High surface energy enhances cell response to titanium substrate microstructure

Clinical and radiographic outcomes of lateral sinus floor elevation with simultaneous hydrophilic implants placement: A retrospective study of 2-5 years

AIMS

To investigate the clinical and radiographic outcomes of a chemically modified sandblasted large-grit acid-etched implant (hydrophilic) in lateral sinus floor elevation (LSFE), compared with a conventional one (hydrophobic).

MATERIALS AND METHODS

A retrospective study design was adopted. Patients who received LSFE with simultaneous implant placement were recruited. According to different types of implant surfaces, patients were divided into two groups (the hydrophilic group and the hydrophobic group). Implant survival rate (SR), endo-sinus bone stability on the radiographs, mean probing depths, percentage of bleeding on probing, marginal bone loss, and patient satisfaction were evaluated.

RESULTS

A total of 106 patients with 180 implants (hydrophilic:101, hydrophobic:79) in 119 maxillary sinuses were included. The follow-up period ranged from 2 to 5 years. Three hydrophobic implants and one hydrophilic implant in four different patients failed. The SR of the hydrophilic group was higher than that of the hydrophobic group but without a significant difference (p > .05). The change and change rate of endo-sinus bone height (ΔESBH and RΔESBH) and bone volume (ΔESBV and RΔESBV) in the hydrophilic group were less than those in the hydrophobic group, with a significant difference at 6 months after implantation. No other significant difference was found between the two groups.

CONCLUSION

Within the limitations of this study, both hydrophilic and hydrophobic implants were suitable for LSFE with predictable clinical outcomes. Meanwhile, hydrophilic implants could contribute to the grafted endo-sinus bone stability during healing time.

Assessment of a novel electrochemically deposited smart bioactive trabecular coating (SBTC®): a randomized controlled clinical trial

OBJECTIVES

A randomized controlled clinical trial of dental implants was conducted to compare the clinical properties of a novel electrochemically deposited calcium phosphate coating to those of a common marketed surface treatment.

MATERIAL AND METHODS

Forty implants of the same brand and type were placed in 20 fully edentulous participants requiring mandibular implantation. The two study groups were defined by the surface treatment of the implants. 20 implants in the control group were coated via a commercial electrochemical surface treatment that forms a mixture of brushite and hydroxyapatite, while the remaining 20 in the test group were coated with a novel electrochemical Smart Bioactive Trabecular Coating (SBTC®). A split-mouth design was employed, with each participants receiving one control implant in one mandibular side and a test implant in the other. To mitigate potential operator-handedness bias, control and test implants were randomly assigned to mandibular sides. All cases underwent digital planning, implant placement with a static surgical guide, and participants received locator-anchored full-arch dentures. The primary outcome was implant stability (measured using Osstell ISQ) assessed at insertion, loading, and then 3 months, 9 months, and 2 years post-insertion. The secondary outcome was bone level change (in millimeters) over the 2-year observation period. Oral health-related quality of life (OHRQL) was monitored using the OHIP-14 questionnaire. Complications and adverse events were recorded.

RESULTS

Successful osseointegration and implant stability were achieved in all cases, allowing loading. ISQ values steadily increased throughout the observation period. While no significant differences were observed between the SBTC® and control coatings, the test group exhibited a higher ISQ gain. Bone resorption was somewhat lower in the SBTC® but not significantly so. Patients' OHRQL significantly improved after denture delivery and remained stable throughout the follow-up. No complications or adverse events were observed.

CONCLUSIONS

Based on the study results, we conclude that the new surface treatment is a safe alternative to the widely used control surface, demonstrating similar osseointegrative properties and time-dependent bone level changes. Further research may explore the broader implications of these findings.

TRIAL REGISTRATION

The study is registered on clinicaltrials.gov under the identifier ID: NCT06034171.

Different Methods to Modify the Hydrophilicity of Titanium Implants with Biomimetic Surface Topography to Induce Variable Responses in Bone Marrow Stromal Cells

The osteoblastic differentiation of bone marrow stromal cells (bMSCs), critical to the osseointegration of titanium implants, is enhanced on titanium surfaces with biomimetic topography, and this is further enhanced when the surfaces are hydrophilic. This is a result of changing the surface free energy to change protein adsorption, improving cell attachment and differentiation, and improving bone-to-implant contact in patients. In this study, we examined different methods of plasma treatment, a well-accepted method of increasing hydrophilicity, and evaluated changes in surface properties as well as the response of bMSCs in vitro. Commercially pure Ti and titanium-aluminum-vanadium (Ti6Al4V) disks were sand-blasted and acid-etched to impart microscale and nanoscale roughness, followed by treatment with various post-processing surface modification methods, including ultraviolet light (UV), dielectric barrier discharge (DBD)-generated plasma, and plasma treatment under an argon or oxygen atmosphere. Surface wettability was based on a sessile water drop measurement of contact angle; the elemental composition was analyzed using XPS, and changes in topography were characterized using scanning electron microscopy (SEM) and confocal imaging. The cell response was evaluated using bMSCs; outcome measures included the production of osteogenic markers, paracrine signaling factors, and immunomodulatory cytokines. All plasma treatments were effective in inducing superhydrophilic surfaces. Small but significant increases in surface roughness were observed following UV, DBD and argon plasma treatment. No other modifications to surface topography were noted. However, the relative composition of Ti, O, and C varied with the treatment method. The cell response to these hydrophilic surfaces depended on the plasma treatment method used. DBD plasma treatment significantly enhanced the osteogenic response of the bMSCs. In contrast, the bMSC response to argon plasma-treated surfaces was varied, with an increase in OPG production but a decrease in OCN production. These results indicate that post-packaging methods that increased hydrophilicity as measured by contact angle did not change the surface free energy in the same way, and accordingly, cells responded differently. Wettability and surface chemistry alone are not enough to declare whether an implant has an improved osteogenic effect and do not fully explain how surface free energy affects cell response.

Comparison of Zirconia Implant Surface Modifications for Optimal Osseointegration

Zirconia ceramic implants are commercially available from a rapidly growing number of manufacturers. Macroscopic and microscopic surface design and characteristics are considered to be key determining factors in the success of the osseointegration process. It is, therefore, crucial to assess which surface modification promotes the most favorable biological response. The purpose of this study was to conduct a comparison of modern surface modifications that are featured in the most common commercially available zirconia ceramic implant systems. A review of the currently available literature on zirconia implant surface topography and the associated bio-physical factors was conducted, with a focus on the osseointegration of zirconia surfaces. After a review of the selected articles for this study, commercially available zirconia implant surfaces were all modified using subtractive protocols. Commercially available ceramic implant surfaces were modified or enhanced using sandblasting, acid etching, laser etching, or combinations of the aforementioned. From our literature review, laser-modified surfaces emerged as the ones with the highest surface roughness and bone-implant contact (BIC). It was also found that surface roughness could be controlled to achieve optimal roughness by modifying the laser output power during manufacturing. Furthermore, laser surface modification induced a very low amount of preload microcracks in the zirconia. Osteopontin (OPN), an early-late osteogenic differentiation marker, was significantly upregulated in laser-treated surfaces. Moreover, surface wettability was highest in laser-treated surfaces, indicating favorable hydrophilicity and thus promoting early bone forming, cell adhesion, and subsequent maturation. Sandblasting followed by laser modification and sandblasting followed by acid etching and post-milling heat treatment (SE-H) surfaces featured comparable results, with favorable biological responses around zirconia implants.

The relationship of peri-implant soft tissue wound healing with implant cover screw design: Cross-sectional study

INTRODUCTION

Dental implants are frequently preferred method for oral rehabilitation all over the world. The incidence of various complications such as incorrect prosthesis, peri-implant mucositis, and peri-implantitis is high; premature loss of implants is encountered due to osteointegration process not being completed for some unexplained reasons. However, there is no study in the literature examining the nonfunctional period of implants. Closure screws of different implant companies have different designs like surface properties, and areas, where closure screws sit, are important reservoirs for microorganism colonization. Our study aims to evaluate the inflammatory response, epithelial maturation, and epithelial-connective tissue interaction around closure screws.

METHODS

For this purpose, 52 implants belonging to five different implant companies were included in the study. Tissues removed over the cover screw during fitting of healing caps were used as biopsy material and for epithelial proliferation Ki-67, for epithelium-connective tissue interaction Syndecan-1, and for macrophage activation CD-68 expressions were evaluated by immunohistochemical analysis. Scanning electron microscopy (SEM) analyzes were performed to evaluate the presence of gap between the implant and the cover screw.

RESULTS

As a result of our study, intensity of subepithelial inflammation between groups wasn't statistically different. Differences in CD-68 and Syndecan-1 levels were obtained at the lamina propria level. H score of CD-68 was statistically significantly different in epithelium (p = 0.032), and H score of Syndecan-1 was different in lamina propria (p = 0.022). There wasn't a statistically significant difference between the groups for Ki-67 (p = 0.151).

CONCLUSION

Our study results indicate that in addition to the implant surface morphology, the design of the closure screws is important in the inflammatory response and epithelial maturation that develops during wound healing. Although the inflammatory response is required for healing, osteointegration, and implant survival, further investigation is needed to investigate the relationship between initial neck resorption and closure screws with radiographic and microbiological examinations.

