Diameter of titanium nanotubes influences anti-bacterial efficacy

In vitro and in vivo evaluation of antibacterial activity of polyhexamethylene guanidine (PHMG)-loaded TiO2 nanotubes

Artificial joint replacement is an effective surgical method for treating end-stage degenerative joint diseases, but peripheral bacterial infection of prosthesis can compromise the effect of the surgery. Herein, antibacterial effects of titanium dioxide nanotubes (TNTs) coated with polyhexamethylene guanidine (PHMG) were examined via in vitro and in vivo experiments. TNTs with a pore diameter 46.4 ± 5.9 nm and length of 300-500 nm for the slice and 650-800 nm for the rod were fabricated by anodization. Then, 3.46 ± 0.40 mg and 1.27 ± 0.28 mg of PHMG were coated onto the TNT slice and rod, respectively. In vitro studies of the release of PHMG showed that the antibacterial agent was released in two stages: initial burst release and relatively slow release. In vitro and in vivo antibacterial studies showed that the PHMG-loaded TNTs (PHMG-TNTs) had excellent antibacterial abilities to prevent bacterial infections. Clinical pathological analysis of rabbit femurs indicated that the implanted PHMG-TNTs had no apparent pathological changes. Real-time quantitative reverse transcription polymerase chain reaction analysis of the femur tissues around the implants showed that the expression of osteogenic-related genes, including runt-related transcription factor 2, osteocalcin, alkaline phosphatase, bone sialoprotein, bone morphogenetic protein 2 and vascular endothelial growth factor A, was significantly upregulated in the PHMG-TNT implanted group as compared to the other groups. Overall, these findings provide a promising approach for the fabrication of antibacterial and bone biocompatible titanium-based implants in orthopedics.

Effect of surface characteristics on the antibacterial properties of titanium dioxide nanotubes produced in aqueous electrolytes with carboxymethyl cellulose

Nanotubular structures were produced on a commercially pure titanium surface by anodization in an aqueous electrolyte that contained carboxymethyl cellulose and sodium fluoride. The internal diameters obtained were about 100, 48, and 9.5 nm, respectively. Several heat treatments at 200, 350, and 600°C were made to produce nanotubes with different titanium dioxide polymorphs (anatase, rutile). All tested surfaces were superhydrophilic, this behavior was maintained after at least 30 days, regardless of the heat treatment. Although in previous works the nanotube features effect on the bacteria behavior had been studied; this item still unclear. For the best of our knowledge, the effect of small internal diameters (about 10 nm) with and without heat treatment and with and without ultraviolet (UV) irradiation on the bacteria strains comportment has not been reported. From our results, both the internal diameter and the postanodized treatments have an effect on the bacteria strains comportment. All nanotubular coatings UV treated and heat treated at 350 and 600°C; despite they have different inner diameters, inhibit the bacteria growth of both Staphylococcus aureus and Pseudomonas aeruginosa strains. The nanotubular coatings obtained at 20 V and heat treated at 350°C produced the lower bacteria adhesion against both strains evaluated.

Drug Delivery Systems Based on Titania Nanotubes and Active Agents for Enhanced Osseointegration of Bone Implants

TiO2 nanotubes (TNTs) are attractive nanostructures for localized drug delivery. Owing to their excellent biocompatibility and physicochemical properties, numerous functionalizations of TNTs have been attempted for their use as therapeutic agent delivery platforms. In this review, we discuss the current advances in the applications of TNT-based delivery systems with an emphasis on the various functionalizations of TNTs for enhancing osteogenesis at the bone-implant interface and for preventing implant-related infection. Innovation of therapies for enhancing osteogenesis still represents a critical challenge in regeneration of bone defects. The overall concept focuses on the use of osteoconductive materials in combination with the use of osteoinductive or osteopromotive factors. In this context, we highlight the strategies for improving the functionality of TNTs, using five classes of bioactive agents: growth factors (GFs), statins, plant derived molecules, inorganic therapeutic ions/nanoparticles (NPs) and antimicrobial compounds.

Antibacterial activity of AgNPs–TiO2 nanotubes: influence of different nanoparticle stabilizers

Enhanced antibacterial properties of nanomaterials such as TiO₂ nanotubes (TNTs) and silver nanoparticles (AgNPs) have attracted much attention in biomedicine and industry. The antibacterial properties of nanoparticles depend, among others, on the functionalization layer of the nanoparticles. However, the more complex information about the influence of different functionalization layers on antibacterial properties of nanoparticle decorated surfaces is still missing. Here we show the array of ∼50 nm diameter TNTs decorated with ∼50 nm AgNPs having different functionalization layers such as polyvinylpyrrolidone, branched polyethyleneimine, citrate, lipoic acid, and polyethylene glycol. To assess the antibacterial properties, the viability of Gram-positive (Staphylococcus aureus) and Gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa) has been assessed. Our results showed that the functional layer of nanoparticles plays an important role in antibacterial properties and the synergistic effect such nanoparticles and TiO₂ nanotubes have had different effects on adhesion and viability of G⁻ and G⁺ bacteria. These findings could help researchers to optimally design any surfaces to be used as an antibacterial including the implantable titanium biomaterials.

Synergictic antibacterial effect of AgNPs–TiO₂ nanotubes is influenced by different nanoparticle stabilizers.

