Overview of surface variability of metallic endosseous dental implants: textured and porous surface-structured designs

A variety of successful endosseous dental implants with different surface forms are currently available for clinical use. These all achieve implant-to-bone fixation primarily (if not totally) through mechanical interlock of bone with implant surface features introduced by design or chance during implant fabrication. Equally important to establishment of rigid fixation is the rate at which it is achieved, because faster rates allow earlier implant loading and less chance of inadvertent early loading that might prevent implant "osseointegration." Investigations of surface modification to favorably affect osteoconductivity and bone bonding represent an active area of research in the field of dental implant development. This article presents a review of available surface designs and future research directions for improved devices.

Damage modes in dental layer structures

Natural teeth (enamel/dentin) and most restorations are essentially layered structures. This study examines the hypothesis that coating thickness and coating/substrate mismatch are key factors in the determination of contact-induced damage in clinically relevant bilayer composites. Accordingly, we study crack patterns in two model "coating/substrate" bilayer systems conceived to simulate crown and tooth structures, at opposite extremes of elastic/plastic mismatch: porcelain on glass-infiltrated alumina ("soft/hard"); and glass-ceramic on resin composite ("hard/soft"). Hertzian contacts are used to investigate the evolution of fracture damage in the coating layers, as functions of contact load and coating thickness. The crack patterns differ radically in the two bilayer systems: In the porcelain coatings, cone cracks initiate at the coating top surface; in the glass-ceramic coatings, cone cracks again initiate at the top surface, but additional, upward-extending transverse cracks initiate at the internal coating/substrate interface, with the latter dominant. The substrate is thereby shown to have a profound influence on the damage evolution to ultimate failure in the bilayer systems. However, the cracks are highly stabilized in both systems, with wide ranges between the loads to initiate first cracking and to cause final failure, implying damage-tolerant structures. Finite element modeling is used to evaluate the tensile stresses responsible for the different crack types. The clinical relevance of these observations is considered.

Fibrinogen adsorbs from aqueous media to microscopic droplets of poly(dimethylsiloxane) and remains coagulable

Fibrinogen binds from aqueous media containing it to droplets of linear trimethylsilyl-terminated poly(dimethylsiloxane) (PDMS) dispersed in those same media. Once bound, fibrinogen elutes from emulsified droplets of PDMS only very slowly, even when incubated in buffer that contains a physiologic concentration of the protein. The bound fibrinogen is coagulable, as indicated by the thrombin-dependent agglutination of droplets. Thus fibrinogen bound to droplets of PDMS renders an adhesive potential to the surface of the droplets, a potential that may have relevance to the biologic processing of the polymer in vivo.

Solution ripening of hydroxyapatite nanoparticles: effects on electrophoretic deposition

Electrophoretic deposition is a low-cost, simple, and flexible coating method for producing hydroxyapatite (Hap) coatings on metal implants. However, densification requires heating the coated metal to high temperatures, which, for commercial HAp powders, generally means at least 1200 degrees C. At such temperatures, the metal tends to react with the HAp coating, inducing decomposition, and the strength of titanium and stainless steel implants is severely degraded. With the use of raw uncalcined nanoparticulate Hap, densification can occur at 900 degrees -1050 degrees C; however, such coatings are prone to cracking due to the high drying shrinkage. This problem was solved by precipitating nanoparticulate HAp by the metathesis process [10Ca(NO3)2 + 6NH4H2PO4 + 8NH4OH] and optimizing the approximately 30 nm of nanoprecipitates by an Ostwald ripening approach, that is, by boiling and/or ambient aging in the mother liquor. While the as-precipitated nanoparticles produced severely cracked coatings, 2 h of boiling or 10 days of ambient aging ripened the "gel-like" mass into unagglomerated nanoparticles, which produced crack-free coatings. Since boiling enhanced particle size but ambient aging did not, crack elimination probably was due to the transition from the highly agglomerated gel-like state to the dispersed nanoparticulate state rather than to particle growth. Furthermore, boiling only reduced the amount of cracking whereas aging completely eliminated cracking.

Solution ripening of hydroxyapatite nanoparticles: effects on electrophoretic deposition

Electrophoretic deposition is a low-cost, simple, and flexible coating method for producing hydroxyapatite (Hap) coatings on metal implants. However, densification requires heating the coated metal to high temperatures, which, for commercial HAp powders, generally means at least 1200 degrees C. At such temperatures, the metal tends to react with the HAp coating, inducing decomposition, and the strength of titanium and stainless steel implants is severely degraded. With the use of raw uncalcined nanoparticulate Hap, densification can occur at 900 degrees -1050 degrees C; however, such coatings are prone to cracking due to the high drying shrinkage. This problem was solved by precipitating nanoparticulate HAp by the metathesis process [10Ca(NO3)2 + 6NH4H2PO4 + 8NH4OH] and optimizing the approximately 30 nm of nanoprecipitates by an Ostwald ripening approach, that is, by boiling and/or ambient aging in the mother liquor. While the as-precipitated nanoparticles produced severely cracked coatings, 2 h of boiling or 10 days of ambient aging ripened the "gel-like" mass into unagglomerated nanoparticles, which produced crack-free coatings. Since boiling enhanced particle size but ambient aging did not, crack elimination probably was due to the transition from the highly agglomerated gel-like state to the dispersed nanoparticulate state rather than to particle growth. Furthermore, boiling only reduced the amount of cracking whereas aging completely eliminated cracking.

Effects of photochemically immobilized polymer coatings on protein adsorption, cell adhesion, and the foreign body reaction to silicone rubber

Photochemical immobilization technology was utilized to covalently couple polymers to silicone rubber either at multiple points along a polymer backbone or at the endpoint of an amphiphilic chain. The coating variants then were tested in vitro and in vivo for improvement of desired responses compared to uncoated silicone rubber. All coating variants suppressed the adsorption of fibrinogen and immunoglobulin G, and most also inhibited fibroblast growth by 90-99%. None of the coating variants inhibited monocyte or neutrophil adhesion in vitro. However, the surfaces that supported the highest levels of monocyte adhesion also elicited the lowest secretion of pro-inflammatory cytokines. None of the materials elicited a strong inflammatory response or significantly (p< 0.05) reduced the thickness of the fibrous capsule when implanted subcutaneously in rats. Overall, the most passivating coating variant was an endpoint immobilized polypeptide that reduced protein adsorption, inhibited fibroblast growth by 90%, elicited low cytokine secretion from monocytes, and reduced fibrous encapsulation by 33%. In general, although some coating variants modified the adsorption of proteins and the behavior of leukocytes or fibroblasts in vitro, none abolished the development of a fibrous capsule in vivo.