Selective Laser Melting of the Porous Ta Scaffold with Mg-Doped Calcium Phosphate Coating for Orthopedic Applications

Addressing the repair of large-scale bone defects has become a hot research topic within the field of orthopedics. This study assessed the feasibility and effectiveness of using porous tantalum scaffolds to treat such defects. These scaffolds, manufactured using the selective laser melting (SLM) technology, possessed biomechanical properties compatible with natural bone tissue. To enhance the osteogenesis bioactivity of these porous Ta scaffolds, we applied calcium phosphate (CaP) and magnesium-doped calcium phosphate (Mg-CaP) coatings to the surface of SLM Ta scaffolds through a hydrothermal method. These degradable coatings released calcium and magnesium ions, demonstrating osteogenic bioactivity. Experimental results indicated that the Mg-CaP group exhibited biocompatibility comparable to that of the Ta group in vivo and in vitro. In terms of osteogenesis, both the CaP group and the Mg-CaP group showed improved outcomes compared to the control group, with the Mg-CaP group demonstrating superior performance. Therefore, both CaP and magnesium-CaP coatings can significantly enhance the osseointegration of three-dimensional-printed porous Ta, thereby increasing the surface bioactivity. Overall, the present study introduces an innovative approach for the biofunctionalization of SLM porous Ta, aiming to enhance its suitability as a bone implant material.

Effect of argon plasma abutment activation on soft tissue healing: RCT with histological assessment

OBJECTIVE

To assess the peri-implant soft tissue profiles between argon plasma treatment (PT) and non-treated (NPT) healing abutments by comparing clinical and histological parameters 2 months following abutment placement.

MATERIALS AND METHODS

Thirty participants were randomly assigned to argon-plasma treatment abutments group (PT) or non-treated abutments (NPT) group. Two months after healing abutment placement, soft peri-implant tissues and abutment were harvested, and histological and clinical parameters including plaque index, bleeding on probing, and keratinized mucosa diameter (KM) were assessed. Specialized stainings (hematoxylin-eosin and picrocirious red) coupled with immunohistochemistry (vimentin, collagen, and CK10) were performed to assess soft tissue inflammation and healing, and the collagen content keratinization. In addition to standard statistical methods, machine learning algorithms were applied for advanced soft tissue profiling between the test and control groups.

RESULTS

PT group showed lower plaque accumulation and inflammation grade (6.71% vs. 13.25%, respectively; p-value 0.02), and more advanced connective tissue healing and integration compared to NPT (31.77% vs. 23.3%, respectively; p = 0.009). In the control group, more expressed keratinization was found compared to the PT group, showing significantly higher CK10 (>47.5%). No differences in KM were found between the groups.

SIGNIFICANCE

PT seems to be a promising protocol for guided peri-implant soft tissue morphogenesis reducing plaque accumulation and inflammation, and stimulating collagen and soft tissue but without effects on epithelial tissues and keratinization.

A comprehensive review on anticorrosive/antifouling superhydrophobic coatings: Fabrication, assessment, applications, challenges and future perspectives

Superhydrophobicity (SHP) is an incredible phenomenon of extreme water repellency of surfaces ubiquitous in nature (E.g. lotus leaves, butterfly wings, taro leaves, mosquito eyes, water-strider legs, etc). Historically, surface exhibiting water contact angle (WCA) > 150° and contact angle hysteresis <10° is considered as SHP. The SHP surfaces garnered considerable attention in recent years due to their applications in anti-corrosion, anti-fouling, self-cleaning, oil-water separation, viscous drag reduction, anti-icing, etc. As corrosion and marine biofouling are global problems, there has been focused efforts in combating these issues using innovative environmentally friendly coatings designs taking cues from natural SHP surfaces. Over the last two decades, though significant progress has been made on the fabrication of various SHP surfaces, the practical adaptation of these surfaces for various applications is hampered, mainly because of the high cost, non-scalability, lack of simplicity, non-adaptability for a wide range of substrates, poor mechanical robustness and chemical inertness. Despite the extensive research, the exact mechanism of corrosion/anti-fouling of such coatings also remains elusive. The current focus of research in recent years has been on the development of facile, eco-friendly, cost-effective, mechanically robust chemically inert, and scalable methods to prepare durable SHP coating on a variety of surfaces. Although there are some general reviews on SHP surfaces, there is no comprehensive review focusing on SHP on metallic and alloy surfaces with corrosion-resistant and antifouling properties. This review is aimed at filling this gap. This review provides a pedagogical description with the necessary background, key concepts, genesis, classical models of superhydrophobicity, rational design of SHP, coatings characterization, testing approaches, mechanisms, and novel fabrication approaches currently being explored for anticorrosion and antifouling, both from a fundamental and practical perspective. The review also provides a summary of important experimental studies with key findings, and detailed descriptions of the evaluation of surface morphologies, chemical properties, mechanical, chemical, corrosion, and antifouling properties. The recent developments in the fabrication of SHP -Cr-Mo steel, Ti, and Al are presented, along with the latest understanding of the mechanism of anticorrosion and antifouling properties of the coating also discussed. In addition, different promising applications of SHP surfaces in diverse disciplines are discussed. The last part of the review highlights the challenges and future directions. The review is an ideal material for researchers practicing in the field of coatings and also serves as an excellent reference for freshers who intend to begin research on this topic.

The effect of graphene and graphene oxide induced reactive oxygen species on polycaprolactone scaffolds for bone cancer applications

Bone cancer remains a critical healthcare problem. Among current clinical treatments, tumour resection is the most common strategy. It is usually effective but may present several limitations such as multiple operations, long hospital time, and the potential recurrence caused by the incomplete removal of cancer cells. To address these limitations, three-dimensional (3D) scaffolds fabricated through additive manufacturing have been researched for both bone cancer treatment and post-treatment rehabilitation. Polycaprolactone (PCL)-based scaffolds play an important role in bone regeneration, serving as a physical substrate to fill the defect site, recruiting cells, and promoting cell proliferation and differentiation, ultimately leading to the regeneration of the bone tissue without multiple surgical applications. Multiple advanced materials have been incorporated during the fabrication process to improve certain functions and/or modulate biological performances. Graphene-based nanomaterials, particularly graphene (G) and graphene oxide (GO), have been investigated both in vitro and in vivo, significantly improving the scaffold's physical, chemical, and biological properties, which strongly depend on the material type and concentration. A unique targeted inhibition effect on cancer cells was also discovered. However, limited research has been conducted on utilising graphene-based nanomaterials for both bone regeneration and bone cancer treatment, and there is no systematic study into the material- and dose-dependent effects, as well as the working mechanism on 3D scaffolds to realise these functions. This paper addresses these limitations by designing and fabricating PCL-based scaffolds containing different concentrations of G and GO and assessing their biological behaviour correlating it to the reactive oxygen species (ROS) release level. Results suggest that the ROS release from the scaffolds is a dominant mechanism that affects the biological behaviour of the scaffolds. ROS release also contributes to the inhibition effect on bone cancer due to healthy cells and cancer cells responding differently to ROS, and the osteogenesis results also present a certain correlation with ROS. These observations revealed a new route for realising bone cancer treatment and subsequent new bone regeneration, using a single dual-functional 3D scaffold.

Enhancing osteogenic differentiation of MC3T3-E1 cells during inflammation using UPPE/β-TCP/TTC composites via the Wnt/β-catenin pathway

Periodontitis can lead to defects in the alveolar bone, thus increasing the demand for dependable biomaterials to repair these defects. This study aims to examine the pro-osteogenic and anti-bacterial properties of UPPE/β-TCP/TTC composites (composed of unsaturated polyphosphoester [UPPE], β-tricalcium phosphate [β-TCP], and tetracycline [TTC]) under an inflammatory condition. The morphology of MC3T3-E1 cells on the composite was examined using scanning electron microscopy. The toxicity of the composite to MC3T3-E1 cells was assessed using the Alamar-blue assay. The pro-osteogenic potential of the composite was assessed through ALP staining, ARS staining, RT-PCR, and WB. The antimicrobial properties of the composite were assessed using the zone inhibition assay. The results suggest that: (1) MC3T3-E1 cells exhibited stable adhesion to the surfaces of all four composite groups; (2) the UPPE/β-TCP/TTC composite demonstrated significantly lower toxicity to MC3T3-E1 cells; and (3) the UPPE/β-TCP/TTC composite had the most pronounced pro-osteogenic effect on MC3T3-E1 cells by activating the WNT/β-catenin pathway and displaying superior antibacterial properties. UPPE/β-TCP/TTC, as a biocomposite, has been shown to possess antibacterial properties and exhibit excellent potential in facilitating osteogenic differentiation of MC3T3-E1 cells.

Influence of nanosecond laser surface patterning on dental 3Y-TZP: Effects on the topography, hydrothermal degradation and cell response

OBJECTIVES

Laser surface micropatterning of dental-grade zirconia (3Y-TZP) was explored with the objective of providing defined linear patterns capable of guiding bone-cell response.

METHODS

A nanosecond (ns-) laser was employed to fabricate microgrooves on the surface of 3Y-TZP discs, yielding three different groove periodicities (i.e., 30, 50 and 100 µm). The resulting topography and surface damage were characterized by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). X-Ray diffraction (XRD) and Raman spectroscopy techniques were employed to assess the hydrothermal degradation resistance of the modified topographies. Preliminary biological studies were conducted to evaluate adhesion (6 h) of human mesenchymal stem cells (hMSC) to the patterns in terms of cell number and morphology. Finally, Staphylococcus aureus adhesion (4 h) to the microgrooves was investigated.

