Biological performance of biomimetic calcium phosphate coating of titanium implants in the dog mandible

Visualization of bone formation in sheep's middle ear by using fluorochrome sequential labelling (FSL)

One factor for the lacking integration of the middle ear stapes footplate prosthesis or the missing healing of stapes footplate fractures could be the known osteogenic inactivity. In contrast, it was recently demonstrated that titanium prostheses with an applied collagen matrix and immobilised growth factors stimulate osteoblastic activation and differentiation on the stapes footplate. Regarding those findings, the aim of this study was to evaluate the potential of bone regeneration including bone remodeling in the middle ear. Ten one-year-old female merino sheep underwent a middle ear surgery without implantation of middle ear prostheses or any other component for activating bone formation. Post-operatively, four fluorochromes (tetracycline, alizarin complexion, calcein green and xylenol orange) were administered by subcutaneous injection at different time points after surgery (1 day: tetracycline, 7 days: alizarin, 14 days: calcein, 28 days: xylenol). After 12 weeks, the temporal bones including the lateral skull base were extracted and histologically analyzed. Fluorescence microscopy analysis of the entire stapes with the oval niche, but in particular stapes footplate and the Crura stapedis revealed evidence of new bone formation. Calcein was detected in all and xylenol in 60% of the animals. In contrast, tetracycline and alizarin could only be verified in two animals. The authors were able to demonstrate the osseoregenerative potential of the middle ear, in particular of the stapes footplate, using fluorescence sequence labelling.

Surface Functionalization of Titanium-Based Implants with a Nanohydroxyapatite Layer and Its Impact on Osteoblasts: A Systematic Review

This study aims to evaluate the influence of a nanohydroxyapatite layer applied to the surface of titanium or titanium alloy implants on the intricate process of osseointegration and its effect on osteoblast cell lines, compared to uncoated implants. Additionally, the investigation scrutinizes various modifications of the coating and their consequential effects on bone and cell line biocompatibility. On the specific date of November 2023, an exhaustive electronic search was conducted in esteemed databases such as PubMed, Web of Science, and Scopus, utilizing the meticulously chosen keywords ((titanium) AND ((osteoblasts) and hydroxyapatite)). Methodologically, the systematic review meticulously adhered to the PRISMA protocol. Initially, a total of 1739 studies underwent scrutiny, with the elimination of 741 duplicate records. A further 972 articles were excluded on account of their incongruence with the predefined subjects. The ultimate compilation embraced 26 studies, with a predominant focus on the effects of nanohydroxyapatite coating in isolation. However, a subset of nine papers delved into the nuanced realm of its modifiers, encompassing materials such as chitosan, collagen, silver particles, or gelatine. Across many of the selected studies, the application of nanohydroxyapatite coating exhibited a proclivity to enhance the osseointegration process. The modifications thereof showcased a positive influence on cell lines, manifesting in increased cellular spread or the attenuation of bacterial activity. In clinical applications, this augmentation potentially translates into heightened implant stability, thereby amplifying the overall procedural success rate. This, in turn, renders nanohydroxyapatite-coated implants a viable and potentially advantageous option in clinical scenarios where non-modified implants may not suffice.

Collagen-Based Osteogenic Nanocoating of Microrough Titanium Surfaces

The aim of the present study was to develop a collagen/heparin-based multilayer coating on titanium surfaces for retarded release of recombinant human bone morphogenic protein 2 (rhBMP2) to enhance the osteogenic activity of implant surfaces. Polyelectrolyte multilayer (PEM) coatings were constructed on sandblasted/acid-etched surfaces of titanium discs using heparin and collagen. PEM films of ten double layers were produced and overlayed with 200 µL of a rhBMP2 solution containing 15 µg rhBMP2. Subsequently, cross-linking of heparin molecules was performed using EDC/NHS chemistry to immobilize the incorporated rhBMP2. Release characteristics for 3 weeks, induction of Alkaline Phosphatase (ALP) in C2C12 cells and proliferation of human mesenchymal stem cells (hMSCs) were evaluated to analyze the osteogenic capacity of the surface. The coating incorporated 10.5 µg rhBMP2 on average per disc and did not change the surface morphology. The release profile showed a delivery of 14.5% of the incorporated growth factor during the first 24 h with a decline towards the end of the observation period with a total release of 31.3%. Cross-linking reduced the release with an almost complete suppression at 100% cross-linking. Alkaline Phosphatase was significantly increased on day 1 and day 21, indicating that the growth factor bound in the coating remains active and available after 3 weeks. Proliferation of hMSCs was significantly enhanced by the non-cross-linked PEM coating. Nanocoating using collagen/heparin-based PEMs can incorporate clinically relevant amounts of rhBMP2 on titanium surfaces with a retarded release and a sustained enhancement of osteogenic activity without changing the surface morphology.

