Personalized 3D printed bone scaffolds: A review

3D printed bone scaffolds have the potential to replace autografts and allografts because of advantages such as unlimited supply and the ability to tailor the scaffolds' biochemical, biological and biophysical properties. Significant progress has been made over the past decade in additive manufacturing techniques to 3D print bone grafts, but challenges remain in the lack of manufacturing techniques that can recapitulate both mechanical and biological functions of native bones. The purpose of this review is to outline the recent progress and challenges of engineering an ideal synthetic bone scaffold and to provide suggestions for overcoming these challenges through bioinspiration, high-resolution 3D printing, and advanced modeling techniques. The article provides a short overview of the progress in developing the 3D printed scaffolds for the repair and regeneration of critical size bone defects. STATEMENT OF SIGNIFICANCE: Treatment of critical size bone defects is still a tremendous clinical challenge. To address this challenge, diverse sets of advanced manufacturing approaches and materials have been developed for bone tissue scaffolds. 3D printing has sparked much interest because it provides a close control over the scaffold's internal architecture and in turn its mechanical and biological properties. This article provides a critical overview of the relationships between material compositions, printing techniques, and properties of the scaffolds and discusses the current technical challenges facing their successful translation to the clinic. Bioinspiration, high-resolution printing, and advanced modeling techniques are discussed as future directions to address the current challenges.

Dual-functional porous and cisplatin-loaded polymethylmethacrylate cement for reconstruction of load-bearing bone defect kills bone tumor cells

Malignant bone tumors are usually treated by resection of tumor tissue followed by filling of the bone defect with bone graft substitutes. Polymethylmethacrylate (PMMA) cement is the most commonly used bone substitute in clinical orthopedics in view of its reliability. However, the dense nature of PMMA renders this biomaterial unsuitable for local delivery of chemotherapeutic drugs to limit the recurrence of bone tumors. Here, we introduce porosity into PMMA cement by adding carboxymethylcellulose (CMC) to facilitate such local delivery of chemotherapeutic drugs, while retaining sufficient mechanical properties for bone reconstruction in load-bearing sites. Our results show that the mechanical strength of PMMA-based cements gradually decreases with increasing CMC content. Upon incorporation of ≥3% CMC, the PMMA-based cements released up to 18% of the loaded cisplatin, in contrast to cements containing lower amounts of CMC which only released less than 2% of the cisplatin over 28 days. This release of cisplatin efficiently killed osteosarcoma cells in vitro and the fraction of dead cells increased to 91.3% at day 7, which confirms the retained chemotherapeutic activity of released cisplatin from these PMMA-based cements. Additionally, tibias filled with PMMA-based cements containing up to 3% of CMC exhibit comparable compressive strengths as compared to intact tibias. In conclusion, we demonstrate that PMMA cements can be rendered therapeutically active by introducing porosity using CMC to allow for release of cisplatin without compromising mechanical properties beyond critical levels. As such, these data suggest that our dual-functional PMMA-based cements represent a viable treatment option for filling bone defects after bone tumor resection in load-bearing sites.

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Dual-functional porous PMMA cements are developed by introducing CMC as both pore generator and drug vehicle for cisplatin.

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PMMA-based cements containing ≥3% CMC release sufficient amounts of chemotherapeutically active cisplatin.

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PMMA-based cements containing ≤3% CMC retain sufficient mechanical properties for bone reconstruction at load-bearing sites.

3D Bioprinted Scaffolds for Bone Tissue Engineering: State-Of-The-Art and Emerging Technologies

