lattice architecture analogous to commercial implants used in subsidence testing and implanted in an endplate-sparing, ovine intervertebral body fusion model.

RESULTS

The cage stiffness was reduced by 16.7% by the porous body lattice, and by 16.6% by the microporous endplates. The porous titanium cage with both porous features showed the lowest stiffness with a value of 40.4±0.3 kN/mm (Mean±SEM) and a block stiffness of 1976.8±27.4 N/mm for subsidence. The body lattice showed no significant impact on the block stiffness (1.4% reduction), while the microporous endplates decreased the block stiffness significantly by 24.9% (p<.0001). All segments implanted with porous titanium cages were deemed rigidly fused by manual palpation, except one at 12 weeks, consistent with robotic ROM testing and radiographic and histologic observations. A reduction in ROM was noted from 12 to 26 weeks (4.1±1.6° to 2.2±1.4° in lateral bending, p<.05; 2.1±0.6° to 1.5±0.3° in axial rotation, p<.05); and 3.3±1.6° to 1.9±1.2° in flexion extension, p=.07). Bone in the available void improved with time in the central aperture (54±35% to 83±13%, p<.05) and porous cage structure (19±26% to 37±21%, p=.15).

CONCLUSIONS

Body lattice and microporous endplates features can effectively reduce the cage stiffness, therefore reducing the risk of stress shielding and promoting early fusion. While body lattice showed no impact on block stiffness and the microporous endplates reduced the block stiffness, a titanium cage with microporous endplates and internal lattice supported bone ingrowth and segmental mechanical stability as early as 12 weeks in ovine interbody fusion.

CLINICAL SIGNIFICANCE

Porous titanium cage architecture can offer an attractive solution to increase the available space for bone ingrowth and bridging to support successful spinal fusion while mitigating risks of increased subsidence.

The contribution of pore size and porosity of 3D printed porous titanium scaffolds to osteogenesis

Porous titanium implants were popularly fabricated to promote bone formation. A desirable porous scaffold was recommended to be with porosity of >60% or/and pore size of >300 μm for better osteointegration. However, whether the pore size and porosity could be randomly selected within the recommended values? And what is the correlation between pore size and porosity for accelerating osteointegration? In this study, porous titanium with cubic cell structure was produced by selective laser melting. The designed porosities of scaffolds with 700-μm pore size were 40%, 70% and 90%; and the pore sizes of scaffolds with 70% porosity were 400, 700 and 900 μm. The in vitro osteogenic potential and in vivo bone formation were investigated. Results showed that porosity and pore size could be tuned by altering strut size, which was further directly responsible for mechanical properties. Besides, pore size and porosity synergistically contributed to osteogenic activity in vitro and new bone formation in vivo. In regard to pore sizes herein, the optimized one for better osteogenic response and bone forming ability was ~600-700 μm (p70). Too smaller or too larger pore size might more or less hinder cellular behaviors and bone regeneration, even if both pore size (300-900 μm) and porosity (70%) were within the recommended value range. At a constant pore size (~600-700 μm), p70 and p90 with higher porosity was more conductive to biological effects, compared with p40. As a result, pore-size variation revealed more significant influence on osteogenesis, compared with variation of porosity within recommended values. However, the applicable porosity within recommended values should be designed with the consideration of specific load-bearing conditions. This study helps to provide guidance for designing porous scaffolds with appropriate mechanical strengths and effective bone-forming ability, so as to develop better custom-made bone substitutes.

Effect of supporting dies' mechanical properties on fracture behavior of monolithic zirconia molar crowns

The aim of this study was to investigate the effects of supporting dies with different mechanical properties on the fracture strengths and failure modes of monolithic zirconia crowns, and identify a suitable die material for testing high-strength ceramic restorations. Thirty six dies from teeth, porous titanium and composite-resin with 36 zirconia crowns were fabricated based on 3D model. Crowns were cemented, then underwent load-to-fracture testing. Fractographic analysis was performed with scanning electron microscopy, and finite element analysis was made. During loading, a high stress concentration zone formed near the loading point and on surface of die. Cracks generated on failure penetrated the crown and extended to die in 9 teeth group specimens, while composite-resin samples exhibited fracture of both crowns and dies. All dies remained intact in porous titanium group. Fracture mode was undistinguishable in all groups. It was concluded that porous titanium appears suitable as die material for dental restorations with high fracture strength.