A systematic review on the effect of inorganic surface coatings in large animal models and meta-analysis on tricalcium phosphate and hydroxyapatite on periimplant bone formation

The aim of the present systematic review was to analyse studies using inorganic implant coatings and, in a meta‐analysis, the effect of specifically tricalcium phosphate (TCP) and hydroxyapatite (HA) implant surface coatings on bone formation according to the PRISMA criteria. Inclusion criteria were the comparison to rough surfaced titanium implants in large animal studies at different time points of healing. Forty studies met the inclusion criteria for the systematic review. Fifteen of these analyzed the bone‐to‐implant contact (BIC) around the most investigated inorganic titanium implant coatings, namely TCP and HA, and were included in the meta‐analysis. The results of the TCP group show after 14 days a BIC being 3.48% points lower compared with the reference surface. This difference in BIC decreases to 0.85% points after 21–28 days. After 42–84 days, the difference in BIC of 13.79% points is in favor of the TCP‐coatings. However, the results are not statistically significant, in part due to the fact that the variability between the studies increased over time. The results of the HA group show a significant difference in mean BIC of 6.94% points after 14 days in favor of the reference surface. After 21–28 days and 42–84 days the difference in BIC is slightly in favor of the test group with 1.53% points and 1.57% points, respectively, lacking significance. In large animals, there does not seem to be much effect of TCP‐coated or HA‐coated implants over uncoated rough titanium implants in the short term.

Controlled M1-to-M2 transition of aged macrophages by calcium phosphate coatings

Older adults suffer from weakened and delayed bone healing due to age-related alterations in bone cells and in the immune system. Given the interaction between the immune system and skeletal cells, therapies that address deficiencies in both the skeletal and the immune system are required to effectively treat bone injuries of older patients. The sequence of macrophage activation observed in healthy tissue repair involves a transition from a pro-inflammatory state followed by a pro-reparative state. In older patients, inflammation is slower to resolve and impedes healing. The goal of this study was to design a novel drug delivery system for temporal guidance of the polarization of macrophages using bone grafting materials. A biomimetic calcium phosphate coating (bCaP) physically and temporally separated the pro-inflammatory stimulus interferon-gamma (IFNγ) from the pro-reparative stimulus simvastatin (SIMV). Effective doses were identified using a human monocyte line (THP-1) and testing culminated with bone marrow macrophages obtained from old mice. Sequential M1-to-M2 activation was achieved with both cell types. These results suggest that this novel immunomodulatory drug delivery system holds potential for controlling macrophage activation in bones of older patients.

A systematic review and meta-analysis on the influence of biological implant surface coatings on periimplant bone formation

This systematic review and meta-analysis evaluated the influence of biological implant surface coatings on periimplant bone formation in comparison to an uncoated titanium reference surface in experimental large animal models. The analysis was structured according to the PRISMA criteriae. Of the1077 studies, 30 studies met the inclusion criteriae. Nineteen studies examined the bone implant contact (BIC) and were included in the meta-analysis. Overall, the mean increase in BIC for the test surfaces compared to the reference surfaces was 3.7 percentage points (pp) (95% CI -3.9-11.2, p = 0.339). Analyzing the increase in BIC for specific coated surfaces in comparison to uncoated reference surfaces, inorganic surface coatings showed a significant mean increase in BIC of 14.7 pp (95% CI 10.6-18.9, p < 0.01), extracellular matrix (ECM) surface coatings showed an increase of 10.0 pp (95% CI 4.4-15.6, p < 0.001), and peptide coatings showed a statistical trend with 7.1 pp BIC increase (95% CI -0.8-15.0, p = 0.08). In this review, no statistically significant difference could be found for growth factor surface coatings (observed difference -3.3 pp, 95% CI -16.5-9.9, p = 0.6). All analyses are exploratory in nature. The results show a statistically significant effect of inorganic and ECM coatings on periimplant bone formation. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2898-2910, 2016.

On the Collagen Mineralization. A Review

Collagen mineralization (CM) is a challenging process that has received a lot of attention in the past years. Among the reasons for this interest, the key role is the importance of collagen and hydroxyapatite in natural bone, as major constituents. Different protocols of mineralization have been developed, specially using simulated body fluid (SBF) and many methods have been used to characterize the systems obtained, starting with methods of determining the mineral content (XRD, FTIR, Raman, High-Resolution Spectral Ultrasound Imaging), continuing with imaging methods (AFM, TEM, SEM, Fluorescence Microscopy), thermal analysis (DSC and TGA), evaluation of the mechanical and biological properties, including statistical methods and molecular modeling. In spite of the great number of studies regarding collagen mineralization, its mechanism, both in vivo and in vitro, is not completely understood. Some of the methods used in vitro and investigation methods are reviewed here.