Enhanced antibacterial properties of orthopedic implants by titanium nanotube surface modification: a review of current techniques

Prosthesis-associated infections are one of the main causes of implant failure; thus it is important to enhance the long-term antibacterial ability of orthopedic implants. Titanium dioxide nanotubes (TNTs) are biomaterials with good physicochemical properties and biocompatibility. Owing to their inherent antibacterial and drug-loading ability, the antibacterial application of TNTs has received increasing attention. In this review, the process of TNT anodizing fabrication is summarized. Also, the mechanism and the influencing factors of the antibacterial property of bare TNTs are explored. Furthermore, different antibacterial strategies for carrying drugs, as well as modifications to prolong the antibacterial effect and reduce drug-related toxicity are discussed. In addition, antibacterial systems based on TNTs that can automatically respond to infection are introduced. Finally, the currently faced problems are reviewed and potential solutions are proposed. This review provides new insight on TNT fabrication and summarizes the most advanced antibacterial strategies involving TNTs for the enhancement of long-term antibacterial ability and reduction of toxicity.

Nanomaterials as Promising Alternative in the Infection Treatment

Both the prevalence of antibiotic resistance and the increased biofilm-associated infections are boosting the demand for new advanced and more effective treatment for such infections. In this sense, nanotechnology offers a ground-breaking platform for addressing this challenge. This review shows the current progress in the field of antimicrobial inorganic-based nanomaterials and their activity against bacteria and bacterial biofilm. Herein, nanomaterials preventing the bacteria adhesion and nanomaterials treating the infection once formed are presented through a classification based on their functionality. To fight infection, nanoparticles with inherent antibacterial activity and nanoparticles acting as nanovehicles are described, emphasizing the design of the carrier nanosystems with properties targeting the bacteria and the biofilm.

Bone marrow stromal cells interaction with titanium; Effects of composition and surface modification

Inflammation and implant loosening are major concerns when using titanium implants for hard tissue engineering applications. Surface modification is one of the promising tools to enhance tissue-material integration in metallic implants. Here, we used anodization technique to modify the surface of commercially pure titanium (CP-Ti) and titanium alloy (Ti-6Al-4V) samples. Our results show that electrolyte composition, anodization time and voltage dictated the formation of well-organized nanotubes. Although electrolyte containing HF in water resulted in nanotube formation on Ti, the presence of NH4F and ethylene glycol was necessary for successful nanotube formation on Ti-6Al-4V. Upon examination of the interaction of bone marrow stromal cells (BMSCs) with the modified samples, we found that Ti-6Al-4V without nanotubes induced cell proliferation and cluster of differentiation 40 ligand (CD40L) expression which facilitates B-cell activation to promote early bone healing. However, the expression of glioma associated protein 2 (GLI2), which regulates CD40L, was reduced in Ti-6Al-4V and the presence of nanotubes further reduced its expression. The inflammatory cytokine interleukin-6 (IL-6) expression was reduced by nanotube presence on Ti. These results suggest that Ti-6Al-4V with nanotubes may be suitable implants because they have no effect on BMSC growth and inflammation.

Icariin-Functionalized Coating on TiO2 Nanotubes Surface to Improve Osteoblast Activity In Vitro and Osteogenesis Ability In Vivo

Surface modification of titanium is encouraged to facilitate early osseointegration in dental and orthopedic fields. Icariin is the main active constituents of Herba Epimedii, which has good bone-promoting ability. We established an icariin-functionalized coating composed of icariin and poly (lactic-co-glycolic acid) (PLGA) on TiO2 nanotubes surface (NT-ICA-PLGA) to promote osteoblast cell activity and early osseointegration. Surface topography, wettability and drug release pattern of the established NT-ICA-PLGA surface were characterized by scanning electron microscopy (SEM), contact angle test and drug release test. MC3T3-E1 osteoblast cell activity tests were performed using SEM, immunofluorescent staining, cell counting kit-8 and alkaline phosphatase assays. The osteogenic effects of different surfaces were observed using a rat model. Surface characterization proved the successful fabrication of the icariin-functionalized coating on the TiO2 nanotube structure, with increased wettability. The NT-ICA-PLGA substrate showed sustained release of icariin until two weeks. Osteoblast cells grown on the NT-ICA-PLGA substrate displayed improved cell adhesion, proliferation and differentiation ability than the control Ti surface. The in vivo experiment also revealed superior bone forming ability on the NT-ICA-PLGA surface, compared to the pure Ti control. These results imply that the developed NT-ICA-PLGA substrate has a promising future use as functionalized coating for implant surface modification.

Fabrication of a Low Adhesive Superhydrophobic Surface on Ti6Al4V Alloys Using TiO₂/Ni Composite Electrodeposition

A superhydrophobic surface with low adhesion and good wear resistance was fabricated on Ti6Al4V substrates via TiO₂/Ni composite electrodeposition, and subsequently modified with a fluoroalkylsilane (FAS) film. Scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), and optical contact angle measurements were used to characterize the surface morphologies, chemical compositions, and surface wettability. The superhydrophobicity of the as-prepared surface results from the fabrication of a hierarchical structure and the assembly of low-surface energy fluorinated components. The as-prepared surface had a water contact angle as high as 162.6° and a sliding angle close to 1.8°. Scratch and abrasion tests showed that the superhydrophobic coating provided a superior wear resistance and stable mechanical abrasion protection. In addition, the influence of processing conditions, such as working voltage, deposited time, pH value, and TiO₂ concentration, was also investigated.

