Interactions between human whole blood and modified TiO2-surfaces: influence of surface topography and oxide thickness on leukocyte adhesion and activation

Advanced Antimicrobial and Anti-Infective Strategies to Manage Peri-Implant Infection: A Narrative Review

Despite reductions in bacterial infection and enhanced success rate, the widespread use of systemic antibiotic prophylaxis in implant dentistry is controversial. This use has contributed to the growing problem of antimicrobial resistance, along with creating significant health and economic burdens. The basic mechanisms that cause implant infection can be targeted by new prevention and treatment methods which can also lead to the reduction of systemic antibiotic exposure and its associated adverse effects. This review aims to summarize advanced biomaterial strategies applied to implant components based on anti-pathogenic mechanisms and immune balance mechanisms. It emphasizes that modifying the dental implant surface and regulating the early immune response are promising strategies, which may further prevent or slow the development of peri-implant infection, and subsequent failure.

Fibroblasts and osteoblasts behavior after contact with different titanium surfaces used as implant abutment: An in vitro experimental study

Background

The goal of this in vitro study was to compare three different surfaces: two types of implant surfaces commercially available ([a] smooth/machined and [b] acid-treated surface) versus (c) anodized surface. Discs were manufactured with commercially pure titanium (CP) grade IV, which were subsequently analyzed by scanning microscopy and fibroblastic and osteoblastic cell cultures.

Methods

Ninety-nine discs (5 × 2 mm) were manufactured in titanium grade IV and received different surface treatments: (i) Mach group: machined; (ii) AA group: double acid etch; and (iii) AN group: anodizing treatment. Three discs from each group were analyzed by Scanning Electron Microscopy (SEM) to obtain surface topography images and qualitatively analyzed by EDS. Balb/c 3T3 fibroblasts and pre-osteoblastic cells (MC3T3-E1 lineage) were used to investigate each group's biological response (n = 10/cellular type). The data were compared statistically using the ANOVA one-way test, considered as a statistically significant difference p < 0.05.

Results

The AA group had numerous micropores with diameters between 5 and 10 μm, while nanopores between 1 and 5 nm were measured in the AN group. The EDX spectrum showed a high titanium concentration in all the analyzed samples. The contact angle and wetting tension were higher in the AA, whereas similar results were observed for the other groups. A lower result was observed for base width in the AA, which was higher in the other two groups. The AN showed the best values in the fibroblast cells, followed by Mach and AA; whereas, in the culture of the MC3T3 cells, the result was precisely the opposite (AA > Mach > AN). There was similar behavior for cell adhesion for the test groups (Mach and AN), with greater adhesion of Balb/c 3T3 fibroblasts compared to MC3T3 cells; in the AA group, there was greater adherence for MC3T3 cells compared to Balb/c 3T3 fibroblasts.

Conclusions

The findings suggest that different surface characteristics can produce different biological responses, possibly cell-line dependent. These findings have important implications for the design of implantable medical devices, where the surface characteristics can significantly impact its biocompatibility.

Effects of Micro-Arc Oxidation Discharge Parameters on Formation and Biomedical Properties of Hydroxyapatite-Containing Flower-like Structure Coatings

The micro-arc oxidation (MAO) process was used to prepare hydroxyapatite-containing flower-like structure coatings on commercially pure titanium substrates with various values of the applied voltage (330, 390, 450 V), applied current (0.4, 0.5, 0.6 A), and duration time (1, 3, 5 min). It was found that the surface morphology of the coatings was determined primarily by the applied voltage. A voltage of 330 V yielded a flower-like/plate-like structure, while voltages of 390 V and 450 V produced a flower-like structure and a porous morphology, respectively. The applied current and duration time mainly affected the coating formation speed and petal size of the flower-like structures, respectively. The coatings prepared using voltages of 330 V and 390 V (0.6 A, 5 min) both contained Ti, TiO₂-A (anatase), TiO₂-R (rutile), DCPD (CaHPO₄·2H₂O, calcium hydrogen phosphate), and hydroxyapatite (HA). However, the latter coating contained less DCPD and had a higher HA/DCPD ratio and a Ca/P ratio closer to the ideal value of HA. The coating prepared with a voltage of 450 V consisted mainly of Ti, TiO₂-A, TiO₂-R, and CaTiO₃. For the coatings prepared with a voltage of 390 V, the flower-like structures consisted mainly of HA-containing compounds. DCPD plate-like structures were observed either between the HA-containing flower-like structures (330 V samples) or within the flower-like structures themselves (390 V samples). The coating surfaces with flower-like/plate-like or flower-like structures had a greater roughness, which increased their hydrophilicity and resulted in superior bioactivity (SBF immersion) and biocompatibility (MG-63 cell culture). The optimal biomedical performance was found in the 390 V coating due to its flower-like structure and high HA/DCPD ratio.

Surface Properties and In Vitro Corrosion Studies of Blasted and Thermally Treated Ti6Al4V Alloy for Bioimplant Applications

The biomedical Ti6Al4V alloy was thermally treated under sandblasting and mirror finish surface preparation conditions. The surface morphology, structure, roughness, wettability, and energy were characterized. Microhardness and in vitro corrosion studies were carried out. X-ray diffraction results showed a formation of rutile TiO₂ phase for thermally treated samples under different pretreated conditions. The thermally oxidized samples exhibited an increase in microhardness compared to the untreated mirror finish and sandblasted samples by 22 and 33%, respectively. The wettability study revealed enhanced hydrophilicity of blasted and thermally treated samples. The surface energy of the thermal treatment samples increased by 26 and 32.6% for mirror surface and blasted preconditions, respectively. The acquired in vitro corrosion results using potentiodynamic polarization measurement and electrochemical impedance spectroscopy confirmed the surface protective performance against corrosion in Hank's medium. The enhanced surface characteristics and corrosion protection of treated Ti6Al4V alloy give it potential for bio-implant applications.