Evaluation of osseointegration of titanium alloyed implants modified by plasma polymerization

By means of plasma polymerization, positively charged, nanometre-thin coatings can be applied to implant surfaces. The aim of the present study was to quantify the adhesion of human bone cells in vitro and to evaluate the bone ongrowth in vivo, on titanium surfaces modified by plasma polymer coatings. Different implant surface configurations were examined: titanium alloy (Ti6Al4V) coated with plasma-polymerized allylamine (PPAAm) and plasma-polymerized ethylenediamine (PPEDA) versus uncoated. Shear stress on human osteoblast-like MG-63 cells was investigated in vitro using a spinning disc device. Furthermore, bone-to-implant contact (BIC) was evaluated in vivo. Custom-made conical titanium implants were inserted at the medial tibia of female Sprague-Dawley rats. After a follow-up of six weeks, the BIC was determined by means of histomorphometry. The quantification of cell adhesion showed a significantly higher shear stress for MG-63 cells on PPAAm and PPEDA compared to uncoated Ti6Al4V. Uncoated titanium alloyed implants showed the lowest BIC (40.4%). Implants with PPAAm coating revealed a clear but not significant increase of the BIC (58.5%) and implants with PPEDA a significantly increased BIC (63.7%). In conclusion, plasma polymer coatings demonstrate enhanced cell adhesion and bone ongrowth compared to uncoated titanium surfaces.

Topographical and chemical effects of electrochemically assisted deposited hydroxyapatite coatings on osteoblast-like cells

A recently commercialised hydroxyapatite electrochemically assisted chemical deposition technique (BoneMaster) has been shown to induce increased bone apposition; whether this response is caused by the surface topography or chemistry is unknown. An in-vitro examination using human osteoblast-like cells was performed on a series of BoneMaster-coated surfaces. The chemistry was separated from the topography using a thin gold coating; Thermanox coverslips were used as a control. BoneMaster surfaces showed significantly greater alkaline phosphatase activity and osteocalcin production compared with controls; however, no difference was found between the gold-coated and uncoated BoneMaster samples, indicating topography is the main contributing factor.

Significance of nano- and microtopography for cell-surface interactions in orthopaedic implants

Cell-surface interactions play a crucial role for biomaterial application in orthopaedics. It is evident that not only the chemical composition of solid substances influence cellular adherence, migration, proliferation and differentiation but also the surface topography of a biomaterial. The progressive application of nanostructured surfaces in medicine has gained increasing interest to improve the cytocompatibility and osteointegration of orthopaedic implants. Therefore, the understanding of cell-surface interactions is of major interest for these substances. In this review, we elucidate the principle mechanisms of nano- and microscale cell-surface interactions in vitro for different cell types onto typical orthopaedic biomaterials such as titanium (Ti), cobalt-chrome-molybdenum (CoCrMo) alloys, stainless steel (SS), as well as synthetic polymers (UHMWPE, XLPE, PEEK, PLLA). In addition, effects of nano- and microscaled particles and their significance in orthopaedics were reviewed. The significance for the cytocompatibility of nanobiomaterials is discussed critically.

Bioactive and biodegradable nanocomposites and hybrid biomaterials for bone regeneration

Strategies for bone tissue engineering and regeneration rely on bioactive scaffolds to mimic the natural extracellular matrix and act as templates onto which cells attach, multiply, migrate and function. Of particular interest are nanocomposites and organic-inorganic (O/I) hybrid biomaterials based on selective combinations of biodegradable polymers and bioactive inorganic materials. In this paper, we review the current state of bioactive and biodegradable nanocomposite and O/I hybrid biomaterials and their applications in bone regeneration. We focus specifically on nanocomposites based on nano-sized hydroxyapatite (HA) and bioactive glass (BG) fillers in combination with biodegradable polyesters and their hybrid counterparts. Topics include 3D scaffold design, materials that are widely used in bone regeneration, and recent trends in next generation biomaterials. We conclude with a perspective on the future application of nanocomposites and O/I hybrid biomaterials for regeneration of bone.

Biofunctionalization of the implant surface with different concentrations of a synthetic peptide (P-15)

OBJECTIVE

This study aimed at identifying the ideal concentration of a biofunctional surface coating of dental implants with a synthetic peptide (P-15). In a previous study, P-15 was shown to enhance osseointegration parameters.

MATERIAL AND METHODS

Implants (modified ANKYLOS(®) A8; FRIADENT Plus(®) surface) with five different concentrations (0-400 μg/ml) of a P-15 coating as well as uncoated controls were inserted in the frontal bone of 45 adult domestic pigs. The histomorphometric and microradiographic findings for the coated implants were compared to those for the uncoated ones after 7, 14, and 30 days.

RESULTS

No significant differences were observed comparing the peri-implant bone density between the coated and uncoated implants The bone-to-implant contact, as the primary histological parameter for osseointegration, showed high rates for all surfaces investigated (between 73.3 ± 17.9% for the control and 81.9 ± 15.2% for P15 20 μg/ml after 30 days).

