New Ti-Alloys and Surface Modifications to Improve the Mechanical Properties and the Biological Response to Orthopedic and Dental Implants: A Review

In situ production of low-modulus Ti-Nb alloys by selective laser melting and their functional assessment toward orthopedic applications

This work aimed to manufacture Ti-28.5Nb and Ti-40.0Nb (wt%) alloys in situ via selective laser melting (SLM) from Ti and Nb elemental powders. X-ray diffraction analysis revealed complete β-phase (cubic) in Ti-40.0Nb and a mixture of (α'' orthorhombic + β cubic) phases in Ti-28.5Nb were formed, whereas few of the Nb particles remained only partially fused during manufacturing. The fraction of partially melted Nb particles was determined as ∼2 and ∼18% in Ti-28.5Nb and Ti-40Nb, respectively. Mechanical characterization revealed higher hardness and more strength in Ti-28.5Nb than in Ti-40.0Nb due to the presence of the α'' phase in the former. Tribocorrosion tests reveal a significantly better wear-corrosion resistance for Ti-40.0Nb, as determined from a lower total volume loss in Ti-40.0Nb (∼2 × 10-4 mm-3) than in Ti-28.5Nb (∼13 × 10-2 mm-3). The lower volume loss and better corrosion resistance behavior are attributed to the β phase, which was dominant in Ti-40.0Nb. Cell studies reveal no toxicity for up to 7 days. Both the alloys were better at supporting cell proliferation than wrought Ti6Al4V. This study presents a route to preparing Ti-Nb alloys in situ by SLM that are promising candidates for biomedical applications.

Numerical investigation of the optimal porosity of titanium foam for dental implants

Background

This paper aims to indicate numerically the accurate porosity used for dental implants, following the emphasis on the preference for titanium foam on pure titanium implants. A 3D-optimized numerical model is created to demonstrate the detailed differences between models.

Method

A 3D finite element model was generated using Abaqus for titanium and titanium foam implants with different porosities (50,60,62.5,70, and 80%) fixed in cortical and cancellous bone. The mechanical data for titanium foam is extracted from published literature. We evaluate an artificial intelligent equation for the stress-strain response of titanium foam with various porosities to describe their variations.

Results

To evaluate the stress-strain variations for different porosities, exponential artificial intelligence provides high accuracy (>0.99). The numerical results show that titanium foam implants appear to transfer more loads to the bordering bones due to their lower stiffness and higher energy absorption, which can help reduce stress shielding problems. In surrounding bones, the maximum VM stress occurs at the neck region from 5.42 MPa for pure titanium to 21.53 MPa for titanium foam with 80% porosity. Additionally, a porosity of 62.5% appears to be the most suitable since Young's modulus for this porosity (13.82 GPa) is close to the cortical bone's modulus (14.5 GPa). This suitability is shown in FEA by the similarity in stress level between pure titanium and the corresponding porosity. Overall, titanium foam implants appear to be a promising option for improving the effectiveness and longevity of bone implants in surgical dentistry.

Conclusion

Systematic numerical studies on titanium foam dental implants with different porosities. Analysis of the FE results shows that titanium foam with a porosity of 62.5% is more beneficial for use in dental implants.

Preparation of Cu2+/TA/HAP composite coating with anti-bacterial and osteogenic potential on 3D-printed porous Ti alloy scaffolds for orthopedic applications

Because of stress shielding effects, traditional titanium (Ti) alloy scaffolds have a high elastic modulus, which might promote looseness and bone disintegration surrounding the implant, increasing the likelihood of a second surgery. In contrast, 3D-printed porous Ti alloy scaffolds can reduce the scaffold weight while enhancing biocompatibility. Further, these scaffolds' porous nature allows bone tissue ingrowth as well as strong pore connectivity, which can improve nutrient absorption. Nevertheless, bare Ti alloy implants may fail because of inadequate bone integration; hence, adding a coating on the implant surface is an effective technique for improving implant stability. In this study, a composite coating comprising hydroxyapatite (HAP), chitosan (CS), tannic acid (TA) and copper ions (Cu2+) (Cu2+/TA/HAP composite coating) was prepared on the surface of 3D printed porous Ti alloy scaffolds using electrophoretic deposition. Using the standard plate count method, Live/Dead bacteria staining assay, FITC Phalloidin and 4',6-diamidino-2-phenylindole staining assay, and live/dead staining of cells we determined that the composite coating has better antibacterial properties and cytocompatibility as well as lower cytotoxicity. The Alkaline Phosphatase assay revealed that the coating results showed good osteogenesis potential. Overall, the composite coatings produced in this investigation give new potential for the application of Ti alloys in clinics.

Cheminformatics-Based Design and Synthesis of Hydroxyapatite/Collagen Nanocomposites for Biomedical Applications

This paper presents a novel cheminformatics approach for the design and synthesis of hydroxyapatite/collagen nanocomposites, which have potential biomedical applications in tissue engineering, drug delivery, and orthopedic and dental implants. The nanocomposites are synthesized by the co-precipitation method with different ratios of hydroxyapatite and collagen. Their mechanical, biological, and degradation properties are analyzed using various experimental and computational techniques. Attenuated total reflection-Fourier-transform infrared spectroscopy, thermogravimetric analysis, and X-ray diffraction unveil the low crystallinity and nanoscale particle size of hydroxyapatite (22.62 nm) and hydroxyapatite/collagen composites (14.81 nm). These findings are substantiated by scanning electron microscopy with energy-dispersive X-ray spectroscopy, confirming the Ca/P ratio between 1.65 and 1.53 and attesting to the formation of non-stoichiometric apatites in all samples, further validated by molecular simulation. The antimicrobial activity of the nanocomposites is evaluated in vitro against several bacterial and fungal strains, demonstrating their medical potential. Additionally, in silico analyses are performed to predict the absorption, distribution, metabolism, and excretion properties and the bioavailability of the collagen samples. This study paves the way for the development of novel biomaterials using chemoinformatics tools and methods, facilitating the optimization of design and synthesis parameters, as well as the prediction of biological outcomes. Future research directions should encompass the investigation of in vivo biocompatibility and bioactivity of the nanocomposites, while exploring further applications and functionalities of these innovative materials.

Comprehensive Review on Biomaterials and Their Inherent Behaviors for Hip Repair Applications

Developing biomaterials for hip prostheses is challenging and requires dedicated attention from researchers. Hip replacement is an inevitable and remarkable orthopedic therapy for enhancing the quality of patient life for those who have arthritis as well as trauma. Generally, five types of hip replacement procedures are successfully performed in the current medical market: total hip replacements, hip resurfacing, hemiarthroplasty, bipolar, and dual mobility systems. The average life span of artificial hip joints is about 15 years, and several studies have been conducted over the last 60 years to improve the performance and thereby increase the lifespan of artificial hip joints. Present-day prosthetic hip joints are linked to the wide availability of biomaterials. Metals, ceramics, and polymers are some of the most promising types of biomaterials; nevertheless, each biomaterial has advantages and disadvantages. Metals and ceramics fail in most applications owing to stress shielding and the emission of wear debris; ongoing research is being carried out to find a remedy to these unfavorable responses. Recent research found that polymers and composites based on polymers are significant alternative materials for artificial joints. With growing research and several biomaterials, recent reviews lag in effectively addressing hip implant materials' individual mechanical, tribological, and physiological behaviors. This Review comprehensively investigates the historical evolution of artificial hip replacement procedures and related biomaterials' mechanical, tribological, and biological characteristics. In addition, the most recent advances are also discussed to stimulate and guide future researchers as they seek more effective methods and synthesis of innovative biomaterials for hip arthroplasty application.

