Ultrastructural differences of the interface zone between bone and Ti 6Al 4V or commercially pure titanium

Chondroitin-4-sulfate transferase-1 depletion inhibits formation of a proteoglycan-rich layer and alters immunotolerance of bone marrow mesenchymal stem cells on titanium oxide surfaces

Successful osseointegration is essential for dental implants. However, the complete molecular mechanism of osseointegration remains to be elucidated. In this study, we focused on the proteoglycan (PG)-rich layer between titanium oxides (TiOx) and bone, and chondroitin-4-sulfate transferase-1 (C4ST-1), which forms the sugar chain in PGs. Human bone marrow mesenchymal stem cells (hBMSCs) depleted of C4ST-1 were cultured on titanium (Ti) plates, and the interface between hBMSCs and TiOx was analyzed using transmission electron microscopy. Immunotolerance, proliferation, initial adhesion, and calcification of the cells were analyzed in vitro. At 14 days of cultivation, a PG-rich layer was observed between hBMSCs and TiOx. However, the PG-rich layer was reduced in C4ST-1-depleted hBMSCs on TiOx. Real-time RT-PCR showed that conditioned media increased the levels of expression of M1-macrophage markers in human macrophages. However, depletion of C4ST-1 did not affect calcification, cell proliferation, or initial cell adhesion on Ti plates. These results suggested that C4ST-1 in hBMSCs affects their immunotolerance and alters the formation of PG-rich layer formation on TiOx.

Osseointegration and current interpretations of the bone-implant interface

Complex physical and chemical interactions take place in the interface between the implant surface and bone. Various descriptions of the ultrastructural arrangement to various implant design features, ranging from solid and macroporous geometries to surface modifications on the micron-, submicron-, and nano- levels, have been put forward. Here, the current knowledge regarding structural organisation of the bone-implant interface is reviewed with a focus on solid devices, mainly metal (or alloy) intended for permanent anchorage in bone. Certain biomaterials that undergo surface and bulk degradation are also considered. The bone-implant interface is a heterogeneous zone consisting of mineralised, partially mineralised, and unmineralised areas. Within the meso-micro-nano-continuum, mineralised collagen fibrils form the structural basis of the bone-implant interface, in addition to accumulation of non-collagenous macromolecules such as osteopontin, bone sialoprotein, and osteocalcin. In the published literature, as many as eight distinct arrangements of the bone-implant interface ultrastructure have been described. The interpretation is influenced by the in vivo model and species-specific characteristics, healing time point(s), physico-chemical properties of the implant surface, implant geometry, sample preparation route(s) and associated artefacts, analytical technique(s) and their limitations, and non-compromised vs compromised local tissue conditions. The understanding of the ultrastructure of the interface under experimental conditions is rapidly evolving due to the introduction of novel techniques for sample preparation and analysis. Nevertheless, the current understanding of the interface zone in humans in relation to clinical implant performance is still hampered by the shortcomings of clinical methods for resolving the finer details of the bone-implant interface. STATEMENT OF SIGNIFICANCE: Being a hierarchical material by design, the overall strength of bone is governed by composition and structure. Understanding the structure of the bone-implant interface is essential in the development of novel bone repair materials and strategies, and their long-term success. Here, the current knowledge regarding the eventual structural organisation of the bone-implant interface is reviewed, with a focus on solid devices intended for permanent anchorage in bone, and certain biomaterials that undergo surface and bulk degradation. The bone-implant interface is a heterogeneous zone consisting of mineralised, partially mineralised, and unmineralised areas. Within the meso-micro-nano-continuum, mineralised collagen fibrils form the structural basis of the bone-implant interface, in addition to accumulation of non-collagenous macromolecules such as osteopontin, bone sialoprotein, and osteocalcin.

Commercially pure titanium (cp-Ti) versus titanium alloy (Ti6Al4V) materials as bone anchored implants - Is one truly better than the other?

Commercially pure titanium (cp-Ti) and titanium alloys (typically Ti6Al4V) display excellent corrosion resistance and biocompatibility. Although the chemical composition and topography are considered important, the mechanical properties of the material and the loading conditions in the host have, conventionally, influenced material selection for different clinical applications: predominantly Ti6Al4V in orthopaedics while cp-Ti in dentistry. This paper attempts to address three important questions: (i) To what extent do the surface properties differ when cp-Ti and Ti6Al4V materials are manufactured with the same processing technique?, (ii) Does bone tissue respond differently to the two materials, and (iii) Do bacteria responsible for causing biomaterial-associated infections respond differently to the two materials? It is concluded that: (i) Machined cp-Ti and Ti6Al4V exhibit similar surface morphology, topography, phase composition and chemistry, (ii) Under experimental conditions, cp-Ti and Ti6Al4V demonstrate similar osseointegration and biomechanical anchorage, and (iii) Experiments in vitro fail to disclose differences between cp-Ti and Ti6Al4V to harbour Staphylococcus epidermidis growth. No clinical comparative studies exist which could determine if long-term, clinical differences exist between the two types of bulk materials. It is debatable whether cp-Ti or Ti6Al4V exhibit superiority over the other, and further comparative studies, particularly in a clinical setting, are required.