CONCLUSIONS

No significant benefit on osseointegration of a biofunctional P-15 coating of dental implants could be displayed in the present study.

Evaluation of trabecular bone formation in a canine model surrounding a dental implant fixture immobilized with an antimicrobial peptide derived from histatin

JH8194 induces osteoblast differentiation, although it was originally designed to improve antifungal activity. This suggests that JH8194 is useful for implant treatment. Therefore, the aim of this study was to evaluate the osseointegration capacity of JH8194-modified titanium dental implant fixtures (JH8194-Fi). The implants were randomly implanted into the edentulous ridge of dog mandibles. Healing abutments were inserted immediately after implant placement. Three weeks later, peri-implant bone levels, the first bone-to-implant contact points, and trabecular bone formation surrounding the implants were assessed by histological and digital image analyses based on microcomputed tomography (microCT). The histological analysis revealed an enhancement of mature trabecular bone around the JH8194-Fi compared with untreated fixtures (control-Fi). Similarly, microCT combined with analysis by Zed View™ also showed increased trabecular bone formation surrounding the JH8194-Fi compared with the control-Fi (Student's t-test, P < 0.05). JH8194 may offer an alternative biological modification of titanium surfaces to enhance trabecular bone formation around dental implants, which may contribute to the transient acquirement of osseointegration and the long-term success of implant therapy.

Early outcome of an implant system with a resorbable adhesive calcium-phosphate coating--a prospective clinical study in partially dentate patients

This study aims to investigate the early outcome of a dental implant with bioactive calcium-phosphate (CaP) coating in the first year of usage in different clinical indications in partially edentulous patients, after early and delayed prosthetic loading. Therefore, in a prospective follow-up study, the cumulative survival and success rate of a conical, self-drilling and self-tapping implant system after 6 months and 1 year post-insertion was evaluated. A total of 311 CaP-coated implants were placed in 124 patients. Seventy-two implants in clinical high-quality bone situation were loaded after 2 weeks post-insertion with the definite restoration; the rest after 6 months. The indication for implant placement was treatment of partial dentate mandible and maxilla. One hundred sixty-three implants were placed in the posterior mandible, 117 in the posterior maxilla. In the frontal maxilla, 25 implants and in the frontal mandible, eight implants were used. In 126 cases (36%), bone augmentation procedures (guided bone regeneration and sinus lift) were performed concomitant with implant placement. The difference between primary and secondary stability (implant stability quotient (ISQ), Periotest, insertion torque), peri-implant clinical parameter as well as survival and success criteria were evaluated. In total, ISQ mean values after 6 months were higher than after implant placement. Periotest values increased in the period of the first 6 months and remained constant afterwards. After 6 months of insertion, the mean bone loss was 0.051 mm. After 12 months, a bone gain with a mean of +0.016 mm was observed; implants in the posterior maxilla showed significant less bone resorption than implants in the posterior mandible (p < 0.0001). In the most of the implants (74%), clinical normal gingival tissue could be observed. In 24%, a mild inflammation was analysed. In 35 implants, a provocation of peri-implant bleeding was possible. In the early loading group, no implant failure was seen. Altogether, one implant in D4 bone has been lost. The cumulative survival rate summed up to 99.7%. In general, implant success assessment analysis according to Albrektsson and Buser displayed success in 99.7% of the implants. With respect to the patient selection including 124 implants with minor and major augmentations as well as early loading prosthetic function, the 1-year clinical use of the studied implant system with CaP coating showed good results, comparable to that of conventional implants without a specific coating. After 1 year, neither special disadvantages nor benefits of CaP-coated implants could be evaluated. Long-term results are further needed.

Improved interaction of osteoblast-like cells with apatite-nanodiamond coatings depends on fibronectin

New apatite (AP)/nanodiamond (ND) coating has been developed to improve physical and biological properties of stainless steel (SS) versus single AP coating. Homogeneously electrodeposited AP-ND layer demonstrates increased mechanical strength, interlayer cohesion and ductility. In the absence of serum, osteoblast-like MG63 cells attach well but poorly spread on both AP and AP-ND substrata. Pre-adsorption with serum or fibronectin (FN) improves the cellular interaction-an effect that is better pronounced on the AP-ND coating. In single protein adsorption study fluorescein isothiocyanate-labeled FN (FITC-FN) shows enhanced deposition on the AP-ND layer consistent with the significantly improved cell adhesion, spreading and focal adhesions formation (in comparison to SS and AP), particularly at low FN adsorption concentrations (1 μg/ml). Higher FN concentrations (20 μg/ml) abolish this difference suggesting that the promoted cellular interaction of serum (where FN is low) is caused by the greater affinity for FN. Moreover, it is found that MG63 cells tend to rearrange both adsorbed and secreted FN on the AP-ND layer suggesting facilitated FN matrix formation.