A systematic review on neutrophils interactions with titanium and zirconia surfaces: Evidence from in vitro studies

Objectives

This systematic review aimed to assess in vitro studies that evaluated neutrophil interactions with different roughness levels in titanium and zirconia implant surfaces.

Material and Methods

An electronic search for literature was conducted on PubMed, Embase, Scopus, and Web of Science and a total of 14 studies were included. Neutrophil responses were assessed based on adhesion, cell number, surface coverage, cell structure, cytokine secretion, reactive oxygen species (ROS) production, neutrophil activation, receptor expression, and neutrophil extracellular traps (NETs) release. The method of assessing the risk of bias was done using the toxicological data reliability assessment tool (TOXRTOOL).

Results

Ten studies have identified a significant increase in neutrophil functions, such as surface coverage, cell adhesion, ROS production, and NETs released when interacting with rough titanium surfaces. Moreover, neutrophil interaction with rough–hydrophilic surfaces seems to produce less proinflammatory cytokines and ROS when compared to naive smooth and rough titanium surfaces. Regarding membrane receptor expression, two studies have reported that the FcγIII receptor (CD16) is responsible for initial neutrophil adhesion to hydrophilic titanium surfaces. Only one study compared neutrophil interaction with titanium alloy and zirconia toughened alumina surfaces and reported no significant differences in neutrophil cell count, activation, receptor expression, and death.

Conclusions

There are not enough studies to conclude neutrophil interactions with titanium and zirconia surfaces. However, different topographic modifications such as roughness and hydrophilicity might influence neutrophil interactions with titanium implant surfaces.

Chemical Evaluation of Energy Dispersive X-ray Spectroscopy Analysis of Different Failing Dental Implant Surfaces: A Comparative Clinical Trial

The aim of the present study is to compare two different implant surface chemistries of failing dental implants. Sixteen patients (mean age: 52 ± 8.27 with eight females and eight males) and 34 implants were included in the study. Group-I implants consisted of a blasted/etched surface with a final process surface, while Group-II implants consisted of the sandblasted acid etching (SLA) method. The chemical surface analysis was performed by the energy dispersive X-ray spectroscopy (EDX) method from coronal, middle, and apical parts of each implant. Titanium (Ti) element values were found to be 20.22 ± 15.7 at.% in Group I and 33.96 ± 13.62 at.% in Group-II in the middle of the dental implants. Aluminum (Al) element values were found to be 0.01 ± 0.002 in Group-I and 0.17 ± 0.28 at.% in Group II in the middle of the dental implants, and statistically significant differences were found between the groups for the Al and Ti elements in the middle of the dental implants (p < 0.05). There was a statistically significant difference for the Ti, Al, O, Ca, Fe, P, and Mg elements in the coronal, middle, and apical parts of the implants in the intragroup evaluation (p < 0.05). It is reported that different parts of the implants affected by peri-implant inflammation show different surface chemistries, from coronal to apical, but there is no difference in the implants with different surfaces.

Combating Implant Infections: Shifting Focus from Bacteria to Host

The widespread use of biomaterials to support or replace body parts is increasingly threatened by the risk of implant-associated infections. In the quest for finding novel anti-infective biomaterials, there generally has been a one-sided focus on biomaterials with direct antibacterial properties, which leads to excessive use of antibacterial agents, compromised host responses, and unpredictable effectiveness in vivo. This review sheds light on how host immunomodulation, rather than only targeting bacteria, can endow biomaterials with improved anti-infective properties. How antibacterial surface treatments are at risk to be undermined by biomaterial features that dysregulate the protection normally provided by critical immune cell subsets, namely, neutrophils and macrophages, is discussed. Accordingly, how the precise modification of biomaterial surface biophysical cues, or the incorporation of immunomodulatory drug delivery systems, can render biomaterials with the necessary immune-compatible and immune-protective properties to potentiate the host defense mechanisms is reviewed. Within this context, the protective role of host defense peptides, metallic particles, quorum sensing inhibitors, and therapeutic adjuvants is discussed. The highlighted immunomodulatory strategies may lay a foundation to develop anti-infective biomaterials, while mitigating the increasing threat of antibacterial drug resistance.

Comparative Evaluation of the Effects of CO2 and Er:YAG Lasers on Smear Layer Removal and Blood Cell Attachment to Tooth Root Surfaces

Introduction: The tooth root surfaces are modified by different agents for better removal of the smear layer, the formation of fibrin clots, and the attachment of blood cells. This in vitro study compared the removal of the smear layer, the formation of fibrin clots and the attachment of blood cells after exposing periodontally compromised root surfaces to ER:YAG and CO₂ laser beams. Methods: Eighteen dentin block samples were prepared from freshly extracted periodontally compromised teeth that were deemed hopeless, and they were divided into 3 groups: exposed to Er:YAG laser beams, exposed to CO₂ laser beams, and the control group. The samples were evaluated using scanning electron microscopy and micrographs were taken. Smear layer removal and blood cell attachment were scored. Data were analyzed using Kruskal-Wallis and MannWhitney tests. Results: In the Er:YAG laser group, the smear layer was removed completely. In the specimens exposed to blood, better fibrin clot formation and blood cell attachment were observed in the Er:YAG laser group. In the CO₂ laser group, the smear layer was also removed; however, there were no significant differences between the CO₂ laser and control groups in fibrin clot formation and blood cell attachment. Conclusion: The application of the Er:YAG laser to the root dentin appears to result in the formation of a suitable surface for fibrin clot formation and blood cell attachment. Further clinical studies are necessary to support these results.