Mechanical behavior of Ti6Al4V produced by laser powder bed fusion with engineered open porosity for dental applications

Implant failure due to biofilm formation is a substantial problem in the field of dental prosthetics. A solution has been proposed in the form of implants with a built-in drug reservoir, but combining sufficient strength and longevity with controlled release capability has proven difficult. This work investigates the feasibility of using laser powder bed fusion to create Ti6Al4V structures with open pore channels while maintaining their mechanical stability. These interconnected pore channels are generated by increasing the distance between consecutive melt pools, denominated as oversized hatch spacing. The impact of varying hatch spacing, laser power and scan speed on the degree of porosity was examined, with both an increase in hatch spacing and a decrease in energy density leading to higher porosity. The pore channels were found to be fully interconnected at total porosity values of 14% or more. The compressive modulus, yield strength and ultimate compressive strength are shown to be strongly related to the density of the structure. Based on the minimal strength and full interconnectivity requirements, the optimal additive manufacturing building conditions were determined. The fatigue properties of the resulting samples were investigated under uniaxial and under inclined compression-compression testing according to ISO 14801, which indicated an endurance limit of 217 MPa in the heat treated state. The results indicate that the use of an oversized hatch spacing is suitable for engineering open porous networks.

Titanium-based composite scaffolds reinforced with hydroxyapatite-zirconia: Production, mechanical and in-vitro characterization

In this study, titanium (Ti)-based composite scaffolds reinforced with hydroxyapatite-zirconia (HA-ZrO₂) were successfully produced with powder metallurgy and atmosphere-controlled sintering processes. The scaffolds structures were theoretically selected as 40% and 60% porosity, and fabricated with approximately 1.47 and 4.02 std dev values, respectively. The porosity of the scaffolds was verified by Archimedes' measurements. The scaffolds were characterized by DTA, SEM/EDS, XRD analyses. The mechanical behaviors of the scaffolds were evaluated by compression and hardness tests. Besides, the electrochemical corrosion behaviors of the structures were compared with potentiodynamic scanning (PDS) measurements in simulated body fluids (SBF) at 37 ± 1 °C. It has been observed that all scaffolds have a bimodal porous structure as they contain varying proportions of micropores as well as macropores in desired dimensions. Biocompatible phases such as Ti_xP_y, Ca₃(PO₄)₂ and CaTiO₃, respectively, were found in the microstructure after sintering. In compression tests, 40% porous Ti had the highest strength with 37.98 MPa, interestingly, the lowest strength was seen in Ti/HA-ZrO₂ scaffold with 60% porosity with 3.80 MPa. Young's modulus values of all scaffolds vary between 1.67 - 7.20 GPa, due to the bimodal pore structure and composition effect. However, in-vitro corrosion resistance of scaffolds decreased with HA reinforcement, while increased with ZrO₂ additive to HA.

Fabrication and characterization of porous titanium-based PbO2 electrode through the pulse electrodeposition method: Deposition condition optimization by orthogonal experiment

