Characteristics of multi-layer coating formed on commercially pure titanium for biomedical applications

Surface modifications and coatings to improve osseointegration and antimicrobial activity on titanium surfaces: A statistical review over the last decade

Background

Titanium (Ti) is commonly employed therapeutically in many medical sectors associated with bone healing because of its superior mechanical properties and capacity to osseointegrate in the host bone tissue. The titanium surfaces may now be functionalized to offer additional and potentially valuable features. This review article discusses many titanium implant surface modifications, emphasizing their biological significance and the challenges that each one mainly addresses. Before reviewing the genuine reason for titanium surface modification in implanted devices, we briefly explore the process of osseointegration, enhancement of antibacterial properties, biocompatibility, and the historical significance of titanium as an implantable material, and the significant challenges involved. The various physical and chemical alterations that could take place on Ti surfaces are next examined. The rest of our talk will focus on creating inorganic and organic coatings for implanted Ti devices. Finally, we present a synopsis of the surface modification strategies currently being evaluated in clinical settings.

Target

This systematic review aims to evaluate research on titanium implants with significant surface modifications, coatings, and antibacterial capabilities.

Methods

Following the PRISMA paradigm, we searched for three electronic databases (Web of Science, PubMed Central, and Google Scholar) using the keywords "titanium implants," "titanium surface modification," and "titanium osseointegration," and "titanium antibacterial activity."

Results

We identified 1,39,336 articles overall that were published between 2012 and 2021, and we then focused on 8917 articles that concentrated on a particular topic. Clear inclusion and exclusion criteria were used in a rigorous screening procedure. Articles that didn't meet certain requirements (were irrelevant, used incorrect techniques, had unsuitable data values, or were only brief letters or communications) were eliminated. Finally, 120 research publications in total are taken into account for this extensive systematic review.

Conclusion

The report summarises current information on titanium implants with significant surface modifications, antibacterial activity, and coatings. It also gives some strong recommendations for future study topics.

Advanced Strategies for Enhancing the Biocompatibility and Antibacterial Properties of Implantable Structures

This review explores the latest advancements in enhancing the biocompatibility and antibacterial properties of implantable structures, with a focus on titanium (Ti) and its alloys. Titanium implants, widely used in dental and orthopedic applications, demonstrate excellent mechanical strength and biocompatibility, yet face challenges such as peri-implantitis, a bacterial infection that can lead to implant failure. To address these issues, both passive and active surface modification strategies have been developed. Passive modifications, such as altering surface texture and chemistry, aim to prevent bacterial adhesion, while active approaches incorporate antimicrobial agents for sustained infection control. Nanotechnology has emerged as a transformative tool, enabling the creation of nanoscale materials and coatings like TiO2 and ZnO that promote osseointegration and inhibit biofilm formation. Techniques such as plasma spraying, ion implantation, and plasma electrolytic oxidation (PEO) show promising results in improving implant integration and durability. Despite significant progress, further research is needed to refine these technologies, optimize surface properties, and address the clinical challenges associated with implant longevity and safety. This review highlights the intersection of surface engineering, nanotechnology, and biomedical innovation, paving the way for the next generation of implantable devices.

Antibacterial Properties and Biocompatibility of Multicomponent Titanium Oxides: A Review

The simple oxides like titania, zirconia, and ZnO are famous with their antibacterial (or even antimicrobial) properties as well as their biocompatibility. They are broadly used for air and water filtering, in food packaging, in medicine (for implants, prostheses, and scaffolds), etc. However, these application fields can be broadened by switching to the composite multicomponent compounds (for example, titanates) containing in their unit cell, together with oxygen, several different metallic ions. This review begins with a description of the synthesis methods, starting from wet chemical conversion through the manufacturing of oxide (nano)powders toward mechanosynthesis methods. The morphology of these multicomponent oxides can also be very different (like thin films, complicated multilayers, or porous scaffolds). Further, we discuss in vitro tests. The antimicrobial properties are investigated with Gram-positive or Gram-negative bacteria (like Escherichia coli or Staphylococcus aureus) or fungi. The cytotoxicity can be studied, for example, using mouse mesenchymal stem cells, MSCs (C3H10T1/2), or human osteoblast-like cells (MG63). Other human osteoblast-like cells (SaOS-2) can be used to characterize the cell adhesion, proliferation, and differentiation in vitro. The in vitro tests with individual microbial or cell cultures are rather far away from the real conditions in the human or animal body. Therefore, they have to be followed by in vivo tests, which permit the estimation of the real applicability of novel materials. Further, we discuss the physical, chemical, and biological mechanisms determining the antimicrobial properties and biocompatibility. The possible directions of future developments and novel application areas are described in the concluding section of the review.

