Long-term changes of hydroxyapatite-coated dental implants

Assessment of the Addition of Fluorapatite–Alumina Coating for a Durable Adhesion of the Interface Prosthesis/Bone Cells: Implementation In Vivo

Purpose

Fluorapatite (Fap), an alumina (Al2O3) known for its excellent bio-inertia, can significantly increase the biocompatibility and bioactivity of biomaterials. This study is an investigation of the interface bone/Al2O3–Fap composite coatings implanted in the tibia of the rabbit.

Methods

Two techniques T1 and T2 were implemented on four rabbits, R1–R4 to assess the effect of the alumina (Al2O3)–Fap [Ca10(PO4)6F2] composite, coating for 316L stainless steel, on bone contact. The fluorapatite powder was synthesized using a wet-chemical method. The biocompatibility and the bioactivity of the Al2O3–Fap composite were evaluated by in vitro/in vivo tests. The characteristics of the bone/implant interface were investigated with scanning electron microscopy, radiology and 3D scanner.

Results

The results showed that T2 was more effective than T1, with a good contact between the implant/bone on the radiographs performed after 28 days. Implants coated with alumina did not show any integration signs with bone tissue. The addition of Fap to alumina coating would increase the adhesion of prosthesis on bone cells and guarantee a stable implantation.

Conclusion

Al2O3–Fap coating showed excellent behavior in vitro and in vivo tests revealing that the Fap is effective in improving biocompatibility and bioactivity.

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.

Cytotoxicity of Titanate-Calcium Complexes to MC3T3 Osteoblast-Like Cells

Monosodium titanates (MST) are a relatively novel form of particulate titanium dioxide that have been proposed for biological use as metal sorbents or delivery agents, most recently calcium (II). In these roles, the toxicity of the titanate or its metal complex is crucial to its biological utility. The aim of this study was to determine the cytotoxicity of MST and MST-calcium complexes with MC3T3 osteoblast-like cells; MST-Ca(II) complexes could be useful to promote bone formation in various hard tissue applications. MC3T3 cells were exposed to native MST or MST-Ca(II) complexes for 24–72 h. A CellTiter-Blue® assay was employed to assess the metabolic activity of the cells. The results showed that MST and MST-Ca(II) suppressed MC3T3 metabolic activity significantly in a dose-, time-, and cell-density-dependent fashion. MST-Ca(II) suppressed MC3T3 metabolism in a statistically identical manner as native MST at all concentrations. We concluded that MST and MST-Ca(II) are significantly cytotoxic to MC3T3 cells through a mechanism yet unknown; this is a potential problem to the biological utility of these complexes.

Comparison of Removal Torques for Implants With Hydroxyapatite-Blasted and Sandblasted and Acid-Etched Surfaces

PURPOSE

Sandblasted and acid-etched (SLA) implants are widely known and used by many practitioners. A resorbable blasting media (RBM) surface is produced by blasting with bioceramic particles. We studied the correlation between the particle sizes of the media and the biomechanical force, evaluating the removal torque of hydroxyapatite-blasted implants.

MATERIALS AND METHODS

Commercial SLA implants comprised the control group, and RBM surface-treated implants of the same size and design comprised the experimental group. These implants were installed on both sides of rabbits' tibiae. Four weeks after the implants were installed, the implant removal torque was measured using a digital torque device. The roughness of the implant surface was analyzed using field-emission scanning electron microscopy and confocal laser scanning microscopy.

RESULTS

Both groups of surface textures exhibited a regular porosity. The 2 groups exhibited different surface roughness. No significant differences in removal torques were observed between the control and experimental groups.

CONCLUSION

There were no significant differences in our measures of osseointegration between hydroxyapatite-blasted and SLA implants.