Characterization of hydroxyapatite and titanium coatings sputtered on Ti-6Al-4V substrate

A series of thin (<10 microm), single-layered HA/Ti coatings were deposited on Ti-6Al-4V substrate using a radio frequency magnetron-assisted sputtering system. The adhesion strength, microstructure, and chemistry of the coatings were characterized. Experimental results showed that higher Ti contents in targets or coatings resulted in higher deposition rates. When Ti was added the highly crystalline structure of monolithic HA coating was largely disrupted and the coating became amorphous-like. The highly crystalline structure of the monolithic Ti coating was also disrupted by introducing small amounts of Ca, P, and O into the coating. The HA/Ti coatings had quite uniform thicknesses and appeared smooth, dense, and well bonded to the substrate. A scanning electron microscope with an energy dispersive spectroscopy system showed that monolithic HA, 95HA/5Ti, 25HA/75Ti, and 50HA/50Ti coatings had the lowest Ca/P ratios while the 75HA/25Ti coating had the highest. The adhesion strengths of all coatings were between 60 and 80 MPa.

Direct morphological comparison of vacuum plasma sprayed and detonation gun sprayed hydroxyapatite coatings for orthopaedic applications

Hydroxyapatite coatings on titanium substrates were produced using two thermal spray techniques vacuum plasma spraying and detonation gun spraying. X-ray diffraction was used to compare crystallinity and residual stresses in the coatings. Porosity was measured using optical microscopy in conjunction with an image analysis system. Scanning electron microscopy and surface roughness measurements were used to characterise the surface morphologies of the coatings. The vacuum plasma sprayed coatings were found to have a lower residual stress, a higher crystallinity and a higher level of porosity than the detonation gun coatings. It is concluded that consideration needs to be given to the significance of such variations within the clinical context.

Corrosion of stainless steel, nickel-titanium, coated nickel-titanium, and titanium orthodontic wires

Orthodontic wires containing nickel have been implicated in allergic reactions. The potential for orthodontic wires to cause allergic reactions is related to the pattern and mode of corrosion with subsequent release of metal ions, such as nickel, into the oral cavity. The purpose of this study was to determine if there is a significant difference in the corrosive potential of stainless steel, nickel titanium, nitride-coated nickel titanium, epoxy-coated nickel titanium, and titanium orthodontic wires. At least two specimens of each wire were subjected to potentiostatic anodic dissolution in 0.9% NaCl solution with neutral pH at room temperature. Using a Wenking MP 95 potentiostat and an electrochemical corrosion cell, the breakdown potential of each wire was determined. Photographs were taken of the wire speci mens using a scanning electron microscope, and surface changes were qualitatively evaluated. The breakdown potentials of stainless steel, two nickel titanium wires, nitride-coated nickel titanium, epoxy-coated nickel titanium, and titanium were 400 mV, 300 mV, 750 mV, 300 mV, 1800 mV, and >2000 mV, respectively. SEM photographs revealed that some nickel titanium and stainless steel wires were susceptible to pitting and localized corrosion. The results indicate that corrosion occurred readily in stainless steel. Variability in breakdown potential of nickel titanium alloy wires differed across vendors' wires. The nitride coating did not affect the corrosion of the alloy, but epoxy coating decreased corrosion. Titanium wires and epoxy-coated nickel titanium wires exhibited the least corrosive potential. For patients allergic to nickel, the use of titanium or epoxy-coated wires during orthodontic treatment is recommended.

Stability of chitosan and poly-L-lysine membranes coating DNA-alginate beads when exposed to hydrolytic enzymes

Soluble chitosan and poly-L-lysine are readily hydrolysed using lysozyme or chitosanase for chitosan, and trypsin, chymotrypsin or proteinase K for poly-L-lysine. For similar amounts of enzyme, chitosanase hydrolysed 57% of the chitosan, compared to 35% for lysozyme. In the case of poly-L-lysine, chymotrypsin and trypsin exhibited similar activities, hydrolysing approximately 41% of the polymer compared to proteinase K at only 16%. In contrast, chitosan and poly-L-lysine membranes, coating alginate beads, were almost totally inert to the respective hydrolytic enzymes. Less than 2% of the membrane weight was hydrolysed. It appears that either membrane material would be stable for in vivo application, and in particular in the protection of DNA during gastrointestinal transit. At chitosanase concentrations of 1.4 mg/ml and in the presence of sodium ions, 20% of the total double-stranded DNA was released from chitosan coated beads. An exchange of calcium for sodium within the bead liquefied the alginate core releasing DNA. The presence of calcium stabilized the alginate bead, retaining all the DNA. Highly pure DNA was recovered from beads through mechanical membrane disruption, core liquefaction in citrate and use of DNA spin-columns to separate DNA/alginate mixtures in a citrate buffer. DNA recovery efficiencies as high as 94% were achieved when the initial alginate/DNA weight ratio was 1000.

Formation of mineralizing osteoblast cultures on machined, titanium oxide grit-blasted, and plasma-sprayed titanium surfaces

Altering osseous responses at implant surfaces to enhance bone is a current goal of clinical therapy. Cell culture may be used to investigate surface-dependent responses of bone-forming cells. In this report, the ability of primary fetal bovine mandibular osteoblast cultures to form a mineralizing matrix on machined, titanium plasma-sprayed, and titanium oxide grit-blasted surfaces has been compared. Immunohistochemical markers associated with bone formation were used to define the differentiated state of the formed matrix using qualitative light microscopy, and von Kossa staining was used to demonstrate the presence of mineralization within this matrix. Compared to either titanium oxide grit-blasted or machined surfaces, titanium plasma-sprayed surfaces displayed a unique pattern of mineralized matrix formation. Scanning electron microscopy further revealed that each surface accumulated unique organic and inorganic deposits during matrix formation, suggesting that surface-dependent physicochemical and biochemical conditioning of implant surfaces takes place. Surface topographic features of commercially pure titanium substrates can alter cultured osteoblast extracellular matrix formation and mineralization. Similar molecular and cellular assessment of in vivo responses to implant surface topography may contribute to improved engineering of endosseous implants.