Synergistic Bactericidal Effect of Zn2+ Ions and Reactive Oxygen Species Generated in Response to Either UV or X-ray Irradiation of Zn-Doped Plasma Electrolytic Oxidation TiO2 Coatings

Zn-containing TiO2-based coatings with Na, Ca, Si, and K additives were obtained by plasma electrolytic oxidation (PEO) of Ti in order to achieve an effective and broad bactericidal protection without compromising biocompatibility. A protocol has been developed for cleaning the coating surface from electrolyte residues, ensuring the preservation of the microstructure and composition of the surface layer. Using high-resolution transmission electron microscopy, three characteristic microstructural zones in the PEO-Zn coating are well documented: zone 1 with a TiO2-based nanocrystalline structure, zone 2 with an amorphous structure, and zone 3 around pores with an amorphous-nanocrystalline structure. The excellent cytocompatibility of PEO-Zn samples was confirmed by three different methods: monitoring the proliferation of MC3T3-E1 cells, assessing the viability of sheep osteoblast cells using calcein-AM staining and fluorescence microscopy, and incubation with spheroids based on primary osteoblast cells and mouse embryonic fibroblast NIH3T3 cells. The PEO-Zn coatings absorb >60% of the incident light over the UV and Vis-NIR spectral ranges. After 24 h, the PEO-Zn coatings completely inactivate four types of strains: Gram-positive Staphylococcus aureus CSA154 and ATCC29213 and Gram-negative Escherichia coli K261 and U20, and also prevent E. coli U20 and K261 biofilm formation. The superior antibacterial activity is associated with the synergistic effect of Zn2+ ions in safe concentration and reactive oxygen species (ROS) generated in response to either UV irradiation or soft short-term X-ray irradiation. The X-ray irradiation-induced ROS formation by a PEO coating is reported for the first time. The enhanced bactericidal activity after X-ray irradiation compared to UV illumination is attributed to the more intense ROS generation in the first few hours. The results obtained significantly expand the possibilities of using PEO coatings on the surfaces of titanium implants.

Influence of Alloying Materials Al, Cu, and Ca on Microstructures, Mechanical Properties, And Corrosion Resistance of Mg Alloys for Industrial Applications: A Review

Magnesium is renowned for its favorable low-density attributes, rendering it a viable choice for commercial engineering applications in which weight has substantial design implications. Magnesium (Mg) stands as a readily obtainable metallic element, exhibiting robustness, efficient heat dissipation, and excellent damping properties. The utilization of pure magnesium remains infrequent due to its susceptibility to instability under high temperatures and pronounced vulnerability to corrosion within humid environments. Hence, the incorporation of magnesium alloys into the design process of aircraft, automotive, and biomedical applications assumes paramount importance. This Review presents a comprehensive review of research endeavors and their resultant achievements concerning the advancement of magnesium alloys. Specifically focusing on aerospace, automotive, and biomedical applications, the Review underscores the pivotal role played by alloying constituents, namely aluminum (Al), copper (Cu), calcium (Ca), and PEO coatings, in influencing the microstructural attributes, mechanical potency, and resistance to corrosion.

