Surface modification of Ti-6Al-4V alloy for biomineralization and specific biological response: Part I, inorganic modification

Nano-topography and functionalization with the synthetic peptoid GN2-Npm9 as a strategy for antibacterial and biocompatible titanium implants

In recent years, antimicrobial peptides (AMPs) have attracted great interest in scientific research, especially for biomedical applications such as drug delivery and orthopedic applications. Since they are readily degradable in the physiological environment, scientific research has recently been trying to make AMPs more stable. Peptoids are synthetic N-substituted glycine oligomers that mimic the structure of peptides. They have a structure that does not allow proteolytic degradation, which makes them more stable while maintaining microbial activity. This structure also brings many advantages to the molecule, such as greater diversity and specificity, making it more suitable for biological applications. For the first time, a synthesized peptoid (GN2-Npm9) was used to functionalize a nanometric chemically pre-treated (CT) titanium surface for bone-contact implant applications. A preliminary characterization of the functionalized surfaces was performed using the contact angle measurements and zeta potential titration curves. These preliminary analyses confirmed the presence of the peptoid and its adsorption on CT. The functionalized surface had a hydrophilic behaviour (contact angle = 30°) but the hydrophobic tryptophan-like residues were also exposed. An electrostatic interaction between the lysine residue of GN2-Npm9 and the surface allowed a chemisorption mechanism. The biological characterization of the CT_GN2-Nmp9 surfaces demonstrated the ability to prevent surface colonization and biofilm formation by the pathogens Escherichia coli and Staphylococcus epidermidis thus showing a broad-range activity. The cytocompatibility was confirmed by human mesenchymal stem cells. Finally, a bacteria-cells co-culture model was applied to demonstrate the selective bioactivity of the CT_GN2-Nmp9 surface that was able to preserve colonizing cells adhered to the device surface from bacterial infection.

Effect of Surface Modifications on Surface Roughness of Ti6Al4V Alloy Manufactured by 3D Printing, Casting, and Wrought

This work aimed to comprehensively evaluate the influence of different surface modifications on the surface roughness of Ti6Al4V alloys produced by selective laser melting (SLM), casting and wrought. The Ti6Al4V surface was treated using blasting with Al₂O₃ (70-100 µm) and ZrO₂ (50-130 µm) particles, acid etching with 0.017 mol/dm³ hydrofluoric acids (HF) for 120 s, and a combination of blasting and acid etching (SLA). It was found that the optimization of the surface roughness of Ti6Al4V parts produced by SLM differs significantly from those produced by casting or wrought processes. Experimental results showed that Ti6Al4V alloys produced by SLM and blasting with Al₂O₃ followed by HF etching had a higher surface roughness (Ra = 2.043 µm, Rz = 11.742 µm), whereas cast and wrought Ti6Al4V components had surface roughness values of (Ra = 1.466, Rz = 9.428 m) and (Ra = 0.940, Rz = 7.963 m), respectively. For Ti6Al4V parts blasted with ZrO₂ and then etched by HF, the wrought Ti6Al4V parts exhibited higher surface roughness (Ra = 1.631 µm, Rz = 10.953 µm) than the SLM Ti6Al4V parts (Ra = 1.336 µm, Rz = 10.353 µm) and the cast Ti6Al4V parts (Ra = 1.075 µm, Rz = 8.904 µm).

Conferring Antioxidant Activity to an Antibacterial and Bioactive Titanium Surface through the Grafting of a Natural Extract

The main unmet medical need of bone implants is multifunctional activity, including their ability to induce rapid and physiological osseointegration, counteract bacterial biofilm formation, and prevent in situ chronic inflammation at the same time. This research starts from an already developed c.p. titanium surface with proven bioactive (in vitro hydroxyl apatite precipitation) and antibacterial activities, due to a calcium titanate layer with nano- and micro-scale roughness and loaded with iodine ions. Here, antioxidant ability was added to prevent chronic inflammation by grafting polyphenols of a green tea extract onto the surface, without compromising the other functionalities of the surface. The surface was characterized before and after functionalization through XPS analysis, zeta potential titrations, ion release measurements, in vitro bioactivity tests, SEM and fluorescence microscopy, and Folin-Ciocalteu and biological tests. The presence of grafted polyphenols as a homogeneous layer was proven. The grafted polyphenols maintained their antioxidant ability and were anchored to the surface through the linking action of Ca²⁺ ions added to the functionalizing solution. Iodine ion release, cytocompatibility towards human mesenchymal stem cells (hMSC), and antibacterial activity were maintained even after functionalization. The antioxidant ability of the functionalized surface was effective in preserving hMSC viability in a chemically induced pro-inflammatory environment, thus showing a scavenger activity towards toxic active species responsible for inflammation.

Role of BMP-7 on biological parameters osseointegration of dental implants: Preliminary results of a preclinical study

The aim of this work was to analyze and compare the effect of bone morphogenetic protein-7 on biological parameters related to implant osseointegration in an experimental animal model. Sixteen dental implants were placed in the tibias of four randomly selected minipigs for the following dental implant surface treatments: Group A: conventional treatment of the dental implant surface by SLA (n = 8) and Group B: treatment of the dental implant surface with carboxyethylphosphonic acid and bone morphogenetic protein-7 (n = 8). The animals were sacrificed one month after dental implants placement and a histomorphometric study was performed for the evaluation of bone-to-implant contact, corrected bone-to-implant contact, new bone formation, interthread bone density and peri-implant density using Student's t-test and the non-parametric Mann-Whitney test. The histomorphometric parameters bone-to-implant contact and corrected bone-to-implant contact showed statistically significant differences between the study groups; 34.00% ± 9.92% and 50.02% ± 10.94%, respectively (p = 0.004) for SLA and 43.08% ± 10.76% and 63.30% ± 11.30%, respectively (p = 0.003) for BMP-7. The parameters new bone formation, interthread bone density and peri-implant density did not show statistically significant differences between the study groups (p = 0.951, p = 0.967 and p = 0.894, respectively). Dental implant surfaces treated with carboxyethylphosphonic acid and BMP-7 improve the biological response of dental implants to osseointegration.