Formation of Solution-derived Hydroxyapatite Coatings on Titanium Alloy in the Presence of Magnetron-sputtered Alumina Bond Coats

Hydroxyapatite Ca₁₀(PO₄)₆₍OH)₂ (HAp) and calcium phosphate ceramic materials and coatings are widely used in medicine and dentistry because of their ability to enhance the tissue response to implant surfaces and promote bone ingrowth and osseoconduction processes. The deposition conditions have a great influence on the structure and biofunctionality of calcium phosphate coatings. Corrosion processes and poor adhesion to substrate material reduce the lifetime of implants with calcium phosphate coatings. The research has focused on the development of advanced methods to deposit double-layered ceramic oxide/calcium phosphate coatings by a hybrid technique of magnetron sputtering and thermal methods. The thermal method can promote the crystallization and the formation of HAp coatings on titanium alloy Ti6Al4V substrates at low temperature, based on the principle that the solubility of HAp in aqueous solutions decreases with increasing substrate temperature. By this method, hydroxyapatite directly coated the substrate without precipitation in the initial solution. Using a thermal substrate method, calcium phosphate coatings were prepared at substrate temperatures of 100-105 ^oC. The coated metallic implant surfaces with ceramic bond coats and calcium phosphate layers combine the excellent mechanical properties of metals with the chemical stability of ceramic materials. The corrosion test results show that the ceramic oxide (alumina) coatings and the double-layered alumina-calcium phosphate coatings improve the corrosion resistance compared with uncoated Ti6Al4V and single-layered Ti6Al4V/calcium phosphate substrates. In addition, the double-layered alumina/hydroxyapatite coatings demonstrate the best biocompatibility during in vitro tests.

VEGF promotes osteogenic differentiation of ASCs on ordered fluorapatite surfaces

Vascular endothelial growth factor (VEGF) has been reported to mediate both osteogenesis and angiogenesis in bone regeneration. We previously found an upregulation of VEGF in adipose-derived stem cells (ASCs) when obvious mineralization occurred on a novel fluorapatite (FA)-coated surfaces. This study investigated the effect of FA and VEGF on the growth, differentiation and mineralization of (ASC) grown on ordered FA surfaces. Cells grown on FA and treated with VEGF demonstrated osteogenic differentiation as measured with ALP staining, and obvious mineralization as measured by Alizarin red staining. A combined stimulating effect of FA and VEGF was seen using both indicators. VEGF signaling pathway perturbation using a specific VEGF receptor inhibitor showed the lowest levels of ALP and Alizarin red staining, which was partially rescued when the cells were grown on FA and/or treated with the addition of VEGF. The osteogenic differentiation of ASCs stimulated by these FA surfaces as well as VEGF has been shown to be mediated through, but probably not only, the VEGF signaling pathway. The enhancement of osteogenic differentiation and mineralization supports the potential use of therapeutic VEGF and FA coatings in bone regeneration.

POLYMER-ASSISTED DEPOSITION OF HYDROXYAPATITE COATINGS USING ELECTROPHORETIC TECHNIQUE

Hydroxyapatite (HA) finds use as powder, scaffold, paste, and coatings for orthopedic and dental applications. Plasma spraying is the most commonly used technique to coat HA on metallic implants. However, undesirable phase changes at high temperatures encourage to adopt ambient temperature deposition techniques such as dip coating, electrophoretic, and physical vapor deposition (PVD). Electrophoretic technique is being used extensively to deposit HA, however sintering is required after the deposition to enhance adhesion of coatings to the substrate. In the present work, polyethylene glycol (PEG) modified HA was deposited on 316L Stainless Steel plates using electrophoretic deposition (EPD), which improved the binding strength of the HA to the substrate with increased packing density of HA particles without the need of sintering. PEG is a biocompatible and soluble polymer that helps HA to bond well with the substrate and in addition, prevents the agglomeration and precipitation of HA. Phase identification and crystal structure of the coatings were determined using X-ray diffraction (XRD). The stability of the coatings was assessed by Fourier transform infrared spectroscopy (FTIR), whereas scanning electron microscopy (SEM) was utilized in order to investigate the morphological properties of the deposited coatings. The mechanical properties of the coatings were investigated using the indentation testing that depicted an enhanced level of adhesion of coatings to the substrate.