In Vitro Thrombogenicity Testing of Biomaterials

The short- and long-term thrombogenicity of implant materials is still unpredictable, which is a significant challenge for the treatment of cardiovascular diseases. A knowledge-based approach for implementing biofunctions in materials requires a detailed understanding of the medical device in the biological system. In particular, the interplay between material and blood components/cells as well as standardized and commonly acknowledged in vitro test methods allowing a reproducible categorization of the material thrombogenicity requires further attention. Here, the status of in vitro thrombogenicity testing methods for biomaterials is reviewed, particularly taking in view the preparation of test materials and references, the selection and characterization of donors and blood samples, the prerequisites for reproducible approaches and applied test systems. Recent joint approaches in finding common standards for a reproducible testing are summarized and perspectives for a more disease oriented in vitro thrombogenicity testing are discussed.

Effects of calcium and phosphorus incorporation on the properties and bioactivity of TiO2 nanotubes

In this study, we investigate the formation of calcium and phosphorus-doped TiO₂ nanotubes, produced by potentiostatic anodization of Ti in viscous electrolyte-containing HF and Ca/P ions. Characterization of the produced oxide layer was conducted using scanning electron microscopy, glancing-angle X-ray diffraction, X-ray photoelectron spectroscopy, contact angle, and protein adsorption measurements. Adipose-derived stem cells were used to study material cytotoxicity, cell viability and proliferation, and cell morphology and growth. To evaluate the adipose-derived stem-cell differentiation, we investigated the expression of osteocalcin and osteopontin by cells as well as calcium mineralization. Results show that it was possible to produce a superhydrophilic titanium oxide nanotube layer with incorporation of Ca and P ions. The presence of Ca and P in the oxide layer not only improved the cell adhesion and proliferation but also stimulated the production of key marker proteins indicating differentiation of cells.

Biological responses of human bone mesenchymal stem cells to Ti and TiZr implant materials

BACKGROUND

Titanium-zirconium alloy (TiZr1317) is a new material used for biological implants. There are several studies on the effects of TiZr implants on the biological characteristics of human bone mesenchymal stem cells (hBMSCs).

PURPOSE

The purpose of this study was to investigate the biological responses of hBMSCs to implant holes affected by the physicochemical properties of oral implants (Ti_SLA , Ti_SLActive , TiZr_SLA , and TiZr_SLActive ).

MATERIALS AND METHODS

Grade 4 Ti and TiZr (13-17% Zr) substrates were modified by sand-blasted large-grit acid-etched (SLA) or hydrophilic sand-blasted large-grit acid-etched (SLActive), resulting in four types of surface with complex microstructures corresponding to the commercially-available implants SLA, RoxolidSLA, SLActive, and RoxolidSLActive (Institute Straumann AG, Basel, Switzerland). Physicochemical properties were detected and the biological responses of hBMSCs were observed.

RESULTS

Surface morphology characterization by scanning electron microscopy and atomic force microscopy revealed differences between the four groups. SLA_ctive had higher surface energy/wettability than SLA, indicating that increased surface energy/wettability can promote the absorption of osteogenic proteins and enhance osseointegration. hBMSCs seeded on SLActive substrates exhibited better performance in terms of cell attachment, proliferation and osteoblastic differentiation than cells seeded on SLA.

CONCLUSION

Because of their more suitable physicochemical properties, Ti_SLActive and TiZr_SLActive materials demonstrated more pronounced effects on the biological responses of hBMSCs compared with Ti_SLA and TiZr_SLA .

Silver release of Ag (I) doped hydroxyapatite: In vitro study

A material is produced by doping of silver (Ag (I)) which has antibacterial property to nano hydroxyapatite (nHAp), to remove the hipersensitivity in the teeth by closing the dentine tubules or dental micro cracks of the teeth and effective against for some bacteria. The doping of Ag (I) can also produces a toxic effect. Ag (I) can be released from the structure as a result of biological, physical and chemical effects and may cause toxicity. Therefore, it is important to determine whether the presence of Ag (I) has a toxic effect. In this study, Ag (I)-doped nHAp was synthesized by precipitation method and tried to determine the release values as a function of time compared to the doping rate by using the ICP-OES. Also, the products we produce in simulated body fluid were kept for retention periods of 4-20 weeks to determine degradation percentages. A cytotoxicity study was performed to observe the toxic effect that may be caused by possible Ag (I) release. According to the analysis, the release values in all products were observed in ppb level. And it is concluded that the materials produced are not degraded. Cell viability values of more than 70% were obtained. It was observed that the release of Ag (I) bound to Ag (I)-doped nHAp hexagonal structure was very low. It was concluded that the products are not degraded and Ag (I)-doped nHAp to a certain ratio is a biocompatible material that can be used in dentistry for treatment.

Increasing the Stability of Dental Implants: the Concept of Osseodensification

One of the most important factors that affect osseointegration is the primary stability of the implant. Dental implants inserted at the posterior region of the maxilla exhibit the lowest success rates as the low density bone in this area often jeopardize rigid fixation of the implant. Many surgical techniques have been developed to increase the primary stability of an implant placed in low density bone, such as bicortical fixation of the implant, undersized preparation of the implant bed and bone condensation by the use of osteotomes. A new promising technique, named osseodensification, has been recently developed that creates an autograft layer of condensed bone at the periphery of the implant bed by the aid of specially designed burs rotating in a clockwise and anti-clockwise direction. The purpose of this review is to emphasize that implant primary stability is strongly influenced by the surgical technique, to quote and briefly analyse the various surgical procedures laying weight to osseodensification procedure.

