Biocompatibility of nickel-titanium shape memory metal and its corrosion behavior in human cell cultures

Development and characterization of smart composites reinforced with fibrillated cellulose and nickel-titanium alloy

The current study presents the synergistic effects of fibrillated cellulose (FC) and nickel-titanium (NiTi) alloy on the performance properties of smart composites. Epoxy resin was reinforced with loadings of 1 %, 3 %, and 5 % FC and 3 % NiTi. The composites were produced using the casting method. The morphological properties have been analyzed using scanning electron microscopy (SEM). For mechanical properties, yield strength, modulus of elasticity, hardness, and impact energy were determined. The corrosion rate was determined via electrochemical corrosion testing. The recovery test was used to measure the shape-memory of the composites. The self-healing of the artificial defect in the composites was observed using a thermal camera. The yield strength, modulus of elasticity, hardness, and impact energy of composites reinforced with 5 % FC and 3 % NiTi increased by 168.2 %, 290 %, 33.3 %, and 114.3 %, respectively, compared to pure epoxy resin. There has been a 56.3 % decrease in the corrosion rate. The percentage of composites that returned from the final state to the original state after a deformation was 4 %. Self-healing analysis revealed that the scratch defect in composites was healed after 24 h. It is concluded that smart composites can be used in the aviation and automotive industries.

Pharmacologic targeting of coagulation factors XII and XI by monoclonal antibodies reduces thrombosis in nitinol stents under flow

BACKGROUND

Cardiovascular implantable devices, such as vascular stents, are critical for the treatment of cardiovascular diseases. However, their success is dependent on robust and often long-term antithrombotic therapies. Yet, the current standard-of-care therapies often pose significant bleeding risks to patients. Coagulation factor (F)XI and FXII have emerged as potentially safe and efficacious targets to safely reduce pathologic thrombin generation in medical devices.

OBJECTIVES

To study the efficacy of monoclonal antibody-targeting FXII and FXI of the contact pathway in preventing vascular device-related thrombosis.

METHODS

The effects of inhibition of FXII and FXI using function-blocking monoclonal antibodies were examined in a nonhuman primate model of nitinol stent-related thrombosis under arterial and venous flow conditions.

RESULTS

We found that function-blocking antibodies of FXII and FXI reduced markers of stent-induced thrombosis in vitro and ex vivo. However, FXI inhibition resulted in more effective mitigation of thrombosis markers under varied flow conditions.

CONCLUSION

This work provides further support for the translation of contact pathway of coagulation inhibitors for their adjunctive clinical use with cardiovascular devices.

Design, simulation and experimental analysis of a monolithic bending section for enhanced maneuverability of single use laparoscopic devices

Standard laparoscopes, which are widely used in minimally invasive surgery, have significant handling limitations due to their rigid design. This paper presents an approach for a bending section for laparoscopes based on a standard semi-finished tube made of Nitinol with laser-cut flexure hinges. Flexure hinges simply created from a semi-finished product are a key element for realizing low-cost compliant structures with minimal design space. Superelastic materials such as Nitinol allow the reversible strain required for this purpose while maintaining sufficient strength in abuse load cases. This paper focuses on the development of a bending section for single use laparoscopic devices (OD 10 mm) with a bending angle of 100°, which enables the application of 100 µm diameter Nitinol actuator wires. For this purpose, constructive measures to realise a required bending curvature and Finite Element Analysis for determining the strain distribution in the flexural region are applied and described for the design of the flexure hinges. In parallel, the influence of the laser-based manufacturing process on the microstructure is investigated and evaluated using micrographs. The deformation behavior of the bending section is experimentally determined using Digital Image Correlation. The required actuation forces and the failure load of the monolithic bending section is measured and compared to a state of the art riveted bending section made of stainless steel. With the developed monolothic bending section the actuation force could be reduced by 50% and the available inner diameter could be increased by 10% while avoiding the need of any assembly step.

Nitinol: From historical milestones to functional properties and biomedical applications

Isoatomic NiTi alloy (Nitinol) has become an important biomaterial due to its unique characteristics, including shape memory effect, superelasticity, and high damping. Nitinol has been widely used in the biomedical field, including orthopedics, vascular stents, orthodontics, and other medical devices. However, there have been convicting views about the biocompatibility of Nitinol. Some studies have shown that Nitinol has extremely low cytotoxicity, indicating Nitinol has good biocompatibility. However, some studies have shown that the in-vivo corrosion resistance of Nitinol significantly decreases. This comprehensive paper discusses the historical developments of Nitinol, its biomedical applications, and its specific functional property. These render the suitability of Nitinol for such biomedical applications and provide insights into its in vivo and in vitro biocompatibility in the physiological environment and the antimicrobial strategies that can be applied to enhance its biocompatibility. Although 3D metal printing is still immature and Nitinol medical materials are difficult to be processed, Nitinol biomaterials have excellent potential and commercial value for 3D printing. However, there are still significant problems in the processing of Nitinol and improving its biocompatibility. With the deepening of research and continuous progress in surface modification and coating technology, a series of medical devices made from Nitinol are expected to be released soon.

Biocompatibility of titanium from the viewpoint of its surface

Among metals, Ti and majority of its alloys exhibit excellent biocompatibility or tissue compatibility. Although their high corrosion resistance is a factor in the biocompatibility of Ti and Ti alloys, it is clear that other factors exist. In this review, the corrosion resistance and passive film of Ti are compared to those of other metallic biomaterials, and their band gap energies, E_gs, are compared to discuss the role of E_g in the reactivity with living tissues. From the perspective of the material's surface, it is possible to explain the excellent biocompatibility of Ti by considering the following factors: Ti ions are immediately stabilized not to show toxicity if it is released to body fluids; good balance of positive and negative charges by the dissociation of surface hydroxyl groups on the passive film; low electrostatic force of the passive film inducing a natural adsorption of proteins maintaining their natural conformation; strong property as n-type semiconductor; lower band gap energy of the passive film on Ti generating optimal reactivity; and calcium phosphate formation is caused by this reactivity. The results suggest that due to the passive oxide film, the optimal balance between high corrosion resistance and appropriate reactivity of Ti is the predominate solution for the excellent biocompatibility of Ti.

Toxicity of Orthodontic Brackets Examined by Single Cell Tracking

Subtle toxic effects may be masked in traditional assays that average or summate the response of thousands of cells. We overcome this by using the recent method of single cell tracking in time-lapse recordings. This follows the fate and behavior of individual cells and their progeny and provides unambiguous results for multiple simultaneous biological responses. Further, single cell tracking permits correlation between progeny relationships and cell behavior that is not otherwise possible, including disruption by toxins and toxicants of similarity between paired sister cells. Notably, single cell tracking seems not to have been previously used to study biomaterials toxicity. The culture medium was pre-conditioned by 79 days incubation with orthodontic brackets from seven separate commercial sources. Metal levels were determined by Inductively Coupled Plasma Mass Spectrometry. Metal levels varied amongst conditioned media, with elevated Cr, Mn, Ni, and Cu and often Mo, Pb, Zn, Pd, and Ag were occasionally found. The effect on human dermal fibroblasts was determined by single cell tracking. All bracket-conditioned media reduced cell division (p < 0.05), while some reduced cell migration (p < 0.05). Most bracket-conditioned media increased the rate of asynchronous sister cell division (p < 0.05), a seemingly novel measure for toxicity. No clear effect on cell morphology was seen. We conclude that orthodontic brackets have cytotoxic effects, and that single cell tracking is effective for the study of subtle biomaterials cytotoxicity.