Bone response to a novel Ti-Ta-Nb-Zr alloy

Commercially pure titanium (cp-Ti) is regarded as the state-of-the-art material for bone-anchored dental devices, whereas the mechanically stronger alloy (Ti-6Al-4V), made of titanium, aluminum (Al) and vanadium (V), is regarded as the material of choice for high-load applications. There is a call for the development of new alloys, not only to eliminate the potential toxic effect of Al and V but also to meet the challenges imposed on dental and maxillofacial reconstructive devices, for example. The present work evaluates a novel, dual-stage, acid-etched, Ti-Ta-Nb-Zr alloy implant, consisting of elements that create low toxicity, with the potential to promote osseointegration in vivo. The alloy implants (denoted Ti-Ta-Nb-Zr) were evaluated after 7 days and 28 days in a rat tibia model, with reference to commercially pure titanium grade 4 (denoted Ti). Analyses were performed with respect to removal torque, histomorphometry and gene expression. The Ti-Ta-Nb-Zr showed a significant increase in implant stability over time in contrast to the Ti. Further, the histological and gene expression analyses suggested faster healing around the Ti-Ta-Nb-Zr, as judged by the enhanced remodeling, and mineralization, of the early-formed woven bone and the multiple positive correlations between genes denoting inflammation, bone formation and remodeling. Based on the present experiments, it is concluded that the Ti-Ta-Nb-Zr alloy becomes osseointegrated to at least a similar degree to that of pure titanium implants. This alloy is therefore emerging as a novel implant material for clinical evaluation.

Photofunctionalization increases the bioactivity and osteoconductivity of the titanium alloy Ti6Al4V

This study examined the effect of photofunctionalization on bioactivity and osteoconductivity of titanium alloy Ti6Al4V. We also tested a hypothesis that the effect of photofunctionalization is as substantial as the one of surface roughening. Two different surface morphology, a roughened surface (sandblasted and acid-etched surface) and relatively smooth surface (machined surface), was tested. Ti6Al4V samples were photofunctionalized with UV light for 15 min using a photo device. Photofunctionalization converted Ti6Al4V surfaces from hydrophobic to superhydrophilic. The attachment, spread, proliferation, and the expression of functional phenotype of bone marrow-derived osteoblasts were promoted on photofunctionalized Ti6Al4V surfaces. The strength of bone-implant integration examined using a biomechanical push-in test in a rat femur model was at least 100% greater for photofunctionalized implants than for untreated implants. These effects were seen on both surface types. The strength of bone-implant integration for photofunctionalized machined implants was greater than that for untreated roughened implants, indicating that the impact of photofunctionalization may be greater than that of surface roughening. Newly prepared Ti alloy was hydrophilic, whereas the hydrophilic status degraded with time and was converted to hydrophobic in 4 weeks. This finding uncovered biological aging of Ti alloy and allowed us to consider photofunctionalization as a countermeasure for aging. These results suggest that photofunctionalization accelerates and enhances bone-implant integration of Ti6Al4V regardless of smooth and roughened surface features, supporting photofunctionalization as an effective and viable measure for improving efficacy of a wide range of Ti6Al4V-based materials used in dental and orthopedic medicine.

Biomechanical, histological, and ultrastructural analyses of laser micro- and nano-structured titanium alloy implants: a study in rabbit

The aim of this study was to evaluate the biomechanical properties and ultrastructure of the bone response of partly laser-modified Ti6Al4V implants compared with turned, machined implants after 8 weeks in rabbit. The surface analyses performed with interference microscopy and electron microscopy showed increased surface topography with micro- and nano-sized surface features as well as increased oxide thickness of the modified surface. The biomechanical testing demonstrated a 270% increase in torque value for the surface modified implants compared with the control implants. Histological evaluation of ground sections of specimens subjected to biomechanical testing revealed ongoing bone formation and remodeling. A histological feature exclusively observed at the laser-modified surface was the presence of fracture in the mineralized bone rather than at the interface between the bone and implant. Transmission electron microscopy (TEM) was performed on Focused Ion Beam (FIB) prepared samples of the intact bone-implant interface, demonstrating a direct contact between nanocrystalline hydroxyapatite and the oxide of the laser-modified implant surface. In conclusion, laser-modified titanium alloy implants have significantly stronger bone anchorage compared with machined implants and show no adverse tissue reactions.

Morphological studies on machined implants of commercially pure titanium and titanium alloy (Ti6Al4V) in the rabbit

The aim of this study was to evaluate the bone response to commercially pure titanium grade I and titanium alloy grade V (90% Ti, 6% Al, and 4% V, depicted Ti6Al4V) after 8 weeks in rabbit tibia. Interference microscopy and scanning electron microscopy were used for surface analyses. Transmission electron microscopy (TEM) was used for evaluation of surface crystallinity and chemistry after preparation of ultrathin sections using focused ion beam (FIB) microscopy. Three different embedding resins commonly used for histological preparation were evaluated with respect to adaptation to a turned implant surface. Epoxy Agar 100 resin and acrylic Technovit 7200 resin showed low separation while acrylic LR White resin showed large separation at the interface. The retrieved specimens were embedded in acrylic Technovit 7200 resin after fixation and dehydration. The histological evaluation revealed osseointegration for both c.p. titanium grade I and Ti6Al4V alloy, but no quantitative differences in bone contact and bone area were detected. Because a separation of implant and tissue occurred in the interface between implant and bone embedded in acrylic Technovit 7200 resin, additional factors related to implant surface properties and technical procedures are likely to influence the possibilities to prepare ultrathin sections by FIB.

A histomorphometric study on collagen-apatite composite as a graft material: the influence of gap size at the titanium-bone interface in animal model

The purpose of this study was to evaluate the healing process of collagen-apatite composite (CAC) at the titanium-bone interface in animal model. Small gaps (0.5 or 1.0 mm-sized wells) were prepared in the epoxy-resin block implants coated with pure titanium. The gaps were filled with CAC or demineralized freeze-dried bone (DFDB). The titanium-coated epoxy-resin block implants were inserted in the tibia of rabbit for 4 weeks or 8 weeks. The microscopic features of bony healing process in the grafted gaps were examined and analyzed. In the histomorphometric analysis, CAC group showed higher fraction of newly-formed bone than DFDB group in both 0.5 and 1.0 mm gap subgroup at 4-week specimen (P < 0.05). In the transmission electron microscopic examinations, osteoblasts of the newly-formed bone of CAC group showed more cellular activity than that of DFDB group. From the results, it was expected that CAC had more beneficial property on early bony healing process than DFDB at the titanium-bone interface.

