Comparison between sol-gel-derived anatase- and rutile-structured TiO2 coatings in soft-tissue environment

Influence of Surface Characteristics of TiO2 Coatings on the Response of Gingival Cells: A Systematic Review of In Vitro Studies

The soft tissue-implant interface requires the formation of epithelium and connective tissue seal to hinder microbial infiltration and prevent epithelial down growth. Nanoporous titanium dioxide (TiO₂) surface coatings have shown good potential for promoting soft tissue attachment to implant surfaces. However, the impact of their surface properties on the biological response of gingival cells needs further investigation. This systematic review aimed to investigate the cellular behavior of gingival cells on TiO₂-implant abutment coatings based on in vitro studies. The review was performed to answer the question: "How does the surface characteristic of TiO₂ coatings influence the gingival cell response in in vitro studies?". A search in MEDLINE/PubMed and the web of science databases from 1990 to 2022 was performed using keywords. A quality assessment of the studies selected was performed using the SciRAP method. A total of 11 publications were selected from the 289 studies that fulfilled the inclusion criteria. The mean reporting and methodologic quality SciRAP scores were 82.7 ± 6.4/100 and 87 ± 4.2/100, respectively. Within the limitations of this in vitro systematic review, it can be concluded that the TiO₂ coatings with smooth nano-structured surface topography and good wettability improve gingival cell response compared to non-coated surfaces.

A Novel Technique to Increase the Thickness of TiO₂ of Dental Implants by Nd: DPSS Q-sw Laser Treatment

High bone-implant contact is a crucial factor in the achievement of osseointegration and long time clinical success of dental implants. Micro, nano, microtopography, and oxide layer of dental implants influence tissue response. The lasers were used for achieving an implant surface with homogeneous micro texturing and uncontaminated surface. The present study aimed to characterize the implant surfaces treated by Nd: DPSS Q-sw Laser treatment compared to machined implants. A total of 10 machined implants and 10 lasered surface implants were evaluated in this study. The implant surfaces were evaluated by X-ray Photoelectron Spectroscopy (XPS), Auger Electron Spectroscopy (AES), and metallography to characterize and measure the thickness of the oxide layer on the implant titanium surface. The machined surfaces showed a non-homogeneous oxide layer ranging between 20 and 30 nm. The lasered implant surfaces showed a homogeneous oxide layer ranging between 400 nm and 460 nm in the area of the laser holes, while outside the layer, thickness ranged between 200 nm and 400 nm without microcracks or evidence of damage. Another exciting result after this laser treatment is a topographically controlled, repeatable, homogeneous, and clean surface. This technique can obtain the implant surface without leaving residues of foreign substances on it. The study results indicate that the use of Nd: DPSS Q-sw laser produces a predictable and reproducible treatment able to improve the titanium oxide layer on the dental implant surface.

Titanium surface modifications and their soft-tissue interface on nonkeratinized soft tissues-A systematic review (Review)

In this systematic review, the authors explored the surface aspects of various titanium (Ti) or Ti alloy medical implants, examining the interface formed between the implant and surrounding nonkeratinized soft tissues (periosteum, muscles, tendons, fat, cicatrix, or dura mater). A comprehensive search undertaken in July 2019 used strict keywords in relevant electronic databases to identify relevant studies. Based on the authors' inclusion criteria (restricted to in vivo studies), 19 of 651 publications qualified, all pertaining to animal models. The syrcle's risk of bias tool for animal studies was applied at study level. Given the broad nature of the reported results and the many different parameters measured, the articles under scrutiny were assigned to five research subgroups according to their surface modification types: mechanical surface modifications, oxidative processes (e.g., acid etching, anodization, microarc oxidation), sol-gel derived titania (TiO₂) coatings, biofunctionalized surfaces, and a subgroup for other modifications. The primary outcome was a liquid space at the interface (e.g., seroma formation) that was reported in six studies. Machining Ti implants to a roughness between R_a = 0.5 and 1.0 μm was shown to induce soft-tissue adhesion. Smoother surfaces, with the exception of acid polished and anodized Ti (R_a = 0.2 μm), prevented soft-tissue adhesion. A fibroblast growth factor 2 apatite composite coating promoted soft-tissue attachment via Sharpey-like fibers. In theory, this implant-soft tissue interface could be nearly perfect.