The effect on bone growth enhancement of implant coatings with hydroxyapatite and collagen deposited electrochemically and by plasma spray

Skeletal bone consists of hydroxyapatite (HA) [Ca(10)(PO(4))(6)(OH)(2)] and collagen type I, both of which are osseoconductive. The goal of osseointegration of orthopedic and dental implants is the rapid achievement of a mechanically stable long-lasting fixation between bone and an implant surface. In this study, we evaluated the mechanical fixation and tissue distribution surrounding implants coated with three surfaces: plasma-sprayed HA coating, thinner coating of electrochemical-assisted deposition of HA, and an identical thin coating with a top layer of mineralized collagen. Uncoated plasma-sprayed titanium (Ti-6Al-4V) served as negative control. The electrochemical-assisted deposition was performed near physiological conditions. We used a canine experimental joint replacement model with four cylindrical implants (one of each treatment group) inserted in the humeri cancellous metaphyseal bone in a 1 mm gap. Observation time was 4 weeks. The mechanical fixation was quantified by push-out test to failure, and the peri-implant tissue formation by histomorphometric evaluation. HA coatings deposited by plasma spray technique or electrochemically, increased the mechanical fixation and bone ongrowth, but there was no statistical difference between the individual HA applications. Addition of collagen to the mineralized phase of the coating to create a more bone natural surface did not improve the osseoconductive effect of HA.

Electrophoretic deposition of nanobiocomposites for orthopedic applications: influence of current density and coating duration

Frequently metal implants undergo detachment from the host tissue due to inadequate biocompatibility and poor osteointegration. In view of this, bioactive porous apatite-wollastonite/chitosan nanocomposite coating was prepared using electrophoretic deposition (EPD) technique in the present work. The effect of coating duration and current density on surface characteristics of the nanocomposite coating was assessed using optical microscope and scanning electron microscope. EPD led to the formation of thick and homogeneous coating. Adhesion of the composite coating on titanium substrate was evaluated using tape test and bioactivity of the coatings was studied by immersing in simulated body fluid (SBF). The coating with higher current density and longer coating duration was found to be suitable with improved adhesion and bioactivity for intended metal implants.

Effects of implant surface coatings and composition on bone integration: a systematic review

OBJECTIVE

The aim of the present review was to evaluate the bone integration efficacy of recently developed and marketed oral implants as well as experimental surface alterations.

MATERIALS AND METHODS

A PubMed search was performed for animal studies, human reports and studies presenting bone-to-implant contact percentage or data regarding mechanical testing.

RESULTS

For recently developed and marketed oral implants, 29 publications and for experimental surface alterations 51 publications fulfilled the inclusion criteria for this review.

CONCLUSIONS

As demonstrated in the available literature dealing with recently developed and marketed oral implants, surface-roughening procedures also affect the surface chemical composition of oral implants. There is sufficient proof that surface roughening induces a safe and predictable implant-to-bone response, but it is not clear whether this effect is due to the surface roughness or to the related change in the surface composition. The review of the experimental surface alterations revealed that thin calcium phosphate (CaP) coating technology can solve the problems associated with thick CaP coatings, while they still improve implant bone integration compared with non-coated titanium implants. Nevertheless, there is a lack of human studies in which the success rate of thin CaP-coated oral implants is compared with just roughened oral implants. No unequivocal evidence is available that suggests a positive effect on the implant bone integration of peptide sequences or growth factors coated on titanium oral implants. In contrast, the available literature suggests that bone morphogenetic protein-2 coatings might even impede the magnitude of implant-to-bone response.

Cyclo-DfKRG peptide modulates in vitro and in vivo behavior of human osteoprogenitor cells on titanium alloys

The first aim of the present study was to investigate the capacity of a cyclo-DfKRG-coated hydroxyapatite-titanium alloy (Ti-HA-RGD) to activate in vitro human osteoprogenitor cells adhesion and differentiation. The second purpose was to examine in vivo the role of a autologous cell seeding on cyclo-DfKRG-functionalized materials to provide bone repair after implantation in femoral condyle of rabbits. Our in vitro results have demonstrated that both titanium alloy functionalized with hydroxyapatite (Ti-HA-RGD and Ti-HA) contributed to higher cell adhesion than titanium alloy alone respectively 85 and 55% vs 15% compared to tissue culture polystyrene after one hour of cell seeding. As for differentiation, after 3 days of culture, Ti-HA presented the highest increase of ALP mRNA of all surfaces studied. Ti-HA-RGD showed an intermediate value about half as high as Ti-HA. Moreover after 3 days, both Ti-HA and Ti-HA-RGD surfaces showed the highest increase of cbfa1 mRNA expression. Two weeks following implantation, in vivo findings revealed that percentage of lacunae contact observed with pre-cellularized Ti-HA-RGD samples remains significantly lower than with Ti-HA group (10.5+/-9.6 % vs 33.7+/-11.5 %, P<0.03). Meanwhile, RGD peptide coating had no significant additional effect on the bone implant contact and area. Moreover, histomorphometry analysis revealed that implantation of pre-cellularized RGD coated materials with ROP cells increased significantly peri-implant fibrous area (24+/-11.6% vs 3+/-1.7% for Ti-HA-RGD, P<0.02). RGD coatings demonstrated osteoblastic adhesion, differentiation and in vivo bone regeneration at most equivalent to HA coatings.

