Resorption of hydroxyapatite and fluorapatite ceramic coatings on weight-bearing implants: a quantitative and morphological study in dogs

3D Printing of Cobalt-Incorporated Chloroapatite Bioceramic Composite Scaffolds with Antioxidative Activity for Enhanced Osteochondral Regeneration

Osteochondral defects are often accompanied by excessive reactive oxygen species (ROS) caused by osteoarthritis or acute surgical inflammation. An inflammatory environment containing excess ROS will not only hinder tissue regeneration but also impact the quality of newly formed tissues. Therefore, there is an urgent need to develop scaffolds with both ROS scavenging and osteochondral repair functions to promote and protect osteochondral tissue regeneration. In this work, by using 3D printing technology, a composite scaffold based on cobalt-incorporated chloroapatite (Co-ClAP) bioceramics, which possesses ROS-scavenging activity and can support cell proliferation, adhesion, and differentiation, is developed. Benefiting from the catalytic activity of Co-ClAP bioceramics, the composite scaffold can protect cells from oxidative damage under ROS-excessive conditions, support their directional differentiation, and simultaneously mediate an anti-inflammatory microenvironment. In addition, it is also confirmed by using rabbit osteochondral defect model that the Co-ClAP/poly(lactic-co-glycolic acid) scaffold can effectively promote the integrated regeneration of cartilage and subchondral bone, exhibiting an ideal repair effect in vivo. This study provides a promising strategy for the treatment of defects with excess ROS and inflammatory microenvironments.

Bone on-a-chip: a 3D dendritic network in a screening platform for osteocyte-targeted drugs

Age-related musculoskeletal disorders, including osteoporosis, are frequent and associated with long lasting morbidity, in turn significantly impacting on healthcare system sustainability. There is therefore a compelling need to develop reliable preclinical models of disease and drug screening to validate novel drugs possibly on a personalized basis, without the need ofin vivoassay. In the context of bone tissue, although the osteocyte (Oc) network is a well-recognized therapeutic target, currentin vitropreclinical models are unable to mimic its physiologically relevant and highly complex structure. To this purpose, several features are needed, including an osteomimetic extracellular matrix, dynamic perfusion, and mechanical cues (e.g. shear stress) combined with a three-dimensional (3D) culture of Oc. Here we describe, for the first time, a high throughput microfluidic platform based on 96-miniaturized chips for large-scale preclinical evaluation to predict drug efficacy. We bioengineered a commercial microfluidic device that allows real-time visualization and equipped with multi-chips by the development and injection of a highly stiff bone-like 3D matrix, made of a blend of collagen-enriched natural hydrogels loaded with hydroxyapatite nanocrystals. The microchannel, filled with the ostemimetic matrix and Oc, is subjected to passive perfusion and shear stress. We used scanning electron microscopy for preliminary material characterization. Confocal microscopy and fluorescent microbeads were used after material injection into the microchannels to detect volume changes and the distribution of cell-sized objects within the hydrogel. The formation of a 3D dendritic network of Oc was monitored by measuring cell viability, evaluating phenotyping markers (connexin43, integrin alpha V/CD51, sclerostin), quantification of dendrites, and responsiveness to an anabolic drug. The platform is expected to accelerate the development of new drug aimed at modulating the survival and function of osteocytes.

Monocyte Differentiation on Atomic Layer-Deposited (ALD) Hydroxyapatite Coating on Titanium Substrate

Hydroxyapatite (HA; Ca₁₀(PO₄)₆(OH)₂) coating of bone implants has many beneficial properties as it improves osseointegration and eventually becomes degraded and replaced with new bone. We prepared HA coating on a titanium substrate with atomic layer deposition (ALD) and compared monocyte differentiation and material resorption between ALD-HA and bone. After stimulation with macrophage colony-stimulating factor (M-CSF) and receptor activator of nuclear factor kappa-B ligand (RANKL), human peripheral blood monocytes differentiated into resorbing osteoclasts on bovine bone, but non-resorbing foreign body cells were observed on ALD-HA. The analysis of the topography of ALD-HA and bone showed no differences in wettability (water contact angle on ALD-HA 86.2° vs. 86.7° on the bone), but the surface roughness of ALD-HA (Ra 0.713 µm) was significantly lower compared to bone (Ra 2.30 µm). The cellular reaction observed on ALD-HA might be a consequence of the topographical properties of the coating. The absence of resorptive osteoclasts on ALD-HA might indicate inhibition of their differentiation or the need to modify the coating to induce osteoclast differentiation.

Physicochemical and Biological Evaluation of Chitosan-Coated Magnesium-Doped Hydroxyapatite Composite Layers Obtained by Vacuum Deposition

In the present work, the effectiveness of vacuum deposition technique for obtaining composite thin films based on chitosan-coated magnesium-doped hydroxyapatite Ca10−xMgx(PO4)6 (OH)2 with xMg = 0.025 (MgHApCh) was proved for the first time. The prepared samples were exposed to three doses (0, 3, and 6 Gy) of gamma irradiation. The MgHApCh composite thin films nonirradiated and irradiated were evaluated by scanning electron microscopy (SEM), atomic force microscopy (AFM), and X-ray photoelectron spectroscopy (XPS) studies. The biological evaluation of the samples was also presented. All the results obtained from this study showed that the vacuum deposition method allowed for obtaining uniform and homogeneous layers. Fine cracks were observed on the MgHApCh composite thin films’ surface after exposure to a 6 Gy irradiation dose. Additionally, after gamma irradiation, a decrease in Ca, P, and Mg content was noticed. The MgHApCh composite thin films with doses of 0 and 3 Gy of gamma irradiation showed a cellular viability similar to that of the control. Samples with 6 Gy doses of gamma irradiation did not cause significantly higher fibroblast cell death than the control (p > 0.05). On the other hand, the homogeneous distribution of pores that appeared on the surface of coatings after 6 Gy doses of gamma irradiation did not prevent the adhesion of fibroblast cells and their spread on the coatings. In conclusion, we could say that the thin films could be suitable both for use in bone implants and for other orthopedic and dentistry applications.

