Implantable PEKK/tantalum microparticles composite with improved surface performances for regulating cell behaviors, promoting bone formation and osseointegration

A poly(ether-ketone-ketone) composite scaffold simulating the immune-osteogenic cascade for in situ bone regeneration

The process of bone repair is intrinsically associated with the immune response. Following scaffold implantation, the pro-inflammatory response initiates the immune-osteogenic cascade. Efficient recruitment and timely conversion of macrophages to an anti-inflammatory phenotype are critical for promoting subsequent bone regeneration. Poly(ether-ketone-ketone) (PEKK) is an attractive orthopaedic material, but exhibits biological inertness. In this study, an immunomodulatory PEKK/bioglass composite scaffold was fabricated by fused deposition modeling and a soft cryogel containing monocyte chemotactic protein-1 (MCP-1) was infilled into the macropores of the scaffold (PBCM). The rapid release of MCP-1 from PBCM initially mobilized endogenous macrophages, which subsequently recruited rat mesenchymal stem cells (rMSCs). Continuous release of bioactive ions not only facilitated the polarization of macrophages towards the M2 phenotype, thereby establishing a favorable anti-inflammatory microenvironment conducive to bone formation, but also stimulated the osteogenic differentiation of rMSCs. Moreover, cytokines secreted by macrophages further promoted osteogenesis. In vivo experiments demonstrated excellent bone regeneration following PBCM implantation. Taken together, this study aimed to develop a novel immunomodulatory PEKK composite scaffold that can simulate the immune-osteogenic cascade for timely recruitment of endogenous cells, efficient immunomodulation of macrophages and superior osteogenic abilities, potentially serving as potent implants for tissue engineering applications.

Bio-functional niobium-based metallic biomaterials: Exploring their physicomechanical properties, biological significance, and implant applications

The significance of biomedical applications of bio-functional niobium (Nb)-based metallic biomaterials is underscored by their potential utilization in implant application. Nb-based metallic materials present reliable physicomechanical and biological properties, thus represent materials highly suitable for implant application. This review provides an overview on the advances of pure niobium and Nb-based metallic materials as implant materials over the past 20 years, and highlights the advantages of Nb-based metallic biomaterials for implant application in terms of their physicomechanical properties, corrosion resistance in biological media, magnetic resonance imaging (MRI) compatibility, cell compatibility, blood compatibility, osteogenesis, and bioactivity. An introduction is provided for the production and processing techniques for Nb-based metallic biomaterials, including traditional melting processes like vacuum arc remelting, additive manufacturing like selective laser melting (SLM), electron beam melting (EBM), spark plasma sintering (SPS), and severe plastic deformation like equal channel angular pressing (ECAP), multi-axial forging (MAF), high pressure torsion (HPT), as well as their physicomechanical properties and implant application. Also suggested are the critical issues, challenges, and prospects in the further development of Nb-based metallic biomaterials for implant applications. STATEMENT OF SIGNIFICANCE: Nb-based biomaterials have gained significant interest for bioimplantable scaffolds because of their appropriate mechanical characteristics and biocompatibility. No prior work has been published specifically reviewing bio-functional Nb-based biomaterials for exploring their physicomechanical properties, biological significance, and implant applications. This review provides an overview on the advances of niobium and Nb-based materials as implant materials over the past 20 years, and highlights the advantages of Nb-based biomaterials for implant application. An introduction is provided for the production and processing techniques for Nb-based biomaterials, as well as their physicomechanical properties and implant application. Also suggested are the critical issues, challenges, and prospects in the further development of Nb-based biomaterials for implant applications.

Progress of research on the surface functionalization of tantalum and porous tantalum in bone tissue engineering

Tantalum and porous tantalum are ideal materials for making orthopedic implants due to their stable chemical properties and excellent biocompatibility. However, their utilization is still affected by loosening, infection, and peripheral inflammatory reactions, which sometimes ultimately lead to implant removal. An ideal bone implant should have exceptional biological activity, which can improve the surrounding biological microenvironment to enhance bone repair. Recent advances in surface functionalization have produced various strategies for developing compatibility between either of the two materials and their respective microenvironments. This review provides a systematic overview of state-of-the-art strategies for conferring biological functions to tantalum and porous tantalum implants. Furthermore, the review describes methods for preparing active surfaces and different bioactive substances that are used, summarizing their functions. Finally, this review discusses current challenges in the development of optimal bone implant materials.