Enhanced Anti-Infective Efficacy of ZnO Nanoreservoirs through a Combination of Intrinsic Anti-Biofilm Activity and Reinforced Innate Defense

The increasing prevalence of implant-associated infections (IAIs) imposes a heavy burden on patients and medical providers. Bacterial biofilms are recalcitrant to antiseptic drugs and local immune defense and can attenuate host proinflammatory response to interfere with bacterial clearance. Zinc oxide nanoparticles (ZnO NPs) play a dual role in antibacterial and immunomodulatory activities but compromise the cytocompatibility because of their intracellular uptake. Here, ZnO NPs were immobilized on titanium to form homogeneous nanofilms (from discontinuous to continuous) through magnetron sputtering, and the possible antimicrobial activity and immunomodulatory effect of nano-ZnO films were investigated. Nano-ZnO films were found to prohibit sessile bacteria more than planktonic bacteria in vitro, and the antibacterial effect occurred in a dose-dependent manner. Using a novel mouse soft tissue IAI model, the in vivo results revealed that nano-ZnO films possessed outstanding antimicrobial efficacy, which could not be ascribed solely to the intrinsic anti-infective activity of nano-ZnO films observed in vitro. Macrophages and polymorphonuclear leukocytes (PMNs), two important factors in innate immune response, were cocultured with nano-ZnO and bacteria/lipopolysaccharide in vitro, and the nano-ZnO films could enhance the antimicrobial efficacy of macrophages and PMNs through promoting phagocytosis and secretion of inflammatory cytokines. This study provides insights into the anti-infective activity and mechanism of ZnO and consolidates the theoretical basis for future clinical applications of ZnO.

Role for Mechanotransduction in Macrophage and Dendritic Cell Immunobiology

Tissue homeostasis is not only controlled by biochemical signals but also through mechanical forces that act on cells. Yet, while it has long been known that biochemical signals have profound effects on cell biology, the importance of mechanical forces has only been recognized much more recently. The types of mechanical stress that cells experience include stretch, compression, and shear stress, which are mainly induced by the extracellular matrix, cell-cell contacts, and fluid flow. Importantly, macroscale tissue deformation through stretch or compression also affects cellular function.Immune cells such as macrophages and dendritic cells are present in almost all peripheral tissues, and monocytes populate the vasculature throughout the body. These cells are unique in the sense that they are subject to a large variety of different mechanical environments, and it is therefore not surprising that key immune effector functions are altered by mechanical stimuli. In this chapter, we describe the different types of mechanical signals that cells encounter within the body and review the current knowledge on the role of mechanical signals in regulating macrophage, monocyte, and dendritic cell function.

Effects of nanotopography on the in vitro hemocompatibility of nanocrystalline diamond coatings

Nanocrystalline diamond (NCD) coatings have been investigated for improved wear resistance and enhanced hemocompatibility of cardiovascular devices. The goal of this study was to evaluate the effects of NCD surface nanotopography on in vitro hemocompatibility. NCD coatings with small (NCD-S) and large (NCD-L) grain sizes were deposited using microwave plasma chemical vapor deposition and characterized using scanning electron microscopy, atomic force microscopy, contact angle testing, and Raman spectroscopy. NCD-S coatings exhibited average grain sizes of 50-80 nm (RMS 5.8 nm), while NCD-L coatings exhibited average grain sizes of 200-280 nm (RMS 23.1 nm). In vitro hemocompatibility testing using human blood included protein adsorption, hemolysis, nonactivated partial thromboplastin time, platelet adhesion, and platelet activation. Both NCD coatings demonstrated low protein adsorption, a nonhemolytic response, and minimal activation of the plasma coagulation cascade. Furthermore, the NCD coatings exhibited low thrombogenicity with minimal platelet adhesion and aggregation, and similar morphological changes to surface-bound platelets (i.e., activation) in comparison to the HDPE negative control material. For all assays, there were no significant differences in the blood-material interactions of NCD-S versus NCD-L. The two tested NCD coatings, regardless of nanotopography, had similar hemocompatibility profiles compared to the negative control material (HDPE) and should be further evaluated for use in blood-contacting medical devices. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 253-264, 2017.

Surface properties of Ti-6Al-4V alloy part I: Surface roughness and apparent surface free energy

Titanium (Ti) and its alloys are the most often used implants material in dental treatment and orthopedics. Topography and wettability of its surface play important role in film formation, protein adhesion, following osseointegration and even duration of inserted implant. In this paper, we prepared Ti-6Al-4V alloy samples using different smoothing and polishing materials as well the air plasma treatment, on which contact angles of water, formamide and diiodomethane were measured. Then the apparent surface free energy was calculated using four different approaches (CAH, LWAB, O-W and Neumann's Equation of State). From LWAB approach the components of surface free energy were obtained, which shed more light on the wetting properties of samples surface. The surface roughness of the prepared samples was investigated with the help of optical profilometer and AFM. It was interesting whether the surface roughness affects the apparent surface free energy. It was found that both polar interactions the electron donor parameter of the energy and the work of water adhesion increased with decreasing roughness of the surfaces. Moreover, short time plasma treatment (1min) caused decrease in the surface hydrophilic character, while longer time (10min) treatment caused significant increase in the polar interactions and the work of water adhesion. Although Ti-6Al-4V alloy has been investigated many times, to our knowledge, so far no paper has been published in which surface roughness and changes in the surface free energy of the alloy were compared in the quantitative way in such large extent. This novel approach deliver better knowledge about the surface properties of differently smoothed and polished samples which may be helpful to facilitate cell adhesion, proliferation and mineralization. Therefore the results obtained present also potentially practical meaning.