A Novel Intelligent Fan Clutch for Large Hybrid Vehicles

To solve the problems of complex structure, poor reliability, and low intelligence of existing fan clutches for large hybrid vehicles, this paper proposes a new adaptive shape memory alloy intelligent fan clutch for large hybrid vehicle motor cooling. Based on the pure shear shape memory alloy thermodynamic effects, the relationship between shape memory alloy spring recovery force and temperature has been established; based on the shape memory alloy spring thermal drive characteristics and clutch construction dimensions, clutch torque transmission equations have been established. The shape memory alloy fan clutch transmission characteristics were quantitatively analyzed in terms of temperature, torque, rotational speed, and slip rate. The results show that the shape memory alloy fan clutch model based on the finite element method (FEM) and the established transmission model can accurately describe the mechanical characteristics of the shape memory alloy phase change process and the clutch torque transmission characteristics. When the clutch input speed is 3000 rad/min and the temperature is 100 °C, the output torque is 19.04 N·m, the speed is 2877.2 rad/min, and the slip rate is 4.3%. Due to the shape memory effect of shape memory alloy, the clutch can intelligently adjust the fan speed by sensing the ambient temperature. A fan clutch can satisfy the heat dissipation requirement of a large hybrid vehicle’s transmission system under complicated road conditions.

Nitinol Release of Nickel under Physiological Conditions: Effects of Surface Oxide, pH, Hydrogen Peroxide, and Sodium Hypochlorite

Nitinol is a nickel-titanium alloy widely used in medical devices for its unique pseudoelastic and shape-memory properties. However, nitinol can release potentially hazardous amounts of nickel, depending on surface manufacturing yielding different oxide thicknesses and compositions. Furthermore, nitinol medical devices can be implanted throughout the body and exposed to extremes in pH and reactive oxygen species (ROS), but few tools exist for evaluating nickel release under such physiological conditions. Even in cardiovascular applications, where nitinol medical devices are relatively common and the blood environment is well understood, there is a lack of information on how local inflammatory conditions after implantation might affect nickel ion release. For this study, nickel release from nitinol wires of different finishes was measured in pH conditions and at ROS concentrations selected to encompass and exceed literature reports of extracellular pH and ROS. Results showed increased nickel release at levels of pH and ROS reported to be physiological, with decreasing pH and increasing concentrations of hydrogen peroxide and NaOCl/HOCl having the greatest effects. The results support the importance of considering the implantation site when designing studies to predict nickel release from nitinol and underscore the value of understanding the chemical milieu at the device-tissue interface.

Metallic Implants Used in Lumbar Interbody Fusion

Over the last decade, pedicle fixation systems have evolved and modifications in spinal fusion techniques have been developed to increase fusion rates and improve clinical outcomes after lumbar interbody fusion (LIF). Regarding materials used for screw and rod manufacturing, metals, especially titanium alloys, are the most popular resources. In the case of pedicle screws, that biomaterial can be also doped with hydroxyapatite, CaP, ECM, or tantalum. Other materials used for rod fabrication include cobalt-chromium alloys and nitinol (nickel-titanium alloy). In terms of mechanical properties, the ideal implant used in LIF should have high tensile and fatigue strength, Young's modulus similar to that of the bone, and should be 100% resistant to corrosion to avoid mechanical failures. On the other hand, a comprehensive understanding of cellular and molecular pathways is essential to identify preferable characteristics of implanted biomaterial to obtain fusion and avoid implant loosening. Implanted material elicits a biological response driven by immune cells at the site of insertion. These reactions are subdivided into innate (primary cellular response with no previous exposure) and adaptive (a specific type of reaction induced after earlier exposure to the antigen) and are responsible for wound healing, fusion, and also adverse reactions, i.e., hypersensitivity. The main purposes of this literature review are to summarize the physical and mechanical properties of metal alloys used for spinal instrumentation in LIF which include fatigue strength, Young's modulus, and corrosion resistance. Moreover, we also focused on describing biological response after their implantation into the human body. Our review paper is mainly focused on titanium, cobalt-chromium, nickel-titanium (nitinol), and stainless steel alloys.

Recent progress in advanced biomaterials for long-acting reversible contraception

Unintended pregnancy is a global issue with serious ramifications for women, their families, and society, including abortion, infertility, and maternal death. Although existing contraceptive strategies have been widely used in people's lives, there have not been satisfactory feedbacks due to low contraceptive efficacy and related side effects (e.g., decreased sexuality, menstrual cycle disorder, and even lifelong infertility). In recent years, biomaterials-based long-acting reversible contraception has received increasing attention from the viewpoint of fundamental research and practical applications mainly owing to improved delivery routes and controlled drug delivery. This review summarizes recent progress in advanced biomaterials for long-acting reversible contraception via various delivery routes, including subcutaneous implant, transdermal patch, oral administration, vaginal ring, intrauterine device, fallopian tube occlusion, vas deferens contraception, and Intravenous administration. In addition, biomaterials, especially nanomaterials, still need to be improved and prospects for the future in contraception are mentioned.

Confirmation of the systematic presence of tin particles in fallopian tubes or uterine horns of Essure implant explanted patients: A study of 18 cases with the same pathological process

OBJECTIVE

To examine associations between local and systemic symptoms and the wear of the tin weld of Essure implants.

DESIGN

study of a series of cases.

SETTINGS

Two French hospitals.

PARTICIPANTS

Eighteen patients explanted by hysterectomy and salpingectomy for removal of their Essure implants between September 2019 and July 2020, have had a common anatomopathological process.

MAIN OUTCOME MEASURES

anatomopathological examination by optical microscopy and mineralogical analysis of the fallopian tube or uterine horn with scanning electron microscopy coupled with energy dispersive X-ray (SEM-EDX). Evaluation of local and systemic symptoms with a questionnaire. Examination of blood metal assays (nickel, chromium, and tin).

RESULTS

anatomopathological examination highlights foreign body granulomas, fibrosis, adenomyosis, nonspecific inflammation, cysts and myomas in the Fallopian tubes, uterine horns, or both and mentions the presence of foreign bodies in seven cases. SEM-EDX analyses showed, systematically, the presence of tin particles integrated in the wall near the weld, generally in clusters, and with a size ranging from about one micron to several dozen microns. The questionnaire shows that the most frequent local symptoms were pelvic pain, urinary disorders, bleeding, and pains during intercourse. The most common systemic symptoms were: asthenia, visual disturbances, amnesia, giddiness, dorsal pains, headaches, and joint pains. The majority of local and systemic symptoms decreased after explantation, but sometimes incompletely. Before explantation, high levels of nickel, tin and chromium were observed in 11/17, 1/7 and 2/17 patients. After explantation, tin levels were high in 3/11 patients.

CONCLUSIONS

our new anatomopathological process systematically demonstrates the presence of tin particles in tissue near the weld. These particles could be responsible for granulomatous inflammations as well as local symptoms. Many of the systemic symptoms are consistent with chronic organotin poisoning but further studies are needed to find out whether tin from the solder can be converted to organotin in the patients' bodies.