Porous titanium-based PbO₂ electrodes were successfully fabricated by pulse electrodeposition method. The primary pulse electrodeposition parameters, including pulse frequency (f), duty ratio (γ), average current density (J_a) and electrodeposition time (t) were considered in this study. An orthogonal experiment was designed based on those four factors and in three levels. SEM images and XRD results suggest that the surface morphology and structure of PbO₂ electrodes could be easily changed by varying pulse electrodeposition parameters. Orthogonal analysis reveals that the increase of f and J_a could decrease the average grain size of PbO₂ electrodes, which is conducive to create more active sites and promote the generation of hydroxide radicals. The electrochemical degradation of Azophloxine was carried out to evaluate the electrochemical oxidation performance of pulse electrodeposited electrodes. The results indicate that the influences of four factors can be ranked as follow: J_a >γ≈ t > f. The higher f, larger J_a and longer t could facilitate the optimization of the integrated electrochemical degradation performance of prepared PbO₂ electrode. The accelerated life time is dominated by J_a and t, coincident with the average weight increase of β-PbO₂ layer. The optimal parameters of pulse electrodeposition turn out to be: f = 50 Hz, γ = 30%, J_a = 25 mA cm^-2, t = 60 min. Together, the consequences of the experiments give assistance to uncover and roughly conclude the mechanism of pulse electrodeposition.

Comparison of 3D-printed porous tantalum and titanium scaffolds on osteointegration and osteogenesis

Metals such as Ta (tantalum) and Ti (titanium) have been popularly used as a bone substitute or implants in orthopedic surgery and dentistry, since they have excellent corrosion. For manufacturing porous implants with precise structure, SLM (Selective laser melting), which is one of the 3D (three-dimensional) printing techniques, is always be chosen. To compare biological performances between porous Ta and Ti implants, we designed them with the same porosity, pore shape, pore size, and pore distribution via CAD (computer aided design), and then produced them by SLM. It was shown that the equivalent stress of porous Ta and Ti were 393.62 ± 1.39 MPa and 139.75 ± 14.50 MPa, and their Young's modulus were 3.10 ± 0.03GPa and 5.42 ± 0.07GPa, respectively. Meanwhile, we investigated their biological performance with hBMMSCs (human Bone marrow mesenchymal stem cells) in vitro. The results revealed that both two scaffolds were in favor of hBMMSCs proliferation and osteogenic differentiation. In addition, porous scaffolds were implanted in the femur bone defects rabbits in vivo showed the both porous scaffolds were beneficial to the bone ingrowth and bone-implant fixation. In summary, porous Ta has an equivalent biological performance as traditional porous Ti implants in small bone defect repair. Taken together, porous Ta is a promising material for bone regeneration.

Direct calciothermic reduction of porous calcium titanate to porous titanium

A metallurgical material integration concept, using porous calcium titanate (CaTiO₃) as raw material, was put forward for preparation of metallic titanium powder and porous titanium by calciothermic reduction. Porous metallic titanium was prepared by calcium vapor reduction at 1273 K for 6 h with two types of interconnected pores in titanium samples. The interconnected macropores about 50-300 μm were inherited from porous CaTiO₃, and the micropores about 5-40 μm were made by leaching removal of byproduct CaO in reduction products. Metallic porous titanium was fabricated in Ca-dissolved CaO-CaCl₂ molten salt mixtures by self-sintering and had a good interconnectivity inside with thickness about 155 μm and the porosities of the porous titanium are 65-81%.

Effects of acid-alkali treatment on bioactivity and osteoinduction of porous titanium: An in vitro study

BACKGROUND

To elucidate the bioactivity and bone regeneration of porous titanium surfaces treated using acid-alkali combination, and to define the optimal alkali reaction time.

METHODS

Ten groups of porous Ti with at least 3 per group undergoing different acid-alkali treated time were prepared. The surface was characterized by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), bicinchoninic acid method (BCA), optical contact angle measurement and Raman spectrometry. Compression testing was performed with a universal testing machine. The bioactivity and osteoinduction were evaluated by a series of biological tests using a simulated body fluid (SBF) test, cell proliferation test, vinculin, ALP and OCN expression, and cell mineralization.