The role of angiogenesis in implant dentistry part I: Review of titanium alloys, surface characteristics and treatments

Background

Angiogenesis plays an important role in osseointegration process by contributing to inflammatory and regenerative phases of surrounding alveolar bone. The present review evaluated the effect of titanium alloys and their surface characteristics including: surface topography (macro, micro, and nano), surface wettability/energy, surface hydrophilicity or hydrophobicity, surface charge, and surface treatments of dental implants on angiogenesis events, which occur during osseointegration period.

Material and Methods

An electronic search was performed in PubMed, MEDLINE, and EMBASE databases via OVID using the keywords mentioned in the PubMed and MeSH headings regarding the role of angiogenesis in implant dentistry from January 2000-April 2014.

Results

Of the 2,691 articles identified in our initial search results, only 30 met the inclusion criteria set for this review. The hydrophilicity and topography of dental implants are the most important and effective surface characteristics in angiogenesis and osteogenesis processes. The surface treatments or modifications of dental implants are mainly directed through the enhancement of biological activity and functionalization in order to promote osteogenesis and angiogenesis, and accelerate the osseointegration procedure.

Conclusions

Angiogenesis is of great importance in implant dentistry in a manner that most of the surface characteristics and treatments of dental implants are directed toward creating a more pro-angiogenic surface on dental implants. A number of studies discussed the effect of titanium alloys, dental implant surface characteristic and treatments on agiogenesis process. However, clinical trials and in-vivo studies delineating the mechanisms of dental implants, and their surface characteristics or treatments, action in angiogenesis processes are lagging.

Key words:Angiogenesis, dental implant, osseointergration.

Mineralization at Titanium Surfaces is a Two-Step Process

Mapping the initial reaction of implants with blood or cell culture medium is important for the understanding of the healing process in bone. In the present study, the formation of low crystalline carbonated hydroxyapatite (CHA) onto commercially pure titanium (Ti) implants from cell culture medium and blood, is described as an early event in bone healing at implants. The Ti-implants were incubated with cell culture medium (DMEM) or whole blood and the surface concentration of Ca, P and HA was analyzed by XPS, EDX and Tof-SIMS. After incubation with DMEM for 16 h and 72 h, EDX and XPS analysis showed stable levels of Ca and P on the Ti-surface. ESEM images showed an even distribution of Ca and P. Further analysis of the XPS results indicated that CHA was formed at the implants. Analysis with ToF-SIMS yielded high m.w. fragments of HA, such as Ca₂PO4 at m/z 174.9 and Ca₃PO₅ at m/z 230.8, as secondary ions at the Ti-surfaces. Analysis of implants incubated in blood for 16 h, with ToF-SIMS, showed initial formation of CHA yielding CaOH as secondary ion. The results indicate that early mineralization at Ti-surfaces is an important step in the healing of implants into bone.

A comparative study to evaluate the osteoblastic cell behavior of two nano coated titanium surfaces with NAFION stabilized the membrane

AIM

The aim of the study was to comparatively analyze the in vitro cell adhesion between nano coated titanium dioxide, and calcium hydroxyapatite (HA) coated titanium samples.

MATERIALS AND METHODS

Nano coated titanium dioxide, and calcium HA were coated onto the titanium samples by drop casting with NAFION membrane and cell culture was done by seeding human osteoblastic sarcoma cells on the coated samples.

RESULTS AND CONCLUSION

There was marked cell adhesion seen in the samples coated by titanium dioxide nano particles and more cells spreading as compared to calcium HA nano particles.

Histologic analysis of resorbable blasting media surface implants retrieved from humans: a report of two cases

The purpose of this study is to evaluate the degree of osseointegration of resorbable blasting media (RBM) surface implants retrieved from humans. Three implants in the mandibular molar region that were surface-treated with RBM were retrieved from two patients. The implants were used to manufacture specimens in order to measure the bone-implant contact (BIC) ratio. The BIC ratios of the three implants were found to be an average of 69.0%±9.1%. In conclusion, that RBM surface implants are integrated into the host environment with histological significance and the BIC ratio of the RBM surface-treated implant was not significantly different from that of other surface-treated implants.

Halloysite Nanotube Coatings Suppress Leukocyte Spreading

The nanoscale topography of adhesive surfaces is known to be an important factor governing cellular behavior. Previous work has shown that surface coatings composed of halloysite nanotubes enhance the adhesion, and therefore capture of, rare target cells such as circulating tumor cells. Here we demonstrate a unique feature of these coatings in their ability to reduce the adhesion of leukocytes and prevent leukocyte spreading. Surfaces were prepared with coatings of halloysite nanotubes and functionalized for leukocyte adhesion with E-selectin, and the dilution of nanotube concentration revealed a threshold concentration below which cell spreading became comparable to smooth surfaces. Evaluation of surface roughness characteristics determined that the average distance between discrete surface features correlated with adhesion metrics, with a separation distance of ∼2 μm identified as the critical threshold. Computational modeling of the interaction of leukocytes with halloysite nanotube-coated surfaces of varying concentrations demonstrates that the geometry of the cell surface and adhesive counter-surface produces a significantly diminished effective contact area compared to a leukocyte interacting with a smooth surface.