A Critical Appraisal of the Use and Properties of Nickel-Titanium Dental Alloys

Nickel-titanium (NiTi) archwires are used in dentistry for orthodontic treatment. NiTi alloys have favourable mechanical characteristics, such as superelasticity and shape memory, and are also known as a corrosion-resistant alloy. In specific cases, an archwire could be attacked by certain types of corrosion or wear degradation, which can cause the leaching of metal ions and a hypersensitive response due to increased concentrations of Ni in the human body. A systematic search of the literature retrieved 102 relevant studies. The review paper focuses on three main fields: (i) electrochemical properties of NiTi wires and the effect of different environments on the properties of NiTi wires (fluoride and low pH); (ii) tribocorrosion, a combination of chemical and mechanical wear of the material, and (iii) the biocompatibility of NiTi alloy and its subsequent effect on the human body. The review showed that corrosion properties are affected by microstructure, pH of saliva and the presence of fluorides. A high variation in published results should be, therefore, interpreted with care. The release of nickel ions was assessed using the same unit, showing that the vast majority of metal ions were released in the first few days of exposure, then a stable, steady state was reached. In tribocorrosion studies, the increased concentrations of Ni ions were reported.

Design and analysis of a continuum robot for transnasal skull base surgery

BACKGROUND

The traditional surgical instruments for transnasal endoscopic skull base surgery have poor flexibility and continuum robot has attracted extensive attention for its high dexterity and safety.

METHODS

A new type of micro continuum surgical robot is designed. On the basis of kinematic analysis, a superposition method is proposed to analyse the reachable configuration space of the system, and the workspace is analysed. The results obtained by superposition method can provide reference for the selection of joint parameters. At last, the static model of the system is established considering friction and coupling between two segments.

RESULTS

The simulation results show that the workspace can meet the requirements of surgery. And the validity of the static model is verified by numerical simulation and experiment, which lays a foundation for the establishment of the driving force transmission system and precise control of the robot.

CONCLUSIONS

The research results of this study contribute to the real-time control and movement of robot. The proposed continuum robot provides convenient conditions for the clinical application.

Risk Assessment of Oxidative Stress Induced by Metal Ions Released from Fixed Orthodontic Appliances during Treatment and Indications for Supportive Antioxidant Therapy: A Narrative Review

The treatment with fixed orthodontic appliances could have an important role in the induction of oxidative stress and associated negative consequences. Because of the simultaneous effects of corrosion, deformation, friction, and mechanical stress on fixed orthodontic appliances during treatment, degradation of orthodontic brackets and archwires occurs, causing higher concentrations of metal ions in the oral cavity. Corroded appliances cause the release of metal ions, which may lead to the increased values of reactive oxygen species (ROS) due to metal-catalyzed free radical reactions. Chromium, iron, nickel, cobalt, titanium, and molybdenum all belong to the group of transition metals that can be subjected to redox reactions to form ROS. The estimation of health risk due to the amount of heavy metals released and the level of selected parameters of oxidative stress generated for the time of treatment with fixed orthodontic appliances is presented. Approaches to avoid oxidative stress and recommendations for the preventive use of topical or systemic antioxidants during orthodontic treatment are discussed.

Investigation of Post-Processing of Additively Manufactured Nitinol Smart Springs with Plasma-Electrolytic Polishing

Additive manufacturing of Nitinol is a promising field, as it can circumvent the challenges associated with its conventional production processes and unlock unique advantages. However, the accompanying surface features such as powder adhesions, spatters, ballings, or oxide discolorations are undesirable in engineering applications and therefore must be removed. Plasma electrolytic polishing (PeP) might prove to be a suitable finishing process for this purpose, but the effects of post-processing on the mechanical and functional material properties of additively manufactured Nitinol are still largely unresearched. This study seeks to address this issue. The changes on and in the part caused by PeP with processing times between 2 and 20 min are investigated using Nitinol compression springs manufactured by Laser Beam Melting. As a benchmark for the scanning electron microscope images, the differential scanning calorimetry (DSC) measurements, and the mechanical load test cycles, conventionally fabricated Nitinol springs of identical geometry with a medical grade polished surface are used. After 5 min of PeP, a glossy surface free of powder adhesion is achieved, which is increasingly levelled by further polishing. The shape memory properties of the material are retained without a shift in the transformation temperatures being detectable. The decreasing spring rate is primarily attributable to a reduction in the effective wire diameter. Consequently, PeP has proven to be an applicable and effective post-processing method for additively manufactured Nitinol.

Comparison of the Kirschner Wire Tension Band with a Novel Nickel-Titanium Arched Shape-Memory Alloy Connector in Transverse Patellar Fractures: A Retrospective Study

This study aims to compare the clinical outcomes of the nickel-titanium arched shape-memory alloy connector (hereafter referred to as the ASC) and tension band fixation for the treatment of transverse patellar fractures. We retrospectively analyzed a total of 257 patients with transverse patellar fractures who were treated at our emergency orthopaedics department from March 2010 to March 2017. Either an ASC or the Kirschner wire (K-wire) tension band had been used to treat these fractures according to surgeons' experience and preference. We compared operative details, postoperative recovery, and postoperative knee function at 6 months. In terms of surgical duration, blood loss, incision length, length of hospital stay, and postoperative complications, patients in the ASC group showed significantly better results than patients in the K-wire group (p < 0.05). There were no significant differences between the two groups in terms of fracture healing time, knee mobility, and the Boström score at the postoperative 6-month evaluation (p > 0.05). Though, there were similar functional outcomes between two groups whose transverse patellar fractures were different methods, we found that the ASC method was a more reliable, more minimally invasive, and safer treatment option than the tension band wiring method using K-wires, resulting in less tissue damage, shorter surgical duration, shorter length of hospital stay, and fewer complications.

Titanium and Other Metal Hypersensitivity Diagnosed by MELISA® Test: Follow-Up Study

This study is aimed at proving the clinical benefit of the MELISA® test in the minimization or complete elimination of health problems in patients with confirmed hypersensitivity to metals used for tissue replacements. A group of 305 patients aged 20-75 years with previously proven metal hypersensitivity (initial MELISA® test), mainly to titanium and then to another fifteen metals, was chosen from the database at the Institute of Dental Medicine. From these patients, a final group of 42 patients agreed to participate in the study, 35 of which were female and 7 were male. The patients completed a special questionnaire aimed at information regarding change of health status from their last visit and determining whether the results of the initial MELISA® test and recommendations based on it were beneficial for patients or not. They were clinically examined, and peripheral blood samples were taken to perform follow-up MELISA® tests. Questionnaire data was processed, and the follow-up MELISA® test results were compared with the results of the initial MELISA® tests. For statistical analysis, the Fisher's exact test and paired T-test were used. Thirty-two patients reported that they followed the recommendations based on the results of the initial MELISA® tests, and of these, 30 patients (94%) confirmed significant health improvement. Six patients did not follow the recommendation, and from these, only one patient reported an improvement in his health problems. By comparison of the initial and follow-up MELISA® test results, it can be stated that the hypersensitivity to the given metal decreased or disappeared after the therapeutic interventions performed based on the initial MELISA® test results. The evaluation of the data obtained from patients in this study confirmed a significant clinical benefit of MELISA® test.

