Blood and fibroblast responses to thermoset BisGMA-TEGDMA/glass fiber-reinforced composite implants in vitro

Evolution in Bone Tissue Regeneration: From Grafts to Innovative Biomaterials

Bone defects caused by various traumas and diseases such as osteoporosis, which affects bone density, and osteosarcoma, which affects the integrity of bone structure, are now well known. Given this situation, several innovative research projects have been reported to improve orthopedic methods and technologies that positively contribute to the regeneration of affected bone tissue, representing a significant advance in regenerative medicine. This review article comprehensively analyzes the transition from existing methods and technologies for implants and bone tissue regeneration to innovative biomaterials. These biomaterials have been of great interest in the last decade due to their physicochemical characteristics, which allow them to overcome the most common limitations of traditional grafting methods, such as the availability of biomaterials and the risk of rejection after their application in regenerative medicine. This could be achieved through an exhaustive study of the applications and properties of various materials with potential applications in regenerative medicine, such as using magnetic nanoparticles and hydrogels sensitive to external stimuli, including pH and temperature. In this regard, this review article describes the most relevant compounds used in bone tissue regeneration, promoting the integration of these biomaterials with the affected area's bone structure, thereby allowing for regeneration and preventing amputation. Additionally, the types of interactions between biomaterials and mesenchymal stem cells and their effects on bone tissue are discussed, which is critical for developing biomaterials with optimal regenerative properties. Furthermore, the mechanisms of action of the various biomaterials that enhance osteoconduction and osteoinduction, ensuring the success of orthopedic therapies, are analyzed. This enables the treatment of bone defects tailored to each patient's condition, thereby avoiding limb amputation. Consequently, a promising future for regenerative medicine is emerging, with various therapies that could revolutionize the management of bone defects, offering more efficient and safer solutions.

Zirconia implants interfere with the evaluation of peri-implant bone defects in cone beam computed tomography (CBCT) images even with artifact reduction, a pilot study

OBJECTIVES

Three-dimensional cone beam computed tomography (CBCT) imaging can be considered, especially in patients with complicated peri-implantitis (PI). Artifacts induced by dense materials are the drawback of CBCT imaging and the peri-implant bone condition may not be assessed reliably because the artifacts are present in the same area. This pilot study investigates the performance of the artifact reduction algorithm (ARA) of the Planmeca Viso G7 CBCT device (Planmeca, Helsinki, Finland) with three different implant materials and imaging parameters.

METHODS

Three pairs of dental implants consisting of titanium, zirconia, and fiber reinforced composite (FRC) were set into a pig mandible. A vertical defect simulating peri-implantitis bone loss was made on the buccal side of one of each implant. The defect was identified and measured by two observers and compared to the actual dimensions. In addition, the bone structure and the marginal cortex visibility between the implants were estimated visually.

RESULTS

The bone defect and its dimensions with the zirconia implant could not be identified in any image with or without the metal artifact reduction algorithm. The bone defect of titanium and FRC implants were identified with all three imaging parameters or even without ARA. The interobserver agreement between the two observers was almost perfect for all categories analyzed.

CONCLUSION

Peri-implantitis defect of the zirconia implant and the peri-implant bone structure of the zirconia implants cannot be recognized reliably with any ARA levels, or any imaging parameters used with the Planmeca Viso G7. The need for ARA when imaging the peri-implant bone condition of the titanium and FRC implants may be unnecessary.

Blood Coagulation on Titanium Dioxide Films with Various Crystal Structures on Titanium Implant Surfaces

Background: Titanium (Ti) is one of the most popular implant materials, and its surface titanium dioxide (TiO₂) provides good biocompatibility. The coagulation of blood on Ti implants plays a key role in wound healing and cell growth at the implant site; however, researchers have yet to fully elucidate the mechanism underlying this process on TiO₂. Methods: This study examined the means by which blood coagulation was affected by the crystal structure of TiO₂ thin films (thickness < 50 nm), including anatase, rutile, and mixed anatase/rutile. The films were characterized in terms of roughness using an atomic force microscope, thickness using an X-ray photoelectron spectrometer, and crystal structure using transmission electron microscopy. The surface energy and dielectric constant of the surface films were measured using a contact angle goniometer and the parallel plate method, respectively. Blood coagulation properties (including clotting time, factor XII contact activation, fibrinogen adsorption, fibrin attachment, and platelet adhesion) were then assessed on the various test specimens. Results: All of the TiO₂ films were similar in terms of surface roughness, thickness, and surface energy (hydrophilicity); however, the presence of rutile structures was associated with a higher dielectric constant, which induced the activation of factor XII, the formation of fibrin network, and platelet adhesion. Conclusions: This study provides detailed information related to the effects of TiO₂ crystal structures on blood coagulation properties on Ti implant surfaces.