Bacteriostatic Poly Ethylene Glycol Plasma Coatings for Orthodontic Titanium Mini-Implants

Titanium mini-implants are used as anchorage for orthodontic tooth movements. However, these implants present problems due to the infection of surrounding tissues. The aim of this work was to obtain a polyethylene glycol (PEG) layer by plasma in order to achieve a bacteriostatic surface. Titanium surfaces were activated by argon plasma and, after, by PEG plasma with different powers (100, 150 and 200 W) for 30 and 60 min. The roughness was determined by white light interferometer microscopy and the wettability was determined by the contact angle technique. Surface chemical compositions were characterized by X-ray photoelectron spectroscopy (XPS) and cytocompatibility and cell adhesion studies were performed with fibroblast (hFFs) and osteoblast (SAOS-2) cells. Bacterial cultures with Spectrococcus Sanguinis and Lactobacillus Salivarius were performed, and bacterial colonization was determined. The results showed that plasma treatments do not affect the roughness. Plasma makes the surfaces more hydrophilic by decreasing the contact angles from 64.2° for titanium to 5.2° for argon-activated titanium, with values ranging from 12° to 25° for the different PEG treatments. The plasma has two effects: the cleaning of the surface and the formation of the PEG layer. The biocompatibility results were, for all cases, higher than 80%. The polymerization treatment with PEG reduced the adhesion of hFFs from 7000 to 6000 and, for SAOS-2, from 14,000 to 6500, for pure titanium and those treated with PEG, respectively. Bacterial adhesion was also reduced from 600 to 300 CFU/mm² for Spetrococcuns Sanguinis and from 10,000 to 900 CFU/mm² for Lactobacillus Salivarius. The best bacteriostatic treatment corresponded to PEG at 100 W and 30 s. As a consequence, the PEG coating would significantly prevent the formation of bacterial biofilm on the surface of titanium mini-implants.

Role of chitosan in titanium coatings. trends and new generations of coatings

Survival studies of dental implants currently reach high figures. However, considering that the recipients are middle-aged individuals with associated pathologies, research is focused on achieving bioactive surfaces that ensure osseointegration. Chitosan is a biocompatible, degradable polysaccharide with antimicrobial and anti-inflammatory properties, capable of inducing increased growth and fixation of osteoblasts around chitosan-coated titanium. Certain chemical modifications to its structure have been shown to enhance its antibacterial activity and osteoinductive properties and it is generally believed that chitosan-coated dental implants may have enhanced osseointegration capabilities and are likely to become a commercial option in the future. Our review provided an overview of the current concepts and theories of osseointegration and current titanium dental implant surfaces and coatings, with a special focus on the in vivo investigation of chitosan-coated implants and a current perspective on the future of titanium dental implant coatings.

Titanium Dental Implants: An Overview of Applied Nanobiotechnology to Improve Biocompatibility and Prevent Infections

This review addresses the different aspects of the use of titanium and its alloys in the production of dental implants, the most common causes of implant failures and the development of improved surfaces capable of stimulating osseointegration and guaranteeing the long-term success of dental implants. Titanium is the main material for the development of dental implants; despite this, different surface modifications are studied aiming to improve the osseointegration process. Nanoscale modifications and the bioactivation of surfaces with biological molecules can promote faster healing when compared to smooth surfaces. Recent studies have also pointed out that gradual changes in the implant, based on the microenvironment of insertion, are factors that may improve the integration of the implant with soft and bone tissues, preventing infections and osseointegration failures. In this context, the understanding that nanobiotechnological surface modifications in titanium dental implants improve the osseointegration process arouses interest in the development of new strategies, which is a highly relevant factor in the production of improved dental materials.

Current Knowledge on Biomaterials for Orthopedic Applications Modified to Reduce Bacterial Adhesive Ability

A significant challenge in orthopedics is the design of biomaterial devices that are able to perform biological functions by substituting or repairing various tissues and controlling bone repair when required. This review presents an overview of the current state of our recent research into biomaterial modifications to reduce bacterial adhesive ability, compared with previous reviews and excellent research papers, but it is not intended to be exhaustive. In particular, we investigated biomaterials for replacement, such as metallic materials (titanium and titanium alloys) and polymers (ultra-high-molecular-weight polyethylene), and biomaterials for regeneration, such as poly(ε-caprolactone) and calcium phosphates as composites. Biomaterials have been designed, developed, and characterized to define surface/bulk features; they have also been subjected to bacterial adhesion assays to verify their potential capability to counteract infections. The addition of metal ions (e.g., silver), natural antimicrobial compounds (e.g., essential oils), or antioxidant agents (e.g., vitamin E) to different biomaterials conferred strong antibacterial properties and anti-adhesive features, improving their capability to counteract prosthetic joint infections and biofilm formation, which are important issues in orthopedic surgery. The complexity of biological materials is still far from being reached by materials science through the development of sophisticated biomaterials. However, close interdisciplinary work by materials scientists, engineers, microbiologists, chemists, physicists, and orthopedic surgeons is indeed necessary to modify the structures of biomaterials in order to achieve implant integration and tissue regeneration while avoiding microbial contamination.