Key Properties of a Bioactive Ag-SiO2/TiO2 Coating on NiTi Shape Memory Alloy as Necessary at the Development of a New Class of Biomedical Materials

Recent years have seen the dynamic development of methods for functionalizing the surface of implants using biomaterials that can mimic the physical and mechanical nature of native tissue, prevent the formation of bacterial biofilm, promote osteoconduction, and have the ability to sustain cell proliferation. One of the concepts for achieving this goal, which is presented in this work, is to functionalize the surface of NiTi shape memory alloy by an atypical glass-like nanocomposite that consists of SiO2-TiO2 with silver nanoparticles. However, determining the potential medical uses of bio(nano)coating prepared in this way requires an analysis of its surface roughness, tribology, or wettability, especially in the context of the commonly used reference coat-forming hydroxyapatite (HAp). According to our results, the surface roughness ranged between (112 ± 3) nm (Ag-SiO2)-(141 ± 5) nm (HAp), the water contact angle was in the range (74.8 ± 1.6)° (Ag-SiO2)-(70.6 ± 1.2)° (HAp), while the surface free energy was in the range of 45.4 mJ/m2 (Ag-SiO2)-46.8 mJ/m2 (HAp). The adhesive force and friction coefficient were determined to be 1.04 (Ag-SiO2)-1.14 (HAp) and 0.247 ± 0.012 (Ag-SiO2) and 0.397 ± 0.034 (HAp), respectively. The chemical data showed that the release of the metal, mainly Ni from the covered NiTi substrate or Ag from Ag-SiO2 coating had a negligible effect. It was revealed that the NiTi alloy that was coated with Ag-SiO2 did not favor the formation of E. coli or S. aureus biofilm compared to the HAp-coated alloy. Moreover, both approaches to surface functionalization indicated good viability of the normal human dermal fibroblast and osteoblast cells and confirmed the high osteoconductive features of the biomaterial. The similarities of both types of coat-forming materials indicate an excellent potential of the silver-silica composite as a new material for the functionalization of the surface of a biomaterial and the development of a new type of functionalized implants.

Innovative Bioactive Ag-SiO2/TiO2 Coating on a NiTi-Shape Memory Alloy: Structure and Mechanism of Its Formation

In recent years, more and more emphasis has been placed on the development and functionalization of metallic substrates for medical applications to improve their properties and increase their applicability. Today, there are many different types of approaches and materials that are used for this purpose. Our idea was based on a combination of a chemically synthesized Ag-SiO2 nanocomposite and the electrophoretic deposition approach on a NiTi-shape memory substrate. As a result, silver-silica coating was developed on a previously passivated alloy, which was then subjected to sintering at 700 °C for 2 h. The micrometer-sized coat-forming material was composed of large agglomerates consisting of silica and a thin film of submicron- and nano- spherical-shaped particles built of silver, carbon, and oxygen. Structurally, the coatings consisted of a combination of nanometer-sized silver-carbonate that was embedded in thin amorphous silica and siloxy network. The temperature impact had forced morphological and structural changes such as the consolidation of the coat-forming material, and the partial coalescence of the silver and silica particles. As a result, a new continuous complex ceramic coating was formed and was analyzed in more detail using the XPS, XRD, and Raman methods. According to the structural and chemical analyses, the deposited Ag-SiO2 nanocomposite material's reorganization was due to its reaction with a passivated TiO2 layer, which formed an atypical glass-like composite that consisted of SiO2-TiO2 with silver particles that stabilized the network. Finally, the functionalization of the NiTi surface did not block the shape memory effect.

Nitinol in Passive Ossicular Reconstruction-First Results From Temporal Bone Experiments

HYPOTHESIS

Nitinol is a suitable material for passive middle ear prosthesis.

BACKGROUND

In modern ear microsurgery, the restitution of hearing is tremendously important. In passive ossicular reconstruction, rigid alloplastic materials are widespread in use. However, rigid prostheses fail to adapt to atmospheric pressure changes. We describe the use of the super-elastic material nitinol in passive ossicular reconstruction to overcome this limitation.

METHODS

Together with an industrial partner, we developed a nitinol clip prosthesis equipped with a flexible prosthesis headplate. The new prosthesis was evaluated for flexibility and its sound transmission properties were compared with standard clip prostheses. For this purpose, the sound-induced acceleration of the stapes footplate was measured by laser-doppler vibrometry in temporal bones. Furthermore, the flexibility of the prosthesis plate was tested in a load-cell experiment.

RESULTS

On average, the pure tone transmission characteristics of the nitinol prosthesis is statistically not distinguishable from standard titanium clip prostheses. The tests in the load cell confirmed the flexibility of the prosthesis. Any measured prosthesis returns to its original state after deformation.

CONCLUSION

The newly developed nitinol clip prosthesis shows similar sound transmission properties in comparison to established prostheses with high flexibility indicating a step forward to a physiological ossicular chain reconstruction.

Functionalization of the NiTi Shape Memory Alloy Surface by HAp/SiO2/Ag Hybrid Coatings Formed on SiO2-TiO2 Glass Interlayer

The surface modification of NiTi shape memory alloys is a method for increasing their multi-functionalities. In our solution, hydroxyapatite powder was mixed with a chemically synthesized silicon dioxide/silver (nSiO2/Ag) nanocomposite in a different weight ratio between components (1:1, 5:1, and 10:1) and then electrophoretically deposited on the surface of the NiTi alloy, under various time and voltage conditions. Subsequently, uniform layers were subjected to heat treatment at 700 °C for 2 h in an argon atmosphere to improve the strength of their adhesion to the NiTi substrate. A change in linear dimensions of the co-deposited materials during the sintering process was also analyzed. After the heat treatment, XRD, Raman, and Scanning Electron Microscopy (SEM) + Energy Dispersive Spectrometer (EDS) studies revealed the formation of completely new composite coatings, which consisted of rutile and TiO2-SiO2 glass with silver oxide and HAp particles that were embedded into such coatings. It was found that spalling characterized the 1:1 ratio coating, while the others were crack-free, well-adhered, and capable of deformation to 3.5%. Coatings with a higher concentration of nanocomposite were rougher. Electrochemical impedance spectroscopy (EIS) tests in Ringer's solution revealed the capacitive behavior of the material with high corrosion resistance. The kinetics and susceptibility to pitting corrosion was the highest for the NiTi electrode that was coated with a 5:1 ratio HAp/nSiO2/Ag hybrid coating.

Study of Interfacial Adhesion between Nickel-Titanium Shape Memory Alloy and a Polymer Matrix by Laser Surface Pattern

The aim of this article is to investigate the interfacial adhesion of Ni-Ti shape memory alloy with a polymer matrix of Poly (methyl methacrylate) (PMMA). The surface pattern on Ni-Ti plates was channeled by a solid state laser machine. The laser machine allows for creating channels on the Ni-Ti surface for infiltration of the PMMA matrix, which could be attached as an intra-surface locking pattern to the Ni-Ti surface. The influence of the PMMA matrix on the surface of the NiTi plate was evaluated by thermomechanical analysis (TMA) and dynamic mechanical analysis (DMA). The surface characterization was carried out by an optical microscope on the PMMA/NiTi composite after mechanical testing. During mechanical testing, the polymer displays the multiple cracks in the longitudinal direction that result in slipping and fracture. TMA and DMA analyses were performed on the Ni-Ti- and PMMA-coated Ni-Ti ribbon to observe elasticity and the storage modulus for both samples. Better adhesion than 80 % was observed in the Ni-Ti surface, in the laser surface pattern, in comparison to the free plain surface. However, the polymer acts as mechanical backing that caused a reduction in the shape-memory properties of the composite material.