Electrophoretic deposition of silicon-substituted hydroxyapatite/poly(epsilon-caprolactone) composite coatings

Silicon-substituted hydroxyapatite/poly(epsilon-caprolactone) composite coatings were prepared on titanium substrate by electrophoretic deposition in n-butanol and chloroform mixture. The effect of the concentration of poly(epsilon-caprolactone) in suspension on the morphology and the microstructure of coatings were investigated, furthermore, the thermal behavior and in vitro bioactivity were also investigated. The results show that the coarse and accidented silicon-substituted hydroxyapatite/poly(epsilon-caprolactone) composite coatings were obtained by electrophoretic deposition when the concentration of poly(epsilon-caprolactone) in suspension was 6-16 g/l. The adsorption of poly(epsilon-caprolactone) on the surface of Si-HA particles hinders the electrophoretic deposition of Si-HA. The shear-testing experiments indicated that the addition of poly(epsilon-caprolactone) in suspension is in favor of improving the bonding strength of the coatings. After immersion in simulated body fluid for 8 days, silicon-substituted hydroxyapatite/poly(epsilon-caprolactone) composite coatings have the ability to induce the bone-like apatite formation.

Structural evolution and adhesion of titanium oxide film containing phosphorus and calcium on titanium by anodic oxidation

This study investigated the microstructure evolution and defects of the titanium oxide layer containing calcium (Ca) and phosphorus (P) formed by anodic oxidation in a solution containing Ca and P compounds. Results show that the anodic film exhibited a two-layer structure: a pore-containing amorphous titanium oxide layer dispersed with nano-sized crystallites formed prior to sparking, and a porous overlay dotted with craters formed after sparking. Ca and P were predominantly incorporated in the porous overlay, in which the amorphous region contained more Ca and P than the crystalline region regardless of the anodizing voltages. Moreover, the ratio of amorphous to crystalline regions in the porous overlay changed insignificantly with anodizing voltage. Increasing anodizing voltage enhanced the incorporation of Ca and P in the anodic film, but deteriorated the adhesion of the anodic film to the substrate. This deterioration was related to two inherent adhesive weaknesses: the aligned pores in the titanium oxide layer and the craters in the major overlay, signifying that a new anodic oxidation process that can produce high Ca- and P-containing oxide film at relatively-low anodizing voltages, i.e. approximately 200 V, is a necessity.

Characterization of biomimetic calcium phosphate on phosphorylated chitosan films

This study examined the effect of chitosan degree of deacetylation (DDA), concentration of simulated body fluid (SBF), and mineralization time on the composition, structure, and crystallinity of calcium phosphate (CaP) biomimetically deposited on chitosan and on osteoblast cell growth. Phosphorylated chitosan films of 92.3%, 87.4%, and 80.6% DDA were soaked in SBF (1.0x or 1.5x) for 7, 14, or 21 days. Scanning electron microscopy revealed that CaP precipitated from 1.5x SBF had a porous, granular morphology; while the coatings precipitated in 1.0x SBF were smoother and more uniform. X-ray diffraction showed that films mineralized in 1.0x SBF were amorphous, while films mineralized in 1.5x SBF for 21 days exhibited crystalline peaks similar to hydroxyapatite, with the most crystalline peaks seen on 92.3% DDA chitosan. When mineralized films were placed in cell media for 14 days, more calcium phosphate precipitated onto all films, and the most calcium phosphate was found on 92.3% DDA films mineralized in 1.5x SBF. After seven days of osteoblast culture, there were approximately three times as many cells (based on DNA measurements, p < 0.05) on 92.3% DDA films soaked in 1.0x SBF for seven or 21 days than on 80.6% DDA films soaked in 1.0x SBF for any length of time or any films soaked in 1.5x SBF. The DDA of chitosan, concentration of SBF and mineralization time affect the structure of and biological response to chitosan/biomimetic CaP films, and these factors must be considered when designing new materials to be used in orthopaedic and dental/craniofacial implant applications.