Effect of Conductivity on In Situ Deactivation of Catechol-Boronate Complexation-Based Reversible Smart Adhesive

To reduce the need for elevated electrical potential to deactivate catechol-based smart adhesive and preserve its reversibility, conductive 1-pyrenemethyl methacrylate (PyMA) was incorporated into a catechol and phenylboronic acid-containing adhesive coating immobilized on aluminum (Al) discs. Electrochemical impedance spectroscopy (EIS) indicated that incorporation of 26 mol % of PyMA reduced ionic resistance (R_s) and charge-transfer resistance (R_c) of the coating from over 22 Ω/mm² to 5.9 and 1.2 Ω/mm², respectively. A custom-built Johnson-Kendall-Roberts (JKR) contact mechanics test setup was used to evaluate the adhesive property of the coating with in situ applied electricity using a titanium (Ti) sphere both as a test substrate as well as the cathode for application of electricity and the Al disc as the anode. The adhesive coating demonstrated over 95% reduction in the adhesive property when electricity (1-2 V) was applied while the adhesive was in direct contact with the Ti surface. The addition of PyMA enables the deactivation of the adhesive using a voltage as low as 1 V. Both cyclic voltammetry (CV) and attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectra confirmed the formation of catechol-boronate complexation through electrochemical stimulation. Breaking the complex with an acidic buffer (pH 3) recovered the catechol for strong wet adhesion and the coating could be repeatedly deactivated and reactivated using low electrical potential for up to five cycles. Incorporation of both conductive PyMA and boronic acid as the temporary protecting group was required to achieve rapidly switchable adhesive that could be deactivated with low applied voltage.

Enhanced Osseointegration by the Hierarchical Micro-Nano Topography on Selective Laser Melting Ti-6Al-4V Dental Implants

Currently, selective laser melting (SLM) has been thriving in implant dentistry for on-demand fabricating dental implants. Based on the coarse microtopography of SLM titanium surfaces, constructing nanostructure to form the hierarchical micro-nano topography is effective in enhancing osseointegration. Given that current nanomodification techniques of SLM implants, such as anodization and hydrothermal treatment, are facing the inadequacy in costly specific apparatus and reagents, there has been no recognized nanomodified SLM dental implants. The present study aimed to construct hierarchical micro-nano topography on self-made SLM dental implants by a simple and safe inorganic chemical oxidation, and to evaluate its contribution on osteoblastic cells bioactivity and osseointegration. The surface chemical and physical parameters were characterized by FE-SEM, EDS, profilometer, AFM, and contact angle meter. The alteration on bioactivity of MG-63 human osteoblastic cells were detected by qRT-PCR. Then the osseointegration was assessed by implanting implants on the femur condyle of New Zealand Rabbits. The hierarchical micro-nano topography was constituted by the microrough surface of SLM implants and nanoneedles (diameter: 20∼50 nm, height: 150∼250 nm), after nanomodifying SLM implants in 30% hydrogen peroxide and 30% hydrochloride acid (volume ratio 1:2.5) at room temperature for 36 h. Low chemical impurities content and high hydrophilicity were observed in the nanomodified group. Cell experiments on the nanomodified group showed higher expression of mitophagy related gene (PINK1, PARKIN, LC3B, and LAMP1) at 5 days and higher expression of osteogenesis related gene (Runx2 and OCN) at 14 days. In the early stage of bone formation, the nanomodified SLM implants demonstrated higher bone-to-implant contact. Intriguingly, the initial bone-to-implant contact of nanomodified SLM implants consisted of more mineralized bone with less immature osteoid. After the cessation of bone formation, the bone-to-implant contact of nanomodified SLM implants was equal to untreated SLM implants and marketable TixOs implants. The overall findings indicated that the inorganic chemical oxidized hierarchical micro-nano topography could enhance the bioactivity of osteoblastic cells, and consequently promote the peri-implant bone formation and mineralization of SLM dental implants. This study sheds some light on improvements in additive manufactured dental implants.

The mechanical and chemical stability of the interfaces in bioactive materials: The substrate-bioactive surface layer and hydroxyapatite-bioactive surface layer interfaces

Bioactive materials should maintain their properties during implantation and for long time in contact with physiological fluids and tissues. In the present research, five different bioactive materials (a bioactive glass and four different chemically treated bioactive titanium surfaces) have been studied and compared in terms of mechanical stability of the surface bioactive layer-substrate interface, their long term bioactivity, the type of hydroxyapatite matured and the stability of the hydroxyapatite-surface bioactive layer interface. Numerous physical and chemical analyses (such as Raman spectroscopy, macro and micro scratch tests, soaking in SBF, Field Emission Scanning Electron Microscopy equipped with Energy Dispersive Spectroscopy (SEM-EDS), zeta potential measurements and Fourier Transformed Infra-Red spectroscopy (FTIR) with chemical imaging) were used. Scratch measurements evidenced differences among the metallic surfaces concerning the mechanical stability of the surface bioactive layer-substrate interface. All the surfaces, despite of different kinetics of bioactivity, are covered by a bone like carbonate-hydroxyapatite with B-type substitution after 28 days of soaking in SBF. However, the stability of the apatite layer is not the same for all the materials: dissolution occurs at pH around 4 (close to inflammation condition) in a more pronounced way for the surfaces with faster bioactivity together with detachment of the surface bioactive layer. A protocol of characterization is here suggested to predict the implant-bone interface stability.

Innovative Coatings Based On Peppermint Essential Oil on Titanium and Steel Substrates: Chemical and Mechanical Protection Ability

A coating that was made of peppermint essential oil was obtained on different metal substrates: Ti6Al4V alloy (mechanically polished and chemically etched) and 316L stainless steel (mechanically polished and mechanically ground). The final aim is to get a multifunctional (chemical and mechanical) protection of metal surfaces in contact with water media. The coatings were characterized by means of fluorescence microscopy, contact angle measurements, and Fourier Transformed Infrared spectroscopy (FTIR) spectroscopy. The chemical stability of the coatings was tested by means of soaking in water for different times (up to seven days) and washing with different alkaline or acidic solutions. The mechanical adhesion of the coating was tested by tape adhesion test (before and after soaking) and scratch tests to verify whether it has protection ability with respect to the metal substrate. All of the performed characterizations show that the coatings are chemically stable on all of the substrates and are nor dissolved or removed by water during soaking or by alkaline solutions during washing. The adhesion is high and classified as 4B or 5B (on the chemically etched or mechanically ground substrates) according to ASTM D3359-97, depending on the substrate roughness, both before and after soaking. In the case of scratch test (up to 10 N), the coating is not removed and it has a protection action that is able to avoid the surface damage, even if the substrate has a plastic deformation.