Interaction of biomolecules with anatase, rutile and amorphous TiO2 surfaces: A molecular dynamics study

The adhesion of biomolecules to dental and orthopedic implants is a fundamental step in the process of osseointegration. Short peptide motifs, such as RGD or KRSR, carried by extracellular matrix proteins or coated onto implant surfaces, accelerate cell adhesion and tissue formation. For this reason, understanding the binding mechanisms of adhesive peptides to oxidized surfaces of titanium implants is of paramount importance. We performed molecular dynamics simulations to compare the adhesion properties of 6 peptides, including the tripeptide RGD, its variants KGD and LGD, as well as the tetrapeptide KRSR, its variant LRSR and its truncated version RSR, on anatase, rutile, and amorphous titanium dioxide (TiO2) surfaces. The migration of these molecules from the water phase to the surface was simulated in an aqueous environment. Based on these simulations, we calculated the residence time of each peptide bound to the three different TiO2 structures. It was found that the presence of an N-terminal lysine or arginine amino acid residue resulted in more efficient surface binding. A pulling simulation was performed to detach the adhered molecules. The maximum pulling force and the binding energy were determined from the results of these simulations. The tri- and tetrapeptides had slightly greater adhesion affinity to the amorphous and anatase structure than to rutile in general, however specific surface and peptide binding characters could be detected. The binding energies obtained from our simulations allowed us to rank the adhesion strengths of the studied peptides.

Impact of Beam Deflection Geometry on the Surface Architecture and Mechanical Properties of Electron-Beam-Modified TC4 Titanium Alloy

This paper aims to investigate the impact of beam deflection geometry on the structure, surface architecture, and friction coefficient of electron-beam-modified TC4 titanium alloys. During the experiments, the electron beam was deflected in the form of different scanning geometries, namely linear, circular, and matrix. The structure of the treated specimens was investigated in terms of their phase composition by employing X-ray diffraction experiments. The microstructure was studied by scanning electron microscopy (SEM). The surface architecture was examined by atomic force microscopy (AFM). The friction coefficient was studied by a mechanical wear test. It was found that the linear and circular deflection geometries lead to a transformation of the phase composition, from double-phase α + β to α' martensitic structure. The application of a linear manner of scanning leads to a residual amount of beta phase. The use of a matrix does not tend to structural changes on the surface of the TC4 alloy. In the case of linear geometry, the thickness of the modified zone is more than 800 μm while, in the case of EBSM using circular scanning, the thickness is about 160 μm. The electron-beam surface modification leads to a decrease in the surface roughness to about 27 nm in EBSM with linear deflection geometry and 31 nm in circular deflection geometry, compared to that of the pure TC4 substrate (about 160 nm). The electron-beam surface modification of the TC4 alloy leads to a decrease in the coefficient of friction (COF), with the lowest COF values obtained in the case of linear deflection geometry (0.32). The results obtained in this study show that beam deflection geometry has a significant effect on the surface roughness and friction coefficient of the treated surfaces. It was found that the application of a linear manner of scanning leads to the formation of a surface with the lowest roughness and friction coefficient.

Influence of Aluminum and Copper on Mechanical Properties of Biocompatible Ti-Mo Alloys: A Simulation-Based Investigation

The use of titanium and titanium-based alloys in the human body due to their resistance to corrosion, implant ology and dentistry has led to significant progress in promoting new technologies. Regarding their excellent mechanical, physical and biological performance, new titanium alloys with non-toxic elements and long-term performance in the human body are described today. The main compositions of Ti-based alloys and properties comparable to existing classical alloys (C.P. TI, Ti-6Al-4V, Co-Cr-Mo, etc.) are used for medical applications. The addition of non-toxic elements such as Mo, Cu, Si, Zr and Mn also provides benefits, such as reducing the modulus of elasticity, increasing corrosion resistance and improving biocompatibility. In the present study, when choosing Ti-9Mo alloy, aluminum and copper (Cu) elements were added to it. These two alloys were chosen because one element is considered a favorable element for the body (copper) and the other element is harmful to the body (aluminum). By adding the copper alloy element to the Ti-9Mo alloy, the elastic modulus decreases to a minimum value of 97 GPa, and the aluminum alloy element increases the elastic modulus up to 118 GPa. Due to their similar properties, Ti-Mo-Cu alloys are found to be a good optional alloy to use.

Surface modification techniques of titanium and titanium alloys for biomedical orthopaedics applications: A review

Biomedical alloys have an important share in orthopedic applications. Among them, titanium and its titanium alloys are widely used as implant materials because of their excellent mechanical properties and non-cytotoxicity. However, its disadvantages such as its biological inertness and poor antibacterial properties inhibit its further development. Therefore, the surface properties of titanium are crucial in the implantation process and determine the success of the implant. The main purpose of this review is to provide a comprehensive and detailed description of the modification techniques used for the surface modification of titanium implants. In this paper, the corresponding technical methods are introduced systematically from four aspects: mechanical method, physical surface modification, chemical surface modification and electrochemical technique to understand the experimental mechanism of each modification technique, and the above methods can indeed improve the various properties of titanium and its alloys. With the increasing demand for implants in the future, the requirements for surface properties will also increase. Therefore, the development of new coating materials with higher performance by combining various advantages of existing modification technologies is the main trend of future research on surface modification of titanium alloys.

Surface Modification of Biomedical Ti-18Zr-15Nb Alloy by Atomic Layer Deposition and Ag Nanoparticles Decoration

Superelastic biocompatible alloys attract significant attention as novel materials for bone tissue replacement. These alloys are often composed of three or more components that lead to the formation of complex oxide films on their surfaces. For practical use, it is desirable to have a single-component oxide film with a controlled thickness on the surface of biocompatible material. Herein we investigate the applicability of the atomic layer deposition (ALD) technique for surface modification of Ti-18Zr-15Nb alloy with TiO₂ oxide. It was found that a 10-15 nm thick, low-crystalline TiO₂ oxide layer is formed by ALD method over the natural oxide film (~5 nm) of the Ti-18Zr-15Nb alloy. This surface consists of TiO₂ exclusively without any additions of Zr or Nb oxides/suboxides. Further, the obtained coating is modified by Ag nanoparticles (NPs) with a surface concentration up to 1.6% in order to increase the material's antibacterial activity. The resulting surface exhibits enhanced antibacterial activity with an inhibition rate of more than 75% against E. coli bacteria.

Surface Characterization of New β Ti-25Ta-Zr-Nb Alloys Modified by Micro-Arc Oxidation

The technique of surface modification using electrolytic oxidation, called micro-arc oxidation (MAO), has been used in altering the surface properties of titanium alloys for biomedical purposes, enhancing their characteristics as an implant (biocompatibility, corrosion, and wear resistance). The layer formed by the micro-arc oxidation process induces the formation of ceramic oxides, which can improve the corrosion resistance of titanium alloys from the elements in the substrate, enabling the incorporation of bioactive components such as calcium, phosphorus, and magnesium. This study aims to modify the surfaces of Ti-25Ta-10Zr-15Nb (TTZN1) and Ti-25Ta-20Zr-30Nb (TTZN2) alloys via micro-arc oxidation incorporating Ca, P, and Mg elements. The chemical composition results indicated that the MAO treatment was effective in incorporating the elements Ca (9.5 ± 0.4 %atm), P (5.7 ± 0.1 %atm), and Mg (1.1 ± 0.1 %atm), as well as the oxidized layer formed by micropores that increases the surface roughness (1160 nm for the MAO layer of TTZN1, 585 nm for the substrate of TTZN1, 1428 nm for the MAO layer of TTZN2, and 661 nm for the substrate of TTZN2). Regarding the phases formed, the films are amorphous, with low crystallinity (4 and 25% for TTZN2 and TTZN1, respectively). Small amounts of anatase, zirconia, and calcium carbonate were detected in the Ti-25Ta-10Zr-15Nb alloy.

