Effect of modifications of dual acid-etched implant surfaces on periimplant bone formation. Part II: calcium phosphate coatings

Collagen-Based Osteogenic Nanocoating of Microrough Titanium Surfaces

The aim of the present study was to develop a collagen/heparin-based multilayer coating on titanium surfaces for retarded release of recombinant human bone morphogenic protein 2 (rhBMP2) to enhance the osteogenic activity of implant surfaces. Polyelectrolyte multilayer (PEM) coatings were constructed on sandblasted/acid-etched surfaces of titanium discs using heparin and collagen. PEM films of ten double layers were produced and overlayed with 200 µL of a rhBMP2 solution containing 15 µg rhBMP2. Subsequently, cross-linking of heparin molecules was performed using EDC/NHS chemistry to immobilize the incorporated rhBMP2. Release characteristics for 3 weeks, induction of Alkaline Phosphatase (ALP) in C2C12 cells and proliferation of human mesenchymal stem cells (hMSCs) were evaluated to analyze the osteogenic capacity of the surface. The coating incorporated 10.5 µg rhBMP2 on average per disc and did not change the surface morphology. The release profile showed a delivery of 14.5% of the incorporated growth factor during the first 24 h with a decline towards the end of the observation period with a total release of 31.3%. Cross-linking reduced the release with an almost complete suppression at 100% cross-linking. Alkaline Phosphatase was significantly increased on day 1 and day 21, indicating that the growth factor bound in the coating remains active and available after 3 weeks. Proliferation of hMSCs was significantly enhanced by the non-cross-linked PEM coating. Nanocoating using collagen/heparin-based PEMs can incorporate clinically relevant amounts of rhBMP2 on titanium surfaces with a retarded release and a sustained enhancement of osteogenic activity without changing the surface morphology.

A systematic review on the effect of inorganic surface coatings in large animal models and meta-analysis on tricalcium phosphate and hydroxyapatite on periimplant bone formation

The aim of the present systematic review was to analyse studies using inorganic implant coatings and, in a meta‐analysis, the effect of specifically tricalcium phosphate (TCP) and hydroxyapatite (HA) implant surface coatings on bone formation according to the PRISMA criteria. Inclusion criteria were the comparison to rough surfaced titanium implants in large animal studies at different time points of healing. Forty studies met the inclusion criteria for the systematic review. Fifteen of these analyzed the bone‐to‐implant contact (BIC) around the most investigated inorganic titanium implant coatings, namely TCP and HA, and were included in the meta‐analysis. The results of the TCP group show after 14 days a BIC being 3.48% points lower compared with the reference surface. This difference in BIC decreases to 0.85% points after 21–28 days. After 42–84 days, the difference in BIC of 13.79% points is in favor of the TCP‐coatings. However, the results are not statistically significant, in part due to the fact that the variability between the studies increased over time. The results of the HA group show a significant difference in mean BIC of 6.94% points after 14 days in favor of the reference surface. After 21–28 days and 42–84 days the difference in BIC is slightly in favor of the test group with 1.53% points and 1.57% points, respectively, lacking significance. In large animals, there does not seem to be much effect of TCP‐coated or HA‐coated implants over uncoated rough titanium implants in the short term.

Microscopic Characterization of Bioactivate Implant Surfaces: Increasing Wettability Using Salts and Dry Technology

The surface topography of dental implants plays an important role in cell-surface interaction promoting cell adhesion, proliferation and differentiation influencing osseointegration. A hydrophilic implant leads to the absorption of water molecules and subsequently promotes the adhesion of cells to the implant binding protein. Dried salts on the implant surfaces allow one to store the implant surfaces in a dry environment while preserving their hydrophilic characteristics. This process has been identified as “dry technology”. The aim of the present study is to describe from a micrometric and nanometric point of view the characteristics of this new bioactivated surface obtained using salts dried on the surface. Topographic analysis, energy-dispersive X-ray spectroscopy, and contact angle characterization were performed on the samples of a sandblasted and dual acid-etched surface (ABT), a nanosurface (Nano) deriving from the former but with the adding of salts air dried and a nanosurface with salts dissolved with distilled water (Nano H₂O). The analysis revealed promising results for nanostructured surfaces with increased wettability and a more articulated surface nanotopography than the traditional ABT surface. In conclusion, this study validates a new promising ultra-hydrophilic nano surface obtained by sandblasting, double acid etching and surface salt deposition using dry technology.

