Polyetheretherketone/nano-fluorohydroxyapatite composite with antimicrobial activity and osseointegration properties

Immunomodulatory multifunctional janus collagen-based membrane for advanced bone regeneration

Guided bone regeneration (GBR) is a standard therapy for treating bone defects, with collagen-based barrier membranes widely used clinically. However, these membranes face challenges like poor mechanical properties, early bacterial invasion and immunomodulation deficiency, potentially risking GBR failure. Orchestrating macrophage activation and controlling their M1 or M2 polarization are effective strategies for bone repair. Here, we present a Janus collagen-based barrier membrane with immunomodulation. The porous layer promotes direct osteogenic differentiation and inward growth of osteoblasts. The dense layer prevents invasion of soft tissue into bone defects and protects bone defects from bacterial infection. The membrane also enhances rat bone marrow-derived mesenchymal stem cell infiltration, proliferation, and osteogenic differentiation by regulating the immune microenvironment, demonstrating superior bone regeneration compared to the commercial Bio-Gide® membrane. Overall, the Janus collagen-based membrane reduces tissue inflammation and fosters an osteoimmune environment conducive to new bone formation, offering effective material design for advanced GBR technology.

Overcoming biological inertness: multifaceted strategies to optimize PEEK bioactivity for interdisciplinary clinical applications

Polyether ether ketone (PEEK), characterized by a comparable elastic modulus to human bone with high wear resistance, radiolucency, and biocompatibility, demonstrates considerable promise for clinical applications. However, due to the significant limitations in clinical applications caused by the biological inertness of PEEK, it should first be modified to meet clinical needs. Currently, the field of PEEK modifications is rapidly advancing, with a particular emphasis on enhancing its biological properties. Most of the previous reviews have separately discussed strategies like antibacterial, osteogenic, and angiogenic enhancements for PEEK. This review combines cross-domain insights to update and synthesize recent research on PEEK composites, focusing on advanced multi-component sustained release platforms that mimic postoperative biological processes. Such temporal alignment between material functionality and physiological healing phases demonstrates unprecedented potential for expanding PEEK's clinical versatility.

A pH-Responsive Polyetheretherketone Implant Modified with a Core-Shell Metal-Organic Framework to Promote Antibacterial and Osseointegration Abilities

Polyetheretherketone (PEEK) is considered to be a potential material for oral implants due to its elastic modulus being similar to that of human cortical bone. However, the poor antibacterial, anti-inflammatory, and osseointegration properties of bioinert PEEK have hindered its clinical application. Therefore, this study designed and constructed a pH-responsive PEEK implant with a bilayer core-shell zeolitic imidazolate framework-8 (ZIF-8) structure loaded on its surface, with an antimicrobial peptide (KR12) encapsulated in the outer shell and an osteogenic peptide (osteogenic growth peptide ) encapsulated in its inner core. In this study, the bilayer core-shell ZIF-8 structure was confirmed to have pH-responsive properties. In vitro studies proved that the implant could promote bone marrow mesenchymal stem cells' proliferation and differentiation and the M1 phenotype to M2 phenotype conversion of RAW 264.7 and could inhibit bacterial adhesion and proliferation. By constructing rats' distal femur with/without infection models, it was further demonstrated that the novel implant could effectively inhibit bacterial adhesion and growth, inhibit inflammation, and promote peri-implant osseointegration, which was more substantial when the local area was infected and the pH was lower than that of normal tissue. Collectively, the results suggest that this novel pH-responsive PEEK implant loaded with a bilayer core-shell ZIF-8 structure is a promising peptide delivery implant system, which is well suited for dental applications and offers a potential solution for the prevention of infection during the early phase after implantation.

Comparison of the Performance Parameters of BioHPP® and Biocetal® Used in the Production of Prosthetic Restorations in Dentistry-Part II: Physicochemical and Microbiological Tests: An In Vitro Study

The natural aging process of the human organism leads to both physiological and pathological changes, including tooth loss. This requires dental prosthetic interventions aimed at restoring patients' quality of life. The use of such prostheses necessitates selection of sufficiently strong, aesthetic and biocompatible materials, which also offer ease of shaping. The market for materials used in prosthetic applications offers a wide array of options; however, selection of the most suitable material for specific clinical scenarios can be challenging for dental professionals. This paper continues the comprehensive investigation of the physiochemical and mechanical/functional properties of two commonly used prosthetic-Biocetal and BioHPP-offering a comparative analysis of their characteristics to provide valuable insights for dentists and prosthodontists. The study focuses on in vitro analyses of physiochemical parameters, including density, water sorption, contact angle, and surface roughness. The structure of the materials was examined via scanning electron microscopy. Additionally, microbiological studies were performed using strains of Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa and Candida albicans. Statistical analysis was performed using Shapiro-Wilk test, Q-Q plot analysis, Grubbs test, and Student's T-test (p < 0.05). The findings indicate that BioHPP demonstrates superior physiochemical and microbiological properties. However, Biocetal exhibit better surface characteristics. Despite its high performance, BioHPP presents certain drawbacks, which may influence dentists' material choice in specific clinical cases, particularly for certain prosthetic restorations.

A comprehensive review on the State of the Art in the research and development of poly-ether-ether-ketone (PEEK) biomaterial-based implants

Polyetheretherketone (PEEK) is a preferred high-performance polymer in the spine, orthopedic, and craniomaxillofacial implant industry. However, despite its commendable mechanical properties, its bioinert nature limits the implants from integrating with neighboring tissues, impacting the implant's long-term performance. To address this limitation, various kinds of surface functionalization techniques have been developed over the years. Noteworthy efforts have been made to incorporate bioactive fillers in the PEEK matrix to develop standalone bioactive composites. In personalized medicine, significant advances have been made in the 3D Printing of PEEK implants. 3D-printed PEEK implants are now being developed at Point-of-Care, significantly reducing manufacturing and logistic time. Given the recent clinical follow-up updates and advancements in PEEK-based implants, PEEK implants are witnessing an important phase in its history. Recognizing this vital phase, this paper aims to comprehensively review the advancements of PEEK implants over the past decade. The review starts with an overview of the clinical impact of varying PEEK implants, followed by PEEK's surface functionalization techniques and engineering of PEEK-based bioactive composites. Next, this review describes the advancements made in the 3D printing of PEEK implants and points out the essential considerations that should be considered when developing 3D-printed PEEK-based implants. Finally, the review ends with an estimated projection about the future of PEEK-based implants. Readers are expected to gain an all-encompassing and in-depth understanding of PEEK biomedical implants' past, present, and future, enabling researchers to advance the research and development of PEEK-based implants in the required direction. STATEMENT OF SIGNIFICANCE: PEEK is a preferred high-performance polymer in the implant industry, with notable benefits over metallic and ceramic implants, such as bone-matching stiffness and durability. Significant strides have been made in the last decade to make PEEK implants bioactive and utilize 3D Printing to develop patient-specific implants. Given the recent advancements in PEEK-based implants, this review aims to provide an all-encompassing and in-depth understanding of PEEK biomedical implants' past, present, and future. It will comprehensively discuss the know-how gained from the clinical follow-up, the strategies to address the limitations of PEEK implants, and the essential considerations in 3D Printing of PEEK implants. This review will enable researchers to advance the research and development of PEEK implants in the required direction.