RESULTS

The acid-alkali treatment formed micro- and nano-scale structures on the sample surfaces. The alkali treatment for 12 h achieved the sharpest nano-scale surface relief and the most protein absorption. The treated porous surface was coated with a NaHTiO₃ layer. The acid-alkali etching did not compromise the elastic modulus and compressive strength of the porous Ti samples. In addition to hydroxyapatite, a perovskite phase was also formed on the treated porous samples in SBF. Non-treated dense Ti showed more cell adhesion and proliferation (P < 0.05), while osteoinduction and mineralization were more pronounced on the treated porous sample (P < 0.05).

CONCLUSION

Acid-alkali treatment is an effective means of generating nano-scale relief on porous Ti surface, and is beneficial for bioactivity and bone regeneration. The 15 min acid and 12 h alkali etching is the optimal combination. The osteoinductive efficacy may be attributable to the surface physical chemistry and the formation of hydroxyapatite and perovskite layers, rather than direct cell adhesion and proliferation.

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.

Different models for simulation of mechanical behaviour of porous materials

Commercially pure Titanium (cpTi) and its alloys are the most successful metallic biomaterials for bone replacement, due to its excellent biomechanical and biofunctional balance. However, these materials have higher elastic modulus when compared with bone, leading to the stress-shielding phenomenon and promoting bone resorption. Development of porous implants with low elastic modulus, providing a good mechanical and functional balance (suitable mechanical strength and optimum osseointegration), is the focus of emergent research in advanced Ti-based alloy biomaterials. With the aim of understanding the mechanical behaviour of porous materials with relation to the porosity level and the porous morphology, a new improved model with three different versions have been developed in this work. The proposed FE model combines the simplicity of a 2D periodic geometry with the complex information of the pore morphology extracted from experimentation. The methodology to generate the 2D simulated microstructure is based on a series of nxn pores distributed in a square matrix. The different versions of the model differ in the way of building the porous geometry. In the first version of the model ("Basic-Pattern Model"), the pores are supposed to be circular and periodically distributed in the matrix, following a perfect pattern. The second version of the model ("Pattern Model") is similar to the previous one, but with elliptic pores with a morphology randomly generated, following statistical information from experiments. In the third version ("Semi-random Model"), a controlled random distribution of the pores is obtained by including a randomness factors in both directions. By making use of the proposed FE model with its different versions, five different porous titanium obtained by the space-holders technique (with porosities θ = 28%, 37%, 47%, 57% and 66%) have been modeled based on experimental information of the pore morphology, and its macroscopic mechanical behaviour has been simulated, showing relatively good agreement with experimental results.

Pore structures and mechanical properties of porous titanium scaffolds by bidirectional freeze casting

Porous titanium scaffolds with long-range lamellar structure were fabricated using a novel bidirectional freeze casting method. Compared with the ordinarily porous titanium materials made by traditional freeze casting, the titanium walls can offer the structure of ordered arrays with parallel to each other in the transverse cross-sections. And titanium scaffolds with different pore width, wall size and porosity can be synthesized in terms of adjusting the fabrication parameters. As the titanium content was increased from 15vol.% to 25vol.%, the porosity and pore width decreased from 67±3% to 50±2% and 80±10μm to 67±7μm, respectively. On the contrary, as the wall size was increased from 18±2μm to 30±3μm, the compressive strength and stiffness were increased from 58±8MPa to 162±10MPa and from 2.5±0.7GPa to 6.5±0.9GPa, respectively. The porous titanium scaffolds with long-range lamellar structure and controllable pore structure produced in present work will be capable of having potential application as bone tissue scaffold materials.

Influence of pore size of porous titanium fabricated by vacuum diffusion bonding of titanium meshes on cell penetration and bone ingrowth