DMP1 and IFITM5 Regulate Osteogenic Differentiation of MC3T3-E1 on PEO-Treated Ti-6Al-4V-Ca2+/Pi surface

Despite numerous studies on various surface modifications on titanium and its alloys, it remains unclear what kind of titanium-based surface modifications are capable of controlling cell activity. This study aimed to understand the mechanism at the cellular and molecular levels and investigate the in vitro response of osteoblastic MC3T3-E1 cultured on the Ti-6Al-4V surface modified by plasma electrolytic oxidation (PEO) treatment. A Ti-6Al-4V surface was prepared by PEO at 180, 280, and 380 V for 3 or 10 min in an electrolyte containing Ca²⁺/P_i ions. Our results showed that PEO-treated Ti-6Al-4V-Ca²⁺/P_i surfaces enhanced the cell attachment and differentiation of MC3T3-E1 compared to the untreated Ti-6Al-4V control but did not affect cytotoxicity as shown by cell proliferation and cell death. Interestingly, on the Ti-6Al-4V-Ca²⁺/P_i surface treated by PEO at 280 V for 3 or 10 min, MC3T3-E1 showed a higher initial adhesion and mineralization. In addition, the alkaline phosphatase (ALP) activity significantly increased in MC3T3-E1 on the PEO-treated Ti-6Al-4V-Ca²⁺/P_i (280 V for 3 or 10 min). In RNA-seq analysis, the expression of dentin matrix protein 1 (DMP1), sortilin 1 (Sort1), signal-induced proliferation-associated 1 like 2 (SIPA1L2), and interferon-induced transmembrane protein 5 (IFITM5) was induced during the osteogenic differentiation of MC3T3-E1 on the PEO-treated Ti-6Al-4V-Ca²⁺/P_i. DMP1 and IFITM5 silencing decreased the expression of bone differentiation-related mRNAs and proteins and ALP activity in MC3T3-E1. These results suggest that the PEO-treated Ti-6Al-4V-Ca²⁺/P_i surface induces osteoblast differentiation by regulating the expression of DMP1 and IFITM5. Therefore, surface microstructure modification through PEO coatings with Ca²⁺/P_i ions could be used as a valuable method to improve biocompatibility properties of titanium alloys.

The Effects of Titanium Dioxide Nanoparticles on Osteoblasts Mineralization: A Comparison between 2D and 3D Cell Culture Models

Although several studies assess the biological effects of micro and titanium dioxide nanoparticles (TiO₂ NPs), the literature shows controversial results regarding their effect on bone cell behavior. Studies on the effects of nanoparticles on mammalian cells on two-dimensional (2D) cell cultures display several disadvantages, such as changes in cell morphology, function, and metabolism and fewer cell-cell contacts. This highlights the need to explore the effects of TiO₂ NPs in more complex 3D environments, to better mimic the bone microenvironment. This study aims to compare the differentiation and mineralized matrix production of human osteoblasts SAOS-2 in a monolayer or 3D models after exposure to different concentrations of TiO₂ NPs. Nanoparticles were characterized, and their internalization and effects on the SAOS-2 monolayer and 3D spheroid cells were evaluated with morphological analysis. The mineralization of human osteoblasts upon exposure to TiO₂ NPs was evaluated by alizarin red staining, demonstrating a dose-dependent increase in mineralized matrix in human primary osteoblasts and SAOS-2 both in the monolayer and 3D models. Furthermore, our results reveal that, after high exposure to TiO₂ NPs, the dose-dependent increase in the bone mineralized matrix in the 3D cells model is higher than in the 2D culture, showing a promising model to test the effect on bone osteointegration.

FEATURES OF BONE REMODELING AROUND SURFACE-MODIFIED TITANIUM AND TANTALUM IMPLANTS

OBJECTIVE

The aim: To study the osseointegrative properties of titanium and tantalum implants with different surface structures in animal experiments.

PATIENTS AND METHODS

Materials and methods: The histological and morphometric study was carried out on 60 male white rats after titanium implants with different surface structures made by 3D printed technology were inserted in the distal femur bone: presented by the multilayered layers of interlacing pores of 300 microns (series 1); rough (> 2 microns) (series 2); and tantalum implants with 300 microns pores and 80% porosity (series 3) as control material.

RESULTS

Results: On the 30 days we found statistically significant differences in the bone-implant contact rate between the 2nd experiment series (44.77 ± 1.86)% and 1st (59.91 ± 2.86)% (p=0.000047) and 3rd (53.89 ± 2.11)% (р=0.000065), on the 90 days between the 2nd experiment series (51.26 ± 2.7)% and 1st (66.84 ± 2.63)% (p=0.000187) and 3rd (70.35 ± 4.32)% (p=0.000349). There was a difference between the indices of the bone-implant volume at day 90 between the 1st (48.43 ± 2.2)% and 2nd (36.88 ± 2.56)% series (p=0.000919), between the 2nd and 3rd series (51.2 ± 3.06)% (p=0.000107). There were no significant differences between the studied indices in the 1st and 3rd series of the experiment.

CONCLUSION

Conclusions: Titanium implants with multilayered interlaced pore layers of 300 microns and tantalum with 300 microns pore size and 80% porosity may be promising. Rough-surface titanium also has osseointegrative qualities, but they are lower compared to other materials.

Fabrication of multilevel porous structure networks on Nb-Ta-Ti alloy scaffolds and the effects of surface characteristics on behaviors of MC3T3-E1 cells

Porous Nb-25Ta-25Ti alloys (60% porosity and 100-600 μm pore size) for bone implant applications were manufactured combining impregnation and sintering methods. Surfaces with porous micro-nanostructured networks on Nb-Ta-Ti alloys were successfully modified by various surface pre-treatments (acid etching, alkali-heat treatment and annealing treatment). Surface characteristics and Ca-P layer deposition behaviors of the multilevel structured porous Nb-Ta-Ti alloys were investigated by conducting various tests, including x-ray diffraction, scanning electron microscopy, energy-dispersive x-ray, atomic force microscopy and optical contact angle measurement. In particular, bulk Nb-Ta-Ti alloys were also used as mutual control. The results demonstrated that the porous alloy exhibited a unique multilevel porous structure with macro-networks and micro-pits after pre-treatments. The surface passive TiO₂/Nb₂O₅/Ta₂O₅layers on Nb-Ta-Ti alloys were partially dissolved by the corrosive attack of hydroxyl ions during alkali heat treatment. In addition, subsequent annealing treatment increased the density of the gel layers formed during alkali heat treatment. After immersion in SBF for 14 d, a continuous relatively uniform apatite layer was formed on the multilevel structured surfaces. Moreover, the mechanism of surface mineralization can be construed as electrostatic interactions between substrates and ions. Furthermore,in vitrocell culture showed that Nb-Ta-Ti alloys had a good biocompatibility and the multilevel porous structure could enhance the cellular behaviors including: cell adhesion and spreading.

Structure, Properties, and Corrosion Behavior of Ti-Rich TiZrNbTa Medium-Entropy Alloys with β+α″+α' for Biomedical Application

Five Ti-rich β+α″+α′ Ti−Zr−Nb−Ta biomedical medium-entropy alloys with excellent mechanical properties and corrosion resistance were developed by considering thermodynamic parameters and using the valence electron concentration formula. The results of this study demonstrated that the traditional valence electron concentration formula for predicting phases is not entirely applicable to medium-entropy alloys. All solution-treated samples with homogeneous compositions were obtained at a low temperature (900 °C) and within a short period (20 min). All solution-treated samples exhibited low elastic moduli ranging from 49 to 57 GPa, which were significantly lower than those of high-entropy alloys with β phase. Solution-treated Ti65−Zr29−Nb3−Ta3 exhibited an ultra-high bending strength (1102 MPa), an elastic recovery angle (>30°), and an ultra-low elastic modulus (49 GPa), which are attributed to its α″ volume fraction as high as more than 60%. The pitting potentials of all samples were higher than 1.8 V, and their corrosion current densities were lower than 10−5 A/cm3 in artificially simulated body fluid at 37 °C. The surface oxide layers on Ti65−Zr29−Nb3−Ta3 comprised TiO2, ZrO2, Nb2O5, and Ta2O5 (as discovered through X-ray photoelectron spectroscopy) and provided the alloy with excellent corrosion and pitting resistance.