Formation of calcium phosphates on titanium implants with four different bioactive surface preparations. An in vitro study

The aim of the present study was to compare the nucleating and growing behaviour on four types of bioactive surfaces by using the simulated body fluid (SBF) model. Titanium discs were blasted and then prepared by alkali and heat treatment, anodic oxidation, fluoridation, or hydroxyapatite coating. The discs were immersed in SBF for 1, 2, 4 and 6 weeks. Calcium phosphates were found on all specimens, as analysed with scanning electron microscopy/energy dispersive X-ray analysis (SEM/EDX). After 1 and 2 weeks of SBF immersion more titanium was accessible with SEM/EDX on the blasted surfaces than the four bioactive surface types, indicating a difference in coverage by calcium phosphates. The Ca/P mean ratio of the surfaces was approximately 1.5 after 1 week, in contrast to the fluoridated specimens which displayed a Ca/P mean ratio of approximately 2. Powder X-ray diffraction (P-XRD) analyses showed the presence of hydroxyapatite on all types of surfaces after 4 and 6 weeks of immersion. The samples immersed for 6 weeks showed a higher degree of crystallinity than the samples immersed for 4 weeks. In conclusion, differences appeared at the early SBF immersion times of 1 and 2 weeks between controls and bioactive surface types, as well as between different bioactive surface types.

Effect of passivation and surface modification on the dissolution behavior and nano-surface characteristics of Ti-6Al-4V in Hank/EDTA solution

The aim of the present study was to investigate the effects of passivation treatment (34% nitric acid passivation, 400 ( composite function)C heated in air, and aged in 100 ( composite function)C de-ionized water) and surface modification (2 hr and 8 hr vacuum-brazed treatments) on the ion dissolution and nano-surface characteristics of Ti-6Al-4V exposed in Hank's solution with 8.0 mM ethylene diamine tetra-acetic acid (EDTA) at 37 ( composite function)C. The results indicated that the original nano-surface characteristics and microstructure would influence the ion dissolution but not change the capability of the Ca and P adsorption upon immersion. Of the three passivated treatments, 400 ( composite function)C thermal treatment for both 2 hr brazed Ti-6Al-4V (B2) and 8 hr brazed Ti-6Al-4V (B8) exhibits a substantial reduction in the constituent release compared to the acid passivated and water aged treatment, because the thicker thickness and rutile structure of surface oxide could provide the better dissolution resistance for 400 ( composite function)C-treated specimens. Moreover, the reduced Ti(2)Cu and increased alpha -titanium structure in B8 specimen could also improve ion dissolution resistance in comparison with B2 specimen. After soaking in Hank/EDTA solution, the adsorbed non-elemental Ca and P for all groups of specimens were observed by XPS analysis, and the AES depth-profile analysis indicate that the oxide films of all groups of specimens thicken with the longer immersion periods. The increasing oxide thickness may be the factor in the improved dissolution resistance at the longer immersion periods. The relation between lower dissolution rate and thicker oxide films were observed for all groups of specimens. The results suggest that the dissolution kinetics was governed by the metal ion transport through the oxide film in this study.

Attachment and proliferation of neonatal rat calvarial osteoblasts on Ti6Al4V: effect of surface chemistries of the alloy

This study examined the cell attachment and proliferation of neonatal rat calvarial osteoblasts on Ti6Al4V alloy as affected by the surface modifications. The modifications could alter simultaneously the surface chemistries of the alloy (elemental difference of Ti, Al, V, Cu and Ni about 300-600mum thick examined by EDS) as well as the XPS nano-surface characteristics of oxides on the metal surface (chemistries of oxides, amphoteric OH group adsorbed on oxides, and oxide thickness). Three materials including two from modifications and a control were examined. It is argued that a slight change of the nano-surface characteristics of oxides as a result of the modifications neither alters the in vitro capability of Ca and P ion adsorption nor affects the metal ion dissolution behavior of the alloy. This implies that any influence on the cytocompatibility of the materials should only be correlated to the effect of surface chemistries of the alloy and the associated metal ion dissolution behavior of the alloy. The experimental results suggest that the cell response of neonatal rat calvarial osteoblasts on the Ti6Al4V alloy should neither be affected by the variation of surface chemistries of the alloy in a range studied.

Surface roughness parameters as predictors of anchorage strength in bone: a critical analysis

The surface roughness of a bone implant was defined parametrically. The values of the parameters defining the surface were varied. Some traditionally used surface roughness parameters were calculated. By means of a theoretical model the bone-implant interfacial shear strength was estimated. No simple correlation between the values of the surface roughness parameters and the estimated interfacial shear strength was found. It was concluded that the value of the traditional surface roughness parameters as predictors of interfacial shear strength is limited. If however a change of the surface topography of an implant is restricted to scale a positive correlation was found between the theoretical interfacial shear strength and some surface roughness parameters. It is suggested that the bone-implant interfacial shear strength in the general case be estimated by means of strength analyses based upon a study of the size, shape and density of the individual elements constituting the rough surface.

A comparison of the surface characteristics and ion release of Ti6Al4V and heat-treated Ti6Al4V

This work seeks to investigate the nanosurface characteristics and ion release for a Ti6Al4V alloy prepared by various methods (as received and heat treated at 1300 degrees C for 2 h) with three different passivation treatments (34% nitric acid passivation, 400 degrees C heating in air, and aging in 100 degrees C deionized water). The surface and nanosurface composition are not related to the surface passivation treatments and experimental materials as evaluated by energy dispersive spectroscopy and X-ray photoelectron spectroscopy (XPS) analyses. After passivation and autoclaving treatments, the specimens were immersed in 8.0 mM ethylenediaminetetraacetic acid (EDTA) in Hank's solution and maintained at 37 degrees C for periods of time up to 16 days. The 400 degrees C treated specimens exhibit a substantial reduction in constituent release, which may be attributed to the thicker thickness and rutile structure of the surface oxides. After soaking in Hank's-EDTA solution, a significant time-related decrease in constituent release rate is observed for all kinds of specimens throughout the 0-16 day experimental period. The thicker oxides may be a factor in the improved dissolution resistance. Upon immersion, nonelemental Ca and P are both detected on the surfaces of all kinds of specimens by XPS analysis, and this could be explained by the existence of two types of hydroxyl groups (acidic and basic OH groups) on the oxide surface of the specimens.