The present work assesses the potential of three-dimensional (3D) porous titanium (pore size of 188-390 μm and porosity of 70%) fabricated by vacuum diffusion bonding of titanium meshes for applications in bone engineering. Rat bone marrow mesenchymal stem cells were used to investigate the proliferation and differentiation of cells on titanium scaffolds with different pore sizes at day 7, day 14 and day 21 based on DNA contents, alkaline phosphatase (ALP) activity, collagen (COL) secretion and osteogenic gene expressions including ALP, COL-1, bone morphogenetic protein-2 (BMP-2), osteopontin (OPN), runt-related transcription factor 2 (RUNX2), using smooth solid titanium plate as reference material. The rabbit models with distal femoral condyles defect were used to investigate the bone ingrowth into the porous titanium. All samples were subjected to Micro-CT and histological analysis after 4 and 12 weeks of healing. A one-way ANOVA followed by Tukey post hoc tests was used to analyze the data. It was found that the differentiation stage of cells on the porous titanium delayed compared with the smooth solid titanium plate and Ti 188 was more inclined to promote cell differentiation at the initial stage (day 14) while cell proliferation (day 1, 4, 7, 10, 14 and 21) and bone ingrowth (4 and 12 weeks) were biased to Ti 313 and Ti 390. The study indicates that the hybrid porous implant design which combines the advantages of different pore sizes may be meaningful and promising for bone defect restoration.

STATEMENT OF SIGNIFICANCE

One of the significant challenges in bone defect restoration is the integration of biomaterials and surrounding bone tissue. Porous titanium may be a promising choice for bone ingrowth and mineralization with appropriate mechanical and biological properties. In this study, based on porous titanium fabricated by vacuum diffusion bonding of titanium meshes, we have evaluated the influence of various pore sizes on rat bone marrow mesenchymal stem cells (rBMMSCs) penetration in vitro and bone ingrowth in vivo. It was interesting that we found the proliferation and differentiation abilities of rBMMSCs, as well as bone ingrowth were related to different pore sizes of such porous scaffolds. The results may provide guidance for porous titanium design for bone defect restoration.

Porous titanium bases for osteochondral tissue engineering

Tissue engineering of osteochondral grafts may offer a cell-based alternative to native allografts, which are in short supply. Previous studies promote the fabrication of grafts consisting of a viable cell-seeded hydrogel integrated atop a porous, bone-like metal. Advantages of the manufacturing process have led to the evaluation of porous titanium as the bone-like base material. Here, porous titanium was shown to support the growth of cartilage to produce native levels of Young's modulus, using a clinically relevant cell source. Mechanical and biochemical properties were similar or higher for the osteochondral constructs compared to chondral-only controls. Further investigation into the mechanical influence of the base on the composite material suggests that underlying pores may decrease interstitial fluid pressurization and applied strains, which may be overcome by alterations to the base structure. Future studies aim to optimize titanium-based tissue engineered osteochondral constructs to best match the structural architecture and strength of native grafts.

STATEMENT OF SIGNIFICANCE

The studies described in this manuscript follow up on previous studies from our lab pertaining to the fabrication of osteochondral grafts that consist of a bone-like porous metal and a chondrocyte-seeded hydrogel. Here, tissue engineered osteochondral grafts were cultured to native stiffness using adult chondrocytes, a clinically relevant cell source, and a porous titanium base, a material currently used in clinical implants. This porous titanium is manufactured via selective laser melting, offering the advantages of precise control over shape, pore size, and orientation. Additionally, this manuscript describes the mechanical influence of the porous base, which may have applicability to porous bases derived from other materials.

Effect of pore size on bone ingrowth into porous titanium implants fabricated by additive manufacturing: An in vivo experiment