Review of titanium surface modification techniques and coatings for antibacterial applications

Implanted biomaterials play a key role in the current success of orthopedic and dental procedures. Pure titanium and its alloys are the most commonly used materials for permanent implants in contact with bone. However, implant-related infections remain among the leading reasons for failure. The most critical pathogenic event in the development of infection on biomaterials is biofilm formation, which starts immediately after bacterial adhesion. In the last decade, numerous studies reported the ability of titanium surface modifications and coatings to minimize bacterial adhesion, inhibit biofilm formation and provide effective bacterial killing to protect implanted biomaterials. In the present review, the different strategies to prevent infection onto titanium surfaces are reported: surface modification and coatings by antibiotics, antimicrobial peptides, inorganic antibacterial metal elements and antibacterial polymers. STATEMENT OF SIGNIFICANCE: Implanted biomaterials play a key role in the current success of orthopedic and dental procedures. Pure titanium and its alloys are the most commonly used materials for permanent implants in contact with bone. Microbial infection is one of the main causes of implant failure. Currently, the global infection risk is 2-5% in orthopedic surgery. Numerous solutions exist to render titanium surfaces antibacterial. The LBPS team is an expert on the functionalization of titanium surfaces by using bioactive polymers to improve the biologiocal response. In this review, the different strategies to prevent infection are reported onto titanium and titanium alloy surfaces such as surface modification by antibiotics, antimicrobial peptides, inorganic antibacterial metal elements and antibacterial polymers.

Polymethacrylic acid encapsulated TiO2 nanotubes for sustained drug release and enhanced antibacterial activities

A long-term antibacterial and sustained drug release system was fabricated, in which the TNTs acted as the loading platform of NOR and then encapsulated with PMAA.

Nanochannelar Topography Positively Modulates Osteoblast Differentiation and Inhibits Osteoclastogenesis

Based on previously reported findings showing reduced foreign body reactions on nanochannelar topography formed on TiZr alloy, this study explores the in vitro effects of such a nanostructured surface on cells relevant for implant osseointegration, namely osteoblasts and osteoclasts. We show that such nanochannelar surfaces sustain adhesion and proliferation of mouse pre-osteoblast MC3T3-E1 cells and enhance their osteogenic differentiation. Moreover, this specific nanotopography inhibits nuclear factor kappa-B ligand (RANKL)-mediated osteoclastogenesis. The nanochannels’ dual mode of action on the bone-derived cells could contribute to an enhanced bone formation around the bone implants. Therefore, these results warrant further investigation for nanochannels’ use as surface coatings of medical implant materials.

Effects of differently shaped TiO2NPs (nanospheres, nanorods and nanowires) on the in vitro model (Caco-2/HT29) of the intestinal barrier

BACKGROUND

The biological effects of nanoparticles depend on several characteristics such as size and shape that must be taken into account in any type of assessment. The increased use of titanium dioxide nanoparticles (TiO2NPs) for industrial applications, and specifically as a food additive, demands a deep assessment of their potential risk for humans, including their abilities to cross biological barriers.

METHODS

We have investigated the interaction of three differently shaped TiO2NPs (nanospheres, nanorods and nanowires) in an in vitro model of the intestinal barrier, where the coculture of Caco-2/HT29 cells confers inherent intestinal epithelium characteristics to the model (i.e. mucus secretion, brush border, tight junctions, etc.).

RESULTS

Adverse effects in the intestinal epithelium were detected by studying the barrier's integrity (TEER), permeability (LY) and changes in the gene expression of selected specific markers. Using Laser Scanning Confocal Microscopy, we detected a different behaviour in the bio-adhesion and biodistribution of each of the TiO2NPs. Moreover, we were able to specifically localize each type of TiO2NPs inside the cells. Interestingly, general DNA damage, but not oxidative DNA damage effects, were detected by using the FPG version of the comet assay.

CONCLUSIONS

Results indicate different interactions and cellular responses related to differently shaped TiO2NPs, nanowires showing the most harmful effects.

A Review on the Electrochemically Self-organized Titania Nanotube Arrays: Synthesis, Modifications, and Biomedical Applications

Titania nanotubes grown by anodic oxidation have intrigued the material science community by its many unique and potential properties, and the synthesis of technology is merging to its mature stage. The present review will focus on TiO2 nanotubes grown by self-organized electrochemical anodization from Ti metal substrate, which critically highlights the synthesis of this type of self-organized titania nanotube layers and the means to influence the size, shape, the degree of order, and crystallized phases via adjusting the anodization parameters and the subsequent thermal annealing. The relationship between dimensions and properties of the anodic TiO2 nanotube arrays will be presented. The latest progress and significance of the research on formation mechanism of anodic TiO2 nanotubes are briefly discussed. Besides, we will show the most promising applications reported recently in biomedical directions and modifications carried out by doping, surface modification, and thermal annealing toward improving the properties of anodically formed TiO2 nanotubes. At last, some unsolved issues and possible future directions of this field are indicated.

In-vitro study of hierarchical structures: Anodic oxidation and alkaline treatments onto highly rough titanium cold gas spray coatings for biomedical applications

Hierarchical structures were obtained applying two different nanotexturing surface treatments onto highly rough commercial pure titanium coatings by cold spray: (i) anodic oxidation and (ii) alkaline treatments. An extended surface characterization in terms of topography, composition, and wettability has been performed to understand how those parameters affect to cell response. Primary human osteoblasts extracted from knee were seeded onto the as-sprayed titanium surface before and after the nanotexturing treatments. Cell viability was tested by using MTS and LIVE/DEAD assays, as well as osteoblasts differentiation by alkaline phosphatase (ALP) quantification at 3 and 10 days of cell culture. The combination of micro-/nano-roughness results in a significantly increase of cell proliferation, as well as cell differentiation after 10 days of cell culture in comparison with the non-treated coatings.