Influence of silicon morphology on direct current plasma electrolytic oxidation process in AlSi10Mg alloy produced with laser powder bed fusion

In this work, plasma electrolytic oxidation (PEO) process was applied on AlSi10Mg samples, produced with laser powder bed fusion (L-PBF), in the as printed condition and after different heat treatments, and, for comparison, on as-cast samples of AlSi10Mg. PEO process was performed in direct-current mode using high current densities and short time in a basic silicate electrolyte. For the first time, the effects of silicon morphology in L-PBF AlSi10Mg samples, in as printed condition and after different heat treatments, on the obtained PEO coating were investigated in terms of microstructure and corrosion properties. The microstructure of the substrate was characterized with optical and electron microscopy observations (optical microscopy OM, scanning electron microscopy SEM, and transmission electron microscopy TEM) and with X-ray diffraction (XRD). The analysis showed that heat treatments of annealing and solution treating modified the morphology and distribution of silicon in the samples obtained through L-PBF. The PEO coated samples were characterized with SEM, both on the surface and in the cross-section, and compositional analysis were performed with energy dispersive spectroscopy (EDS) analysis and elemental mapping. The coatings were also analyzed with XRD and the corrosion properties evaluated through electrochemical impedance spectroscopy (EIS) tests. Also microhardness tests were performed on the substrates and on the coatings. The microstructure of the coatings was strongly influenced by the silicon distribution. In particular, a non-uniform distribution of silicon and the presence of iron-rich intermetallic (obtained in the as-cast and solution treated samples) induced the formation of more porous and thinner coatings in comparison with the ones obtained in the as printed and annealed samples. The not-uniform silicon distribution produced a not-homogenous distribution of silicon into the coatings. The particular cellular structure of the as printed sample induced the formation of a coating with a higher amorphous fraction, in comparison with the ones produced on the other samples. The higher thickness and lower porosity of the coatings obtained on the annealed and as printed samples resulted in an increase of the corrosion resistance.

Nanoparticles in Endodontics Disinfection: State of the Art

Endodontic-related diseases constitute the fourth most expensive pathologies in industrialized countries. Specifically, endodontics is the part of dentistry focused on treating disorders of the dental pulp and its consequences. In order to treat these problems, especially endodontic infections, dental barriers and complex root canal anatomy should be overcome. This constitutes an unmet medical need since the rate of successful disinfection with the currently marketed drugs is around 85%. Therefore, nanoparticles constitute a suitable alternative in order to deliver active compounds effectively to the target site, increasing their therapeutic efficacy. Therefore, in the present review, an overview of dental anatomy and the barriers that should be overcome for effective disinfection will be summarized. In addition, the versatility of nanoparticles for drug delivery and their specific uses in dentistry are comprehensively discussed. Finally, the latest findings, potential applications and state of the art nanoparticles with special emphasis on biodegradable nanoparticles used for endodontic disinfection are also reviewed.

In Vitro and Electrochemical Characterization of Laser-Cladded Ti-Nb-Ta Alloy for Biomedical Applications

Titanium (Ti) and its alloys are predominant choices for use as biomaterials in human implants. Research has shown the adverse effects of using commercial Ti alloy Ti-6Al-4V in the human body, and this presents a need for viable alternatives. In this study, Ti alloy Ti-17Nb-6Ta was manufactured by laser cladding—a prominent additive manufacturing (AM) technology. Laser cladded specimens were evaluated for their in vitro and electrochemical behavior. A human osteosarcoma cell line (MG-63 cells) was used for in vitro investigations. Cell proliferation was good in the physiological medium, and cells were alive when in contact with the laser cladded alloy, even after two to three weeks, indicating good cell viability and compatibility with this alloy. Electrochemical characterization was carried out in Ringer’s solution, and noticeably lower corrosion current density and corrosion rate values were observed. The lower amounts of these parameters indicated the passivation behavior due to multi-layer Ti, Nb, and Ta alloy oxide films. These oxide films also enhanced osseointegration. Thus, the Ti-17Nb-6Ta alloy can be an ideal biocompatible alternative to Ti-6Al-4V.

Multifunctional TiO2 coatings developed by plasma electrolytic oxidation technique on a Ti20Nb20Zr4Ta alloy for dental applications

A newly developed β-Ti alloy based on the Ti-Nb-Zr-Ta system (Ti20Nb20Zr4Ta) has been subjected to Plasma Electrolytic Oxidation (PEO) treatment to obtain a multifunctional ceramic-like (TiO₂) coating with superior tribocorrosion (wear and corrosion) resistance and improved biocompatibility. For this aim, elements such as Ca, P, and Ag NPs have been incorporated into the oxide film to obtain bioactive and biocide properties. The chemical composition and morphology of the TiO₂-PEO coating was characterized, and its multifunctionality was addressed by several means, including antibacterial activity assessment, formation of bone-like apatite, metallic ion release evaluation, in vitro cellular response analysis, and corrosion and tribocorrosion tests in artificial saliva. The developed coatings enhanced the corrosion and tribocorrosion resistance of the bare alloy and exhibited antibacterial ability with low cytotoxicity and negligible ion release. Furthermore, they were able to sustain MC3T3-E1 preosteoblast viability/proliferation and osteogenic differentiation. Altogether, the results obtained demonstrate the potential of the TiO₂ coating incorporating Ca, P, and Ag NPs to be used for dental applications.

Metallic Implants Used in Lumbar Interbody Fusion

Over the last decade, pedicle fixation systems have evolved and modifications in spinal fusion techniques have been developed to increase fusion rates and improve clinical outcomes after lumbar interbody fusion (LIF). Regarding materials used for screw and rod manufacturing, metals, especially titanium alloys, are the most popular resources. In the case of pedicle screws, that biomaterial can be also doped with hydroxyapatite, CaP, ECM, or tantalum. Other materials used for rod fabrication include cobalt-chromium alloys and nitinol (nickel-titanium alloy). In terms of mechanical properties, the ideal implant used in LIF should have high tensile and fatigue strength, Young's modulus similar to that of the bone, and should be 100% resistant to corrosion to avoid mechanical failures. On the other hand, a comprehensive understanding of cellular and molecular pathways is essential to identify preferable characteristics of implanted biomaterial to obtain fusion and avoid implant loosening. Implanted material elicits a biological response driven by immune cells at the site of insertion. These reactions are subdivided into innate (primary cellular response with no previous exposure) and adaptive (a specific type of reaction induced after earlier exposure to the antigen) and are responsible for wound healing, fusion, and also adverse reactions, i.e., hypersensitivity. The main purposes of this literature review are to summarize the physical and mechanical properties of metal alloys used for spinal instrumentation in LIF which include fatigue strength, Young's modulus, and corrosion resistance. Moreover, we also focused on describing biological response after their implantation into the human body. Our review paper is mainly focused on titanium, cobalt-chromium, nickel-titanium (nitinol), and stainless steel alloys.

Microstructure, mechanical properties and osseointegration ability of Ta-20Zr alloy used as dental implant material

The aim of this study was to evaluate the application prospect of a tantalum (Ta) and zirconium (Zr) alloy as a dental implant material. The Ta-20Zr (wt.%) alloy was prepared by powder metallurgy, and its microstructure and mechanical properties were analyzed by standard techniques. The effect of Ta-20Zr alloy on inflammation, bone remodeling and osseointegration was analyzed in rat and rabbit models by biochemical, histological and imaging tests. The Ta-20Zr alloy showed excellent mechanical compatibility with the bone tissue on account of similar elastic modulus (49.2 GPa), thereby avoiding the 'stress shielding effect'. Furthermore, Ta-20Zr alloy enhanced the inflammatory response by promoting secretion of interleukin-6 (IL-6) and IL-10, and facilitated the balance between the M1/M2 macrophage phenotypes. Finally, Ta-20Zr also showed excellent osseointegration and osteogenic ability without any systemic side effects, making it an ideal dental implant material.

Effects of titanium dioxide microparticles and nanoparticles on cytoskeletal organization, cell adhesion, migration, and proliferation in human gingival fibroblasts in the presence of lipopolysaccharide

BACKGROUND AND OBJECTIVE

Titanium wear particles may participate in the etiology of peri-implantitis. However, the influence of titanium wear particles on biological behavior of human gingival fibroblasts (HGFs) in the presence of LPS is still not clear. The present study demonstrated the effects of titanium dioxide micro- and nanoparticles (TiO₂  MPs and NPs) on HGF cell viability, cytoskeletal organization, adhesion, migration, and proliferation in vitro, and LPS was used to mimic the in vivo condition.

METHODS

Primary HGFs were treated with TiO₂ MPs (primary particle size <5 μm, 0.1 mg/ml) and NPs (primary particle size <100 nm, 0.1 mg/ml) with or without 1 μg/ml LPS. The effects of TiO₂ MPs and NPs on HGFs cell viability was measured by CCK-8 assay. The proliferation of HGF was detected by Ki67 nuclear staining. The confocal laser scanning microscope (CLSM) was used to detect the internalization of TiO₂ MPs and NPs in HGFs as well as the arrangement of F-actin, vinculin, and vimentin organization. Wound healing assay and transwell assay were performed to measure the migration of HGFs induced by TiO₂ MPs and NPs. Cell adhesion was measured using fibronectin-coated plates. The relative mRNA and protein expression of adhesion relative protein such as focal adhesion kinase (FAK), fibronectin (FN), and type I collagen (COL1) were measured using quantitative RT-PCR and western blot analysis. One-way analysis of variance (ANOVA) and Student's t-test were used to analyze the statistical significance, and p < .05 was considered statistically significant.