Influence of the Thermal Treatment to Address a Better Osseointegration of Ti6Al4V Dental Implants: Histological and Histomorphometrical Study in a Rabbit Model

Background

Pure titanium continues to be the first choice for dental implants and represents the gold standard for their biocompatibility and physical and mechanical characteristics, while the titanium alloy (Ti6Al4V) has good mechanical properties. The surface structure of the titanium oxide layer formation on the surface influences and improves the bone response around dental implants.

Purpose

The purpose of this study is to evaluate the influence of a thermal treatment of Ti6Al4V implant surfaces and the bone healing response in a rabbit model.

Methods

Altogether sixteen implants with same design were inserted into the distal femoral metaphysis. A screw (13 mm long, 4 mm in diameter) was inserted in an implant bed. Each rabbit received two implants, one in the left femur and one in the right femur. The samples were histologically and histomorphometrically evaluated at 8 weeks.

Results

A statistically significant difference (p = 0.000034) was present histologically in the percentages of bone-implant contact (BIC) between the test group (BIC = 69.25±4.49%.) and control group (BIC = 56.25 ± 4.8%) by one-way analysis of variance (ANOVA). Significance was set at p ≤ 0.05.

Conclusions

The outcome of the present study indicates a novel approach to improving bone healing around titanium implants.

Bioactive glass particulate filler composite: Effect of coupling of fillers and filler loading on some physical properties

OBJECTIVES

The aim of this study was to investigate the effect of silanization of biostable and bioactive glass fillers in a polymer matrix on some of the physical properties of the composite.

METHODS

The water absorption, solubility, flexural strength, flexural modulus and toughness of different particulate filler composite resins were studied in vitro. Five different specimen groups were analyzed: A glass-free control, a non-silanized bioactive glass, a silanized bioactive glass, a non-silanized biostable glass and a silanized biostable glass groups. All of these five groups were further divided into sub-groups of dry and water-stored materials, both of them containing groups with 3wt%, 6wt%, 9wt% or 12wt% of glass particles (n=8 per group). The silanization of the glass particles was carried out with 2% of gamma-3-methacryloxyproyltrimethoxysilane (MPS). For the water absorption and solubility tests, the test specimens were stored in water for 60 days, and the percentages of weight change were statistically analyzed. Flexural strength, flexural modulus and toughness values were tested with a three-point bending test and statistically analyzed.

RESULTS

Higher solubility values were observed in non-silanized glass in proportion to the percentage of glass particles. Silanization, on the other hand, decreased the solubility values of both types of glass particles and polymer. While 12wt% non-silanized bioactive glass specimens showed -0.98wt% solubility, 12wt% silanized biostable glass specimens were observed to have only -0.34wt% solubility. The three-point bending results of the dry specimens showed that flexural strength, toughness and flexural modulus decreased in proportion to the increase of glass fillers. The control group presented the highest results (106.6MPa for flexural strength, 335.7kPA for toughness, 3.23GPa for flexural modulus), whereas for flexural strength and toughness, 12wt% of non-silanized biostable glass filler groups presented the lowest (70.3MPa for flexural strength, 111.5kPa for toughness). For flexural modulus on the other hand, 12wt% of silanized biostable glass filler group gave the lowest results (2.57GPa).

SIGNIFICANCE

The silanization of glass fillers improved the properties of the glass as well as the properties of the composite. Silanization of bioactive glass may protect the glass from leaching at early stage of water storage.

