In vivo behaviour of hydroxyapatite coatings on titanium implants: a quantitative study in the rabbit

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.

Effect of Er:YAG Pulsed Laser-Deposited Hydroxyapatite Film on Titanium Implants on M2 Macrophage Polarization In Vitro and Osteogenesis In Vivo

In a previous study, we successfully coated hydroxyapatite (HAp) onto titanium (Ti) plates using the erbium-doped yttrium aluminum garnet pulsed-laser deposition (Er:YAG-PLD) method. In this study, we performed further experiments to validate the in vitro osteogenic properties, macrophage polarization, and in vivo osseointegration activity of HAp-coated Ti (HAp-Ti) plates and screws. Briefly, we coated a HAp film onto the surfaces of Ti plates and screws via Er:YAG-PLD. The surface morphological, elemental, and crystallographic analyses confirmed the successful surface coating. The macrophage polarization and osteogenic induction were evaluated in macrophages and rat bone marrow mesenchymal stem cells, and the in vivo osteogenic properties were studied. The results showed that needle-shaped nano-HAp promoted the early expression of osteogenic and immunogenic genes in the macrophages and induced excellent M2 polarization properties. The calcium deposition and osteocalcin production were significantly higher in the HAp-Ti than in the uncoated Ti. The implantation into rat femurs revealed that the HAp-coated materials had superior osteoinductive and osseointegration activities compared with the Ti, as assessed by microcomputed tomography and histology. Thus, HAp film on sandblasted Ti plates and screws via Er:YAG-PLD enhances hard-tissue differentiation, macrophage polarization, and new bone formation in tissues surrounding implants both in vitro and in vivo.

Biomimetic Composite Coatings for Activation of Titanium Implant Surfaces: Methodological Approach and In Vivo Enhanced Osseointegration

Innovative nanomaterials are required for the coatings of titanium (Ti) implants to ensure the activation of Ti surfaces for improved osseointegration, enhanced bone fracture healing and bone regeneration. This paper presents a systematic investigation of biomimetic composite (BC) coatings on Ti implant surfaces in a rat model of a diaphyseal femoral fracture. Methodological approaches of surface modification of the Ti implants via the usual joining methods (e.g., grit blasting and acid etching) and advanced physicochemical coating via a self-assembled dip-coating method were used. The biomimetic procedure used multi-substituted hydroxyapatite (ms-HAP) HAP-1.5 wt% Mg-0.2 wt% Zn-0.2 wt% Si nanoparticles (NPs), which were functionalized using collagen type 1 molecules (COL), resulting in ms-HAP/COL (core/shell) NPs that were embedded into a polylactic acid (PLA) matrix and finally covered with COL layers, obtaining the ms-HAP/COL@PLA/COL composite. To assess the osseointegration issue, first, the thickness, surface morphology and roughness of the BC coating on the Ti implants were determined using AFM and SEM. The BC-coated Ti implants and uncoated Ti implants were then used in Wistar albino rats with a diaphyseal femoral fracture, both in the absence and the presence of high-frequency pulsed electromagnetic shortwave (HF-PESW) stimulation. This study was performed using a bone marker serum concentration and histological and computer tomography (micro-CT) analysis at 2 and 8 weeks after surgical implantation. The implant osseointegration was evaluated through the bone–implant contact (BIC). The bone–implant interface was investigated using FE-SEM images and EDX spectra of the retrieved surgical implants at 8 weeks in the four animal groups. The obtained results showed significantly higher bone–implants contact and bone volume per tissue volume, as well as a greater amount of newly formed bone, in the BC-coated Ti implants than in the uncoated Ti implants. Direct bone–implant contact was also confirmed via histological examination. The results of this study confirmed that these biomimetic composite coatings on Ti implants were essential for a significant enhancement of osseointegration of BC-coated Ti implants and bone regeneration. This research provides a novel strategy for the treatment of bone fractures with possible orthopedic applications.

Nanohydroxyapatite Electrodeposition onto Electrospun Nanofibers: Technique Overview and Tissue Engineering Applications

Nanocomposite scaffolds based on the combination of polymeric nanofibers with nanohydroxyapatite are a promising approach within tissue engineering. With this strategy, it is possible to synthesize nanobiomaterials that combine the well-known benefits and advantages of polymer-based nanofibers with the osteointegrative, osteoinductive, and osteoconductive properties of nanohydroxyapatite, generating scaffolds with great potential for applications in regenerative medicine, especially as support for bone growth and regeneration. However, as efficiently incorporating nanohydroxyapatite into polymeric nanofibers is still a challenge, new methodologies have emerged for this purpose, such as electrodeposition, a fast, low-cost, adjustable, and reproducible technique capable of depositing coatings of nanohydroxyapatite on the outside of fibers, to improve scaffold bioactivity and cell–biomaterial interactions. In this short review paper, we provide an overview of the electrodeposition method, as well as a detailed discussion about the process of electrodepositing nanohydroxyapatite on the surface of polymer electrospun nanofibers. In addition, we present the main findings of the recent applications of polymeric micro/nanofibrous scaffolds coated with electrodeposited nanohydroxyapatite in tissue engineering. In conclusion, comments are provided about the future direction of nanohydroxyapatite electrodeposition onto polymeric nanofibers.

Electrodeposited Hydroxyapatite-Based Biocoatings: Recent Progress and Future Challenges

Hydroxyapatite has become an important coating material for bioimplants, following the introduction of synthetic HAp in the 1950s. The HAp coatings require controlled surface roughness/porosity, adequate corrosion resistance and need to show favorable tribological behavior. The deposition rate must be sufficiently fast and the coating technique needs to be applied at different scales on substrates having a diverse structure, composition, size, and shape. A detailed overview of dry and wet coating methods is given. The benefits of electrodeposition include controlled thickness and morphology, ability to coat a wide range of component size/shape and ease of industrial processing. Pulsed current and potential techniques have provided denser and more uniform coatings on different metallic materials/implants. The mechanism of HAp electrodeposition is considered and the effect of operational variables on deposit properties is highlighted. The most recent progress in the field is critically reviewed. Developments in mineral substituted and included particle, composite HAp coatings, including those reinforced by metallic, ceramic and polymeric particles; carbon nanotubes, modified graphenes, chitosan, and heparin, are considered in detail. Technical challenges which deserve further research are identified and a forward look in the field of the electrodeposited HAp coatings is taken.