HA-hybrid matrix composite coating on Ti-Cp for biomedical application

Calcium phosphate coatings have been applied to titanium metal substrates and their alloys as a synergistic alternative capable of combining the mechanical properties of metals and the excellent bioactive properties provided by ceramic materials. However, the unsatisfactory adhesion of hydroxyapatite coatings on metallic substrates, as well as their limitation when subjected to mechanical stresses have been reported as a limitation. Biofunctional coatings have been proposed as an alternative to single ceramic coatings, aiming at optimizing the long-term clinical success of biomaterials such as Ti. This work aims at evaluating the morphological properties and biological behavior of Ti-cp coated with matrix composite coating hydroxyapatite-containing hybrid. The hybrid matrix was obtained from TEOS and MTES silicon precursors, with dispersed hydroxyapatite suspended by dip coating. For the morphological characterization FTIR, SEM/FEG, AFM and contact angle measurement were used. Biological behavior was evaluated for toxicity, cell viability and the osteogenic differentiation capacity of mesenchymal stem cells. The composite coatings obtained showed regular dispersion of hydroxyapatite particles in the hybrid matrix, with uniform coating adhering to the Ti-Cp substrate. Nevertheless, although they provided similar viability behavior of mesenchymal stem cells to the Ti-Cp substrate, the evaluated coatings did not present osteoinductive properties. This result is probably due to the pronounced hydrophobic behavior caused by the incorporation of HA.

Comparative investigations of in vitro and in vivo bioactivity of titanium vs. Ti-24Nb-4Zr-8Sn alloy before and after sandblasting and acid etching

To avoid the failure of clinical surgery due to "stress shielding" and the loosening of an implant, a new type of alloy, Ti-24Nb-4Zr-8Sn (TNZS), with a low Young's modulus acted as a new implant material in this work. Meanwhile, the surface characteristics, MC3T3-E1 cell behavior and in vivo osseointegration of the titanium and TNZS before and after sandblasting and acid etching were studied comparatively. TNZS and Ti had the same microstructure based on the transmission electron microscopy results. Meanwhile, the TNZS alloy had a lower Young's modulus and surface nanohardness compared with pure titanium. However, the corrosion resistance of Ti was better than that of the TNZS sample in simulated body fluid solution. In addition, the TNZS alloy after sandblasting and acid etching (SLATNZS) had excellent cell adhesion, proliferation, differentiation, ALP activity and in vivo osseointegration ability such as there being almost no soft tissue as compared with other implants. Based on the current results, the new type of Ti-24Nb-4Zr-8Sn alloy showed good potential and promising application prospects in its biochemical aspects.

Peri-Implant Bone Behavior after Single Drill versus Multiple Sequence for Osteotomy Drill

Objectives

The present study aims to compare the drilling protocol effect on osseointegration event in three commercially available titanium dental implants with different drill protocol using a rabbit tibia model.

Materials and Methods

Three different drilling sequences were compared as follows: drilling sequence using a single unique drill of 4.2 mm conical implant (Group 1), drilling sequence using 3 consecutive cylindrical drills for a 4.1 mm cylindrical implant (Group 2), and drilling sequence using 3 consecutive conical drills for a 4.3 mm conical implant (Group 3). For each group, 18 drilling procedures and implant placements were performed, totalizing 54 commercially available titanium dental implants. The samples were removed 6 weeks after implantation. Resonance frequency analyses (RFA) were performed immediately after the implantation, and at 6 weeks removal torque test (RTt) and histological analysis were performed.

Results

The RFA measured showed statistical difference between the groups in time 1 and no significant statistical differences in time 2 (p > 0.05). In the RTt no significant difference was found between the 3 groups tested. Histomorphometric analysis showed no significant difference between groups in the bone-to-implant contact% (p > 0.05).