RESULTS

The surface analysis showed grooves of approximately 1.8 µm height that exhibited surface damage in the form of pile-up at the edge of the microgrooves, microcracks and cavities. Accelerated aging tests revealed a slight decrease of the hydrothermal degradation resistance after laser patterning, and the Raman mapping showed the presence of monoclinic phase heterogeneously distributed along the patterned surfaces. An increase of the hMSC area was identified on all the microgrooved surfaces, although only the 50 µm periodicity, which is closer to the cell size, significantly favored cell elongation and alignment along the grooves. A decrease in Staphylococcus aureus adhesion was observed on the investigated micropatterns.

SIGNIFICANCE

The study suggests that linear microgrooves of 50 µm periodicity may help in promoting hMSC adhesion and alignment, while reducing bacterial cell attachment.

Effects of Argon Gas Plasma Treatment on Biocompatibility of Nanostructured Titanium

In this study, we applied argon plasma treatment to titanium surfaces with nanostructures deposited by concentrated alkali treatment and investigated the effects on the surface of the material and the tissue surrounding an implant site. The results showed that the treatment with argon plasma removed carbon contaminants and increased the surface energy of the material while the nanoscale network structure deposited on the titanium surface remained in place. Reactive oxygen species reduced the oxidative stress of bone marrow cells on the treated titanium surface, creating a favorable environment for cell proliferation. Good results were observed in vitro evaluations using rat bone marrow cells. The group treated with argon plasma exhibited the highest apatite formation in experiments using simulated body fluids. The results of in vivo evaluation using rat femurs revealed that the treatment improved the amount of new bone formation around an implant. Thus, the results demonstrate that argon plasma treatment enhances the ability of nanostructured titanium surfaces to induce hard tissue differentiation and supports new bone formation around an implant site.

Genome-wide transcriptional responses of osteoblasts to different titanium surface topographies

This is the first genome-wide transcriptional profiling study using RNA-sequencing to investigate osteoblast responses to different titanium surface topographies, specifically between machined, smooth and acid-etched, microrough surfaces. Rat femoral osteoblasts were cultured on machine-smooth and acid-etched microrough titanium disks. The culture system was validated through a series of assays confirming reduced osteoblast attachment, slower proliferation, and faster differentiation on microrough surfaces. RNA-sequencing analysis of osteoblasts at an early stage of culture revealed that gene expression was highly correlated (r = 0.975) between the two topographies, but 1.38 % genes were upregulated and 0.37 % were downregulated on microrough surfaces. Upregulated transcripts were enriched for immune system, plasma membrane, response to external stimulus, and positive regulation to stimulus processes. Structural mapping confirmed microrough surface-promoted gene sharing and networking in signaling pathways and immune system/responses. Target-specific pathway analysis revealed that Rho family G-protein signaling pathways and actin genes, responsible for the formation of stress fibers, cytoplasmic projections, and focal adhesion, were upregulated on microrough surfaces without upregulation of core genes triggered by cell-to-cell interactions. Furthermore, disulfide-linked or -targeted extracellular matrix (ECM) or membranous glycoproteins such as laminin, fibronectin, CD36, and thrombospondin were highly expressed on microrough surfaces. Finally, proliferating cell nuclear antigen (PCNA) and cyclin D1, whose co-expression reduces cell proliferation, were upregulated on microrough surfaces. Thus, osteoblasts on microrough surfaces were characterized by upregulation of genes related to a wide range of functions associated with the immune system, stress/stimulus responses, proliferation control, skeletal and cytoplasmic signaling, ECM-integrin receptor interactions, and ECM-membranous glycoprotein interactions, furthering our knowledge of the surface-dependent expression of osteoblastic biomarkers on titanium.

Influence of Surface Contaminants and Hydrocarbon Pellicle on the Results of Wettability Measurements of Titanium

Hydrophilicity/hydrophobicity-or wettability-is a key surface characterization metric for titanium used in dental and orthopedic implants. However, the effects of hydrophilicity/hydrophobicity on biological capability remain uncertain, and the relationships between surface wettability and other surface parameters, such as topography and chemistry, are poorly understood. The objective of this study was to identify determinants of surface wettability of titanium and establish the reliability and validity of the assessment. Wettability was evaluated as the contact angle of ddH2O. The age of titanium specimens significantly affected the contact angle, with acid-etched, microrough titanium surfaces becoming superhydrophilic immediately after surface processing, hydrophobic after 7 days, and hydrorepellent after 90 days. Similar age-related loss of hydrophilicity was also confirmed on sandblasted supra-micron rough surfaces so, regardless of surface topography, titanium surfaces eventually become hydrophobic or hydrorepellent with time. On age-standardized titanium, surface roughness increased the contact angle and hydrophobicity. UV treatment of titanium regenerated the superhydrophilicity regardless of age or surface roughness, with rougher surfaces becoming more superhydrophilic than machined surfaces after UV treatment. Conditioning titanium surfaces by autoclaving increased the hydrophobicity of already-hydrophobic surfaces, whereas conditioning with 70% alcohol and hydrating with water or saline attenuated pre-existing hydrophobicity. Conversely, when titanium surfaces were superhydrophilic like UV-treated ones, autoclaving and alcohol cleaning turned the surfaces hydrorepellent and hydrophobic, respectively. UV treatment recovered hydrophilicity without exception. In conclusion, surface roughness accentuates existing wettability and can either increase or decrease the contact angle. Titanium must be age-standardized when evaluating surface wettability. Surface conditioning techniques significantly but unpredictably affect existing wettability. These implied that titanium wettability is significantly influenced by the hydrocarbon pellicle and other contaminants inevitably accumulated. UV treatment may be an effective strategy to standardize wettability by making all titanium surfaces superhydrophilic, thereby allowing the characterization of individual surface topography and chemistry parameters in future studies.

Evaluation of UV photofunctionalization effect on ultrastructural properties of SLA titanium disks: An in vitro study

Background

The success rate of dental implants diminishes over time; the lack of osseointegration and infection are the major causes of most implant failures. One of the effective methods to improve the surface properties is to irradiate ultraviolet (UV) light. This study investigated the effect of UV photofunctionalization on the ultrasuperficial properties of sandblasted, large-grit, acid-etched (SLA) titanium discs.

Methods

In this in vitro study, 24 sandblasted and acid-etched titanium discs, with a lifespan of more than four weeks, were categorized into three groups (n=8): control, ultraviolet C (UVC), and ultraviolet B (UVB). Then, they were exposed to a UV light source for 48 hours at a 1-cm distance. In addition to measuring the contact angle between the liquid and the disc surface in each of the three groups, the atomic concentrations of carbon, oxygen, and nitrogen atoms were measured at three different sites on each disc. One-way ANOVA and post hoc Tukey tests were used to analyze data.

Results

The mean concentration of carbon atoms significantly differed in the control, UVC, and UVB groups (P<0.001). The mean concentrations of nitrogen atoms differed significantly between the three groups (P<0.001). However, the mean concentrations of oxygen atoms were not significantly different between the three groups. In examining the contact angle, wettability was higher in the UVC group than in the UVB group and higher in the UBV group than in the control group.

Conclusion

Photofunctionalization with UV light significantly decreased carbon and nitrogen concentrations on the surface of titanium implants, indicating that the implant's superficial hydrocarbons were eliminated. It was observed that UVC photofunctionalization was more effective than UVB photofunctionalization in reducing superficial contamination and improving wettability.

XPS Characterization of TiO2 Nanotubes Growth on the Surface of the Ti15Zr15Mo Alloy for Biomedical Applications

Ti15Zr15Mo (TMZ alloy) has been studied in recent years for biomedical applications, mainly due to phase beta formation. From the surface modification, it is possible to associate the volume and surface properties with a better biomedical response. This study aimed to evaluate the possibility of using anodization to obtain TiO₂ nanotubes due to the presence of valve-type metal (Zr) in their composition. X-ray photoelectron spectroscopy (XPS) was performed to determine the surface chemical composition in both after-processing conditions (passive layer) and after-processing plus anodization (TiO₂ nanotube growth). The anodization resulted in nanotubes with diameters and thicknesses of 126 ± 35 and 1294 ± 193 nm, respectively, and predominated anatase phase. Compared to the passive layer of titanium, which is less than ~10 nm, the oxide layer formed was continuous and thicker. High-resolution spectra revealed that the oxide layer of the element alloys contained different oxidation states. The major phase in all depths for the nanotube samples was TiO2. While the stable form of each oxide was found to predominate on the surface, the inner part of the oxide layer consisted of suboxides and metallic forms. This composition included different oxidation states of the substrate elements Ti, Zr, and Mo.

Comparison of Osseointegration in Novel Laser-Textured and SLA Implants

Background

Osseointegration is defined as the direct structural and functional connection between neo-formed bone and dental implants. Among the parameters suggested to predominantly influencing the establishment of a successful osseointegration is the quality of the implant surface, which may enhance the strength and speed of this biomechanical process.