Stem Cell-Friendly Scaffold Biomaterials: Applications for Bone Tissue Engineering and Regenerative Medicine

Bone is a dynamic organ with high regenerative potential and provides essential biological functions in the body, such as providing body mobility and protection of internal organs, regulating hematopoietic cell homeostasis, and serving as important mineral reservoir. Bone defects, which can be caused by trauma, cancer and bone disorders, pose formidable public health burdens. Even though autologous bone grafts, allografts, or xenografts have been used clinically, repairing large bone defects remains as a significant clinical challenge. Bone tissue engineering (BTE) emerged as a promising solution to overcome the limitations of autografts and allografts. Ideal bone tissue engineering is to induce bone regeneration through the synergistic integration of biomaterial scaffolds, bone progenitor cells, and bone-forming factors. Successful stem cell-based BTE requires a combination of abundant mesenchymal progenitors with osteogenic potential, suitable biofactors to drive osteogenic differentiation, and cell-friendly scaffold biomaterials. Thus, the crux of BTE lies within the use of cell-friendly biomaterials as scaffolds to overcome extensive bone defects. In this review, we focus on the biocompatibility and cell-friendly features of commonly used scaffold materials, including inorganic compound-based ceramics, natural polymers, synthetic polymers, decellularized extracellular matrix, and in many cases, composite scaffolds using the above existing biomaterials. It is conceivable that combinations of bioactive materials, progenitor cells, growth factors, functionalization techniques, and biomimetic scaffold designs, along with 3D bioprinting technology, will unleash a new era of complex BTE scaffolds tailored to patient-specific applications.

New Insights into Osteointegration and Delamination from a Multidisciplinary Investigation of a Failed Hydroxyapatite-Coated Hip Joint Replacement

Hydroxyapatite (HA) coatings have become very popular in uncemented total hip arthroplasty (THA). Analysis of retrievals and tissue samples from an HA-coated femoral stem, which failed within 14 months after THA, provides exceptional insights into the failure mechanism, as well as the process of osteointegration of such an implant. Methods: Retrievals were photo-documented. Samples were examined by micro-computed tomography, X-ray diffraction (XRD) and embedded in polymethylmethacrylate for histology. Results: The coating had partially delaminated. The sandblasted surface of the stem was partially polished by the delaminated HA coating, indicating failure before revision. In the tissue samples, the HA coating was well integrated by newly formed bone trabeculae. No adverse biological reaction was observed. XRD analysis showed that residues of the HA coating were still present and could clearly be differentiated from the surrounding bone. Preferential orientation of the HA crystallites could be identified within the newly formed bone, representing a potential mechanical weakness induced either by physiologic strain or by the coating. Conclusion: current HA coatings, relatively thick and made of high crystallinity HA, may be prone to delamination, as also seen in our study. Recent efforts have aimed towards thinner (<1 μm) coatings with nanocrystalline HA structures that possibly relate to lower delamination risks. However, the question arises if HA coatings are beneficial since sandblasted non-coated stems offer similar results without the risk of delamination. XRD not only permits differentiation between the HA from the coating and the HA of the ongrown bone, it also provides new insights into the microstructure of this newly formed bone.

Zn-HA/Bi-HA biphasic coatings on Titanium: Fabrication, characterization, antibacterial and biological activity

Hydroxyapatite (HA) coatings have been of important as biocompatible coatings for dental and bone tissue engineering application. However, the poor antibacterial performance and weak biological activity of HA coatings limited their clinical applications. As a strategy to improve the antibacterial performance and biological activity of HA, Zinc and bismuth ions were incorporated into HA lattice by substituting Ca²⁺ ions, respectively, and thus zinc substituted hydroxyapatite/bismuth substituted hydroxyapatite (Zn-HA/Bi-HA) biphasic coatings on titanium plates with various ratios were fabricated via sol-gel and dip-coating processes. The purity of the Zn-HA and Bi-HA phase was confirmed by X-ray diffraction (XRD) test. The biphasic coatings showed slower dissolution rate than pure HA coating. Furthermore, the Zn-HA/Bi-HA coatings reveal good biomineralization activity in simulated body fluid (SBF) by forming regular spherical apatite agglomerates. Moreover, the biphasic Zn-HA/Bi-HA coatings exhibited that improved antimicrobial activity against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) as compared to pure HA coatings. The CCK-8 assays demonstrate Zn-HA/Bi-HA coatings showed no toxicity to MG63 cells, and the Zn-HA/Bi-HA2 (Zn-HA:Bi-HA=64:1) coating is more effective to enhance the proliferation of MG63 cells compared to other coatings. This finding suggests Zn-HA/Bi-HA biphasic coatings are promising candidates for biomedical applications.