Titanium substrata composition influences osteoblastic phenotype: In vitro study

In spite of observed differences at the interface between boon and either commercially pure titanium [Ti(cpi)] or titanium alloy (Ti-6Al-4V), the mechanism of such a response is ill understood. This prompted further investigation of the influence of similar metals on human bone-derived cells (HBDCs). This study investigated the influence of Ti(cpi) and its alloy on osteoblastic proteins formed by HBDCs grown for 5, 7, 10, and 14 days on these metals and compared them to cells grown on tissue culture polystyrene plates. Messenger RNA and translated proteins that form an array of osteogenic parameters were determined: alkaline phosphatase (ALP), thrombospondin, osteopontin, osteocalcin (OC), osteonectin (ON/SPARC), type I collagen (Col I) and bone sialoprotein (BSP). At the four predetermined time points, cells grown on either Ti(cpi) or Ti-6Al-4V generally expressed similar mRNA levels, while levels of their respective proteins differed. Cells on Ti(cpi) had peak levels for most proteins at day 7, whereas those on Ti-6Al-4V peaked at either day 5 and/or day 7. At day 5 cells grown on Ti-6Al-4V had higher levels of ALP, Col I, ON/SPARC, OC, and BSP than those in Ti(cpi); this difference was not maintained at later time points in culture. The differential regulation of proteins occurring between cells from the same patient grown on titanium and its alloy implies that HBDCs respond to small differences in the surface chemistry and/or microcrystallinity.

The relation between surface roughness and interfacial shear strength for bone-anchored implants. A mathematical model

A rough bone implant surface was conceptualized as being built up of pits of different sizes and of different shapes. Hypotheses were formulated regarding the mechanical strength of the interfacial bone based upon the present knowledge of the character of the tissues adjacent to endosseous implants and the mechanical characteristics of different bone constituents. A surface roughness parameter was derived, the pit effectivity factor (fpe), which describes how effective the individual pits of the rough surface are as retention elements with regard to shear. Another surface roughness parameter was defined, the pit density factor (fpd), the value of which depends upon how densely packed the pits are. The interfacial shear strength of a rough implant surface with known microgeometry can be estimated by means of these two surface roughness parameters. The effectiveness of pits of different sizes and of different shapes was investigated using this model.

Histological and histomorphometrical evaluation of the bone reaction to three different titanium alloy and hydroxyapatite coated implants

The aim of this study was to investigate the bone response to three different types of titanium (Ti) alloys and hydroxyapatite (HA) coated titanium alloy by histological and histomorphometrical analysis. Therefore, implants made of these materials were inserted into the tibia of rabbits. Implantation times were 6 and 16 weeks. The histological evaluation included measurement of the amount of bone apposition and analysis of the bone reaction and interface characteristics around the implants. The results demonstrated no marked differences in bony reaction to the different implant materials. In addition, the HA coatings showed loss of thickness.

Proteoglycans at the bone-implant interface

The widespread success of clinical implantology stems from bone's ability to form rigid, load-bearing connections to titanium and certain bioactive coatings. Adhesive biomolecules in the extracellular matrix are presumably responsible for much of the strength and stability of these junctures. Histochemical and spectroscopic analyses of retrievals have been supplemented by studies of osteoblastic cells cultured on implant materials and of the adsorption of biomolecules to titanium powder. These data have often been interpreted to suggest that proteoglycans permeate a thin, collagen-free zone at the most intimate contact points with implant surfaces. This conclusion has important implications for the development of surface modifications to enhance osseointegration. The evidence for proteoglycans at the interface, however, is somewhat less than compelling due to the lack of specificity of certain histochemical techniques and to possible sectioning artifacts. With this caveat in mind, we have devised a working model to explain certain observations of implant interfaces in light of the known physical and biological properties of bone proteoglycans. This model proposes that titanium surfaces accelerate osseointegration by causing the rapid degradation of a hyaluronan meshwork formed as part of the wound-healing response. It further suggests that the adhesive strength of the thin, collagen-free zone is provided by a bilayer of decorin proteoglycans held in tight association by their overlapping glycosaminoglycan chains.

Osseointegration of surface-blasted implants made of titanium alloy and cobalt-chromium alloy in a rabbit intramedullary model

The purpose of this study was to compare the osseointegration of surface-blasted Ti6A14V and CoCr implants in vivo. Ti6A14V and CoCr rods blasted with 710 microm A12O3 particles were bilaterally press-fit into the medullary space of distal femora of 24 rabbits. Evaluation was made radiographically, histologically, histomorphometrically (3, 6, and 12 weeks after implantation), and mechanically (12 weeks). Both Ti6A14V and CoCr implants demonstrated good biocompatibility radiographically and histologically. Toluidine blue-stained sections revealed an osteoconductive effect of the blasted surface, and fluorochrome labeling analysis showed active bone formation at the bone-implant interface at as late as 12 weeks for both specimens. CoCr showed significantly lower interfacial shear strength than Ti6A14V although the bone contact area with the implant surface was comparable and no intervening soft tissue at the bone-implant interface could be seen for either implant by scanning electron microscopy backscatter analysis. Unmineralized tissue (cartilage and osteoid) was observed more frequently on the CoCr surface than on the Ti6A14V surface. These data show less osseointegration of CoCr implants with this blasted surface for this short period, possibly due to a slight difference in surface roughness and some negative effects of CoCr on bone attachment.