Progress in TiO2 nanotube coatings for biomedical applications: a review

Titanium dioxide nanotubes (TNTs) have drawn wide attention and been extensively applied in the field of biomedicine, due to their large specific surface area, good corrosion resistance, excellent biocompatibility, and enhanced bioactivity. This review describes the preparation of TNTs and the surface modification that entrust the nanotubes with better antibacterial property and enhanced osteoblast adhesion, proliferation, and differentiation. Considering the contact between TNTs' surface and surrounding tissues after implantation, the interactions between TNTs (with properties including their diameter, length, wettability, and crystalline phase) and proteins, platelets, bacteria, and cells are illustrated. The state of the art in the applications of TNTs in dentistry, orthopedic implants, and cardiovascular stents are introduced. In particular, the application of TNTs in biosensing has attracted much attention due to its ability for the rapid diagnosis of diseases. Finally, the difficulties and challenges in the practical application of TNTs are also discussed.

Osteogenic nanostructured titanium surfaces with antibacterial properties under conditions that mimic the dynamic situation in the oral cavity

The study aim was to assess the impact of different surface nanofeatures on otherwise smooth titanium surfaces on bacterial adhesion as well as on their osteogenic potential.

Engineering of Micro- to Nanostructured 3D-Printed Drug-Releasing Titanium Implants for Enhanced Osseointegration and Localized Delivery of Anticancer Drugs

Primary and secondary bone cancers are major causes of pathological bone fractures which are usually treated through implant fixation and chemotherapy. However, both approaches face many limitations. On one hand, implants may suffer from poor osseointegration, and their rejection results in repeated surgery, patient's suffering, and extensive expenses. On the other hand, there are severe systemic adverse effects of toxic chemotherapeutics which are administrated systemically. In this paper, in order to address these two problems, we present a new type of localized drug-releasing titanium implants with enhanced implants' biointegration and drug release capabilities that could provide a high concentration of anticancer drugs locally to treat bone cancers. The implants are fabricated by 3D printing of Ti alloy followed by an anodization process featuring unique micro- (particles) and nanosurface (tubular arrays) topography. We successfully demonstrate their enhanced bone osseointegration and drug loading capabilities using two types of anticancer drugs, doxorubicin (DOX) and apoptosis-inducing ligand (Apo2L/TRAIL). In vitro study showed strong anticancer efficacy against cancer cells (MDA-MB-231-TXSA), confirming that these drug-releasing implants can be used for localized chemotherapy for treatment of primary and secondary bone cancers together with fracture support.

Antibacterial properties of PEKK for orthopedic applications

Orthopedic implant infections have been steadily increasing while, at the same time, antibiotics developed to kill such bacteria have proven less and less effective with every passing day. It is clear that new approaches that do not rely on the use of antibiotics are needed to decrease medical device infections. Inspired by cicada wing surface topographical features, nanostructured surfaces represent a new approach for imposing antibacterial properties to biomaterials without using drugs. Moreover, new chemistries with altered surface energetics may decrease bacterial attachment and growth. In this study, a nanostructured surface was fabricated on poly-ether-ketone-ketone (PEKK), a new orthopedic implant chemistry, comprised of nanopillars with random interpillar spacing. Specifically, after 5 days, when compared to the orthopedic industry standard poly-ether-ether-ketone (PEEK), more than 37% less Staphylococcus epidermidis were found on the PEKK surface. Pseudomonas aeruginosa attachment and growth also decreased 28% after one day of culture, with around a 50% decrease after 5 days of culture when compared to PEEK. Such decreases in bacteria function were achieved without using antibiotics. In this manner, this study demonstrated for the first time, the promise that nanostructured PEKK has for numerous anti-infection orthopedic implant applications.

Optimization of the Silver Nanoparticles PEALD Process on the Surface of 1-D Titania Coatings

Plasma enhanced atomic layer deposition (PEALD) of silver nanoparticles on the surface of 1-D titania coatings, such as nanotubes (TNT) and nanoneedles (TNN), has been carried out. The formation of TNT and TNN layers enriched with dispersed silver particles of strictly defined sizes and the estimation of their bioactivity was the aim of our investigations. The structure and the morphology of produced materials were determined using X-ray photoelectron spectroscopy (XPS) and scanning electron miscroscopy (SEM). Their bioactivity and potential usefulness in the modification of implants surface have been estimated on the basis of the fibroblasts adhesion and proliferation assays, and on the basis of the determination of their antibacterial activity. The cumulative silver release profiles have been checked with the use of inductively coupled plasma-mass spectrometry (ICPMS), in order to exclude potential cytotoxicity of silver decorated systems. Among the studied nanocomposite samples, TNT coatings, prepared at 3, 10, 12 V and enriched with silver nanoparticles produced during 25 cycles of PEALD, revealed suitable biointegration properties and may actively counteract the formation of bacterial biofilm.

Antibacterial properties and toxicity from metallic nanomaterials

The era of antibiotic resistance is a cause of increasing concern as bacteria continue to develop adaptive countermeasures against current antibiotics at an alarming rate. In recent years, studies have reported nanoparticles as a promising alternative to antibacterial reagents because of their exhibited antibacterial activity in several biomedical applications, including drug and gene delivery, tissue engineering, and imaging. Moreover, nanomaterial research has led to reports of a possible relationship between the morphological characteristics of a nanomaterial and the magnitude of its delivered toxicity. However, conventional synthesis of nanoparticles requires harsh chemicals and costly energy consumption. Additionally, the exact relationship between toxicity and morphology of nanomaterials has not been well established. Here, we review the recent advancements in synthesis techniques for silver, gold, copper, titanium, zinc oxide, and magnesium oxide nanomaterials and composites, with a focus on the toxicity exhibited by nanomaterials of multidimensions. This article highlights the benefits of selecting each material or metal-based composite for certain applications while also addressing possible setbacks and the toxic effects of the nanomaterials on the environment.