Osteoblast Attachment on Titanium Coated with Hydroxyapatite by Atomic Layer Deposition

Background: The increasing demand for bone implants with improved osseointegration properties has prompted researchers to develop various coating types for metal implants. Atomic layer deposition (ALD) is a method for producing nanoscale coatings conformally on complex three-dimensional surfaces. We have prepared hydroxyapatite (HA) coating on titanium (Ti) substrate with the ALD method and analyzed the biocompatibility of this coating in terms of cell adhesion and viability. Methods: HA coatings were prepared on Ti substrates by depositing CaCO₃ films by ALD and converting them to HA by wet treatment in dilute phosphate solution. MC3T3-E1 preosteoblasts were cultured on ALD-HA, glass slides and bovine bone slices. ALD-HA and glass slides were either coated or non-coated with fibronectin. After 48h culture, cells were imaged with scanning electron microscopy (SEM) and analyzed by vinculin antibody staining for focal adhesion localization. An 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) test was performed to study cell viability. Results: Vinculin staining revealed similar focal adhesion-like structures on ALD-HA as on glass slides and bone, albeit on ALD-HA and bone the structures were thinner compared to glass slides. This might be due to thin and broad focal adhesions on complex three-dimensional surfaces of ALD-HA and bone. The MTT test showed comparable cell viability on ALD-HA, glass slides and bone. Conclusion: ALD-HA coating was shown to be biocompatible in regard to cell adhesion and viability. This leads to new opportunities in developing improved implant coatings for better osseointegration and implant survival.

Sol-Gel Derived Hydroxyapatite Coatings for Titanium Implants: A Review

With the growing demands for bone implant therapy, titanium (Ti) and its alloys are considered as appropriate choices for the load-bearing bone implant substitutes. However, the interaction of bare Ti-based implants with the tissues is critical to the success of the implants for long-term stability. Thus, surface modifications of Ti implants with biocompatible hydroxyapatite (HAp) coatings before implantation is important and gained interest. Sol-gel is a potential technique for deposition the biocompatible HAp and has many advantages over other methods. Therefore, this review strives to provide widespread overview on the recent development of sol-gel HAp deposition on Ti. This study shows that sol-gel technique was able to produce uniform and homogenous HAp coatings and identified the role of surface pretreatment of Ti substrate, optimizing the sol-gel parameters, substitution, and reinforcement of HAp on improving the coating properties. Critical factors that influence on the characteristics of the deposited sol-gel HAp films as corrosion resistance, adhesion to substrate, bioactivity, morphological, and structural properties are discussed. The review also highlights the critical issues, the most significant challenges, and the areas requiring further research.

Comparative study of hydroxyapatite, fluor-hydroxyapatite and Si-substituted hydroxyapatite nanoparticles on osteogenic, osteoclastic and antibacterial ability

This study compared the effects of hydroxyapatite (HA), fluor-hydroxyapatite (FHA) and Si-substituted hydroxyapatite (SiHA) on osteogenic differentiation, osteoclastic activity and antibacterial properties. HA, FHA and SiHA were prepared via a sol-gel reaction and characterized by scanning electron microscopic analysis (SEM), transmission electron microscopic analysis (TEM), and X-ray photoelectron spectrometry. Cell proliferation was evaluated using an MTT assay and cytoskeletal morphology was observed by fluorescence microscopy. Osteogenic differentiation was evaluated using alkaline phosphatase activity and Alizarin red staining. Quantitative real-time PCR was used to evaluate the mRNA expression of runt-related transcription factor 2 (Runx2) and osteopontin (OPN). New bone formation was tested using μCT, haematoxylin and eosin staining and TRAP staining. The antibacterial actions against Porphyromonas gingivalis (P. g) were evaluated through plate counting and live-dead bacterial staining. The results demonstrated that HA, FHA and SiHA can promote proliferation of bone mesenchymal stem cells (BMSCs). ALP activity in FHA extract with a concentration of 625 μg mL-1 was the highest after 14 days osteogenic induction; similar results were observed for Runx2 and OPN mRNA expression. HA, FHA and SiHA decreased trabecular space in bone defects, but FHA reduced osteoclastic activity and inhibited P. g growth. In conclusion, FHA can promote osteogenic activity, reduce osteoclastic activity and enhance antibacterial effects.