Effect of the surface finish on the mechanical properties and cellular adhesion in (Ce,Y)-TZP/Al2O3 ceramic composites for denture implants

Ceramic composites based on (Ce, Y)-TZP/Al₂O₃ system have great potential for applications as dental implants due to their unusually great balance between good mechanical properties and resistance to hydrothermal degradation. Surface roughness plays an important role in controlling these properties, but few studies have investigated the relationship between cytocompatibility and surface roughness, at levels considered moderate and low, comparable to titanium implants. In this work, bending strength, hydrothermal degradation and biological evaluation of a ceramic composite based on (Ce,Y)-TZP/Al₂O₃ system were investigated as a function of surface roughness. Compacted samples were sintered at 1500 °C - 2h and then submitted to different surface treatments: Group 1 composed of samples with smooth surfaces, Group 2 and Group 3 composed of rough surfaces (grinded with 15 μm or 45 μm diamond sandpaper, respectively. Samples were characterized by X-ray diffraction, scanning electron microscopy, contact angle and optical profilometry and then subjected to hydrothermal degradation tests in autoclave (134 °C - 2 bar) using artificial saliva. The Piston-on-three-balls (P-3B) testing was used to determine flexural strength. To assess indirect cytotoxicity, samples were immersed in the culture medium for NIH-3T3 cells for 72 h. Furthermore, cell adhesion and proliferation were investigated using MG63 cells (human osteosarcoma) after 3, 7, 14, and 21 days of culture. Cytotoxicity, adhesion, and cell proliferation were examined by the Methyl Tetrazolium salt (MTS) and Alizarin Red, using a confocal laser microscope. The results indicated that the materials have high resistance to degradation. Furthermore, the (Ce,Y)-TZP/Al₂O₃ composites are not cytotoxic. The flexural strength of the composites was 913 ± 103 MPa in samples presenting original (smooth) surface, however, a reduction in the order of 17% was observed in samples containing rough surfaces. The rougher samples show the best cellular adhesion and proliferation, leading to the formation of a mineralized matrix after 21 days. These results clearly suggest that the new (Ce,Y)-TZP/Al₂O₃ brand is strong and highly biocompatible and warrants further study.

Biostable glass fibre-reinforced dimethacrylate-based composites as potential candidates for fracture fixation plates in toy-breed dogs: Mechanical testing and finite element analysis

In toy-breed dogs (bodyweight <5 kg), the fractures of the radius and ulna are particularly common and can be caused by minimal trauma. While fracture fixation using metallic plates is a feasible treatment modality, the excessive stiffness of these devices produces the underloading of the bone which may result in the adverse bone remodelling and complications in the healing of the fracture. In this study, we investigated bisphenol A glycidylmethacrylate -based glass fibre reinforced composites as potential alternatives to metals in the devices intended for the fracture fixation of the distal radius in toy-breed dogs. Four composites with different glass fibre reinforcements were prepared as rectangular specimens and as fracture fixation plates. These were mechanically tested in three-point and four-point bending. There were two controls: polyether etherketone reinforced with short carbon fibres (specimens and plates) and commercially available stainless-steel plates. Finite element simulations were used for the assessment of the behaviour of the plates. For the control stainless steel plate, the bending strength was 1.358 N*m, superior to that of any of the composite plates. The composite plate with the matrix reinforced with continuous unidirectional glass fibres had the bending strength of 1.081 N*m, which is sufficient in this clinical context. For the plates made of polyether etherketone reinforced with carbon fibres, the strength was 0.280 N*m. Similar conclusions on the biomechanical behaviour of the plates could be made solely based on the results of the finite element simulations, provided the geometries and the material properties are well defined.