Characterization of wet powder-sprayed zirconia/calcium phosphate coating for dental implants

PURPOSE

Yttria-stabilized zirconia (TZ) is used for dental applications because of its low toxicity and beneficial mechanical properties, but it does not stimulate bone regeneration around the implant due to its bioinertness. Therefore, hydroxyapatite (HA) coatings are often utilized to increase the surface bioactivity and to achieve a better osseointegration. These coatings, however, are chemically nonstable and provide a weak bonding to the substrate surface.

MATERIALS AND METHODS

In this study, zirconia substrates were coated with a calcium phosphate/zirconia mixture to achieve ceramic coatings with a high bioactivity potential and a good mechanical stability. The coatings were obtained by wet powder spraying (WPS). Pure HA and TZ coatings were employed as reference materials. The coatings were characterized with regard to microstructure, surface roughness, and phase composition. Scratch tests were carried out to investigate the coating adhesion. The influence of the coating on the mechanical strength was evaluated with the ball on three balls test (B3B). In addition, zirconia dental implant screws were also coated and inserted in a biomechanical test block and bovine rip bone.

RESULTS

After sintering, the mixed coating exhibited a porous morphology with a surface roughness of about 4 μm and a total porosity of 17%. Phase analysis showed a transformation from TZ and HA to calcium zirconium oxide and tricalcium phosphate. Investigations of the bond strength confirmed a strong adhesion of the mixed coating to the substrate, while the biaxial fracture strength was only slightly affected. Insertion experiments confirmed the scratch test results and evidenced an intact mixed coating on the zirconia screw.

CONCLUSIONS

The present study revealed a higher stability and firm adhesion of the mixed coating compared with a pure calcium phosphate coating. We also successfully demonstrate the particular versatility of the WPS technique for dental implants by coating a complex curved surface.

Preparation and analysis of chemically gradient functional bioceramic coating formed by pulsed laser deposition

Bioactive ceramic coatings based on calcium phosphates yield better functionality in the human body for a variety of metallic implant devices including orthopaedic and dental prostheses. In the present study chemically and hence functionally gradient bioceramic coating was obtained by pulsed laser deposition method. Calcium phosphate bioactive ceramic coatings based on hydroxyapatite (HA) and tricalcium phosphate (TCP) were deposited over titanium substrate to produce gradation in physico-chemical characteristics and in vitro dissolution behaviour. Sintered targets of HA and α-TCP were deposited in a multi target laser deposition system. The obtained deposits were characterized by X-ray diffraction, fourier transform infrared spectroscopy, scanning electron microscopy and energy dispersive X-ray analysis. Inductively coupled plasma spectroscopy was used to estimate the in vitro dissolution behaviour of coatings. The variation in mechanical property of the gradient layer was evaluated through scratch test and micro-indentation hardness. The bioactivity was examined in vitro with respect to the ability of HA layer to form on the surface as a result of contact with simulated body fluid. It could be inferred that chemically gradient functional bioceramic coating can be produced by laser deposition of multiple sintered targets with variable chemical composition.

Enhanced osteocalcin expression by osteoblast-like cells (MC3T3-E1) exposed to bioactive coating glass (SiO2-CaO-P2O5-MgO-K2O-Na2O system) ions