3D-printed porous tantalum artificial bone scaffolds: fabrication, properties, and applications

Porous tantalum scaffolds offer a high degree of biocompatibility and have a low friction coefficient. In addition, their biomimetic porous structure and mechanical properties, which closely resemble human bone tissue, make them a popular area of research in the field of bone defect repair. With the rapid advancement of additive manufacturing, 3D-printed porous tantalum scaffolds have increasingly emerged in recent years, offering exceptional design flexibility, as well as facilitating the fabrication of intricate geometries and complex pore structures that similar to human anatomy. This review provides a comprehensive description of the techniques, procedures, and specific parameters involved in the 3D printing of porous tantalum scaffolds. Concurrently, the review provides a summary of the mechanical properties, osteogenesis and antibacterial properties of porous tantalum scaffolds. The use of surface modification techniques and the drug carriers can enhance the characteristics of porous tantalum scaffolds. Accordingly, the review discusses the application of these porous tantalum materials in clinical settings. Multiple studies have demonstrated that 3D-printed porous tantalum scaffolds exhibit exceptional corrosion resistance, biocompatibility, and osteogenic properties. As a result, they are considered highly suitable biomaterials for repairing bone defects. Despite the rapid development of 3D-printed porous tantalum scaffolds, they still encounter challenges and issues when used as bone defect implants in clinical applications. Ultimately, a concise overview of the primary challenges faced by 3D-printed porous tantalum scaffolds is offered, and corresponding insights to promote further exploration and advancement in this domain are presented.

Evaluation of sustained drug release performance and osteoinduction of magnetron-sputtered tantalum-coated titanium dioxide nanotubes

Modifying the drug-release capacity of titanium implants is essential for maintaining their long-term functioning. Titanium dioxide nanotube (TNT) arrays, owing to their drug release capacity, are commonly used in the biomaterial sphere. Their unique half open structure and arrangement in rows increase the drug release capacity. However, their rapid drug release ability not only reduces drug efficiency but also produces excessive local and systemic deposition of antibiotics. In this study, we designed a tantalum-coated TNT system for drug-release optimization. A decreased nanotube size caused by the tantalum nanocoating was observed through SEM and analyzed (TNT: 110 nm, TNT-Ta1: 80 nm, TNT-Ta3: 40 nm, TNT-Ta5: 20 nm, TNT-Ta7: <5 nm). XPS analysis revealed the distribution of the chemical components, especially that of the tantalum element. In vitro experiments showed that the tantalum nanocoating enhanced cell proliferation; in particular, TNT-Ta5 possessed the best cell viability (about 1.18 of TNT groups at 7d). It also showed that the tantalum nanocoating had a positive effect on osteogenesis (especially TNT-Ta5 and TNT-Ta7). Additionally, hydrophilic/hydrophobic drug (vancomycin/raloxifene) release results indicated that the TNT-Ta5 group possessed the most desirable sustained release capacity. Moreover, in this drug release system, the hydrophobic drug showed more sustained release capacity than the hydrophilic drug (vancomycin: sustained release for more than 48 h, raloxifene: sustained release for more than 168 h). More importantly, TNT-Ta5 is proved to be an appropriate drug release system, which possesses cytocompatibility, osteogenic capacity, and sustained drug release capacity.

Research progress on antibacterial activity of medical titanium alloy implant materials

Titanium and its alloys are the preferred materials for medical implants. However, easy infection is a fatal shortcoming of Ti implants. Fortunately, the ongoing development of antibacterial implant materials is a promising solution, and Ti alloys with antibacterial properties hold immense potential for medical applications. In this review, we briefly outline the mechanisms of bacterial colonization and biofilm formation on implants; discuss and classify the major antimicrobials currently in use and development, including inorganic and organic antimicrobials; and describe the important role of antimicrobials in the development of implant materials for clinical applications. Strategies and challenges related to improving the antimicrobial properties of implant materials as well as the prospects of antibacterial Ti alloys in the medical field are also discussed.

Enhancing cell adhesive and antibacterial activities of glass-fibre-reinforced polyetherketoneketone through Mg and Ag PIII

Glass-fibre-reinforced polyetherketoneketone (PEKK-GF) shows great potential for application as a dental implant restoration material; however, its surface bioinertness and poor antibacterial properties limit its integration with peri-implant soft tissue, which is critical in the long-term success of implant restoration. Herein, functional magnesium (Mg) and silver (Ag) ions were introduced into PEKK-GF by plasma immersion ion implantation (PIII). Surface characterization confirmed that the surface morphology of PEKK-GF was not visibly affected by PIII treatment. Further tests revealed that PIII changed the wettability and electrochemical environment of the PEKK-GF surface and enabled the release of Mg²⁺ and Ag⁺ modulated by Giavanni effect. In vitro experiments showed that Mg/Ag PIII-treated PEKK-GF promoted the proliferation and adhesion of human gingival fibroblasts and upregulated the expression of adhesion-related genes and proteins. In addition, the treated samples inhibited the metabolic viability and adhesion of Streptococcus mutans and Porphyromonas gingivalis on their surfaces, distorting bacterial morphology. Mg/Ag PIII surface treatment improved the soft tissue integration and antibacterial activities of PEKK-GF, which will further support and broaden its adoption in dentistry.

Polyetheretherketone implants with hierarchical porous structure for boosted osseointegration

BACKGROUND

Good osseointegration is the key to the long-term stability of bone implants. Thermoplastic polyetheretherketone (PEEK) has been widely used in orthopedics; however, its inherent biological inertia causes fibrous tissue to wrap its surface, which leads to poor osseointegration and thus greatly limits its clinical applications.