Water resistance of resin-bonded joints with time related to alloy surface treatment

OBJECTIVES

This paper attempts to study the resistance of resin-bonded metallic joints to damage in water with time.

METHODS

Unlike the shear or tensile test, a cleavage test (Double Cantilever Beam test) allows us to follow the crack propagation in water, according to the fracture mechanics concept. Moreover, it is possible to follow the kinetic degradation of the metal/resin interface because this test is not totally destructive to the assembly. We have worked on 18 batches according to the nature of the alloys (Pd, Pd-Ag, Au, Co-Cr and Ni-Cr) and the surface treatment (sandblasting, Silicoater MD, Rocatec, V-Primer). The crack length was measured over a period of 20 days. The results are expressed in terms of adherence energy.

RESULTS

The adherence energy dramatically decreased with time in water. The slope of the regression straight line appears to be a good criterion for evaluating the durability of the alloy/adhesive interface. We have demonstrated the importance of silica coating and, especially, the effectiveness of the Rocatec system upon the degree of hydrolytic degradation, and have shown how the development of cracks depends upon surface treatment.

Albumin-binding surfaces: in vitro activity

Immobilized monoclonal antibodies (Mabs) have been used to attract specific molecules to a solid surface from complex mixtures such as blood, plasma or serum, thereby directing the response to the modified substrate, a key goal in rational biomaterial design. The nature of the Mab dictated the nature of the response: anti-albumin antibodies were used to prevent cell and platelet adhesion in vitro, whilst anti-fibronectin Mabs promoted attachment. Patterned surfaces could be formed, bearing Mabs that generated adhesive and non-adhesive regions. Fibrinogen adsorption from plasma showed a Vroman peak on unmodified control polymer, which was reduced by 64% in the presence of surface-bound anti-albumin Mab. Immobilization of a control Mab reduced fibrinogen adsorption only slightly, implying an albumin-mediated effect. In static tests, platelet adhesion from human platelet rich plasma was significantly reduced by the immobilization of anti-HSA Mab when compared to the untreated FEP surface (p < 0.0001). This effect was also seen with citrated blood flowing through Mab-treated polyurethane tubing at a shear rate of 132 s(-1) (p=0.034). Since platelets and proteins (as blood, plasma or serum) were introduced to the surface simultaneously, the generation of a defined protein film must have been sufficiently rapid as to shape the platelet or cell response.

Protein and platelet interactions with thermally denatured fibrinogen and cross-linked fibrin coated surfaces

In this work the hypothesis that a mature, cross-linked fibrin clot, pre-formed on a biomaterial, may be relatively nonthrombogenic was investigated. A cross-linked fibrin layer was formed on polyethylene which had been precoated with thermally denatured fibrinogen. Plasma protein adsorption and platelet interactions with the cross-linked fibrin and denatured fibrinogen surfaces were investigated. The adsorption of albumin, fibrinogen, and fibronectin from plasma was measured. For all three proteins, the cross-linked fibrin surface exhibited much higher levels of adsorption than either the thermally denatured fibrinogen or the polyethylene surface. Vroman peaks were observed for fibrinogen and fibronectin on polyethylene but not on the cross-linked fibrin and thermally denatured fibrinogen materials. In dilute plasma the thermally denatured fibrinogen surface showed considerable resistance to protein adsorption. However, at plasma concentrations greater than about 5% normal, this protein resistance was apparently lost. Platelet interactions (adhesion and release of granule constituents from adherent platelets) using suspensions of washed platelets in the presence of red cells were investigated at shear rates of 50, 300, and 525 s(-1) using a cone and plate apparatus. The levels of platelet adhesion on the different surfaces were in the order: adsorbed fibrinogen > cross-linked fibrin > thermally denatured fibrinogen = polyethylene. Platelets on the cross-linked fibrin surface also showed high levels of release indicating significant platelet activation. Scanning electron microscopic observations were in agreement with the platelet adhesion and release data, showing only a few (but well-spread) adherent platelets on the cross-linked fibrin surface.

Efficacy of silver-coated medical devices

Silver coating of medical devices is believed to prevent device-associated infection. Several in-vitro and in-vivo studies, as well as clinical observations on silver-nylon, silver-intramedullary pins, silver oxide Foley catheters and silver-coated vascular prostheses have been performed during the past 30 years. Nevertheless, randomized clinical studies showing efficacy of such coated medical devices in high-risk patient populations are rare, have dealt with very small numbers of patients or are controversial. Physico-chemical, pharmacological and microbiological data explaining the antimicrobial efficacy of silver in prophylaxis of implants are presented here, as well as the scientific background for the established clinical benefits of silver-preparations in burns.

In vivo performance of a modified CSTi dental implant coating

Cylindrical dental implants coated with cancellous structured titanium (CSTi) were studied in a dog model. CSTi-2-coated and hydroxyapatite-coated (HA) implants were placed in 8 mongrel dogs. The porosity of the CSTi-2 coating was 9% less than that of the previously studied CSTi-1, resulting in greatly improved mechanical strength and cosmetic appearance. A slightly lower level of bone ingrowth was observed for CSTi-2 than for CSTi-1. However, the in vivo attachment strength of the CSTi-2 coating was comparable both to CSTi-1 and to an HA-coated control after 8 weeks. Measured porosity is technique dependent; digital analysis of in vitro samples yielded higher porosity values than in vivo histology cross sections.

Effects of extracellular matrix constituents on the attachment of human oral epithelial cells at the titanium surface

This in vitro study attempts to delineate the role of extracellular matrix (ECM) constituents at the epithelial tissue-implant interface. To know which ECM constituents have a beneficial influence on the behavior of epithelial cells, the attachment, proliferation, morphologic pattern, and differentiation or cytoskeletal organization of human oral epithelial cells on ECM-coated (type IV collagen, fibronectin, type I collagen, laminin, and vitronectin) and noncoated titanium surface have been evaluated and compared. In each experiment comparing commercially pure titanium and oxygen plasma-cleaned titanium, the same ECM constituents were used. In this study, type IV collagen could provide an excellent substratum for epithelial cell attachment on titanium surface, but vitronectin-coated titanium revealed lower effectiveness for attachment of epithelial cells than noncoated titanium. These results suggested that type IV collagen could be used as a means for obtaining good epithelial seal, whereas vitronectin could be used to restrain the attachment of epithelium to dental implants.