This study tested the hypothesis that bioactive coating glass (SiO(2)-CaO-P(2)O(5)-MgO-K(2)O-Na(2)O system), used for implant coatings, enhanced the induction of collagen type 1 synthesis and in turn enhanced the expression of downstream markers alkaline phosphatase, Runx2 and osteocalcin during osteoblast differentiation. The ions from experimental bioactive glass (6P53-b) and commercial Bioglass(TM) (45S5) were added to osteoblast-like MC3T3-E1 subclone 4 cultures as a supplemented ion extract (glass conditioned medium (GCM)). Ion extracts contained significantly higher concentrations of Si and Ca (Si, 47.9+/-10.4 ppm; Ca, 69.8+/-14.0 for 45S5; Si, 33.4+/-3.8 ppm; Ca, 57.1+/-2.8 ppm for 6P53-b) compared with the control extract (Si<0.1 ppm, Ca 49.0 ppm in alpha-MEM) (ANOVA, p<0.05). Cell proliferation rate was enhanced (1.5x control) within the first 3 days after adding 45S5 and 6P53-b GCM. MC3T3-E1 subclone 4 cultures were then studied for their response to the addition of test media (GCM and control medium along with ascorbic acid (AA; 50 ppm)). Each GCM+AA treatment enhanced collagen type 1 synthesis as observed in both gene expression results (day 1, Col1alpha1, 45S5 GCM+AA: 3x control+AA; 6P53-b GCM+AA: 4x control+AA; day 5, Col1alpha2, 45S5 GCM+AA: 3.15x control+AA; 6P53-b GCM+AA: 2.35x control+AA) and in histological studies (Picrosirius stain) throughout the time course of early differentiation. Continued addition of each GCM and AA treatment led to enhanced expression of alkaline phosphatase (1.4x control+AA after 5 days, 2x control+AA after 10 days), Runx2 (2x control+AA after 7 days) and osteocalcin gene (day 3, 45S5 GCM+AA: 14x control+AA; day 5, 6P53-b GCM+AA: 19x control+AA) and protein expression (40x-70x control+AA after 6 days). These results indicated the enhanced effect of bioactive glass ions on key osteogenic markers important for the bone healing process.

Surface nanocrystallization of hydroxyapatite coating

Nanocharactered biomaterials, such as nanopowders, nanocrystalline compacts and nanostructured films, as well as materials with nanoscale roughness, have attracted much attention recently, due to their clear effects on cell response. Surface nanocrystallization of plasma-sprayed hydroxyapatite (HA) coating can be realized by conventional post-heat treatment. This study reveals that 20-30nm nanocrystals formed on HA coatings post-heat treated at 650 degrees C, and the increase in holding time increased the number of surface nanocrystals and intensified their aggregation. Hard aggregation occurred when HA coatings were repetitively post-heat treated. This indicates that the surface nanocrystallization is controllable. Cell experiments were carried out with rat calvarial osteoblasts. The post-heat treated HA coatings exhibit an obviously better osteoblast response than the as-sprayed coatings. Well-flattened cells attached themselves to the coating surfaces, with a good interaction between their filopodia and the nanocrystallized region. It is proposed that the surface nanocrystallization should be taken into account when the post-heat treatment process is introduced for the fabrication of HA coatings.

Novel sphene coatings on Ti-6Al-4V for orthopedic implants using sol-gel method

Hydroxyapatite (HAp) is commonly used to coat titanium alloys (Ti-6Al-4V) for orthopedic implants. However, their poor adhesion strength and insufficient long-term stability limit their application. Novel sphene (CaTiSiO5) ceramics possess excellent chemical stability and cytocompatibility. The aim of this study is to use the novel sphene ceramics as coatings for Ti-6Al-4V. The sol-gel method was used to produce the coatings and the thermal properties, phase composition, microstructure, thickness, surface roughness and adhesion strength of sphene coatings were analyzed by differential thermal analysis-thermal gravity (DTA-TG), X-ray diffraction (XRD), scanning electron microscopy (SEM), atom force microscopy (AFM) and scratch test, respectively. DTA analysis confirmed that the temperature of the sphene phase formation is 875 degrees C and XRD analysis indicated pure sphene coatings were obtained. A uniform structure of the sphene coating was found across the Ti-6Al-4V surface, with a thickness and surface roughness of the coating of about 0.5-1 microm and 0.38 microm, respectively. Sphene-coated Ti-6Al-4V possessed a significantly improved adhesion strength compared to that for HAp coating and their chemical stability was evaluated by testing the profile element distribution and the dissolution kinetics of calcium (Ca) ions after soaking the sphene-coated Ti-6Al-4V in Tris-HCl solution. Sphene coatings had a significantly improved chemical stability compared to the HAp coatings. A layer of apatite formed on the sphene-coated Ti-6Al-4V after they were soaked in simulated body fluids (SBF). Our results indicate that sol-gel coating of novel sphene onto Ti-6Al-4V possessed improved adhesion strength and chemical stability, compared to HAp-coated Ti-6Al-4V prepared under the same conditions, suggesting their potential application as coatings for orthopedic implants.