Treating large bone defects, known as critical-sized defects (CSDs), is challenging because they are not spontaneously healed by the patient’s body. Due to the limitations associated with conventional bone grafts, bone tissue engineering (BTE), based on three-dimensional (3D) bioprinted scaffolds, has emerged as a promising approach for bone reconstitution and treatment. Bioprinting technology allows for incorporation of living cells and/or growth factors into scaffolds aiming to mimic the structure and properties of the native bone. To date, a wide range of biomaterials (either natural or synthetic polymers), as well as various cells and growth factors, have been explored for use in scaffold bioprinting. However, a key challenge that remains is the fabrication of scaffolds that meet structure, mechanical, and osteoconductive requirements of native bone and support vascularization. In this review, we briefly present the latest developments and discoveries of CSD treatment by means of bioprinted scaffolds, with a focus on the biomaterials, cells, and growth factors for formulating bioinks and their bioprinting techniques. Promising state-of-the-art pathways or strategies recently developed for bioprinting bone scaffolds are highlighted, including the incorporation of bioactive ceramics to create composite scaffolds, the use of advanced bioprinting technologies (e.g., core/shell bioprinting) to form hybrid scaffolds or systems, as well as the rigorous design of scaffolds by taking into account of the influence of such parameters as scaffold pore geometry and porosity. We also review in-vitro assays and in-vivo models to track bone regeneration, followed by a discussion of current limitations associated with 3D bioprinting technologies for BTE. We conclude this review with emerging approaches in this field, including the development of gradient scaffolds, four-dimensional (4D) printing technology via smart materials, organoids, and cell aggregates/spheroids along with future avenues for related BTE.

Impact of simultaneous placement of implant and block bone graft substitute: an in vivo peri-implant defect model

Background

Insufficient bone volume around an implant is a common obstacle when dental implant treatment is considered. Limited vertical or horizontal bone dimensions may lead to exposed implant threads following placement or a gap between the bone and implant. This is often addressed by bone augmentation procedures prior to or at the time of implant placement. This study evaluated bone healing when a synthetic TiO₂ block scaffold was placed in circumferential peri-implant defects with buccal fenestrations.

Methods

The mandibular premolars were extracted and the alveolar bone left to heal for 4 weeks prior to implant placement in six minipigs. Two cylindrical defects were created in each hemi-mandible and were subsequent to implant placement allocated to treatment with either TiO₂ scaffold or sham in a split mouth design. After 12 weeks of healing time, the samples were harvested. Microcomputed tomography (MicroCT) was used to investigate defect fill and integrity of the block scaffold. Distances from implant to bone in vertical and horizontal directions, percentage of bone to implant contact and defect fill were analysed by histology.

Results

MicroCT analysis demonstrated no differences between the groups for defect fill. Three of twelve scaffolds were partly fractured. At the buccal sites, histomorphometric analysis demonstrated higher bone fraction, higher percentage bone to implant contact and shorter distance from implant top to bone 0.5 mm lateral to implant surface in sham group as compared to the TiO₂ group.

Conclusions

This study demonstrated less bone formation with the use of TiO₂ scaffold block in combination with implant placement in cylindrical defects with buccal bone fenestrations, as compared to sham sites.

Guided bone regeneration of chronic non-contained bone defects using a volume stable porous block TiO2 scaffold: An experimental in vivo study

OBJECTIVES

To evaluate new lateral bone formation and lateral volume augmentation by guided bone regeneration (GBR) in chronic non-contained bone defects with the use of a non-resorbable TiO₂ -block.

MATERIALS AND METHODS

Three buccal bone defects were created in each hemimandible of eight beagle dogs and allowed to heal for 8 weeks before treatment by GBR. Each hemimandible was randomly allocated to 4- or 12-week healing time after GBR, and three intervention groups were assigned by block randomization: TiO₂ block: TiO₂ -scaffold and a collagen membrane, DBBM particles: Deproteinized bovine bone mineral (DBBM) and a collagen membrane, Empty control: Collagen membrane only. Microcomputed tomography (microCT) was used to measure the lateral bone formation and width augmentation. Histological outcomes included descriptive analysis and histomorphometric measurements.

RESULTS

MicroCT analysis demonstrated increasing new bone formation from 4 to 12 weeks of healing. The greatest width of mineralized bone was seen in the empty controls, and the largest lateral volume augmentation was observed in the TiO₂ block sites. The DBBM particles demonstrated more mineralized bone in the grafted area than the TiO₂ blocks, but small amounts and less than the empty control sites.

CONCLUSION

The TiO₂ blocks rendered the largest lateral volume augmentation but also less new bone formation compared with the DBBM particles. The most new lateral bone formation outward from the bone defect margins was observed in the empty controls, indicating that the presence of either graft material leads to slow appositional bone growth.