METHODS

Herein, we developed a facile yet effective surface modification strategy. A commonly used sulfonation coupled with "cold pressing" treatment in the presence of porogenic agent formed a three-dimensional hierarchical porous structure on PEEK surface. Subsequently, the effects of porous surface on the in vitro adhesion, proliferation and differentiation of rat bone marrow-derived mesenchymal stem cells (BMSCs) were evaluated. Finally, the osteoinduction and osseointegration of surface-porous PEEK implant were examined in the rat distal femoral defect model.

RESULTS

In vitro results showed that the surface modification did not significantly affect the mechanical performance and cytocompatibility of PEEK substance, and the porous structure on the modified PEEK substrate provided space for cellular ingrowth and enhanced osteogenic differentiation and mineralization of BMSCs. In vivo tests demonstrated that the surface-porous PEEK implant could effectively promote new bone formation and had higher bone-implant contact rate, thereby achieving good bone integration with the surrounding host bone. In addition, this modification technique was also successfully demonstrated on a medical PEEK interbody fusion cage.

CONCLUSION

The present study indicates that topological morphology plays a pivotal role in determining implant osseointegration and this facile and effective modification strategy developed by us is expected to achieve practical applications quickly.

Impact of different CAD/CAM materials on internal and marginal adaptations and fracture resistance of endocrown restorations with: 3D finite element analysis

PURPOSE

To assess and compare the impact of various computers aided design/manufacturing (CAD/CAM) materials on internal and marginal discrepancies, fracture resistance and failure probability of Endocrown restorations with 3D Finite Element analysis.

MATERIAL AND METHODS

Forty devitalized human maxillary first molars were collected. After endodontic treatment, they classified into 4 groups (n = 10) based on the materials used for endocrown fabrication. Group V (Vita-Enamic), Group N (Nacera Hybrid), Group T (Translucent Prettau Zirconia) and Group P (Pekkton ivory). All samples were exposed to artificial aging method simulating one year of clinical service. Silicone replica technique and stereomicroscope (25X) utilized to evaluate the marginal and internal gaps of endocrowns at different areas. Fracture resistance test used for cemented specimens followed by qualitative investigation utilizing Stereomicroscopy. Four models representing four endocrown systems used for restoration of severely-damaged endodontically treated upper first molar were generated for finite element analysis (FEA). Axially and centrally static occlusal compressive load was applied. Modified Von Mises and maximum principal stress values on the remaining tooth structure, cement lines and restorative materials were assessed independently. Resulted data were statistically analyzed at P-value ≤ 0.05.

RESULTS

In the current study, the highest mean values of internal and marginal discrepancies (μm) among studied groups were reported for Zirconia group (100.300 and 102.650) respectively, while the lowest mean value of internal discrepancy (μm) was observed for Nacera group (69.275) and the lowest mean value of marginal discrepancy (μm) was observed for PEKK group (78.4750). Regarding internal discrepancy, Vita-Enamic and PEKK groups did not exhibit any statistically significant differences (P = 0.293), however zirconia and the other tested groups exhibited statistically significant differences in the mean values of the marginal gap region (p 0.05).On the other hand, PEKK group showed the highest mean value of fracture resistance (1845.20 N) and the lowest value was observed for Vita-Enamic group (946.50 N). Regarding to stress distributions through 3D FEA, and according to modified von Mises (mvM) analysis, the greatest possible stress values were noticed in PEKK model in relation to tooth structure, cement line, and flowable composite as the following: (93.1, 64.5, 58.4 MPa) respectively, while Zirconia revealed lower maximum stress values (11.4, 13.6, 11.6 MPa) respectively.

CONCLUSIONS

Statistically excellent marginal and internal fit was observed for PEKK in relation to other used endocrown materials. Also, PEKK material explained fracture resistance comparable to zirconia value while the lowest value was detected for Vita Enamic material.

Biological properties of hydroxyapatite coatings on titanium dioxide nanotube surfaces using negative pressure method

Titanium (Ti) exhibits superior biocompatibility and mechanical properties but is bioinert, while hydroxyapatite (HA) possesses excellent osteogenesis and is widely used for the modification of Ti surface coatings. However, the synthesis of homogeneous and stable HA on metallic materials is still a major challenge. In this study, porous titanium dioxide nanotube arrays were prepared on Ti surface by anodic oxidation, loaded with calcium and phosphorus precursors by negative pressure immersion, and HA coating was formed by in situ crystallization of calcium and phosphorus on the surface by hydrothermal heating. Scanning electron microscopy (SEM), X-ray diffraction (XRD), and bonding strength were conducted to confirm the surface characteristics of each group. The cell proliferation, mineralization degree, and alkaline phosphatase (ALP) activity of MC3T3-E1 cells on samples were calculated and compared in vitro experiments. Cylindrical samples were implanted into rat femurs to evaluate biocompatibility and osteogenesis in vivo. The results showed that HA crystals successfully synthesized in TiO₂ nanotubes, enhancing the bonding strength of HA coating and Ti substrate under negative pressure. Moreover, HA coating on Ti substrate remarkably enhanced cell proliferation and osteogenic differentiation activity in vitro, and improved new bone formation as well as osseointegration in vivo.