The research status and future direction of polyetheretherketone in dental implant -A comprehensive review

Currently, dental implants primarily rely on the use of titanium and titanium alloys. However, the extensive utilization of these materials in clinical practice has unveiled various problems including stress shielding, corrosion, allergic reactions, cytotoxicity, and image artifacts. As a result, polyetheretherketone (PEEK) has emerged as a notable alternative due to its favorable mechanical properties, corrosion resistance, wear resistance, biocompatibility, radiation penetrability and MRI compatibility. Meanwhile, the advancement and extensive application of 3D printing technology has expanded the range of medical applications for PEEK, including artificial spines, skulls, ribs, shinbones, hip joints, and temporomandibular joints. In this review, we aim to assess the advantages and disadvantages of PEEK as a dental implant material, summarize the measures taken to address its shortcomings and their effects, and provide insight into the future potential of PEEK in dental implant applications, with the goal of offering guidance and reference for future research endeavors.

Toward the Production of Hydroxyapatite/Poly(Ether-Ether-Ketone) (PEEK) Biocomposites: Exploring the Physicochemical, Mechanical, Cytotoxic and Antimicrobial Properties

The development of hydroxyapatite (HAp) and polyether ether ketone (PEEK) biocomposites has been extensively studied for bone repair applications due to the synergistic properties of the involved materials. In this study, we aimed to develop HAp/PEEK biocomposites using high-energy ball milling, with HAp concentrations (20%, 40%, and 60% w/v) in PEEK, to evaluate their physicochemical, mechanical, cytotoxicity, and antimicrobial properties for potential applications in Tissue Engineering (TE). The biocomposites were characterized by structure, morphology, apparent porosity, diametral compression strength, cytotoxicity, and antimicrobial activity. The study results demonstrated that the HAp/PEEK biocomposites were successfully synthesized. The C2 biocomposite, containing 40% HAp, stood out due to the optimal distribution of HAp particles in the PEEK matrix, resulting in higher compression strength (246 MPa) and a homogeneous microstructure. It exhibited antimicrobial activity against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli, with no cytotoxicity observed. These properties make the C2 biocomposite promising for regenerative medicine applications, combining mechanical strength, bioactivity, and biocompatibility.

Polyetheretherketone subperiosteal implant retaining a maxillary fixed prosthesis: A case series

STATEMENT OF PROBLEM

Patients needing dental rehabilitation of a complete atrophic maxilla would benefit from simplified treatment plans.

PURPOSE

The purpose of this case series was to demonstrate the prosthetic management of 4 edentulous patients with severe maxillary ridge resorption who declined multiple stage surgery and sought a fixed prosthesis in single-stage surgery.

MATERIAL AND METHODS

The patients were provided with completely digital computer-aided designed and computer-aided manufactured (CAD-CAM) polyetheretherketone (PEEK) maxillary subperiosteal frameworks, which were surgically placed in a 1-step procedure. The patients were followed up for 12 months and evaluated for signs of implant rejection, infection, prosthetic fracture or mobility, or implant exposure.

RESULTS

At the 12-month follow-up, all the implants were functionally stable with healthy soft tissue and showed no sign of prosthetic fracture, infection, or pus discharge.

CONCLUSIONS

PEEK subperiosteal implants for maxillary atrophied ridges can be considered a promising treatment option within the limitations of this clinical study with low patient numbers and a short observational time.

Biomaterials science and surface engineering strategies for dental peri-implantitis management

Peri-implantitis is a bacterial infection that causes soft tissue inflammatory lesions and alveolar bone resorption, ultimately resulting in implant failure. Dental implants for clinical use barely have antibacterial properties, and bacterial colonization and biofilm formation on the dental implants are major causes of peri-implantitis. Treatment strategies such as mechanical debridement and antibiotic therapy have been used to remove dental plaque. However, it is particularly important to prevent the occurrence of peri-implantitis rather than treatment. Therefore, the current research spot has focused on improving the antibacterial properties of dental implants, such as the construction of specific micro-nano surface texture, the introduction of diverse functional coatings, or the application of materials with intrinsic antibacterial properties. The aforementioned antibacterial surfaces can be incorporated with bioactive molecules, metallic nanoparticles, or other functional components to further enhance the osteogenic properties and accelerate the healing process. In this review, we summarize the recent developments in biomaterial science and the modification strategies applied to dental implants to inhibit biofilm formation and facilitate bone-implant integration. Furthermore, we summarized the obstacles existing in the process of laboratory research to reach the clinic products, and propose corresponding directions for future developments and research perspectives, so that to provide insights into the rational design and construction of dental implants with the aim to balance antibacterial efficacy, biological safety, and osteogenic property.

