NaOH treatment of vacuum-plasma-sprayed titanium on carbon fibre-reinforced poly(etheretherketone)

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

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

In-vitro study of hierarchical structures: Anodic oxidation and alkaline treatments onto highly rough titanium cold gas spray coatings for biomedical applications

Hierarchical structures were obtained applying two different nanotexturing surface treatments onto highly rough commercial pure titanium coatings by cold spray: (i) anodic oxidation and (ii) alkaline treatments. An extended surface characterization in terms of topography, composition, and wettability has been performed to understand how those parameters affect to cell response. Primary human osteoblasts extracted from knee were seeded onto the as-sprayed titanium surface before and after the nanotexturing treatments. Cell viability was tested by using MTS and LIVE/DEAD assays, as well as osteoblasts differentiation by alkaline phosphatase (ALP) quantification at 3 and 10 days of cell culture. The combination of micro-/nano-roughness results in a significantly increase of cell proliferation, as well as cell differentiation after 10 days of cell culture in comparison with the non-treated coatings.

Preparation Methods for Improving PEEK's Bioactivity for Orthopedic and Dental Application: A Review

There is an increased interest in the use of polyether ether ketone (PEEK) for orthopedic and dental implant applications due to its elastic modulus close to that of bone, biocompatibility, and its radiolucent properties. However, PEEK is still categorized as bioinert due to its low integration with surrounding tissues. Many studies have reported on methods to increase the bioactivity of PEEK, but there is still one-preparation method for preparing bioactive PEEK implant where the produced implant with desirable mechanical and bioactivity properties is required. The aim of this review is to present the progress of the preparation methods for improvement of the bioactivity of PEEK and to discuss the strengths and weaknesses of the existing methods.

Spine interbody implants: material selection and modification, functionalization and bioactivation of surfaces to improve osseointegration

The clinical outcome of lumbar spinal fusion is correlated with achievement of bony fusion. Improving interbody implant bone on-growth and in-growth may enhance fusion, limiting pseudoarthrosis, stress shielding, subsidence and implant failure. Polyetheretherketone (PEEK) and titanium (Ti) are commonly selected for interbody spacer construction. Although these materials have desirable biocompatibility and mechanical properties, they require further modification to support osseointegration. Reports of extensive research on this topic are available in biomaterial-centric published reports; however, there are few clinical studies concerning surface modification of interbody spinal implants. The current article focuses on surface modifications aimed at fostering osseointegration from a clinician's point of view. Surface modification of Ti by creating rougher surfaces, modifying its surface topography (macro and nano), physical and chemical treatment and creating a porous material with high interconnectivity can improve its osseointegrative potential and bioactivity. Coating the surface with osteoconductive materials like hydroxyapatite (HA) can improve osseointegration. Because PEEK spacers are relatively inert, creating a composite by adding Ti or osteoconductive materials like HA can improve osseointegration. In addition, PEEK may be coated with Ti, effectively bio-activating the coating.

Current strategies to improve the bioactivity of PEEK

The synthetic thermoplastic polymer polyetheretherketone (PEEK) is becoming a popular component of clinical orthopedic and spinal applications, but its practical use suffers from several limitations. Although PEEK is biocompatible, chemically stable, radiolucent and has an elastic modulus similar to that of normal human bone, it is biologically inert, preventing good integration with adjacent bone tissues upon implantation. Recent efforts have focused on increasing the bioactivity of PEEK to improve the bone-implant interface. Two main strategies have been used to overcome the inert character of PEEK. One approach is surface modification to activate PEEK through surface treatment alone or in combination with a surface coating. Another strategy is to prepare bioactive PEEK composites by impregnating bioactive materials into PEEK substrate. Researchers believe that modified bioactive PEEK will have a wide range of orthopedic applications.