Using optical tweezers for measuring the interaction forces between human bone cells and implant surfaces: System design and force calibration

Optical tweezers were used to study the interaction and attachment of human bone cells to various types of medical implant materials. Ideally, the implant should facilitate cell attachment and promote migration of the progenitor cells in order to decrease the healing time. It is therefore of interest, in a controlled manner, to be able to monitor the cell adhesion process. Results from such studies would help foresee the clinical outcome of integrating medical implants. The interactions between two primary cell culture models, human gingival fibroblasts and bone forming human osteoblast cells, and three different implant materials, glass, titanium, and hydroxyapatite, were studied. A novel type of optical tweezers, which has a newly designed quadrant detector and a powerful 3 W laser was constructed and force calibrated using two different methods: one method in which the stiffness of the optical trap was obtained by monitoring the phase lag between the trap and the moved object when imposing a forced oscillation on the trapped object and another method in which the maximum trapping force was derived from the critical velocity at which the object escapes the trap. Polystyrene beads as well as cells were utilized for the calibrations. This is the first time that cells have been used directly for these types of force calibrations and, hence, direct measurements of forces exerted on cells can be performed, thus avoiding the difficulties often encountered when translating the results obtained from cell measurements to the calibrations obtained with reference materials. This more straightforward approach represents an advantage in comparison to established methods.

Soft tissue healing at titanium implants coated with type I collagen. An experimental study in dogs

OBJECTIVE

To analyse the soft tissue healing at titanium implants coated with type 1 collagen.

MATERIAL AND METHODS

Six dogs were used. The mandibular pre-molars and the three anterior maxillary pre-molars were extracted. Three months later mucoperiosteal flaps were raised and two test and two control implants were installed (3i TG Osseotite 3.75 x 10 and 2.8 mm transmucosal collar). The test implants were coated with a purified porcine type I collagen. Cover screws were placed and flaps were sutured. The sutures were removed 2 weeks later and a plaque-control programme was initiated. Another 2 weeks later, the procedure was repeated in the contra-lateral mandibular region. Four weeks after the second implant surgery, biopsies were obtained and prepared for histological examination.

RESULTS/CONCLUSION

The vertical dimensions of the epithelial and connective tissue components as well as the composition of the connective tissue portion facing the implant were similar at collagen-coated and uncoated implants after 4 and 8 weeks of healing. It is suggested that soft tissue healing to implants coated with type I collagen was similar to that at non-coated titanium implants and that no adverse reactions to the collagen-coated implants occurred.

Adjusting the chlorhexidine content of calcium phosphate coatings by electrochemically assisted co-deposition from aqueous solutions

Currently, a number of strategies to create either biologically active or antimicrobial surfaces of biomaterials are being developed and commercially applied. However, for metallic implants in contact with bone, both osteomyelitis and a fast and stable long-term fixation of implants are challenges to be overcome, especially in the case of bad bone quality. Therefore, the present work aims to develop compound coatings of calcium phosphate phases (CPP) and chlorhexidine (CHD) that combine bioactive properties with a strategy to prevent initial bacterial adhesion and thus offer a possible solution to the two major problems of implant surgery mentioned above. Using electrochemically assisted deposition of CPP on samples of Ti6Al4V together with the pH-dependent solubility of CHD, the preparation of coatings with a wide range of CHD concentrations (150 ng/cm(2) to 65 microg/cm(2)) from electrolytes with CHD concentrations between 50 and 200 microM was possible, thus allowing the adaptation of implant surface properties to different surgical and patient situations. Detailed SEM and FTIR analysis showed that coatings are formed by a co-deposition process of both phases and that CHD interacts with the deposition and transformation of CPP in the coating. For high CHD contents, coatings consist of CHD crystals coated by nano-crystalline hydroxyapatite.

Preliminary β-tricalcium phosphate coating prepared by discharging in a modified body fluid enhances collagen immobilization onto titanium

Because of its excellent scaffold properties toward bone cells, collagen has been recognized as a promising extracellular matrix protein for surface modification of titanium implants. Hydroxyapatite (HA) coatings have been investigated as a preliminary coating for collagen immobilization on titanium implants. However, the composition of HA-collagen is recognized as being difficult, and while many studies have suggested that biodegradable beta-tricalcium phosphate (beta-TCP) has better osteoconductivity than HA, the efficiency of preliminary beta-TCP coating for collagen immobilization on titanium surfaces has yet to be evaluated. This investigation aimed to evaluate the applicability of HA and beta-TCP coatings, prepared by discharging in modified body fluids, as preliminary collagen coatings. To increase collagen induction on preliminary HA and beta-TCP coatings, we used a new cathodic polarization method. X-ray photoelectron spectroscopy revealed that the bonding strength between the collagen NH(+) amino groups of collagen and phosphate (PO(4) (3-)) was greater on the beta-TCP coating than the HA coating. The preliminary beta-TCP coating was tightly crosslinked with RCOO(-) carboxyl groups of the collagen molecules and showed high cellular responses, even in the early stage of cell cultivation. Thus, this coating was found to be more effective than HA as a preliminary coating for collagen immobilization on titanium implants.