Biomimicking covalent organic frameworks nanocomposite coating for integrated enhanced anticorrosion and antifouling properties of a biodegradable magnesium stent

The utilization of biodegradable magnesium (Mg) alloys in the fabrication of temporary non-vascular stents is an innovative trend in biomedical engineering. However, the heterogeneous degradation profiles of these biomaterials, together with potential bacterial colonization that could precipitate infectious or stenotic complications, are critical obstacles precluding their widespread clinical application. In pursuit of overcoming these limitations, this study applies the principles of biomimicry, particularly the hydrophobic and anti-fouling characteristics of lotus leaves, to pioneer the creation of nanocomposite coatings. These coatings integrate poly-trimethylene carbonate (PTMC) with covalent organic frameworks (COFs), to modify the stent's surface property. The strategic design of the coating's topography, porosity, and self-polishing capabilities collectively aims to decelerate degradation processes and minimize biological adhesion. The protective qualities of the coatings were substantiated through rigorous testing in both in vitro dynamic bile tests and in vivo New Zealand rabbit choledochal models. Empirical findings from these trials confirmed that the implementation of COF-based nanocomposite coatings robustly fortifies Mg implantations, conferring heightened resistance to both biocorrosion and biofouling as well as improved biocompatibility within bodily environments. The outcomes of this research elucidate a comprehensive framework for the multifaceted strategies against stent corrosion and fouling, thereby charting a visionary pathway toward the systematic conception of a new class of reliable COF-derived surface modifications poised to amplify the efficacy of Mg-based stents. STATEMENT OF SIGNIFICANCE: Biodegradable magnesium (Mg) alloys are widely utilized in temporary stents, though their rapid degradation and susceptibility to bacterial infection pose significant challenges. Our research has developed a nanocomposite coating inspired by the lotus, integrating poly-trimethylene carbonate with covalent organic frameworks (COF). The coating achieved self-polishing property and optimal surface energy on the Mg substrate, which decelerates stent degradation and reduces biofilm formation. Comprehensive evaluations utilizing dynamic bile simulations and implantation in New Zealand rabbit choledochal models reveal that the coating improves the durability and longevity of the stent. The implications of these findings suggest the potential COF-based Mg alloy stent surface treatments and a leap forward in advancing stent performance and endurance in clinical applications.

Application of Polyether Ketone in Oral Implantology and Prosthodontics

Polyetheretherketone (PEEK) is a polymer that has a comprehensive range of possible uses in dental treatment. The goal of this study was to compile research findings on the substance of dental claims and highlight the upcoming predictions of PEEK in clinical dentistry. PEEK is a novel polymeric material that is yet in its preliminary stage of evolution. Biomolecules are elastic materials with remarkable mechanical strength, barrier properties, and heat resistance compared to other matrix materials. The efficacy of PEEK in clinical dentistry has been acknowledged. Polyetherketone (PEKK) and PEEK are the most commonly mentioned members of the polyaryletherketone (PAEK) family. PEEK has also found significant use in dentistry, notably in prosthodontics and implant dentistry. It also offers exceptional mechanical qualities, including high strength and toughness, making it ideal for dental implants and prostheses. It can endure the stresses of chewing and grinding, resulting in long-lasting restorations. PEEK's tooth-colored look and ability to simulate natural tooth translucency make it suitable for use in dental prostheses such as crowns and bridges. This makes it a more esthetically acceptable alternative to standard metal-based repairs.

The Formation Process and Mechanism of the 3D Porous Network on the Sulfonated PEEK Surface

A three-dimensional (3D) porous network can be prepared on the PEEK surface by sulfonation with enhanced osseointegration and antibacterial properties. However, few studies have been conducted on the formation mechanism of a 3D porous network. In this work, the surface and cross-sectional morphologies, chemical compositions, functional groups, surface wettability, and crystalline states of sulfonated PEEK were investigated at different sulfonation times and coagulant concentrations. The results show that the number of nodular structures and broken fibers on the sulfonated PEEK surface as well as the size of macrovoids in the cross sections increase with increasing sulfonation times when water is used as a coagulant. In contrast, dilute sulfuric acid as a coagulant can inhibit the formation of surface porous structures and macrovoids in the cross sections. Moreover, all of the sulfonated PEEK samples have the same chemical compositions but exhibit better hydrophilicity as the number of microsized pores decreases. It is proposed that non-solvent-induced phase separation (NIPS) occurs during the sulfonation process, and the formation mechanism of surface and cross-sectional morphologies is discussed. Furthermore, it is assumed that the air is trapped in the microsized pores, leaving the surface of the 3D porous network in the Cassie-wetting state. All of these preliminary results throw light on the nature of the sulfonation process and may guide further modification of the structures of sulfonated PEEK.

Methods to improve antibacterial properties of PEEK: A review

As a thermoplastic and bioinert polymer, polyether ether ketone (PEEK) serves as spine implants, femoral stems, cranial implants, and joint arthroplasty implants due to its mechanical properties resembling the cortical bone, chemical stability, and radiolucency. Although there are standards and antibiotic treatments for infection control during and after surgery, the infection risk is lowered but can not be eliminated. The antibacterial properties of PEEK implants should be improved to provide better infection control. This review includes the strategies for enhancing the antibacterial properties of PEEK in four categories: immobilization of functional materials and functional groups, forming nanocomposites, changing surface topography, and coating with antibacterial material. The measuring methods of antibacterial properties of the current studies of PEEK are explained in detail under quantitative, qualitative, andin vivomethods. The mechanisms of bacterial inhibition by reactive oxygen species generation, contact killing, trap killing, and limited bacterial adhesion on hydrophobic surfaces are explained with corresponding antibacterial compounds or techniques. The prospective analysis of the current studies is done, and dual systems combining osteogenic and antibacterial agents immobilized on the surface of PEEK are found the promising solution for a better implant design.

Nanomaterials for Anti-Infection in Orthopedic Implants: A Review

Postoperative implant infection is a severe complication in orthopedic surgery, often leading to implant failure. Current treatment strategies mainly rely on systemic antibiotic therapies, despite contributing to increasing bacterial resistance. In recent years, nanomaterials have gained attention for their potential in anti-infection methods. They exhibit more substantial bactericidal effects and lower drug resistance than conventional antimicrobial agents. Nanomaterials also possess multiple bactericidal mechanisms, such as physico-mechanical interactions. Additionally, they can serve as carriers for localized antimicrobial delivery. This review explores recent applications of nanomaterials with different morphologies in post-orthopedic surgery infections and categorizes their bactericidal mechanisms.

Aligned electrospun fibers of different diameters for improving cell migration capacity

Electrospun fibers have gained significant attention as scaffolds in skin tissue engineering due to their biomimetic properties, which resemble the fibrous extracellular matrix. The morphological characteristics of electrospun fibers play a crucial role in determining cell behavior. However, the effects of electrospun fibers' arrangement and diameters on human skin fibroblasts (HSFs) remain elusive. Here, we revealed the impact of electrospun fiber diameters (700 nm, 2000 nm, and 3000 nm) on HSFs' proliferation, migration, and functional expression. The results demonstrated that all fibers exhibited good cytocompatibility. HSFs cultured on nanofibers (700 nm diameter) displayed a more dispersed and elongated morphology. Conversely, fibers with a diameter of 3000 nm exhibited a reduced specific surface area and lower adsorption of adhesion proteins, resulting in enhanced cell migration speed and effective migration rate. Meanwhile, the expression levels of migration-related genes and proteins were upregulated at 48 h for the 3000 nm fibers. This study demonstrated the unique role of fiber diameters in controlling the physiological functions of cells, especially decision-making and navigating migration in complex microenvironments of aligned electrospun fibers, and highlights the utility of these bioactive substitutes in skin tissue engineering applications.