Current Advances and Applications of Tantalum Element in Infected Bone Defects

Infected bone defects (IBDs) cause significant economic and psychological burdens, posing a huge challenge to clinical orthopedic surgeons. Traditional approaches for managing IBDs possess inevitable shortcomings; therefore, it is necessary to develop new functionalized scaffolds. Tantalum (Ta) has been widely used in load-bearing orthopedic implants due to its good biocompatibility and corrosion resistance. However, undecorated Ta could only structurally repair common bone defects, which failed to meet the clinical needs of bacteriostasis for IBDs. Researchers have made great efforts to functionalize Ta scaffolds to enhance their antibacterial activity through various methods, including surface coating, alloying, and micro- and nanostructure modifications. Additionally, several studies have successfully utilized Ta to modify orthopedic scaffolds for enhanced antibacterial function. These studies remarkably extended the application range of Ta. Therefore, this review systematically outlines the advances in the fundamental and clinical application of Ta in the treatment of IBDs, focusing on the antibacterial properties of Ta, its functionalization for bacteriostasis, and its applications in the modification of orthopedic scaffolds. This study provides researchers with an overview of the application of Ta in the treatment of IBDs.

Why Is Tantalum Less Susceptible to Bacterial Infection?

Periprosthetic infection is one of the trickiest clinical problems, which often leads to disastrous consequences. The emergence of tantalum and its derivatives provides novel ideas and effective methods to solve this problem and has attracted great attention. However, tantalum was reported to have different anti-infective effects in vivo and in vitro, and the inherent antibacterial capability of tantalum is still controversial, which may restrict its development as an antibacterial material to some extent. In this study, the polished tantalum was selected as the experimental object, the implant-related tibia osteomyelitis model was first established to observe whether it has an anti-infective effect in vivo compared to titanium, and the early studies found that the tantalum had a lower infectious state in the implant-related tibia osteomyelitis model in vivo than titanium. However, further in vitro studies found that the polished tantalum was not superior to the titanium against bacterial adhesion and antibacterial efficacy. In addition, we focus on the state of interaction between cells, bacteria and materials to restore the internal environment as realistically as possible. We found that the adhesion of fibroblasts to tantalum was faster and better than that of titanium. Moreover, what is more, interesting is that, in the early period, bacteria were more likely to adhere to cells that had already attached to the surface of tantalum than to the bare surface of it, and over time, the cells eventually fell off the biomaterials and took away more bacteria in tantalum, making it possible for tantalum to reduce the probability of infection in the body through this mechanism. Moreover, these results also explained the phenomenon of the "race for the surface" from a completely different perspective. This study provides a new idea for further exploring the relationship between bacteria and host tissue cells on the implant surface and a meaningful clue for optimizing the preparation of antibacterial implants in the future.

Advances in surface modification of tantalum and porous tantalum for rapid osseointegration: A thematic review

After bone defects reach a certain size, the body can no longer repair them. Tantalum, including its porous form, has attracted increasing attention due to good bioactivity, biocompatibility, and biomechanical properties. After a metal material is implanted into the body as a medical intervention, a series of interactions occurs between the material’s surface and the microenvironment. The interaction between cells and the surface of the implant mainly depends on the surface morphology and chemical composition of the implant’s surface. In this context, appropriate modification of the surface of tantalum can guide the biological behavior of cells, promote the potential of materials, and facilitate bone integration. Substantial progress has been made in tantalum surface modification technologies, especially nano-modification technology. This paper systematically reviews the progress in research on tantalum surface modification for the first time, including physicochemical properties, biological performance, and surface modification technologies of tantalum and porous tantalum.

Lactoferrin network with MC3T3-E1 cell proliferation, auxiliary mineralization, antibacterial functions: A multifunctional coating for biofunctionalization of implant surfaces

Developing biocompatible, low-immunoreactive, and antibacterial implants are challenging yet fundamental to osteosynthesis. In this study, mineralization-stimulative and antibacterial networking nanostructures are assembled via amyloid-like aggregation of lactoferrin (LF) triggered by reducing the intramolecular disulfide bonds. Due to the adhesive property of their rich β-sheet architecture, the LF networks are amenable to the deposition upon the surface of various implant materials, functionalizing the implants with cell-proliferative, mineralization-stimulative, and antibacterial properties. Specifically, the abundant functional groups and amino acids exposed on the surface of LF networks provide abundant functional microdomains for subsequent mineralization of different forms of calcium ions and promote the formation of hydroxyapatite (HAp) crystals in simulated body fluids. We further demonstrate that the LF network inherits the innate antibacterial properties of LF and exerts a synergistic antibacterial ability with surface-enriched positively charged and hydrophobic amino acid residues, disrupting bacterial biofilm formation, enhancing microbial cell wall perturbation, and ultimately leading to microbial death. The results underscore the feasibility of the LF network as a multifunctional coating on bioscaffold surfaces, which may provide insight into its future applications in next-generation artificial bone implants with bacterial/biofilm clearance and bone tissue remodeling capabilities.