Mesenchymal stem cell response to conformal sputter deposited calcium phosphate thin films on nanostructured titanium surfaces

Biomaterial surfaces that can directly induce the osteogenic differentiation of mesenchymal stem cells (MSCs) present an exciting strategy for bone tissue engineering and offers significant benefits for improving the repair or replacement of damaged or lost bone tissue. In this study, titanium nanostructures with distinctive topographical features were produced by radio frequency magnetron sputtering. The response of MSCs to the nanostructured titanium (Ti) surfaces before and after augmentation by a sputter deposited calcium phosphate (CaP) coating has been investigated. The sputtered CaP has the characteristics of a calcium enriched hydroxyapatite surface layer, as determined by X-ray photoelectron spectroscopy and X-ray diffraction studies. The sputter deposited Ti has a polycrystalline surface morphology, as confirmed by atomic force microscopy, and CaP layers deposited thereon (TiCaP) conform to this topography. The effects of these surfaces on MSC focal adhesion formation, actin cytoskeleton organization and Runx2 gene expression were examined. The Ti and TiCaP surfaces were found to promote changes in MSC morphology and adhesion known to be associated with subsequent downstream osteogenic differentiation; however, the equivalent events were not as pronounced on the CaP surface. A significant increase in Runx2 expression was observed for CaP compared to Ti, but no such difference was seen between either Ti and TiCaP, nor CaP and TiCaP. Importantly, the Ti surface engendered the expected contribution of nanoscale features to the MSC response; moreover, the CaP layer when used in combination with this topography has been found to cause no adverse effects in respect of MSC behavior.

Bone response to physical-vapour-deposited titanium dioxide coatings on titanium implants

OBJECTIVES

The aim of this study was to investigate the correlation between coating thickness and the crystal structure of physical-vapour-deposited (PVD) titanium dioxide coatings, and to evaluate their in vivo biocompatibility.

MATERIALS AND METHODS

The PVD TiO 2 coatings of different thickness were deposited on machined titanium grade 2 screw-shaped implants. Non-coated titanium implants were used as controls. Coating properties such as thickness, crystal structure, coating morphology and roughness were characterized. Forty-eight implants were placed randomly into both tibias of 16 rats. The animals were euthanized 7 and 28 days postsurgery and block biopsies were prepared for histology, histomorphometry and SEM analysis.

RESULTS

The thicknesses of the PVDTiO 2 coatings were 120 and 1430 nm respectively. Histologically, new bone formed on all implant surfaces. The mean percentage of newly formed bone in contact with the implant (BIC) was significantly higher at early healing time (7 days) for the 120 nm thick PVD coating (39 ± 14%) than for both the 1430 nm thick PVD coating (22 ± 10%) (P = 0.043) and the machined surface (22 ± 9%) (P = 0.028). This difference was no longer evident after 28 days (P = 0.867).

CONCLUSION

Bone formation and bone-to-implant contact are achieved to the same degree for TiO 2 surface modifications prepared by a PVD process as clinically used, machined titanium. Furthermore, a relatively thinner PVD coating promotes a higher degree of bone apposition shortly after implantation, thereby providing rationales for exploring the potential clinical use of these modifications.

Adhesion and proliferation of human fibroblasts on sol-gel coated titania

The objective of this study was to evaluate growth and attachment of human gingival fibroblasts on nonresorbable sol-gel-derived nanoporous titania (TiO2) coated discs and noncoated commercially pure titania (cpTi) discs in vitro. The strength of attachment was evaluated using serial trypsinization. The number of cells detached from TiO2-substrates was 30% +/- 3%, whereas those detached from the cpTi was 58% +/- 4% indicating a stronger cell attachment on the coated surfaces. In scanning electron microscopy (SEM) images fewer cells, with more rounded shape, were seen with cpTi than with TiO2 after the detachment assay. Fibroblasts grew more efficiently on TiO2 than on cpTi substrates, showing significantly higher cell activities at all times. In transmission electron microscopy (TEM), a continuous layer of two to three cells thick covered the coated and noncoated discs after 7 days of culture. The plasma membrane of cells in contact with the coating was in close opposition and the cytoplasm was ultrastructurally similar to the cells grown on noncoated discs with well-preserved organelles. In conclusion, we demonstrated that the sol-gel-derived TiO2 coatings can facilitate cell growth and attachment of human gingival fibroblasts on titanium in vitro. This in vitro study is in line with our previous in vivo observations of improved soft tissue attachment of TiO2 coatings in comparison with cpTi.