Treatments for enhancing the biocompatibility of titanium implants

Titanium surface treatment is a crucial process for achieving sufficient osseointegration of an implant into the bone. If the implant does not heal sufficiently, serious complications may occur, e.g. infection, inflammation, aseptic loosening of the implant, or the stress-shielding effect, as a result of which the implant may need to be reoperated. After a titanium graft has been implanted, several interactions are crucial in order to create a strong bone-implant connection. It is essential that cells adhere to the surface of the implant. Surface roughness has a significant influence on cell adhesion, and also on improving and accelerating osseointegration. Other highly important factors are biocompatibility and resistance to bacterial contamination. Bio-inertness of titanium is ensured by the protective film of titanium oxides that forms spontaneously on its surface. This film prevents the penetration of metal compounds, and it is well-adhesive for calcium and phosphate ions, which are necessary for the formation of the mineralized bone structure. Since the presence of the film alone is not sufficient for the biocompatibility of titanium, a suitable surface finish is required to create a firm bone-implant connection. In this review, we explain and compare the most widely-used methods for modulating the surface roughness of titanium implants in order to enhance cell adhesion on the surface of the implant, e.g. plasma spraying, sandblasting, acid etching, laser treatment, sol-gel etc., The methods are divided into three overlapping groups, according to the type of modification.

Bioactive calcium phosphate materials and applications in bone regeneration

BACKGROUND

Bone regeneration involves various complex biological processes. Many experiments have been performed using biomaterials in vivo and in vitro to promote and understand bone regeneration. Among the many biomaterials, calcium phosphates which exist in the natural bone have been conducted a number of studies because of its bone regenerative property. It can be directly contributed to bone regeneration process or assist in the use of other biomaterials. Therefore, it is widely used in many applications and has been continuously studied.

MAINBODY

Calcium phosphate has been widely used in bone regeneration applications because it shows osteoconductive and in some cases osteoinductive features. The release of calcium and phosphorus ions regulates the activation of osteoblasts and osteoclasts to facilitate bone regeneration. The control of surface properties and porosity of calcium phosphate affects cell/protein adhesion and growth and regulates bone mineral formation. Properties affecting bioactivity vary depending on the types of calcium phosphates such as HAP, TCP and can be utilized in various applications because of differences in ion release, solubility, stability, and mechanical strength. In order to make use of these properties, different calcium phosphates have been used together or mixed with other materials to complement their disadvantages and to highlight their advantages. Calcium phosphate has been utilized to improve bone regeneration in ways such as increasing osteoconductivity for bone ingrowth, enhancing osteoinductivity for bone mineralization with ion release control, and encapsulating drugs or growth factors.

CONCLUSION

Calcium phosphate has been used for bone regeneration in various forms such as coating, cement and scaffold based on its unique bioactive properties and bone regeneration effectiveness. Additionally, several studies have been actively carried out to improve the efficacy of calcium phosphate in combination with various healing agents. By summarizing the properties of calcium phosphate and its research direction, we hope that calcium phosphate can contribute to the clinical treatment approach for bone defect and disease.

Biocompatibility of polyamide 12 intramedullary rod after humeral consolidation in white Plymouth Rock birds

ABSTRACT: Technological and tissue engineering have enabled available, biologically inert, and low cost materials to be considered as viable alternatives in the surgical treatment of long bone fractures in birds. The aim of this study was to microscopically analyse osteotomized humerus of birds following the insertion of solid laser-sintered polyamide 12 rods in order to detect foreign body reaction and, thus, verify the bioinert property of the material in the bone fracture environment. Polyamide 12 intramedullary rods were inserted into the osteotomized humerus of 10 birds (white Plymouth Rock) and blocked using 2mm diameter cortical screws of varying lengths. The birds were operated at 60 days of age and monitored post-operatively for three months. Animals were euthanized at 150 days old and samples of the operated humerus collected for immunohistochemistry, light and scanning electron microscopy analysis. Results show bone consolidation without rejection of the implant and absence of inflammatory cells. Vascular Endothelial Growth Factor (VEGF) was expressed in the endothelial cells of the blood vessels at the site of the newly formed bone surrounding the implant, indicative of local angiogenesis. There was no bone growth on the surface of the rod; however, the implant did not interfere with the circumjacent bone repair. Thus, the findings of this study corroborate with the literature in characterizing polyamide as a bioinert material and, under the studied conditions, it can be concluded that polyamide 12 intramedullary rod is biocompatible and provides adequate bone consolidation in humeral fractures with no signs of rejection.

Biomechanical, histological, and computed X-ray tomographic analyses of hydroxyapatite coated PEEK implants in an extended healing model in rabbit

A nanosized hydroxyapatite (HA) modification on polyetheretherketone (PEEK) using a novel spin coating technique was investigated in a rabbit model. Spin coating technique creates a 20-40 nm thick layer of nanosized HA particles with similar shape, size, and crystallinity as human bone. Some implants were designed with a perforating hole in the apical region to mimic a fusion chamber of a spinal implant. The coating nano-structures were assessed using a scanning electron microscope. The in vivo response to HA-PEEK was compared to untreated PEEK with respect to removal torque, histomorphometry, and computed microtomography. The HA-coated and pure PEEK implants were inserted in the tibia and femur bone according to simple randomization. The rabbits were sacrificed 20 weeks after implantation. Removal torque analysis showed significantly higher values for HA-PEEK. Qualitative histological evaluation revealed an intimate contact between PEEK and the bone at the threads and perforated hole. Histomorphometric assessment showed higher bone-implant and bone area values for HA-PEEK but without statistical significance. The effect of the HA coating showed most prominent effect in the removal torque which may be correlated to an alteration in the bone quality around the HA-PEEK implants. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 1440-1447, 2018.

Novel and facile microwave-assisted synthesis of Mo-doped hydroxyapatite nanorods: Characterization, gamma absorption coefficient, and bioactivity

In the current work, the authors report the microwave-assisted synthesis Molybdenum-doped (from 0.05 to 5wt%) hydroxyapatite (HAp) for the first time. The morphology of Mo-doped HAp is nanorods of diameter in the range of 25-70nm and length in the range of 25nm to 200nm. The good crystalline nature was confirmed from X-ray diffraction patterns and also lattice parameters, grain size, strain and dislocation density were determined. The crystallite size was found to be in the range 16 to 30nm and crystallinity was found to be enhanced from 0.5 to 0.7 with doping. The field emission SEM micrographs show that the morphology of the synthesized nanostructures of pure and Mo-doped HAp are nanorods of few nanometers. The vibrational modes were identified using the FT-Raman and FT-IR spectroscopy. The dielectric properties were studied and the AC electrical conductivity was found to be increased with increasing the concentration of Mo ions doping in HAp. Moreover, antimicrobial studies were also carried out to understand the anti-bacterial and anti-fungi properties. The results suggest that it may be a good bio-ceramics material for bio-medical applications. Mo-doped HAp was subjected to the gamma irradiation produced from Cs-137 (662keV) and its related parameters such as linear absorption coefficient, the half-value layer (HVL) and the tenth value layer TVL were calculated and analyzed.