Enhanced anti-microbial activity and osseointegration of Ta/Cu co-implanted polyetheretherketone

Polyetheretherketone (PEEK) has been widely applied for orthopedic and oral implants due to its excellent mechanical properties, biocompatibility, and radiolucency. However, its bioinert and the lack of anti-microbial activity limit its application. We modified the PEEK surface with Ta/Cu co-implantation using plasma immersion ion-implantation technology. After implantation of Ta/Cu ions, the morphology and roughness of the PEEK surface were not significantly changed at micron level. We estimated the cytocompatibility, anti-microbial ability, and osteogenic differentiation of rat bone mesenchymal stem cells (BMSCs) of the modified surfaces in vitro. Compared to the untreated surfaces, the Ta ion-treated surface showed improved adhesion, proliferation, ALP activity, ECM mineralization, and osteogenic gene expression of BMSCs. Further, the Cu ion-treated surface showed reduced initial adhesion and proliferation of Escherichia coli and Staphylococcus aureus in vitro and proliferation of Staphylococcus aureus in the mouse subcutaneous implant-associated infection model. According to a rat bone repair model, all Ta ion-implanted groups demonstrated improved new bone formation. In summary, Ta/Cu ion co-impanation improved anti-microbial activity and promoted osseointegration of the PEEK surface.

Characterization and Antibacterial Properties of Polyetherketoneketone Coated with a Silver Nanoparticle-in-Epoxy Lining

Polyetherketoneketone (PEKK) is an alternative material for use in removable partial denture frameworks; these frameworks must exhibit antibacterial properties to reduce the risk of periodontal disease. In the present study, silver nanoparticles (AgNPs) were synthesized via the reduction of silver nitrate with sodium borohydride in a solution containing polyvinyl pyrrolidone (PVP). Transmission electron microscope images and dynamic light scattering confirmed that metallic nanoparticles had been created with an average size of 32 nm. Furthermore, the coating of the PEKK polymeric substrate with 0.5% AgNPs was carried out using an epoxy resin lining at room temperature. Fourier transform infrared (FTIR) spectra confirmed the successful transfer of the AgNP-in-resin lining onto the polymeric substrate. Scanning electron microscopy and atomic force microscopy confirmed that the AgNPs had been uniformly deposited onto the PEKK specimens. Finally, the antibacterial activity of the specimens was tested against Porphyromonas gingivalis. An inhibition zone of 22.5 mm and an antibacterial rate of 83.47% were found for the PEKK coated with 0.5% AgNPs (0.5% Ag-PEKK) compared to an untreated polyetheretherketone (PEEK) substrate, evidencing that 0.5% Ag-PEKK has potential antibacterial properties for implant applications.

Heterostructured Metal-Organic Frameworks/Polydopamine Coating Endows Polyetheretherketone Implants with Multimodal Osteogenicity and Photoswitchable Disinfection

Clinically, bacteria-induced contagion and insufficient osseointegrative property inevitably elicit the failure of orthopedic implants. Herein, a heterostructured coating consisting of simvastatin (SIM)-laden metal-organic frameworks and polydopamine nanolayers is created on a porous bioinert polyetheretherketone implant. The heterostructured coating significantly promotes cytocompatibility and osteogenic differentiation through multimodal osteogenicity mechanisms of zinc ion (Zn²⁺ ) therapy, SIM drug therapy, and surface micro-/nano-topological stimulation. Under the illumination of near-infrared (NIR) light, singlet oxygen (¹ O₂ ) and local hyperthermia are produced; besides, NIR light dramatically accelerates the release of Zn²⁺ ions from heterostructured coatings. Gram-positive and -negative bacteria are effectively eradicated by the synergy of photothermal/photodynamic effects and photo-induced accelerated delivery of Zn²⁺ ions. The superior osteogenicity and osseointegration, as well as photoswitchable disinfection controlled by NIR light are corroborated via in vivo results. This work highlights the great potential of photoresponsive heterostructured orthopedic implants in treatment of the noninvasive bone reconstruction of bacteria-associated infectious tissues through multimodal phototherapy and photoswitchable ion-therapy.