Enhancement of Antibacterial Properties, Surface Morphology and In Vitro Bioactivity of Hydroxyapatite-Zinc Oxide Nanocomposite Coating by Electrophoretic Deposition Technique

To develop medical-grade stainless-steel 316L implants that are biocompatible, non-toxic and antibacterial, such implants need to be coated with biomaterials to meet the current demanding properties of biomedical materials. Hydroxyapatite (HA) is commonly used as a bone implant coating due to its excellent biocompatible properties. Zinc oxide (ZnO) nanoparticles are added to HA to increase its antibacterial and cohesion properties. The specimens were made of a stainless-steel grade 316 substrate coated with HA-ZnO using the electrophoretic deposition technique (EPD), and were subsequently characterized using scanning electron microscopy (SEM), energy dispersive X-ray (EDX), stylus profilometry, electrochemical corrosion testing and Fourier transform infrared (FTIR) spectroscopy. Additionally, cross-hatch tests, cell viability assays, antibacterial assessment and in vitro activity tests in simulated body fluid (SBF) were performed. The results showed that the HA-ZnO coating was uniform and resistant to corrosion in an acceptable range. FTIR confirmed the presence of HA-ZnO compositions, and the in vitro response and adhesion were in accordance with standard requirements for biomedical materials. Cell viability confirmed the viability of cells in an acceptable range (>70%). In addition, the antibacterial activity of ZnO was confirmed on Staphylococcus aureus. Thus, the HA-ZnO samples are recommended for biomedical applications.

The race for the optimal antimicrobial surface: perspectives and challenges related to plasma electrolytic oxidation coating for titanium-based implants

Plasma electrolytic oxidation (PEO) is a low-cost, structurally reliable, and environmentally friendly surface modification method for orthopedic and dental implants. This technique is successful for the formation of porous, corrosion-resistant, and bioactive coatings, besides introducing antimicrobial compounds easily. Given the increase in implant-related infections, antimicrobial PEO-treated surfaces have been widely proposed to surmount this public health concern. This review comprehensively discusses antimicrobial implant surfaces currently produced by PEO in terms of their in vitro and in vivo microbiological and biological properties. We present a critical [part I] and evidence-based [part II] review about the plethora of antimicrobial PEO-treated surfaces. The mechanism of microbial accumulation on implanted devices and the principles of PEO technology to ensure antimicrobial functionalization by one- or multi-step processes are outlined. Our systematic literature search showed that particular focus has been placed on the metallic and semi-metallic elements incorporated into PEO surfaces to facilitate antimicrobial properties, which are often dose-dependent, without leading to cytotoxicity in vitro. Meanwhile, there are concerns over the biocompatibility of PEO and its long-term antimicrobial effects in animal models. We clearly highlight the importance of using clinically relevant infection models and in vivo long-term assessments to guarantee the rational design of antimicrobial PEO-treated surfaces to identify the 'finish line' in the race for antimicrobial implant surfaces.

Porous construction and surface modification of titanium-based materials for osteogenesis: A review

Titanium and titanium alloy implants are essential for bone tissue regeneration engineering. The current trend is toward the manufacture of implants from materials that mimic the structure, composition and elasticity of bones. Titanium and titanium alloy implants, the most common materials for implants, can be used as a bone conduction material but cannot promote osteogenesis. In clinical practice, there is a high demand for implant surfaces that stimulate bone formation and accelerate bone binding, thus shortening the implantation-to-loading time and enhancing implantation success. To avoid stress shielding, the elastic modulus of porous titanium and titanium alloy implants must match that of bone. Micro-arc oxidation technology has been utilized to increase the surface activity and build a somewhat hard coating on porous titanium and titanium alloy implants. More recently, a growing number of researchers have combined micro-arc oxidation with hydrothermal, ultrasonic, and laser treatments, coatings that inhibit bacterial growth, and acid etching with sand blasting methods to improve bonding to bone. This paper summarizes the reaction at the interface between bone and implant material, the porous design principle of scaffold material, MAO technology and the combination of MAO with other technologies in the field of porous titanium and titanium alloys to encourage their application in the development of medical implants.