Corrosion resistance of a Nitinol ocular microstent: Implications on biocompatibility

Nitinol is commonly used in medical implants due to its unique thermomechanical properties of shape memory and superelasticity. Free nickel has the potential to induce biological responses that may be a concern for permanent implants manufactured from nickel-containing alloys. Although there are extensive reports on the effects of surface treatments on corrosion behavior in cardiovascular Nitinol implants, there is a lack of data on corrosion resistance and impact on biocompatibility for ocular implants. Therefore, the objective of this study was to determine localized corrosion and nickel elution resistance of an electropolished Nitinol-based ocular device (Hydrus Microstent, Ivantis, Inc.) intended for patients with primary open angle glaucoma. Pitting corrosion susceptibility was characterized by potentiodynamic polarization testing per ASTM F2129. In addition, nickel ion release was quantified with immersion testing to 63 days. The results indicated high localized corrosion resistance as all samples reached polarization potentials of 800 mV without pitting initiation. Maximum nickel elution rates per device were less than approximately 1.1 ng/device/day after the first day of immersion and reduced to less than 0.1 ng/device/day after 7 days. For a patient with bilateral microstents, these nickel concentrations are ×10,000 lower than previously published tolerable intake levels for systemic toxicity. Overall, these corrosion results are in good agreement with literature values of well processed and biocompatible Nitinol devices indicating adverse systemic biological responses are not expected in vivo.

Effect of Ni ion release on the cells in contact with NiTi alloys

Nickel-titanium alloys have been used in medical applications for several years; however, biocompatibility of the material remains controversial. In the present study, the human umbilical vein endothelial cells (HUVEC) were cultured in contact with the nitinol used in two different heat treatment  surface modifications-helium and hydrogen. The amount of Ni ions released from these alloys in contact with HUVEC was measured in media and in the cells by ICP-MS. An increased release of Ni ions was detected in He alloy compared with H₂ alloy modification with an elevation with the metal exposition duration (24 h vs. 72 h). The cells contained the Ni ions in both selected alloy modifications with the lower levels in H₂ alloys. To evaluate the potential of multiple metal applications, similar values were observed in media and in cell suspension for all surface modification combinations. The model analysis of effect of metal ion release on distant cells in the body showed that the concentration is interestingly similar to concentrations in cells in direct contact with the metal alloy. The cells are able to regulate the concentration of Ni ions within the cell. According to our best knowledge, the study for the first time describes the presence of Ni ions released from nitinol directly in the cells. In the case of the H₂ modification, the lowest levels of Ni ions were detected both in medium and in the cells, which likely increases the biocompatibility of the nitinol alloy.

Ion Release and Surface Characterization of Nanostructured Nitinol during Long-Term Testing

The corrosion resistance of nanostructured nitinol (NiTi) was investigated using long-term tests in solutions simulating physiological fluids at static conditions, reflecting the material structure and metal concentration in the solutions. Mechanical polishing reduced the ion release by a factor of two to three, whereas annealing deteriorated the corrosion resistance. The depassivation and repassivation of nitinol surfaces were considered. We found that nanostructured nitinol might increase the corrosion leaching of titanium into solutions, although the nickel release decreased. Metal dissolution did not occur in the alkaline environment or artificial plasma. A Ni-free surface with a protective 25 nm-thick titanium oxide film resulted from soaking mechanically treated samples of the NiTi wire in a saline solution for two years under static conditions. Hence, the medical application of nanostructured NiTi, such as for the production of medical devices and implants such as stents, shows potential compared with microstructured NiTi.

Biocompatibility and Clinical Application of Porous TiNi Alloys Made by Self-Propagating High-Temperature Synthesis (SHS)

Porous TiNi alloys fabricated by self-propagating high-temperature synthesis (SHS) are biomaterials designed for medical application in substituting tissue lesions and they were clinically deployed more than 30 years ago. The SHS process, as a very fast and economically justified route of powder metallurgy, has distinctive features which impart special attributes to the resultant implant, facilitating its integration in terms of bio-mechanical/chemical compatibility. On the phenomenological level, the fact of high biocompatibility of porous SHS TiNi (PTN) material in vivo has been recognized and is not in dispute presently, but the rationale is somewhat disputable. The features of the SHS TiNi process led to a multifarious intermetallic Ti4Ni2(O,N,C)-based constituents in the amorphous-nanocrystalline superficial layer which entirely conceals the matrix and enhances the corrosion resistance of the unwrought alloy. In the current article, we briefly explore issues of the high biocompatibility level on which additional studies could be carried out, as well as recent progress and key fields of clinical application, yet allowing innovative solutions.

Characterisation of NiTi Orthodontic Archwires Surface after the Simulation of Mechanical Loading in CACO2-2 Cell Culture

Nickel-titanium (NiTi) orthodontic archwires are crucial in the initial stages of orthodontic therapy when the movement of teeth and deflection of the archwire are the largest. Their great mechanical properties come with their main disadvantage—the leakage of nickel. Various in vitro studies measured nickel leakage from archwires that were only immersed in the medium with little or minimal simulation of all stress and deflection forces that affect them. This study aims to overcome that by simulating deflection forces that those archwires are exposed to inside the mouth of a patient. NiTi orthodontic archwires were immersed in CACO2-2 cell culture medium and then immediately loaded while using a simulator of multiaxial stress for 24 h. After the experiment, the surface of the NiTi orthodontic archwires were analysed while using scanning electron microscopy (SEM) and auger electron spectroscopy (AES). The observations showed significant microstructural and compositional changes within the first 51 nm thickness of the archwire surface. Furthermore, the released nickel and titanium concentrations in the CACO2-2 cell culture medium were measured while using Inductively Coupled Plasma Mass Spectroscopy (ICP-MS). It was found out that the level of released nickel ions was 1.310 µg/L, which can be assigned as statistically significant results. These data represent the first mention of the already detectable release of Ni ions after 24 h during the simulation of mechanical loading in the CACO2-2 cell culture medium, which is important for clinical orthodontic praxis.

Potential mechanisms of endothelialisation in individuals implanted with a leadless pacemaker systems: An experimental in vitro study

BACKGROUND

Leadless pacemaker technology is a promising upcoming field in clinical rhythmology. Today, the most commonly used system in the clinical setting is the Micra™ leadless pacemaker system (Medtronic). In autopsies of patients who witnessed non-pacemaker associated death, unexpected ingrowth/encapsulation within the wall of the right ventricle was reported. The occurrence of a complete encapsulation was not expected and the process of endothelialisation remains unclear. We hypothesized, that a local inflammatory response might be the cause of these findings. The aim of our experimental in-vitro study was to investigate the effect of the Micra™ system and its single components on inflammatory processes.

METHODS

For this purpose, whole Micra™ pacemakers were incubated in heparin plasma from 25 healthy volunteers for 48 h at 37 °C. Furthermore, 1 g gold, steel, titanium, tungsten and nitinol wires were incubated in heparin plasma for 48 h at 37 °C as well (n = 10). To detect eventual inflammatory processes, interleukin- (IL) 1β, IL-6, and tumor necrosis factor alpha (TNF-α), the chemokine IL-8 were measured using enzyme-linked immunosorbent assay (ELISA). Additionally, the level of transforming growth factor beta 1 (TGF-β1) and vascular endothelial growth factor (VEGF) were analysed.