Porous Titanium Granules in comparison with Autogenous Bone Graft in Femoral Osseous Defects: A Histomorphometric Study of Bone Regeneration and Osseointegration in Rabbits

Background

The high resorption rate of autogenous bone is a well-documented phenomenon that can lead to insufficient bone quality and quantity in an augmented area. Nonresorbable bone substitutes might perform better than autogenous bone in certain applications if they are able to provide adequate bone formation and graft osseointegration.

Purpose

The aim of this study was to compare the osseous regeneration and graft integration in standardized defects in the rabbit femur treated either with porous titanium granules or autogenous osseous graft.

Materials and Methods

Standardized femoral osseous defects were surgically induced in 45 New Zealand rabbits. Fifteen were treated with porous titanium granules (TIGRAN™-PTG) and membrane (PTGM), 15 with autogenous graft and membrane (AGM), and 15 with membrane alone (CM, control). At six weeks, the defects were assessed histologically and histomorphometrically.

Results

PTGM as compared to AGM presented similar percentages of newly formed bone tissue, but a significantly higher fraction of the region of interest was filled with the bone substitute material. Accordingly, the composite of new bone plus bone substitute material showed significantly higher volumes for PTGM. Yet, the smaller amount of remaining autogenous bone was far better osseointegrated than the titanium granules, which in large regions showed no connection to newly formed bone. Both PTGM and AGM as compared to CM presented higher values of newly formed bone.

Conclusions

This study demonstrated that PTG was similarly effective as autogenous osseous graft in achieving osseous regeneration while PTG performed markedly better in graft volume stability. The resulting higher total percentage of new bone combined with the bone substitute material in PTG could provide a superior foundation for implant placement.

Modification of Titanium Implant and Titanium Dioxide for Bone Tissue Engineering

Bone tissue engineering using titanium (Ti) implant and titanium dioxide (TiO₂) with their modification is gaining increasing attention. Ti has been adopted as an implant material in dental and orthopedic fields due to its superior properties. However, it still requires modification in order to achieve robust osteointegration between the Ti implant and surrounding bone. To modify the Ti implant, numerous methods have been introduced to fabricate porous implant surfaces with a variety of coating materials. Among these, plasma spraying of hydroxyapatite (HA) has been the most commonly used with commercial success. Meanwhile, TiO₂ nanotubes have been actively studied as the coating material for implants, and promising results have been reported about improving osteogenic activity around implants recently. Also porous three-dimensional constructs based on TiO₂ have been proposed as scaffolding material with high biocompatibility and osteoconductivity in large bone defects. However, the use of the TiO₂ scaffolds in load-bearing environment is somewhat limited. In order to optimize the TiO₂ scaffolds, studies have tried to combine various materials with TiO₂ scaffolds including drug, mesenchymal stem cells, Al₂O₃-SiO₂ solid and HA. This article will shortly introduce the properties of Ti and Ti-based implants with their modification, and review the progress of bone tissue engineering using the TiO₂ nanotubes and scaffolds.

Computational characterization of the structural and mechanical properties of nanoporous titania

Nanoporous titania is one of the most commonly used biomaterials with good biocompatibility and mechanical strength. Understanding to the influence of pore structures on their performances is crucial for the design and preparation of titania-based materials. Two kinds of structural models for nanoporous titania were constructed and used to investigate the effect of pore size and/or porosity on their mechanical properties by using molecular dynamic simulations with the Matsui-Akaogi potentials. The porous structures were relaxed and their elastic constants were computed and used to evaluated their bulk, shear and Young's moduli. Overlap effect in small pores, pore size and porosity have considerable influence on computed elastic moduli. Compared to bulk rutile TiO₂, reduced mechanical moduli were predicted. Simulations on uniaxial tensile tests revealed an anisotropic stress-strain relationship and a brittle-to-ductile transition for structures with large porosities. Fracture failure was predicted for all the studied porous structures. The maximum stress decreases with pore size and porosity, while the corresponding strain decreases with pore size, but increases with porosity.

The chemical surface evaluation of black and white porous titanium granules and different commercial dental implants with energy-dispersive x-ray spectroscopy analysis

BACKGROUND

The chemical surface structure of the porous titanium grafts has not been found to study in the literature on the similarity of chemical surfaces of different commercial dental implants.