Plasma Electrolytic Oxidation Ceramic Coatings on Zirconium (Zr) and Zr-Alloys: Part-II: Properties and Applications

A plasma electrolytic oxidation (PEO) is an electrochemical and eco-friendly process where the surface features of the metal substrate are changed remarkably by electrochemical reactions accompanied by plasma micro-discharges. A stiff, adhesive, and conformal oxide layer on the Zr and Zr-alloy substrates can be formed by applying the PEO process. The review describes recent progress on various applications and functionality of PEO coatings in light of increasing industrial, medical, and optoelectronic demands for the production of advanced coatings. Besides, it explains how the PEO coating can address concerns about employing protective and long-lasting coatings with a remarkable biocompatibility and a broad excitation and absorption range of photoluminescence. A general overview of the process parameters of coatings is provided, accompanied by some information related to the biological conditions, under which, coatings are expected to function. The focus is to explain how the biocompatibility of coatings can be improved by tailoring the coating process. After that, corrosion and wear performance of PEO coatings are described in light of recognizing parameters that lead to the formation of coatings with outstanding performance in extreme loading conditions and corrosive environments. Finally, a future outlook and suggested research areas are outlined. The emerging applications derived from paramount features of the coating are considered in light of practical properties of coatings in areas including biocompatibility and bioactivity, corrosion and wear protection, and photoluminescence of coatings

Antibacterial Titanium Implants Biofunctionalized by Plasma Electrolytic Oxidation with Silver, Zinc, and Copper: A Systematic Review

Patients receiving orthopedic implants are at risk of implant-associated infections (IAI). A growing number of antibiotic-resistant bacteria threaten to hamper the treatment of IAI. The focus has, therefore, shifted towards the development of implants with intrinsic antibacterial activity to prevent the occurrence of infection. The use of Ag, Cu, and Zn has gained momentum as these elements display strong antibacterial behavior and target a wide spectrum of bacteria. In order to incorporate these elements into the surface of titanium-based bone implants, plasma electrolytic oxidation (PEO) has been widely investigated as a single-step process that can biofunctionalize these (highly porous) implant surfaces. Here, we present a systematic review of the studies published between 2009 until 2020 on the biomaterial properties, antibacterial behavior, and biocompatibility of titanium implants biofunctionalized by PEO using Ag, Cu, and Zn. We observed that 100% of surfaces bearing Ag (Ag-surfaces), 93% of surfaces bearing Cu (Cu-surfaces), 73% of surfaces bearing Zn (Zn-surfaces), and 100% of surfaces combining Ag, Cu, and Zn resulted in a significant (i.e., >50%) reduction of bacterial load, while 13% of Ag-surfaces, 10% of Cu-surfaces, and none of Zn or combined Ag, Cu, and Zn surfaces reported cytotoxicity against osteoblasts, stem cells, and immune cells. A majority of the studies investigated the antibacterial activity against S. aureus. Important areas for future research include the biofunctionalization of additively manufactured porous implants and surfaces combining Ag, Cu, and Zn. Furthermore, the antibacterial activity of such implants should be determined in assays focused on prevention, rather than the treatment of IAIs. These implants should be tested using appropriate in vivo bone infection models capable of assessing whether titanium implants biofunctionalized by PEO with Ag, Cu, and Zn can contribute to protect patients against IAI.

A Stable and Indurative Superhydrophobic Film with Excellent Anti-Bioadhesive Performance for 6061 Al Protection

Superhydrophobic surfaces have attracted intensive attention in the antifouling field because of their excellent anti-bioadhesive performance and environmental friendliness. However, promising surfaces have met great challenges of poor mechanical robustness under harsh serving conditions. Herein, an organic-inorganic composite strategy, that the silane-modified TiO2 nanoparticles are compounded into the porous framework provided by the stable and indurative aluminum oxide film, is proposed to address the common serious problem in superhydrophobic surfaces. Different from the traditional superhydrophobic surfaces, this composite film possesses a ~18 μm thick layer which can provide strong support to silane-modified TiO2 nanoparticles. The resulting film can reserve superhydrophobicity to the surface even after a thickness loss of ~15 μm under continuous abrasion. At the same time, the results of the bacterial adhesive tests also verify that the film has the same long-term anti-bioadhesive performance. The film with superhydrophobicity, excellent anti-bioadhesive property, and stable robustness will make it a promising candidate for serving in a harsh environment, and the design concept of this film could be applied to various substrates.