Selective laser melting (SLM) is an additive manufacturing technique with the ability to produce metallic scaffolds with accurately controlled pore size, porosity, and interconnectivity for orthopedic applications. However, the optimal pore structure of porous titanium manufactured by SLM remains unclear. In this study, we evaluated the effect of pore size with constant porosity on in vivo bone ingrowth in rabbits into porous titanium implants manufactured by SLM. Three porous titanium implants (with an intended porosity of 65% and pore sizes of 300, 600, and 900μm, designated the P300, P600, and P900 implants, respectively) were manufactured by SLM. A diamond lattice was adapted as the basic structure. Their porous structures were evaluated and verified using microfocus X-ray computed tomography. Their bone-implant fixation ability was evaluated by their implantation as porous-surfaced titanium plates into the cortical bone of the rabbit tibia. Bone ingrowth was evaluated by their implantation as cylindrical porous titanium implants into the cancellous bone of the rabbit femur for 2, 4, and 8weeks. The average pore sizes of the P300, P600, and P900 implants were 309, 632, and 956μm, respectively. The P600 implant demonstrated a significantly higher fixation ability at 2weeks than the other implants. After 4weeks, all models had sufficiently high fixation ability in a detaching test. Bone ingrowth into the P300 implant was lower than into the other implants at 4weeks. Because of its appropriate mechanical strength, high fixation ability, and rapid bone ingrowth, our results indicate that the pore structure of the P600 implant is a suitable porous structure for orthopedic implants manufactured by SLM.

Novel anti-infective implant substrates: controlled release of antibiofilm compounds from mesoporous silica-containing macroporous titanium

Bone implants with open porosity enable fast osseointegration, but also present an increased risk of biofilm-associated infections. We design a novel implant material consisting of a mesoporous SiO2 diffusion barrier (pore diameter: 6.4 nm) with controlled drug release functionality integrated in a macroporous Ti load-bearing structure (fully interconnected open porosity: 30%; pore window size: 0.5-2.0 μm). Using an in vitro tool consisting of Ti/SiO2 disks in an insert set-up, through which molecules can diffuse from feed side to release side, a continuous release without initial burst effect of the antibiofilm compound toremifene is sustained for at least 9 days, while release concentrations (up to 17 μM daily) increase with feed concentrations (up to 4mM). Toremifene diffusivity through the SiO2 phase into H2O is estimated around 10(-13)m(2)/s, suggesting configurational diffusion through mesopores. Candida albicans biofilm growth on the toremifene-release side is significantly inhibited, establishing a proof-of-concept for the drug delivery functionality of mesoporous SiO2 incorporated into a high-strength macroporous Ti carrier. Next-generation implants made of this composite material and equipped with an internal reservoir (feed side) can yield long-term controlled release of antibiofilm compounds, effectively treating infections on the implant surface (release side) over a prolonged time.

Comparative in vitro study regarding the biocompatibility of titanium-base composites infiltrated with hydroxyapatite or silicatitanate

BACKGROUND

The development of novel biomaterials able to control cell activities and direct their fate is warranted for engineering functional bone tissues. Adding bioactive materials can improve new bone formation and better osseointegration. Three types of titanium (Ti) implants were tested for in vitro biocompatibility in this comparative study: Ti6Al7Nb implants with 25% total porosity used as controls, implants infiltrated using a sol-gel method with hydroxyapatite (Ti HA) and silicatitanate (Ti SiO2). The behavior of human osteoblasts was observed in terms of adhesion, cell growth and differentiation.

RESULTS

The two coating methods have provided different morphological and chemical properties (SEM and EDX analysis). Cell attachment in the first hour was slower on the Ti HA scaffolds when compared to Ti SiO2 and porous uncoated Ti implants. The Alamar blue test and the assessment of total protein content uncovered a peak of metabolic activity at day 8-9 with an advantage for Ti SiO2 implants. Osteoblast differentiation and de novo mineralization, evaluated by osteopontin (OP) expression (ELISA and immnocytochemistry), alkaline phosphatase (ALP) activity, calcium deposition (alizarin red), collagen synthesis (SIRCOL test and immnocytochemical staining) and osteocalcin (OC) expression, highlighted the higher osteoconductive ability of Ti HA implants. Higher soluble collagen levels were found for cells cultured in simple osteogenic differentiation medium on control Ti and Ti SiO2 implants. Osteocalcin (OC), a marker of terminal osteoblastic differentiation, was most strongly expressed in osteoblasts cultivated on Ti SiO2 implants.