Calcium Phosphate Bioceramics: A Review of Their History, Structure, Properties, Coating Technologies and Biomedical Applications

Calcium phosphate (CaP) bioceramics are widely used in the field of bone regeneration, both in orthopedics and in dentistry, due to their good biocompatibility, osseointegration and osteoconduction. The aim of this article is to review the history, structure, properties and clinical applications of these materials, whether they are in the form of bone cements, paste, scaffolds, or coatings. Major analytical techniques for characterization of CaPs, in vitro and in vivo tests, and the requirements of the US Food and Drug Administration (FDA) and international standards from CaP coatings on orthopedic and dental endosseous implants, are also summarized, along with the possible effect of sterilization on these materials. CaP coating technologies are summarized, with a focus on electrochemical processes. Theories on the formation of transient precursor phases in biomineralization, the dissolution and reprecipitation as bone of CaPs are discussed. A wide variety of CaPs are presented, from the individual phases to nano-CaP, biphasic and triphasic CaP formulations, composite CaP coatings and cements, functionally graded materials (FGMs), and antibacterial CaPs. We conclude by foreseeing the future of CaPs.

Preparation of up-converting nano-biphasic calcium phosphate

The nano-biphasic calcium phosphate co-doped with 1 mol% Er³⁺ and 5 mol% Yb³⁺ ions was prepared using modified Pechini's technique.

Comparison of Physical-chemical and Mechanical Properties of Chlorapatite and Hydroxyapatite Plasma Sprayed Coatings

Chlorapatite can be considered a potential biomaterial for orthopaedic applications. Its use as plasma-sprayed coating could be of interest considering its thermal properties and particularly its ability to melt without decomposition unlike hydroxyapatite. Chlorapatite (ClA) was synthesized by a high-temperature ion exchange reaction starting from commercial stoichiometric hydroxyapatites (HA). The ClA powder showed similar characteristics as the original industrial HA powder, and was obtained in the monoclinic form. The HA and ClA powders were plasma-sprayed using a low-energy plasma spraying system with identical processing parameters. The coatings were characterized by physical-chemical methods, i.e. X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and Raman spectroscopy, including distribution mapping of the main phases detected such as amorphous calcium phosphate (ACP), oxyapatite (OA), and HA or ClA. The unexpected formation of oxyapatite in ClA coatings was assigned to a side reaction with contaminating oxygenated species (O2, H2O). ClA coatings exhibited characteristics different from HA, showing a lower content of oxyapatite and amorphous phase. Although their adhesion strength was found to be lower than that of HA coatings, their application could be an interesting alternative, offering, in particular, a larger range of spraying conditions without formation of massive impurities.

Hydroxyapatite and fluorapatite coatings on dental screws: effects of blast coating process and biological response

This paper describes the deposition of hydroxyapatite (HA) and fluorapatite (FA) onto titanium dental screws using a novel ambient temperature coating technique named CoBlast. The process utilises a coating medium and a blast medium sprayed simultaneously at the substrate surface. The blast medium was a sintered apatite (sHA) and two particles sizes (<106 and <180 µm) were used to assess their influence on the coating process. The influence of the coating process on the coating composition, coating adhesion, screw morphology and screw microstructure was examined. XRD analysis revealed the coating crystallinity was the same as the original HA and FA feedstock powders. Examining the screw's morphology, the threads of the CoBlasted screws exhibited rounding compared to the unmodified screw. This is due to the abrasive nature of the CoBlast process. The degree of rounding was more significant for the screws blasted with the 180 µm sHA than the 106 µm sHA. The blast media particle size significantly influences the surface roughness of both the substrate and coating and the microstructure of the substrate. The screws did not exhibit any loss of coating after insertion into a model bone material, indicating that the coating was strongly adhered to the substrate. There was no statistically significant difference in cell attachment and cell morphology on the unmodified substrates compared to the coated substrates. In conclusion, the CoBlast process can be used to deposit HA and FA onto complex geometries such as dental screws. The choice of blast medium particle size influences the screws morphology. The coating process does not negatively impact on the cell attachment and morphology in vitro.

Effect of TiO2 addition on surface microstructure and bioactivity of fluorapatite coatings deposited using Nd:YAG laser

To study the effect of titania (TiO2) addition on the surface microstructure and bioactivity of fluorapatite coatings, fluorapatite was mixed with TiO2 in 1:0.5 (FA + 0.5TiO2), 1:0.8 (FA + 0.8TiO2), and 1:1 (FA + TiO2) ratios (wt%) and clad on Ti-6Al-4V substrates using an Nd:YAG laser system. The experimental results show that the penetration depth of the weld decreases with increasing TiO2 content. Moreover, the subgrain structure of the coating layer changes from a fine cellular-like structure to a cellular-dendrite-like structure as the amount of TiO2 increases. Consequently, as the proportion of TiO2 decreases (increase in fluorapatite content), the Ca/P ratio of the coating layer also decreases. The immersion of specimens into simulated body fluid resulted in the formation of individual apatite. With a lower Ca/P ratio before immersion, the growth of the apatite was faster and then the coating layer provided a better bioactivity. X-ray diffraction analysis results show that prior to simulated body fluid immersion, the coating layer in all three specimens was composed mainly of fluorapatite, CaTiO3, and Al2O3 phases. Following simulated body fluid immersion, a peak corresponding to hydroxycarbonated apatite appeared after 2 days in the FA + 0.5TiO2 and FA + 0.8TiO2 specimens and after 7 days in the FA + TiO2 specimen. Overall, the results show that although the bioactivity of the coating layer tended to decrease with increasing TiO2 content, in accordance with the above-mentioned ratios, the bioactivity of all three specimens remained generally good.