Recent Development and Applications of Polydopamine in Tissue Repair and Regeneration Biomaterials

The various tissue damages are a severe problem to human health. The limited human tissue regenerate ability requires suitable biomaterials to help damage tissue repair and regeneration. Therefore, many researchers devoted themselves to exploring biomaterials suitable for tissue repair and regeneration. Polydopamine (PDA) as a natural and multifunctional material which is inspired by mussel has been widely applied in different biomaterials. The excellent properties of PDA, such as strong adhesion, photothermal and high drug-loaded capacity, seem to be born for tissue repair and regeneration. Furthermore, PDA combined with different materials can exert unexpected effects. Thus, to inspire researchers, this review summarizes the recent and representative development of PDA biomaterials in tissue repair and regeneration. This article focuses on why apply PDA in these biomaterials and what PDA can do in different tissue injuries.

Zizyphus mauritiana seed extract: Paving the way for next-generation bone constructs with nano-fluorohydroxyapatite/carboxymethyl chitosan nanocomposite scaffold

This is the first study that explored the potential use of Zizyphus mauritiana seed extract (ZSE) to synthesize nano-fluorohydroxyapatite/carboxymethyl chitosan nanocomposite scaffolds at different concentrations (CFZ1, CFZ2 and CFZ3) using co-precipitation method. The proposed scaffolds showed presence of intermolecular H bonding interactions between the constituents, according to the FTIR. The mechanical studies revealed shore hardness of 72 ± 4.6 and optimal compressive modulus in case of CFZ3 [1654.48 ± 1.6 MPa], that was comparable with that of human cortical bone. The SEM, TEM and platelet adhesion images corroborated uniformly distributed needle like particles in case of CFZ3 with an average size ranging from 22 to 26 nm, linked rough morphology, and appropriate hemocompatibility. The markedly up regulation in the ALP activity and protein adsorption upon increasing ZSE concentration demonstrated that CFZ nanocomposite scaffolds were compatible with osteoblastic cells relative to CF nanocomposite. The cytotoxicity study indicated that CFZ nanocomposite do not induce toxicity over MG-63 and did not aggravate LDH leakage in contrast to CF. The histopathological investigations on albino rats confirmed significantly improved regeneration of bone in the repair of a critical-size [8 mm] calvarium defect. Therefore, CFZ3 nanocomposite scaffold represents a simple, off-the-shelf solution to the combined challenges associated with bone defects.

Polyimide biocomposites coated with tantalum pentoxide for stimulation of cell compatibility and enhancement of biointegration for orthopedic implant

Orthopedic implants are an important tool in the treatment of musculoskeletal conditions and helped many patients to improve their quality of life. Various inorganic-organic biocomposites have been broadly investigated particularly in the area of load-bearing orthopedic/dental applications. Polyimide (PI) is a promising organic material and shows excellent mechanical properties, biocompatibility, bio-stability, and its elastic modulus is similar to human bone but it lacks bioactivity, which is very important for cell adhesion and ultimately for bone regeneration. In this research, tantalum pentoxide (Ta2O5) coating was prepared on the surface of PI by polydopamine (PDA) bonding. The results showed that Ta2O5 was evenly coated on the surface of PI, and with the concentration of Ta2O5 in the PDA suspension increased, the content of Ta2O5 particles on the surface of PI increased significantly. In addition, the Ta2O5 coating significantly increased the roughness and hydrophilicity of the PI matrix. Cell experiments showed that PI surface coating Ta2O5 could promote the proliferation, adhesion, and osteogenic differentiation of bone marrow-derived stromal cells (BMSCs). The results demonstrated that fabricating Ta2O5 coating on the surface of PI through PDA bonding could improve the biocompatibility as well as bioactivity of PI, and increase the application potential of PI in the field of bone repair materials.

Multifunctional electrospun nanofibrous scaffold enriched with alendronate and hydroxyapatite for balancing osteogenic and osteoclast activity to promote bone regeneration

Electrospun composite nanofiber scaffolds are well known for their bone and tissue regeneration applications. This research is focused on the development of PVP and PVA nanofiber composite scaffolds enriched with hydroxyapatite (HA) nanoparticles and alendronate (ALN) using the electrospinning technique. The developed nanofiber scaffolds were investigated for their physicochemical as well as bone regeneration potential. The results obtained from particle size, zeta potential, SEM and EDX analysis of HA nanoparticles confirmed their successful fabrication. Further, SEM analysis verified nanofiber's diameters within 200-250 nm, while EDX analysis confirmed the successful incorporation of HA and ALN into the scaffolds. XRD and TGA analysis revealed the amorphous and thermally stable nature of the nanofiber composite scaffolds. Contact angle, FTIR analysis, Swelling and biodegradability studies revealed the hydrophilicity, chemical compatibility, suitable water uptake capacity and increased in-vitro degradation making it appropriate for tissue regeneration. The addition of HA into nanofiber scaffolds enhanced the physiochemical properties. Additionally, hemolysis cell viability, cell adhesion and proliferation by SEM as well as confocal microscopy and live/dead assay results demonstrated the non-toxic and biocompatibility behavior of nanofiber scaffolds. Alkaline phosphatase (ALP) and tartrate-resistant acid phosphatase (TRAP) assays demonstrated osteoblast promotion and osteoclast inhibition, respectively. These findings suggest that developed HA and ALN-loaded PVP/PVA-ALN-HA nanofiber composite scaffolds hold significant promise for bone regeneration applications.

Effect of Fluorohydroxyapatite on Biological and Physical Properties of MTA Angelus

Objectives

This study aimed to assess the effect of addition of fluorohydroxyapatite (FHI) on biological and physical properties of mineral trioxide aggregate (MTA) Angelus.