In vivo implant fixation of carbon fiber-reinforced PEEK hip prostheses in an ovine model

Carbon fiber-reinforced polyetheretherketone (CFR/PEEK) is theoretically suitable as a material for use in hip prostheses, offering excellent biocompatibility, mechanical properties, and the absence of metal ions. To evaluate in vivo fixation methods of CFR/PEEK hip prostheses in bone, we examined radiographic and histological results for cementless or cemented CFR/PEEK hip prostheses in an ovine model with implantation up to 52 weeks. CFR/PEEK cups and stems with rough-textured surfaces plus hydroxyapatite (HA) coatings for cementless fixation and CFR/PEEK cups and stems without HA coating for cement fixation were manufactured based on ovine computed tomography (CT) data. Unilateral total hip arthroplasty was performed using cementless or cemented CFR/PEEK hip prostheses. Five cementless cups and stems and six cemented cups and stems were evaluated. On the femoral side, all cementless stems demonstrated bony ongrowth fixation and all cemented stems demonstrated stable fixation without any gaps at both the bone-cement and cement-stem interfaces. All cementless cases and four of the six cemented cases showed minimal stress shielding. On the acetabular side, two of the five cementless cups demonstrated bony ongrowth fixation. Our results suggest that both cementless and cemented CFR/PEEK stems work well for fixation. Cup fixation may be difficult for both cementless and cemented types in this ovine model, but bone ongrowth fixation on the cup was first seen in two cementless cases. Cementless fixation can be achieved using HA-coated CFR/PEEK implants, even under load-bearing conditions.

Microstructure and chemistry affects apatite nucleation on calcium phosphate bone graft substitutes

The bioactivity of calcium phosphate bone grafts of varying chemistry and strut-porosity was compared by determining the rate of formation of hydroxycarbonate apatite crystals on the material surface after being soaked in simulated body fluid for up to 30 days. Three groups of silicate-substituted hydroxyapatite material were tested, with each group comprising a different quantity of strut-porosity (23, 32, and 46 % volume). A commercially available porous β-tricalcium phosphate bone graft substitute was tested for comparison. Results indicate that strut-porosity of a material affects the potential for formation of a precursor to bone-like apatite and further confirms previous findings that β-tricalcium phosphate is less bioactive than hydroxyapatite.

A novel method for creating an optimal emergence profile adjacent to dental implants

In order to establish an optimal esthetic implant result, creation of an optimal emergence profile is necessary. The purpose of this clinical report is to describe a new method for creating an emergence profile starting at the time of immediate implant placement. Clinical steps for creating the emergence profile are described from the time of implant placement to restoration.

CLINICAL SIGNIFICANCE

Prefabricated abutments that can be modified and used as healing abutments or for provisional restorations offer clinicians the opportunity to create emergence profiles during the healing phase after immediate implant treatment. This procedure eliminates the need for creation of an arbitrary emergence profile in the dental laboratory and eliminates the need for a surgical procedure prior to impression making.

On the kinetics of apatite growth on substrates under physiological conditions

Derived from reaction kinetics, a simple but useful method, based on "apatite forming capacity" or AFC of solutions mimicking blood plasma, is proposed to decipher the rate of calcium phosphate mineralization. Apatite growth rate constants were calculated using this method for a model composite surface varying the volume fraction of synthetic hydroxyapatite (HA) in a polymer matrix. Previously reported data for mineralized surfaces on Ta, Ti, and its alloys are also analyzed similarly and compared. Utilizing the growth rate constant, the bioactivity of the materials was indexed in vitro. Complementarily, semiempirical quantum mechanical calculation (ZINDO method) showed that the interaction of cations with TRIS-hydroxymethyl aminomethane molecules in the solution is stronger than that with the polymer substrate considered, but weaker than hydrated Ti and TiO(2) surfaces. This analysis then quantifies for example the extent of polymer inertness and the "bioactivity" of alkali treated Ti. The growth rate constants for the model materials prepared in this work are explained on the basis of localized dissolution of HA, the amount of which simply increases with increasing volume fraction of HA in the composite.