Significance of calcium phosphate coatings for the enhancement of new bone osteogenesis--a review

A systematic analysis of results available from in vitro, in vivo and clinical trials on the effects of biocompatible calcium phosphate (CaP) coatings is presented. An overview of the most frequently used methods to prepare CaP-based coatings was conducted. Dense, homogeneous, highly adherent and biocompatible CaP or hybrid organic/inorganic CaP coatings with tailored properties can be deposited. It has been demonstrated that CaP coatings have a significant effect on the bone regeneration process. In vitro experiments using different cells (e.g. SaOS-2, human mesenchymal stem cells and osteoblast-like cells) have revealed that CaP coatings enhance cellular adhesion, proliferation and differentiation to promote bone regeneration. However, in vivo, the exact mechanism of osteogenesis in response to CaP coatings is unclear; indeed, there are conflicting reports of the effectiveness of CaP coatings, with results ranging from highly effective to no significant or even negative effects. This review therefore highlights progress in CaP coatings for orthopaedic implants and discusses the future research and use of these devices. Currently, an exciting area of research is in bioactive hybrid composite CaP-based coatings containing both inorganic (CaP coating) and organic (collagen, bone morphogenetic proteins, arginylglycylaspartic acid etc.) components with the aim of promoting tissue ingrowth and vascularization. Further investigations are necessary to reveal the relative influences of implant design, surgical procedure, and coating characteristics (thickness, structure, topography, porosity, wettability etc.) on the long-term clinical effects of hybrid CaP coatings. In addition to commercially available plasma spraying, other effective routes for the fabrication of hybrid CaP coatings for clinical use still need to be determined and current progress is discussed.

A review of protein adsorption on bioceramics

Bioceramics, because of its excellent biocompatible and mechanical properties, has always been considered as the most promising materials for hard tissue repair. It is well know that an appropriate cellular response to bioceramics surfaces is essential for tissue regeneration and integration. As the in vivo implants, the implanted bioceramics are immediately coated with proteins from blood and body fluids, and it is through this coated layer that cells sense and respond to foreign implants. Hence, the adsorption of proteins is critical within the sequence of biological activities. However, the biological mechanisms of the interactions of bioceramics and proteins are still not well understood. In this review, we will recapitulate the recent studies on the bioceramic-protein interactions.

A modified cementing technique using BoneSource to augment fixation of the acetabulum in a sheep model

BACKGROUND AND PURPOSE

Our aim was to assess in an animal model whether the use of HA paste at the cement-bone interface in the acetabulum improves fixation. We examined, in sheep, the effect of interposing a layer of hydroxyapatite cement around the periphery of a polyethylene socket prior to fixing it using polymethylmethacrylate (PMMA).

METHODS

We performed a randomized study involving 22 sheep that had BoneSource hydroxyapatite material applied to the surface of the acetabulum before cementing a polyethylene cup at arthroplasty. We studied the gross radiographic appearance of the implant-bone interface and the histological appearance at the interface.

RESULTS

There were more radiolucencies evident in the control group. Histologically, only sheep randomized into the BoneSource group exhibited a fully osseointegrated interface. Use of the hydroxyapatite material did not give any detrimental effects. In some cases, the material appeared to have been fully resorbed. When the material was evident in histological sections, it was incorporated into an osseointegrated interface. There was no giant cell reaction present. There was no evidence of migration of BoneSource to the articulation.

INTERPRETATION

The application of HA material prior to cementation of a socket produced an improved interface. The technique may be useful in humans, to extend the longevity of the cemented implant by protecting the socket interface from the effect of hydrodynamic fluid flow and particulate debris.

Early bone apposition and 1-year performance of the electrodeposited calcium phosphate coatings: an experimental study in rabbit femora

OBJECTIVES

The aim of this study was to investigate the early bone apposition and 1-year performance of the electrodeposited calcium phosphate coatings with or without chitosan.

MATERIAL AND METHODS

Seventy-two cylindrical implants with a length of 8 mm and a diameter of 3.3 mm were divided into three groups: electrodeposited calcium phosphate coated without chitosan, with chitosan, and an uncoated control. The implants adopted the special gap design and were inserted into the rabbit femora. After 2, 4, 26, and 52 weeks, the implants were retrieved and analyzed for bone formation, bone-to-implant contact, and coating degradation.

RESULTS

It was found that the coatings without chitosan had the highest bone contact at early time (P<0.05). The coatings with chitosan had the least bone formation within gaps after 2, 4, and 26 weeks of implantation (P<0.05). However, no difference was found among the three groups after 52 weeks. Both coatings showed degradation as early as 2 weeks post-implantation. And after 52 weeks, most of the coatings had been degraded. There were no inflammatory reactions and hardly any osteoclasts around the implants and the coatings. The confocal laser scanning microscopy observation further demonstrated the different bone deposition characteristics. With scanning electron microscopy, no coatings could be found on both the implant surface and the bone interface.

CONCLUSIONS

Bone apposition to both electrodeposited calcium phosphate coatings was different at early time but almost the same after 52 weeks. And both coatings showed early as well as a continued degradation in the rabbit femora. To cite this article: Wang J, Sun C, Wang Y, Wang Y. Early bone apposition and 1-year performance of the electrodeposited calcium phosphate coatings: an experimental study in rabbit femora. Clin.