Conclusion

In the present preclinical study, osteotomy using a single bur did not show differences regarding the proposed and evaluated tests parameters for assessing the peri-implant behavior.

Wool-derived keratin hydrogel enhances implant osseointegration in cancellous bone

AIM

This study investigated whether a keratin hydrogel derived from wool enhances ossointegration of dental implants, using a cancellous bone model in sheep.

METHOD

Ten female sheep received one dental implant per hind leg in the distal femoral condyles. Test implants were coated with 1 mL of keratin hydrogel containing sulphonated keratin and hydroxyapatite; control implants remained uncoated; implants were not functionally loaded axially. Biomechanical stability was tested with resonance frequency analysis (RFA) at placement and euthanasia. Animals were sacrificed after 4 weeks and resin-embedded histomorphometry performed.

FINDINGS

Bone appeared denser and more mature around the keratin-treated test implants. Average % bone-implant contact was significantly increased for the test (58.1 ± 4.6 [SD]%) compared to control implants (34.4 ± 7.5%) (p = 0.01). RFA values were lower for control (76.5 ± 4.2 ISQ) than test implants (80.4 ± 1.4) after 4 weeks (p = 0.04).

CONCLUSION

the increase in osseointegration found in this model suggests that keratin hydrogel has the potential to enhance the successful osseointegration of dental implants placed into poor quality bone. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2447-2454, 2018.

Evaluation of the osseointegration of dental implants coated with calcium carbonate: an animal study

In an attempt to overcome the limitations of titanium in dental and orthopaedic clinical applications, a new method has been developed to prepare calcium carbonate coatings on sandblasted and acid-etched (SA) titanium implants. The purpose of this study was to investigate the effect of calcium carbonate-SA (CC-SA) implants on osseointegration in vivo. The surfaces of SA and CC-SA implants were characterised for surface morphology and surface chemistry. Subsequently, these two kinds of implants were implanted in the femoral condyles of rabbits. The implants were retrieved and prepared for histological and histomorphometric evaluation 1, 2, 4, 8 and 12 weeks after implantation. Significantly higher values of bone-to-implant contact of the entire implant except the gap area (BIC_ALL) and the bone-to-implant contact of the gap area (BIC_GAP) were found in animals with the CC-SA implants than in those with the SA implants at 4 weeks. Higher values of total gap bone were found in those with the CC-SA implants than in those with the SA implants at 1, 2 and 4 weeks. In conclusion, the current findings demonstrate that the calcium carbonate coating can improve and accelerate the early ingrowth of bone and osseointegration at the early healing phase. This may reduce clinical healing times and thus improve implant success rates.

A systematic review and meta-analysis on the influence of biological implant surface coatings on periimplant bone formation

This systematic review and meta-analysis evaluated the influence of biological implant surface coatings on periimplant bone formation in comparison to an uncoated titanium reference surface in experimental large animal models. The analysis was structured according to the PRISMA criteriae. Of the1077 studies, 30 studies met the inclusion criteriae. Nineteen studies examined the bone implant contact (BIC) and were included in the meta-analysis. Overall, the mean increase in BIC for the test surfaces compared to the reference surfaces was 3.7 percentage points (pp) (95% CI -3.9-11.2, p = 0.339). Analyzing the increase in BIC for specific coated surfaces in comparison to uncoated reference surfaces, inorganic surface coatings showed a significant mean increase in BIC of 14.7 pp (95% CI 10.6-18.9, p < 0.01), extracellular matrix (ECM) surface coatings showed an increase of 10.0 pp (95% CI 4.4-15.6, p < 0.001), and peptide coatings showed a statistical trend with 7.1 pp BIC increase (95% CI -0.8-15.0, p = 0.08). In this review, no statistically significant difference could be found for growth factor surface coatings (observed difference -3.3 pp, 95% CI -16.5-9.9, p = 0.6). All analyses are exploratory in nature. The results show a statistically significant effect of inorganic and ECM coatings on periimplant bone formation. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2898-2910, 2016.