Nanoantibiotics: a new paradigm for the treatment of surgical infection

Infections following orthopedic device implantations often impose a substantial health burden and result in high medical costs. Currently, preventative methods are often employed following an orthopedic implant to reduce risk of infection; however, contamination of the surgical site can still occur. Although antibiotics have demonstrated a substantial reduction in bacterial growth and maintenance, biofilm formation around the implant can often minimize efficacy of the antibiotic. Recently, nanotechnology has garnered significant interest, resulting in the development of several antibiotic delivery strategies that exhibit extended release and increased efficacy. In this review, treatment methods of orthopedic-device-related infections will be discussed and an overview of antimicrobial-based nanotechnologies will be provided. Specifically, nonmetal-, metal- and oxide-based nanotechnologies, incorporating antibacterial strategies, will be discussed.

In Vitro Assessment of Early Bacterial Activity on Micro/Nanostructured Ti6Al4V Surfaces

It is imperative to understand and systematically compare the initial interactions between bacteria genre and surface properties. Thus, we fabricated a flat, anodized with 80 nm TiO₂ nanotubes (NTs), and a rough Ti6Al4V surface. The materials were characterized using field-emission scanning electron microscopy (FE-SEM), energy dispersive X-ray spectroscopy (EDX) and atomic force microscopy (AFM). We cultured in vitro Staphylococcus epidermidis (S. epidermidis) and Pseudomonas aeruginosa (P. aeruginosa) to evaluate the bacterial-surface behavior by FE-SEM and viability calculation. In addition, the initial effects of human osteoblasts were tested on the materials. Gram-negative bacteria showed promoted adherence and viability over the flat and rough surface, while NTs displayed opposite activity with altered morphology. Gram-positive bacteria illustrated similar cellular architecture over the surfaces but with promoted surface adhesion bonds on the flat alloy. Rough surfaces supported S. epidermidis viability, whilst NTs exhibited lower vitality. NTs advocated promoted better osteoblast organization with enhanced vitality. Gram-positive bacteria suggested preferred adhesion capability over flat and carbon-rich surfaces. Gram-negative bacteria were strongly disturbed by NTs but largely stimulated by flat and rough materials. Our work proposed that the chemical profile of the material surface and the bacterial cell wall characteristics might play an important role in the bacteria-surface interactions.

Investigation of the mechanical and chemical characteristics of nanotubular and nano-pitted anodic films on grade 2 titanium dental implant materials

OBJECTIVE

The objective of this study was to investigate the reproducibility, mechanical integrity, surface characteristics and corrosion behavior of nanotubular (NT) titanium oxide arrays in comparison with a novel nano-pitted (NP) anodic film.

METHODS

Surface treatment processes were developed to grow homogenous NT and NP anodic films on the surface of grade 2 titanium discs and dental implants. The effect of process parameters on the surface characteristics and reproducibility of the anodic films was investigated and optimized. The mechanical integrity of the NT and NP anodic films were investigated by scanning electron microscopy, surface roughness measurement, scratch resistance and screwing tests, while the chemical and physicochemical properties were investigated in corrosion tests, contact angle measurement and X-ray photoelectron spectroscopy (XPS).

RESULTS AND DISCUSSION

The growth of NT anodic films was highly affected by process parameters, especially by temperature, and they were apt to corrosion and exfoliation. In contrast, the anodic growth of NP film showed high reproducibility even on the surface of 3-dimensional screw dental implants and they did not show signs of corrosion and exfoliation. The underlying reason of the difference in the tendency for exfoliation of the NT and NP anodic films is unclear; however the XPS analysis revealed fluorine dopants in a magnitude larger concentration on NT anodic film than on NP surface, which was identified as a possible causative. Concerning other surface characteristics that are supposed to affect the biological behavior of titanium implants, surface roughness values were found to be similar, whereas considerable differences were revealed in the wettability of the NT and NP anodic films.

CONCLUSION

Our findings suggest that the applicability of NT anodic films on the surface of titanium bone implants may be limited because of mechanical considerations. In contrast, it is worth to consider the applicability of nano-pitted anodic films over nanotubular arrays for the enhancement of the biological properties of titanium implants.

Nanoengineered Superhydrophobic Surfaces of Aluminum with Extremely Low Bacterial Adhesivity

Bacterial adhesion and biofilm formation on surfaces are troublesome in many industrial processes. Here, nanoporous and nanopillared aluminum surfaces were engineered by anodizing and postetching processes and made hydrophilic (using the inherent oxide layer) or hydrophobic (applying a Teflon coating) with the aim of discouraging bacterial adhesion. Adhesion of Staphylococcus aureus ATCC 12600 (Gram-positive, spherically shaped) and Escherichia coli K-12 (Gram-negative, rod-shaped) was evaluated to the nanoengineered surfaces under both static and flow conditions (fluid shear rate of 37 s^-1). Compared to a nonstructured electropolished flat surface, the nanostructured surfaces significantly reduced the number of adhering colony forming units (CFUs) for both species, as measured using agar plating. For the hydrophilic surfaces, this was attributed to a decreased contact area, reducing bacterial adhesion forces on nanoporous and nanopillared surfaces to 4 and 2 nN, respectively, from 8 nN on flat surfaces. Reductions in the numbers of adhering CFUs were more marked on hydrophobic surfaces under flow, amounting to more than 99.9% and 99.4% for S. aureus and E. coli on nanopillared surfaces, respectively. Scanning electron microscopy revealed a few bacteria found on the hydrophobic nanopillared surfaces adhered predominantly to defective or damaged areas, whereas the intact area preserving the original nanopillared morphology was virtually devoid of adhering bacteria. The greater decrease in bacterial adhesion to hydrophobic nanopillared surfaces than to hydrophilic or nanoporous ones is attributed to effective air entrapment in the three-dimensional pillar morphology, rendering them superhydrophobic and slippery, in addition to providing a minimized contact area for bacteria to adhere to.