PURPOSE

The purpose of this study is to investigate the chemical composition and surface energies of white (WPTG) and black porous titanium granules (PTG) by energy dispersive x-ray spectrometry (EDX) analysis to compare with different commercial dental implant surface.

MATERIALS AND METHODS

The surface chemical compositions of six commercially available dental implants with different surface structures, PTG and WPTG were examined by EDX analysis. Surface analyzes were performed on the apical, middle, and coronal parts of each implant and on the top, flank, and valley regions on each side. Surface analyzes of dental implants were evaluated at ×200 and ×2000 magnifications. The EDX evaluation of PTG grafts were evaluated at ×250, ×2000, ×5000, and ×50 000 magnifications.

RESULTS

PTG grafts showed elements of Na (8.88 ± 9.98%), Cl (2.44 ± 1.96%), and Al (0.99 ± 0.37%) as well as Ti (90.06 ± 11.34%) molecule at ×5000 magnification. In WPTG, Ti (%34.55 ± 6.41%) and O (%65.44 ± 6.42%) molecules were detected.

CONCLUSIONS

It has been found that PTG surface was not made of pure titanium, it has different chemical molecules at larger magnifications. Cell culture and experimental studies are needed to establish a relationship between the different commercial implants and the surface structure of the titanium granules.

Osteogenic Potential of Porous Titanium. An Experimental Study in Sheep

The search for osteoinductive as well as osteoconductive materials has led to the novel idea of using titanium in bone augmentations of the alveolar crest. Due to its excellent biocompatibility and favorable osteogenic properties, highly porous TiO₂ granules has been proposed as a promising material for non-resorbable synthetic bone grafts in the restoration of large bone defects, and for bone augmentation in dental applications.

OBJECTIVES

The aim of this study was to investigate the osteoconductive properties and biological performance of porous titanium granules used in osseous defects adjacent to the maxillary sinus in sheep. The experimental animal study involved 15 yearling sheep with a focus on the osteogenic potential of porous titanium used for subantral augmentation.

MATERIAL AND METHODS

Calibrated defects were prepared in the subantral region of sheep. The defects were randomized into tests and control group. The test defects were grafted with porous titanium granules (PTG), whereas control defects were left empty (sham). Defects were left for healing for 30, 60, and 90 days. After healing, the grafted areas were removed and finally osteoconductivity was analyzed by an orthopantograph (OPG} and histology.

RESULTS

Significantly more new bone formed in PTG grafted defects compared with sham. The control group showed significantly less expression of key inflammation cells, but with no significant difference in key inflammation cells compared with the experimental groups.

CONCLUSION

Porous titanium can offer as an effective alternative to calcium phosphate and bone collagen-based materials used for subantral augmentation of the maxillary bone in cases of dental implantation.

Impact of particulate deproteinized bovine bone mineral and porous titanium granules on early stability and osseointegration of dental implants in narrow marginal circumferential bone defects

The use of two particulate bone graft substitute materials in experimental narrow marginal peri-implant bone defects was investigated with respect to early bone healing and implant stability. Porous titanium granules, oxidized white porous titanium granules (WPTG), and demineralized bovine bone mineral (DBBM) were characterized in vitro, after which the two latter materials were tested in experimental peri-implant bone defects in six minipigs, with empty defects as control. After mandibular premolar extraction, the top 5mm of the alveoli were widened to 6mm in diameter, followed by the placement of six implants, three on each side, in each pig. Six weeks of healing was allowed. The WPTG showed better mechanical properties. No significant differences in resonance frequency analysis were found directly after compacting or healing, and similar quantities of defect bone formation were observed on micro-computed tomography for all groups. Histomorphometric analysis demonstrated a more coronal bone-to-implant contact in the DBBM group, which also displayed more defect bone fill as compared to the WPTG group. The better mechanical properties observed for WPTG appear of negligible relevance for the early stability and osseointegration of implants.