Antibacterial Property and Biocompatibility of Silver, Copper, and Zinc in Titanium Dioxide Layers Incorporated by One-Step Micro-Arc Oxidation: A Review

Titanium (Ti) and its alloys are commonly used in medical devices. However, biomaterial-associated infections such as peri-implantitis and prosthetic joint infections are devastating and threatening complications for patients, dentists, and orthopedists and are easily developed on titanium surfaces. Therefore, this review focuses on the formation of biofilms on implant surfaces, which is the main cause of infections, and one-step micro-arc oxidation (MAO) as a coating technology that can be expected to prevent infections due to the implant. Many researchers have provided sufficient data to prove the efficacy of MAO for preventing the initial stages of biofilm formation on implant surfaces. Silver (Ag), copper (Cu), and zinc (Zn) are well used and are incorporated into the Ti surface by MAO. In this review, the antibacterial properties, cytotoxicity, and durability of these elements on the Ti surface incorporated by one-step MAO will be summarized. This review is aimed at enhancing the importance of the quantitative control of Ag, Cu, and Zn for their use in implant surfaces and the significance of the biodegradation behavior of these elements for the development of antibacterial properties.

Plasma Electrolytic Oxidation as a Feasible Surface Treatment for Biomedical Applications: an in vivo study

OBJECTIVES

In this in vivo animal study, we evaluated the effect of plasma electrolytic oxidation (PEO) coating on the topographic and biological parameters of implants installed in rats with induced osteoporosis and low-quality bones.

MATERIALS AND METHODS

In total 44 Wistar rats (Rattus novergicus), 6 months old, were submitted to ovariectomy (OXV group) and dummy surgery (SHAM group). After 90 days, the ELISA test was performed and the ovariectomy effectiveness was confirmed. In each tibial metaphysis, an implant with PEO coating containing Ca²⁺ and P⁵⁺ molecules were installed, and the other tibia received an implant with SLA acid etching and blasting (AC) (control surface). After 42 days, 16 rats from each group were euthanized, their tibias were removed for histological and immunohistochemical analysis (OPG, RANKL, OC and TRAP), as well as reverse torque biomechanics. Data were submitted to One-way ANOVA or Kruskal-Wallis tests, followed by a Tukey post-test; P < 0.05. Histological analyses showed higher bone neoformation values among the members of the PEO group, SHAM and OVX groups. Immunohistochemical analysis demonstrated equilibrium in all groups when comparing surfaces for TRAP, OC and RANKL (P > 0.05), whereas OPG showed higher PEO labeling in the OVX group (P < 0.05). Biomechanical analysis showed higher reverse torque values (N.cm) for PEO, irrespective of whether they were OVX or SHAM groups (P < 0.05).

CONCLUSION

The results indicated that the PEO texturing method favored bone formation and showed higher bone maturation levels during later periods in osteoporotic rats.

Phosphate Porous Coatings Enriched with Selected Elements via PEO Treatment on Titanium and Its Alloys: A Review