Bioactive materials: In vitro investigation of different mechanisms of hydroxyapatite precipitation

Bioactive materials, able to induce hydroxyapatite precipitation in contact with body fluids, are of great interest for their bone bonding capacity. . The aim of this paper is to compare bioactive materials with different surface features to verify the mechanisms of action and the relationship with kinetics and type of precipitated hydroxyapatite over time. Four different surface treatments for Ti/Ti6Al4V alloy and a bioactive glass were selected and a different mechanism of bioactivity is supposed for each of them. Apart from the conventional techniques (FESEM, XPS and EDX), less common characterizations (zeta potential measurements on solid surfaces and FTIR chemical imaging) were applied. The results suggest that the OH groups on the surface have several effects: the total number of the OH groups mainly affects hydrophilicity of surfaces, while the isoelectric points, surface charge and ions attraction mainly depend on OH acidic/basic strength. Kinetics of hydroxyapatite precipitation is faster when it involves a mechanism of ion exchange while it is slower when it is due to electrostatic effects . The electrostatic effect cooperates with ion exchange and it speeds up kinetics of hydroxyapatite precipitation. Different bioactive surfaces are able to differently induce precipitation of type A and B of hydroxyapatite, as well as different degrees of crystallinity and carbonation. STATEMENT OF SIGNIFICANCE: The bone is made of a ceramic phase (a specific type of hydroxyapatite), a network of collagen fibers and the biological tissue. A strong bond of an orthopedic or dental implant with the bone is achieved by bioactive materials where precipitation and growth of hydroxyapatite occurs on the implant surface starting from the ions in the physiological fluids. Several bioactive materials are already known and used, but their mechanism of action is not completely known and the type of precipitated hydroxyapatite not fully investigated. In this work, bioactive titanium and bioglass surfaces are compared through conventional and innovative methodologies. Different mechanisms of bioactivity are identified, with different kinetics and the materials are able to induce precipitation of different types of hydroxyapatite, with different degree of crystallinity and carbonation.

Influence of the Titanium Implant Surface Treatment on the Surface Roughness and Chemical Composition

The implant surface features affect the osseointegration process. Different surface treatment methods have been applied to improve the surface topography and properties. Trace of different elements may appear on the implant surface, which can modify surface properties and may affect the body’s response. The aim was to evaluate the roughness based on the surface treatment received and the amount and type of trace elements found. Ninety implants (nine different surface treatment) were evaluated. Roughness parameters were measured using white-light-interferometry (WLI). The arithmetical mean for R_a, R_q, R_t, and R_z of each implant system was calculated, and Fisher’s exact test was applied, obtaining R_a values between 0.79 and 2.89 µm. Surface chemical composition was evaluated using X-ray photoelectron spectroscopy (XPS) at two times: as received by the manufacturer (AR) and after sputter-cleaning (SC). Traces of several elements were found in all groups, decreasing in favor of the Ti concentration after the sputter-cleaning. Within the limitations of this study, we can conclude that the surface treatment influences the roughness and the average percentage of the trace elements on the implant surface. The cleaning process at the implant surface should be improved by the manufacturer before assembling the implant.

Nano-scale modification of titanium implant surfaces to enhance osseointegration

The main aim of this review study was to report the state of art on the nano-scale technological advancements of titanium implant surfaces to enhance the osseointegration process. Several methods of surface modification are chronologically described bridging ordinary methods (e.g. grit blasting and etching) and advanced physicochemical approaches such as 3D-laser texturing and biomimetic modification. Functionalization procedures by using proteins, peptides, and bioactive ceramics have provided an enhancement in wettability and bioactivity of implant surfaces. Furthermore, recent findings have revealed a combined beneficial effect of micro- and nano-scale modification and biomimetic functionalization of titanium surfaces. However, some technological developments of implant surfaces are not commercially available yet due to costs and a lack of clinical validation for such recent surfaces. Further in vitro and in vivo studies are required to endorse the use of enhanced biomimetic implant surfaces. STATEMENT OF SIGNIFICANCE: Grit-blasting followed by acid-etching is currently used for titanium implant modifications, although recent technological biomimetic physicochemical methods have revealed enhanced osteoconductive and anti-microbial outcomes. An improvement in wettability and bioactivity of titanium implant surfaces has been accomplished by combining micro and nano-scale modification and functionalization with protein, peptides, and bioactive compounds. Such morphological and chemical modification of the titanium surfaces induce the migration and differentiation of osteogenic cells followed by an enhancement of the mineral matrix formation that accelerate the osseointegration process. Additionally, the incorporation of bioactive molecules into the nanostructured surfaces is a promising strategy to avoid early and late implant failures induced by the biofilm accumulation.