Bioactivation of titanium dioxide scaffolds by ALP-functionalization

Three dimensional TiO₂ scaffolds are receiving renewed attention for bone tissue engineering (TE) due to their biocompatibility and attractive mechanical properties. However the bioactivity of these scaffolds is comparatively lower than that of bioactive glass or hydroxyapatite (HA) scaffolds. One strategy to improve bioactivity is to functionalize the surface of the scaffolds using biomolecules. Alkaline phosphatase (ALP) was chosen in this study due to its important role in the bone mineralization process. The current study investigated the ALP functionalization of 3D titanium dioxide scaffolds using self-polymerization of dopamine. Robust titanium scaffolds (compressive strength∼2.7 ± 0.3 MPa) were produced via foam replica method. Enzyme grafting was performed by dip-coating in polydopamine/ALP solution. The presence of ALP was indirectly confirmed by contact angle measurements and enzymatic activity study. The influence of the enzyme on the bioactivity, e.g. hydroxyapatite formation on the scaffold surface, was measured in simulated body fluid (SBF). After 28 days in SBF, 5 mg ALP coated titania scaffolds exhibited increased hydroxyapatite formation. It was thus confirmed that ALP enhances the bioactivity of titania scaffolds, converting an inert bioceramic in an attractive bioactive system for bone TE.

Effect of Porous Titanium Granules on Bone Regeneration and Primary Stability in Maxillary Sinus: A Human Clinical, Histomorphometric, and Microcomputed Tomography Analyses

The aim of this randomized controlled study was to comparatively analyze the new bone (NB), residual bone, and graft-bone association in bone biopsies retrieved from augmented maxillary sinus sites by histomorphometry and microcomputed tomography (MicroCT) in a split-mouth model to test the efficacy of porous titanium granules (PTG) in maxillary sinus augmentation. Fifteen patients were included in the study and each patient was treated with bilateral sinus augmentation procedure using xenograft (equine origine, granule size 1000-2000 μm) and xenograft (1 g) + PTG (granule size 700-1000 μm, pore size >50 μm) (1 g), respectively. After a mean of 8.4 months, 30 bone biopsies were retrieved from the implant sites for three-dimensional MicroCT and two-dimensional histomorphometric analyses. Bone volume and vital NB percentages were calculated. Immediate after core biopsy, implants having standard dimensions were placed and implant stability quotient values were recorded at baseline and 3 months follow-up. There were no significant differences between groups according to residual bone height, residual bone width, implant dimensions, and implant stability quotient values (baseline and 3 months). According to MicroCT and two-dimensional histomorphometric analyses, the volume of newly formed bone was 57.05% and 52.67%, and 56.5% and 55.08% for xenograft + PTG and xenograft groups, respectively. No statistically significant differences found between groups according to NB percentages and higher Hounsfield unit values were found for xenograft + PTG group. The findings of the current study supports that PTG, which is a porous, permanent nonresorbable bone substitute, may have a beneficial osteoconductive effect on mechanical strength of NB in augmented maxillary sinus.

Open air plasma deposited antimicrobial SiOx/TiOx composite films for biomedical applications

Open air atmospheric pressure plasma jet (APPJ) enhanced chemical vapour deposition process was used to deposit biocompatible SiOx/TiOx composite coatings. The as deposited films are hydrophilic and show visible light induced photocatalytic effect, which is a consequence of the formation of defects in the TiOx structure due to the plasma process. This photocatalytic effect was verified by the demonstration of an antimicrobial effect under visible light on E. coli as well as by degradation of Rhodamine B. The films are non-cytotoxic as shown by the cytocompatibility tests. The films are conductive to cell growth and are stable in DMEM and isopropanol. The structural evaluation using SEM, EDS and XPS shows a dispersion of TiOx phase in a SiOxCyHz matrix. These analyses were used to correlate the structure-property relationship of the composite coating.

Biocompatibility of Portland Cement Modified with Titanium Oxide and Calcium Chloride in a Rat Model

Introduction:

The aim of the present study was to evaluate the biocompatibility of two modified formulations of Portland cement (PC) mixed with either titanium oxide or both titanium oxide and calcium chloride.