RESULTS

ELISA analyses showed that the whole Micra system leads to a significant increase in the inflammatory cytokine IL-6 which correlates with the data gained by the incubation of whole blood with the different wires. In particular, 0.5 g of tungsten showed a significant rise of IL-6 which could also be found for IL-1β and IL-8.

CONCLUSIONS

The in vitro study of the Micra system showed that the material composition led to an onset of inflammatory processes in whole blood. Consequently, one may speculate that the composition of Micra pacemaker may have a local inflammatory, though subclinical, effects in patients implanted with a Micra™ pacemakers.

Toward the Development of an Innovative Implant: NiTi Alloy Functionalized by Multifunctional β-TCP+Ag/SiO2 Coatings

In recent years, one of the more important and costly problems of modern medicine is the need to replace or supplement organs in order to improve the quality of human life. In this field, promising solutions seem to have been implants which are based on NiTi alloys with shape memory effects. Unfortunately, this material is susceptible to the corrosion and release of toxic nickel to the human organism. Hence, its application as a long-term material is strongly limited. Therefore, this paper presents a new solution which should help to improve the functionality of the NiTi alloy and elongate its medical stability to use. The idea was focused on functionalization of the implant surface by a biocompatible, multifunctional coating without any impact on the features of the substrate, i.e., the martensitic transformation responsible for shape memory effects. For this purpose, we prepared a colloidal suspension, composed of β-TCP (particle size ∼450 nm) and the Ag/SiO₂ nanocomposite which due to the electrophoretic deposition (EPD) led to the formation of structurally atypical calcium phosphosilicate coating. Those biomaterials formed a crack-free coating, adhering well to the NiTi surface when distributed over the entire surface, with low concentration of metallic and oxide silver (<3 at. %). At the same time, the coat-forming materials had resulted in the growth of a Gram-negative bacterial biofilm. Additionally, the additive of the silver-silica composite enhances cell proliferation, effectively a few times higher than commonly used coat-forming materials (e.g., pure β-TCP).

Corrosion of Metallic Biomaterials: A Review

Metallic biomaterials are used in medical devices in humans more than any other family of materials. The corrosion resistance of an implant material affects its functionality and durability and is a prime factor governing biocompatibility. The fundamental paradigm of metallic biomaterials, except biodegradable metals, has been "the more corrosion resistant, the more biocompatible." The body environment is harsh and raises several challenges with respect to corrosion control. In this invited review paper, the body environment is analysed in detail and the possible effects of the corrosion of different biomaterials on biocompatibility are discussed. Then, the kinetics of corrosion, passivity, its breakdown and regeneration in vivo are conferred. Next, the mostly used metallic biomaterials and their corrosion performance are reviewed. These biomaterials include stainless steels, cobalt-chromium alloys, titanium and its alloys, Nitinol shape memory alloy, dental amalgams, gold, metallic glasses and biodegradable metals. Then, the principles of implant failure, retrieval and failure analysis are highlighted, followed by description of the most common corrosion processes in vivo. Finally, approaches to control the corrosion of metallic biomaterials are highlighted.

Osteoarthritic process modifies expression response to NiTi alloy presence

Nickel-titanium alloy (nitinol, NiTi) is a biomaterial with unique thermal shape memory, superelasticity and high damping properties. Therefore NiTi has been used in medical applications. In this in vitro study, the effect of NiTi alloy (with two surface modifications - helium and hydrogen) on gene expression profile of selected interleukins (IL-1β, IL-6 and IL-8) and matrix metalloproteinases (MMP-1 and MMP-2) in human physiological osteoblasts and human osteoarthritic osteoblasts was examined to respond to a question of the different behavior of bone tissue in the implantation of metallic materials in the presence of cells affected by the osteoarthritic process. The cells were cultivated in contact with NiTi and with or without LPS (bacterial lipolysaccharide). Changes in expression of target genes were calculated by 2^-ΔΔCt method. An increased gene expression of IL-1β in osteoarthritic osteoblasts, with even higher expression in cells collected directly from the metal surface was observed. In case of physiological osteoblasts, the change in expression was detected after LPS treatment in cells surrounding the disc. Higher expression levels of IL-8 were observed in osteoarthritic osteoblasts after NiTi treatment in contact with alloy, and in physiological osteoblasts without relation to location in combination of NiTi and LPS. IL-6 was slightly increased in physiological osteoblastes after application of LPS. MMP-1 expression level was obviously significantly higher in osteoarthritic osteoblasts with differences regarding the metal surface and location. MMP-2 expression was decreased in both cell lines after LPS treatment. In conclusion, results of present study show that the NiTi alloy and the treatment by LPS, especially repeated doses of LPS, change the gene expression of selected ILs and MMPs in human osteoblast cell cultures. Some of the changes were depicted solely to osteoarthritic osteoblasts.

Stretchable, Implantable, Nanostructured Flow-Diverter System for Quantification of Intra-aneurysmal Hemodynamics

Random weakening of an intracranial blood vessel results in abnormal blood flow into an aneurysmal sac. Recent advancements show that an implantable flow diverter, integrated with a medical stent, enables a highly effective treatment of cerebral aneurysms by guiding blood flow into the normal vessel path. None of such treatment systems, however, offers post-treatment monitoring to assess the progress of sac occlusion. Therefore, physicians rely heavily on either angiography or magnetic resonance imaging. Both methods require a dedicated facility with sophisticated equipment settings and time-consuming, cumbersome procedures. In this paper, we introduce an implantable, stretchable, nanostructured flow-sensor system for quantification of intra-aneurysmal hemodynamics. The open-mesh membrane device is capable of effective implantation in complex neurovascular vessels with extreme stretchability (500% radial stretching) and bendability (180° with 0.75 mm radius of curvature) for monitoring of the treatment progress. A collection of quantitative mechanics, fluid dynamics, and experimental studies establish the fundamental aspects of design criteria for a highly compliant, implantable device. Hemocompatibility study using fresh ovine blood captures the device feasibility for long-term insertion in a blood vessel, showing less platelet deposition compared to that in existing implantable materials. In vitro demonstrations of three types of flow sensors show quantification of intra-aneurysmal blood flow in a pig aorta and the capability of observation of aneurysm treatment with a great sensitivity (detection limit as small as 0.032 m/s). Overall, this work describes a mechanically soft flow-diverter system that offers an effective treatment of aneurysms with an active monitoring of intra-aneurysmal hemodynamics.

Electropolymerized hydrophilic coating on stainless steel for biomedical applications

Current metal implants (e.g. stents) covered with drug-eluting coatings are not robust for long-term usage. Other types and methods of coatings are needed, especially ones that are not prone to activity loss in vivo. In this paper, the method of stainless steel (SS) coating with poly(ethylene glycol) dimethacrylate (PEGDMA) with the use of electropolymerization (EP) is presented. The application of a specific and simple reaction mixture enabled the production of SS-PEGDMA materials that possessed a homogenous surface. The polymer coating was durable for 28 days of constant washing. The resulting materials were non-toxic and haemolysis did not occur after incubation with blood. Moreover, because the coating filled up scratches present on bare SS and hydrophilized the SS surface, it reduced fibrinogen adsorption five times in comparison to SS and, unlike on SS, no platelet activation was detected. The presented method is a very promising candidate for scale up due to its simplicity and low cost.