Fluoridated hydroxyapatite/titanium dioxide nanocomposite coating fabricated by a modified electrochemical deposition

Fluoridated hydroxyapatite/titanium dioxide nanocomposite coating was successfully fabricated by a modified electrochemical deposition technique. F(-) ions, nanoscaled TiO(2) particles and 6% H(2)O(2) was added into the electrolyte, and ultrasonication was also performed to prepare this nanocomposite coating. The microstructure, phase composition, dissolution rate, bonding strength and in vitro cellular responses of the composite coating were investigated. The results show that the composite coating was uniform and dense owing to the effects of H(2)O(2) and ultrasonication. The thickness of the composite coating was ~5 mum and scanning electron microscopy revealed that nanoscaled TiO(2) particles were imbedded uniformly between FHA crystals. The addition of F(-) and TiO(2) reduced the crystallite size and increased the crystallinity of HA in FHA/TiO(2) composite coating. In addition, the composite coating shows higher bonding strength and lower dissolution rate than pure HA coating, and the in vitro bioactivity of FHA/TiO(2) composite coating was not affected as compared with pure HA coating.

Bone remodeling and hydroxyapatite resorption in coated primary hip prostheses

Hydroxyapatite coatings for THA promote bone ongrowth, but bone and coating are exposed to stress shielding-driven osteoclastic resorption. We asked: (1) if the resorption of hydroxyapatite coating and bone ongrowth correlated with demographics; (2) if the resorption related to the stem level; and (3) what happens to the implant-bone interface when all hydroxyapatite coating is resorbed? We recovered 13 femoral components from cadaveric specimens 3.3 to 11.2 years after uneventful primary THA. Three cross sections (proximal, medial, distal) of the hydroxyapatite-coated proximal implant sleeve were analyzed by measuring the percentage of residual hydroxyapatite and bone ongrowth on the implant perimeter. Hydroxyapatite resorption was independent of patient age but increased with time in vivo and mostly was gone after 8 years. Bone ongrowth was independent of time in vivo but decreased with aging patients. Only in the most proximal section did less residual hydroxyapatite correlate with less bone ongrowth. Hydroxyapatite resorption, which was more proximal than distal, showed no adverse effects on the implant-bone interface.

Biocompatibility evaluation of a novel hydroxyapatite-polymer coating for medical implants (in vitro tests)

Nanocomposites consisting of hydroxyapatite (HA) and a sodium maleate copolymer (maleic polyelectrolyte), synthesized by hydrothermal method and deposited on titanium substrates by Matrix Assisted Pulsed Laser Evaporation (MAPLE) technique were tested for the biological properties. Coating bioanalysis was carried out by triple staining of actin, microtubules and nuclei followed by immunofluorescence microscopy. Within 24 h cells that occupied the biomaterial surface displayed the morphology and cytoskeleton pattern similar to the controls. Cells grown on nanocomposite coated surfaces had a higher proliferation rate than their counterparts grown on Ti coated with HA alone, indicating that maleic polyelectrolyte improved surface bio-adhesive characteristics. The capacity to induce cell attachment, spreading and proliferation demonstrated the potential of Ti coated with HA-polymer nanocomposites to be used as scaffolds in dental or orthopedic implantology.

Histological and histomorphometric investigations on bone integration of rapidly resorbable calcium phosphate ceramics

Resorbable ceramics can promote the bony integration of implants. Their rate of degradation should ideally be synchronized with bone regeneration. We report here the results of a histological study of implants with two resorbable calcium phosphate ceramic coatings: Ca(2)KNa(PO(4))(2)-(GB14) and Ca(10)[K/Na](PO(4))(7)-(602020). The results attained with these ceramic-coated implants show the benefits of these materials with regard to bioactive bone-healing stimulation, compared with uncoated implants. The GB14 ceramic coating exhibited greater bone regeneration and differentiation on its surface than the conventional hydroxyapatite coating and helped bone tissue achieve more extensive contact free of connective tissue. Not until the coating disintegrated did the histological features of GB14- and 602020-coated implants converge-both implant types were integrated into bone. Rapid disintegration of the coating material, as with 602020, supports osteoblast proliferation but has negative effects on bone mineralization. Both resorbable ceramics tested, GB14 and 602020, demonstrated bioactivity; even metal surfaces coated with these materials were populated by mature bone tissue without connective tissue after disintegration of their ceramic coating. The less rapidly degrading material, GB14, achieved better results. Degradable calcium phosphate coatings have the potential to stimulate bone regeneration. From the histological viewpoint, the resorbable ceramics examined here can be recommended as coating materials for clinical use.

Surface characterization of colloidal-sol gel derived biphasic HA/FA coatings

Hydroxyapatite (HA) powders are ultrasonically dispersed in the precursor of fluoridated hydroxyapatite (FHA) or fluorapatite (FA) to form a "colloidal sol". HA/FA biphasic coatings are prepared on Ti6Al4V substrate via dip coating, 150 degrees C drying and 600 degrees C firing. The coatings show homogenous distribution of HA particles in the FA matrix. The relative phase proportion can be tailored by the amount of HA in the colloidal sol. The surfaces of the coatings consist of two kinds of distinct domains: HA and FA, resulting in a compositionally heterogeneous surface. The biphasic coating surface becomes increasingly rougher with HA powders, from around 200 nm of pure FA to 400-600 nm in Ra of biphasic coatings. The rougher biphasic HA/FA surfaces with chemically controllable domains will favor cell attachment, apatite layer deposition and necessary dissolution in clinical applications.