In vivo analysis of bacterial biofilm formation on facial plastic bioimplants

OBJECTIVES

This study examines the formation of biofilm on biomaterials commonly used in facial plastics and reconstruction including titanium, silicone, ion-bombarded silicone (Ultrasil), e-PTFE (Gore-Tex), e-PTFE with silver/chlorhexidine (Gore-Tex Plus), and PHDPE (Medpor).

METHODS

These biomaterials were implanted subcutaneously in the dorsum of 11 guinea pigs after contamination with Staphylococcus aureus and examined with scanning electron microscopy after 7 days. Wounds were also inspected for infection and extrusion rates.

RESULTS

Results show biofilm formation on titanium, silicone, ion-bombarded silicone, e-PTFE, and PHDPE associated with high rates of extrusion and infection. Implants of e-PTFE with silver/chlorhexidine, on the other hand, appeared resistant to biofilm formation and demonstrated significantly lower rates of extrusion and infection.

CONCLUSIONS

Contamination of bioimplants in vivo leads to formation of bacterial biofilm on the surface of the biomaterial, causing infection, pus formation, and extrusion. The authors hypothesize that the antiseptic agents impregnated in the biomaterial form a protective coat of silver, chlorhexidine, and inflammatory cells that inhibits initial bacterial adhesion to the biomaterial surface.

Plasma sprayed hydroxyapatite coatings on titanium substrates. Part 2: optimisation of coating properties

Heat treatment and the introduction of a Ti bond coat have been applied to hydroxyapatite (HA) coatings sprayed using different plasma powers and gas mixtures. Attempts were made in this way to achieve optimal coating properties for orthopaedic implants. In particular, the effects on the degree of crystallinity, the adhesion, the OH ion content and the purity were evaluated. Heat treatment at 700 C for 1 h in air proved to be effective in increasing the crystallinity, regaining the OH- ion and removing other non-HA compounds, although it caused a significant decrease in the degree of adhesion (interfacial fracture toughness) for those specimens sprayed at high powers. This heat treatment was found to induce significant transformation of amorphous HA to the crystalline form, while not detrimentally changing the properties of the underlying Ti-6Al-4V substrates. Precoating with a 100 microm Ti layer increased the adhesion of the HA coatings on Ti-6Al-4V substrates, primarily by providing a rougher surface and promoting better mechanical interlocking. Changes in coating properties during immersion in biological fluids were also studied and were found to depend critically on the chemical composition of the fluids. Small precipitates formed on the coating surfaces when immersed in Ringers solution. These might account for the apparent drop in the degree of crystallinity when measured using X-ray diffraction. A significant drop in the interfacial adhesion was found for those coatings sprayed at high powers. This could be offset by prior precoating with a titanium bond coat and suitable heat treatment. In summary, the following processing sequence is suggested in order to achieve optimum coating properties: precoating the substrate with a layer of Ti (approximately 100 microm), spraying HA at a sufficiently high-power level (depending on particle size and gas mixture) and heat treatment at 700 degrees C for 1 h in air.

Hydroxyapatite-coated implants: a case for their use

The information on which this article is based comprises a small fraction of the large database compiled from the DICRG study. These results represent the early performance for HA implants (up to 36 months). The study has been ongoing for 6 years, and there are more than 2,000 implants with 4-year data and 1,500 with 5-year data. These data are similar to the 36-month data, and when they are eventually released, they are likely to reinforce the results reported here. Meanwhile, the evidence presented in this article, along with other corroborating studies cited in the introduction, are sufficient grounds to reach the following conclusion: The ideal implant design and material is one that is easy to use, requires average skills, involves minimal bone trauma, presents a biocompatible contact surface, and produces a high rate of survival in most patients. Based on 36-month survival in the DICRG study, HA-coated implants appeared to satisfy these basic requirements better than the other implants used in the study. HA-coated implants were placed in the most challenging bone types and jaw region, in patients with compromised medical histories, by dentists with different training, skills, and experience, under less than ideal clinical conditions, and still showed the highest survival rates of all implants at every point in the treatment up to 36 months.

Plasma sprayed hydroxyapatite coatings on titanium substrates. Part 1: Mechanical properties and residual stress levels

Hydroxyapatite (HA) coatings have been sprayed on to substrates of Ti-6Al-4V, using a range of input power levels and plasma gas mixtures. Coatings have also been produced on substrates of mild steel and tungsten, in order to explore certain aspects of the mechanical behaviour of HA without the complication of yielding or creep in the substrate. Studies have been made of the phase constitution, porosity, degree of crystallinity, OH ion content, microstructure and surface roughness of the HA coatings. The Young's moduli in tension and in compression were evaluated by the cantilever beam bend test using a tungsten/HA composite beam. The flexural Young's modulus was determined using a free-standing deposit under the same test. Adhesion was characterised using the single-edge notch-bend test; this is considered superior to the tensile bond strength test in common use. Measured interfacial fracture energies were of the order 1-10 J m(-2). Stress levels were investigated using specimen curvature measurements in conjunction with a numerical process model. The quenching stress for HA was measured to be about 10-25 MPa and the residual stress level in HA coatings at room temperature are predicted to lie in the approximate range of 20-40 MPa (tensile). These residual stresses could be reduced in magnitude by maintaining the substrate at a low temperature (possibly below room temperature) during spraying and it may be worthwhile to explore this. Ideally, the HA coating should have low porosity, high cohesive strength, good adhesion to the substrate, a high degree of crystallinity and high chemical purity and phase stability. In practice, such combinations are rather difficult to achieve by just varying the spraying parameters.