Objective

The purpose of this study was to evaluate the ability of a novel laser-treated surface, compared to sandblasted, large-grit, acid-etched (SLA) surfaces, to enhance and accelerate implant integration in delayed implant placement.Methods: Thirty patients with two missing posterior teeth were enrolled in this study. Each patient received, at a randomly allocated site, an implant with a conventional SLA surface, and at a second site, an implant with laser-textured surface. A total of 60 tissue-level implants were subsequently placed. Implant stability (ISQ) was measured using resonance frequency analysis (RFA). ISQ was assessed at baseline (T0), 8 weeks (T1), and 12 weeks (T2) following implant placement. Results: There was a statistical difference in implant stability between laser-textured and SLA group at 12 weeks postoperatively. Implant stabilization showed a successful osseointegration with both surface types.

Conclusion

Both laser and SLA surface treatments had positive impacts on implant stabilization following delayed placement. Laser-treated surfaces presented higher values of osseointegration at 3 months postoperatively.

Migration of endothelial cells on the surface of anodized Ni-Ti stent strut

Background

Stent is widely regarded as the main treatment for curing cardiovascular diseases such as stenosis. Previous research has revealed that the damage of endothelial cells (EC), i.e., the components of endothelium, during stent implantation, could lead to severe complications, such as restenosis. To prevent restenosis, enhancements have been made to surface biocompatibility to accelerate the stent endothelialization process. Anodization on the Ni-Ti is a simple and efficient surface modification method to improve the biocompatibility of the Ni-Ti stent surfaces by enhancing the surface hydrophilicity, leading to an increase in the EC activities. The EC activity is known to be affected by the blood flow. Flow change by stent structure may result in EC dysfunctions, thereby leading to restenosis. It is thus essential to investigate the EC activities resulting from the anodization on the Ni-Ti surface under flow conditions.

Objective

To study the influence of the endothelialization process on the Ni-Ti stent surface through anodization. The EC attachment and morphology on the anodized stent strut were observed under both with and without the flow conditions.

Method

A parallel plate flow chamber was designed to generate a constant wall shear stress (WSS) to study the flow effect on the EC behavior. The hydrophilicity of the Ni-Ti stent strut surface was enhanced by a TiO2 layer fabricated via anodization. The EC distribution on the surface of the anodized nitinol stent strut was observed after 24 h of static (without flow) and flow exposure (with flow) experiment.

Results

Under the static condition, the EC density on the surface of the anodized Ni-Ti stent strut was higher compared with the control. Under the flow condition, the enhancement of the EC density on the surface of the stent strut with anodization was reduced. The EC demonstrates a long and thin spindle-shaped morphology under the flow condition.

Conclusion

Unlike the static condition, the EC is demonstrating a long and thin morphology in response to the flow under the flow condition. By improving the surface hydrophilicity, the anodization could enhance the EC migration onto the strut surface, and subsequently, accelerate the Ni-Ti stent endothelialization process. The improvement of the surface hydrophilicity is lower under the flow conditions when compared with the static conditions.

Ultrahigh Mass Activity Pt Entities Consisting of Pt Single atoms, Clusters, and Nanoparticles for Improved Hydrogen Evolution Reaction

Platinum is one of the best-performing catalysts for the hydrogen evolution reaction (HER). However, high cost and scarcity severely hinder the large-scale application of Pt electrocatalysts. Constructing highly dispersed ultrasmall Platinum entities is thereby a very effective strategy to increase Pt utilization and mass activities, and reduce costs. Herein, highly dispersed Pt entities composed of a mixture of Pt single atoms, clusters, and nanoparticles are synthesized on mesoporous N-doped carbon nanospheres. The presence of Pt single atoms, clusters, and nanoparticles is demonstrated by combining among others aberration-corrected annular dark-field scanning transmission electron microscopy, X-ray absorption spectroscopy, and electrochemical CO stripping. The best catalyst exhibits excellent geometric and Pt HER mass activity, respectively ≈4 and 26 times higher than that of a commercial Pt/C reference and a Pt catalyst supported on nonporous N-doped carbon nanofibers with similar Pt loadings. Noteworthily, after optimization of the geometrical Pt electrode loading, the best catalyst exhibits ultrahigh Pt and catalyst mass activities (56 ± 3 A mg^-1 _Pt and 11.7 ± 0.6 A mg^-1 _Cat at -50 mV vs. reversible hydrogen electrode), which are respectively ≈1.5 and 58 times higher than the highest Pt and catalyst mass activities for Pt single-atom and cluster-based catalysts reported so far.

Bone marrow stromal cells generate an osteoinductive microenvironment when cultured on titanium-aluminum-vanadium substrates with biomimetic multiscale surface roughness

Osseointegration of titanium-based implants possessing complex macroscale/microscale/mesoscale/nanoscale (multiscale) topographies support a direct and functional connection with native bone tissue by promoting recruitment, attachment and osteoblastic differentiation of bone marrow stromal cells (MSCs). Recent studies show that the MSCs on these surfaces produce factors, including bone morphogenetic protein 2 (BMP2) that can cause MSCs not on the surface to undergo osteoblast differentiation, suggesting they may produce an osteogenic environmentin vivo. This study examined if soluble factors produced by MSCs in contact with titanium-aluminum-vanadium (Ti6Al4V) implants possessing a complex multiscale biomimetic topography are able to induce osteogenesis ectopically. Ti6Al4V disks were grit-blasted and acid-etched to create surfaces possessing macroscale and microscale roughness (MM), micro/meso/nanoscale topography (MN), and macro/micro/meso/nanoscale topography (MMN^TM). Polyether-ether-ketone (PEEK) disks were also fabricated by machining to medical-grade specifications. Surface properties were assessed by scanning electron microscopy, contact angle, optical profilometry, and x-ray photoelectron spectroscopy. MSCs were cultured in growth media (GM). Proteins and local factors in their conditioned media (CM) were measured on days 4, 8, 10 and 14: osteocalcin, osteopontin, osteoprotegerin, BMP2, BMP4, and cytokines interleukins 6, 4 and 10 (IL6, IL4, and IL10). CM was collected from D14 MSCs on MMN^TMand tissue culture polystyrene (TCPS) and lyophilized. Gel capsules containing active demineralized bone matrix (DBM), heat-inactivated DBM (iDBM), and iDBM + MMN-GM were implanted bilaterally in the gastrocnemius of athymic nude mice (N= 8 capsules/group). Controls included iDBM + GM; iDBM + TCPS-CM from D5 to D10 MSCs; iDBM + MMN-CM from D5 to D10; and iDBM + rhBMP2 (R&D Systems) at a concentration similar to D5-D10 production of MSCs on MMN^TMsurfaces. Legs were harvested at 35D. Bone formation was assessed by micro computed tomography and histomorphometry (hematoxylin and eosin staining) with the histology scored according to ASTM 2529-13. DNA was greatest on PEEK at all time points; DNA was lowest on MN at early time points, but increased with time. Cells on PEEK exhibited small changes in differentiation with reduced production of BMP2. Osteoblast differentiation was greatest on the MN and MMN^TM, reflecting increased production of BMP2 and BMP4. Pro-regenerative cytokines IL4 and IL10 were increased on Ti-based surfaces; IL6 was reduced compared to PEEK. None of the media from TCPS cultures was osteoinductive. However, MMN-CM exhibited increased bone formation compared to iDBM and iDBM + rhBMP2. Furthermore, exogenous rhBMP2 alone, at the concentration found in MMN-CM collected from D5 to D10 cultures, failed to induce new bone, indicating that other factors in the CM play a critical role in that osteoinductive microenvironment. MSCs cultured on MMN^TMTi6Al4V surfaces differentiate and produce an increase in local factors, including BMP2, and the CM from these cultures can induce ectopic bone formation compared to control groups, indicating that the increased bone formation arises from the local response by MSCs to a biomimetic, multiscale surface topography.

Autologous Tooth Graft: Innovative Biomaterial for Bone Regeneration. Tooth Transformer® and the Role of Microbiota in Regenerative Dentistry. A Systematic Review

Different biomaterials, from synthetic products to autologous or heterologous grafts, have been suggested for the preservation and regeneration of bone. The aim of this study is to evaluate the effectiveness of autologous tooth as a grafting material and examine the properties of this material and its interactions with bone metabolism. PubMed, Scopus, Cochrane Library, and Web of Science were searched to find articles addressing our topic published from 1 January 2012 up to 22 November 2022, and a total of 1516 studies were identified. Eighteen papers in all were considered in this review for qualitative analysis. Demineralized dentin can be used as a graft material, since it shows high cell compatibility and promotes rapid bone regeneration by striking an ideal balance between bone resorption and production; it also has several benefits, such as quick recovery times, high-quality newly formed bone, low costs, no risk of disease transmission, the ability to be performed as an outpatient procedure, and no donor-related postoperative complications. Demineralization is a crucial step in the tooth treatment process, which includes cleaning, grinding, and demineralization. Since the presence of hydroxyapatite crystals prevents the release of growth factors, demineralization is essential for effective regenerative surgery. Even though the relationship between the bone system and dysbiosis has not yet been fully explored, this study highlights an association between bone and gut microbes. The creation of additional scientific studies to build upon and enhance the findings of this study should be a future objective of scientific research.