Osteoblastic cell response on fluoridated hydroxyapatite coatings

Fluoridated hydroxyapatite (FHA) coatings were deposited onto Ti6Al4V substrates by sol-gel dip-coating method. X-ray photoelectron spectroscopy results showed that fluoride ions were successfully incorporated into the hydroxyapatite (HA) lattice structure. The dissolution behavior in Tris-buffered physiological saline indicated that all fluoridated HA coatings had lower solubility than that of the pure HA coating. The lowest solubility was obtained at fluoride ion concentrations of 0.8-1.1M. In vitro cell responses were evaluated with human osteosarcoma MG63 cells in terms of cell morphology, proliferation and differentiation (alkaline phosphatase activity and osteocalcin level). For all coatings tested, similar cell morphologies and good cell viability were observed. Coatings fluoridated to 0.8-1.1 had a stronger stimulating effect on cell proliferation and differentiation activities. The influences on cell phenotypes were attributed mainly to a combined ion effect of Ca, P and F released from the coating during dissolution. For the best dissolution resistance and cell activities, it is recommended that the molar level of fluoride ion be from 0.8 to 1.1, such that the coating takes the form of Ca(10)(PO(4))(6)(OH)(1.2-0.9)F(0.8-1.1).

Bond-coating in plasma-sprayed calcium-phosphate coatings

The influence of bond-coating on the mechanical properties of plasma-spray coatings of hydroxyatite on Ti was investigated. Plasma-spray powder was produced from human teeth enamel and dentine. Before processing the main apatite coating, a very thin layer of Al2O3/TiO2 was applied on super clean and roughened, by Al2O3 blasting, Ti surface as bond-coating. The experimental results showed that bond-coating caused significant increase of the mechanical properties of the coating layer: In the case of the enamel powder from 6.66 MPa of the simple coating to 9.71 MPa for the bond-coating and in the case of the dentine powder from 6.27 MPa to 7.84 MPa, respectively. Both tooth derived powders feature high thermal stability likely due to their relatively high content of fluorine. Therefore, F-rich apatites, such those investigated in this study, emerge themselves as superior candidate materials for calcium phosphate coatings of producing medical devices. The methods of apatite powder production and shaping optimization of powder particles are both key factors of a successful coating. The methods used in this study can be adopted as handy, inexpensive and reliable ways to produce high quality of powders for plasma spray purposes.

Early failure of hemispheric hydroxyapatite-coated acetabular cups

Total hip arthroplasties with hydroxyapatite coatings have shown encouraging results after early-term followup. We presumed hydroxyapatite-coating on a smooth hemispheric press-fit acetabular cup would enhance bone osseointegration and maintain stability of cup after midterm (minimum 5-year) followup. Sixty-three patients had 70 consecutive total hip arthroplasties. Five patients (eight hips) died from problems unrelated to surgery. The remaining patients (62 hips) were followed up for an average of 7 years (range, 6-9 years). The mean age of the patients was 49 years (range, 23-61 years). The average Harris hip score improved from 59 points (range, 32-82 points to 82 points (range, 37-100 points) at final followup. There were seven acetabular component revisions. Of the 55 unrevised cups, 47 hips (85%) were stable by bony ingrowth, five hips (9%) were fibrous stable, and three hips (5%) were unstable with cup migration. Osteolysis around the cup was observed in 18 hips (33%). The average polyethylene wear rate was 0.15 mm/year. Survival rates of the cups at 6 and 8 years were 94.3% and 60.5%, respectively. Total hip arthroplasties using an hydroxyapatite-coated smooth hemispheric acetabular cup showed an unexpected high failure rate in terms of fixation, occurrence of osteolysis, and revision after midterm followup.

LEVEL OF EVIDENCE

Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

The effect of fluoride contents in fluoridated hydroxyapatite on osteoblast behavior

Fluoridated hydroxyapatite (FHA) discs with various fluoride contents (0-0.567 mol F(-)/mol) [corrected] have been used to investigate the effect of fluoride content on osteoblastic cell behavior. SAOS-3 rat osteosarcoma cells were cultured on FHA discs for different time periods. The cell behavior was examined in terms of cell attachment, proliferation, morphology and differentiation. The fluoride content in FHA discs strongly affected the cell activities. More cell attachment and proliferation were observed on the fluoride-containing FHA discs than on pure hydroxyapatite (HA). The fluoride content also affected the differentiation behavior of osteoblastic cells. Cells on FHA discs demonstrated a higher alkaline phosphatase (ALP) activity than those on pure HA after 2 [corrected] weeks of culturing. These results suggested that fluoride ions have a significant impact on different osteoblastic cell activities.

Some considerations on biomaterials and bone

Osteoinduction is a property not traditionally attributed to Calcium Phosphate ceramics. Histologic, SEM and X-ray microanalyses of a biopsy of pulmonary alveolar microlithiasis allow to discredit this opinion. Bone, even lamellar type, was ectopically formed on microliths undergoing osteoclastic erosion. The SEM and X-ray microanalyses of coral granules implanted in humans indicate an osteoconductive property for both Calcium and Phosphorus. Analysis of in vitro allows to propose an enhancement of the osteocapability of coral. Lamellar bone formation in the near absence of loads undermines the opinion which sees a correlation between lamellar bone and mechanical loads. Analysis of the bone surrounding an uncemented titanium hip prosthesis highlights that both remodeled and newly formed bone have lamellae oriented parallel to prosthesis surfaces, i.e. orthogonal to loads, as opposed to that of lamellar bone of osteons which are oriented parallel to loads. Analysis of longitudinal sections of cortical bone under polarized light points out that lamellae are displaced parallel to the cement line surface both in the conic end of osteons and in Volkman's canals with thick wall, i.e. undergoing sloped load directions. In conclusion, there may be a relationship between lamellae formation and gravity.