RESULTS

TiO₂ NPs significantly inhibited HGF cell viability, proliferation, and migration compared with TiO₂ MPs group and control group. Compared with control group (2.64 ± 0.09), the mean absorbance of the cells in 1 mg/ml TiO₂ MPs group and 0.25 mg/ml TiO₂ NPs group were significantly decreased to 1.93 ± 0.33 (p < .05) and 2.22 ± 0.18 (p < .01), respectively. The cytoskeleton disruption was found in TiO₂ NPs group. The mRNA and protein expression were significantly downregulated by TiO₂ NPs. Furthermore, both TiO₂ NPs and MPs induced more adverse effects on HGFs in the presence of LPS.

CONCLUSION

Our results indicate that TiO₂ NPs but not TiO₂ MPs significantly disrupt the cytoskeletal organization and inhibited cell adhesion, migration, and proliferation of HGFs. However, in the presence of LPS, TiO₂ MPs, and TiO₂ NPs enhance these negative effects in HGFs. Titanium wear particles are probably involved in the initiation and progression of peri-implant diseases.

Effect of Bone Remodeling on Dental Implant Fatigue Limit Predicted Using 3D Finite Element Analysis

BACKGROUND

To evaluate the effect of bone remodelling around a reduced-diameter dental implant on its fatigue limit using finite element analysis (FEA).

METHODS

A dental implant assembly, which included a reduced-diameter dental implant (Biomet-3i external hex), an abutment (GingiHue^®) and a connector screw (Gold-Tite Square screw), was scanned using micro-computed tomography (Skyscan 1172). Its dimensions were measured using Mimics (Materialise) and an optical microscope (Keyence). The digital replicas of the physical specimens were constructed using SOLIDWORKS (Dassault Systems). A cylindrical bone specimen holder with two layers (cortical and cancellous bone) was designed in SOLIDWORKS. Two assemblies were created: (a) Model 1: Having non-remodelled bone; (b) Model 2: Cancellous bone remodelled at the regions adjacent to the implant screw threads. FEA was performed in ABAQUS (SIMULIA). In Model 1, the Young's modulus of cortical and cancellous bone were 20 GPa and 14 GPa, respectively. For Model 2, the region of the cancellous bone adjacent to the implant screw threads was assigned a Young's modulus of 20 GPa. fe-safe (SIMULIA) was used to estimate the fatigue limit.

RESULTS

The maximum von Mises stress under 100 N load was 439.9 MPa for both models 1 and 2 and was located at the connector screw. The fatigue limit was 116.4 N for both models 1 and 2.

CONCLUSIONS

The results suggest that implant fatigue resistance tested according to ISO 14801 may be accurately predicted without bothering to simulate the non-homogeneous stiffness that occurs at the bone-implant interface in the clinical case.

SiC- and Ag-SiC-Doped Hydroxyapatite Coatings Grown Using Magnetron Sputtering on Ti Alloy for Biomedical Application

SiC- and Ag-SiC-doped hydroxyapatite (HA) coatings were deposited via magnetron sputtering aiming at increased corrosion protection of Ti-10Nb-10Zr-5Ta alloy in simulated body fluid environment and superior mechanical properties compared to plain hydroxyapatite. The coatings had a total thickness of about 350 nm. The X ray diffraction patterns indicate that HA coatings are polycrystalline with a hexagonal structure and the addition of SiC determined the coating amorphization. All coatings presented a lower roughness compared to the Ti alloy and were hydrophilic. Ag-SiC-HA coating presented the best corrosion resistance and tribological parameters. All coatings were biocompatible, as ascertained via indirect cytocompatibility studies conducted on Vero cells.

BMP-2 Delivery through Liposomes in Bone Regeneration

Bone regeneration is a central focus of maxillofacial research, especially when dealing with dental implants or critical sized wound sites. While bone has great regeneration potential, exogenous delivery of growth factors can greatly enhance the speed, duration, and quality of osseointegration, making a difference in a patient’s quality of life. Bone morphogenic protein 2 (BMP-2) is a highly potent growth factor that acts as a recruiting molecule for mesenchymal stromal cells, induces a rapid differentiation of them into osteoblasts, while also maintaining their viability. Currently, the literature data shows that the liposomal direct delivery or transfection of plasmids containing BMP-2 at the bone wound site often results in the overexpression of osteogenic markers and result in enhanced mineralization with formation of new bone matrix. We reviewed the literature on the scientific data regarding BMP-2 delivery with the help of liposomes. This may provide the ground for a future new bone regeneration strategy with real chances of reaching clinical practice.

Synthesis and Characterization of Ti-Sn Alloy for Orthopedic Application

Titanium (Ti)-based alloys (e.g., Ti6Al4V) are widely used in orthopedic implant applications owing to their excellent mechanical properties and biocompatibility. However, their corrosion resistance needs to be optimized. In addition, the presence of aluminum and vanadium cause alzheimer and cancer, respectively. Therefore, in this study, titanium-based alloys were developed via powder metallurgy route. In these alloys, the Al and V were replaced with tin (Sn) which was the main aim of this study. Four sets of samples were prepared by varying Sn contents, i.e., 5 to 20 wt. %. This was followed by characterization techniques including laser particle analyzer (LPA), X-ray diffractometer (XRD), scanning electron microscope (SEM), computerized potentiostate, vicker hardness tester, and nanoindenter. Results demonstrate the powder sizes between 50 and 55 µm exhibiting very good densification after sintering. The alloy contained alpha at all concentrations of Sn. However, as Sn content in the alloy exceeded from 10 wt. %, the formation of intermetallic compounds was significant. Thus, the presence of such intermetallic phases are attributed to enhanced elastic modulus. In particular, when Sn content was between 15 and 20 wt. % a drastic increase in elastic modulus was observed thereby surpassing the standard/reference alloy (Ti6Al4V). However, at 10 wt. % of Sn, the elastic modulus is more or less comparable to reference counterpart. Similarly, hardness was also increased in an ascending order upon Sn addition, i.e., 250 to 310 HV. Specifically, at 10 wt. % Sn, the hardness was observed to be 250 HV which is quite near to reference alloy, i.e., 210 HV. Moreover, tensile strength (TS) of the alloys were calculated using hardness values since it was very difficult to prepare the test coupons using powders. The TS values were in the range of 975 to 1524 MPa at all concentrations of Sn. In particular, the TS at 10 wt. % Sn is 1149 MPa which is comparable to reference counterpart (1168 MPa). The corrosion rate of Titanium-Sn alloys (as of this study) and reference alloy, i.e., Ti6Al4V were also compared. Incorporation of Sn reduced the corrosion rate at large than that of reference counterpart. In particular, the trend was in decreasing order as Sn content increased from 5 to 20 wt. %. The minimum corrosion rate of 3.65 × 10⁻⁹ mm/year was noticed at 20 wt. % than that of 0.03 mm/year of reference alloy. This shows the excellent corrosion resistance upon addition of Sn at all concentrations.