Enhanced differentiation of human osteoblasts on Ti surfaces pre-treated with human whole blood

Early and effective integration of a metal implant into bone tissue is of crucial importance for its long-term stability. While different material properties including surface roughness and wettability but also initial blood-implant surface interaction are known to influence this osseointegration, implications of the latter process are still poorly understood. In this study, early interaction between blood and the implant surface and how this affects the mechanism of osseointegration were investigated. For this, blood coagulation on a micro-roughened hydrophobic titanium (Ti) surface (SLA-H(phob)) and on a hydrophilic micro-roughened Ti surface with nanostructures (SLActive-H(phil)NS), as well as the effects of whole human blood pre-incubation of these two surfaces on the differentiation potential of primary human bone cells (HBC) was assessed. Interestingly, pre-incubation with blood resulted in a dense fibrin network over the entire surface on SLActive-H(phil)NS but only in single patches of fibrin and small isolated fibre complexes on SLA-H(phob). On SLActive-H(phil)NS, the number of HBCs attaching to the fibrin network was greatly increased and the cells displayed enhanced cell contact to the fibrin network. Notably, HBCs displayed increased expression of the osteogenic marker proteins alkaline phosphatase and collagen-I when cultivated on both surfaces upon blood pre-incubation. Additionally, blood pre-treatment promoted an earlier and enhanced mineralization of HBCs cultivated on SLActive-H(phil)NS compared to SLA-H(phob). The results presented in this study therefore suggest that blood pre-incubation of implant surfaces mimics a more physiological situation, eventually providing a more predictive in vitro model for the evaluation of novel bone implant surfaces.

The initial inflammatory response to bioactive implants is characterized by NETosis

Implants trigger an inflammatory response, which is important for osseointegration. Here we studied neutrophil extracellular trap (NET) release of human neutrophils in response to sandblasted large-grit acid etched (SLA) implants using fluorescent, confocal laser scanning and scanning electron microscopy. Our studies demonstrate that human neutrophils rapidly adhered to SLA surfaces, which triggered histone citrullination and NET release. Further studies showed that albumin or acetylsalicylic acid had no significant effects on the inflammatory response to SLA surfaces. In contrast to bioinert materials, which do not osseointegrate, the bioactivity of SLA surfaces is coupled with the ability to release NETs. Further investigations are necessary for clarifying the role of NETosis for osseointegration.

Biomechanical and histomorphometric properties of four different mini-implant surfaces

OBJECTIVES

To investigate the effects of surface roughness on the removal torque and bone-to-implant contact of four different orthodontic mini-implants.

MATERIALS AND METHODS

Mini-implants and circular discs were made from alloy Ti6Al4V grade 5. On the basis of surface treatment, the study was divided into four groups-group 1: machined (n = 32), no surface treatment; group 2: acid etched (n = 32), with hydrochloric acid; group 3 (n = 32), grit blasted with alumina; and group 4, grit blasted + acid etched (n = 32). Mean surface roughness (Ra) and quadratic average roughness (Rq) from each group were measured two dimensionally in non-contact mode by the optical profilometer. Contact angle measurement of discs from each group was done with a contact angle goniometer. Contact angle of liquids with different hydrophobicity and hydrophilicity was measured: 1. highly hydrophilic liquid sodium chloride (NaCl), 2. lightly hydrophobic liquid dimethylsulfoxide, 3. distilled water, and 4. human blood. One hundred and twenty-eight miniscrews, differing in surface treatment, were placed into the tibias and femurs of adult male New Zealand white rabbits. Rabbits were euthanized after 8 weeks and removal torque and bone-to-implant contact were measured.

RESULTS

Surface roughness of group 3 was significantly greater than other groups (P < 0.05). Group 4 had significantly lower contact angle measurements, both for blood and sodium chloride (NaCl; 40.26 degrees, 27.20 degrees) when compared to other three groups (P ≤ 0.01). Group 4 had significantly higher torque and bone-to-implant contact than group 3 (P = 0.007), group 2 (P = 0.003), and group 1 (P = 0.0002).

CONCLUSION

Surface roughness and wettability of mini-implants influence their biological response.

Microwave-assisted fabrication of titanium implants with controlled surface topography for rapid bone healing

Morphological surface modifications have been reported to enhance the performance of biomedical implants. However, current methods of introducing graded porosity involves postprocessing techniques that lead to formation of microcracks, delamination, loss of fatigue strength, and, overall, poor mechanical properties. To address these issues, we developed a microwave sintering procedure whereby pure titanium powder can be readily densified into implants with graded porosity in a single step. Using this approach, surface topography of implants can be closely controlled to have a distinctive combination of surface area, pore size, and surface roughness. In this study, the effect of various surface topographies on in vitro response of neonatal rat calvarial osteoblast in terms of attachment and proliferation is studied. Certain graded surfaces nearly double the chance of cell viability in early stages (∼one month) and are therefore expected to improve the rate of healing. On the other hand, while the osteoblast morphology significantly differs in each sample at different periods, there is no straightforward correlation between early proliferation and quantitative surface parameters such as average roughness or surface area. This indicates that the nature of cell-surface interactions likely depends on other factors, including spatial parameters.

A brief historical perspective on dental implants, their surface coatings and treatments

This review highlights a brief, chronological sequence of the history of dental implants. This historical perspective begins with ancient civilizations and spotlights predominant dentists and their contributions to implant development through time. The physical, chemical and biologic properties of various dental implant surfaces and coatings are discussed, and specific surface treatments include an overview of machined implants, etched implants, and sand-blasted implants. Dental implant coatings such as hydroxyapatite, fluoride, and statin usage are further reviewed.

Kinetic effects of TiO2 fine particles and nanoparticles aggregates on the nanomechanical properties of human neutrophils assessed by force spectroscopy

Background

Increasing applications of titanium dioxide (TiO₂) fine particles (FPs) and nanoparticles (NPs) require coupled knowledge improvement concerning their biokinetic effects. Neutrophils are quickly recruited to titanium implantation areas. Neutrophils mechanical properties display a crucial role on cell physiology and immune responsive functions. Then, micro and nanomechanical characterization assessed by force spectroscopy (FS) technique has been largely applied in this field.