Cytocompatible and Anti-bacterial Adhesion Nanotextured Titanium Oxide Layer on Titanium Surfaces for Dental and Orthopedic Implants

It is widely recognized that surface nanotextures applied on a biomaterial can affect wettability, protein absorption and cellular and/or bacterial adhesion; accordingly, they are nowadays of great interest to promote fast osseointegration and to maintain physiological healing around biomedical implants. In order to be suitable for clinical applications, surface nanotextures must be not only safe and effective, but also, they should be produced through industrial processes scalable to real devices with sustainable processes and costs: this is often a barrier to the market entry. Based on these premises, a chemical surface treatment designed for titanium and its alloys able to produce an oxide layer with a peculiar sponge like nanotexture coupled with high density of hydroxyl group is here presented. The modified Ti-based surfaces previously showed inorganic bioactivity intended as the ability to induce apatite precipitation in simulated body fluid. Physicochemical properties and morphology of the obtained layers have been characterized by means of FESEM, XPS, and Zeta-potential. Biological response to osteoblasts progenitors and bacteria has been tested. The here proposed nanotextured surfaces successfully supported osteoblasts progenitors' adhesion, proliferation and extracellular matrix deposition thus demonstrating good biocompatibility. Moreover, the nanotexture was able to significantly reduce bacteria surface colonization when the orthopedic and the periodontal pathogens Staphylococcus aureus and Aggregatibacter actinomycetemcomitans strains were applied for a short time. Finally, the applicability of the proposed surface treatment to real biomedical devices (a 3D acetabular cup, a dental screw and a micro-sphered laryngeal implant) has been here demonstrated.

Grafting of Gallic Acid onto a Bioactive Ti6Al4V Alloy: A Physico-Chemical Characterization

Despite increasing interest in the use of natural biomolecules for different applications, few attempts of coupling them to inorganic biomaterials are reported in literature. Functionalization of metal implants with natural biomolecules could allow a local action, overcoming the issue of low bioavailability through systemic administration. In the present work, gallic acid was grafted to a pre-treated Ti6Al4V in order to improve its biological response in bone contact applications. The grafting procedure was optimized by choosing the concentration of gallic acid (1 mg/mL) and the solvent of the solution, which was used as a source for functionalization, in order to maximize the amount of the grafted molecule on the titanium substrate. The functionalized surfaces were characterized. The results showed that functionalization with Simulated Body Fluid (SBF) as solvent medium was the most effective in terms of the amount and activity of the grafted biomolecule. A key role of calcium ions in the grafting mechanism is suggested, involving the formation of coordination compounds formed by way of gallic acid carboxylate and Ti–O− as oxygenated donor groups. Bioactive behavior and surface charge of the pre-treated Ti6Al4V surface were conserved after functionalization. The functionalized surface exposed a greater amount of OH groups and showed higher wettability.

A critical review of multifunctional titanium surfaces: New frontiers for improving osseointegration and host response, avoiding bacteria contamination

Evolution of metal implants progressively shifted the focus from adequate mechanical strength to improved biocompatibility and absence of toxicity and, finally, to fast osseointegration. Recently, new frontiers and challenges of Ti implants have been addressed to improvement of bioactivity, fighting of bacterial infection and biofilm formation, as well as modulation of inflammation. This is closely related to the clinical demand of multifunctional implants able to simultaneously have a number of specific responses with respect to body fluids, cells (osteoblasts, fibroblasts, macrophages) and pathogenic agents (bacteria, viruses). This complex system of multiple biological stimuli and surface responses is a major arena of the current research on biomaterials and biosurfaces. This review covers the strategies explored to this purpose since 2010 in the case of Ti and Ti alloys, considering that the number of related papers doubled about in the last seven years and no review has comprehensively covered this engaging research area yet. The different approaches followed for producing multifunctional Ti-based surfaces involve the use of thick and thin inorganic coatings, chemical surface treatments, and functionalization strategies coupled with organic coatings.

STATEMENT OF SIGNIFICANCE

According to the clinical demand of multifunctional implants able to simultaneously have a number of specific responses with respect to body fluids, cells and pathogenic agents, new frontiers of Ti implants have been addressed to improvement of bioactivity, fighting of bacterial infection and biofilm formation, as well as modulation of inflammation. Literature since 2010 is here reviewed. Several strategies for getting bioactive and antibacterial actions on Ti surfaces have been suggested, but they still need to be optimized with respect to several concerns. A further step will be to combine on the same surface a proven ability of modulation of inflammatory response. The achievement of multifunctional surfaces able to modulate inflammation and to promote osteogenesis is a grand challenge.

Green Tea Polyphenols Coupled with a Bioactive Titanium Alloy Surface: In Vitro Characterization of Osteoinductive Behavior through a KUSA A1 Cell Study

A chemically-treated titanium alloy (Ti6Al4V) surface, able to induce hydroxyapatite precipitation from body fluids (inorganic mineralization activity), was functionalized with a polyphenolic extract from green tea (tea polyphenols, TPH). Considering that green tea polyphenols have stimulating effects on bone forming cells (biological mineralization), the aim was to test their osteoinductive behavior due to co-operation of inorganic and biological mineralization on mesenchymal stem cells KUSA A1. The functionalized surfaces were characterized by using the Folin⁻Ciocalteu method and X-ray photoelectron spectroscopy to confirm the successful outcome of the functionalization process. Two cell cultures of mesenchymal stem cells, KUSA A1 were performed, with or without osteoinductive factors. The cells and surfaces were characterized for monitoring cell viability and hydroxyapatite production: Fourier Transform Infrared Spectroscopy and Raman spectroscopy analyses showed deposition of hydroxyapatite and collagen due to the cell activity, highlighting differentiation of KUSA A1 into osteoblasts. A higher production of extracellular matrix was highlighted on the functionalized samples by laser microscope and the fluorescence images showed higher viability of cells and greater presence of osteocalcin in these samples. These results highlight the ability of polyphenols to improve cell differentiation and to stimulate biological mineralization, showing that surface functionalization of metal implants could be a promising way to improve osteointegrability.