Osteoblastic Cell Behavior and Gene Expression Related to Bone Metabolism on Different Titanium Surfaces

The surface topography of titanium dental implants has a great influence on osseointegration. In this work, we try to determine the osteoblastic behavior and gene expression of cells with different titanium surfaces and relate them to the physicochemical properties of the surface. For this purpose, we have used commercial titanium discs of grade 3: as-received corresponds to machined titanium without any surface treatment (MA), chemically acid etched (AE), treated via sand blasting with Al₂O₃ particles (SB) and a sand-blasting treatment with acid etching (SB+AE). The surfaces have been observed using scanning electron microscopy (SEM) and the roughness, wettability and surface energy with dispersive and polar components have been characterized. Osteoblastic cultures were performed with SaOS-2 osteoblastic cells determining cell viability as well as alkaline phosphatase levels for 3 and 21 days, and osteoblastic gene expression was determined. The roughness values of the MA discs was 0.02 μm, which increases to 0.3 μm with acid attack and becomes the maximum for the sand-blasted samples, reaching values of 1.2 μm for SB and SB+AE. The hydrophilic behavior of the MA and AE samples with contact angles of 63° and 65° is superior to that of the rougher samples, being 75° for SB and 82° for SB+AE. In all cases, they show good hydrophilicity. GB and GB+AE surfaces present a higher polar component in the surface energy values, 11.96 and 13.18 mJ/m², respectively, than AE and MA, 6.64 and 9.79 mJ/m², respectively. The osteoblastic cell viability values at three days do not show statistically significant differences between the four surfaces. However, the viability of the SB and SB+AE surfaces at 21 days is much higher than that of the AE and MA samples. From the alkaline phosphatase studies, higher values were observed for those treated with sand blasting with and without acid etching compared to the other two surfaces, indicating a greater activity in osteoblastic differentiation. In all cases except in the Osterix (Ostx) -osteoblast-specific transcription factor-a decrease in gene expression is observed in relation to the MA samples (control). The most important increase was observed for the SB+AE condition. A decrease in the gene expression of Osteoprotegerine (OPG), Runt-related transcription factor 2 (Runx2), Receptor Activator of NF-κB Ligand (RANKL) and Alkaline Phosphatase (Alp) genes was observed in the AE surface.

Surface modifications to promote the osteoconductivity of ultra-high-molecular-weight-polyethylene fabrics for a novel biomimetic artificial disc prosthesis: An in vitro study

A novel biomimetic artificial intervertebral disc (bioAID) for the cervical spine was developed, containing a hydrogel core representing the nucleus pulposus, an UHMWPE fiber jacket as annulus fibrosis, and titanium endplates with pins for mechanical fixation. Osseointegration of the UHMWPE fibers to adjacent bone structures is required to achieve proper biomimetic behavior and to provide long-term stability. Therefore, the aim of this study was to assess the osteoconductivity of several surface modifications of UHMWPE fabrics, 2D weft-knitted, using non-treated UHMWPE fibers (N), plasma treated UHMWPE fibers (PT), 10% hydroxy apatite (HA) loaded UHMWPE fibers (10%HA), plasma treated 10%HA UHMWPE fibers (PT-10%HA), 15%HA loaded UHMWPE fibers (15%HA) and plasma treated 15%HA UHMWPE fibers (PT-15%HA). Scanning electron microscopy (SEM) was used for surface characterization. Biological effects were assessed by evaluating initial cell attachment (SEM, DNA content), metabolic activity (PrestoBlue assay), proliferation, differentiation (alkaline phosphatase activity) and mineralization (energy dispersive x-ray, EDX analysis) using human bone marrow stromal cells. Plasma treated samples showed increased initial cell attachment, indicating the importance of hydrophilicity for cell attachment. However, incorporation only of HA or plasma treatment alone was not sufficient to result in upregulated alkaline phosphatase activity (ALP) activity. Combining HA loaded fibers with plasma treatment showed a combined effect, leading to increased cell attachment and upregulated ALP activity. Based on these results, combination of HA loaded UHMWPE fibers and plasma treatment provided the most promising fabric surface for facilitating bone ingrowth.

Effect of argon plasma pre-treatment of healing abutments on peri-implant microbiome and soft tissue integration: a proof-of-concept randomized study

PURPOSE

Biofilm-free implant surface is ultimate prerequisite for successful soft and bone tissue integration. Objective of the study was to estimate the effects of argon plasma healing abutment pre-treatment (PT) on peri-implant soft-tissue phenotype (PiSP), inflammation, plaque accumulation and the microbiome (PiM) between non-treated (NPT) and treated (PT) abutments following 3-months healing period. The hypothesis was that cell-conductive and antimicrobial properties of PT would yield optimal conditions for soft tissue integration.

MATERIAL AND METHODS

Two months following second-phase surgery, microbiological and clinical parameters were assessed around thirty-six healing abutments with two types of microtopography, smooth surface (MACHINED) and ultrathin threaded microsurface (ROUGH). A two level randomization schema was used to achieve equal distribution and abutments were randomly divided into rough and machined groups, and then divided into PT and NPT groups. PiM was assessed using next-generation DNA sequencing.

RESULTS

PiM bacterial composition was highly diverse already two months post-implantation, consisting of key-stone pathogens, early and late colonizers, while the mycobiome was less diverse. PT was associated with lower plaque accumulation and inflammation without significant impact on PiSP, while in NPT clinical parameters were increased and associated with periopathogens. NPT mostly harbored late colonizers, while PT exerted higher abundance of early colonizers suggesting less advanced plaque formation. Interaction analysis in PT demonstrated S. mitis co-occurrence with pro-healthy Rothia dentocariosa and co-exclusion with Parvimonas micra, Porphyromonas endodontalis and Prevotella oris. PiSP parameters were generally similar between the groups, but significant association between PiM and keratinized mucosa width was observed in both groups, with remarkably more expressed diversity in NPT compared to PT. PT resulted in significantly lower BOP and PI around rough and machined abutments, respectively, without specific effect on PiM and PiSP.

CONCLUSIONS

PT contributed to significantly the less advanced biofilm accumulation and inflammation without specific effects on PiSP.

Application of Lyophilized Gene-Delivery Formulations to Dental Implant Surfaces: Non-Cariogenic Lyoprotectant Preserves Transfection Activity of Polyplexes Long-Term

Titanium is the metal of choice for dental implants because of its biocompatibility and ability to merge with human bone tissue. Despite the great success rate of dental implants, early and late complications occur. Coating titanium dental implant surfaces with polyethyleneimine (PEI)-plasmid DNA (pDNA) polyplexes improve osseointegration by generating therapeutic protein expression at the implantation site. Lyophilization is an approach for stabilizing polyplexes and extending their shelf life; however, most lyoprotectants are sugars that can aid bacterial growth in the peri-implant environment. In our research, we coated titanium surfaces with polyplex solutions containing varying amounts of lyoprotectants. We used two common lyoprotectants (sucrose and polyvinylpyrrolidone K30) and showed for the first time that sucralose (a sucrose derivative used as an artificial sweetener) might act as a lyoprotectant for polyplex solutions. Human embryonic kidney (HEK) 293T cells were used to quantify the transfection efficiency and cytotoxicity of the polyplex/lyoprotectant formulations coating titanium surfaces. Polyplexes that were lyophilized in the presence of a lyoprotectant displayed both preserved particle size and high transfection efficiencies. Polyplexes lyophilized in 2% sucralose have maintained transfection efficacy for three years. These findings suggest that modifying dental implants with lyophilized polyplexes might improve their success rate in the clinic.

Strategies to Mitigate and Treat Orthopaedic Device-Associated Infections

Orthopaedic device implants play a crucial role in restoring functionality to patients suffering from debilitating musculoskeletal diseases or to those who have experienced traumatic injury. However, the surgical implantation of these devices carries a risk of infection, which represents a significant burden for patients and healthcare providers. This review delineates the pathogenesis of orthopaedic implant infections and the challenges that arise due to biofilm formation and the implications for treatment. It focuses on research advancements in the development of next-generation orthopaedic medical devices to mitigate against implant-related infections. Key considerations impacting the development of devices, which must often perform multiple biological and mechanical roles, are delineated. We review technologies designed to exert spatial and temporal control over antimicrobial presentation and the use of antimicrobial surfaces with intrinsic antibacterial activity. A range of measures to control bio-interfacial interactions including approaches that modify implant surface chemistry or topography to reduce the capacity of bacteria to colonise the surface, form biofilms and cause infections at the device interface and surrounding tissues are also reviewed.

Osteoblast Response of Additively Manufactured Zirconia and Alumina-Toughened Zirconia

Zirconia ceramics have been widely used in dentistry. Herein, we assess the surface morphology, surface texture, and osteoblast response of additively manufactured zirconia and alumina-toughened zirconia (ATZ) in comparison with titanium. The surface roughness, contact angle, and surface microstructure of titanium sandblasted with large-grit alumina and subsequently acid-etched using 18% HCl and 49% H₂SO₄ (SLA-titanium), uniaxially pressed zirconia (UP zirconia), additively manufactured zirconia (AM zirconia), and additively manufactured ATZ (AM ATZ) were investigated. Moreover, the cell viability, alkaline phosphatase (ALP) activity, and gene expression of type I collagen on these materials were evaluated. The data were statistically analyzed using one-way ANOVA with Tukey's post hoc test. SLA-titanium showed the highest surface roughness and contact angle. The other three materials showed comparable surface roughness and contact angles. Micro- and nanoroughness were observed on the surface of SLA-titanium. UP zirconia and AM zirconia had similar surface morphologies. The cell viability, ALP activity, and gene expression of type I collagen on AM zirconia were comparable to or better than those on SLA-titanium. Our results indicate that AM zirconia is a promising material for zirconia dental implants.