An immunoelectron microscopic localization of noncollagenous bone proteins (osteocalcin and osteopontin) at the bone-titanium interface of rat tibiae

This study was designed to investigate by postembedding immunogold method the localization and distribution of osteocalcin (Ocl) and osteopontin (Opn) at the bone-titanium interface in rat tibiae 14 and 28 days postimplantation to determine which bone proteins are present at this interface. Both proteins were widely distributed on the newly formed bone and accumulated predominantly in the region of bone close to the titanium, in electron-dense patches in the bone, and at the osteocytic lacunae. Collagenous osteoid showed little or no labeling for either Ocl or Opn. An amorphous zone (20-50 nm) was interposed between the titanium and interfacial slender cells, osteoid, or bone, and was labeled strongly for Ocl but only weakly for Opn. Furthermore, a second electron-dense layer, the lamina limitans, which faces the titanium, was labeled strongly for Opn but weakly for Ocl. Ocl as a marker protein of osteoblasts was sometimes found in the granules and vesicles of the interfacial cells and extracellularly in their intercellular spaces, close to the titanium. However, Opn was not detected in any granules. This is the first report to show that the amorphous zone contains large amounts of Ocl and small amounts of Opn, and that bone contacts titanium through this Ocl-rich amorphous zone. Furthermore, it is suggested that the interfacial cells seem to be osteoblasts, and that Ocl in the amorphous zone is produced and secreted by these cells and functions with Opn as a regulator of the mineralization front close to the titanium, and as a mediator of cell-matrix and matrix-matrix/mineral adhesion along the titanium.

Chemical modification of titanium surfaces for covalent attachment of biological molecules

The surface of implantable biomaterials is in direct contact with the host tissue and plays a critical role in determining biocompatibility. In order to improve the integration of implants, it is desirable to control interfacial reactions such that nonspecific adsorption of proteins is minimized and tissue-healing phenomena can be controlled. In this regard, our goal has been do develop a method to functionalize oxidized titanium surfaces by the covalent immobilization of bioactive organic molecules. Titanium first was chemically treated with a mixture of sulfuric acid and hydrogen peroxide to eliminate surface contaminants and to produce a consistent and reproducible titanium oxide surface layer. An intermediary aminoalkylsilane spacer molecule was then covalently linked to the oxide layer, followed by the covalent binding of either alkaline phosphatase or albumin to the free terminal NH2 groups using glutaraldehyde as a coupling agent. Surface analyses following coating procedures consisted of X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), and atomic force microscopy (AFM). Enzymatic activity of coupled alkaline phosphatase was assayed colorimetrically, and surface coverage by bound albumin was evaluated by SEM visualization of colloidal gold immunolabeling. Our results indicate that the linkage of the aminoalkylsilane to the oxidized surface is stable and that bound proteins such alkaline phosphatase and albumin retain their enzymatic activity and antigenicity, respectively. The density of immunolabeling for albumin suggests that the binding and surface coverage obtained is in excess of what would be expected for inducing biological activity. In conclusion, this method offers the possibility of covalently linking selected molecules with known biological activity to oxidized titanium surfaces in order to guide and promote the tissue healing that occurs during implant integration in bone and soft tissues.

Chemical modification of titanium surfaces for covalent attachment of biological molecules

The surface of implantable biomaterials is in direct contact with the host tissue and plays a critical role in determining biocompatibility. In order to improve the integration of implants, it is desirable to control interfacial reactions such that nonspecific adsorption of proteins is minimized and tissue-healing phenomena can be controlled. In this regard, our goal has been do develop a method to functionalize oxidized titanium surfaces by the covalent immobilization of bioactive organic molecules. Titanium first was chemically treated with a mixture of sulfuric acid and hydrogen peroxide to eliminate surface contaminants and to produce a consistent and reproducible titanium oxide surface layer. An intermediary aminoalkylsilane spacer molecule was then covalently linked to the oxide layer, followed by the covalent binding of either alkaline phosphatase or albumin to the free terminal NH2 groups using glutaraldehyde as a coupling agent. Surface analyses following coating procedures consisted of X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), and atomic force microscopy (AFM). Enzymatic activity of coupled alkaline phosphatase was assayed colorimetrically, and surface coverage by bound albumin was evaluated by SEM visualization of colloidal gold immunolabeling. Our results indicate that the linkage of the aminoalkylsilane to the oxidized surface is stable and that bound proteins such alkaline phosphatase and albumin retain their enzymatic activity and antigenicity, respectively. The density of immunolabeling for albumin suggests that the binding and surface coverage obtained is in excess of what would be expected for inducing biological activity. In conclusion, this method offers the possibility of covalently linking selected molecules with known biological activity to oxidized titanium surfaces in order to guide and promote the tissue healing that occurs during implant integration in bone and soft tissues.

Long-term evaluation of bone-titanium interface in rat tibiae using light microscopy, transmission electron microscopy, and image processing

We conducted a 2-year histologic and histometric evaluation of the tibial bone-titanium (Ti) implant interface in male rats. Thirty male 6-week-old rats were used in this study. They were divided into two groups: 15 for day 28 and 15 for day 730. Microscopic observation at day 28 revealed that the newly formed bone around the implant almost surrounded the implant, but fibroblastlike cells were interposed in some histologic sections. At day 730, in contrast, such cells were rarely seen, and the bone around the implant presented a lamellar structure. Transmission electron microscopic observation at day 28 disclosed mature or poorly mineralized bone near the implant; however, an electron-dense amorphous zone about 50 nm in thickness was interposed between the bone and Ti. In places slender cells were interposed between the bone and Ti. The amorphous zone was also observed at the cell-Ti interface. At day 730, a poorly mineralized layer remained in some areas between the mature bone and the titanium, and the interposed amorphous zone was still observed. Occasionally, a 200-nm-thick layer, thought to be cell remnant, was seen. As calculated in an image-processing, system analysis, the percent bone contact and the thickness and area of the surrounding bone for the Ti implant at day 28 were 43.6%, 30.4 microns, and 0.10 mm2, respectively, and those at day 730 were 89.9%, 53.5 microns, and 0.19 mm2, respectively. In summary, although the passage of time may affect bone maturity, interfacial cells remain at the bone-Ti interface as a uniform layer together with unmineralized bone.