Hot isostatic pressing-processed hydroxyapatite-coated titanium implants: light microscopic and scanning electron microscopy investigations

Hot isostatic pressing (HIP) was used in a new procedure to produce hydroxyapatite (HA) coatings on a commercially pure titanium (cpTi) substrate for osseous implantation. Eighteen HIP-processed HA-coated implants were placed in the inferior border of the mandibles in 2 Labrador retriever dogs and left submerged for 3 months. As control specimens, 12 sandblasted cpTi implants were placed in the same mandibles and, to compare the bone reaction, 2 additional plasma-sprayed HA-coated implants (Integral) were placed. Tissue reactions at the bony interfaces of the implants were studied in ground sections with the implants in situ, using ordinary, fluorescent, and polarized light microscopy and scanning electron microscopy (SEM). The HIP-processed HA coatings displayed an increased density in light microscopy and SEM as compared to plasma-sprayed coatings. Direct bone-implant contact was found in all 3 types of surfaces. However, the production of new bone was far more abundant for the HA-coated implants than for sandblasted cpTi implants. The presence of bone-forming and bone-resorbing cells indicated active bone remodeling in the interface area at 3 months after implant placement. The present results support the view that epitaxial bone growth may occur from the HA-coated implant surface. It was concluded that the increased density of the present HIP-processed HA material does not reduce the bioactive properties of the coatings.

Total hip arthroplasty. Concerns with extensively porous coated femoral components

A series of 507 consecutive, unselected cementless hip arthroplasties performed by one surgeon was reviewed to address specifically potential concerns with the use of extensively coated femoral components, including the frequency and nature of reoperation, thigh pain, component stability, osteolysis, and stress shielding. Excluding hips in patients who had died or were lost to followup, there were 426 hips with minimum 5-year followup. The overall femoral reoperation rate of 2.6% (13 cases) included seven for failure of fixation and six for osteolysis. Of the unrevised cases, 96% of the femoral components showed radiographic bone ingrowth, and 3.7% showed a stable fibrous pattern. Fixation did not deteriorate with time. A 2.9% incidence of activity limiting thigh pain did affect clinical outcome (limp, ambulation tolerance, support), but there were no clinical or radiographic predisposing variables. There was no detectable femoral osteolysis in 88.3% of cases. The remainder had lesions confined to Gruen Zones 1 and 7, suggesting that circumferential extensive coating was protective against distal osteolysis. Although osteolysis did not affect component stability, in six cases it did result in pathologic trochanteric fracture, contributing to the frequency of reoperation. Stress shielding was common (25%) and was related to older patients and the use of larger diameter stems (> 15 mm), but did not predispose to thigh pain, loosening, osteolysis, or an inferior clinical result. These results documented the clinical and radiographic success in the use of extensively coated cementless femoral components. Debris generation from wear and resulting osteolysis remain significant concerns in a hip arthroplasty with this design as with many others. However, concerns about the high incidence of reoperation, thigh pain, component instability, or stress shielding are not supported by this study.

Platelet adhesion, contact phase coagulation activation, and C5a generation of polyethylene glycol acid-grafted high flux cellulosic membrane with varieties of grafting amounts

Grafting of polyethylene glycol chains onto cellulosic membrane can be expected to reduce the interaction between blood (plasma protein and cells) and the membrane surface. Alkylether carboxylic acid (PEG acid) grafted high flux cellulosic membranes for hemodialysis, in which the polyethylene glycol chain bears an alkyl group at one side and a carboxyl group at the other side, have been developed and evaluated. PEG acid-grafted high flux cellulosic membranes with various grafting amounts have been compared with respect to platelet adhesion, the contact phase of blood coagulation, and complement activation in vitro. A new method of quantitating platelet adhesion on hollow-fiber membrane surfaces has been developed, which is based on the determination of lactate dehydrogenase (LDH) activity after lysis of the adhered platelets. PEG acid-grafted high flux cellulosic membranes showed reduced platelet adhesion and complement activation effects in grafting amounts of 200 ppm or higher without detecting adverse effects up to grafting amounts of 850 ppm. The platelet adhesion of a PEG acid-grafted cellulosic membrane depends on both the flux and grafting amounts of the membrane. It is concluded that the grafting of PEG acid onto a cellulosic membrane improves its biocompatibility as evaluated in terms of platelet adhesion, complement activation, and thrombogenicity.

Some characteristics of hydroxylapatite powder particles after plasma spraying

We have studied the particles of hydroxylapatite (HA) powder, the particles after plasma spraying, their distribution on substrate surface and their condition after transfer through the plasma torch. Mean particle size of HA powders was as follows: HA-A: 3.8 microm, HA-B 88.2 microm. The area of HA coating after plasma spraying, when the torch had a constant position against the substrate surface, shows two characteristic zones: the central part of coating formed mainly from deformed particles and the marginal part of coating with small non-deformed particles. These small non-deformed particles can be found in all zones of the coating and together with greater non-deformed particles and partially deformed particles will unfavourably affect the adhesive and cohesive strength of the coating and its porosity. The maximum diameter of the molten (spherical) particles in the conditions of Ar + H2 plasma, output P = 24 kW was: DA = 25 microm (HA-A) and DB = 65 microm (HA-B). The intervals of dimensions in which most of molten particles occurred were HA-A: 0-15 microm (98%), HA-B: 5-35 microm (84%). From comparison of HA-A and HA-B powders it can be concluded that the transport of HA-A powder was not continuous, the amount of molten HA-A particles was considerably greater (90%) than that of HA-B powder (63%). Phase decomposition and also solubility of HA-A powder (at in vitro tests) was greater. If we consider transport of particles, their melting, splitting and spraying efficiency, the suitable size of HA powder particles for the given spraying conditions is somewhere between the size of HA-A and HA-B particles--let us say--in the interval from 20 to 60 microm.