Materials and Methods

In this in vitro, experimental study, nano-FHI powder was first synthesized, and the morphology and chemical structure of particles were evaluated by scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), and X-ray diffraction (XRD). Three groups were evaluated in this study: MTA Angelus, MTA modified with 10% FHA, and MTA modified with 15% FHA. After mixing, the materials were applied to ring molds (10 mm diameter, 1 mm height), and the setting time of the three groups was evaluated according to ISO6876 and ASTMC266-03 with a Gillmore needle. The pH was measured using a pH meter at 24 and 48 hours and 7 days after mixing. The cytotoxicity of the materials was assessed in freshly mixed form and after 1 and 7 days using the methyl thiazolyl tetrazolium (MTT) assay according to ISO10993-5. Data were analyzed by one-way and repeated measures ANOVA and Tukey's test (alpha = 0.05).

Results

The addition of FHA to MTA significantly decreased the initial setting time (P < 0.05) and had no significant effect on cell viability (compared with pure MTA Angelus) at 1 and 7 days. However, modified MTA groups in freshly mixed form showed significantly lower cell viability (P < 0.05). The pH remained alkaline at all time points.

Conclusion

Addition of 15% FHA to MTA Angelus decreased its setting time with no adverse effect on cell viability (except for fresh form) or pH.

Research and Application of Medical Polyetheretherketone as Bone Repair Material

Polyetheretherketone (PEEK) can potentially be used for bone repair because its elastic modulus is similar to that of human natural bone and good biocompatibility and chemical stability. However, its hydrophobicity and biological inertness limit its application in the biomedical field. Inspired by the composition, structure, and function of bone tissue, many strategies are proposed to change the structure and functionality of the PEEK surface. In this review, the applications of PEEK in bone repair and the optimization strategy for PEEK's biological activity are reviewed, which provides a direction for the development of multifunctional bone repair materials in the future.

Research progress and future prospects of antimicrobial modified polyetheretherketone (PEEK) for the treatment of bone infections

Infection of the bone is a difficult problem in orthopedic diseases. The key and basis of the treatment of bone infection is the effective control of local infection, as well as the elimination of infection focus and dead cavities. The most commonly used approach utilized for the prevention and management of bone infection is the application of antibiotic bone cement. However, the incorporation of antibiotics into the cement matrix has been found to considerably compromise the mechanical characteristics of bone cement. Moreover, some investigations have indicated that the antibiotic release rate of antibiotic bone cement is relatively low. Polyetheretherketone (PEEK) and its composites have been considered to perfectly address the challenges above, according to its favorable biomechanical characteristics and diverse surface functionalizations. This article provides a comprehensive overview of the recent advancements in the antimicrobial modification of PEEK composites in the field of antibacterial therapy of bone infection. Furthermore, the potential application of PEEK-modified materials in clinical treatment was discussed and predicted.

Aligned Ice Templated Biomaterial Strategies for the Musculoskeletal System

Aligned pore structures present many advantages when conceiving biomaterial strategies for treatment of musculoskeletal disorders. Aligned ice templating (AIT) is one of the many different techniques capable of producing anisotropic porous scaffolds; its high versatility allows for the formation of structures with tunable pore sizes, as well as the use of many different materials. AIT has been found to yield improved compressive properties for bone tissue engineering (BTE), as well as higher tensile strength and optimized cellular alignment and proliferation in tendon and muscle repair applications. This review evaluates the work that has been done in the last decade toward the production of aligned pore structures by AIT with an outlook on the musculoskeletal system. This work describes the fundamentals of the AIT technique and focuses on the research carried out to optimize the biomechanical properties of scaffolds by modifying the pore structure, categorizing by material type and application. Related topics including growth factor incorporation into AIT scaffolds, drug delivery applications, and studies about immune system response will be discussed.

Polyetheretherketone development in bone tissue engineering and orthopedic surgery

Polyetheretherketone (PEEK) has been widely used in the medical field as an implant material, especially in bone tissue engineering and orthopedic surgery, in recent years. This material exhibits superior stability at high temperatures and is biosecured without harmful reactions. However, the chemical and biological inertness of PEEK still limits its applications. Recently, many approaches have been applied to improve its performance, including the modulation of physical morphology, chemical composition and antimicrobial agents, which advanced the osteointegration as well as antibacterial properties of PEEK materials. Based on the evolution of PEEK biomedical devices, many studies on the use of PEEK implants in spine surgery, joint surgery and trauma repair have been performed in the past few years, in most of which PEEK implants show better outcomes than traditional metal implants. This paper summarizes recent studies on the modification and application of biomedical PEEK materials, which provides further research directions for PEEK implants.

Surface Modification of Titanium Implants by Metal Ions and Nanoparticles for Biomedical Application

Implant surface modification can improve osseointegration and reduce peri-implant inflammation. Implant surfaces are modified with metals because of their excellent mechanical properties and significant functions. Metal surface modification is divided into metal ions and nanoparticle surface modification. These two methods function by adding a finishing metal to the surface of the implant, and both play a role in promoting osteogenic, angiogenic, and antibacterial properties. Based on this, the nanostructural surface changes confer stronger antibacterial and cellular affinity to the implant surface. The current paper reviews the forms, mechanisms, and applications of nanoparticles and metal ion modifications to provide a foundation for the surface modification of implants.

AFM Analysis of a Three-Point Flexure Tested, 3D Printing Definitive Restoration Material for Dentistry

Background: Three-dimensional printing is a rapidly developing technology across all industries. In medicine recent developments include 3D bioprinting, personalized medication and custom prosthetics and implants. To ensure safety and long-term usability in a clinical setting, it is essential to understand material specific properties. This study aims to analyze possible surface changes of a commercially available and approved DLP 3D printed definitive restoration material for dentistry after three-point flexure testing. Furthermore, this study explores whether Atomic Force Microscopy (AFM) is a feasible method for examination of 3D printed dental materials in general. This is a pilot study, as there are currently no studies that analyze 3D printed dental materials using an AFM. Methods: The present study consisted of a pretest followed by the main test. The resulting break force of the preliminary test was used to determine the force used in the main test. The main test consisted of atomic force microscopy (AFM) surface analysis of the test specimen followed by a three-point flexure procedure. After bending, the same specimen was analyzed with the AFM again, to observe possible surface changes. Results: The mean root mean square (RMS) roughness of the segments with the most stress was 20.27 nm (±5.16) before bending, while it was 26.48 nm (±6.67) afterward. The corresponding mean roughness (Ra) values were 16.05 nm (±4.25) and 21.19 nm (±5.71) Conclusions: Under three-point flexure testing, the surface roughness increased significantly. The p-value for RMS roughness was p = 0.003, while it was p = 0.006 for Ra. Furthermore, this study showed that AFM surface analysis is a suitable procedure to investigate surface changes in 3D printed dental materials.