Interaction of KRSR Peptide with Titanium Dioxide Anatase (100) Surface: A Molecular Dynamics Simulation Study

Due to its tensile strength and excellent biocompatibility, titanium (Ti) is commonly used as an implant material in medicine and dentistry. The success of dental implants depends on the formation of a contact between the oxidized surface of Ti implant and the surrounding bone tissue. The adsorption of proteins and peptides to the implant surface allows the bone-forming osteoblast cells to adhere to such modified surfaces. Recently, it has been observed that tetrapeptide KRSR (Lys-Arg-Ser-Arg) functionalization could promote osteoblast adhesion to implant surfaces. This may facilitate the establishment of an efficient bone-to implant contact and improve implant stability during the healing process. GROMACS, a molecular dynamics software package was used to perform a 200 ns simulation of adsorption of the KRSR peptide to the TiO₂ (anatase) surface in an aqueous environment. The molecule conformations were mapped with Replica Exchange Molecular Dynamics (REMD) simulations to assess the possible peptide conformations on the anatase surface, and the umbrella sampling method was used to calculate the binding energy of the most common conformation. The simulations have shown that the KRSR peptide migrates and attaches to the surface in a stable position. The dominant amino acid residue interacting with the TiO₂ surface was the N-terminal charged lysine (K) residue. REMD indicated that there is a distinct conformation that is taken by the KRSR peptide. In this conformation the surface interacts only with the lysine residue while the ser (S) and arg (R) residues interact with water molecules farther from the surface. The binding free energy of the most common conformation of KRSR peptide to the anatase (100) surface was ΔG = −8.817 kcal/mol. Our result suggests that the N-terminal lysine residue plays an important role in the adhesion of KRSR to the TiO₂ surface and may influence the osseointegration of dental implants.

Biomimetic Deposition of Hydroxyapatite Layer on Titanium Alloys

Over the last decade, researchers have been concerned with improving metallic biomaterials with proper and suitable properties for the human body. Ti-based alloys are widely used in the medical field for their good mechanical properties, corrosion resistance and biocompatibility. The TiMoZrTa system (TMZT) evidenced adequate mechanical properties, was closer to the human bone, and had a good biocompatibility. In order to highlight the osseointegration of the implants, a layer of hydroxyapatite (HA) was deposited using a biomimetic method, which simulates the natural growth of the bone. The coatings were examined by scanning electron microscopy (SEM), X-ray diffraction (XRD), micro indentation tests and contact angle. The data obtained show that the layer deposited on TiMoZrTa (TMZT) support is hydroxyapatite. Modifying the surface of titanium alloys represents a viable solution for increasing the osseointegration of materials used as implants. The studied coatings demonstrate a positive potential for use as dental and orthopedic implants.

Influence of Process Parameters on the Tribological Behavior of PEO Coatings on CP-Titanium 4+ Alloys for Biomedical Applications

Wear resistant ceramic coatings were generated on novel commercially pure titanium grade 4+ alloys by the plasma electrolytic oxidation technique (PEO) in an aluminate and zirconia containing electrolyte. The coatings were obtained adopting a full regular two-level factorial design of experiments (DoE) varying the PEO process parameters current density, repetition rate and duty cycle. The generated coatings were characterized with respect to its wear resistance and mechanical properties by reciprocal ball-on-flat tests and nanoindentation measurements. Thickness, morphology and phase formation of the PEO coatings was analyzed by scanning electron microscopy (SEM/EDS) and X-ray diffraction. XRD results indicate the formation of crystalline aluminium titanate (TiAl2O5) as well as t-ZrO2 and alumina leading to an increase in hardness and wear resistance of the PEO coatings. Evaluation of the DoE’s parameter interaction shows that the main effects for generating wear resistant coatings are current density and repetition rate. In particular, the formation of mechanically stable and adhesive corundum and zirconia containing coatings with increasing current density and frequency turned out to be responsible for the improvement of the tribological properties. Overall, the PEO processing significantly improves the wear resistance of the CP titanium base alloy.

Tantalum and its derivatives in orthopedic and dental implants: Osteogenesis and antibacterial properties

Implant-associated infections and aseptic loosening are some of the main reasons for implant failure. Therefore, there is an urgent need to improve the osseointegration and antibacterial capabilities of implant materials. In recent years, a large number of breakthroughs in the biological application of tantalum and its derivatives have been achieved. Owing to their corrosion resistance, biocompatibility, osseointegration ability, and antibacterial properties, they have shown considerable potential in orthopedic and dental implant applications. In this review, we provide the latest progress and achievements in the research on osseointegration and antibacterial properties of tantalum as well as its derivatives, and summarize the surface modification methods to enhance their osseointegration and antibacterial properties.

Toward Bactericidal Enhancement of Additively Manufactured Titanium Implants

Implant-associated infections (IAIs) are among the most intractable and costly complications in implant surgery. They can lead to surgery failure, a high economic burden, and a decrease in patient quality of life. This manuscript is devoted to introducing current antimicrobial strategies for additively manufactured (AM) titanium (Ti) implants and fostering a better understanding in order to pave the way for potential modern high-throughput technologies. Most bactericidal strategies rely on implant structure design and surface modification. By means of rational structural design, the performance of AM Ti implants can be improved by maintaining a favorable balance between the mechanical, osteogenic, and antibacterial properties. This subject becomes even more important when working with complex geometries; therefore, it is necessary to select appropriate surface modification techniques, including both topological and chemical modification. Antibacterial active metal and antibiotic coatings are among the most commonly used chemical modifications in AM Ti implants. These surface modifications can successfully inhibit bacterial adhesion and biofilm formation, and bacterial apoptosis, leading to improved antibacterial properties. As a result of certain issues such as drug resistance and cytotoxicity, the development of novel and alternative antimicrobial strategies is urgently required. In this regard, the present review paper provides insights into the enhancement of bactericidal properties in AM Ti implants.

An In Vitro Evaluation of the Hierarchical Micro/Nanoporous Structure of a Ti3Zr2Sn3Mo25Nb Alloy after Surface Dealloying

A process to dealloy a Ti-3Zr-2Sn-3Mo-25Nb (TLM) titanium alloy to create a porous surface structure has been reported in this paper aiming to enhance the bioactivity of the alloy. A simple nanoporous topography on the surface was produced through dealloying the as-solution treated TLM alloy. In contrast, dealloying the as-cold rolled alloy created a hierarchical micro/nanoporous topography. SEM and XPS were performed to characterize the topography and element chemistry of both porous structures. The roughness, hydrophilicity, protein adsorption, cell adhesion, proliferation, and osteogenic differentiation were tested. The elements of Zr, Mo, Sn, and Nb were depleted at the nanoporous TLM surface with a diameter of 15.6 ± 2.3 nm. Dissolving the microscale α phase from the alloy surface contributed to the formation of the microscale grooves on the surface. The simple nanoporous topographical surface exhibited hydrophilicity and higher protein adsorption ability, which facilitated the early adhesion of osteoblasts compared with the hierarchical micro/nanoporous surface. On the other hand, the hierarchical micro/nanoporous surface improved cell proliferation and differentiation and still retained the contact guidance function, which implied good bonding for osseointegration. This research revealed the effect of phase composition on the surface morphology of dealloying titanium alloy and the synergistic effect of micron and nanometer topography on the function of osteoblasts. This paper therefore provides insights into the surface topological design of titanium-based biomaterials with improved biocompatibility.

Synergistic Effect of rhBMP-2 Protein and Nanotextured Titanium Alloy Surface to Improve Osteogenic Implant Properties

One of the major limitations during titanium (Ti) implant osseointegration is the poor cellular interactions at the biointerface. In the present study, the combined effect of recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) and nanopatterned Ti6Al4V fabricated with Directed irradiation synthesis (DIS) is investigated in vitro. This environmentally-friendly plasma uses ions to create self-organized nanostructures on the surfaces. Nanocones (≈36.7 nm in DIS 80°) and thinner nanowalls (≈16.5 nm in DIS 60°) were fabricated depending on DIS incidence angle and observed via scanning electron microscopy. All samples have a similar crystalline structure and wettability, except for sandblasted/acid-etched (SLA) and acid-etched/anodized (Anodized) samples which are more hydrophilic. Biological results revealed that the viability and adhesion properties (vinculin expression and cell spreading) of DIS 80° with BMP-2 were similar to those polished with BMP-2, yet we observed more filopodia on DIS 80° (≈39 filopodia/cell) compared to the other samples (<30 filopodia/cell). BMP-2 increased alkaline phosphatase activity in all samples, tending to be higher in DIS 80°. Moreover, in the mineralization studies, DIS 80° with BMP-2 and Anodized with BMP-2 increased the formation of calcium deposits (>3.3 fold) compared to polished with BMP-2. Hence, this study shows there is a synergistic effect of BMP-2 and DIS surface modification in improving Ti biological properties which could be applied to Ti bone implants to treat bone disease.

Cytotoxic effects of submicron- and nano-scale titanium debris released from dental implants: an integrative review

OBJECTIVE

This integrative review aimed to report the toxic effect of submicron and nano-scale commercially pure titanium (cp Ti) debris on cells of peri-implant tissues.