Zeta Potential Measurements on Solid Surfaces for in Vitro Biomaterials Testing: Surface Charge, Reactivity Upon Contact With Fluids and Protein Absorption

Surface properties of biomaterials (e.g., roughness, chemical composition, charge, wettability, and hydroxylation degree) are key features to understand and control the complex interface phenomena that happens upon contact with physiological fluids. Numerous physico-chemical techniques can be used in order to investigate in depth these crucial material features. Among them, zeta potential measurements are widely used for the characterization of colloidal suspensions, but actually poorly explored in the study of solid surfaces, even if they can give significant information about surface charge in function of pH and indirectly about surface functional groups and reactivity. The aim of the present research is application of zeta potential measurements of solid surfaces for the in vitro testing of biomaterials. In particular, bare and surface modified Ti6Al4V samples have been compared in order to evaluate their isoelectric points (IEPs), surface charge at physiological pH, in vitro bioactivity [in simulated body fluid (SBF)] and protein absorption. Zeta potential titration was demonstrated as a suitable technique for the surface characterization of surface treated Ti6Al4V substrates. Significant shift of the isoelectric point was recorded after a chemical surface treatment (because of the exposition of hydroxyl groups), SBF soaking (because of apatite precipitation IEP moves close to apatite one) and protein absorption (IEP moves close to protein ones). Moreover, the shape of the curve gives information about exposed functional groups (e.g., a plateau in the basic range appears due to the exposition of acidic OH groups and in the acidic range due to exposition of basic NH₂ groups).

Impact of Surface Potential on Apatite Formation in Ti Alloys Subjected to Acid and Heat Treatments

Titanium metal (Ti) and its alloys are widely used in orthopedic and dental fields. We have previously shown that acid and heat treatment was effective to introduce bone bonding, osteoconduction and osteoinduction on pure Ti. In the present study, acid and heat treatment with or without initial NaOH treatment was performed on typical Ti-based alloys used in orthopedic and dental fields. Dynamic movements of alloying elements were developed, which depended on the kind of treatment and type of alloy. It was found that the simple acid and heat treatment enriched/remained the alloying elements on Ti-6Al-4V, Ti-15Mo-5Zr-3Al and Ti-15Zr-4Nb-4Ta, resulting in neutral surface charges. Thus, the treated alloys did not form apatite in a simulated body fluid (SBF) within 3 days. In contrast, when the alloys were subjected to a NaOH treatment prior to an acid and heat treatment, alloying elements were selectively removed from the alloy surfaces. As a result, the treated alloys became positively charged, and formed apatite in SBF within 3 days. Thus, the treated alloys would be useful in orthopedic and dental fields since they form apatite even in a living body and bond to bone.

Bioactivation of titanium dioxide scaffolds by ALP-functionalization

Three dimensional TiO₂ scaffolds are receiving renewed attention for bone tissue engineering (TE) due to their biocompatibility and attractive mechanical properties. However the bioactivity of these scaffolds is comparatively lower than that of bioactive glass or hydroxyapatite (HA) scaffolds. One strategy to improve bioactivity is to functionalize the surface of the scaffolds using biomolecules. Alkaline phosphatase (ALP) was chosen in this study due to its important role in the bone mineralization process. The current study investigated the ALP functionalization of 3D titanium dioxide scaffolds using self-polymerization of dopamine. Robust titanium scaffolds (compressive strength∼2.7 ± 0.3 MPa) were produced via foam replica method. Enzyme grafting was performed by dip-coating in polydopamine/ALP solution. The presence of ALP was indirectly confirmed by contact angle measurements and enzymatic activity study. The influence of the enzyme on the bioactivity, e.g. hydroxyapatite formation on the scaffold surface, was measured in simulated body fluid (SBF). After 28 days in SBF, 5 mg ALP coated titania scaffolds exhibited increased hydroxyapatite formation. It was thus confirmed that ALP enhances the bioactivity of titania scaffolds, converting an inert bioceramic in an attractive bioactive system for bone TE.

Osteogenic activity of titanium surfaces with hierarchical micro-/nano-structures obtained by hydrofluoric acid treatment

An easier method for constructing the hierarchical micro-/nano-structures on the surface of dental implants in the clinic is needed. In this study, three different titanium surfaces with microscale grooves (width 0.5–1, 1–1.5, and 1.5–2 μm) and nanoscale nanoparticles (diameter 20–30, 30–50, and 50–100 nm, respectively) were obtained by treatment with different concentrations of hydrofluoric acid (HF) and at different etching times (1%, 3 min; 0.5%, 12 min; and 1.5%, 12 min, respectively; denoted as groups HF1, HF2, and HF3). The biological response to the three different titanium surfaces was evaluated by in vitro human bone marrow-derived mesenchymal stem cell (hBMMSC) experiments and in vivo animal experiments. The results showed that cell adhesion, proliferation, alkaline phosphatase activity, and mineralization of hBMMSCs were increased in the HF3 group. After the different surface implants were inserted into the distal femurs of 40 rats, the bone–implant contact in groups HF1, HF2, and HF3 was 33.17%±2.2%, 33.82%±3.42%, and 41.04%±3.08%, respectively. Moreover, the maximal pullout force in groups HF1, HF2, and HF3 was 57.92±2.88, 57.83±4.09, and 67.44±6.14 N, respectively. The results showed that group HF3 with large micron grooves (1.5–2.0 μm) and large nanoparticles (50–100 nm) showed the best bio-functionality for the hBMMSC response and osseointegration in animal experiments compared with other groups.

Topographic characterisation of dental implants for commercial use

BACKGROUND

To characterize the surface topography of several dental implants for commercial use.

MATERIAL AND METHODS

Dental implants analyzed were Certain (Biomet 3i), Tissue Level (Straumann), Interna (BTI), MG-InHex (MozoGrau), SPI (Alphabio) and Hikelt (Bioner). Surface topography was ascertained using a confocal microscope with white light. Roughness parameters obtained were: Ra, Rq, Rv, Rp, Rt, Rsk and Rku. The results were analysed using single-factor ANOVA and Student-Neuman-Keuls (p<0.05) tests.