Results

Scanning electron microscopy (SEM) images highlighted neutrophils morphological changes along TiO₂ FPs and NPs aggregates exposure time (1, 5, and 30 min) compared to controls. FS approaches showed an increasing on attraction forces to TiO₂ FPs and NPs treated neutrophils. This group depicted stronger stiffness features than controls just at 1 min of exposure. Treated neutrophils showed a tendency to increase adhesive properties after 1 and 5 min of exposure. These cells maintained comparatively higher elasticity behavior for a longer time possibly due to intense phagocytosis and cell stiffness opposing to the tip indentation. Neutrophils activation caused by FPs and NPs uptake could be related to increasing dissipated energy results.

Conclusions

Mechanical modifications resulted from TiO₂ FPs and NPs aggregates interaction with neutrophils showed increasing stiffness and also cell morphology alteration. Cells treatment by this metal FPs and NPs caused an increase in attractive forces. This event was mainly observed on the initial exposure times probably regarding to the interaction of neutrophils membrane and phagocytosis. Similar results were found to adhesion forces and dissipated energy outcomes. Treated cells presented comparatively higher elasticity behavior for a longer time. SEM images clearly suggested cell morphology alteration along time course probably related to activation, cytoskeleton rearrangement and phagocytosis. This scenario with increase in stiffness strongly suggests a direct relationship over neutrophil rolling, arrest, and transmigration. Scrutinizing these interactions represents an essential step to clarify the mechanisms involved on treatments containing micro and nanomaterials and their fates on the organisms.

A comparative study of the influence of three pure titanium plates with different micro- and nanotopographic surfaces on preosteoblast behaviors

There is a great demand for dental implants with the ability to accelerate periimplant bone regeneration. Modification of surface micro- and nanotopographies has been revealed to affect bone cell metabolism. In this study, we utilized dielectric barrier discharge (DBD) technology to modify commercially pure titanium (Ti-tr) surfaces and then investigated the cytocompability of DBD-modified Ti surface when compared with machined (Ti-m) and polished (Ti-p) Ti surfaces. These three kinds of Ti plates exhibited different surface energies and topographies at the micro- and nanoscale levels. The DBD-treated pure Ti surface significantly enhances cell adhesion, spread, and proliferation of MC3T3-E1 preosteoblast cells compared with the Ti-p and Ti-m surfaces, suggesting that Ti-tr has better cytocompatibility compared with the other two surfaces. Preosteoblast cells on Ti-m surface exhibited higher alkaline phosphatase activity than cells on Ti-tr and Ti-p surfaces 14 days after seeding. No significant difference in alkaline phosphatase activity was observed between cells grown on Ti-tr and Ti-p surfaces. Our study demonstrated that DBD modification significantly enhanced cell adhesion, spread, and proliferation of preosteoblasts with no negative effects on cell differentiation. Microtopography and nanotopography of the surfaces of different materials and chemical/energetic properties have a synergistic effect on cell attachment, proliferation, and differentiation.

Evaluation of blood cell attachment on Er: YAG laser applied root surface using scanning electron microscopy

BACKGROUND

Periodontal regeneration is dependent on the uninterrupted adhesion, maturation and absorption of fibrin clots to a periodontally compromised root surface. The modification of the root surface with different agents has been used for better fibrin clot formation and blood cell attachment. It is known that Er:YAG laser application on dentin removes the smear layer succesfully.

AIM

The aim of this study is to observe blood cell attachment and fibrin network formation following ER:YAG laser irradiation on periodontally compromised root surfaces in comparison to chemical root conditioning techniques in vitro.

MATERIALS AND METHODS

40 dentin blocks prepared from freshly extracted periodontally compromised hopeless teeth. Specimens were divided in 5 groups; those applied with PBS, EDTA, Citric acid and Er:YAG. They were further divided into two groups: those which had received these applications, and the control group. The specimens were evaluated with scanning electron microscope and micrographs were taken. Smear layer and blood cell attachment scoring was performed.

RESULTS

In the Er:YAG laser applied group, smear layer were totally removed. In the blood applied specimens, better fibrin clot formation and blood cell attachment were observed in the Er:YAG group. In the group that had been applied with citric acid, the smear layer was also removed. The smear layer could not be fully removed in the EDTA group.

CONCLUSION

Er:YAG laser application on the root dentin seems to form a suitable surface for fibrin clot formation and blood cell attachment. Further clinical studies to support these results are necessitated.

Drug delivery from hydroxyapatite-coated titanium surfaces using biodegradable particle carriers

The goal of this study was to develop a functional titanium (Ti) implant loaded with bioactive molecules using biodegradable polymeric particles as drug delivery carrier for dental applications. In this study, dexamethasone (DEX)-loaded poly(lactic-co-glycolic acid) (PLGA) particles were electrostatically immobilized on a Ti disc surface coated with hydroxyapatite (HA) nanocrystals using a low temperature high speed collision (LTHSC) method. Resorbable blasting media (RBM) Ti discs (S1), HA-Ti discs (S2), and HA-Ti discs treated with DEX-loaded PLGA particles (S3) were fabricated in this study as sample discs. To facilitate surface immobilization, PLGA particles were coated with polyethyleneimine (PEI) to produce a positive surface charge. This modification of PLGA particle surfaces, allowed DEX-loaded PLGA particles to be immobilized on negatively charged S2 disc surface. It was found that DEX-loaded PLGA particles were well dispersed and immobilized onto the S3 disc surfaces. Release profile studies of DEX from S3 discs in a 4-week immersion study indicated an initial burst release followed by sustained release. In vitro evaluation of bone marrow derived mesenchymal stem cells (BMSCs) cultured for 1 and 2 weeks on S3 discs showed greater BMSC differentiation than on S1 or S2 discs, demonstrating that this innovative delivery platform potently induced BMSC differentiation in vitro, and suggesting that it could be exploited for stem cell therapy purposes or to enhance in vivo osteogenesis. In addition, the results of the present study shows that various bioactive molecules that promote bone regeneration can be efficiently incorporated onto HA-Ti surfaces using biodegradable polymeric particles.