Intracavitary deposits on Essure® hysteroscopic sterilization devices: A case report

Objective

To study the composition of intracavitary deposits on Essure® hysteroscopic sterilization devices.

Design

Case report.

Setting

Reproductive Medicine and Gynecology department of a University Hospital.

Patient(s)

A 39 years old patient presenting with a request for surgical removal of Essure® sterilization devices. Diagnostic hysteroscopy showed a crystal like white deposit attached to one of the devices.

Intervention

Diagnostic hysteroscopy and surgical removal of Essure® devices was performed. The deposits were collected and infrared spectroscopy analysis was performed.

Main Outcome Measure

Chemical composition of the deposits attached to the device.

Result(s)

Infrared spectroscopy of the material showed patterns conclusive with calcite (calcium carbonate, CaCO₃).

Conclusion

Until now, it is not clear if there is a relationship between reported complaints and formation of calcite deposits on Essure®.

Capsule

Infrared spectroscopy of deposits on Essure® devices showed a pattern conclusive with calcite. The relationship between reported complaints and the formation of calcite deposits on Essure® remains unclear.

•

A white, strongly attached deposit was observed on Essure sterilization devices.

•

Infrared spectroscopy of this deposit showed a pattern conclusive with calcite.

•

A relationship between reported complaints and the deposits remains unclear.

•

Future research should focus on the genesis of the deposits, to determine its clinical relevance.

Shape memory response of porous NiTi shape memory alloys fabricated by selective laser melting

Porous NiTi scaffolds display unique bone-like properties including low stiffness and superelastic behavior which makes them promising for biomedical applications. The present article focuses on the techniques to enhance superelasticity of porous NiTi structures. Selective Laser Melting (SLM) method was employed to fabricate the dense and porous (32-58%) NiTi parts. The fabricated samples were subsequently heat-treated (solution annealing + aging at 350 °C for 15 min) and their thermo-mechanical properties were determined as functions of temperature and stress. Additionally, the mechanical behaviors of the samples were simulated and compared to the experimental results. It is shown that SLM NiTi with up to 58% porosity can display shape memory effect with full recovery under 100 MPa nominal stress. Dense SLM NiTi could show almost perfect superelasticity with strain recovery of 5.65 after 6% deformation at body temperatures. The strain recoveries were 3.5, 3.6, and 2.7% for samples with porosity levels of 32%, 45%, and 58%, respectively. Furthermore, it was shown that Young's modulus (i.e., stiffness) of NiTi parts can be tuned by adjusting the porosity levels to match the properties of the bones.

In Vitro Corrosion Assessment of Additively Manufactured Porous NiTi Structures for Bone Fixation Applications

NiTi alloys possess distinct functional properties (i.e., shape memory effect and superelasticity) and biocompatibility, making them appealing for bone fixation applications. Additive manufacturing offers an alternative method for fabricating NiTi parts, which are known to be very difficult to machine using conventional manufacturing methods. However, poor surface quality, and the presence of impurities and defects, are some of the major concerns associated with NiTi structures manufactured using additive manufacturing. The aim of this study is to assess the in vitro corrosion properties of additively manufactured NiTi structures. NiTi samples (bulk and porous) were produced using selective laser melting (SLM), and their electrochemical corrosion characteristics and Ni ion release levels were measured and compared with conventionally fabricated NiTi parts. The additively manufactured NiTi structures were found to have electrochemical corrosion characteristics similar to those found for the conventionally fabricated NiTi alloy samples. The highest Ni ion release level was found in the case of 50% porous structures, which can be attributed to their significantly higher exposed surface area. However, the Ni ion release levels reported in this work for all the fabricated structures remain within the range of most of values for conventionally fabricated NiTi alloys reported in the literature. The results of this study suggest that the proposed SLM fabrication process does not result in a significant deterioration in the corrosion resistance of NiTi parts, making them suitable for bone fixation applications.

The Spatiotemporal Control of Osteoblast Cell Growth, Behavior, and Function Dictated by Nanostructured Stainless Steel Artificial Microenvironments

The successful application of a nanostructured biomaterial as an implant is strongly determined by the nanotopography size triggering the ideal cell response. Here, nanoporous topography on 304L stainless steel substrates was engineered to identify the nanotopography size causing a transition in the cellular characteristics, and accordingly, the design of nanostructured stainless steel surface as orthopedic implants is proposed. A variety of nanopore diameters ranging from 100 to 220 nm were fabricated by one-step electrolysis process and collectively referred to as artificial microenvironments. Control over the nanopore diameter was achieved by varying bias voltage. MG63 osteoblasts were cultured on the nanoporous surfaces for different days. Immunofluorescence (IF) and scanning electron microscopy (SEM) were performed to compare the modulation in cell morphologies and characteristics. Osteoblasts displayed differential growth parameters and distinct transition in cell behavior after nanopore reached a certain diameter. Nanopores with 100-nm diameter promoted cell growth, focal adhesions, cell area, viability, vinculin-stained area, calcium mineralization, and alkaline phosphatase activity. The ability of these nanoporous substrates to differentially modulate the cell behavior and assist in identifying the transition step will be beneficial to biomedical engineers to develop superior implant geometries, triggering an ideal cell response at the cell-nanotopography interface.

Inverted L-Arm Gripper Compliant Mechanism

This work exploits the advantages of compliant mechanisms (devices that achieve their motion through the deflection of flexible members) to enable the creation of small instruments for minimally invasive surgery (MIS). Using flexures to achieve motion presents challenges, three of which are considered in this work. First, compliant mechanisms generally perform inadequately in compression. Second, for a ±90deg range of motion desired for each jaw, the bending stresses in the flexures are prohibitive considering materials used in current instruments. Third, for cables attached at fixed points on the mechanism, the mechanical advantage will vary considerably during actuation. Research results are presented that address these challenges using compliant mechanism principles as demonstrated in a two-degree-of-freedom (2DoF) L-Arm gripper.

The effect of mucin, fibrinogen and IgG on the corrosion behaviour of Ni-Ti alloy and stainless steel

In this study, Ni-Ti alloy and stainless steal were exposed to artificial saliva containing fibrinogen, IgG or mucin, and the resultant corrosion behavior was studied. The purpose was to determine the mechanisms by which different types of protein contribute to corrosion. The effect of different proteins on the electrochemical resistance of Ni-Ti and SS was tested by potentiodynamic polarization, and the repair capacity of passivation film was tested by cyclic polarization measurements. The dissolved corrosion products were determined by ICP-OES, and the surface was analyzed by SEM and AFM. The results showed fibrinogen, IgG or mucin could have different influences on the susceptibility to corrosion of the same alloy. Adding protein lead to the decrease of corrosion resistance of SS, whereas protein could slow down the corrosion process of Ni-Ti. For Ni-Ti, adding mucin could enhance the corrosion stability and repair capacity of passivation film. The susceptibility to pitting corrosion of Ni-Ti and stainless steal in fibrinogen AS is not as high as mucin and IgG AS. There are different patterns of deposition formation on the metal surface by different types of protein, which is associated with their effects on the corrosion process of the alloys.