Synthesis, Characterization, and Biological Evaluation of Nanostructured Hydroxyapatite with Different Dimensions

Nanosized hydroxyapatite (HA) is a promising candidate for a substitute for apatite in bone in biomedical applications. Furthermore, due to its excellent bone bioactivity, nanosized strontium-substituted HA (SrHA) has aroused intensive interest. However, the size effects of these nanoparticles on cellular bioactivity should be considered. In this study, nanosized HA and SrHA with different dimensions and crystallization were synthesized by hydrothermal methods. The phase, crystallization and chemical composition were analyzed by X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FT-IR), respectively. The morphology was observed under field emission scanning electron microscopy (FE-SEM) and transmission electron microscopy (TEM). The degradation behaviors of the samples were monitored by determining the ions release profile with inductively coupled plasma mass spectrometry (ICP-MS). The releasing behavior of Ca2+ and Sr2+ showed that the degradation rate was proportional to the specific surface area and inversely proportional to crystallization. The in vitro experiment evaluated by MG63 cells showed that SrHA nanorods with a length greater than 100 nm had the best biological performance both in cell proliferation and differentiation (* p < 0.05 compared with HA-1 and SrHA-1; * p < 0.01 compared with HA-2). In addition, HA nanoparticles with a lower aspect ratio had better bioactivity than higher ones (* p < 0.05). This study demonstrated that nanosized HA and SrHA with subtle differences (including dimensions, crystallization, specific surface area, and degradation rate) could affect the cellular growth and thus might have an impact on bone growth in vivo. This work provides a view of the role of nano-HAs as ideal biocompatible materials in future clinical applications.

Bioactivity and mechanical stability of Ti-6Al-4V implants superplastically embedded with hydroxyapatite in rats

In this in vivo study, Sprague Dawley (SD) rats were used to investigate the bioactivity as well as the microstructural and mechanical properties of Ti-6Al-4V samples embedded with hydroxyapatite (HA) using two different coating methods-superplastic embedment (SPE) and superplastic deformation (SPD). The HA layer thickness for the SPE and SPD samples increased from 249.1  ±  0.6 nm to 874.8  ±  13.7 nm, and from 206.1  ±  5.8 nm to 1162.7  ±  7.9 nm respectively, after 12 weeks of implantation. The SPD sample exhibited much faster growth of newly formed HA compared to SPE. The growth of the newly formed HA was strongly dependent on the degree of HA crystallinity in the initial HA layer. After 12 weeks of implantation, the surface hardness value of the SPE and SPD samples decreased from 661  ±  0.4 HV to 586  ±  1.3 HV and from 585  ±  6.6 HV to 425  ±  86.9 HV respectively. The decrease in surface hardness values was due to the newly formed HA layer that was more porous than the initial HA layer. However, the values were still higher than the substrate surface hardness of 321  ±  28.8 HV. Wear test results suggest that the original HA layers for both samples were still strongly intact, and to a certain extent the newly grown HA layers also were strongly bound with the original HA layers. This study confirms the bioactivity and mechanical stability of the HA layer on both samples in vivo.

Antibacterial and osteo-stimulatory effects of a borate-based glass series doped with strontium ions

This work considered the effect of both increasing additions of Strontium (Sr²⁺) and incubation time on solubility and both antibacterial and osteo-stimulatory effects of a series of glasses based on the B₂O₃-P₂O₅-CaCO₃-Na₂CO₃-TiO₂-SrCO₃ series. The amorphous nature of all the glasses was confirmed by X-ray diffraction. Discs of each glass were immersed in de-ionized water for 1, 7 and 30 days, and the water extracts were used for ion release profiles, pH measurements and cytotoxicity testing. Atomic absorption spectroscopy was employed to detect the release of Na⁺, Ca²⁺ and Sr²⁺ ions from the glasses with respect to maturation, which indicated that the addition of Sr²⁺ retarded solubility of the glass series. This effect was also confirmed by weight loss analysis through comparing the initial weight of glass discs before and after periods of incubation. The incorporation of Sr²⁺ in the glasses did not influence the pH of the water extracts when the glasses were stored for up to 30 days. Cytotoxicity testing with an osteoblastic cell line (MC3T3-E1) indicated that glasses with the higher (20 mol% and 25 mol%) Sr²⁺ incorporation promoted proliferation of osteoblast cells, while the glasses with lower Sr²⁺ contents inhibited cell growth. The glass series, except for Ly-B5 (which contained the highest Sr²⁺ incorporation; 25 mol%), were bacteriostatic against S. aureus in the short term (1-7 days) as a result of the dissolution products released.