CONCLUSIONS

The behavior of osteoblasts depends on the type of implant and culture conditions. Ti SiO2 scaffolds sustain osteoblast adhesion and promote differentiation with increased collagen and non-collagenic proteins (OP and OC) production. Ti HA implants have a lower ability to induce cell adhesion and proliferation but an increased capacity to induce early mineralization. Addition of growth factors BMP-2 and TGFβ1 in differentiation medium did not improve the mineralization process. Both types of infiltrates have their advantages and limitations, which can be exploited depending on local conditions of bone lesions that have to be repaired. These limitations can also be offset through methods of functionalization with biomolecules involved in osteogenesis.

Mechanical properties and in vitro biological response to porous titanium alloys prepared for use in intervertebral implants

The generation of titanium foams is a promising strategy for modifying the mechanical properties of intervertebral reinforcements. Thus, the aim of this study was to compare the in vitro biological response of Ti6Al4V alloys with different pore sizes for use in intervertebral implants in terms of the adhesion, proliferation, and differentiation of pre-osteoblastic cells. We studied the production of Ti6Al4V foams by powder metallurgy and the biological responses to Ti6Al4V foams were assessed in terms of different pore interconnectivities and elastic moduli. The Ti6Al4V foams obtained had similar porosities of approximately 34%, but different pore sizes (66 µm for fine Ti6Al4V and 147 µm for coarse Ti6Al4V) due to the sizes of the microsphere used. The Ti6Al4V foams had a slightly higher Young׳s modulus compared with cancellous bone. The dynamic mechanical properties of the Ti6Al4V foams were slightly low, but these materials can satisfy the requirements for intervertebral prosthesis applications. The cultured cells colonized both sizes of microspheres near the pore spaces, where they occupied almost the entire area of the microspheres when the final cell culture time was reached. No statistical differences in cell proliferation were observed; however, the cells filled the pores on fine Ti6Al4V foams but they only colonized the superficial microspheres, whereas the cells did not fill the pores on coarse Ti6Al4V foams but they were distributed throughout most of the material. In addition, the microspheres with wide pores (coarse Ti6Al4V) stimulated higher osteoblast differentiation, as demonstrated by the Alcaline Phosphatase (ALP) activity. Our in vitro results suggest that foams with wide pore facilitate internal cell colonization and stimulate osteoblast differentiation.

Repair of segmental long bone defect in a rabbit radius nonunion model: comparison of cylindrical porous titanium and hydroxyapatite scaffolds

A segmental long bone defect in a rabbit radius nonunion model was repaired using cylindrical porous titanium (Ti) and hydroxyapatite (HA) scaffolds. Each scaffold was produced using the same method, namely, a slurry foaming method. Repairing ability was characterized using x-radiographic score 12 and 24 weeks postprocedure; failure load of the radius-ulna construct, under three-point bending, 12 weeks postprocedure; and the percentage of newly formed bone within the implant, 12 and 24 weeks after postprocedure. For each of these parameters, the difference in the results when porous Ti scaffold was used compared with when HA scaffolds were used was not significant; both porous scaffolds showed excellent repairing ability. Because the trabecular bone is a porous tissue, the interconnected porous scaffolds have the advantages of natural bone, and vasculature can grow into the porous structure to accelerate the osteoconduction and osteointegration between the implant and bone. The porous Ti scaffold not only enhanced the bone repair process, similar to porous HA scaffolds, but also has superior biomechanical properties. The present results suggest that porous Ti scaffolds may have promise for use in the clinical setting.

Development of porous titanium for biomedical applications: A comparison between loose sintering and space-holder techniques

One of the most important concerns in long-term prostheses is bone resorption as a result of the stress shielding due to stiffness mismatch between bone and implant. The aim of this study was to obtain porous titanium with stiffness values similar to that exhibited by cortical bone. Porous samples of commercial pure titanium grade-4 were obtained by following both loose-sintering processing and space-holder technique with NaCl between 40 and 70% in volume fraction. Both mechanical properties and porosity morphology were assessed. Young's modulus was measured using uniaxial compression testing, as well as ultrasound methodology. Complete characterization and mechanical testing results allowed us to determine some important findings: (i) optimal parameters for both processing routes; (ii) better mechanical response was obtained by using space-holder technique; (iii) pore geometry of loose sintering samples becomes more regular with increasing sintering temperature; in the case of the space-holder technique that trend was observed for decreasing volume fraction; (iv) most reliable Young's modulus measurements were achieved by ultrasound technique.