Mechanical and shape memory properties of porous Ni50.1Ti49.9 alloys manufactured by selective laser melting

Near equiatomic NiTi shape memory alloys were fabricated in dense and designed porous forms by Selective Laser Melting (SLM) and their mechanical and shape memory properties were systematically characterized. Particularly, the effects of pore morphology on their mechanical responses were investigated. Dense and porous NiTi alloys exhibited good shape memory effect with a recoverable strain of about 5% and functional stability after eight cycles of compression. The stiffness and residual plastic strain of porous NiTi were found to depend highly on the pore shape and the level of porosity. Since porous NiTi structures have lower elastic modulus and density than dense NiTi with still good shape memory properties, they are promising materials for lightweight structures, energy absorbers, and biomedical implants.

Biocompatibility and Inflammatory Potential of Titanium Alloys Cultivated with Human Osteoblasts, Fibroblasts and Macrophages

The biomaterials used to maintain or replace functions in the human body consist mainly of metals, ceramics or polymers. In orthopedic surgery, metallic materials, especially titanium and its alloys, are the most common, due to their excellent mechanical properties, corrosion resistance, and biocompatibility. Aside from the established Ti6Al4V alloy, shape memory materials such as nickel-titanium (NiTi) have risen in importance, but are also discussed because of the adverse effects of nickel ions. These might be reduced by specific surface modifications. In the present in vitro study, the osteoblastic cell line MG-63 as well as primary human osteoblasts, fibroblasts, and macrophages were cultured on titanium alloys (forged Ti6Al4V, additive manufactured Ti6Al4V, NiTi, and Diamond-Like-Carbon (DLC)-coated NiTi) to verify their specific biocompatibility and inflammatory potential. Additive manufactured Ti6Al4V and NiTi revealed the highest levels of metabolic cell activity. DLC-coated NiTi appeared as a suitable surface for cell growth, showing the highest collagen production. None of the implant materials caused a strong inflammatory response. In general, no distinct cell-specific response could be observed for the materials and surface coating used. In summary, all tested titanium alloys seem to be biologically appropriate for application in orthopedic surgery.

Improvement of mechanical and biological properties of TiNi alloys by addition of Cu and Co to orthodontic archwires

The purpose of this study was to investigate improved performances of TiNi in order to promote tooth movement. Special attention was paid to the effect on the clinical properties of TiNi of adding Cu and Co to this alloy. Ti49.4Ni50.6, Ti49Ni46Cu5 and Ti50Ni47Co3 (at %) alloys were prepared. Specimens were cold-rolled at 30% reduction and heat-treated at 400°C for 60min. Then, the test results were compared with two types of commercial archwires. The findings showed that superelasticity properties were confirmed in the manufactured commercial alloys at mouth temperature. The difference of stress plateau in TiNi, TiNiCo and commercial wires B at 25°C changed significantly at various testing temperatures due to the combination of martensite and austenite phases. At certain temperatures the alloys exhibited zero recovery stress at 2% strain and consequently produced zero activation force for moving teeth. The corrosion test showed that the addition of Cu and Co to TiNi alloys generates an increase in corrosion potential (Ecorr) and corrosion current densities (Icorr). Finally, we observed that addition of Cu and Co improved cell viability. We conclude that addition of an appropriate amount of a third alloying element can help enhance the performances of TiNi orthodontic archwires.

Biocompatibility and Biostability of Metallic Endovascular Implants: State of the Art and Perspectives

This work was partly supported by the Natural Science and Engineering Research Council (NSERC) of Canada.

More than a million metallic endovascular devices are implanted each year, but the quest for the perfect material continues. The importance of interfacial properties in the overall biocompatibility of metals and alloys has been recognized for a long time. In particular, these properties modulate the hemocompatibility of devices in contact with blood and, in turn, strongly influence implantation outcomes. In this article, the relative properties of metallic materials commonly used in endovascular applications are reviewed. Particular emphasis is given to the corrosion behavior of metallic endovascular materials and the specific surface treatments used in the production processes. Issues relative to corrosion assays will also be reviewed in terms of their relevance to in vivo applications. The potential adverse effects of degradation products with respect to endovascular applications will be described. Finally, this review addresses future perspectives of metallic devices in endovascular procedures in view of the recent promises of antiproliferative strategies that are likely to profoundly modify current procedures.

Retrospective Analysis of Outcomes after Stapedotomy with Implantation of a Self-Crimping Nitinol Stapes Prosthesis

OBJECTIVE: To review hearing results after implantation of a self-crimping stapes prosthesis.

STUDY DESIGN AND SETTING: Analysis of hearing results in patients implanted with a self-crimping stapes prosthesis at two academic hospitals from 2000 to 2004.

RESULTS: Seventy-nine ears were divided into short-term and intermediate follow-up groups. The mean postoperative air-bone gap (ABG), preoperative minus postoperative ABG, and preoperative minus postoperative bone conduction values were 5.7, 21.4, and 4.1 dB, respectively, for the short-term group, and 6.3, 22.3, and 4.7dB, respectively, for the intermediate group. The ABG was <10 dB in 88 percent of the short-term group and in 79 percent of the intermediate group.

CONCLUSIONS: The self-crimping Nitinol stapes prosthesis provides excellent short-term and intermediate postoperative hearing results, and may overcome the limitations of stapes prostheses requiring manual crimping.

SIGNIFICANCE: This paper provides evidence for the use of a self-crimping Nitinol stapes prosthesis, which may simplify hearing restoration surgery for stapes fixation.

A novel low-profile ventriculoamniotic shunt for foetal aqueductal stenosis

This study proposed a novel ventriculoamniotic shunt device for foetal aqueductal stenosis treatment fabricated with 3Fr or 4Fr size catheters that have a longitudinal bending stiffness with kink resistance, sufficient luminal area for cerebrospinal fluid drainage and capacity for valve integration. Computational flow dynamics studies were carried out to optimise the device design, including size of the lumen and length of the device. An in vitro pressure and flow rate measurement test circuit was constructed to assess the high pressure relieving functionality of draining cerebrospinal fluid from foetal brain. Additionally, a resistance force measurement test platform was built to quantitatively evaluate the anchor performance of various geometric designs. The valve functionality was qualitatively evaluated through the visualisation of the flow patterns in the amniotic sac with injected red coloured fluid under stereomicroscopy. These in vitro results demonstrate the feasibility of the ventriculoamniotic shunt device designed for placement in the foetal brain.

In vitro and in vivo evidence of the cytotoxic and genotoxic effects of metal ions released by orthodontic appliances: A review

Intraoral fixed orthodontic appliances are frequently used in the clinical practice of dentistry. They are made from alloys containing different metals at various percentages. The use of these appliances leads to the long-term exposure of patients to these materials, and the potential toxic effects of this exposure raises concerns about patient safety. Thus, the biocompatibility (corrosion behaviour and toxicity) of these materials has to be evaluated prior to clinical use. In the present report, the most recent studies in the scientific literature examining metal ion release from orthodontic appliances and the toxic effects of these ions have been reviewed with a special focus on cytotoxicity and genotoxicity. Previous studies suggest that a case-by-case safety evaluation is required to take into account the increasing variability of materials, their composition and the manufacturing processes. Moreover, in vivo toxicity studies in regard to metal release, cytotoxicity and genotoxicity are still scarce. Therefore, in vitro and in vivo monitoring studies are needed to establish cause-effect relationships between metal ion release and biomarkers of cytotoxicity and genotoxicity. Further investigations could be performed to elucidate the toxic mechanisms involved in the observed effects with a special emphasis on oxidative damage.