This paper shows that the subject of porous coatings fabrication by Plasma Electrolytic Oxidation (PEO), known also as Micro Arc Oxidation (MAO), is still current, inter alia because metals and alloys, which can be treated by the PEO method, for example, titanium, niobium, tantalum and their alloys, are increasingly available for sale. On the international market, apart from scientific works/activity developed at universities, scientific research on the PEO coatings is also underway in companies such as Keronite (Great Britain), Magoxid-Coat (Germany), Mofratech (France), Machaon (Russia), as well as CeraFuse, Tagnite, Microplasmic (USA). In addition, it should be noted that the development of the space industry and implantology will force the production of trouble-free micro- and macro-machines with very high durability. Another aspect in favor of this technique is the rate of part treatment, which does not exceed several dozen minutes, and usually only lasts a few minutes. Another advantage is functionalization of fabricated surface through thermal or hydrothermal modification of fabricated coatings, or other methods (Physical vapor deposition (PVD), chemical vapor deposition (CVD), sol-gel), including also reoxidation by PEO treatment in another electrolyte. In the following chapters, coatings obtained both in aqueous solutions and electrolytes based on orthophosphoric acid will be presented; therein, dependent on the PEO treatment and the electrolyte used, they are characterized by different properties associated with their subsequent use. The possibilities for using coatings produced by means of plasma electrolytic oxidation are very wide, beginning from various types of catalysts, gas sensors, to biocompatible and antibacterial coatings, as well as hard wear coatings used in machine parts, among others, used in the aviation and aerospace industries.

Antibacterial and cytocompatible coatings based on poly(adipic anhydride) for a Ti alloy surface

This paper describes a formation of hybrid coatings on a Ti–2Ta–3Zr–36Nb surface. This is accomplished by plasma electrolytic oxidation and a dip-coating technique with poly(adipic anhydride) ((C₆H₈O₃)n) that is loaded with drugs: amoxicillin (C₁₆H₁₉N₃O₅S), cefazolin (C₁₄H₁₄N₈O₄S₃) or vancomycin (C₆₆H₇₅Cl₂N₉O₂₄ · xHCl). The characteristic microstructure of the polymer was evaluated using scanning electron microscopy and confocal microscopy. Depending on the surface treatment, the surface roughness varied (between 1.53 μm and 2.06 μm), and the wettability was change with the over of time. X-ray photoelectron spectroscopy analysis showed that the oxide layer did not affect the polymer layer or loaded drugs. However, the drugs lose their stability in a phosphate-buffered saline solution after 6.5 h of exposure, and its decrease was greater than 7% (HPLC analysis). The stability, drug release and concentration of the drug loaded into the material were precisely analyzed by high-performance liquid chromatography. The results correlated with the degradation of the polymer in which the addition of drugs caused the percent of degraded polymer to be between 35.5% and 49.4% after 1 h of material immersion, depending on the mass of the loaded drug and various biological responses that were obtained. However, all of the coatings were cytocompatible with MG-63 osteoblast-like cells. The drug concentrations released from the coatings were sufficient to inhibit adhesion of reference and clinical bacterial strains (S. aureus). The coatings with amoxicillin showed the best results in the bacterial inhibition zone, whereas coatings with cefazolin inhibited adhesion of the above bacteria on the surface.

•

Hybrid layers containing fast degradable poly(adipic anhydride) (PADA) were performed.

•

Drugs stability, concentration of released and loaded drugs were evaluated using HPLC.

•

Adhesion of S. aureus clinical and reference strains confirmed the antibaterial properties.

•

Performed hybrid layers were cytocompatible (MG-63 tests).

Electrical stimulation as a novel tool for regulating cell behavior in tissue engineering

Recently, electrical stimulation as a physical stimulus draws lots of attention. It shows great potential in disease treatment, wound healing, and mechanism study because of significant experimental performance. Electrical stimulation can activate many intracellular signaling pathways, and influence intracellular microenvironment, as a result, affect cell migration, cell proliferation, and cell differentiation. Electrical stimulation is using in tissue engineering as a novel type of tool in regeneration medicine. Besides, with the advantages of biocompatible conductive materials coming into view, the combination of electrical stimulation with suitable tissue engineered scaffolds can well combine the benefits of both and is ideal for the field of regenerative medicine. In this review, we summarize the various materials and latest technologies to deliver electrical stimulation. The influences of electrical stimulation on cell alignment, migration and its underlying mechanisms are discussed. Then the effect of electrical stimulation on cell proliferation and differentiation are also discussed.