RESULTS

Certain and Hikelt obtained the highest Ra and Rq scores, followed by Tissue Level. Interna and SPI obtained lower scores, and MG-InHex obtained the lowest score. Rv scores followed the same trend. Certain obtained the highest Rp score, followed by SPI and Hikelt, then Interna and Tissue Level. MG-InHex obtained the lowest scores. Certain obtained the highest Rt score, followed by Interna and Hikelt, then SPI and Tissue Level. The lowest scores were for MG-InHex. Rsk was negative (punctured surface) in the MG-InHex, SPI and Tissue Level systems, and positive (pointed surface) in the other systems. Rku was higher than 3 (Leptokurtic) in Tissue Level, Interna, MG-InHex and SPI, and lower than 3 (Platykurtic) in Certain and Hikelt.

CONCLUSIONS

The type of implant determines surface topography, and there are differences in the roughness parameters of the various makes of implants for clinical use.

Growth of Novel Ceramic Layers on Metals via Chemical and Heat Treatments for Inducing Various Biological Functions

The present authors' systematic studies on growth of novel ceramic layers on Ti metal and its alloys by chemical and heat treatments for inducing bone-bonding bioactivity and some other biological functions are reviewed. Ti metal formed an apatite on its surface in a simulated body fluid, when heat-treated after exposure to strong acid solutions to form rutile surface layer, or to strong alkali solutions to form sodium titanate surface layer. Both types of Ti metal tightly bonded to the living bone. The alkali and heat treatment was applied to the surface Ti metal of an artificial hip joint and successfully used in the clinic since 2007. The acid and heat treatments was applied to porous Ti metal to induce osteoconductivity as well as osteoinductivity. The resulting product was successfully used in clinical trials for spinal fusion devices. For the Ti-based alloys, the alkali and heat treatment was little modified to form calcium titanate surface layer. Bone-growth promoting Mg, Sr, and Zn ions as well as the antibacterial Ag ion were successfully incorporated into the calcium titanate layer.

Nanostructured Ti6Al4V alloy fabricated using modified alkali-heat treatment: Characterization and cell adhesion

In order to optimize the creation of a nanostructured surface on Ti6Al4V titanium alloy, an alkali treatment was performed using a 10-M NaOH solution at various temperatures (30, 40, 50, and 60°C) so as to determine the optimal temperature. This was combined with subsequent heat treatments (200, 400, 600, and 800°C) in air. The effects of different temperatures for the latter treatments on the nanostructure surface and the initial cell adhesion were evaluated, and the optimal temperature of the alkali solution was found to be 30°C. Further, the nanotopography, surface chemistry, and surface roughness of the nanoporous structure were retained after heat treatments performed at 200, 400, and 600°C, and only the phase structure was altered. The amorphous sodium titanate phase, the content of which increased with increased heat-treatment temperature, may have played a role in promoting cell adhesion on the nanoporous surface. However, heat treatment at 800°C did not enhance the cell-surface attachment. Rather, the nanostructure degraded significantly with the reappearance of Al and V.

Surface Modifications and Their Effects on Titanium Dental Implants

This review covers several basic methodologies of surface treatment and their effects on titanium (Ti) implants. The importance of each treatment and its effects will be discussed in detail in order to compare their effectiveness in promoting osseointegration. Published literature for the last 18 years was selected with the use of keywords like titanium dental implant, surface roughness, coating, and osseointegration. Significant surface roughness played an important role in providing effective surface for bone implant contact, cell proliferation, and removal torque, despite having good mechanical properties. Overall, published studies indicated that an acid etched surface-modified and a coating application on commercial pure titanium implant was most preferable in producing the good surface roughness. Thus, a combination of a good surface roughness and mechanical properties of titanium could lead to successful dental implants.

MULTIFUNCTIONAL TITANIUM: SURFACE MODIFICATION PROCESS AND BIOLOGICAL RESPONSE

A proper stimulation of the cell activity is the last request to the new biomaterials, intended for bone substitution and osseointegration. In this regard, the scientific literature suggests that the surface modification on a nanoscale is a major source of innovation. The nano features and multiscale topographies can stimulate cell differentiation and activity. Moreover, the presence of specific biological molecules grafted onto the biosurfaces can properly stimulate cells to tissue regeneration. The final aim is to promote a fast and physiological bone healing, at the implant site. In order to be suitable for implantation, the modified surfaces must sustain the implantation and working load/friction without damages. Two different innovative surface modifications of the Ti6Al4V alloy were tested in this research. The first one is an inorganic modification and it is aimed at inducing in vivo apatite precipitation (inorganic bioactivity) and cell interaction through nano features. The modified surface shows a complex topography (micro and nanoroughness), a modified surface chemistry (high density of hydroxyls groups), high wettability and protein absorption. Moreover, an additional biological modification by grafting of alkaline phosphatase (ALP) was tested. The modified surfaces were compared with the traditional polished and blasted ones, in terms of osteoblast adhesion, proliferation and morphology. A significant increase in the cell proliferation rate was observed on the modified materials. Moreover, the osteoblasts showed a more differentiated aspect and filopodia exploring the nanotextures on both the treated materials.

Bioactive titanate layers formed on titanium and its alloys by simple chemical and heat treatments

To reveal general principles for obtaining bone-bonding bioactive metallic titanium, Ti metal was heat-treated after exposure to a solution with different pH. The material formed an apatite layer at its surface in simulated body fluid when heat-treated after exposure to a strong acid or alkali solution, because it formed a positively charged titanium oxide and negatively charged sodium titanate film on its surface, respectively. Such treated these Ti metals tightly bonded to living bone. Porous Ti metal heat-treated after exposure to an acidic solution exhibited not only osteoconductive, but also osteoinductive behavior. Porous Ti metal exposed to an alkaline solution also exhibits osteoconductivity as well as osteoinductivity, if it was subsequently subjected to acid and heat treatments. These acid and heat treatments were not effective for most Ti-based alloys. However, even those alloys exhibited apatite formation when they were subjected to acid and heat treatment after a NaOH treatment, since the alloying elements were removed from the surface by the latter. The NaOH and heat treatments were also not effective for Ti-Zr-Nb-Ta alloys. These alloys displayed apatite formation when subjected to CaCl₂ treatment after NaOH treatment, forming Ca-deficient calcium titanate at their surfaces after subsequent heat and hot water treatments. The bioactive Ti metal subjected to NaOH and heat treatments has been clinically used as an artificial hip joint material in Japan since 2007. A porous Ti metal subjected to NaOH, HCl and heat treatments has successfully undergone clinical trials as a spinal fusion device.