Methods and Materials:

Polyethylene tubes were filled with modified PCs or Angelus MTA as the control; the tubes were then implanted in 28 Wistar rats subcutaneously. One tube was left empty as a negative control in each rat. Histologic samples were taken after 7, 15, 30 and 60 days. Sections were assessed histologically for inflammatory responses and presence of fibrous capsule and granulation tissue formation. Data were analyzed using the Fisher’s exact and Kruskal-Wallis tests.

Result:

PC mixed with titanium oxide showed the highest mean scores of inflammation compared with others. There was no statistically significant difference in the mean inflammatory grades between all groups in each of the understudy time intervals.

Conclusion:

The results showed favorable biocompatibility of these modified PC mixed with calcium chloride and titanium oxide.

Alginate hydrogel enriched with enamel matrix derivative to target osteogenic cell differentiation in TiO2 scaffolds

The purpose of bone tissue engineering is to employ scaffolds, cells, and growth factors to facilitate healing of bone defects. The aim of this study was to assess the viability and osteogenic differentiation of primary human osteoblasts and adipose tissue–derived mesenchymal stem cells from various donors on titanium dioxide (TiO₂) scaffolds coated with an alginate hydrogel enriched with enamel matrix derivative. Cells were harvested for quantitative reverse transcription polymerase chain reaction on days 14 and 21, and medium was collected on days 2, 14, and 21 for protein analyses. Neither coating with alginate hydrogel nor alginate hydrogel enriched with enamel matrix derivative induced a cytotoxic response. Enamel matrix derivative–enriched alginate hydrogel significantly increased the expression of osteoblast markers COL1A1, TNFRSF11B, and BGLAP and secretion of osteopontin in human osteoblasts, whereas osteogenic differentiation of human adipose tissue–derived mesenchymal stem cells seemed unaffected by enamel matrix derivative. The alginate hydrogel coating procedure may have potential for local delivery of enamel matrix derivative and other stimulatory factors for use in bone tissue engineering.

Toughening and strengthening mechanisms of porous akermanite scaffolds reinforced with nano-titania

Akermanite possesses excellent biocompatibility and biodegradability, while low fracture toughness and brittleness have limited its use in load bearing sites of bone tissue.

Cell growth on pore-graded biomimetic TiO2 bone scaffolds

In order to prevent soft tissue down-growth into osseous defect areas, membranes are used when placing bone graft materials. These membranes still show shortcomings in their performance and applications. In the current study, we choose an approach to integrate micro-porous surface structures into a macro-porous scaffold. Low porous surfaces were fabricated by dip-coatings. Four different material compositions (titanium dioxide, polycaprolactone, polycaprolactone/water, polycaprolactone/β-tricalcium phosphate) were characterised in terms of their appearance, architecture, topographical features and cell response. Titanium dioxide surfaces exhibited rougher and more complex textures, resulting in the highest number of osteosarcoma cells and distinct morphologies in terms of cell spreading. Polycaprolactone-based surfaces showed a smoother topography and enhanced microporosity, but the effect on secretion of the bone markers sclerostin and interleukin-6 from human osteoblasts was lower compared to secretion from cells cultured on titanium dioxide. β-Tricalcium phosphate modification of polycaprolactone did not show any significant improvement regarding cell-material interaction. Nevertheless, surfaces show potential in the mechanical blockage of epithelial and soft tissue cells and may still permit sufficient nutrient transport.

Gene expression and morphometric parameters of human bone biopsies after maxillary sinus floor elevation with autologous bone combined with Bio-Oss® or BoneCeramic®

OBJECTIVES

Although the clinical success of Bio-Oss(®) and BoneCeramic(®) has been corroborated by histologic and histomorphometric findings, the biological events that occur during healing after maxillary sinus floor elevation (MSFE) are unknown. Here, we evaluated biopsies of grafted bone with a mixture of autologous bone and Bio-Oss(®) or BoneCeramic(®) after two different healing time periods to understand the molecular process underlying bone formation after MSFE.

MATERIAL AND METHODS

Seven patients, following a bilateral split-mouth design model and needing a MSFE to allow implant placement, were recruited for this study. Right or left sinuses were grafted with autologous maxillary bone combined either with Bio-Oss(®) or BoneCeramic(®) , respectively. Twenty biopsies were taken at the time of implant insertion after 4-5 months or 6-8 months of MSFE, and analyzed by micro-computed tomography (microCT) and gene-expression analysis.