Metal release in patients who have had a primary total hip arthroplasty. A prospective, controlled, longitudinal study

There is an increasing recognition that, in the long term, total joint replacement may be associated with adverse local and remote tissue responses that are mediated by the degradation products of prosthetic materials. Particular interest has centered on the metal-degradation products of total joint replacements because of the known toxicities of the metal elements that make up the alloys used in the implants. We measured the concentrations of titanium, aluminum, cobalt, and chromium in the serum and the concentration of chromium in the urine of seventy-five patients during a three-year prospective, longitudinal study. Twenty patients had had a so-called hybrid total hip replacement (insertion of a modular cobalt-alloy femoral stem and head with cement and a titanium acetabular cup without cement), fifteen had had insertion of an extensively porous-coated cobalt-alloy stem with a cobalt-alloy head and a titanium-alloy socket without cement, and twenty had had insertion of a proximally porous-coated titanium-alloy stem with a cobalt-alloy head and a titanium socket without cement. The remaining twenty patients did not have an implant and served as controls. The results of our study showed that, thirty-six months postoperatively, patients who have a well functioning prosthesis with components containing titanium have as much as a threefold increase in the concentration of titanium in the serum and those who have a well functioning prosthesis with cobalt-alloy components have as much as a fivefold and an eightfold increase in the concentrations of chromium in the serum and urine, respectively. The predominant source of the disseminated chromium-degradation products is probably the modular head-neck junction and may be a function of the geometry of the coupling. Passive dissolution of extensively porous-coated cobalt-alloy stems was not found to be a dominant mode of metal release.

CLINICAL RELEVANCE

Increased concentrations of circulating metal-degradation products derived from orthopaedic implants may have deleterious biological effects over the long term that warrant investigation. This is a particularly timely concern because of recent clinical trends, including the reintroduction of metal-on-metal bearing surfaces and the increasing popularity of extensively porous-coated devices with large surface areas of exposed metal. Accurate monitoring of the concentrations of metal in the serum and urine after total hip replacement also can provide insights into the mechanisms of metal release. Our findings suggest that fretting corrosion at the head-neck coupling is an important source of metal release that can lead to increased concentrations of chromium in the serum. Determinations of the concentrations of metal in the serum and urine may be useful in the diagnosis of patients who are symptomatic after a total joint replacement as increased levels are indicative of at least one mode of mechanical dysfunction (for example, fretting corrosion) of the device.

A novel method to immobilize bioactive substances on hydrophobic surfaces using a polymerizable cationic lipid

We have successfully developed a novel method to stably immobilize bioactive substances that have anionic groups, such as heparin and succinylated collagen (SC), on hydrophobic surfaces through ionic complexation using a polymerizable cationic lipid, diallyl(dioleyl)ammonium bromide (DADOA). It is composed of a hydrophobic part consisting of long hydrocarbon chains and a hydrophilic head with double bonds which render it polymerizable. Analysis of the modification with DADOA and heparin suggested that the modification formed a thin layer, roughly 60 nm in thickness, as a result of the spontaneous deposition of DADOA and heparin dissolved in water, through the hydrophobic interaction between DADOA and the surface and the ionic complexation between DADOA and heparin. The heparin deposition and its rate of release in plasma were 1.5 microg/cm2 and 0.0017 U/cm2/min, respectively. Cytotoxicity test results showed that the polymerization of the deposited DADOA rendered the modified surface stable and noncytotoxic. Further, antithrombogenicity and cell attachability test results demonstrated that heparin and SC were effectively immobilized on hydrophobic surfaces through ionic complexation. This method has proved useful for the modification of the hydrophobic surfaces of medical devices because the modification process can be performed under aqueous conditions without the use of organic solvents which induce crazing/cracking of plastic casings.

Reduced protein adsorption on novel phospholipid polymers

We have synthesized phospholipid polymers containing 2-methacryloyloxyethyl phosphorylcholine (MPC) units as novel blood compatible polymers and have evaluated their interactions with blood components. It was found that in the absence of anticoagulants, blood clotting was delayed and blood cell adhesion and activation were effectively prevented on the MPC copolymer surface. A little amount of protein adsorbed on the MPC copolymer from human plasma was compared with conventional polymers, and the amount was reduced with increasing MPC unit fraction. To clarify the reason for the little protein adsorption on the MPC copolymer, the water structure in the hydrated polymer was examined with attention to the free water fraction. Hydration of the polymers occurred when they were immersed in water. The thermal analysis of these hydrated polymers revealed that the free water fractions in the poly(MPC-co-n-butyl methacrylate (BMA)) and poly(MPC-co-n-dodecyl methacrylate) were significantly larger than those in the poly(2-hydroxyethyl methacrylate(HEMA)). The conformation of proteins adsorbed on poly(HEMA) changed considerably but that on poly(MPC-co-BMA) was almost the same as the native state. We concluded from these results that the proteins are hardly adsorbed and do not change their original conformation on the polymer surfaces which possess a high free water fraction such as phospholipid polymers.

A new heparin-bonded dense membrane lung combined with minimal systemic heparinization prolonged extracorporeal lung assist in goats

Heparin was covalently bonded to a new hollow-fiber dense membrane artificial lung and extracorporeal circuit using a silane coupling agent and polyethyleneimine. This study investigated whether prolonged, venoarterial bypass extracorporeal lung assist (V-A bypass ECLA) could be sustained in a goat by the combination of the new membrane lung and minimal systemic heparinization. We maintained ECLA with the hollow-fiber lungs (surface area, 0.8 m2) and circuits by titrating the activated clotting time (ACT) to below 150 s with minimal systemic heparinization in 5 goats. The outcome was assessed from the function of the artificial lung via macro and microscopic examinations after the experiments and the incidence of systemic complications. The 5 goats were maintained on ECLA for 6 to 27 days. The bypass flow rate, blood gases at the return and drainage sites, platelet counts, and platelet aggregation activity were well maintained. Although the hemoglobin concentration, hematocrit, and plasma protein at the start of the ECLA were significantly lower than the pre-ECLA values due to hemodilution, the values remained stable during ECLA. A cerebral infarction occurred in 1 goat. However, in the other 4 goats, no complications such as bleeding, thrombosis, or plasma leakage from the artificial lung were observed. Although several thrombi were observed in the stagnant area of the artificial lung, these local thrombi did not cause the function of the artificial lung to deteriorate. We found that this new type of highly biocompatible, dense membrane artificial lung, when combined with minimal systemic heparinization, prolonged ECLA without the deterioration of the artificial lung function and was suitable for prolonged ECLA.