Initial attachment of osteoblastic cells onto sol-gel derived fluoridated hydroxyapatite coatings

Initial cell attachment and spreading of anchorage-dependent cells onto the material surface are crucial concerns for the development of more effective implants. In this study, MG63 cells were employed to investigate the initial cell response to sol-gel derived fluoridated hydroxyapatite (FHA) coatings. Along with that, surface roughness, wettability, and protein adsorption were also characterized for those FHA coatings, respectively. It was observed that both the surface roughness and contact angle have a slight increase in response to the incorporation of more fluorine ions. All FHA coatings showed similar amount of adsorbed proteins (approximately 1.6 microg/cm(2)) upon testing in culture medium. Cell counting showed that no significant difference was observed for the amount of initially attached cells between HA and fluoridated HA coatings during the first 4 h culture. On the other hand, the well-spread cell on all prepared coating surface indicates that the incorporated fluorine ions have no adverse effect on cell spreading process. Therefore, it was suggested from this study that the prepared fluoridated hydroxyapatite coatings have comparable bioactivity to that of pure hydroxyapatite coating, and these results are meaningful for further investigation for application of FHA coatings.

Effect of coating thickness and its material on the stress distribution for dental implants

Dental implants have been increasingly used to recover the masticatory function of lost teeth. It has been well known that the success of a dental implant is heavily dependent on initial stability and long-term osseointegration due to optimal stress distribution in the surrounding bones by the concept implant surface coating. Hydroxyapatite (HAP), as a coating material, has been widely used in dentistry due to its biocompatibility. Some investigations show a benefit of coating dental implants with HAP, and others concluded that HAP coating reduces the long-term implant survival. Therefore, the aim of this investigation is to design a new functionally graded dental implant coating, as well as studying the effect of coating thickness on the maximum von Mises stresses in bone adjacent to the coating layer. The gradation of the elastic modulus is changed along the longitudinal direction. Stress analysis using a finite element method showed that using a coating thickness of 150 microm, functionally graded from titanium at the apex to the collagen at the root, will successfully reduce the maximum von Mises stress in bone by 19% and 17% compared to collagen and HAP coating respectively.

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).

Nanoscale characterization of the interface between bone and hydroxyapatite implants and the effect of silicon on bone apposition

Silicon plays an important role in bone mineralization and formation and is therefore incorporated into a wide variety of medical implants and bone grafts used today. The significance of silicon (Si) can be understood through an analysis of the mechanisms of bone bonding to calcium containing biomaterials and through comparisons of hydroxyapatite (HA) and silicon-substituted hydroxyapatite (Si-HA). The addition of Si to HA causes a decrease in grain size that subsequently affects surface topography, dissolution-reprecipitation rates and the bone apposition process. Through the use of high-resolution transmission electron microscopy (HR-TEM) studies, the interactions between bone and silicon hydroxyapatite (Si-HA) at interfaces are reviewed and related to their impact on bone apposition and ultimately the performance of medical implants.

The engineering of craniofacial tissues in the laboratory: a review of biomaterials for scaffolds and implant coatings

Tissue engineering is a rapidly growing interdisciplinary field that focuses on the interactions between cells, growth factors, and scaffolds to produce replacement tissue and organs. Recent developments in tissue engineering technology include refinements in isolation and differentiation of progenitor cells, 3-D printing technology to produce scaffolds, new biomaterials for scaffolds, and growth factor delivery systems. The purpose of this article is to review advances in biomaterials, scaffolds, and implant coatings for craniomaxillofacial (bone) tissue engineering.