Scanning electron microscopy of the bone-bioactive implant interface

Rods of three bioactive materials, apatite/wollastonite glass ceramic (AW-GC), bioactive glass (BG), and dense slip-cast hydroxyapatite (HA), were implanted in the femora of 23 Wistar rats for periods of 1-4 weeks. The samples were harvested following vascular perfusion fixation and the femora freeze-fractured for scanning electron microscopy to expose the bone/implant interface. The focus of our observations was when new bone was forming on the implant surfaces irrespective of the implantation period. Scanning microscopy of the hydroxyapatite rods demonstrated that in areas where bone bonding had occurred, the implant surface was composed of globular accretions which fused to form a cement-like matrix to which collagen fibers were attached. Dissolution of individual grains of the implant surface created a roughened surface topography. Such features were not found in the transcortical portions of these implants. Similar globular accretions were also found on the surface of bulk AW-GC, although bone apposition was not disrupted by the critical point-drying procedure, and thus the interface was more difficult to image. Nevertheless, the collagen of the bony compartment interdigitated with an interfacial layer which was morphologically similar to that found on HA. The most surface reactive material, BG, demonstrated an interfacial structure where the surface reactive calcium phosphate layer was clearly distinguished from the underlying bulk implant material. However, this layer was separated from the overlying collagen-containing bony compartment by a second, thinner, calcified layer which corresponded to the cement line matrix into which the collagen fibers were inserted. Our results show that the new bone interface formed with these three bioactive materials is morphologically comparable to that of cement lines found naturally in bone-remodeling sites, and that this interfacial layer is formed on the chemically active surface of the biomaterial. The degree to which the cement line matrix interdigitated with the implant was a product of the reactivity of the implant surface.

Soft and hard tissue response to endosseous dental implants

The last two decades have seen a remarkable growth in the development of dental implants and their incorporation into the practice of dentistry. This turn of events was made possible by an improved understanding of biological response of living tissues to implants as well as clinical trials that validated the long-term success of these implants. Despite major structural differences between teeth and implants, such as the absence of a periodontal ligament around implants, the latter appear to provide a reliable functional replacement for their natural counterparts. This review briefly summarizes the major structural differences of the interfacial region of teeth and dental implants and their supporting tissues. It focuses on our current understanding of the soft and hard tissue responses to submerged and nonsubmerged root-form dental implants. The influence of a number of factors that affect the tissue response is reviewed, including biomaterials, implant design, surgical technique, and the local microbiota. Our recently acquired ability to modulate wound healing with guided tissue regeneration and growth factors will undoubtedly play an important role in the future utilization and success rates of dental implants.

Light and electron microscopic studies of bone-titanium interface in the tibiae of young and mature rats

Bone-titanium contact was examined in young and mature rats on various days after insertion of pure titanium into the tibia. Under light microscopy, on the 14th day, lamellar mature bone was initially formed, and was seen to make direct contact with the titanium in both groups. In young rats on the 28th day, bone-titanium contact was greater than that in mature animals. On 1-micron sections, an amorphous zone 0.5-1.0 micron thick was found around the titanium, and a slender cell layer lay parallel to the implant, forming the superficial layer of the amorphous zone. Ultrastructurally, these slender cells were identified as osteoblastlike cells and made direct contact with the implant via a 20-50-nm thin amorphous zone. Below this cell layer, a collagen-containing, poorly mineralized zone was present and bordered by lamellar bone with a lamina limitans-like structure. However, this cell layer was absent in places, and therefore the thick amorphous zone without slender cell layer consisted ultrastructurally of a 20-50-nm thin amorphous zone and a poorly mineralized zone bordered by the lamellar bone. Sometimes this poorly mineralized zone was absent, and in such cases, the lamellar bone contacted the titanium by the thin amorphous zone formed on the lamina limitans-like structure. Thus, although bone was seen to make contact with the titanium implant, ultrastructurally a 20-50-nm thin amorphous zone, a slender cell layer, and/or a poorly mineralized zone were interposed between the bone and titanium.

Synthetic implant surfaces. 1. The formation and characterization of sol-gel titania films

Sol-gel has been used to prepare thin titania films. We have investigated the effects of dip rate, sintering temperature and time on the chemical composition of the films, their physical structure and thickness, and adherence to a silica substrate. Our aim has been to produce films that mimic as closely as possible the natural oxide layer that is found on titanium. These films are to be used as substrates in an in vitro model of osseointegration.

Characterizations of titanium implant surfaces. III

There are several reports in the literature concerning the similarities and the differences between the oxide on cpTi and Ti-6A1-4V alloy; however, their biological sequelae are not entirely known. In this work, a series of surface characterization techniques were used in conjunction with short term in vitro biological assays to assess the effects of materials selection (cpTi and Ti alloy) on osteoblast-like cell responses. Surface analysis indicated that with the exception of oxide thickness, there were no significant differences in surface characteristics between the two implant materials. These results were reflected in the biological studies, where the levels of cell attachment and adaptation of the attached cells to the titanium surfaces were similar. These results are in general agreement with previous in vivo studies and continue to indicate that cpTi and Ti alloy are suitable, biologically compatible materials for fabrication of dental implants.