Hydroxyapatite–-Past, Present, and Future in Bone Regeneration

Hydroxyapatite (HA) is an essential element required for bone regeneration. Different forms of HA have been used for a long time. The essence of bone regeneration always revolves around the healthy underlying bone or it may be the surroundings that give enough strength. HA is well known for bone regeneration through conduction or by acting as a scaffold for filling of defects from ancient times, but emerging trends of osteoinductive property of HA are much promising for new bone regeneration. Emerging technology has made the dreams of clinicians to realize the use of HA in different forms for various regenerative purposes both in vivo and in vitro. The nanostructured calcium apatite plays an important role in the construction of calcified tissues. The nanostructured material has the ability to attach biological molecules such as proteins, which can be used as functional materials in many aspects, and the capability of synthesizing controlled structures of apatite to simulate the basic structure of bone and other calcified tissues. The process of regeneration requires a biomimetic and biocompatible nanostructured novel material. The nanostructured bioceramic particles are of interest in synthetic bone grafts and bone cements both injectable and controlled setting, so that such composites will reinforce the strength of bioceramics. Extensive research is being carried out for bone regeneration using nanotechnology. Artificial bone formation is not far from now. Nanotechnology has made many dreams come true. This paper gives comprehensive insights into the history and evolution with changing trends in the use of HA for various regenerative purposes.

Improve the performance of coated cemented hip stem through the advanced composite materials

Design of hip joint implant using functionally graded material (FGM) (advanced composite material) has been used before through few researches. It gives great results regarding the stress distribution along the implant and bone interfaces. However, coating of orthopaedic implants has been widely investigated through many researches. The effect of using advanced composite stem material, which mean by functionally graded stem material, in the total hip replacement coated with the most common coated materials has not been studied yet. Therefore, this study investigates the effect of utilizing these two concepts together; FGM and coating, in designing new stem material. It is concluded that the optimal FGM cemented stem is consisting from titanium at the upper stem layers graded to collagen at a lower stem layers. This optimal graded stem coated with hydroxyapatite found to reduce stress shielding by 57% compared to homogenous titanium stem coated with hydroxyapatite. However, the optimal functionally graded stem coated with collagen reduced the stress shielding by 51% compared to homogenous titanium stem coated with collagen.

Surface Modifications and Their Effects on Titanium Dental Implants

This review covers several basic methodologies of surface treatment and their effects on titanium (Ti) implants. The importance of each treatment and its effects will be discussed in detail in order to compare their effectiveness in promoting osseointegration. Published literature for the last 18 years was selected with the use of keywords like titanium dental implant, surface roughness, coating, and osseointegration. Significant surface roughness played an important role in providing effective surface for bone implant contact, cell proliferation, and removal torque, despite having good mechanical properties. Overall, published studies indicated that an acid etched surface-modified and a coating application on commercial pure titanium implant was most preferable in producing the good surface roughness. Thus, a combination of a good surface roughness and mechanical properties of titanium could lead to successful dental implants.

Synthesis, characterization and the formation mechanism of magnesium- and strontium-substituted hydroxyapatite

The hydroxyapatite crystals grow in different ways when the calcium is substituted by strontium or magnesium.

In vivo and in vitro investigations of a nanostructured coating material - a preclinical study

Immediate loading of dental implants is only possible if a firm bone-implant anchorage at early stages is developed. This implies early and high bone apposition onto the implant surface. A nanostructured coating material based on an osseoinductive bone grafting is investigated in relation to the osseointegration at early stages. The goal is to transmit the structure (silica matrix with embedded hydroxyapatite) and the properties of the bone grafting into a coating material. The bone grafting substitute offers an osseoinductive potential caused by an exchange of the silica matrix in vivo accompanied by vascularization. X-ray diffraction and transmission electron microscopy analysis show that the coating material consists of a high porous silica matrix with embedded nanocrystalline hydroxyapatite with the same morphology as human hydroxyapatite. An in vitro investigation shows the early interaction between coating and human blood. Energy-dispersive X-ray analysis showed that the silica matrix was replaced by an organic matrix within a few minutes. Uncoated and coated titanium implants were inserted into the femora of New Zealand White rabbits. The bone-to-implant contact (BIC) was measured after 2, 4, and 6 weeks. The BIC of the coated implants was increased significantly at 2 and 4 weeks. After 6 weeks, the BIC was decreased to the level of the control group. A histological analysis revealed high bone apposition on the coated implant surface after 2 and 4 weeks. Osteoblastic and osteoclastic activities on the coating material indicated that the coating participates in the bone-remodeling process. The nanostructure of the coating material led to an exchange of the silica matrix by an autologous, organic matrix without delamination of the coating. This is the key issue in understanding initial bone formation on a coated surface.

Characteristics of Micro-Arc Treated Osseointegrated Porous Hydroxyapatite/Titanium Dioxide Coatings on Titanium Metal

A rapid and sufficient osseointegrating functions is obviously essential to the patients who suffered the bone reconstruction period. In order to perfectly target this issue, a single-stage micro-arc treated (MAT) coating beneficial from its inherent porous morphologies with controllable pore sizes, strong adhesive force between coatings and substrate and wide selections in electrolytes, is considered. Hydroxyapatite is extensively utilized and identified as mimic composition to human bone and an active bone ingrowth function. However, a controllable high-purity HAp phase via one-stage MAT has not yet been achieved. This study therefore prepares high-purity HAp coatings using one-stage MAT with the electrolyte combination of Calcium acetate and sodium biphosphate dihydrate on a titanium surface through a systematical evaluation of various MAT parameters, including Ca/P ratios of the electrolyte, electrolyte concentrations, working voltages, and treatment periods. Analytical results show that high-purity HAp can grow at a relatively high Ca/P ratio and electrolyte concentration when combined with a relatively high working voltage and long treatment time, which would otherwise grow with CaTiO3 and/or anatase TiO2 and/or rutile TiO2 simultaneously. Additionally, CaTiO3 acts a precursor phase for HAp formation. Ultimately, the highest purity of HAp coating is obtainable on metal titanium using a Ca/P ratio = 2.16 and applying a working voltage of 450 V for 10 min using one-stage MAT. This highest purity of HAp coating also presents excellent level of Ecorr than that on raw Ti alloys. The high Ecorr of HAp coating contributed from its thick and dense oxide layer by working voltage via one-stage MAT, consequently promises its satisfactory protection. The HAp coating demonstrated in this study not only provides the effective approach to produce the desired purity of HAp coatings but compromises its resistance to SBF. The bioactive HAp coating on Ti alloys via one-stage MAT, thus, considers as one significant surface modification for artificial hip joints and dental implants.