Bone healing at bicortically installed implants with different surface configurations. An experimental study in rabbits

OBJECTIVE

To study the sequential healing at bicortically installed implants with surface modifications by the use of fluoroboric acid and/or H2 O2 .

MATERIAL AND METHODS

Twenty-eight albino New Zealand rabbits were used. Two recipient sites were prepared in the tibiae bilaterally, one in the metaphysis and the second in the diaphysis regions. Four implants with different surface characteristics were randomly installed with bicortical stabilization: (i) sandblasted and acid-etched; (ii) same surface as i, but with a substitution of the hydrofluoric acid with fluoroboric acid; (iii) same surface as i, additionally treated with H2 O2 ; and (iv) same surface modified as ii, additionally treated with H2 O2 . The animals were killed after 5, 8, 15, and 30 days. Ground sections were prepared for histological analyses.

RESULTS

No statistically significant differences in osseointegration were found among various surfaces at any of the healing periods. A higher degree of osseointegration was observed at the implants placed in the metaphysis compared to those placed in the diaphysis, especially during early healing. A higher degree of osseointegration was found at sites with proximity to compact (cortical) bone when compared to the middle portion of the implants, especially in the diaphysis region.

CONCLUSIONS

Surfaces modified with different acids or H2 O2 resulted in similar osseointegration compared to a standard sandblasted and acid-etched surface. The portion of the bicortically installed implants in close contact with the cortical compartment presented a higher percentage of osseointegration compared with the region in contact with the bone marrow compartment.

Microstructural and topographical characterization of different surface treatments of a surgical titanium alloy for dental implants

OBJECTIVE

To perform a topographical characterization of a titanium alloy subjected to different surface treatments using roughness evaluation, scanning electron microscopy, and atomic force microscopy.

MATERIALS AND METHODS

For each group, 6 discs of a titanium alloy had their surfaces modified by 4 treatments. All surfaces were blasted with Al2O3, cleaned, and the specimens were divided into 4 groups: G1, immersion in a standardized acid solution (SAS) (control group); G2, immersion in acetone, followed by immersion in SAS; G3, immersion in acetone, followed by immersion in SAS, followed by immersion in nitric acid; G4, immersion in acetone, followed by immersion in SAS, followed by immersion in sulfuric acid. Roughness parameters were determined with a roughness tester, and data were statistically analyzed using analysis of variance and Tukey tests (α = 5%).

RESULTS

Regarding the roughness parameters, no significant differences were found. Scanning electron microscopy and atomic force microscopy showed irregular surfaces with the presence of particles uniformly deposited on the surfaces.

CONCLUSION

A similar roughness pattern was created for all the groups. The images and topographic profiles indicated that all the groups showed high levels of roughness.

Photocatalytic activity of low temperature oxidized Ti-6Al-4V

Numerous advanced surface modification techniques exist to improve bone integration and antibacterial properties of titanium based implants and prostheses. A simple and straightforward method of obtaining uniform and controlled TiO(2) coatings of devices with complex shapes is H(2)O(2)-oxidation and hot water aging. Based on the photoactivated bactericidal properties of TiO(2), this study was aimed at optimizing the treatment to achieve high photocatalytic activity. Ti-6Al-4V samples were H(2)O(2)-oxidized and hot water aged for up to 24 and 72 h, respectively. Degradation measurements of rhodamine B during UV-A illumination of samples showed a near linear relationship between photocatalytic activity and total treatment time, and a nanoporous coating was observed by scanning electron microscopy. Grazing incidence X-ray diffraction showed a gradual decrease in crystallinity of the surface layer, suggesting that the increase in surface area rather than anatase formation was responsible for the increase in photocatalytic activity.

Biomaterials and implants for orbital floor repair

Treatment of orbital floor fractures and defects is often a complex issue. Repair of these injuries essentially aims to restore the continuity of the orbital floor and to provide an adequate support to the orbital content. Several materials and implants have been proposed over the years for orbital floor reconstruction, in the hope of achieving the best clinical outcome for the patient. Autografts have been traditionally considered as the "gold standard" choice due to the absence of an adverse immunological response, but they are available in limited amounts and carry the need for extra surgery. In order to overcome the drawbacks related to autografts, researchers' and surgeons' attention has been progressively attracted by alloplastic materials, which can be commercially produced and easily tailored to fit a wide range of specific clinical needs. In this review the advantages and limitations of the various biomaterials proposed and tested for orbital floor repair are critically examined and discussed. Criteria and guidelines for optimal material/implant choice, as well as future research directions, are also presented, in an attempt to understand whether an ideal biomaterial already exists or a truly functional implant will eventually materialise in the next few years.

Surface modification of Ti-6Al-4 V alloy for biomineralization and specific biological response: part II, alkaline phosphatase grafting

Titanium and its alloys are the most widespread materials for the realization of orthopaedic and dental implants due to their good mechanical properties and biocompatibility. Surface functionalization of biomaterials aimed to improve and quicken implant integration and tissue regeneration is an active research field. The opportunity to confer biological activity (ability to directly stimulate cells with proper biological signals) to the Ti6Al4 V alloy, previously modified to be bioactive from the inorganic point of view (apatite precipitation), was explored in this research work. The alkaline phosphatase (ALP) enzyme was grafted to metal surface via tresyl chloride activation, maintaining its activity. A synergistic effect between biological functionalization and inorganic bioactivity was observed.