MATERIALS AND METHODS

A systematic search was carried out on the PubMed electronic platform using the following key terms: Ti "OR" titanium "AND" dental implants "AND" nanoparticles "OR" nano-scale debris "OR" nanometric debris "AND" osteoblasts "OR "cytotoxicity" OR "macrophage" OR "mutagenic" OR "peri-implantitis". The inclusion criteria involved articles published in the English language, until December 26, 2020, reporting the effect of nano-scale titanium particles as released from dental implants on the toxicity and damage of osteoblasts.

RESULTS

Of 258 articles identified, 14 articles were selected for this integrative review. Submicron and nano-scale cp Ti particles altered the behavior of cells in culture medium. An inflammatory response was triggered by macrophages, fibroblasts, osteoblasts, mesenchymal cells, and odontoblasts as indicated by the detection of several inflammatory mediators such as IL-6, IL-1β, TNF-α, and PGE2. The formation of a bioactive complex composed of calcium and phosphorus on titanium nanoparticles allowed their binding to proteins leading to the cell internalization phenomenon. The nanoparticles induced mutagenic and carcinogenic effects into the cells.

CONCLUSIONS

The cytotoxic effect of debris released from dental implants depends on the size, concentration, and chemical composition of the particles. A high concentration of particles on nanometric scale intensifies the inflammatory responses with mutagenic potential of the surrounding cells.

CLINICAL RELEVANCE

Titanium ions and debris have been detected in peri-implant tissues with different size, concentration, and forms. The presence of metallic debris at peri-implant tissues also stimulates the migration of immune cells and inflammatory reactions. Cp Ti and TiO₂ micro- and nano-scale particles can reach the bloodstream, accumulating in lungs, liver, spleen, and bone marrow.

Lactoferrin/Calcium Phosphate-Modified Porous Ti by Biomimetic Mineralization: Effective Infection Prevention and Excellent Osteoinduction

The surface modification of titanium (Ti) can enhance the osseointegration and antibacterial properties of implants. In this study, we modified porous Ti discs with calcium phosphate (CaP) and different concentrations of Lactoferrin (LF) by biomimetic mineralization and examined their antibacterial effects and osteogenic bioactivity. Firstly, scanning electron microscopy (SEM), the fluorescent tracing method, X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FTIR), energy dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), and the releasing kinetics of LF were utilized to characterize the modified Ti surface. Then, the antibacterial properties against S. sanguis and S. aureus were investigated. Finally, in vitro cytological examination was performed, including evaluations of cell adhesion, cell differentiation, extracellular matrix mineralization, and cytotoxicity. The results showed that the porous Ti discs were successfully modified with CaP and LF, and that the LF-M group (200 μg/mL LF in simulated body fluid) could mildly release LF under control. Further, the LF-M group could effectively inhibit the adhesion and proliferation of S. sanguis and S. aureus and enhance the osteogenic differentiation in vitro with a good biocompatibility. Consequently, LF-M-modified Ti may have potential applications in the field of dental implants to promote osseointegration and prevent the occurrence of peri-implantitis.

Long-Term Assessment of the In Vitro Corrosion Resistance of Biomimetic ACP Coatings Electrodeposited from an Acetate Bath

Calcium phosphate coatings are able to improve the osseointegration process due to their chemical composition, which is similar to that of bone tissues. In this work, to increase the long-term corrosion resistance and to improve the osseointegration process of commercially pure titanium Grade 4 (CpTi G4), biomimetic amorphous calcium phosphate (ACP) coatings were electrodeposited for the first time from an acetate bath with a pH level of 7.0 and a Ca:P ratio of 1.67. ACP coatings were obtained on CpTi G4 substrate subjected to sandblasting and autoclaving using electrochemically assisted deposition at a potential of -3 V relative to the open circuit potential for 30 min at room temperature. SEM, EDS, 2D roughness profiles, amplitude-sensitive eddy current method, and Kelvin scanning probe were used for the surface characterization of the biomaterial under study. In vitro corrosion resistance tests were conducted for 21 days in artificial saliva using open circuit potential, polarization curves, and electrochemical impedance spectroscopy measurements. The passive-transpassive behavior was revealed for the obtained ACP coatings. The long-term corrosion resistance test showed a deterioration of the protective properties for CpTi G4 uncoated and coated with ACP with immersion time. The mechanism and kinetics of the pitting corrosion on the CpTi G4|TiO2|ACP coating system are discussed in detail.

In vivo performance of Al2O3-Ti bone implants in the rat femur

Background

Alumina-titanium (Al₂O₃-Ti) biocomposites have been recently developed with improved mechanical properties for use in heavily loaded orthopedic sites. Their biological performance, however, has not been investigated yet.

Methods

The aim of the present study was to evaluate the in vivo biological interaction of Al₂O₃-Ti. Spark plasma sintering (SPS) was used to fabricate Al₂O₃-Ti composites with 25 vol.%, 50 vol.%, and 75 vol.% Ti content. Pure alumina and titanium were also fabricated by the same procedure for comparison. The fabricated composite disks were cut into small bars and implanted into medullary canals of rat femurs. The histological analysis and scanning electron microscopy (SEM) observation were carried out to determine the bone formation ability of these materials and to evaluate the bone-implant interfaces.

Results

The histological observation showed the formation of osteoblast, osteocytes with lacuna, bone with lamellar structures, and blood vessels indicating that the healing and remodeling of the bone, and vasculature reconstruction occurred after 4 and 8 weeks of implantation. However, superior bone formation and maturation were obtained after 8 weeks. SEM images also showed stronger interfaces at week 8. There were differences between the composites in percentages of bone area (TB%) and the number of osteocytes. The 50Ti composite showed higher TB% at week 4, while 25Ti and 75Ti represented higher TB% at week 8. All the composites showed a higher number of osteocytes compared to 100Ti, particularly 75Ti.

Conclusions

The fabricated composites have the potential to be used in load-bearing orthopedic applications.

The Influence of ZnO Oxide Layer on the Physicochemical Behavior of Ti6Al4V Titanium Alloy

Titanium and its alloys are characterized by high biocompatibility and good corrosion resistance as a result of the ability to form a TiO₂ oxide layer. However, based on literature data it can be concluded that titanium degradation products, in the form of titanium particles, metal-protein groups, oxides and ions, may cause allergic, inflammatory reactions and bone resorption. The corrosion process of Ti6Al4V in the human body environment may be intensified by a decreased pH and concentration of chloride compounds. The purpose of this article was to analyze the corrosion resistance of the Ti6Al4V alloy, obtained by the selective laser melting method in a corrosion solution of neutral pH and in a solution simulating peri-implant inflammatory conditions. Additionally, the influence of zinc oxide deposited by the atomic layer deposition method on the improvement of the physicochemical behavior of the Ti6Al4V alloy was analyzed. In order to characterize the ZnO layer, tests of chemical and phase composition as well as surface morphology investigation were performed. As part of the assessment of the physicochemical properties of the uncoated samples and those with the ZnO layer, tests of wetting angle, pitting corrosion and impedance corrosion were carried out. The number of ions released after the potentiodynamic test were measured using the inductively coupled plasma atomic emission spectrometry (ICP-AES) method. It can be concluded that samples after surface modification (with the ZnO layer) were characterized by favorable physicochemical properties and had higher corrosion resistance.

Microstructural Analysis and Tribological Behavior of Ti-Based Alloys with a Ceramic Layer Using the Thermal Spray Method

The present article focuses on a recently developed new system of alloys (Ti15MoSi) coated with ZrO2. The thin coatings deposition of ZrO2 on titanium alloys can be a solution to improve their corrosion resistance, biocompatibility, and to extend their long life with the human tissue. In order to improve the corrosion resistance, atmospheric plasma spraying coatings with zirconia have been performed. These coatings present a homogenous aspect with very few cracks. The novelty of the research is that zirconia is much stable in the simulated body fluids and presents no harm effects to the healing process of the bone. To analyze the thin coatings deposition, mechanical properties, chemical structure, and corrosion resistance were examined by a modulus of elasticity, X-ray diffraction (XRD), scanning electron microscopy-energy-dispersive X-ray spectroscopy (SEM-EDS), and linear polarization. The results reveal that Young’s modulus shows a low value (51 GPa for Ti15Mo0.5Si-ZrO2 and 48 GPa for Ti15Mo-ZrO2) and the XRD patterns show the presence of β-Ti and ZrO2 phases having a tetragonal crystalline structure. The research highlighted the morphological aspect of zirconia coatings on the new alloy titanium substrate, being an adherent compact coating with significantly improved corrosion resistance. Moreover, the mechanical properties are similar to the biological bone, which will avoid the stress shielding of the implant with bone tissue.