Enhanced antifungal activity by disinfected titanium dioxide nanotubes via reduced nano-adhesion bonds

We have provided evidence that the beneficial effect of super-oxidized water (SOW) disinfected Ti6Al4V-TiO₂ nanotubes (NTs) can reduce bacterial adhesion and biofilm formation. However, the need of antifungal nanostructured surfaces with osteoactive capabilities is an important goal that has been arising for dental implants (DI) applications. Thus, in the present study we isolated and tested the effects of Candida albicans (C. albicans) on disinfected, wetter and nanoroughness NTs compared to a non-modified control. Moreover, we elucidated part of the fungal adhesion mechanism by studying and relating the mycotic adhesion kinetics and the formation of fungal nanoadhesion bonds among the experimental materials, to gain new insight of the fungal-material-interface. Similarly, the initial behavior of human alveolar bone osteoblasts (HAOb) was microscopically evaluated. NTs significantly reduced the yeasts adhesion and viability with non-outcomes of biofilm than the non-modified surface. Cross-sectioning of the fungal cells revealed promoted nano-contact bonds with superior fungal spread on the control alloy interface; meanwhile NTs evidenced decreased tendency along time; suggesting, down-regulation by the nanostructured morphology and the SOW treatment. Importantly, the initial performance of HAOb demonstrated strikingly promoted anchorage with effects of filopodia formation and increased vital cell on NTs with SOW. The present study proposes SOW treatment as an active protocol for synthesis and disinfection of NTs with potent antifungal capability, acting in part by the reduction of nano-adhesion bonds at the surface-fungal interface; opening up a novel route for the investigation of mycotic-adhesion processes at the nanoscale for bone implants applications.

Poly(methyl methacrylate) with TiO2 nanoparticles inclusion for stereolitographic complete denture manufacturing - the fututre in dental care for elderly edentulous patients?

OBJECTIVES

The aim of this study was to obtain a Poly(methylmethacrylate) (PMMA)-TiO₂ nanocomposite material with improved antibacterial characteristics, suitable for manufacturing 3D printed dental prosthesis.

METHODS

0.2, 0.4, 0.6, 1, 2.5 by weight% of TiO₂ nanoparticles have been added to the commercially available stereolithographic PMMA material and the obtained nanocomposites have been analyzed using FTIR, SEM and also tested for antimicrobial efficacy against bacterial cultures from Candida species (C. scotti).

RESULTS

SEM images and EDX results highlighted the presence of TiO₂ in PMMA nanocomposites. The elemental composition (EDX) also showed the presence of other fillers included in stereolithographic PMMA solution. FTIR analysis clearly revealed changes in polymeric matrix structure when adding TiO₂ nanoparticles. Sample containing 0.4, 1 and 2.5wt% TiO₂ nanoparticles inhibited the growth of Candida scotti strain in standard conditions according to the toxicity control method (DHA). Increasing quantity of nano-titania has resulted in particles fooling, forming new aggregates instead of the homogenous dispersion of nanoparticles with modified viscosity characteristics and expected lower mechanical parameters.

CONCLUSIONS

Significant improvements in polymer characteristics and nice dispersion of the TiO₂ nanoparticles have been noticed for 0.4wt%, therefore it was used for stereolitographic complete denture prototyping.

CLINICAL SIGNIFICANCE

Incorporation of TiO₂ nanoparticles in PMMA polymer matrix was proved to have antibacterial effects, specifically on Candida species. The newly obtained 0.4% nanocomposite was successfully used with stereolitographic technique for complete denture manufacturing. However, mechanical and biocompatibility tests need to be performed in order to extend the clinical usage.

TiO2nanotubes enriched with calcium, phosphorous and zinc: promising bio-selective functional surfaces for osseointegrated titanium implants

TiO₂nanotubes enriched with Ca, P, and Zn by reverse polarization anodization, are promising bio-selective functional structures for osseointegrated titanium implants.

Dental implants modified with drug releasing titania nanotubes: therapeutic potential and developmental challenges

INTRODUCTION

The transmucosal nature of dental implants presents a unique therapeutic challenge, requiring not only rapid establishment and subsequent maintenance of osseointegration, but also the formation of resilient soft tissue integration. Key challenges in achieving long-term success are sub-optimal bone integration in compromised bone conditions and impaired trans-mucosal tissue integration in the presence of a persistent oral microbial biofilm. These challenges can be targeted by employing a drug-releasing implant modification such as TiO₂ nanotubes (TNTs), engineered on titanium surfaces via electrochemical anodization. Areas covered: This review focuses on applications of TNT-based dental implants towards achieving optimal therapeutic efficacy. Firstly, the functions of TNT implants will be explored in terms of their influence on osseointegration, soft tissue integration and immunomodulation. Secondly, the developmental challenges associated with such implants are reviewed including sterilization, stability and toxicity. Expert opinion: The potential of TNTs is yet to be fully explored in the context of the complex oral environment, including appropriate modulation of alveolar bone healing, immune-inflammatory processes, and soft tissue responses. Besides long-term in vivo assessment under masticatory loading conditions, investigating drug-release profiles in vivo and addressing various technical challenges are required to bridge the gap between research and clinical dentistry.