Clinical Effects of Photofunctionalization on Implant Stability and Marginal Bone Loss: Systematic Review and Meta-Analysis

BACKGROUND

Several clinical trials have recently been conducted to elucidate the effectiveness of photofunctionalization. The aim of this review was to systematically analyze the clinical effects of photofunctionalization on implant stability and marginal bone loss (MBL).

METHODS

An electronic search in four databases and a manual search were conducted in September 2022. Randomized controlled trials (RCTs), clinical controlled trials (CCTs), and cohort and case-control studies evaluating the effects of photofunctionalization on implant stability or marginal bone loss (MBL) in humans were included. The methodological quality assessment using RoB 2.0 and the ROBINS-I tool was performed based on different study designs.

RESULTS

Seven studies were included for a qualitative analysis, and five of them were chosen for a meta-analysis. The meta-analysis revealed that photofunctionalization significantly improved the stability of the implant 2 months after implantation (p = 0.04; MD = 3.48; 95% CI = -0.23 to 6.73) and increased the osseointegration speed index (OSI) (p = 0.007; MD = 2.13; 95% CI = 0.57 to 3.68). However, no significant improvements of implant stability were observed 2 weeks (p = 0.62), 4 weeks (p = 0.31), nor 4 months (p = 0.24) after implantation. The evaluation presented no significant reductions in MBL.

CONCLUSIONS

Based on the positive effect of photofunctionalization on the rate of establishing implant stability, photofunctionalization may provide an effective and practical strategy to achieve faster osseointegration and reduce the overall healing time. Photofunctionalization appears to improve the implant stability. However, the clinical effect of photofunctionalization on MBL remains unclear due to the shortage of available studies.

Positive Effects of UV-Photofunctionalization of Titanium Oxide Surfaces on the Survival and Differentiation of Osteogenic Precursor Cells-An In Vitro Study

INTRODUCTION

The UVC-irradiation ("UV-photofunctionalization") of titanium dental implants has proved to be capable of removing carbon contamination and restoring the ability of titanium surfaces to attract cells involved in the process of osteointegration, thus significantly enhancing the biocompatibility of implants and favoring the post-operative healing process. To what extent the effect of UVC irradiation is dependent on the type or the topography of titanium used, is still not sufficiently established.

OBJECTIVE

The present study was aimed at analyzing the effects of UV-photofunctionalization on the TiO₂ topography, as well as on the gene expression patterns and the biological activity of osteogenic cells, i.e., osteogenic precursors cultured in vitro in the presence of different titanium specimens.

METHODOLOGY

The analysis of the surface roughness was performed by atomic force microscopy (AFM) on machined surface grade 2, and sand-blasted/acid-etched surface grades 2 and 4 titanium specimens. The expression of the genes related with the process of healing and osteogenesis was studied in the MC3T3-E1 pre-osteoblastic murine cells, as well as in MSC murine stem cells, before and after exposure to differently treated TiO₂ surfaces.

RESULTS

The AFM determinations showed that the surface topographies of titanium after the sand-blasting and acid-etching procedures, look very similar, independently of the grade of titanium. The UVC-irradiation of the TiO₂ surface was found to induce an increase in the cell survival, attachment and proliferation, which was positively correlated with an increased expression of the osteogenesis-related genes Runx2 and alkaline phosphatase (ALP).

CONCLUSION

Overall, our findings expand and further support the current view that UV-photofunctionalization can indeed restore biocompatibility and osteointegration of TiO₂ implants, and suggest that this at least in part occurs through a stimulation of the osteogenic differentiation of the precursor cells.

Functional engineering strategies of 3D printed implants for hard tissue replacement

Three-dimensional printing technology with the rapid development of printing materials are widely recognized as a promising way to fabricate bioartificial bone tissues. In consideration of the disadvantages of bone substitutes, including poor mechanical properties, lack of vascularization and insufficient osteointegration, functional modification strategies can provide multiple functions and desired characteristics of printing materials, enhance their physicochemical and biological properties in bone tissue engineering. Thus, this review focuses on the advances of functional engineering strategies for 3D printed biomaterials in hard tissue replacement. It is structured as introducing 3D printing technologies, properties of printing materials (metals, ceramics and polymers) and typical functional engineering strategies utilized in the application of bone, cartilage and joint regeneration.

The role of dendritic cells in the immunomodulation to implanted biomaterials

Considering the substantial role played by dendritic cells (DCs) in the immune system to bridge innate and adaptive immunity, studies on DC-mediated immunity toward biomaterials principally center on their adjuvant effects in facilitating the adaptive immunity of codelivered antigens. However, the effect of the intrinsic properties of biomaterials on dendritic cells has not been clarified. Recently, researchers have begun to investigate and found that biomaterials that are nonadjuvant could also regulate the immune function of DCs and thus affect subsequent tissue regeneration. In the case of proteins adsorbed onto biomaterial surfaces, their intrinsic properties can direct their orientation and conformation, forming “biomaterial-associated molecular patterns (BAMPs)”. Thus, in this review, we focused on the intrinsic physiochemical properties of biomaterials in the absence of antigens that affect DC immune function and summarized the underlying signaling pathways. Moreover, we preliminarily clarified the specific composition of BAMPs and the interplay between some key molecules and DCs, such as heat shock proteins (HSPs) and high mobility group box 1 (HMGB1). This review provides a new direction for future biomaterial design, through which modulation of host immune responses is applicable to tissue engineering and immunotherapy.

Functionalization of TiO2 for Better Performance as Orthopedic Implants

This review mainly focuses on the surface functionalization approaches of titanium dioxide (TiO₂) to prevent bacterial infections and facilitate osteointegration simultaneously for titanium (Ti)-based orthopedic implants. Infection is one of the major causes of implant failure. Meanwhile, it is also critical for the bone-forming cells to integrate with the implant surface. TiO₂ is the native oxide layer of Ti which has good biocompatibility as well as enriched physical, chemical, electronic, and photocatalytic properties. The formed nanostructures during fabrication and the enriched properties of TiO₂ have enabled various functionalization methods to combat the micro-organisms and enhance the osteogenesis of Ti implants. This review encompasses the various modifications of TiO₂ in aspects of topology, drug loading, and element incorporation, as well as the most recently developed electron transfer and electrical tuning approaches. Taken together, these approaches can endow Ti implants with better bactericidal and osteogenic abilities via the functionalization of TiO₂.

Canonical Wnt signaling enhances pro-inflammatory response to titanium by macrophages

Biomaterial characteristics like surface roughness and wettability can determine the phenotype of macrophages following implantation. We have demonstrated that inhibiting Wnt ligand secretion abolishes macrophage polarization in vitro and in vivo; however, the role of canonical Wnt signaling in macrophage activation in response to physical and chemical biomaterial cues is unknown. The aim of this study was to understand whether canonical Wnt signaling affects the response of macrophages to titanium (Ti) surface roughness or wettability in vitro and in vivo. Activating canonical Wnt signaling increased expression of toll-like receptors and interleukin receptors and secreted pro-inflammatory cytokines and reduced anti-inflammatory cytokines on Ti, regardless of surface properties. Inhibiting canonical Wnt signaling reduced pro-inflammatory cytokines on all Ti surfaces and increased anti-inflammatory cytokines on rough or rough-hydrophilic Ti. In vivo, activating canonical Wnt signaling increased total macrophages, pro-inflammatory macrophages, and T cells and decreased anti-inflammatory macrophages on both smooth and rough-hydrophilic implants. Functionally, canonical Wnt activation increases pro-inflammatory macrophage response to cell and cell-extracellular matrix lysates. These results demonstrate that activating canonical Wnt signaling primes macrophages to a pro-inflammatory phenotype that affects their response to Ti implants in vitro and in vivo.

Surface Free Energy Dominates the Biological Interactions of Postprocessed Additively Manufactured Ti-6Al-4V

Additive manufacturing (AM) has emerged as a disruptive technique within healthcare because of its ability to provide personalized devices; however, printed metal parts still present surface and microstructural defects, which may compromise mechanical and biological interactions. This has made physical and/or chemical postprocessing techniques essential for metal AM devices, although limited fundamental knowledge is available on how alterations in physicochemical properties influence AM biological outcomes. For this purpose, herein, powder bed fusion Ti-6Al-4V samples were postprocessed with three industrially relevant techniques: polishing, passivation, and vibratory finishing. These surfaces were thoroughly characterized in terms of roughness, chemistry, wettability, surface free energy, and surface ζ-potential. A significant increase in Staphylococcus epidermidis colonization was observed on both polished and passivated samples, which was linked to high surface free energy donor γ^– values in the acid–base, γ^AB component. Early osteoblast attachment and proliferation (24 h) were not influenced by these properties, although increased mineralization was observed for both these samples. In contrast, osteoblast differentiation on stainless steel was driven by a combination of roughness and chemistry. Collectively, this study highlights that surface free energy is a key driver between AM surfaces and cell interactions. In particular, while low acid–base components resulted in a desired reduction in S. epidermidis colonization, this was followed by reduced mineralization. Thus, while surface free energy can be used as a guide to AM device development, optimization of bacterial and mammalian cell interactions should be attained through a combination of different postprocessing techniques.