An experimental and theoretical composite model of the human mandible

The purpose is to design and manufacture a composite mandible replicate suitable for testing the influence of prosthetic materials on the stress distribution of bone. Composite mandibles made of a poly(methylmethacrylate) core and a glass reinforced outer shell are manufactured and characterised through mechanical tests assisted by the finite element analysis. The mandible replicate has been conveniently equipped with strain gauges, moreover a video extensometer has also been used in order to measure the arch width change during loading. A close agreement is found between the experimental data and the theoretical predictions. By laterally loading the mandibles the maximum values of stress and strain take place in the premolar-incisal region. By varying technological parameters such as the fiber volume fraction and orientation, it is easy to replicate the behaviour of mandibles having different stiffnesses. The results obtained by laterally loading the composite mandibles through the condyles or through the gonion regions are consistent with literature data relative to the arch width decrease of natural jaws during opening and closing. This novel synthetic system coupled with the Finite Element model constitutes an experimental-theoretical model suitable to investigate the biomechanical effects of oral rehabilitations on mandibular bone.

Bone bonding to hydroxyapatite and titanium surfaces on femoral stems retrieved from human subjects at autopsy

The success of clinical results obtained with many hydroxyapatite (HA)-coated prosthetic designs has deflected attention from the need to extend the life of the HA coating on the device. In the current study the percentages of HA and titanium surfaces to which bone was bonded, on HA-coated and non-coated titanium femoral stems retrieved from human subjects, were evaluated. Plasma-sprayed hydroxyapatite (PSHA)-coated devices demonstrated wide variability in the percentage of the PSHA coating remaining on the stems. The coating was missing from a substantial portion of a stem after only about 6 months of implantation. The percentage of revealed metal to which bone was bonded was significantly less than the percentage of the HA coating demonstrating such bonding. The revealed metal to which bone was bonded was comparable to the same value for a separate group of non-PSHA-coated titanium stems. If HA-coatings degrade over time precipitous decline in performance may occur even after several functional years. Many ultrastructural features of the bone bonded to the HA coatings on these implants from human subjects were comparable to those found on HA-coated devices implanted in a canine model.

Calcium-phosphate surface coating by casting to improve bioactivity of titanium

In order to improve the bioactivity of titanium, an original surface treatment was attempted with the use of a casting technique was attempted. Pure titanium was cast into a special graphite mold in which the cavity wall was coated with hydroxyapatite (HA) powder. According to analyses of X-ray diffraction and EDX, the existence of HA and CaO and uptake of Ca and P on the surface of the titanium castings were identified. By immersing the specimen in Hank's solution, the concentrations of Ca and P on the surface increased with immersion time, and the formation of a thin layer with characteristics of spherical HA precipitates was observed after 1 week. The concentrations of Ca and P elements and the Ca/P ratio on the HA layer increased with immersion time. The formation of the HA layer on the titanium cast by this treatment was significantly accelerated compared with pure titanium. The present surface treatment of Ti is expected to improve early bone fixation of Ti implants.

A bioengineered implant for a predetermined bone cellular response to loading forces. A literature review and case report

The presence of fibrous tissue has long been known to decrease the long-term survival of a root-form implant. Excessive loads on an osseointegrated implant may result in mobility of the supporting device, and excessive loads may also fracture an implant component or body. Although several conditions may cause crestal bone loss, one of these may be prosthetic overload. Excessive loads on the bone cause strain conditions to increase. These microstrains on the bone may affect the bone remodeling rate in a direct relationship. When strain conditions to the interfacial bone are in the mild overload zone, an increased bone remodeling response occurs, which results in a reactive woven bone formation that is less mineralized and weaker. Greater stresses may cause the interfacial strain to reach the pathologic overload zone and may cause microfracture of the bone, fibrous tissue formation, and/or bone resorption. Recent reports suggest that the bone remodeling rate next to an implant may be used to evaluate biomechanical conditions and their influence on the implant-to-bone interface. These include a number of factors, such as loading conditions, implant body surface conditions, and implant design. For a given load condition, the implant design is one of the primary factors that determine the resultant strain at the interface. A predetermined goal was established to bioengineer a dental implant to load the bone at the interface in a predetermined stress strain relationship, in order to maintain lamellar bone at the interface. A case report is presented of 2 bioengineered implants loaded for 1 year, which demonstrates that the bone was primarily lamellar in structure, the bone turnover rate was less than 5 microns/day, and was the same as the bone away from the interface. These findings corroborate those observed in a prior animal study reported with the same implant design. Although the number of implants evaluated in those 2 reports is few, they support a predetermined histological outcome.