Variability of hydroxyapatite-coated dental implants

Uniformity, surface roughness, and chemical phase structure are all important features of implant coatings. While the first two variables are important for implant placement, the phase structure affects implant fixation. This study examined the coating morphology and the amount, size, and distribution of crystalline regions of press-fit and screw-type dental implants. Implants obtained from five commercial vendors were sectioned sagittally, mounted, and polished to reveal the coating microstructure. The crystalline phase content varied depending on the implant supplier; however, general trends were observed. Amorphous regions were predominantly found at the metal interface and decreased toward the outside of the coating, producing a crystallinity graded coating. The distal end of the implant, where heat build-up was more likely during the coating procedure, displayed a higher crystalline content and larger crystalline regions. Similarly, the thread apex consisted of more of a crystalline phase. The results of this study of coating microstructure may be used to improve the quality and performance of implants and may help to explain different in vivo responses to the many available varieties of hydroxyapatite-coated dental implants.

Thermal changes in endosseous root-form implants as a result of CO2 laser application: an in vitro and in vivo study

Carbon dioxide (CO2) laser surgery is advantageous in current clinical situations. The controlled and precise destruction of target tissue has made it a recommended procedure in intraoral surgery. Implant surgery demands minimal thermal changes in bone surrounding the implant. In this experimental study, different types of implants were placed in vitro in the mandible of a pig and in vivo in the mandibles of two dogs. In continuous mode, 4 and 6 watts, and in repeated pulse, 5 and 8 watts, for 2, 4, and 5 seconds, the CO2 laser contacted several places around and on the implants. Temperature changes were measured at the implant-bone junction. The results showed that the CO2 laser produced minimal temperature changes in the continuous mode power setting at less than 4 watts and in the repeated pulse, 0.05 second-interval power setting at less than 8 watts.

Protein-resistant coatings for glass and metal oxide surfaces derived from oligo(ethylene glycol)-terminated alkytrichlorosilanes

This paper describes the preparation of oligo(ethylene glycol)-terminated alkyltrichlorosilanes, Cl3Si(CH2)11(OCH2CH2)(n)OCH3 (n = 2, 3), and their use in the formation of self-assembled monolayers on an oxide surface. The adsorption of the trichlorosilanes from solution produces densely packed, oriented monolayer films that are 2-3 nm in thickness. The trichlorosilyl group anchors the molecules to the surface, and the resulting film exposes the ethylene glycol units at its surface, as noted by its moderate hydrophilicity (theta2(H2O) approximately 68 degrees). The films are robust with stabilities similar to those of other alkylsiloxane coatings. These oligo(ethylene glycol)-terminated silane reagents produce films that notably exhibit resistances against the non-specific adsorption of proteins from solution that are better than for films prepared from octadecyltrichlorosilane. With insulin, tysozyme, albumin, and hexokinase, no adsorption was observed with the oligo(ethylene glycol)-siloxane coatings whereas protein films of approximately a monolayer formed on surfaces-treated with octadecyltrichlorosilane. With fibrinogen, complete resistance was not possible with either coating; however, the oligo(ethylene glycol)-siloxane coatings exhibited greater resistance against non-specific adsorption. The oligo(ethylene glycol)-siloxane coatings offer performance advantages over available systems and could easily provide a direct and superior replacement in protocols that presently use silane reagents to generate hydrophobic, 'inert' surfaces.

Evaluation of metal ion release and corrosion resistance of ZrO2 thin coatings on the dental Co-Cr alloys

OBJECTIVES

The aim of this study was to determine if electrolytic ZrO2 thin coatings increased the corrosion resistance and decreased the metal ion release of dental cobalt-chromium alloys.

METHODS

Dental Co-Cr alloys were electrolytically deposited with ZrO2 ceramic coatings using a 0.0625 M ZrO(NO3)2 solution, at various potentials, for 500 s. The electrolytic ZrO2 gel-coated specimens were annealed at 723 K for 1 h in air. Scanning electron microscopy (SEM) was used to observe the morphology of the ZrO2 ceramic coatings on Co-Cr alloys. A dynamic polarization test was used to compare the corrosion resistance of the ZrO2 coated and uncoated Co-Cr alloys in artificial saliva. Metal ion concentrations were determined with graphite furnace atomic absorption spectroscopy (AAS).

RESULTS

The SEM micrographs showed that the Co-Cr alloy can be coated with zirconia oxide at -0.7 V more homogeneously and more completely than at -1.5 V. The polarization curves indicated that the ZrO2 coating on Co-Cr alloys annealed at 723 K for 1 h in air exhibited better corrosion resistance in artificial saliva. The results of the AASs showed that the ZrO2-coated Co-Cr alloys decreased chromium ion release levels, as compared with the uncoated Co-Cr alloys. The scratch test indicated a good bond strength between the ZrO2 and Co-Cr alloy.

SIGNIFICANCE

The electrolytically deposited ZrO2 coatings on Co-Cr alloys may improve the corrosion resistance and decrease the release of metal ions. It is suggested that the electrolytic ZrO2 coating method could have a widespread application in dentistry in the future.

Dissolution behaviour of calcium phosphate coatings obtained by laser ablation

Pulsed laser deposited calcium phosphate coatings on titanium alloy have been tested under simulated physiological conditions in order to evaluate the changes in morphology, composition and structure. The coatings were deposited under different conditions to obtain different crystalline structures, ranging from amorphous and mixed crystalline phases to pure crystalline hydroxyapatite (HA). The coated samples were immersed in a Ca-free Hank's balanced salt solution for up to 5 days. Characterization of the coatings was performed by X-ray diffraction, scanning electron microscopy and Fourier-transform Raman spectroscopy before and after immersion. Their dissolution behaviour was also monitored through their mass loss and calcium release. Coatings of pure HA preserve their morphology and structure during the exposure time in solution. In multiphasic coatings, consisting of HA with tetracalcium phosphate (TetraCP) or beta-tricalcium phosphate (beta-TCP) with a-tricalcium phosphate (alpha-TCP), microporosity is induced by the complete dissolution of TetraCP or gamma-TCP. Amorphous calcium phosphate coatings totally dissolve.