Activity of vancomycin release from bioinspired coatings of hydroxyapatite or TiO2 nanotubes

Herein we investigate the efficiency of various biomimetic coatings for localized drug delivery, using vancomycin as key therapeutic drug, which is a widely used antibiotic for the treatment of strong infections caused by positive Gram bacteria. We evaluate classical hydroxyapatite and biomimetic hydroxyapatite-collagen coatings obtained by electrochemical deposition as well as TiO₂ nanotubes arrays obtained by electrochemical anodization. Surface morphology, compositional and structural data confirm the incorporation of vancomycin into the layers and drug release profiles for vancomycin evaluate their release ability. Namely, hydroxyapatite coatings lead to a ≈92% vancomycin release after 30h and hydroxyapatite-collagen to 85%, while the TiO₂ nanotubes layers lead to 78% release. The antibacterial effect of such drug loaded coatings is evaluated against S. aureus (Gram-positive bacteria). Our study shows that the vancomycin incorporated hydroxyapatite coatings lead to a faster release, while the nanotubular coatings may lead to longer time release and additionally both types of coatings ensure a good antibacterial inhibition.

Staphylococcal Adhesion, Detachment and Transmission on Nanopillared Si Surfaces

Nanostructured surfaces are extensively considered with respect to their potential impact on bacterial adhesion from aqueous suspensions or air, but in real-life bacteria are often transmitted between surfaces. Mechanistically, transmission involves detachment of adhering bacteria from a donor and adhesion to a receiver surface, controlled by the relative values of the adhesion forces exerted by both surfaces. We here relate staphylococcal adhesion, detachment and transmission to, from, and between smooth and nanopillared-Si surfaces with staphylococcal adhesion forces. Nanopillared-Si surfaces were prepared with pillar-to-pillar distances of 200, 400, and 800 nm. On smooth surfaces, staphylococcal adhesion forces, measured using bacterial-probe Atomic-Force-Microscopy, amounted to 4.4-6.8 and 1.8-2.1 nN (depending on the AFM-loading force) for extracellular-polymeric-substances (EPS) producing and non-EPS producing strains, respectively. Accordingly the EPS producing strain adhered in higher numbers than the non-EPS producing strain. Fractional adhesion forces on nanopillared-Si surfaces relative to the smooth surface ranged from 0.30 to 0.95, depending on AFM-loading force, strain and pillar-to-pillar distance. However, for each strain, the number of adhering bacteria remained similar on all nanopillared surfaces. Detachment of adhering staphylococci decreased significantly with increasing adhesion forces, while staphylococcal transmission to a receiver surface also decreased with increasing adhesion force exerted by the donor. In addition, the strain with ability to produce EPS was killed in high percentages and induced to produce EPS during transmission on nanopillared-Si surfaces, presumably by high local cell-wall stresses. This must be accounted for in applications of nanostructured surfaces: whereas killing may be favorable, EPS production may reduce antimicrobial efficacy.

Cytocompatibility with osteogenic cells and enhanced in vivo anti-infection potential of quaternized chitosan-loaded titania nanotubes

Infection is one of the major causes of failure of orthopedic implants. Our previous study demonstrated that nanotube modification of the implant surface, together with nanotubes loaded with quaternized chitosan (hydroxypropyltrimethyl ammonium chloride chitosan, HACC), could effectively inhibit bacterial adherence and biofilm formation in vitro. Therefore, the aim of this study was to further investigate the in vitro cytocompatibility with osteogenic cells and the in vivo anti-infection activity of titanium implants with HACC-loaded nanotubes (NT-H). The titanium implant (Ti), nanotubes without polymer loading (NT), and nanotubes loaded with chitosan (NT-C) were fabricated and served as controls. Firstly, we evaluated the cytocompatibility of these specimens with human bone marrow-derived mesenchymal stem cells in vitro. The observation of cell attachment, proliferation, spreading, and viability in vitro showed that NT-H has improved osteogenic activity compared with Ti and NT-C. A prophylaxis rat model with implantation in the femoral medullary cavity and inoculation with methicillin-resistant Staphylococcus aureus was established and evaluated by radiographical, microbiological, and histopathological assessments. Our in vivo study demonstrated that NT-H coatings exhibited significant anti-infection capability compared with the Ti and NT-C groups. In conclusion, HACC-loaded nanotubes fabricated on a titanium substrate show good compatibility with osteogenic cells and enhanced anti-infection ability in vivo, providing a good foundation for clinical application to combat orthopedic implant-associated infections.

In vivo evaluation of the anti-infection potential of gentamicin-loaded nanotubes on titania implants