Enhanced Antibacterial Ability and Bioactivity of Polyetherketoneketone Modified with LL-37

Polyetherketoneketone (PEKK) is considered to be a potential substitute material for metal bone implants because of its advantageous biocompatibility, chemical stability, and mechanical properties, but clinical application has been severely restricted due to PEKK's lack of antibacterial ability and biological activity. In this study, LL-37, a natural human antimicrobial peptide, was successfully modified on the PEKK surface with polydopamine as the intermediate layer and released continuously for more than 6 days. The results of the MTT assay, colony counts, and Live/Dead staining demonstrated that compared to unmodified PEKK, the LL-37-modified PEKK significantly inhibited the adhesion, vitality, and bacterial biofilm growth of Staphylococcus aureus and Escherichia coli in a concentration-dependent way. Furthermore, the LL-37-modified PEKK enhanced biocompatibility (cell adhesion and viability) and promoted osteogenic differentiation of human umbilical cord Wharton's jelly-derived mesenchymal stem cells. Our data suggested that LL-37-modified PEKK might be a promising material for use in orthopedic implants.

Simultaneous incorporation of gallium oxide and tantalum microparticles into micro-arc oxidation coating of titanium possessing antibacterial effect and stimulating cellular response

Orthopedic implants with both osteogenesis and antibacterial functions are particularly promising for bone repair and substitutes. In this study, a micro-arc oxidation (MAO) coating containing titanium dioxide (TiO₂), gallium oxide (Ga₂O₃) and tantalum oxide (Ta₂O₅) on the titanium surface (MGT) was fabricated by dispersing Ga₂O₃ and Ta microparticles in the electrolyte. The results showed that the simultaneous incorporation of Ga₂O₃ and Ta microparticles into the MAO coating resulted in optimized surface performance (e.g., micro-topography, roughness, wettability, surface energy, and protein absorption) of MGT compared with pure titanium (pTi). In addition, MGT exhibited outstanding corrosion resistance owing to the presence of both Ga₂O₃ and Ta microparticles, which exhibit excellent corrosion resistance and their microparticles were incorporated into the micropores of the coating. Moreover, MGT with good cytocompatibility and optimized surface resulted in improved cellular responses (e.g., proliferation and osteogenic differentiation) of rat bone mesenchymal stem cells, which was attributed to Ta microparticles with outstanding osteogenic bioactivity. Furthermore, the excellent antibacterial effect of MGT was attributed to the slow release of Ga³⁺ from the coating. Thus, the simultaneous incorporation of Ga₂O₃ and Ta microparticles into the MAO coating of MGT exhibited excellent cytocompatibility, osteogenic bioactivity, antibacterial functions, and corrosion resistance, suggesting that MGT possesses great potential for bone repair applications.

Comparison of surface properties, cell behaviors, bone regeneration and osseointegration between nano tantalum/PEEK composite and nano silicon nitride/PEEK composite

Both tantalum (Ta) and silicon nitride (SN) exhibit osteogenic bioactivity and antibacterial property. In addition, as a biomaterial for bone repair, polyetheretherketone (PEEK) has outstanding biocompatibility and mechanical performances while it is biologically inert. In this study, by blending PEEK with Ta and SN nanoparticles, respectively, Ta/PEEK composite (TPC) and SN/PEEK composite (SPC) were fabricated for load-bearing bone repair. The surface roughness, hydrophilicity and surface energy of TPC containing Ta nanoparticles were higher than SPC containing SN nanoparticles and PEEK. In addition, TPC with Ta nanoparticles exhibited low antibacterial property while SPC with SN nanoparticles showed high bacterial property. Moreover, the MC3T3-E1 cells responses (e.g. proliferation and differentiation) to TPC was the highest while PEEK was the lowest in vitro. Furthermore, new bone formation and osseointegration for TPC was the highest while PEEK was the lowest in vivo. In conclusion, compared with PEEK, addition of Ta and SN nanoparticles into PEEK fabricated bioactive composites of TPC and SPC with optimized surface property, which played crucial roles in inducing cellular response/bone regeneration. Although the osteogenic activity of SPC was lower than TPC, SPC exhibited osteogenic activity and good antibacterial property, which could prevent infection from bacterial. Therefore, SPC would have better potential for bone substitute.

Alumina and Zirconia-Reinforced Polyamide PA-12 Composites for Biomedical Additive Manufacturing

This work aimed to prepare a composite with a polyamide (PA) matrix and surface-modified ZrO₂ or Al₂O₃ to be used as ceramic fillers (CFs). Those composites contained 30 wt.% ceramic powder to 70 wt.% polymer. Possible applications for this type of composite include bioengineering applications especially in the fields of dental prosthetics and orthopaedics. The ceramic fillers were subjected to chemical surface modification with Piranha Solution and suspension in 10 M sodium hydroxide and Si₃N₄ to achieve the highest possible surface development and to introduce additional functional groups. This was to improve the bonding between the CFs and the polymer matrix. Both CFs were examined for particle size distribution (PSD), functional groups (FTIR), chemical composition (XPS), phase composition (XRD), and morphology and chemical composition (SEM/EDS). Filaments were created from the powders prepared in this way and were then used for 3D FDM printing. Samples were subjected to mechanical tests (tensility, hardness) and soaking tests in a high-pressure autoclave in artificial saliva for 14, 21, and 29 days.