Are Titania Photocatalysts and Titanium Implants Safe? Review on the Toxicity of Titanium Compounds

Titanium and its compounds are broadly used in both industrial and domestic products, including jet engines, missiles, prostheses, implants, pigments, cosmetics, food, and photocatalysts for environmental purification and solar energy conversion. Although titanium/titania-containing materials are usually safe for human, animals and environment, increasing concerns on their negative impacts have been postulated. Accordingly, this review covers current knowledge on the toxicity of titania and titanium, in which the behaviour, bioavailability, mechanisms of action, and environmental impacts have been discussed in detail, considering both light and dark conditions. Consequently, the following conclusions have been drawn: (i) titania photocatalysts rarely cause health and environmental problems; (ii) despite the lack of proof, the possible carcinogenicity of titania powders to humans is considered by some authorities; (iii) titanium alloys, commonly applied as implant materials, possess a relatively low health risk; (iv) titania microparticles are less toxic than nanoparticles, independent of the means of exposure; (v) excessive accumulation of titanium in the environment cannot be ignored; (vi) titanium/titania-containing products should be clearly marked with health warning labels, especially for pregnant women and young children; (vi) a key knowledge gap is the lack of comprehensive data about the environmental content and the influence of titania/titanium on biodiversity and the ecological functioning of terrestrial and aquatic ecosystems.

Metallic Antibacterial Surface Treatments of Dental and Orthopedic Materials

The oral cavity harbors complex microbial communities, which leads to biomaterial-associated infections (BAI) during dental and orthopedic treatments. Conventional antibiotic treatments have met great challenges recently due to the increasing emergency of drug-resistant bacteria. To tackle this clinical issue, antibacterial surface treatments, containing surface modification and coatings, of dental and orthopedic materials have become an area of intensive interest now. Among various antibacterial agents used in surface treatments, metallic agents possess unique properties, mainly including broad-spectrum antibacterial properties, low potential to develop bacterial resistance, relative biocompatibility, and chemical stability. Therefore, this review mainly focuses on underlying antibacterial applications and the mechanisms of metallic agents in dentistry and orthopedics. An overview of the present review indicates that much work remains to be done to deepen the understanding of antibacterial mechanisms and potential side-effects of metallic agents.

3D printed titanium scaffolds with homogeneous diamond-like structures mimicking that of the osteocyte microenvironment and its bone regeneration study

Biofabrication of personalized titanium scaffold mimicking that of the osteocyte microenvironment is challenging due to its complex geometrical cues. The effect of scaffolds geometrical cues and implantation sites on osteogenesis is still not clear. In this study, personalized titanium scaffolds with homogeneous diamond-like structures mimicking that of the osteocyte microenvironment were precisely designed and fabricated by selected laser melting method. The effects of different geometric cues, including porosity, pore sizes and interconnection properties, on cellular behavior were investigated. Biomimetic mechanical properties of porous titanium alloy scaffold were predesigned and simulated by finite element analysis. In vitro experiment revealed that homogeneous diamond-like structures mimicking that of the osteocyte microenvironment triggered osteocyte adhesion and migration behavior. Typical implantation sites, including rabbit femur, beagle femur, and beagle skull, were used to study the implantation sites effects on bone regeneration. In vivo experimental results indicated that different implantation sites showed significant differences. This study helps to understand the scaffolds geometrical microenvironment and implantation sites effects on osteogenesis mechanism. And it is beneficial to the development of bone implants with better bone regeneration ability.

Electrochemical Behavior of Ti6Al4V Alloy Used in Dental Implants Immersed in Streptococcus gordonii and Fusobacterium nucleatum Solutions

The titanium alloy, Ti6Al4V, is used in dentistry for dental implants because of its excellent resistance to corrosion and its high biocompatibility. However, periimplantitis is considered the main reason for treatment failure. The Ti6Al4V alloy was used to study the corrosion behavior for dental implant applications, using an experimental arrangement of three electrodes with the bacteria Streptococcus gordonii and Fusobacterium nucleatum, in addition to Ringer's lactate as electrolytes, at 37 °C and a pH of 5.6. Their electrochemical behavior was studied by open circuit potential (OCP) and cyclic potentiodynamic polarization (CPP) according to ASTM G3-14 and ASTM G61-11, respectively. Scanning electron microscopy (SEM) was employed to determine the morphology of the alloy studied. An experimental model, in situ, was established with the bacteria present in an oral environment to understand the electrochemical behavior of the alloy used in dental implants. The greatest corrosion in Ti6Al4V alloy was produced by the medium that contained the bacterium Streptococcus gordonii, which is considered a primary colonizer. In addition, the Ti6Al4V alloy presented uniform corrosion in the three solutions at the different exposure times showing a negative hysteresis in CPP.

Mechanical properties and biocompatibility of titanium with a high oxygen concentration for dental implants

In order to improve the strength of commercially pure Ti (CP-Ti) for oral implants, the high oxygen content Ti (HOC-Ti) was prepared via powder metallurgy. Its composition and mechanical properties were then characterized. After surface treatment by sandblasting and acid etching (SLA), the surface morphology, wettability and roughness of the HOC-Ti and CP-Ti sample were examined. In an in vitro test that followed an evaluation of the protein adsorption capacity of HOC-Ti, the mouse preosteoblast cells were inoculated onto the specimens to evaluate their biocompatibility, in comparison with those of CP-Ti. The oxygen concentration of the HOC-Ti increased to 0.62 wt%, which is higher than the 0.26 wt% of the CP-Ti, while their compositions and microstructures were very similar. The tensile and compressive yield strength of the HOC-Ti (800 MPa) was improved significantly in comparison to that of the CP-Ti (530 MPa). After surface treatment, a unique structure of micropores with a diameter of 380 nm was observed on the entire surface of the HOC-Ti that facilitates cell adhesion and proliferation. The wettability of the HOC-Ti was obviously superior (p < 0.05). The in vitro study showed that the MC3T3-E1 cells inoculated on the surface of HOC-Ti exhibited a homogeneous microstructure, and the viability was higher than that of the control group on days 4 and 7 (p < 0.05). In addition, the number and differentiation activity of cells that adhered to the surface of the HOC-Ti increased significantly on day 7 (p < 0.05). The experimental results showed that, in view of its mechanical properties and biocompatibility, HOC-Ti is superior to CP-Ti and is promising for oral implant applications.

Sequential release of immunomodulatory cytokines binding on nano-hydroxyapatite coated titanium surface for regulating macrophage polarization and bone regeneration

Inflammation occurs when the material is implanted into the body. As one of the important immune cells in the regulation of inflammation, macrophages are able to remove pathogens and necrotic cells, and polarize to different phenotypes to regulate inflammatory response for tissue regeneration. Therefore, it is known that the sequential release of immunomodulatory cytokines from the surface of titanium (Ti) implants can regulate the polarization of macrophages and promote osseointegration of implants. In order to control the switch of macrophage phenotypes at desired time, we fabricated hydroxyapatite (HAp) nanotube arrays coating on Ti surface, by acid-etching, alkali-heating and HAp coating sequentially. Then we loaded the interleukin-4 (IL-4) encapsulated by poly (lactic-co-glycolic acid) (PLGA) on the bottom of the nanotube and the interferon-γ (IFN-γ) encapsulated by sodium hyaluronate (SH) on the top of the nanotube. Based on the physical and chemical properties of PLGA and SH and the spatial distribution of loaded cytokines, we hypothesized that the programmed release of IFN-γ and IL-4, which made the phenotypic transition of macrophages at a specific time, so as to regulate inflammation and promote osteogenic repair. Our hypothesis created a new type of drug sustained release system, which has high research value for improving the osseointegration of implants.