Titanium-based implants have been widely used in orthopedic surgery; however, failures still occur. Our in vitro study has demonstrated that gentamicin-loaded, 80 nm-diameter nanotubes possessed both antibacterial and osteogenic activities. Thus, the aim of this study was to further investigate the in vivo anti-infection effect of the titanium implants with gentamicin-loaded nanotubes. Thirty-six male Sprague Dawley rats were used to establish an implant-associated infection model. A volume of 50 μL Staphylococcus aureus suspension (1×10(5) CFU/mL) was injected into the medullary cavity of the left femur, and then the titanium rods without modification (Ti), titanium nanotubes without drug loading (NT), and gentamicin-loaded titanium nanotubes (NT-G) were inserted with phosphate-buffered saline-inoculated Ti rods as a blank control. X-ray images were obtained 1 day, 21 days, and 42 days after surgery; micro-computed tomography, microbiological, and histopathological analyses were used to evaluate the infections at the time of sacrifice. Radiographic signs of bone infection, including osteolysis, periosteal reaction, osteosclerosis, and damaged articular surfaces, were demonstrated in the infected Ti group and were slightly alleviated in the NT group but not observed in the NT-G group. Meanwhile, the radiographic and gross bone pathological scores of the NT-G group were significantly lower than those of the infected Ti group (P<0.01). Explant cultures revealed significantly less bacterial growth in the NT-G group than in the Ti and NT groups (P<0.01), and the NT group showed decreased live bacterial growth compared with the Ti group (P<0.01). Confocal laser scanning microscopy, scanning electron microscopy, and histopathological observations further confirmed decreased bacterial burden in the NT-G group compared with the Ti and NT groups. We concluded that the NT-G coatings can significantly prevent the development of implant-associated infections in a rat model; therefore, they may provide an effective drug-loading strategy to combat implant-associated infections in clinic.

Comparative bone tissue integration of nanostructured and microroughened dental implants

AIM

The aim was to compare osteointegration of nanostructured implants to a microsurface widely used for titanium dental implants.

MATERIALS & METHODS

Commercial titanium dental implants with smooth or microroughened surfaces were nanostructured. Implants were inserted into the femoral condyles of rabbits. After 2 and 4 weeks, histomorphometry calculation was performed.

RESULTS

Nanotubes measuring 60 nm in diameter were observed on both S-NANO (roughness: 0.05 μm) and R-NANO (roughness: 0.40 μm) surfaces. The MICRO surface exhibited typical random cavities (roughness: 2.09 μm). At 4 weeks, bone-to-implant contact values were significantly higher for the R-NANO than for the MICRO surface while no differences were observed at 2 weeks.

CONCLUSION

Overall, this study shows that the nanostructured surfaces improved osteointegration similar or higher than the MICRO.

Antimicrobial performance of mesoporous titania thin films: role of pore size, hydrophobicity, and antibiotic release

Implant-associated infections are undesirable complications that might arise after implant surgery. If the infection is not prevented, it can lead to tremendous cost, trauma, and even life threatening conditions for the patient. Development of an implant coating loaded with antimicrobial substances would be an effective way to improve the success rate of implants. In this study, the in vitro efficacy of mesoporous titania thin films used as a novel antimicrobial release coating was evaluated. Mesoporous titania thin films with pore diameters of 4, 6, and 7 nm were synthesized using the evaporation-induced self-assembly method. The films were characterized and loaded with antimicrobial agents, including vancomycin, gentamicin, and daptomycin. Staphylococcus aureus and Pseudomonas aeruginosa were used to evaluate their effectiveness toward inhibiting bacterial colonization. Drug loading and delivery were studied using a quartz crystal microbalance with dissipation monitoring, which showed successful loading and release of the antibiotics from the surfaces. Results from counting bacterial colony-forming units showed reduced bacterial adhesion on the drug-loaded films. Interestingly, the presence of the pores alone had a desired effect on bacterial colonization, which can be attributed to the documented nanotopographical effect. In summary, this study provides significant promise for the use of mesoporous titania thin films for reducing implant infections.

Influence of various sterilization procedures on TiO2 nanotubes used for biomedical devices

Sterilization is the final surface treatment procedure of all implantable devices and is one of the key factors which have to be considered before implementation. Since different sterilization procedures for all implantable devices influence mechanical properties as well as biological response, the influence of different sterilization techniques on titanium nanotubes was studied. Commonly used sterilization techniques such as autoclaving, ultra-violet light sterilization, hydrogen peroxide plasma sterilization as well as the not so frequently used gaseous oxygen plasma sterilization were used. Three different nanotube diameters; 15 nm, 50 nm and 100 nm were employed to study the effects of various sterilization techniques. It was observed that autoclave sterilization resulted in destruction of nanotubular features on all three studied nanotube diameters, while UV-light and both kinds of plasma sterilization did not cause any significant morphological changes on the surfaces. Differences between the sterilization techniques employed influenced cytocompatibility, especially in the case of nanotubes with 100 nm diameter.

Conversion of titania (TiO2) into conductive titanium (Ti) nanotube arrays for combined drug-delivery and electrical stimulation therapy

The conversion of titania (TiO₂) nanotubes into titanium (Ti), while preserving their nanotubular structures is demonstrated for proposed application as bone implants and electrodes for combined local drug delivery and electrical stimulation therapy.

Disinfection of titanium dioxide nanotubes using super-oxidized water decrease bacterial viability without disrupting osteoblast behavior

Amorphous titanium dioxide (TiO2) nanotubes (NTs) on Ti6Al4V alloy were synthesized by anodization using a commercially available super-oxidized water (SOW). The NT surfaces were sterilized by ultraviolet (UV) irradiation and disinfected using SOW. The adhesion and cellular morphology of pig periosteal osteoblast (PPO) cells and the behavior of Staphylococcus aureus (S. aureus) cultured on the sterilized and disinfected surfaces were investigated. A non-anodized Ti6Al4V disc sterilized by UV irradiation (without SOW) was used as control. The results of this study reveal that the adhesion, morphology and filopodia development of PPO cells in NTs are dramatically improved, suggesting that SOW cleaning may not disrupt the benefits obtained by NTs. Significantly decreased bacterial viability in NTs after cleaning with SOW and comparing with non-cleaned NTs was seen. The results suggest that UV and SOW could be a recommendable method for implant sterilization and disinfection without altering osteoblast behavior while decreasing bacterial viability.