Enhanced spreading, migration and osteodifferentiation of HBMSCs on macroporous CS-Ta - A biocompatible macroporous coating for hard tissue repair

Macroporous tantalum (Ta) coating was produced on titanium alloy implant for bone repair by cold spray (CS) technology, which is a promising technology for oxygen sensitive materials. The surface characteristics as well as in vitro cytocompatibility were systematically evaluated. The results showed that a rough and macroporous CS-Ta coating was formed on the Ti6Al4V (TC4) alloy surfaces. The surface roughness showed a significant enhancement from 17.06 μm (CS-Ta-S), 27.48 μm (CS-Ta-M) to 39.21 μm (CS-Ta-L) with the increase of the average pore diameter of CS-Ta coatings from 138.25 μm, 198.25 μm to 355.56 μm. In vitro results showed that macroporous CS-Ta structure with tantalum pentoxide (Ta₂O₅) was more favorable to induce human bone marrow derived mesenchymal stem cells (HBMSCs) spreading, migration and osteodifferentiation than TC4. Compared with the micro-scaled structure outside the macropores, the surface micro-nano structure inside the macropores was more favorable to promote osteodifferentiation with enhanced alkaline phosphatase (ALP) activity and extracellular matrix (ECM) mineralization. In particular, CS-Ta-L with the largest pore size showed significantly enhanced integrin-α5 expression, cell migration, ALP activity, ECM mineralization as well as osteogenic-related genes including ALP, osteopontin (OPN) and osteocalcin (OCN) expression. Our results indicated that macroporous Ta coatings by CS, especially CS-Ta-L, may be promising for hard tissue repairs.

Mechanical Response of PEKK and PEEK As Frameworks for Implant-Supported Full-Arch Fixed Dental Prosthesis: 3D Finite Element Analysis

Objective  Polymeric framework represent an innovative approach for implant-supported dental prostheses. However, the mechanical response of ultra-high performance polymers as frameworks for full-arch prostheses under the “all-on-four concept” remains unclear. The present study applied finite element analysis to examine the behavior of polyetherketoneketone (PEKK) and polyetheretherketone (PEEK) prosthetic frameworks.

Materials and Methods  A three-dimensional maxillary model received four axially positioned morse-taper implants, over which a polymeric bar was simulated. The full-arch prosthesis was created from a previously reported database model, and the imported geometries were divided into a mesh composed of nodes and tetrahedral elements in the analysis software. The materials were assumed as isotropic, elastic, and homogeneous, and all contacts were considered bonded. A normal load (500 N magnitude) was applied at the occlusal surface of the first left molar after the model was fixed at the base of the cortical bone. The microstrain and von-Mises stress were selected as criteria for analysis.

Results  Similarities in the mechanical response were observed in both framework for the peri-implant tissue, as well as for stress generated in the implants (263–264 MPa) and abutments (274–273 MPa). The prosthetic screw and prosthetic base concentrated more stress with PEEK (211 and 58 MPa, respectively) than with PEKK (192 and 49 MPa), while the prosthetic framework showed the opposite behavior (59 MPa for PEEK and 67 MPa for PEKK).

Conclusion  The main differences related to the mechanical behavior of PEKK and PEEK frameworks for full-arch prostheses under the “all-on-four concept” were reflected in the prosthetic screw and the acrylic base. The superior shock absorbance of PEKK resulted in a lower stress concentration on the prosthetic screw and prosthetic base. This would clinically represent a lower fracture risk on the acrylic base and screw loosening. Conversely, lower stress concentration was observed on PEEK frameworks.

Tantalum and its derivatives in orthopedic and dental implants: Osteogenesis and antibacterial properties

Implant-associated infections and aseptic loosening are some of the main reasons for implant failure. Therefore, there is an urgent need to improve the osseointegration and antibacterial capabilities of implant materials. In recent years, a large number of breakthroughs in the biological application of tantalum and its derivatives have been achieved. Owing to their corrosion resistance, biocompatibility, osseointegration ability, and antibacterial properties, they have shown considerable potential in orthopedic and dental implant applications. In this review, we provide the latest progress and achievements in the research on osseointegration and antibacterial properties of tantalum as well as its derivatives, and summarize the surface modification methods to enhance their osseointegration and antibacterial properties.

Deciphering controversial results of cell proliferation on TiO2 nanotubes using machine learning

With the rapid development of biomedical sciences, contradictory results on the relationships between biological responses and material properties emerge continuously, adding to the challenge of interpreting the incomprehensible interfacial process. In the present paper, we use cell proliferation on titanium dioxide nanotubes (TNTs) as a case study and apply machine learning methodologies to decipher contradictory results in the literature. The gradient boosting decision tree model demonstrates that cell density has a higher impact on cell proliferation than other obtainable experimental features in most publications. Together with the variation of other essential features, the controversy of cell proliferation trends on various TNTs is understandable. By traversing all combinational experimental features and the corresponding forecast using an exhausted grid search strategy, we find that adjusting cell density and sterilization methods can simultaneously induce opposite cell proliferation trends on various TNTs diameter, which is further validated by experiments. This case study reveals that machine learning is a burgeoning tool in deciphering controversial results in biomedical researches, opening up an avenue to explore the structure-property relationships of biomaterials.