Characterization, Bioactivity and Antibacterial Properties of Copper-Based TiO2 Bioceramic Coatings Fabricated on Titanium

The bioactive and anti-bacterial Cu-based bioceramic TiO2 coatings have been fabricated on cp-Ti (Grade 2) by two-steps. These two-steps combine micro-arc oxidation (MAO) and physical vapor deposition–thermal evaporation (PVD-TE) techniques for dental implant applications. As a first step, all surfaces of cp-Ti substrate were coated by MAO technique in an alkaline electrolyte, consisting of Na3PO4 and KOH in de-ionized water. Then, as a second step, a copper (Cu) nano-layer with 5 nm thickness was deposited on the MAO by PVD-TE technique. Phase structure, morphology, elemental amounts, thickness, roughness and wettability of the MAO and Cu-based MAO coating surfaces were characterized by XRD (powder- and TF-XRD), SEM, EDS, eddy current device, surface profilometer and contact angle goniometer, respectively. The powder- and TF-XRD spectral analyses showed that Ti, TiO2, anatase-TiO2 and rutile-TiO2 existed on the MAO and Cu-based MAO coatings’ surfaces. All coatings’ surfaces were porous and rough, owing to the presence of micro sparks through MAO. Furthermore, the surface morphology of Cu-based MAO was not changed. Also, the Cu-based MAO coating has more hydrophilic properties than the MAO coating. In vitro bioactivity and in vitro antibacterial properties of the coatings have been investigated by immersion in simulated body fluid (SBF) at 36.5 °C for 28 days and bacterial adhesion for gram-positive (S. aureus) and gram-negative (E. coli) bacteria, respectively. The apatite layer was formed on the MAO and Cu-based MAO surfaces at post-immersion in SBF and therefore, the bioactivity of Cu-based MAO surface was increased to the MAO surface. Also, for S. aureus and E. coli, the antibacterial properties of Cu-based MAO coatings were significantly improved compared to one of the uncoated MAO surfaces. These results suggested that Cu-based MAO coatings on cp-Ti could be a promising candidate for biomedical dental implant applications.

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

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

STATEMENT OF SIGNIFICANCE

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

Influence of macroporosity on NIH/3T3 adhesion, proliferation, and osteogenic differentiation of MC3T3-E1 over bio-functionalized highly porous titanium implant material

Highly porous Ti implant materials are being used in order to overcome the stress shielding effect on orthopedic implants. However, the lack of bioactivity on Ti surfaces is still a major concern regarding the osseointegration process. It is known that the rapid recruitment of osteoblasts in bone defects is an essential prerequisite for efficient bone repair. Conventionally, osteoblast recruitment to bone defects and subsequent bone repair has been achieved using growth factors. Thus, in this study highly porous Ti samples were processed by powder metallurgy using space holder technique followed by the bio-functionalization through microarc oxidation using a Ca- and P-rich electrolyte. The biological response in terms of early cell response, namely, adhesion, spreading, viability, and proliferation of the novel biofunctionalized highly porous Ti was carried out with NIH/3T3 fibroblasts and MC3T3-E1 preosteoblasts in terms of viability, adhesion, proliferation, and alkaline phosphatase activity. Results showed that bio-functionalization did not affect the cell viability. However, bio-functionalized highly porous Ti (22% porosity) enhanced the cell proliferation and activity. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 73-85, 2019.

Surface modification of valve metals using plasma electrolytic oxidation for antibacterial applications: A review

Plasma electrolytic oxidation (PEO) is an advance technique to develop porous oxidation layer on light metals, primarily to enhance corrosion and wear resistance. The oxidation layer can also offer a wide variety of mechanical, biomedical, tribological, and antibacterial properties through the incorporation of several ions and particles. Due to the increasing need of antimicrobial surfaces for biomedical implants, antibacterial PEO coatings have been developed through the incorporation of antibacterial agents. Metallic nanoparticles that have been employed most widely as antibacterial agents are reported to demonstrate serious health and environmental threats. To overcome the current limitations of these coatings, there is a significant need to develop antibacterial surfaces that are not harmful for patient's health and environment. Attention of the readers has been directed to utilize bioactive glasses as antibacterial agents for PEO coatings. Bioactive glasses are well known for their excellent bioactivity, biocompatibility, and antibacterial character. PEO coatings incorporated with bioactive glasses can provide environment-friendly antimicrobial surfaces with exceptional bioactivity, biocompatibility, and osseointegration. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 590-605, 2018.