Magnesium and its alloys as orthopedic biomaterials: A review

As a lightweight metal with mechanical properties similar to natural bone, a natural ionic presence with significant functional roles in biological systems, and in vivo degradation via corrosion in the electrolytic environment of the body, magnesium-based implants have the potential to serve as biocompatible, osteoconductive, degradable implants for load-bearing applications. This review explores the properties, biological performance, challenges and future directions of magnesium-based biomaterials.

Electrochemical activation of titanium for biomimetic coating of calcium phosphate

This article reports an electrochemical method to activate titanium surface for biomimetic calcium phosphate (Ca-P) coatings. Titanium serving as cathode was treated in an electrochemical cell with a supersaturated calcium and phosphate solution serving as electrolyte. This treatment generated a gel-like film with thickness of about 100 nm on the titanium surface. The amorphous film was composed by calcium and phosphate ions and contained a large number of crystal nuclei of octacalcium phosphate (OCP). The effectiveness of this novel treatment was demonstrated by comparing the behavior of treated and untreated titanium when used for biomimetic coating. A uniform Ca-P coating was formed on the treated titanium after immersion for several hours in aqueous solution. This work explored a new method to activate surfaces of metal implants for osseointegration, which is considerably faster than treatments currently in use, such as alkaline treatment.

A composite coating by electrolysis-induced collagen self-assembly and calcium phosphate mineralization

A composite coating that is composed of collagen protein and calcium phosphate minerals is considered to be bioactive and may enhance bone growth and fixation of metallic orthopedic implants. In this study, we have successfully developed a uniform collagen fibril/octacalcium phosphate composite coating on silicon substrate by electrolytic deposition (ELD). The coating deposition was done through applying a constant potential to the cathode in a three-electrode electrochemistry cell that contain a mild acidic (pH 4.8-5.3) aqueous solution of collagen molecules, calcium and phosphate ions. The coating process involved self-assembly of collagen fibrils and the deposition of calcium phosphate minerals as a result of cathode reaction and local pH increase. The two steps could be synchronized to form a bone-like composite at nanometer scale through proper adjustment of the solution and deposition parameters. Coating morphology, crystal structure and compositions were analyzed by optical and fluorescence microscopy, scanning and transmission electron microscopy, energy dispersive X-ray analysis, inductively coupled argon plasma optical emission spectrophotometry, and Fourier-transformed infrared spectroscopy. Under typical deposition conditions, the cathode (Si) surface formed a thin (100 nm) layer of calcium phosphate coating, on top of which a thick (approximately 100 microm) composite layer formed. The porous composite layer consists of a collagen fibril network on which clusters of octacalcium phosphate crystals nucleate and grow. By combining photolithography and ELD, we were also able to pattern the composite coating into regular arrays of squares. Preliminary results by nanoindentation tests showed that properly prepared composite coating may have higher elastic modulus and scratch resistance than monolithic porous calcium phosphate coating. The results not only provide a novel bioactive coating for biomedical implants, but also establish a new experimental protocol for studying biomineralization mechanisms of collagen based biological tissues.

Histological findings in titanium implants coated with calcium phosphate ceramics installed in rabbit's tibias

Oral reconstruction using osteointegrated implants are widely indicated nowadays. The implant bone anchorage is very important for its functional stability. Thus, ceramic biomaterials are widely used as coatings of the implant surfaces to accelerate local osteogenesis. The purpose of this study is to assess the biocompatibility and the osteoconduction of two types of calcium phosphate ceramics used as titanium dental implant coatings. These implants were installed in rabbit tibia during an 8-week healing period. The light and fluorescent microscopy observations showed that the materials are biocompatible and that they have osteoconductive activities.

A low-temperature biomimetic calcium phosphate surface enhances early implant fixation in a rat model

The present study demonstrates increased early mechanical fixation of titanium implants coated with a new biomimetic apatite surface in a rat model. Male Sprague-Dawley rats received unilateral femoral medullary implants for periods of 1-4 weeks. The strength of fixation of the implant to the host bone increased more rapidly in the group receiving apatite-treated implants compared with the control group as evidenced by the apatite group's 21-fold greater fixation strength at 1 week (p = 0.009), 4-fold greater fixation strength at 2 weeks (p = 0.041), and 2-fold greater fixation strength at 4 weeks (p = 0.093) compared with the control. Fixation strength was correlated with bone-implant contact as determined from micro computed tomography assessment of the specimens (r2 = 0.338, p = 0.011 in the control group and r2 = 0.543, p < 0.001 in the apatite group). Furthermore, for a given amount of bone-implant contact, the fixation strength was higher in the apatite group than in the control group (p = 0.011), suggesting that the bone formed a stronger bond to the apatite coating than to the titanium. This difference in bonding strength accounted for the difference in mechanical behavior.