Sol-gel derived titania coating with immobilized bisphosphonate enhances screw fixation in rat tibia

A variety of surface modifications have been tested for the enhancement of screw fixation in bone, and locally delivered anti-osteoporosis drugs such as bisphosphonates (BP) are then of interest. In this in vivo study, the impact of surface immobilized BP was compared with systemic BP delivery and screws with no BP. After due in vitro characterization, differently treated stainless steel (SS) screws were divided into four groups with 10 rats each. Three of the groups received screws coated with sol-gel derived TiO(2) and calcium phosphate (SS+TiO(2)+CaP). One of these had no further treatment, one had alendronate (BP) adsorbed to calcium phosphate mineral, and one received systemic BP treatment. The fourth group received uncoated SS screws and no BP (control). The screw pullout force was measured after 4 weeks of implantation in rat tibiae. The immobilized amount and release rate of alendronate could be controlled by different immersion times. The SS+TiO(2)+CaP coating did not increase the pullout force compared to SS alone. Surface delivered alendronate enhanced the pullout force by 93% [p = 0.000; 95% Confidence Interval (CI): 67-118%] compared to SS, and by 39% (p = 0.044; 95% CI: 7-71%) compared to systemic alendronate delivery. Both surface immobilized and systemically delivered alendronate improved implant fixation. Also, locally delivered, that is, surface immobilized alendronate showed a better fixation than systemically delivered. Using sol-gel derived TiO(2) as a platform, it is possible to administer controllable amounts of a variety of BPs.

Differential adhesion of Streptococcus gordonii to anatase and rutile titanium dioxide surfaces with and without functionalization with chlorhexidine

The majority of dental implants are composed primarily of titanium and have an outer layer of titanium dioxide. Crystalline titanium dioxide most commonly exists in one of the two structures, anatase and rutile, and both of these have been observed on commercially available dental implants. Early implant failure can be associated with postoperative infection due to implant contamination during or immediately after surgery. The impetus of this study was to investigate whether functionalization of anatase and rutile titanium dioxide surfaces with chlorhexidine-reduced subsequent colonization of the surface by Streptococcus gordonii. Exposure to 100 mg x L(-1) chlorhexidine for 60 s resulted in a fivefold reduction in S. gordonii coverage on anatase and a twofold reduction on rutile. This may be related to a preferential adsorption of chlorhexidine to anatase compared with rutile. The reduction in bacterial coverage was not due to desorption of chlorhexidine into solution. More bacteria were observed on anatase than rutile surfaces without chlorhexidine functionalization, indicating that crystal structure may have a significant effect on bacterial colonization. In conclusion, functionalization with chlorhexidine reduced bacterial coverage on titanium dioxide surfaces, and anatase surfaces may be more amenable to such treatment than rutile.

Peri-implant tissue response to TiO2 surface modified implants

OBJECTIVES

The objective of this study was to evaluate peri-implant soft tissue attachment and alveolar bone height on nanoporous TiO(2) thin film on commercial titanium dental implants compared with unmodified standard implants.

MATERIAL AND METHODS

In six adult beagle dogs, the mandibular premolars P2-P4 were extracted bilaterally. Sol-gel-derived nanoporous TiO(2) thin film was produced on smooth coronal part of standard ITI Straumann implants (4.1 mm x 8.0 mm) by dip coating method. After 3 months healing period of the extraction sockets modified (n=24) and unmodified (n=11) control implants were placed bilaterally. The animals were killed after 8 weeks and the samples were retrieved and processed for histologic/histomorfometric and TEM/SEM evaluations.

RESULTS

Histological examination showed mild or absent inflammatory reaction in peri-implant connective tissues around the surface modified implants. Further, junctional epithelium (JE)/connective tissue (CT) appeared to be in immediate contact with the experimental implants. Of the experimental implants, 22% were judged to be detached from the implant surface while 45% of the untreated control implants were detached. Dense plaques of hemidesmosomes were found in TEM evaluation of the JE cell membrane facing the surface-treated implants. In the histomorfometric analysis, the distance between the implant margin and alveolar bone crest was significantly shorter in surface-treated implants than in the control implants (P<0.02).

CONCLUSION

Nanoporous sol-gel-derived TiO(2) thin film on ITI Straumann dental implants improved soft tissue attachment in vivo.