RESULTS

MicroCT analysis revealed no differences in the morphometric parameters or BMD either after 4-5 months or 6-8 months of MSFE between Bio-Oss(®) and BoneCeramic(®) . At molecular level, a higher expression of bone forming gene Runx2 was observed after 4-5 months of MSFE in the Bio-Oss(®) compared with the BoneCeramic(®) group.

CONCLUSIONS

Our results indicate that differences found at the molecular level between Bio-Oss(®) and BoneCeramic(®) are not translated to important differences in the 3D microstructure and BMD of the grafted bone.

Evaluation of dental socket healing after using of porous titanium granules: Histologic and histomorphometric assessment in dogs

Background:

Different methods have been suggested to preserve bone architecture following traumatic events such as teeth extraction. The purpose of the study was to histologically and histomorphometrically evaluate the dental socket healing after applying porous titanium granules (PTG) in dogs.

Materials and Methods:

Four healthy male dogs were involved in the present 6-weeks experimental animal study. Three sockets were surgically created in each side of dog's mandible. One of the sockets in one side was randomly filled by PTG and covered by a resorbable membrane (Tigran + membrane group). Another socket was left unfilled and just covered by the same membrane (membrane group) and the last one was left unfilled and uncovered as the control group. The dogs were killed at two time intervals (2 weeks and 6 weeks, two dogs at each time point). All samples were histologically evaluated under an optical microscope for a new bone formation. Data were analyzed by SPSS ver. 16 and Kruskal–Wallis and Mann–Whitney tests were used to compare data in different groups (α = 0.05).

Results:

There was a significant difference between the Tigran + membrane and the control group in 2 and 6 weeks in the mean amount of total regenerated bone (P < 0.05). The mean amounts of woven, lamellar, and total regenerated bone showed significant differences between 2 weeks and 6 weeks for all three groups (P < 0.05).

Conclusions:

It can be assumed that the use of Tigran bone substitute with membrane can promote the bone regeneration in bone defects.

Porous Titanium Granules and Blood for Bone Regeneration around Dental Implants: Report of Four Cases and Review of the Literature

A regenerative procedure treating a local osseous defect around titanium dental implant using porous titanium granules is described in four patients. Porous titanium granules represent, for maxillofacial surgery, a new alternative in augmenting osseous defects. Its earliest application was in the field of orthopedics for stabilization of tibia plateau fractures and for reoperations in prosthetic fixation of femoral stems. There is emerging scientific evidence regarding titanium for its potential use in the maxillofacial area and porous titanium granules are now commercially available. The scientific background for the osteoconductive use of porous titanium granules is elucidated in this paper and the supporting literature is reviewed.

Porous ceramic titanium dioxide scaffolds promote bone formation in rabbit peri-implant cortical defect model

Titanium oxide (TiO₂) scaffolds have previously been reported to exhibit very low mechanical strength. However, we have been able to produce a scaffold that features a high interconnectivity, a porosity of 91% and a compressive strength above 1.2 MPa. This study analyzed the in vivo performance of the porous TiO₂ scaffolds in a peri-implant cortical defect model in the rabbit. After 8 weeks of healing, morphological microcomputed tomography analyses of the defects treated with the TiO₂ scaffolds had significantly higher bone volume, bone surface and bone surface-to-volume ratio when compared to sham, both in the cortical and bone marrow compartment. No adverse effects, i.e. tissue necrosis or inflammation as measured by lactate dehydrogenase activity and real-time reverse transcription polymerase chain reaction analysis, were observed. Moreover, the scaffold did not hinder bone growth onto the adjacent cortical titanium implant. Histology clearly demonstrated new bone formation in the cortical sections of the defects and the presence of newly formed bone in close proximity to the scaffold surface and the surface of the adjacent Ti implant. Bone-to-material contact between the newly formed bone and the scaffold was observed in the histological sections. Islets of new bone were also present in the marrow compartment albeit in small amounts. In conclusion, the present investigation demonstrates that TiO₂ scaffolds osseointegrate well and are a suitable scaffold for peri-implant bone healing and growth.