Involvement of PI3K/Akt signaling pathway in promoting osteogenesis on titanium implant surfaces modified with novel non-thermal atmospheric plasma

Non-thermal atmospheric plasma (NTAP) modification to induce a hydrophilic titanium (Ti) surface with less carbon contamination, has been demonstrated to boost the osteogenic responses. In this study, we investigated the underlying bone formation mechanism of NTAP-Ti, and the involvement of PI3K/Akt signaling pathway in regulating osteogenic activities on NTAP-Ti surfaces. NTAP was employed for Ti activation, and PI3K inhibitor, LY294002, was applied to the suppression of PI3K/Akt pathway. We systematically and quantitatively detected the cell morphology, attachment, proliferation, osteogenic differentiation and mineralization of MC3T3-E1 mouse preosteoblasts, and molecular expressions involved in osteogenesis and PI3K/Akt signaling pathway in vivo and in vitro. A descent in osteoblast proliferation on Ti surfaces in relation to LY294002. Alkaline phosphatase (ALP) activity, as well as matrix mineralization, was mitigated by PI3K inhibitor in NTAP-Ti. Likewise, the expression levels of osteogenesis-related genes [ALP, osteocalcin (Ocn), osteopontin (Opn) and runt-related transcription factor 2 (Runx2)] on NTAP-Ti were notably attenuated by LY294002, as confirmed by the results of osteogenesis-related proteins (ALP, and Runx2) expression analysis. In addition, the expression of PI3K/Akt signal pathway proteins further verified the inhibition of LY294002 on Ti surfaces modified by NTAP. Collectively, the PI3K/Akt signal pathway was involved in the amelioration of osteogenesis induced by NTAP modification. NTAP treatment for Ti activation is promising in augmented osteogenic potential through the activation of PI3K/Akt signal pathway.

Advances in the superhydrophilicity-modified titanium surfaces with antibacterial and pro-osteogenesis properties: A review

In recent years, the rate of implant failure has been increasing. Microbial infection was the primary cause, and the main stages included bacterial adhesion, biofilm formation, and severe inhibition of implant osseointegration. Various biomaterials and their preparation methods have emerged to produce specific implants with antimicrobial or bactericidal properties to reduce implant infection caused by bacterial adhesion and effectively promote bone and implant integration. In this study, we reviewed the research progress of bone integration promotion and antibacterial action of superhydrophilic surfaces based on titanium alloys. First, the adverse reactions caused by bacterial adhesion to the implant surface, including infection and bone integration deficiency, are briefly introduced. Several commonly used antibacterial methods of titanium alloys are introduced. Secondly, we discuss the antibacterial properties of superhydrophilic surfaces based on ultraviolet photo-functionalization and plasma treatment, in contrast to the antibacterial principle of superhydrophobic surface morphology. Thirdly, the osteogenic effects of superhydrophilic surfaces are described, according to the processes of osseointegration: osteogenic immunity, angiogenesis, and osteogenic related cells. Finally, we discuss the challenges and prospects for the development of this superhydrophilic surface in clinical applications, as well as the prominent strategies and directions for future research.

Effects of Different Titanium Surface Treatments on Adhesion, Proliferation and Differentiation of Bone Cells: An In Vitro Study

The objective of this study was to evaluate the impacts of different sandblasting procedures in acid etching of Ti6Al4V surfaces on osteoblast cell behavior, regarding various physicochemical and topographical parameters. Furthermore, differences in osteoblast cell behavior between cpTi and Ti6Al4V SA surfaces were evaluated. Sandblasting and subsequent acid etching of cpTi and Ti6Al4V discs was performed with Al2O3 grains of different sizes and with varying blasting pressures. The micro- and nano-roughness of the experimental SA surfaces were analyzed via confocal, atomic force and scanning electron microscopy. Surface free energy and friction coefficients were determined. hFOB 1.19 cells were seeded to evaluate adhesion, proliferation and osteoblastic differentiation for up to 12 d via crystal violet assays, MTT assays, ALP activity assays and Alizarin Red staining assays. Differences in blasting procedures had significant impacts on surface macro- and micro-topography. The crystal violet assay revealed a significant inverse relationship between blasting grain size and hFOB cell growth after 7 days. This trend was also visible in the Alizarin Red assays staining after 12 d: there was significantly higher biomineralization visible in the group that was sandblasted with smaller grains (F180) when compared to standard-grain-size groups (F70). SA samples treated with reduced blasting pressure exhibited lower hFOB adhesion and growth capabilities at initial (2 h) and later time points for up to 7 days, when compared to the standard SA surface, even though micro-roughness and other relevant surface parameters were similar. Overall, etched-only surfaces consistently exhibited equivalent or higher adhesion, proliferation and differentiation capabilities when compared to all other sandblasted and etched surfaces. No differences were found between cpTi and Ti6Al4V SA surfaces. Subtle modifications in the blasting protocol for Ti6Al4V SA surfaces significantly affect the proliferative and differentiation behavior of human osteoblasts. Surface roughness parameters are not sufficient to predict osteoblast behavior on etched Ti6Al4V surfaces.

Nanostructuring Effect of Nano-CeO2 Particles Reinforcing Cobalt Matrix during Electrocodeposition Process

The electrodeposition method was used to obtain nanostructured layers of Co/nano-CeO₂ on 304L stainless steel, from a cobalt electrolyte in which different concentrations of CeO₂ nanoparticles (0, 10, 20, and 30 g/L) were dispersed. The electrodeposition was performed at room temperature using three current densities (23, 48, and 72 mA cm^-2), and the time was kept constant at 90 min. The influence of current densities and nanoparticle concentrations on the characteristics of the obtained nanostructured layers is also discussed. An X-ray diffractometer (XRD) was used to investigate the phase structure and cobalt crystallite size of the nanostructured layers, and a contact angle (sessile drop method) was used to assess the wettability of the electrodeposited layers. The roughness of the surfaces was also studied. The results show that the nanostructured layers became more hydrophilic with increasing nanoparticle concentration and increasing current density. In the case of pure cobalt deposits, an increase in the current density led to an increase in the size of the cobalt crystallites in the electrodeposited layer, while for the Co/nano-CeO₂ nanostructured layers, the size of the crystallites decreased with increasing current density. This confirms the nanostructuring effect of nano-CeO₂ electrocodeposited with cobalt.

Contemporary Concepts in Osseointegration of Dental Implants: A Review

In a society highly conscious of esthetics, prosthetic rehabilitation of lost teeth with tissue-integrated implants has gained wide acceptance and demand by patients and clinicians. The backbone of these tissue-integrated implants is the biotechnical process of osseointegration. Although the concept has been introduced and discussed for ages, the deepening knowledge about its cellular and molecular mechanisms has led the researchers to borrow further into the factors influencing the process of osseointegration. This has aided in the hastening and improving the process of osseointegration by exploiting several, even the minutest, details and events taking place in this natural process. Recently, due to the high esthetic expectations of the patients, the implants are being loaded immediately, which demands a high degree of implant stability. Implant stability, especially secondary stability, largely depends on bone formation and integration of implants to the osseous tissues. Various factors that influence the rate and success of osseointegration can either be categorized as those related to implant characteristics like the physical and chemical macro- and microdesign of implants or the bone characteristics like the amount and quality of bone and the local and systemic host conditions, or the time or protocol followed for the functional loading of the dental implant. To address the shortcomings in osseointegration due to any of the factors, it is mandatory that continuous and reliable monitoring of the status of osseointegration is done. This review attempts to encompass the mechanisms, factors affecting, and methods to assess osseointegration, followed by a discussion on the recent advances and future perspectives in dental implantology to enhance the process of osseointegration. The review was aimed at igniting the inquisitive minds to usher further the development of technology that enhances osseointegration.

Osseointegration of a New, Ultrahydrophilic and Nanostructured Dental Implant Surface: A Comparative In Vivo Study

This study compared the osseointegration of acid-etched, ultrahydrophilic, micro- and nanostructured implant surfaces (ANU) with non-ultra-hydrophilic, microstructured (SA) and non-ultrahydrophilic, micro- and nanostructured implant surfaces (AN) in vivo. Fifty-four implants (n = 18 per group) were bilaterally inserted into the proximal tibia of New Zealand rabbits (n = 27). After 1, 2, and 4 weeks, bone-implant contact (BIC, %) in the cortical (cBIC) and spongious bone (sBIC), bone chamber ingrowth (BChI, %), and the supra-crestal, subperiosteal amount of newly formed bone, called percentage of linear bone fill (PLF, %), were analyzed. After one week, cBIC was significantly higher for AN and ANU when compared to SA (p = 0.01 and p = 0.005). PLF was significantly increased for ANU when compared to AN and SA (p = 0.022 and p = 0.025). After 2 weeks, cBIC was significantly higher in SA when compared to AN (p = 0.039) and after 4 weeks, no significant differences in any of the measured parameters were found anymore. Ultrahydrophilic implants initially improved osseointegration when compared to their non-ultrahydrophilic counterparts. In accordance, ultrahydrophilic implants might be appropriate in cases with a necessity for an accelerated and improved osseointegration, such as in critical size alveolar defects or an affected bone turnover.

Enhanced osseointegration of dental implants with reduced graphene oxide coating

Background

The implants of pure titanium (Ti) and its alloys can lead to implant failure because of their poor interaction with bone-associated cells during bone regeneration. Surface modification over implants has achieved successful implants for enhanced osseointegration. Herein, we report a robust strategy to implement bioactive surface modification for implant interface enabled by the combinatorial system of reduced graphene oxide (rGO)-coated sandblasted, large-grit, and acid-etched (SLA) Ti to impart benefits to the implant.