Development of plasma-sprayed bioceramic coatings with bond coats based on titania and zirconia

Bond coats for plasma-sprayed hydroxyapatite (HAp) coatings on Ti-6A1-4V hip endoprotheses are being developed for improved in vivo performance. Bond coat powders consisting of (i) CaO-stabilized zirconia, (ii) a eutectic composition of titania and non-stabilized zirconia, and (iii) titania were applied by atmospheric plasma spraying (APS) to Ti-6A1-4V-coupons and 100 microm-thick Ti-6A1-4V foils. Subsequently, a thick layer of HAp was sprayed onto the thin bond coats. Peel tests on Ti-6A1-4V foil/bond coat/HAp top coat assemblies revealed that titania and titania/ zirconia bond coats increased the peel adhesion strength in a statistically significant way from 22 N m(-1) (HAp without a bond coat) to >42 and 32 N m(-1), respectively. Microstructural investigations by SEM on cross-sections of coatings leached in simulated body fluid for up to 28 days led to the conclusion that the chemically very stable bond coats act as an improved chemical barrier against in vivo release of metal ions from the implant, as well as an improved adhesive bond by development of very thin well-adhering reaction layers, presumbly composed of perovskite, calcium dititanate, and/or calcium zirconate.

In vitro studies on the effect of cleaning methods on different implant surfaces

The effect of specific cleaning procedures was examined on the surfaces of 3 implant types with different coatings and shapes (plasma sprayed [PS]; hydroxyapatite coated [HA] implants; and smooth titanium surface screws) using a scanning electron microscope. Each implant was treated for 60 seconds per instrument with one of 6 different hygiene measures: plastic curet, metal curet, diamond polishing device, ultrasonic scaler, air-powder-water spray with sodium hydrocarbonate solution, and chlorhexidine 0.1% solution rinse. The air-powder-abrasive system, chlorhexidine rinse, and curettage with a plastic instrument caused little or no surface damage in all but the hydroxyapatite-coated fixtures. Therefore, these 3 methods were tested to determine their cleaning efficacy in a second clinical study, which did not include the HA-coated fixture. Two implants were placed on the facial aspects of both upper molar regions using individual acrylic plates. Thus, 2 fixtures on each side were examined in each patient. The examination revealed that only the sodium hydrocarbonate spray yielded a clean fixture without damage to the implant surface. In a third stage, which imitated the clinical procedure of the second approach, the cell growth of mouse-fibroblasts on implant surfaces was examined after cleaning the surface with plastic scaler and the air-abrasive system, which represents the least damaging and most effective methods. In contrast to the implant surfaces treated with plastic scalers, mostly vital cells were found on implants sprayed with the air-abrasive system.

[Study on the method of combining albumin with biomaterials for selecting a substitute for hard ttissue of human body]

This study explored the conditions on combining albumin of surfaces of hydroxyapatite (HA), bioglass ceramics(BGC) and hydroxyl poly-calcium sodium phosphate (HP) by using the method of BrCN activation. The result demonstrates that albumin can be combined with HP, but it can not be combined with HA and BGC.

Magnetron sputtered tin coatings on unbiased ceramic substrates

OBJECTIVES

The aim of this work was to study the application of tin oxide coatings on alumina, with a view to developing improved bonding for high-alumina dental ceramics.

METHODS

By use of a magnetron sputtering technique, alumina was coated with tin which was subsequently oxidized, and the bond strength of coated surfaces to a resin-based dental cement was measured in tension. Tensile bond strength data were assessed for their degree of skewness and the homogeneity of the residual variances with a view to applying appropriate transformations prior to performing ANOVA with subsequent Tukey's analysis as necessary. The color of coatings, as a function of the amount of oxidation of the surface, was noted. Coatings were characterized by SEM and EDAX. It has been found possible to produce esthetic tin oxide coatings on alumina using a simplified magnetron sputtering apparatus in conjunction with post-deposition oxidation.

RESULTS

Although mean tensile bond strength (TBS) values in excess of 15 MPa were recorded for a number of groups, no causal relationship was found between coating time and mean TBS.

SIGNIFICANCE

The need exists for improved bonding of alumina-based ceramics; further development of a magnetron sputtering technique may provide the means for achieving this.

[Conditioning of adolescents--why and how?]

Bioactive polyurethaneurea modified with polyethylene glycol (PEG) and the endothelial cell-adhesive peptide YIGSR was synthesized and fabricated into microporous scaffolds. This material has shown appropriate mechanical properties for vascular graft applications, resists platelet adhesion, and promotes endothelialization. In the current study, microporous scaffolds were formed by a gasfoaming and salt-leaching method. The scaffolds showed highly interconnected open pores throughout the matrices, with porosity of approximately 78% and pore sizes of 20-200 microm. The peptide modified scaffolds showed superior mechanical properties over peptide-free scaffolds (tensile strength, 1.4 +/- 0.03 versus 0.19 +/- 0.01 MPa; p < 0.01). Bovine aortic endothelial cells were seeded on the scaffolds, and cell attachment, proliferation, extracellular matrix production, and migration were investigated. Histological and scanning electron microscopy analysis showed that few cells adhered on peptide-free scaffolds, whereas confluent endothelial cell monolayers formed along the pores in peptide-modified scaffolds. DNA content, hydroxyproline production, and cell migration were also significantly greater in peptide-modified scaffolds.

Ambulatory health care and the nurse practitioner

We modified the surface of electrospun poly(caprolactone) (PCL) nanofibers to improve their compatibility with endothelial cells (ECs) and to show the potential application of PCL nanofibers as a blood vessel tissue-engineering scaffold. Nonwoven PCL nanofibers (PCL NF) and aligned PCL nanofibers (APCL NF) were fabricated by electrospinning technology. To graft gelatin on the nanofiber surface, PCL nanofibers were first treated with air plasma to introduce -COOH groups on the surface, followed by covalent grafting of gelatin molecules, using water-soluble carbodiimide as the coupling agent. The chemical change in the material surface during surface modification was confirmed by X-ray photoelectron spectroscopy and quantified by colorimetric methods. ECs were cultured to evaluate the cytocompatibility of surface-modified PCL NF and APCL NF. Gelatin grafting can obviously enhance EC spreading and proliferation compared with the original material. Moreover, gelatin-grafted APCL NF readily orients ECs along the fibers whereas unmodified APCL NF does not. Immunostaining micrographs showed that ECs cultured on gelatin-grafted PCL NF were able to maintain the expression of three characteristic markers: platelet-endothelial cell adhesion molecule 1 (PECAM-1), intercellular adhesion molecule 1 (ICAM-1), and vascular cell adhesion molecule 1 (VCAM-1). The surface-modified PCL nanofibrous material is a potential candidate material in blood vessel tissue engineering.