Osteointegration of femoral stem prostheses with a bilayered calcium phosphate coating

Our purpose was to evaluate the osteointegration of bilayered calcium phosphate (CaP)-coated femoral hip stems in a canine model. A first layer of hydroxyapatite (HA) 20 microm thick and a superficial layer of Biphasic Calcium Phosphate (BCP) 30 microm thick were plasma-sprayed on to the proximal region of sandblasted Ti6Al4V prostheses. Bilayered CaP-coated and non-coated canine femoral stems were implanted bilaterally under general anesthesia in 6 adult female Beagle dogs. After 6 and 12 months, a significant degradation of the bilayered coating occurred with a remainder of 33.1+/-12.4 and 23.6+/-9.2 microm in thickness, respectively. Lamellar bone apposition was observed on bilayered coated implants while fibrous tissue encapsulation was observed on non-coated femoral stems. The bone-implant contacts (BIC) were 91+/-3% and 81+/-8% for coated and 7+/-8% and 8+/-12% for non-coated implants, at 6 and 12 months, respectively. Our study supports the concept of a direct relationship between the biodegradation of CaP coating and the enhanced osteointegration of titanium prostheses. A bilayered CaP coating might therefore enhance bone apposition in the early stages because of the superior bioactivity of the BCP layer while the more stable HA layer might sustain bone bonding over long periods.

Particle migration and gap healing around trabecular metal implants

Bone on-growth and peri-implant migration of polyethylene particles were studied in an experimental setting using trabecular metal and solid metal implants. Cylindrical implants of trabecular tantalum metal and solid titanium alloy implants with a glass bead blasted surface were inserted either in an exact surgical fit or with a peri-implant gap into a canine knee joint. We used a randomised paired design. Polyethylene particles were injected into the knee joint. In both types of surgical fit we found that the trabecular metal implants had superior bone ongrowth in comparison with solid metal implants (exact fit: 23% vs. 7% [p=0.02], peri-implant gap: 13% vs. 0% [p=0.02]. The number of peri-implant polyethylene particles was significantly reduced around the trabecular metal implants with a peri-implant gap compared with solid implants.

Progression of Experimental Chronic Peri-Implantitis in Dogs: Clinical and Radiographic Evaluation

BACKGROUND

The aim of this study was to evaluate the progression of experimental peri-implantitis in dogs using implants with different surface coatings.

METHODS

Thirty-six dental implants with four different surface coatings, commercially pure titanium (cpTi), titanium plasma sprayed (TPS), hydroxyapatite (HA), and acid-etched (AE), were placed in six mongrel dogs. Five months after implantation, peri-implantitis was induced by cotton ligatures to facilitate plaque accumulation for 60 days. After 60 days, the ligatures were removed and supragingival plaque control was initiated for 12 months. Probing depth (PD), clinical attachment level (CAL), vertical bone level (VBL), horizontal bone level (HBL), and mobility were obtained at baseline, and 20, 40, 60 (acute phase), and 425 days (chronic phase) after ligature removal.

RESULTS

PD and CAL changed around all implant surfaces after ligature placement (P<0.0001). However, the means of PD and CAL were not statistically significant among the different surfaces (P>0.05). The range of CAL variation, calculated between baseline and 60 days (acute phase) and between 60 and 425 days (chronic phase), decreased (P<0.05). Bone loss increased during the entire experiment (P<0.0001). The HA surface showed the greatest bone loss measurement (5.06+/- 0.38 mm) and the TPS showed the smallest bone loss (4.27+/- 0.62 mm). However, statistical significance was not assessed for different coatings (P>0.05).

CONCLUSIONS

The clinical data at the initial phase showed rapid and severe peri-implant tissue breakdown. However, removal of ligatures did not convert the acute destructive peri-implant phase to a non-aggressive lesion and the progression of peri-implantitis was observed at chronic phase. The experimental peri-implantitis in dogs may be a useful model to evaluate the progression of peri-implantitis.

The influence of surface porosity on gap-healing around intra-articular implants in the presence of migrating particles

The aim of the present study was to compare the effect of two different porous coatings on bone ongrowth and on the peri-implant migration of polyethylene (PE) particles. Porous-coated cylindrical implants with an either plasma-sprayed closed-pore coating (Pl) or titanium fiber metal open-pore coating (Fi) were inserted intra-articular in exact fit or with a 0.75 mm peri-implant gap. A weight-loaded implant device in the distal femur was used. We used a randomized paired design in eight dogs. PE particles were injected repeatedly intra-articular in the knee until the dogs were killed after 8 weeks. Fi implants had significantly more bone ongrowth 8 (0-21)% compared with Pl implants 0 (0-0)% in gap situations and reduced the number of peri-implant PE particles significantly. Among exact-fitted implants we found that peri-implant tissue around Pl implants consisted of significantly more fibrous tissue than around Fi implants. A sealing effect against the migration of PE particles was found for both Fi and Pl implants in exact fit.