Evaluation on the efficacy and safety of calcium metaphosphate coated fixture

PURPOSE

The purpose of this study was to assess the difference in efficacy between calcium metaphosphate (CMP)-coated implant fixtures and conventional resorbable blasted media (RBM) processed implant fixtures.

MATERIALS AND METHODS

This study targeted 50 implants from 44 patients who visited Dankook University Dental Hospital. Implantations were done separately for RBM treated and CMP-coated implants, although their design was the same. Calcium metaphosphate has a quicker biodegradation process through hydrolysis compared to other phosphate calcium groups. For the first year of the implantation, the resorption volume of marginal bone analyzed via radiography and perio-test value were measured, under the check plan. Their analyses were composed of a non-inferiority trials test. A 95% level of reliability was used.

RESULTS

In the comparative analysis of the resorption volume of marginal bone and the perio-test value, no statistically significant difference was found between the CMP-coated implants and RBM implants.

CONCLUSION

One year after the implant placement, CMP-coated implants were found not to be inferior to the conventional RBM implants.

Plasma electrolytic oxidation of titanium and improvement in osseointegration

Reducing the osseointegration time for biomedical titanium implants in surgical patients is an important goal. However, a huge controversy exists over the effectiveness of osseointegration of the surface layer by plasma electrolytic oxidation (PEO), which is a widely favored surface modification for titanium-based implants. In this study, various surface coatings, including anatase-TiO2 (A-TiO2 ), rutile-TiO2 (R-TiO2 ), hydroxyapatite (HAp), strontium-containing hydroxyapatite (Sr-HAp), and dual-phase HAp-TiO2 were synthesized on titanium implants by PEO. A comparative study of osseointegration performance (both in vitro and in vivo) and bone/implant adhesion strength conducted using push-out thrust tests were demonstrated. The in vitro experimental test results agree strongly with the in vivo test results: the dual-phase HAp-TiO2 coating exhibits the superior cell adhesion and differentiation condition among all of the coatings in the in vitro tests and therefore has the highest push-out bonding strength of 5.37 MPa after 12 wk of implantation in the in vivo test. The HAp-containing coatings benefit from its bioactivity and therefore perform the others in terms of long-term osteocyte growth (from the in vitro results) and the extent of osseointegration (from the in vivo results). The dual-phase HAp-TiO2 coating provides the advantages of both the bioactive HAp and structural enhancement by the TiO2 , effectively promoting osseointegration.

Antibacterial and biological characteristics of silver containing and strontium doped plasma sprayed hydroxyapatite coatings

Infection in primary total joint prostheses is estimated to occur in up to 3% of all surgery. As a measure to improve the antimicrobial properties of implant materials silver (Ag) was incorporated into plasma sprayed hydroxyapatite (HA) coatings. To offset potential cytotoxic effects of Ag in the coatings strontium (Sr) was also added as a binary dopant. HA powder was doped with 2.0 wt.% Ag(2)O, 1.0 wt.% SrO and was then heat treated at 800 °C. Titanium substrates were coated using a 30 kW plasma spray system equipped with a supersonic nozzle. X-ray diffraction confirmed the phase purity and high crystallinity of the coatings. Samples were evaluated for mechanical stability by adhesive bond strength testing. The results show that the addition of dopants did not affect the overall bond strength of the coatings. The antibacterial efficacies of the coatings were tested against Pseudomonas aeruginosa. Samples that contained the Ag(2)O dopant were found to be highly effective against bacterial colonization. In vitro cell-material interactions using human fetal osteoblast cells were characterized by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay for cell viability, field emission scanning electron microscopy for cell morphology and confocal imaging for the important differentiation marker alkaline phosphatase (ALP). Our results showed evidence of cytotoxic effects of the Ag-HA coatings, characterized by poor cellular morphology and cell death and nearly complete loss of functional ALP activity. The addition of SrO to the Ag-HA coatings was able to effectively offset these negative effects and improve performance compared with pure HA-coated samples.

Comparative assessment of structural and biological properties of biomimetically coated hydroxyapatite on alumina (alpha-Al2O3) and titanium (Ti-6Al-4V) alloy substrates

Previous reports have shown the use of hydroxyapatite (HAp) and related calcium phosphate coatings on metal and nonmetal substrates for preparing tissue-engineering scaffolds, especially for osteogenic differentiation. These studies have revealed that the structural properties of coated substrates are dependent significantly on the method and conditions used for coating and also whether the substrates had been modified prior to the coating. In this article, we have done a comparative evaluation of the structural features of the HAp coatings, prepared by using simulated body fluid (SBF) at 25 degrees C for various time periods, on a nonporous metal substrate titanium-aluminium-vanadium (Ti-6Al-4V) alloy and a bioinert ceramic substrate alpha-alumina (alpha-Al(2)O(3)), with and without their prior treatment with the globular protein bovine serum albumin (BSA). Our analysis of these substrates by scanning electron microscopy (SEM), X-ray diffraction (XRD), and Fourier-transform infrared (FTIR) spectrometry showed significant and consistent differences in the quantitative and qualitative properties of the coatings. Interestingly, the bioactivity of these substrates in terms of supporting in vitro cell adhesion and spreading, and in vivo effects of implanted substrates, showed a predictable pattern, thus indicating that some coated substrates prepared under our conditions could be more suitable for biological/biomedical applications.