The effect of shear on in vitro platelet and leukocyte material-induced activation

The failure to understand the mechanisms of biomaterial-associated thrombosis prevents us from improving the blood compatibility of stents and mechanical heart valves. Blood-material interactions trigger a complex series of events and anticoagulant and anti-platelet therapies are needed to reduce the risks of thrombotic complications with most cardiovascular materials. While material interaction with platelets has been widely studied, little is currently known on material-induced leukocyte activation in the presence of shear. In vitro experiments were performed to assess the effect of flow on blood cell activation induced by medical grade metals, ST316L and TiAl6V4. Blood was circulated in flow chambers preloaded with or without metal wires at shear rates of 100, 500, and 1500 s−1. Platelet and leukocyte activation, leukocyte-platelet aggregation, and tissue factor expression on monocytes were measured by flow cytometry. Metal surfaces were characterized by scanning electron microscopy. Under physiological shear rates, no significant platelet microparticle formation was observed. However, significant CD11b up-regulation, leukocyte-platelet aggregates, and tissue factor expression were observed at 100 s−1. As shear rate increased to 1500 s−1, leukocyte activation reduced to control values. TiAl6V4-induced leukocyte activation was generally lower than that of ST316L. Adhesion significantly decreased with increasing shear rate to 1500 s−1.

In blood, increase within physiological shear rates led to a significant reduction in in vitro material-induced leukocyte activation, suggesting that difference between material biocompatibility may be better identified at low shear rates or under pathological shear conditions.

Free Radical Production in Immune Cell Systems Induced by Ti, Ti6Al4V and SS Assessed by Chemiluminescence Probe Pholasin Assay

The oxidative burst of human blood cells in the presence of different metal materials was investigated using chemiluminescence assay. Commercial pure titanium (Ti), titanium alloy (Ti6Al4V), and stainless steel 316L (SS) in particulate form with <20 μm in size were used. The effect of particulate materials opsonisation on the upregulation of the respiratory burst production by blood cells was also assessed. The largest chemiluminescence response was achieved after simultaneous injection of the stimulants fMLP+PMA. Moreover, Ti and SS induced a greater inflammatory reaction compared to Ti6Al4V, since the respiratory burst mounted was higher for both materials after opsonisation treatment. These results suggest that in vitro chemiluminescence response and respiratory burst measurements proved to be composition and treatment dependent.

Soft tissue response to titanium dioxide nanotube modified implants

Titanium is widely used clinically, yet little is known regarding the effects of modifying its three-dimensional surface geometry at the nanoscale level. In this project we have explored the in vivo response in terms of nitric oxide scavenging and fibrotic capsule formation to nano-modified titanium implant surfaces. We compared titanium dioxide (TiO(2)) nanotubes with 100 nm diameters fabricated by electrochemical anodization with TiO(2) control surfaces. Significantly lower nitric oxide was observed for the nanostructured surface in solution, suggesting that nanotubes break down nitric oxide. To evaluate the soft tissue response in vivo TiO(2) nanotube and TiO(2) control implants were placed in the rat abdominal wall for 1 and 6 weeks. A reduced fibrotic capsule thickness was observed for the nanotube surfaces for both time points. Significantly lower nitric oxide activity, measured as the presence of nitrotyrosine (P<0.05), was observed on the nanotube surface after 1 week, indicating that the reactive nitrogen species interaction is of importance. The differences observed between the titanium surfaces may be due to the catalytic properties of TiO(2), which are increased by the nanotube structure. These findings may be significant for the interaction between titanium implants in soft tissue as well as bone tissue and provide a mechanism by which to improve future clinical implants.

Coating of titanium implant materials with thin polymeric films for binding the signaling protein BMP2

A fast and simple approach for immobilization using copolymers as interlayers is reported. The synthesized copolymers form stable self-assembled layers on implant materials like, e.g., titanium in a simple coating/drying/washing sequence and have functional groups which can bind proteins from an aqueous solution. The copolymer films have been characterized via ellipsometry and contact angle measurements and were tested for biocompatibility. An immunoassay was used to determine the amount of BMP2 and demonstrated an approximately 10-fold increase as compared to previously used self-assembled monolayers. A BMP2-responsive cell line with luciferase detection was used to determine the biological activity of the bound signaling protein.

Influence of titanium surface treatments on formation of the blood clot extension

The aim of this in vitro study was to evaluate the influence of 3 different implant surface treatments on the extension of human blood clot formation. For this purpose, the 3 types of surfaces (as-machined; test group 1, titanium discs blasted with aluminum oxide particles and washed with nitric acid; test group 2, titanium discs blasted with titanium oxide particles and washed with maleic acid) obtained were evaluated regarding topography and blood clot extension formation. Data suggest that different treatments applied on implant surfaces confer different mechanical and chemical properties, and that titanium discs blasted with aluminum oxide particles and washed with nitric acid exhibited the widest blood clot extension (P < .001).