Amyloid-Mediated Nanoarchitectonics with Biomimetic Mineralization of Polyetheretherketone for Enhanced Osseointegration

Polyetheretherketone (PEEK), a widely used implant material, has attracted the attention of scientific researchers because of its bone-matched elastic modulus, radiolucency, and chemical resistance. However, the bioinert chemical properties of PEEK do not promote bone apposition once implanted. In this study, using a phase-transitioned lysozyme (PTL) nanofilm as a sandwiched layer, a robust hydroxyapatite (HAp) coating on PEEK (HAp@PTL@PEEK) is constructed. The PTL nanofilm shows strong adhesion to the PEEK surface and induces biomimetic mineralization to form a compact HAp coating on PEEK in simulated body fluids. This HAp coating not only shares a higher adhesion strength and better stability but can also be applied to implants with complex 3D structures. HAp@PTL@PEEK showed significantly enhanced osteogenic capacity when cultured with rat bone marrow mesenchymal stem cells by promoting initial cell adhesion, proliferation, and osteogenic differentiation in vitro. In vivo evaluations utilizing models of femoral condyle defects and skull defects confirm that the HAp coating substantially augments bone remodeling and osseointegration ability. Compared with the traditional method, our modified method is simpler, more environmentally friendly, and uses less hazardous components. Furthermore, the obtained HAp coating shares a higher adhesion strength to PEEK and a better osteogenic capacity. The study offers a novel method to improve the osseointegration of PEEK-based implants in biointerfaces and tissue engineering.

PEEK for Oral Applications: Recent Advances in Mechanical and Adhesive Properties

Polyetheretherketone (PEEK) is a thermoplastic material widely used in engineering applications due to its good biomechanical properties and high temperature stability. Compared to traditional metal and ceramic dental materials, PEEK dental implants exhibit less stress shielding, thus better matching the mechanical properties of bone. As a promising medical material, PEEK can be used as implant abutments, removable and fixed prostheses, and maxillofacial prostheses. It can be blended with materials such as fibers and ceramics to improve its mechanical strength for better clinical dental applications. Compared to conventional pressed and CAD/CAM milling fabrication, 3D-printed PEEK exhibits excellent flexural and tensile strength and parameters such as printing temperature and speed can affect its mechanical properties. However, the bioinert nature of PEEK can make adhesive bonding difficult. The bond strength can be improved by roughening or introducing functional groups on the PEEK surface by sandblasting, acid etching, plasma treatment, laser treatment, and adhesive systems. This paper provides a comprehensive overview of the research progress on the mechanical properties of PEEK for dental applications in the context of specific applications, composites, and their preparation processes. In addition, the research on the adhesive properties of PEEK over the past few years is highlighted. Thus, this review aims to build a conceptual and practical toolkit for the study of the mechanical and adhesive properties of PEEK materials. More importantly, it provides a rationale and a general new basis for the application of PEEK in the dental field.

Poly (Ether-Ether-Ketone) for Biomedical Applications: From Enhancing Bioactivity to Reinforced-Bioactive Composites-An Overview

The global orthopedic market is forecasted to reach US$79.5 billion by the end of this decade. Factors driving the increase in this market are population aging, sports injury, road traffic accidents, and overweight, which justify a growing demand for orthopedic implants. Therefore, it is of utmost importance to develop bone implants with superior mechanical and biological properties to face the demand and improve patients' quality of life. Today, metallic implants still hold a dominant position in the global orthopedic implant market, mainly due to their superior mechanical resistance. However, their performance might be jeopardized due to the possible release of metallic debris, leading to cytotoxic effects and inflammatory responses in the body. Poly (ether-ether-ketone) (PEEK) is a biocompatible, high-performance polymer and one of the most prominent candidates to be used in manufacturing bone implants due to its similarity to the mechanical properties of bone. Unfortunately, the bioinert nature of PEEK culminates in its diminished osseointegration. Notwithstanding, PEEK's bioactivity can be improved through surface modification techniques and by the development of bioactive composites. This paper overviews the advantages of using PEEK for manufacturing implants and addresses the most common strategies to improve the bioactivity of PEEK in order to promote enhanced biomechanical performance.

Antibacterial and Proliferative Effects of NaOH-Coated Titanium, Zirconia, and Ceramic-Reinforced PEEK Dental Composites on Bone Marrow Mesenchymal Stem Cells

Several metallic and polymer-based implants have been fabricated for orthopedic applications. For instance, titanium (Ti), zirconia (Zr), and polyetheretherketone (PEEK) are employed due to their excellent biocompatibility properties. Hence, the present study aimed to compare the functional and biological properties of these three biomaterials with surface modification. For this purpose, Ti, Zr, and ceramic-reinforced PEEK (CrPEEK) were coated with NaOH and tested for the biological response. Our results showed that the surface modification of these biomaterials significantly improved the water contact, protein adhesion, and bioactivity compared with uncoated samples. Among the NaOH-coated biomaterials, Ti and CrPEEK showed higher protein absorption than Zr. However, the mineral binding ability was higher in CrPEEK than in the other two biomaterials. Although the coating improved the functional properties, NaOH coating did not influence the antibacterial effect against E. coli and S. aureus in these biomaterials. Similar to the antibacterial effects, the NaOH coating did not contribute any significant changes in cell proliferation and cell loading, and CrPEEK showed better biocompatibility among the biomaterials. Therefore, this study concluded that the surface modification of biomaterials could potentially improve the functional properties but not the antibacterial and biocompatibility, and CrPEEK could be an alternative material to Ti and Zr with desirable qualities in orthopedic applications.