An in vivo evaluation of bone response to three implant surfaces using a rabbit intramedullary rod model

Our study was designed to evaluate osseointegration among implants with three surface treatments: plasma-sprayed titanium (P), plasma-sprayed titanium with hydroxyapatite (PHA), and chemical-textured titanium with hydroxyapatite (CHA). Average surface roughness (Ra) was 27 microns for the P group, 17 microns for the PHA group, and 26 microns for the CHA group. Bilateral distal intramedullary implants were placed in the femora of thirty rabbits. Histomorphometry of scanning electron microscopy images was used to analyze the amount of bone around the implants at 6 and 12 weeks after implantation. Greater amounts of osseointegration were observed in the hydroxyapatite-coated groups than in the noncoated group. For all implant surfaces, osseointegration was greater at the diaphyseal level compared to the metaphyseal level. No significant differences were seen in osseointegration between the 6 and 12 week time points. Although the average surface roughness of the P and the CHA groups was similar, osseointegration of the CHA implants was significantly greater. The results of this in vivo lapine study suggest that the presence of an hydroxyapatite coating enhances osseointegration despite similarities in average surface roughness.

Plasma-sprayed hydroxyapatite coating on carbon/carbon composite scaffolds for bone tissue engineering and related tests in vivo

The bioactive hydroxyapatite (HA) coatings were successfully prepared on carbon/carbon composites (C/C) by means of sand-blasting pretreatment and plasma-spraying technology. X-ray diffraction was employed to analyze the phase constitute of the coatings. Meanwhile, the bond strength between the HA coatings and C/C substrates was determined via shear test. Experimental results show that the coatings constitute HA, CaO, and other amorphous phosphates. The post heat treatment could effectively increase crystallization and purity of the coatings. Through observation and analysis by electron microprobe and scanning electron microscopy, it is concluded that the bond strength of the plasma-sprayed HA coatings on C/C is mainly determined by the interface structure and can be further improved by the post heat treatment. Meanwhile, the implantation in vivo was carried out in hybrid goats. The histological observation revealed that the osteoplaque gradually grew on the surface of the HA coatings and the pure C/C surface was covered by the fibrous tissues. No inflammation symptoms were found in the bone tissue around the implants.

Orthopedic coating materials: considerations and applications

The host response to titanium and its alloys is not always favorable, as a fibrous layer may form at the skeletal tissue-device interface, causing aseptic loosening. Therefore, a great deal of current orthopedic research is focused on developing implants with improved osseointegration properties in order to increase their clinical success. Promising new studies have been reported regarding coating the currently available implants with various coating materials and techniques so as to improve the long-term stability of implants. This article will discuss various coating materials developed, their advantages and disadvantages as coating materials and their biological performance.

Fabrication and evaluation of Zn containing fluoridated hydroxyapatite layer with Zn release ability

A biphasic layer with a Zn-containing beta-tricalcium phosphate (ZnTCP) phase and a fluoridated hydroxyapatite (FHA) phase on titanium alloy substrate was prepared by the sol-gel technique. Scanning electron microscopy and energy-dispersive X-ray analysis results showed the ZnTCP/FHA layer to have a heterogeneous surface with microscaled gibbous structures originating from ZnTCP particle agglomeration. This layer had a slow and sustained Zn release behavior. The scratch test result of the ZnTCP/FHA layer was 489+/-4mN, indicating good interface bonding between the layer and substrate. The ZnTCP/FHA layer supported cell growth, and showed a statistically significant increase in cell viability in comparison with another biphasic layer (TCP/FHA) without Zn. This work demonstrates that the present biphasic ZnTCP/FHA layer has the potential to play a significant role in enhancing bone growth when used as the outermost part of bioactive coatings on metallic implants.

Histological and histomorphometric investigations on bone integration of rapidly resorbable calcium phosphate ceramics

Resorbable ceramics can promote the bony integration of implants. Their rate of degradation should ideally be synchronized with bone regeneration. We report here the results of a histological study of implants with two resorbable calcium phosphate ceramic coatings: Ca(2)KNa(PO(4))(2)-(GB14) and Ca(10)[K/Na](PO(4))(7)-(602020). The results attained with these ceramic-coated implants show the benefits of these materials with regard to bioactive bone-healing stimulation, compared with uncoated implants. The GB14 ceramic coating exhibited greater bone regeneration and differentiation on its surface than the conventional hydroxyapatite coating and helped bone tissue achieve more extensive contact free of connective tissue. Not until the coating disintegrated did the histological features of GB14- and 602020-coated implants converge-both implant types were integrated into bone. Rapid disintegration of the coating material, as with 602020, supports osteoblast proliferation but has negative effects on bone mineralization. Both resorbable ceramics tested, GB14 and 602020, demonstrated bioactivity; even metal surfaces coated with these materials were populated by mature bone tissue without connective tissue after disintegration of their ceramic coating. The less rapidly degrading material, GB14, achieved better results. Degradable calcium phosphate coatings have the potential to stimulate bone regeneration. From the histological viewpoint, the resorbable ceramics examined here can be recommended as coating materials for clinical use.

Bone response adjacent to calcium phosphate electrostatic spray deposition coated implants: an experimental study in goats

BACKGROUND

A new technique to deposit calcium phosphate (CaP) coatings onto titanium substrates has been developed recently. This electrostatic spray deposition (ESD) technique seems to be very promising. It appears to have clinical advantages such as an inexpensive and simple set-up, high deposition efficiency and the possibility to synthesize layers with a defined surface morphology.

OBJECTIVE

The aim of this study was to examine biological properties and osteoconductivity of ESD CaP coatings when inserted into the femoral condyle of a goat.

MATERIAL AND METHODS

Twenty-four implants with two gaps, i.e. 1 or 2 mm, were inserted into the femoral condyles of six goats. The implants were coated on one side with either a commercially available plasma-sprayed hydroxyapatite (HAPS) coating or an ESD carbonate apatite (CAESD) coating. The other side of the implant was always left uncoated (Ti). Twelve weeks after implantation the animals were sacrificed and the characteristics of bone ingrowth and bone contact were evaluated.