Titanium with different oxides: in vitro studies of protein adsorption and contact activation

Adsorption of albumin (HSA) and fibrinogen (Fib) from human blood plasma onto titanium surfaces with varying oxide properties was studied with an enzyme-linked immunosorbent assay. The intrinsic activation of blood coagulation (contact activation) was studied in vitro using a kallikrein-sensitive substrate. The sample surfaces were characterized with Fourier transform Raman spectroscopy. Auger electron spectroscopy and atomic force microscopy. Low Fib and high HSA adsorption was observed for all titanium samples except for the radio frequency plasma-treated and water-incubated samples, which adsorbed significantly lower amounts of both. Oxide thickness and carbon contamination showed no influence on protein adsorption or contact activation. Smooth samples with a surface roughness (Rrms) < 1 nm showed some correlation between surface wettability and adsorption of Fib and HSA, whereas rough surfaces (Rrms > 5 nm) did not. To varying degrees, all titanium surfaces indicated activation of the intrinsic pathway of coagulation as determined by their kallikrein formation in plasma.

An in-vitro study of H 2O 2-treated titanium surfaces in contact with blood plasma and a simulated body fluid

Ellipsometry and antibody techniques were used to investigate plasma protein adsorption onto titanium (Ti) surfaces pretreated in hydrogen peroxide (H 2O 2). Surfaces preincubated for short times in 10 mM or 100 mM H 2O 2 bound relatively large amounts of anti-high molecular weight kininogen (a-HMWK) after immersion in blood plasma. Increasing the preincubation time in H 2O 2 led to an increase in the total amount of bound plasma proteins and a large deposition of anti-fibrinogen (a-Fib). Large amounts of a-HMWK and a-Fib were also deposited onto surfaces washed in trichloroethane, acetone and ethanol, whereas radiofrequency plasma-treated surfaces or surfaces incubated in deionized water bound preferentially a-HMWK after plasma immersion. Auger electron spectroscopy (AES) made on Ti-surfaces preincubated in 10 mM and 100 mM H 2O 2 solutions showed an increased oxide thickness and, after 16 h of immersion in a physiological buffer, an increased amount of calcium on and throughout the oxide. The rate of net oxide growth was larger in 10 mM than in 100 mM H 2O 2.

Evaluation of a low-temperature calcium phosphate particulate implant material: physical-chemical properties and in vivo bone response

A study was conducted to evaluate the osteoconductive ability of a particulate, low-temperature hydroxylapatite (HA(LT)) material (OsteoGen; Impladent, Holliswood, NY). An implantable chamber model was used to determine the ability of this material to encourage bone ingrowth into channels lined with either rough-surfaced titanium or rough-surfaced plasma-sprayed hydroxylapatite. The HA(LT) material increased bone ingrowth into the titanium-lined channels comparable with that in plasma-sprayed hydroxylapatite-coated channels. It was incorporated into ingrowing bone without intervening soft tissue, with the bone bonding directly to the material surface in much the same fashion as it bonds at the plasma-sprayed hydroxylapatite surface. Mechanical testing of the ingrown bone showed no weakness because particles were incorporated. At 12 weeks, the particles began to show signs of dissolution. It was concluded that the HA(LT) material is a biocompatible, osteoconductive material that conducts bone ingrowth in much the same way as high-temperature particulate hydroxylapatite ceramics. This material has the additional desirable property of being slowly resorbable, a beneficial characteristic for many bone-filling applications.

Light and transmission electron microscopy of the intact interfaces between non-submerged titanium-coated epoxy resin implants and bone or gingiva

This experiment was aimed at studying the intact tissue/implant interface of non-submerged dental implants with a titanium surface. Epoxy-resin replicas were fabricated from 3.05 x 8 mm cylindrical titanium implants with a plasma-sprayed apical portion and a smooth coronal collar. The replicas were coated with a 90-120-nm-thick layer of pure titanium and autoclaved. The coated replicas were inserted as non-submerged endosseous implants in the edentulous premolar region of dog mandibles and allowed to heal for three months. Jaw sections containing the implants were processed for light and electron microscopic study of the intact tissue/implant interface with and without prior demineralization. Gingival connective tissue fibers were closely adapted to the titanium layer, in an orientation more or less parallel to the implant surface. There was no evidence of any fiber insertions into the surface irregularities of the smooth or rough titanium surface. Undemineralized bone was intimately adapted to the titanium surface without any intervening space. In demineralized sections, the collagen fibers of the bone matrix tended to be somewhat thinner and occasionally less densely packed in the vicinity of the implant surface. However, they extended all the way to the titanium surface, without any intervening fibril-free layer.

Biomechanical factors affecting the bone-dental implant interface

While it is known that dental implants can 'work'--the success of the Branemark 'osseointegrated' implant is a prime example--implants can also fail. The challenge is to develop a basic science understanding of all aspects which contribute to implant performance. In designing a successful dental implant, the main objective is to ensure that the implant can support biting forces and deliver them safely to interfacial tissues over the long term. Biomechanics are central in this design problem. Key topics include: (1) the nature of the biting forces on the implants; (2) how the biting forces are transferred to the interfacial tissues; (3) how the interfacial tissues react, biologically, to stress transfer conditions. For biting forces on dental implants, the basic problem is to determine the in-vivo loading components on implants in various prosthetic situations, e.g. for implants acting as single tooth replacements or as multiple supports for loaded bridgework. Significant progress has been made; several theoretical models have been presented for determining the partitioning of forces among dental implants supporting bridgework. However, more work will be needed to clarify how well these models match reality. Interfacial stress transfer and interfacial biology represent more difficult, interrelated problems. One problem is that the multitude of different shapes, sizes, materials, surgical sites and animal models for dental implants has precluded any generally accepted rules for biologically 'favorable' vs 'unfavorable' interfacial stress transfer conditions. While many engineering studies have shown that variables such as implant shape, elastic modulus, extent of bonding between implant and bone, etc., can affect the stress transfer conditions, the unresolved question is whether there is any biological significance to such differences. Recent research suggests that, at the very least, our search for a more detailed hypothesis regarding the relationship between interface mechanics and biology should take account of basic bone physiology, e.g. wound healing after implantation plus basic processes of bone modeling and remodeling.