Mechanical performance and bioactivation of 3D-printed PEEK for high-performance implant manufacture: a review

Polyetheretherketone (PEEK) has stood out as the leading high-performance thermoplastic for the replacement of metals in orthopaedic, trauma and spinal implant applications due to its high biocompatibility and mechanical properties. Despite its potential for custom-made medical devices, 3D-printed PEEK's mechanical performance depends on processing parameters and its bioinertness may hinder bone opposition to the implant. Concerning these challenges, this review focuses on the available literature addressing the improvement of the mechanical performance of PEEK processed through "fused filament fabrication" (FFF) along with literature on bioactivation of PEEK for improved osseointegration. The reviewed research suggests that improvements can be achieved in mechanical performance of 3D-printed PEEK with adequate FFF parametrization while different bioactivation techniques can be used to improve the bioperformance of 3D-printed PEEK. The adequate approaches towards these procedures can increase PEEK's potential for the manufacture of high-performance custom-made implantable devices that display improved bone-implant integration and prevent stress shielding of the treated bone.

3-D Printed space maintainers - A review

Although the idea of a digital workflow is not new in dentistry, it has just recently started to be applied in pediatric dentistry. Fabrication of space maintainer is a time-consuming procedure that needs constant communication with the laboratory to be receive and provide patients the best outcomes. These devices maintain space created by premature tooth loss so that the erupting permanent teeth will not experience any kind of malocclusion As a result of clinician's natural curiosity 3-D printed space maintainer have been developed. The advanced CAD/CAM technology used for fabricating digital space maintainers improves patient experience and compliance. The current paper provides an insight on available conventional space maintainers and various aspects of technologically advanced digitainers.

A bioactive poly(ether-ether-ketone) nanocomposite scaffold regulates osteoblast/osteoclast activity for the regeneration of osteoporotic bone

Due to the lower regeneration capacity of the osteoporotic bone, the treatment of osteoporotic defects is extremely challenging in clinics. In this study, strontium-doped bioactive glass nanoparticles loaded with sodium alendronate (ALN), namely A-SrBG, were incorporated into the poly(ether-ether-ketone) matrix to fabricate a bioactive composite scaffold (ASP), which was expected to both inhibit bone resorption and promote bone regeneration. The results showed that such a composite scaffold with interconnected macropores (200-400 μm) could release Ca²⁺, Sr²⁺, and ALN in vitro. The proliferation, alkaline phosphatase (ALP) activity, expression of osteogenesis-related genes, and formation of calcified nodules of rat bone marrow stromal cells (rBMSCs) were clearly evidenced, and the reduction in the proliferation, tartrate-resistant acid phosphatase (TRAP) activity, cell fusion, and expression of osteoclastogenesis-related genes of osteoclasts was observed as well. In the presence of the ASP scaffold, enhanced osteogenesis along with inhibiting osteoclastogenesis was observed by modulating the osteoprotegerin (OPG)/receptor activator for nuclear factor κB ligand (RANKL) ratio. The efficacy of the composite scaffold in the regeneration of osteoporotic critical-sized cranial defect in a rat model was evaluated. Therefore, the bioactive composite scaffold with excellent biocompatibility and osteogenic potential could be a promising material for the repair of osteoporotic bone defects.

Recent advances in hydrogels-based osteosarcoma therapy

Osteosarcoma (OS), as a typical kind of bone tumors, has a high incidence among adolescents. Traditional tumor eradication avenues for OS such as chemotherapy, surgical therapy and radiation therapy usually have their own drawbacks including recurrence and metastasis. In addition, another serious issue in the treatment of OS is bone repair because the bone after tumor invasion usually has difficulty in repairing itself. Hydrogels, as a synthetic or natural platform with a porous three-dimensional structure, can be applied as desirable platforms for OS treatment. They can not only be used as carriers for tumor therapeutic drugs but mimic the extracellular matrix for the growth and differentiation of mesenchymal stem cells (MSCs), thus providing tumor treatment and enhancing bone regeneration at the same time. This review focuses the application of hydrogels in OS suppression and bone regeneration, and give some suggests on future development.

Peek dental implants coated with boron-doped nano-hydroxyapatites: Investigation of in-vitro osteogenic activity

BACKGROUND

PEEK is a high-performance thermoplastic that has many potential uses in orthopaedics and dentistry, and it has been shown to be a substitute for titanium (Ti) implants. However, PEEK is an inherently inert material, and that characteristic limits its cellular adhesion and bone integration. The aim of this study is to determine a suitable surface modification method for increasing the osteogenic potential of polyetheretherketone (PEEK) implants used in periodontal applications.

METHODS

In this work, a nanostructured porous surface is created on PEEK material by sulfonation, in sulfuric acid at room temperature for 20 min, and thus SPEEK samples were obtained. Then, PEEK and SPEEK samples were coated with boron (B) doped hydroxyapatite (HAp) nanoparticles (B-nHAp) precipitated from concentrated synthetic body fluid (10xSBF) by a microwave-assisted method conducted at 600 W. In vitro cell culture studies were carried out with periodontal ligament cells (PDL) on the samples. Osteogenic differentiation of PDL cells on PEEK, SPEEK and SPEEK-B-nHAp was evaluated using ALP activity assay, hydroxyproline assay, and RT-qPCR.

RESULTS

In vitro cell culture studies disclosed improved adhesion and proliferation of PDL cells on the SPEEK and B-nHAp coated SPEEK surfaces (SPEEK-B-nHAp). Results of these assays confirmed that treated PEEK surfaces, especially SPEEK-B-nHAp, significantly enhanced osteogenic differentiation of PDL cells in vitro compared with untreated PEEK surfaces.

CONCLUSION

Here a simple, easy to-use, and efficient modification method based on the properties of boron is proposed for increasing osteogenic potential of PEEK implants.

Protein-inorganic hybrid porous scaffolds for bone tissue engineering

Porous scaffolds hold promise in the treatment of bone defects for bone tissue engineering due to their interconnected porous structure and suitable mechanical properties. Herein, LAPONITE® (LAP), which is able to promote osteogenic differentiation, was introduced into regenerated silk fibroin (RSF) porous scaffolds. Due to hydrogen bonding and electrostatic interactions between RSF and LAP, RSF/LAP 3D porous scaffolds were successfully prepared. The pore size, porosity, and mechanical properties of the RSF/LAP 3D porous scaffolds were modulated during the preparation process. Evaluation of the proliferation of bone marrow mesenchymal stem cells (BMSCs) on the RSF/LAP 3D porous scaffolds in vitro indicated that the addition of LAP improved the adhesion and proliferation of cells. Additionally, alkaline phosphatase activity and osteospecific gene expression analysis showed that the RSF/LAP 3D porous scaffolds enhanced the osteogenic differentiation of BMSCs compared to the pristine RSF porous scaffolds, especially with a higher LAP content. The subcutaneous implantation of the RSF/LAP 3D porous scaffolds in rats demonstrated good histocompatibility in vivo. Therefore, RSF/LAP 3D porous scaffolds with good biocompatibility and biodegradability have good application prospects in the field of bone tissue engineering.