Methods

We prepared SLA Ti (ST) implants with different surface modifications [i.e., rGO and recombinant human bone morphogenetic protein-2 (rhBMP-2)] and investigated their dental tissue regenerating ability in animal models. We performed comparative studies in surface property, in vitro cellular behaviors, and in vivo osseointegration activity among different groups, including ST (control), rhBMP-2-immobilized ST (BI-ST), rhBMP-2-treated ST (BT-ST), and rGO-coated ST (R-ST).

Results

Spectroscopic, diffractometric, and microscopic analyses confirmed that rGO was coated well around the surfaces of Ti discs (for cell study) and implant fixtures (for animal study). Furthermore, in vitro and in vivo studies revealed that the R-ST group showed significantly better effects in cell attachment and proliferation, alkaline phosphatase activity, matrix mineralization, expression of osteogenesis-related genes and protein, and osseointegration than the control (ST), BI-ST, and BT-ST groups.

Conclusion

Hence, we suggest that the rGO-coated Ti can be a promising candidate for the application to dental or even orthopedic implants due to its ability to accelerate the healing rate with the high potential of osseointegration.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40824-022-00257-7.

The Effects of Ultrasonic Scaling and Air-Abrasive Powders on the Decontamination of 9 Implant-Abutment Surfaces: Scanning Electron Analysis and In Vitro Study

(1) Background: The aim of this study is to understand from a microscopic point of view whether bicarbonate air-abrasive powders associated with ultrasonic instruments can decontaminate nine different surfaces used for the abutment/implant junction. Fibroblast growth was carried out on decontaminated surface in order to understand if there are significative differences in terms of biocompatibility. (2) Methods: After taking samples of patient plaque, nine different surfaces were contaminated and analyzed by SEM, then their wettability was evaluated. Fibroblasts were cultured on the decontaminated surfaces to understand their ability to establish a connective tissue seal after decontamination. The results were analyzed from a statistical point of view to hypothesize a mathematical model capable of explaining the properties of the surfaces. (3) Results: A negative correlation between roughness and contamination has been demonstrated, whereas a weak correlation was observed between wettability and decontamination capacity. All surfaces were topographically damaged after the decontamination treatment. Grade 5 titanium surfaces appear tougher, whereas anodized surfaces tend to lose the anodizing layer. (4) Conclusions: further studies will be needed to fully understand how these decontaminated surfaces affect the adhesion, proliferation and differentiation of fibroblasts and osteoblasts.

Effect of acid-alkali treatment on serum protein adsorption and bacterial adhesion to porous titanium

Modification of the titanium (Ti) surface is widely known to influence biological reactions such as protein adsorption and bacterial adhesion in vivo, ultimately controlling osseointegration. In this study, we sought to investigate the correlation of protein adsorption and bacterial adhesion with the nanoporous structure of acid-alkali-treated Ti implants, shedding light on the modification of Ti implants to promote osseointegration. We fabricated nontreated porous Ti (NTPT) by powder metallurgy and immersed it in mixed acids and NaOH to obtain acid-alkali-treated porous Ti (AAPT). Nontreated dense sample (NTDT) served as control. Our results showed that nanopores were formed after acid-alkali treatment. AAPT showed a higher specific surface area and became much more hydrophilic than NTPT and NTDT (p < 0.001). Compared to dense samples, porous samples exhibited a lower zeta potential and higher adsorbed protein level at each time point within 120 min (p < 0.001). AAPT formed a thicker protein layer by serum precoating than NTPT and NTDT (p < 0.001). The main adsorbed proteins on AAPT and NTPT were albumin, α1 antitrypsin, transferrin, apolipoprotein A1, complement C3 and haptoglobin α1 chain. The amounts of bacteria adhering to the serum-precoated samples were lower than those adhering to the nonprecoated samples (p < 0.05). Lower-molecular-weight proteins showed higher affinity to porous Ti. In conclusion, acid-alkali treatment facilitated protein adsorption by porous Ti, and the protein coating tended to prevent bacteria from adhering. These findings may be utilized for Ti implant modification aimed at reducing bacterial adhesion and enhancing osseointegration. Graphical abstract.

Conventional and Recent Trends of Scaffolds Fabrication: A Superior Mode for Tissue Engineering

Tissue regeneration is an auto-healing mechanism, initiating immediately following tissue damage to restore normal tissue structure and function. This falls in line with survival instinct being the most dominant instinct for any living organism. Nevertheless, the process is slow and not feasible in all tissues, which led to the emergence of tissue engineering (TE). TE aims at replacing damaged tissues with new ones. To do so, either new tissue is being cultured in vitro and then implanted, or stimulants are implanted into the target site to enhance endogenous tissue formation. Whichever approach is used, a matrix is used to support tissue growth, known as ‘scaffold’. In this review, an overall look at scaffolds fabrication is discussed, starting with design considerations and different biomaterials used. Following, highlights of conventional and advanced fabrication techniques are attentively presented. The future of scaffolds in TE is ever promising, with the likes of nanotechnology being investigated for scaffold integration. The constant evolvement of organoids and biofluidics with the eventual inclusion of organ-on-a-chip in TE has shown a promising prospect of what the technology might lead to. Perhaps the closest technology to market is 4D scaffolds following the successful implementation of 4D printing in other fields.

Conventional and Recent Trends of Scaffolds Fabrication: A Superior Mode for Tissue Engineering

Tissue regeneration is an auto-healing mechanism, initiating immediately following tissue damage to restore normal tissue structure and function. This falls in line with survival instinct being the most dominant instinct for any living organism. Nevertheless, the process is slow and not feasible in all tissues, which led to the emergence of tissue engineering (TE). TE aims at replacing damaged tissues with new ones. To do so, either new tissue is being cultured in vitro and then implanted, or stimulants are implanted into the target site to enhance endogenous tissue formation. Whichever approach is used, a matrix is used to support tissue growth, known as ‘scaffold’. In this review, an overall look at scaffolds fabrication is discussed, starting with design considerations and different biomaterials used. Following, highlights of conventional and advanced fabrication techniques are attentively presented. The future of scaffolds in TE is ever promising, with the likes of nanotechnology being investigated for scaffold integration. The constant evolvement of organoids and biofluidics with the eventual inclusion of organ-on-a-chip in TE has shown a promising prospect of what the technology might lead to. Perhaps the closest technology to market is 4D scaffolds following the successful implementation of 4D printing in other fields.

Antibacterial Performance of Zr-BMG, Stainless Steel, and Titanium Alloy with Laser-Induced Periodic Surface Structures

A laser-induced periodic surface structure (LIPSS) was shown to have antibacterial adhesion properties in previous research. In this study, the antibacterial performance of LIPSS on traditional biometals (stainless steel and titanium alloy) and a potential biometal (zirconium-based bulk metallic glass, Zr-BMG) was investigated. A femtosecond laser was used to fabricate LIPSS on the specimens. Gram-negative Escherichia coli (E. coli) and Gram-positive Staphylococcus aureus (S. aureus) were used to examine the antibacterial behavior of the LIPSS samples. The bacterial adhesion force on each specimen was evaluated by an atomic force microscopy (AFM) cell probe. The results showed that the LIPSS on all three metal surfaces significantly lowered antibacterial adhesion compared to polished metal specimens. E. coli demonstrated a higher adhesion force but a lower surface adhesion rate compared to S. aureus. The Zr-BMG specimen with LIPSS has multiple antimicrobial mechanisms (physical antiadhesion and chemical elimination), while the traditional biometals (316L and TC4) mainly offer physical antiadhesion. Finally, an in vitro/vivo study showed that specimens with LIPSS surfaces did not significantly affect the biocompatibility of the specimens. This study reveals that the Zr-BMG specimen with femtosecond laser-processed LIPSS is an ideal choice for achieving an antibacterial surface.

Immunomodulatory Properties and Osteogenic Activity of Polyetheretherketone Coated with Titanate Nanonetwork Structures

Polyetheretherketone (PEEK) is a potential substitute for conventional metallic biomedical implants owing to its superior mechanical and chemical properties, as well as biocompatibility. However, its inherent bio-inertness and poor osseointegration limit its use in clinical applications. Herein, thin titanium films were deposited on the PEEK substrate by plasma sputtering, and porous nanonetwork structures were incorporated on the PEEK surface by alkali treatment (PEEK-TNS). Changes in the physical and chemical characteristics of the PEEK surface were analyzed to establish the interactions with cell behaviors. The osteoimmunomodulatory properties were evaluated using macrophage cells and osteoblast lineage cells. The functionalized nanostructured surface of PEEK-TNS effectively promoted initial cell adhesion and proliferation, suppressed inflammatory responses, and induced macrophages to anti-inflammatory M2 polarization. Compared with PEEK, PEEK-TNS provided a more beneficial osteoimmune environment, including increased levels of osteogenic, angiogenic, and fibrogenic gene expression, and balanced osteoclast activities. Furthermore, the crosstalk between macrophages and osteoblast cells showed that PEEK-TNS could provide favorable osteoimmunodulatory environment for bone regeneration. PEEK-TNS exhibited high osteogenic activity, as indicated by alkaline phosphatase activity, osteogenic factor production, and the osteogenesis/osteoclastogenesis-related gene expression of osteoblasts. The study establishes that the fabrication of titanate nanonetwork structures on PEEK surfaces could extract an adequate immune response and favorable osteogenesis for functional bone regeneration. Furthermore, it indicates the potential of PEEK-TNS in implant applications.