RESULTS

At 3 months, histological and quantitative histomorphometrical measurements demonstrated more bone ingrowth and bone contact for coated sites as compared with uncoated sites. Statistical testing revealed that for both the 1 and 2 mm gaps HAPS (plasma-sprayed hydroxyapatite) as well as CAESD (ESD carbonate apatite) -coated surfaces always had a significantly higher (P<0.05) amount of bone contact than uncoated Ti surfaces. On HAPS surfaces always significantly more bone was present than on CAESD surfaces. Further statistical testing revealed a significant difference in bone ingrowth between the HAPS as well as CAESD and Ti 1+2 mm gap specimens (P<0.05). Further, HAPS 1 mm gaps showed more bone ingrowth than CAESD 1 mm gaps. No significant difference existed between HAPS and CAESD 2 mm gaps.

CONCLUSION

On the basis of our observations, we conclude that the used ESD technique is a promising new method to deposit CaP coatings onto titanium substrates. On the other hand, plasma-spray HA-coated implants have a still more favourable effect on the bone response.

Potential pitfalls of radiolabel adsorption to ceramic biomaterials

The use of radiolabeled precursor molecules for the metabolic analysis of cell functions is commonplace. Tritiated thymidine, in particular, has been used to quantitate cellular proliferation in numerous cells, including osteoblasts, when cultured on various biomaterials. Our aim was to assess cellular protein synthesis and proliferation, on a range of fluoride ion-substituted hydroxyapatites. Initially, we used a classical metabolic analysis strategy with radiolabeled tracer molecules. Our results suggested that these materials supported enhanced protein synthesis and proliferation of SaOS-2 human osteoblast-like cells. However, control samples also revealed enhanced adsorption of the radiolabeled tracer. We have shown that this arises because partially fluoride ion-substituted hydroxyapatite exhibits enhanced adsorptive characteristics of radiolabeled leucine and thymidine over tissue culture plastic, hydroxyapatite, and fluoroapatite. Moreover, manual cell count data obtained through SEM analysis showed no significant difference in cell proliferation between any of the materials, further indicating that our initial results were artifacts. These results highlight the use and reporting of appropriate cell-free controls are critical in bioassays examining functional responses of cells to biomaterials, and if absent, may confound accurate data interpretation. Our findings have general implications for investigations of cell function on other novel ceramic biomaterials.

The microenvironment around total hip replacement prostheses

The metal stem of the totally replaced hip carries load and resists fatigue, but it is electrochemically corroded. Metallic atoms act as haptens, induce type 1 T-helper cells/Th1-type immune responses and enhance periprosthetic osteolysis. Stiff metal implants, which do not have the same elasticity as the surrounding bone, cause stress shielding. Cyclic loading and lack of ligamentous support lead to mechanical and ischemia reperfusion injury and particle formation from bone, polymethylmethacrylate, and porous implant surfaces, which accelerate third-body polyethylene wear. Surgical injury and micromotion induce the formation of a fibrous capsule interface. Type-B lining cells produce lubricin and surface-active phospholipids to promote solid-to-solid lubrication but may loosen the implant from bone. The pumping action of the cyclically loaded joint and synovial fluid pressure waves dissect the implant-host interface and transports polyethylene particles and pro-inflammatory mediators to the interface. Hyaluronan induces formation of a synovial lining like layer. Because of its localization close to bone, foreign body inflammation at the interface stimulates osteoclastogenesis and peri-implant bone loss. Metal-on-metal and ceramic-on-ceramic pairs might minimize third body wear, but can lead to high-impact load of the acetabulum. Diamond coating of a metal-on-polyethylene couple might solve both of these problems. The basic biomaterial solutions allow good mechanical performance and relatively long life in-service, but surface modifications (porous coating, hydroxyapatite, diamond, bioglass, and others) may facilitate performance of the implant and improve the biomaterial and body interfaces.

Plasma-sprayed hydroxyapatite+titania composite bond coat for hydroxyapatite coating on titanium substrate

A two-layer hydroxyapatite (HA)/HA+TiO(2) bond coat composite coating (HTH coating) on titanium was fabricated by plasma spraying. The HA+TiO(2) bond coat (HTBC) consists of 50 vol% HA and 50 vol% TiO(2) (HT). The microstructural characterization of the HTH coatings before and after heat treatment was conducted by using scanning electron microscopy (SEM), electron probe microanalyser (EPMA), X-ray diffractometer (XRD) and transmission electron microscopy (TEM), in comparison with that of HT coating and pure HA coating. The results revealed that HA and TiO(2) phases layered in an alternating pattern within the HTBC, and the HTBC bonded well to HA top coating (HAT coating) and Ti substrate. The as-sprayed HT coating consists mainly of crystalline HA, rutile TiO(2) and amorphous Ca-P phase. The post-spray heat treatment at 650 degrees C for 120 min effectively restores the structural integrity of HA by transforming non-HA phases into HA. It was found that there exists interdiffusion of the elements within the HTBC, but no chemical product between HA and TiO(2), such as CaTiO(3) was formed. The cross-sectional morphologies confirmed that there is a shift towards a relatively tighter bonding from the HAT coating/HTBC interface in the as-sprayed HTH coating to the HTBC/Ti substrate interface in the heat-treated HTH coating. On quenching the coatings into water, the surface cracking indicates more apparently the positive effect of the HTBC on the decrease of residual stress in HAT coating. The in situ surface cracking also suggests that the stress on the surface of the HTH coating is stable under subjection to a repetitious heat treatment. The toughening and strengthening of HTBC is thought to be mainly due to TiO(2) as obstacles embarrassing cracking, the reduction of the near-tip stresses resulting from stress-induced microcracking and the decrease of CTE mismatch. In the HTH composite coating, the HAT coating is toughened by the decreased CTE mismatch with Ti through the addition of HTBC, which bonds well to the Ti substrate via its TiO(2) hobnobbing with the Ti oxides formed on Ti substrate.