Bone augmentation around a dental implant using demineralized bone sheet containing biologically active substances

This study was designed to evaluate the volume of alveolar bone augmentation after immediate implant placement using demineralized bone. We examined the collagen matrix of demineralized bone and biologically active substances contained therein. Rat maxillary first molars were extracted, and the animals were divided into five groups as follows: tooth extraction only, implant into the mesial root socket, implant and other root sockets covered with demineralized bone sheet, implant and other root sockets filled with demineralized bone powder under the sheet, and implant and other root sockets covered with demineralized bone sheet from which proteins were extracted. We ascertained whether biologically active substances are contained in extracted proteins. Biologically active substances were detected in extracted proteins. Conditions using demineralized bone sheet with biologically active substances significantly augmented the height of the alveolar bone. Such resorbable membranes containing biologically active substances hold promise as clinical agents for bone augmentation upon implantation.

Synergistic effects of elastic modulus and surface topology of Ti-based implants on early osseointegration

Elastic modulus and surface micro-scale topographical structure of Ti alloy implants have a synergistic effect on cell attachment, osteogenic differentiation of rBMSCs in vitro and early osseointegration in vivo.

Clinical evaluation of anodized surface implants submitted to a counter torque of 25 ncm after 60 days of osseointegration: study in humans

INTRODUCTION

Decreasing the time needed for osseointegration has always been a big challenge for modern implantodontics. The main factor which helps to decrease the time needed for osseointegration is the newly developed surfaces being used, as well as their microstructures, in relation to their osseoinductive properties. The aim of this work is to clinically evaluate the osseointegration of the implants when using The anodized surfaces in humans, following a 60 days-period of osseointegration.

METHODOLOGY

Forty-Five implants were placed in different kinds of bones, according to the technique recommended by the manufacturer. Those implants were opened after 60 days of osseointegration. The success of evaluation was made through assessing the counter torque resistance of 25 Ncm. The implants which could withstand the applied torque were considered osseointegrated.

RESULTS

Of the forty-five implants made in different kinds of bones, only one failed to present osseointegration, resulting in a success rate of 97.7 %.

CONCLUSIONS

With this methodology it was possible to conclude that anodized surface implants present primary osseointegration after 60 days of healing, after which they can function normally.

Evaluation of bone healing on sandblasted and Acid etched implants coated with nanocrystalline hydroxyapatite: an in vivo study in rabbit femur

This study aimed at investigating if a coating of hydroxyapatite nanocrystals would enhance bone healing over time in trabecular bone. Sandblasted and acid etched titanium implants with and without a submicron thick coat of hydroxyapatite nanocrystals (nano-HA) were implanted in rabbit femur with healing times of 2, 4, and 9 weeks. Removal torque analyses and histological evaluations were performed. The torque analysis did not show any significant differences between the implants at any healing time. The control implant showed a tendency of more newly formed bone after 4 weeks of healing and significantly higher bone area values after 9 weeks of healing. According to the results from this present study, both control and nano-HA surfaces were biocompatible and osteoconductive. A submicron thick coating of hydroxyapatite nanocrystals deposited onto blasted and acid etched screw shaped titanium implants did not enhance bone healing, as compared to blasted and etched control implants when placed in trabecular bone.

Structural influence from calcium phosphate coatings and its possible effect on enhanced bone integration

OBJECTIVE

The aim of this review was to summarize our present knowledge about calcium phosphate (CaP) coatings on implants with respect to their topographical appearance at micrometer as well as nanometer level and also the reported influence on bone healing.

MATERIAL AND METHODS

The PubMed database was used with the key words - surface roughness, CaP coating, implant, bone integration, clinical studies, experimental studies - used in different combinations. Only in vivo studies were taken into consideration.

CONCLUSIONS

A significantly improved healing capacity associated with CaP-coated implants is often reported, but individual importance of the several modes of surface changes introduced, deliberately or not, is usually very difficult to interpret. Several studies claim this difference to be due to altered chemistry, but in many the result may equally well be dependent on the surface topography. The few studies that have been published indicate that nanometer structures have an impact on early bone healing. However, the optimal size and distribution of nanometer-sized particles or pores applied on implant surfaces is still unknown, as are the evaluation effects of micrometer roughness. Improved surface characterization is needed if we are to reveal effects dependent on isolated nanometer alterations.