The effect of manufacturing techniques on custom-made titanium cranioplasty plates: A pilot study

OBJECTIVE

This study investigated the effect of varying techniques on the surface characteristics of pressed titanium cranioplasty plates, commonly manufactured in laboratory practice. The aim was to highlight the variety of techniques currently used, assess these methods of manufacture and produce manufacturing recommendations.

METHODS

A questionnaire identified manufacturing methods commonly used by maxillofacial prosthetists. The plate surfaces were examined using scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) spectrometry. The surface differences and titanium compositions were statistically analysed.

RESULTS

Bead blasting with aluminium oxide (Al₂O₃) showed a significant decrease (p < 0.001) in titanium surface composition, replaced by a large aluminium content. Trimming tool choice had a significant impact (p = 0.001) on surface contamination by smoothing wheel material deposition; however passivation and anodising techniques had no significant effect (p = 0.293 and p = 0.257, respectively) on the surface composition or roughness of titanium samples.

CONCLUSIONS

A large range of manufacturing techniques of titanium cranioplasty plates was confirmed and significant differences were found. Amongst other recommendations, bead blasting with Al₂O₃ is not recommended for commercially pure titanium implant surface finishing due to aluminium contamination. The recommendations outlined will minimise manufacturing time, reduce risk of complication (thus costs) and unify methods to enable a safe, reliable treatment.

Electrophoretic deposition of organic/inorganic composite coatings containing ZnO nanoparticles exhibiting antibacterial properties

To address one of the serious problems associated with permanent implants, namely bacterial infections, novel organic/inorganic coatings containing zinc oxide nanoparticles (nZnO) are proposed. Coatings were obtained by electrophoretic deposition (EPD) on stainless steel 316L. Different deposition conditions namely: deposition times in the range 60-300s and applied voltage in the range 5-30V as well as developing a layered coating approach were studied. Antibacterial tests against gram-positive Staphylococcus aureus and gram-negative Salmonella enteric bacteria confirmed the activity of nZnO to prevent bacterial growth. Coatings composition and morphology were analyzed by thermogravimetric analysis, Fourier transform infrared spectroscopy, scanning electron microscopy and energy dispersive X-ray spectroscopy. Moreover, the corrosion resistance was analyzed by evaluation of the polarization curves in DMEM at 37°C, and it was found that coatings containing nZnO increased the corrosion resistance compared to the bare substrate. Considering all results, the newly developed coatings represent a suitable alternative for the surface modification of metallic implants.

SEM, EDS and XPS Analysis of the Coatings Obtained on Titanium after Plasma Electrolytic Oxidation in Electrolytes Containing Copper Nitrate

In the paper, the Scanning Electron Microscopy (SEM) with Energy Dispersive X-ray Spectroscopy (EDS) and X-ray Photoelectron Spectroscopy (XPS) results of the surface layer formed on pure titanium after plasma electrolytic oxidation (micro arc oxidation) at the voltage of 450 V are shown. As an electrolyte, the mixture of copper nitrate Cu(NO₃)₂ (10–600 g/L) in concentrated phosphoric acid H₃PO₄ (98 g/mol) was used. The thickness of the obtained porous surface layer equals about 10 μm, and it consists mainly of titanium phosphates and oxygen with embedded copper ions as a bactericidal agent. The maximum percent of copper in the PEO surface layer was equal to 12.2 ± 0.7 wt % (7.6 ± 0.5 at %), which is the best result that the authors obtained. The top surface layer of all obtained plasma electrolytic oxidation (PEO) coatings consisted most likely mainly of Ti₃(PO₄)₄∙nH₃PO₄ and Cu₃(PO₄)₂∙nH₃PO₄ with a small addition of CuP₂, CuO and Cu₂O.