Repair of large osteochondral defects in a beagle model with a novel type I collagen/glycosaminoglycan-porous titanium biphasic scaffold

The limited repair potential of articular cartilage, which hardly heals after injury or debilitating osteoarthritis, is a clinical challenge. The aim of this work was to develop a novel type I collagen (Col)/glycosaminoglycan (GAGs)-porous titanium biphasic scaffold (CGT) and verify its ability to repair osteochondral defects in an animal model with bone marrow stem cells (bMSCs) in the chondral phase. The biphasic scaffold was composed of Col/GAGs as chondral phasic and porous titanium as subchondral phasic. Twenty-four full-thickness defects through the articular cartilage and into the subchondral bone were prepared by drilling into the surface of the femoral patellar groove. Animals were assigned to one of the three groups: 1) CGT with bMSCs (CGTM), 2) only CGT, and 3) no implantation (control). The defect areas were examined grossly, histologically and by micro-CT. The most satisfied cartilage repairing result was in the CGTM group, while CGT alone was better than the control group. Abundant subchondral bone formation was observed in the CGTM and CGT groups but not the control group. Our findings demonstrate that a composite based on a novel biphasic scaffold combined with bMSCs shows a high potential to repair large osteochondral defects in a canine model.

Effects of sintering temperature on morphology and mechanical characteristics of 3D printed porous titanium used as dental implant

Porous titanium samples were manufactured using the 3D printing and sintering method in order to determine the effects of final sintering temperature on morphology and mechanical properties. Cylindrical samples were printed and split into groups according to a final sintering temperature (FST). Irregular geometry samples were also printed and split into groups according to their FST. The cylindrical samples were used to determine part shrinkage, in compressive tests to provide stress-strain data, in microCT scans to provide internal morphology data and for optical microscopy to determine surface morphology. All of the samples were used in microhardness testing to establish the hardness. Below 1100 °C FST, shrinkage was in the region of 20% but increased to approximately 30% by a FST of 1300 °C. Porosity varied from a maximum of approximately 65% at the surface to the region of 30% internally. Between 97 and 99% of the internal porosity is interconnected. Average pore size varied between 24 μm at the surface and 19 μm internally. Sample hardness increased to in excess of 300 HV0.05 with increasing FST while samples with an FST of below 1250 °C produced an elastic-brittle stress/strain curve and samples above this displayed elastic-plastic behaviour. Yield strength increased significantly through the range of sintering temperatures while the Young's modulus remained fairly consistent.

Coating of titanium with hydroxyapatite leads to decreased bone formation: A study in rabbits

OBJECTIVES

An experimental rabbit model was used to test the null hypothesis, that there is no difference in new bone formation around uncoated titanium discs compared with coated titanium discs when implanted into the muscles of rabbits.

METHODS

A total of three titanium discs with different surface and coating (1, porous coating; 2, porous coating + Bonemaster (Biomet); and 3, porous coating + plasma-sprayed hydroxyapatite) were implanted in 12 female rabbits. Six animals were killed after six weeks and the remaining six were killed after 12 weeks. The implants with surrounding tissues were embedded in methyl methacrylate and grinded sections were stained with Masson-Goldners trichrome and examined by light microscopy of coded sections.

RESULTS

Small amounts of bone were observed scattered along the surface of five of the 12 implants coated with porous titanium, and around one out of 12 porous coated surfaces with Bonemaster. No bone formation could be detected around porous coated implants with plasma-sprayed hydroxyapatite.

CONCLUSION

Porous titanium coating is to some degree osteoinductive in muscles.