Effect of surface treatment on the dissolution of titanium-based implant materials

Titanium and its alloys are widely used in load-bearing implants as a result of their excellent mechanical properties and corrosion resistance, but there is concern over the release of metal ions from the prosthesis. Our research investigated the influence of the surface oxide on the dissolution of the substrate material in saline solution, using a combination of atomic absorption spectroscopy, ellipsometry and transmission electron microscopy techniques. It is demonstrated that a substantial reduction in the release of metal ions may be achieved by ageing the surface oxide in boiling distilled water or by thermal oxidation; this is discussed in terms of the structure of the oxide film.

A light and electron microscopic study of the effects of surface topography on the behavior of cells attached to titanium-coated percutaneous implants

Previous studies using light microscopy have demonstrated that micromachined grooved surfaces inhibit epithelial (E) downgrowth and affect cell orientation at the tissue/implant interface. This study investigates the ultrastructure of the epithelial and connective-tissue attachment to titanium-coated micromachined grooved, as well as smooth control, implant surfaces. V-shaped grooves, 3, 10, or 22 microns deep, were produced in silicon wafers by micromachining, replicated in epoxy resin, and coated with 50-nm titanium. These grooved, as well as smooth, titanium-coated surfaces were implanted percutaneously in the parietal area of rats and after 7 days processed for electron microscopy. The tissue preparation technique used in this study enabled us to obtain ultrathin sections with few artifacts from the area of epithelial and connective-tissue attachment. The histological observations demonstrated that E cells closely attached to, and interdigitated with, the 3-microns and 10-microns grooves. In contrast, E cells were not found inside the 22-microns-deep grooves and made contact only with the flat ridges between the grooves. As a general rule, fibroblasts (F) were oriented parallel to the long axis of the implants and produced a connective tissue capsule with 3-microns and 10-microns-deep grooved surfaces as well as smooth surfaces. On the 22-microns-deep grooved surfaces, however, F inserted obliquely into the implant. The attachment of F to the titanium surface was mediated by two zones; a thin (approximately 20 nm), amorphous, electron dense zone immediately contacting the titanium surface, and a fine fibrillar zone extending from the amorphous zone to the cell membrane. As oblique orientation of F has been associated with the inhibition of epithelial downgrowth, micromachined grooved surfaces of appropriate dimensions have the potential to improve the performance of percutaneous devices.

A new canine model to evaluate the biological response of intramedullary bone to implant materials and surfaces

A new canine model utilizing an implantable chamber with multiple bone ingrowth channels has been used to study the response of intramedullary bone to various implant materials and surfaces. The first group of dogs received implants containing channels lined by smooth-surfaced coupons of titanium, titanium alloy, sputter-hydroxyapatite-coated (HA-coated) titanium alloy, and polyethylene. A pattern of early initial bone ingrowth by 2 weeks, becoming maximal at 6 to 12 weeks with remodeling to a more mature lamellar bone, and later resorption by 24 weeks was seen for all test groups, with fibrous tissue interfaces covering the smooth test coupons at all time points. Significantly increased bone ingrowth in the sputter-HA coated group was found only at 6 weeks. The second group of dogs received implants with channels lined by surface-roughened coupons of either titanium or plasma-HA-coated titanium, half of which were also packed with a crystalline-HA grouting at the time of surgery. At both 6 and 12 weeks, bone ingrowth was greatly enhanced by the presence of the plasma-HA coating or the crystalline-HA grouting as compared to the uncoated titanium channels. Histologically, bone was seen to bond directly to the plasma-HA coating and the crystalline-HA grouting. A thin fibrous tissue layer was noted between bone and the titanium in most areas, but evidence of direct bone contact to the metal surface was seen. Mechanical testing in tension of intact coupon-bone-coupon units revealed significant strength of the bone-plasma-HA bond, with failure initiating at the metal-HA interface with forces of 15.3 N at 6 weeks, increasing to 44.8 N at 12 weeks. Plasma-HA-lined channels with crystalline-HA packing required similar forces for failure. No significant adhesion strength was noted for the titanium channels at 6 weeks, and only the crystalline-HA-filled channels displayed measurable strength of the bone-titanium interface at 12 weeks, with a force of 9 N needed for failure.

Qualitative interfacial study between bone and tantalum, niobium or commercially pure titanium

Tantalum (Ta), niobium (Nb) and commercially pure titanium (c.p. Ti) were sputtered on to the surfaces of polycarbonate plastic implants. After 3 month of insertion, in the tibial metaphysis of rabbits, the implants were removed with a surrounding bone collar and processed for light (LM) and electron microscopy (EM). By EM a zone of ground substance tens of nanometers wide without collagen filaments was noticed surrounding the Ta implants. Multinucleated macrophages could occasionally be recognized in the interface zone. Foreign body reactions were more striking at the Nb interface while no multinucleated macrophages were observed in the c.p. Ti interface. The ground substance layer had a thickness in the range of 40-60 nm for the Nb implants, whereas in c.p. Ti sections the collagen filaments were noticed 20-40 nm from the metal surface. There are more subtle differences between tantalum and c.p. titanium than between c.p. titanium and niobium which seems to be less well tolerated when implanted in bone.

Wear of ion-implanted pure titanium against UHMWPE

Six specimens were manufactured from commercially pure titanium (grade IV) to resemble femoral head prostheses, and five of them ion implanted to increase the wear properties. Together with three cobalt-chrome controls they were run for one million cycles on a 10-station joint simulator. For the first time both the polymer and metallic wear were quantified in the same study. The purpose of the investigation was to estimate the potential for using commercially pure titanium as a bearing surface against ultrahigh-molecular-weight polyethylene for total joint application. It was concluded that the wear properties of titanium were improved by ion implantation, and that these positive effects could probably be enhanced with development of a better polishing technique, and by finding methods of extending the penetration depth of the nitrogen ions.