Adapting the Pore Size of Individual, 3D-Printed CPC Scaffolds in Maxillofacial Surgery

Three dimensional (3D) printing allows additive manufacturing of patient specific scaffolds with varying pore size and geometry. Such porous scaffolds, made of 3D-printable bone-like calcium phosphate cement (CPC), are suitable for bone augmentation due to their benefit for osteogenesis. Their pores allow blood-, bone- and stem cells to migrate, colonize and finally integrate into the adjacent tissue. Furthermore, the pore size affects the scaffold’s stability. Since scaffolds in maxillofacial surgery have to withstand high forces within the jaw, adequate mechanical properties are of high clinical importance. Although many studies have investigated CPC for bone augmentation, the ideal porosity for specific indications has not been defined yet. We investigated 3D printed CPC cubes with increasing pore sizes and different printing orientations regarding cell migration and mechanical properties in comparison to commercially available bone substitutes. Furthermore, by investigating clinical cases, the scaffolds’ designs were adapted to resemble the in vivo conditions as accurately as possible. Our findings suggest that the pore size of CPC scaffolds for bone augmentation in maxillofacial surgery necessarily needs to be adapted to the surgical site. Scaffolds for sites that are not exposed to high forces, such as the sinus floor, should be printed with a pore size of 750 µm to benefit from enhanced cell infiltration. In contrast, for areas exposed to high pressures, such as the lateral mandible, scaffolds should be manufactured with a pore size of 490 µm to guarantee adequate cell migration and in order to withstand the high forces during the chewing process.

A microporous surface containing Si3N4/Ta microparticles of PEKK exhibits both antibacterial and osteogenic activity for inducing cellular response and improving osseointegration

As an implantable biomaterial, polyetherketoneketone (PEKK) exhibits good mechanical strength but it is biologically inert while tantalum (Ta) possesses outstanding osteogenic bioactivity but has a high density and elastic modulus. Also, silicon nitride (SN) has osteogenic and antibacterial activity. In this study, a microporous surface containing both SN and Ta microparticles on PEKK (STP) exhibiting excellent osteogenic and antibacterial activity was created by sulfonation. Compared with sulfonated PEKK (SPK) without microparticles, the surface properties (roughness, surface energy, hydrophilicity and protein adsorption) of STP significantly increased due to the SN and Ta particles presence on the microporous surface. In addition, STP also exhibited outstanding antibacterial activity, which inhibited bacterial growth in vitro and prevented bacterial infection in vivo because of the presence of SN particles. Moreover, the microporous surface of STP containing both SN and Ta particles remarkably induced response (e.g., proliferation and differentiation) of rat bone mesenchymal stem (rBMS) cells in vitro. Furthermore, STP significantly improved new bone regeneration and osseointegration in vivo. Regarding the induction of cellular response in vitro and improvement of osseointegration in vivo, the microporous surface containing Ta was better than the surface with SN particles. In conclusion, STP with optimized surface properties activated cellular responses in vitro, enhanced osseointegration and prevented infection in vivo. Therefore, STP possessed the dual biofunctions of excellent osteogenic and antibacterial activity, showing great potential as a bone substitute.

•Microporous surface containing SN/Ta microparticles on PEKK (STP) was created.

•Surface performances (e.g., roughness) of STP were significantly increased.

•STP exhibited antibacterial activity in vitro and prevented infection in vivo.

•STP remarkably induced response of bone mesenchymal stem cells in vitro.

•STP obviously improved bone regeneration and osseointegration in vivo.

Simultaneous engineering of nanofillers and patterned surface macropores of graphene/hydroxyapatite/polyetheretherketone ternary composites for potential bone implants

Incorporating bioactive nanofillers and creating porous surfaces are two common strategies used to improve the tissue integration of polyetheretherketone (PEEK) material. However, few studies have reported the combined use of both strategies to modify PEEK. Herein, for the first time, dual nanoparticles of graphene oxide (GO) and hydroxyapatite (HAp) were incorporated into PEEK matrix to obtain ternary composites that were laser machined to create macropores with diameters ranging from 200 μm to 600 μm on the surfaces. The surface morphology and chemistry, mechanical properties, and cellular responses of the composites were investigated. The results show that micropatterned pores with a depth of 50 μm were created on the surfaces of the composites, which do not significantly affect the mechanical properties of the resultant composites. More importantly, the incorporation of GO and HAp significantly improves the cell adhesion and proliferation on the surface of PEEK. Compared to the smooth surface composite, the composites with macroporous surface exhibit markedly enhanced cell viability. The combined use of nanofillers and surface macropores may be a promising way of improving tissue integration of PEEK for bone implants.