Treatment methods toward improving the anti-infection ability of poly(etheretherketone) implants for medical applications

Due to its favorable chemical stability, biocompatibility, and mechanical properties, Poly(etheretherketone) (PEEK) is a promising material for repairing bone and dental hard tissue defects. However, there are critical disadvantages: PEEK is biologically and chemically inert, which influences osseointegration of implants and bonding strength of prostheses, and its mechanical properties still cannot meet the requirements for some medical applications. Furthermore, bacterial infections and inflammatory reactions often accompany bone defects caused by trauma or inflammation or teeth loss caused by periodontitis. Previous studies mainly focused on enhancing PEEK's bioactivity and mechanical performance, but PEEK also lacks effective anti-infection ability. Thus, it is necessary to improve its anti-infection ability, and this is considered in this paper from two aspects. The first is to inhibit the attachment and growth of bacteria on the material, and the second is to endow the material with immunoregulatory ability, which means mobilizing the host immune system to protect tissue from inflammation. In this review, we analyze and discuss the existing treatment methods to improve the antibacterial and immunomodulatory abilities of PEEK addressing their limitations, relevant future challenges, and required research efforts.

Application of biomolecules modification strategies on PEEK and its composites for osteogenesis and antibacterial properties

As orthopedic and dental implants, polyetheretherketone (PEEK) is expected to be a common substitute material of titanium (Ti) and its alloys due to its good biocompatibility, chemical stability, and elastic modulus close to that of bone tissue. It could avoid metal allergy and bone resorption caused by the stress shielding effect of Ti implants, widely studied in the medical field. However, the lack of biological activity is not conducive to the clinical application of PEEK implants. Therefore, the surface modification of PEEK has increasingly become one of the research hotspots. Researchers have explored various biomolecules modification methods to effectively enhance the osteogenic and antibacterial activities of PEEK and its composites. Therefore, this review mainly summarizes the recent research of PEEK modified by biomolecules and discusses the further research directions to promote the clinical transformation of PEEK implants.

Nanomaterial reinforced composite for biomedical implants applications: a mini-review

There is heavy demand for suitable implant materials with improved mechanical and biological properties. Classically, the demand was catered by conventional materials like metals, alloys, and polymer-based materials. Recently, nanomaterial reinforced composites have played a significant role in replacing conventional materials due to their excellent properties such as biocompatibility, bioactivity, high strength to weight ratio, long life, corrosion & wear resistance, and tailor-ability. Herein, we composed a systematic focus review on the role of nanoparticles in the form of composite materials for the advancements in orthopedic implants. Several nano materials-based reinforcements have been reviewed with various matrix materials, including metals, alloys, ceramics, composites, and polymers for biomedical implant applications. Moreover, the improved biological properties, mechanical properties, and other functionalities like infection resistance, drug delivery at the target, sensing, and detection of bone diseases, and corrosion & wear resistance are elaborated. At last, a particular focus has been given to the un-resolved challenges in orthopedic implant development.

Surface Modification of Poly(ether ether ketone) by Simple Chemical Grafting of Strontium Chondroitin Sulfate to Improve its Anti-Inflammation, Angiogenesis, Osteogenic Properties

Besides inducing osteogenic differentiation, the surface modification of poly(ether ether ketone) (PEEK) is highly expected to improve its angiogenic activity and reduce the inflammatory response in the surrounding tissue. Herein, strontium chondroitin sulfate is first attempted to be introduced into the surface of sulfonated PEEK (SPEEK-CS@Sr) based on the Schiff base reaction between PEEK and ethylenediamine (EDA) and the amidation reaction between EDA and chondroitin sulfate (CS). The surface characteristics of SPEEK-CS@Sr implant are systematically investigated, and its biological properties in vitro and in vivo are also evaluated. The results show that the surface of SPEEK-CS@Sr implant exhibits a 3D microporous structure and good hydrophilicity, and can steadily release Sr ions. Importantly, the SPEEK-CS@Sr not only displays excellent biocompatibility, but also can remarkably promote cell adhesion and spread, improve osteogenic activity and angiogenic activity, and reduce the inflammatory response compared to the original PEEK. Therefore, this study presents the surface modification of PEEK material by simple chemical grafting of strontium chondroitin sulfate to improve its angiogenesis, anti-inflammation, and osteogenic properties, and the as-fabricated SPEEK-CS@Sr has the potential to serve as a promising orthopedic implant in bone tissue engineering.

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.

TiO2 Nanocoatings with Controllable Crystal Type and Nanoscale Topography on Zirconia Implants to Accelerate Bone Formation

In dentistry, zirconia implants have emerged as a promising alternative for replacing missing teeth due to their superior aesthetic performance and chemical stability. To improve the osseointegration of zirconia implants, modifying their surface with hierarchical micro/nanotopography and bioactive chemical composition are two effective ways. In this work, a microscale topography was prepared on a zirconia surface using hydrofluoric acid etching, and then a 50 nm TiO₂ nanocoating was deposited via atomic layer deposition (ALD). Subsequently, an annealing treatment was used to transform the TiO₂ from amorphous to anatase and simultaneously generate nanoscale topography. Various investigations into the coating surface morphology, topography, wettability, and chemical composition were carried out using scanning electron microscopy, white light interferometry, contact-angle measurement, X-ray diffraction, and X-ray photoelectron spectroscopy. In addition, in vitro cytocompatibility and osteogenic potential performance of the coatings were evaluated by human bone marrow mesenchymal stem cells (hBMSCs), and in vivo osseointegration performance was assessed in a rat femoral condyle model. Moreover, the possible mechanism was also investigated. The deposition of TiO₂ film with/without annealing treatment did not alter the microscale roughness of the zirconia surface, whereas the nanotopography changed significantly after annealing. The in vitro studies revealed that the anatase TiO₂ coating with regular wavelike nanostructure could promote the adhesion and proliferation of osteoblasts and further improve the osteogenic potential in vitro and osseointegration in vivo. These positive effects may be caused by nanoscale topography via the canonical Wnt/β-catenin pathway. The results suggest that using ALD in combination with annealing treatment to fabricate a nanotopographic TiO₂ coating is a promising way to improve the osteogenic properties of zirconia implants.