Fabrication and characteristics of bioactive sodium titanate/titania graded film on NiTi shape memory alloy

A bioactive sodium titanate/titania graded film was formed in situ on NiTi shape memory alloy (SMA) by oxidizing in H(2)O(2) solution and subsequent NaOH treatment and characterized by scanning electron microscopy, Raman spectroscopy, X-ray diffraction, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy (XPS). The bioactivity of the film was investigated using a simulated body fluid (SBF) soaking test. A titania (TiO(2)) layer was first found on NiTi substrate after oxidized in H(2)O(2) solution, and then a porous sodium titanate (Na(2)TiO(3))/titania film with many Ti--OH groups and a trace of Ni(2)O(3) was formed by the reaction of partial TiO(2) phase with NaOH solution. After immersion in SBF for 12 h, apatite was observed to nucleate and grow on the film. With longer soaking time, more apatite appeared on its surface but our control experiments didn't reveal any apatite formation on the chemically polished NiTi SMA, which indicates the bioactivity of NiTi implants could be improved by the formation of the bioactive film. Moreover, XPS depth profiles of O, Ni, Ti, and Na show the bioactive film possesses a smooth graded interface structure to NiTi substrate, which is in favor of sufficient mechanical stability of apatite layer by subsequent deposition in SBF.

Hydrothermal modification of titanium surface in calcium solutions

Hydrothermal modification of a titanium surface in calcium solutions was performed. The apatite precipitation on the modified surface in Hanks' solution, as a simulated body fluid, was evaluated and the surface microstructure changes after the modification were characterized by thin-film X-ray diffractometry (TF-XRD) and X-ray photoelectron spectroscopy (XPS). Hydrothermal modification in CaO solution enhanced the precipitation of apatite on the titanium surface. High pH, high pressure and high temperature of the CaO solution increased the thickness of the surface-modified layer and enhanced the synthesis of calcium titanate which possibly promoted the precipitation of apatite in Hanks' solution. Hydrothermal modification in CaCl2 solution, on the other hand, showed reverse effects. The modification of titanium in CaO solution with hydrothermal treatment is expected to result in excellent osteointegration and can be easily performed by using an autoclave, a clinical apparatus widely used.

A comparative study of in vitro apatite deposition on heat-, H(2)O(2)-, and NaOH-treated titanium surfaces

Commercially pure titanium specimens are subjected to three different treatments, and their bioactivity are evaluated by immersing the specimens in a simulated body fluid (SBF, Kokubo's recipe) for various periods up to 7 days, with particular attention being paid to the differences in apatite deposition between surfaces open to SBF and surfaces in contact with the container's bottom. The treatment with a H(2)O(2)/HCl solution at 80 degrees C for 30 min followed by heating at 400 degrees C for 1 h produces an anatase titania gel layer on the specimen surface. This gel layer deposits apatite both on the contact and on open surfaces, and apatite deposition ability does not change with pre-staking in distilled water. The treatment with a NaOH solution at 60 degrees C for 3 days produces a sodium titanate gel layer. This gel layer can deposit apatite only on the contact surface, and the apatite deposition ability is completely lost after 1 day of pre-staking in distilled water. It is concluded, therefore, that the bioactivity of the titania gel originates from the favorable structure of the gel itself while the bioactivity of the sodium titanate gel depends heavily on ion release from the gel. The third treatment, a simple heat treatment at 400 degrees C for 1 h, produces a dense (not porous) oxide layer on the specimen surface. The specimens can deposit apatite on the contact surface after only 3 days of staking in SBF, but they cannot deposit apatite on the open surface for up to 2 months of staking. The implications of such apatite deposition behavior have been discussed in relation to the environments of titanium implants in bone as well as to the methodology of the SBF staking experiment.

Improvement of bioactivity of H(2)O(2)/TaCl(5)-treated titanium after subsequent heat treatments

Commercially pure titanium was treated with a H(2) O(2)/3mM TaCl(5) solution at 80 degrees C for various periods and a titania gel layer was formed on the surface. This gel remained amorphous when heating for 1 h below 200 degrees C and transformed to anatase after heating between 300 degrees and 600 degrees C. The anatase titania gel layers were found to be bioactive as to deposit carbonate ion-incorporated apatite within 1 day of immersion in the Kokubo solution, whereas the amorphous layers did not deposit apatite within 7 days. The apatite particles were found to nucleate preferentially inside the cracks prevailing in the thicker gel layers of 1-h chemically treated specimens. After immersing for 2 days, the titanium specimens were almost completely covered by apatite. Elimination of peroxide radicals from the titania gel and formation of anatase upon subsequent heating are considered to be responsible for the enhanced ability of apatite deposition.