Synthesis and characterization of fluorine-containing hydroxyapatite by a pH-cycling method

Different fluorine-containing hydroxyapatite (FHA) powders were synthesized through a pH-cycling method by varying sodium fluoride (NaF) concentration in hydroxyapatite (HA) suspensions. The powders were then calcined at 1200 ( composite function)C for 1 h. Both uncalcined and calcined powders were characterized using X-ray diffraction (XRD), Fourier transform infra-red (FTIR), and F-electrode. It was discovered that fluorine incorporation increased with the fluorine content in the initial solution and the number of pH cycles employed. A relatively low fluorine incorporation efficiency, approximately 60%, was attained for most of the FHA samples, and it did not vary significantly after calcination. It was also revealed that the FHA particles produced by the pH-cycling method were inhomogeneous. They were a mixture of hydroxyapatite and F-rich apatite (or FA) particles. After calcination, however, these FHA particles were homogenized and became single phased FHA.

Biologic effects of surface roughness and fluorhydroxyapatite coating on osteointegration in external fixation systems: an in vivo experimental study

The concomitant influence of surface roughness and fluorhydroxyapatite (FHA) coating of titanium (Ti) implants on bone response was investigated. For this purpose, titanium screw-shaped implants with a lower degree (Y371) and a higher degree (TiPore300) of surface roughness, coated with FHA and uncoated, were transversally inserted into the diaphyses of sheep tibiae for 12 weeks. Four sheep received Y371 (group A) and Y371 + FHA (group B) screws and four sheep received TiPore300 (group C) and TiPore300 + FHA (group D) screws. For each type of material, the morphology and microstructure of implant-facing bone were evaluated. The host bone of each tibia was used as a control. In all groups the bone tissue did not reach a complete maturation. The higher degree of roughness, perhaps due to an excessive irregularity of the surface, induced the worst osteointegration: a fibrous tissue layer between screw and new bone tissue was often present. Nevertheless, as viewed by XRD, no crystallographic change of the apatite lattice was observed in any of the implants. In contrast, the microhardness value, an index of bone mineralization, was higher in the uncoated screws and decreased progressively in the following order: group C > group A > group B > group D. The association of plasma spraying with roughness treatment constitutes a complex system that seems to interfere with bone mineralization. A chemical change of the surface, perhaps with more Ti release or more coating degradation, could be responsible for such impairment. The authors emphasize the necessity for simultaneous evaluation of surface topography and chemistry as well as an improvement in plasma-spraying and post-processing techniques and in standard procedures for materials characterization.

Detachment of titanium and fluorohydroxyapatite particles in unloaded endosseous implants

The shape, surface composition and morphology of orthopaedic and endosseous dental titanium implants are key factors to achieve post-surgical and long-term mechanical stability and enhance implant osteointegration. In this study a comparison was made between 12 titanium screws, plasma-spray-coated with titanium powders (TPS), and 12 screws with an additional coating of fluorohydroxyapatite (FHA-Ti). Screws were implanted in the femoral and tibial diaphyses of two mongrel sheep and removed with peri-implant tissues 12 weeks after surgery. The vibrational spectroscopic, ultrastructural and morphological analyses showed good osteointegration for both types of implants in host cortical bone. The portion of the FHA-Ti implants in contact with the medullary canal showed a wider area of newly formed peri-implant bone than that of the TPS implants. Morphological and EDAX analyses demonstrated the presence of small titanium debris in the bone medullary spaces near the TPS surface, presumably due to the friction between the host bone and the implant during insertion. Few traces of titanium were detected around FHA-Ti implants, even if smaller FHA debris were present. The present findings suggest that the FHA coating may act as a barrier against the detachment of titanium debris stored in the medullary spaces near the implant surface.

Osteoconductive coatings for total joint arthroplasty

Osteoconductive calcium phosphate coatings for total joint arthroplasty have been in clinical use since the mid1980s. The basic principles involved and basic science evidence for the efficacy of osteoconductive coatings were examined. Hydroxyapatite coatings provide consistent and better filling with bone of the gaps and spaces around cementless joint components after surgery as compared with porous-coated implant surfaces, resulting in better implant stability. Of all the calcium phosphate coatings, hydroxyapatite coatings have had the most widespread application in hip arthroplasty. Their clinical advantages over more conventional implant surfaces are evident in primary and revision hip arthroplasties. A clinical survival rate in the author's series of 97% at a minimum of 11 years followup for the femoral component in a young active patient population (average age, 53 years) was obtained with no mechanical failures. The average polyethylene wear rate in this group was 0.129 mm/year. In a similar group of young patients with revision arthroplasty using hydroxyapatite-coated femoral components, an 11-year survival rate of 93% was obtained. Histologic analysis of specimens retrieved at autopsy confirmed the excellent bony fixation of components. Advantages of the more recent biomimetic hydroxyapatite coatings were examined.

Total hip arthroplasty with a modified cementing technique using hydroxyapatite granules

Results of total hip arthroplasties with a modified cementing technique using hydroxyapatite were evaluated. Femoral and acetabular components were inserted with cement after hydroxyapatite granules (phi = 100-300 microm). The study group comprised 268 hips in 232 patients. The diagnosis was osteoarthritis in 197 patients. After a mean follow-up of 10.3 years, 5 patients died and 30 patients were lost to follow-up, leaving 218 hips (197 patients; mean age, 58.2 years) for evaluation. Three hips were revised because aseptic (1) and septic (2) loosening of acetabular components. Six other sockets were defined as radiologically loose, and no femoral component was loose. Osteolysis was identified in 2 femora and 0 acetabula. The overall loosening rate was 3.2% for acetabular components and 0% for femoral components. These results show that the loosening rate of cemented total hip arthroplasty components, especially the acetabulum, is reduced markedly with this modified cementing technique.