TiO2 Coating and UV Photofunctionalization Enhance Blood Coagulation on Zirconia Surfaces

This in vitro study was designed to evaluate the effect of sol-gel derived TiO₂ coating on blood coagulation, blood protein adsorption, and platelet response on zirconia surfaces. Square-shaped zirconia (n=96) (10x10x2 mm) was cut, ground, sintered, and finally cleansed ultrasonically in each of acetone and ethanol for 5 minutes. Three experimental groups (n=32) were fabricated: (a) zirconia coated with sol-gel derived TiO₂, (b) zirconia coated with sol-gel derived TiO₂ and treated with ultraviolet (UV) irradiation for 1 hour, and (c) non-coated zirconia as control. The coatings were prepared from tetraisopropyl orthotitanate solution by dip-coating. The thrombogenicity of the specimens was evaluated using a whole blood kinetic clotting time method where the extent of blood clotting was evaluated at 10, 20, 30, 40, 50, and 60 minutes (n=4/time point, total n=24/group). Scanning electron microscope images were taken to observe platelet morphologies after 1-hour incubation with platelet-rich plasma (PRP) (n=5/group). Surface characteristics were visualized using atomic force microscopy (n=1/group). Adsorption of plasma proteins and fibronectin on each surface was studied by gel electrophoresis (n=2/group). Significant differences were observed in blood coagulation between the test groups at 20-, 30-, 40-, and 50-minute time points (p<0.005). UV treated TiO₂ coated specimens showed fastest blood coagulation followed by TiO₂ coated and non-coated specimens. Furthermore, platelets appeared at a higher activation state on coated specimens. Gel electrophoresis revealed no difference in protein adsorption among the experimental groups. In summary, TiO₂ coatings promoted blood coagulation, and it was further enhanced by UV treatment, which has the potential to hasten the wound healing process in vivo.

Useful surface parameters for biomaterial discrimination

Topographical features of biomaterials' surfaces are determinant when addressing their application site. Unfortunately up to date there has not been an agreement regarding which surface parameters are more representative in discriminating between materials. Discs (n = 16) of different currently used materials for implant prostheses fabrication, such as cast cobalt-chrome, direct laser metal soldered (DLMS) cobalt-chrome, titanium grade V, zirconia (Y-TZP), E-glass fiber-reinforced composite and polyetheretherketone (PEEK) were manufactured. Nanoscale topographical surface roughness parameters generated by atomic force microscopy (AFM), microscale surface roughness parameters obtained by white light interferometry (WLI) and water angle values obtained by the sessile-water-drop method were analyzed in order to assess which parameter provides the best optimum surface characterization method. Correlations between nanoroughness, microroughness, and hydrophobicity data were performed to achieve the best parameters giving the highest discriminatory power. A subset of six parameters for surface characterization were proposed. AFM and WLI techniques gave complementary information. Wettability did not correlate with any of the nanoroughness parameters while it however showed a weak correlation with microroughness parameters.

In vitro blood and fibroblast responses to BisGMA-TEGDMA/bioactive glass composite implants

This in vitro study was designed to evaluate both blood and human gingival fibroblast responses to bisphenol A-glycidyl methacrylate-triethyleneglycol dimethacrylate (BisGMA-TEGDMA)/bioactive glass (BAG) composite, aimed to be used as composite implant abutment surface modifier. Three different types of substrates were investigated: (a) plain polymer (BisGMA 50 wt%-TEGDMA 50 wt%), (b) BAG-composite (50 wt% polymer + 50 wt% fraction of BAG-particles, <50 μm), and (c) plain BAG plates (100 wt% BAG). The blood response, including the blood-clotting ability and platelet adhesion morphology were evaluated. Human gingival fibroblasts were plated and cultured on the experimental substrates for up to 10 days, then the cell proliferation rate was assessed using AlamarBlue assay™. The BAG-composite and plain BAG substrates had a shorter clotting time than plain polymer substrates. Platelet activation and aggregation were most extensive, qualitatively, on BAG-composite. Analysis of the normalized cell proliferation rate on the different surfaces showed some variations throughout the experiment, however, by day 10 the BAG-composite substrate showed the highest (P < 0.001) cell proliferation rate. In conclusion, the presence of exposed BAG-particles enhances fibroblast and blood responses on composite surfaces in vitro.