Dimensional Ridge Preservation with a Novel Highly Porous TiO(2) Scaffold: An Experimental Study in Minipigs

Despite being considered noncritical size defects, extraction sockets often require the use of bone grafts or bone graft substitutes in order to facilitate a stable implant site with an aesthetically pleasing mucosal architecture and prosthetic reconstruction. In the present study, the effect of novel TiO(2) scaffolds on dimensional ridge preservation was evaluated following their placement into surgically modified extraction sockets in the premolar region of minipig mandibles. After six weeks of healing, the scaffolds were wellintegrated in the alveolar bone, and the convex shape of the alveolar crest was preserved. The scaffolds were found to partially preserve the dimensions of the native buccal and lingual bone walls adjacent to the defect site. A tendency towards more pronounced vertical ridge resorption, particularly in the buccal bone wall of the nongrafted alveoli, indicates that the TiO(2) scaffold may be used for suppressing the loss of bone that normally follows tooth extraction.

Cell adhesion and osteogenic differentiation on three-dimensional pillar surfaces

We hypothesized that when compared with conventional two-dimensional (2D) cultures, substrates containing 3D micropillars would allow cells to grow at levels, activating their cytoskeleton to promote osteogenesis. Fibroblasts, osteoblast-like cells, and mesenchymal stem cells (MSCs) were studied. Planar substrates were compared with 200-nm-, 5-μm-, and 20-μm-high pillars of Ormocomp®, Si, diamond-like carbon, or TiO(2). Scanning electron microscopy and staining of actin cytoskeleton showed 7.5-h adhesion to pillar edges and 5-day stretching between adhesion contacts > 100-μm distances of fibroblast and MSC in 3D networks, whereas SaOS-2 cells adhered flatly and individually on horizontal and vertical surfaces. ERK and ROCK immunostaining at 14 and 21 days confirmed activation of the cytoskeleton. In contrast to expectations, success to induce osteogenesis was dominated by the cytocompatibility of the substrate over the 3D structure. This was shown using early alkaline phosphatase, intermediate osteopontin, and late mineralization markers, together with bone nodule formation, which were seen in planar substrates and low-profile TiO(2) pillars, but were poor in the 20-μm landscape. The lack of intercellular contacts seems to halt the osteogenesis-promoting effects of cytoskeletal organization and tension described earlier.

Bone formation in TiO2 bone scaffolds in extraction sockets of minipigs

The osteoconductive capacity of TiO(2) scaffolds was investigated by analysing the bone ingrowth into the scaffold structure following their placement into surgically modified extraction sockets in Gottingen minipigs. Non-critical size defects were used in order to ensure sufficient bone regeneration for the evaluation of bone ingrowth to the porous scaffold structure, and sham sites were used as positive control. Microcomputed tomographic analysis revealed 73.6±11.1% of the available scaffold pore space to be occupied by newly formed bone tissue, and the volumetric bone mineral density of the regenerated bone was comparable to that of the native cortical bone. Furthermore, histological evidence of vascularization and the presence of bone lamellae surrounding some of the blood vessels were also observed within the inner regions of the scaffold, indicating that the highly interconnected pore structure of the TiO(2) scaffolds supports unobstructed formation of viable bone tissue within the entire scaffold structure. In addition, bone tissue was found to be in direct contact with 50.0±21.5% of the TiO(2) struts, demonstrating the good biocompatibility and osteoconductivity of the scaffold material.

Effect of ZrO2 addition on the mechanical properties of porous TiO2 bone scaffolds

This study aimed at the investigation of the effect of zirconium dioxide (ZrO2) addition on the mechanical properties of titanium dioxide (TiO2) bone scaffolds. The highly biocompatible TiO2 has been identified as a promising material for bone scaffolds, whereas the more bioinert ZrO2 is known for its excellent mechanical properties. Ultra-porous TiO2 scaffolds (>89% porosity) were produced using polymer sponge replication with 0-40 wt.% of the TiO2 raw material substituted with ZrO2. Microstructure, chemical composition, and pore architectural features of the prepared ceramic foams were characterised and related to their mechanical strength. Addition of 1 wt.% of ZrO2 led to 16% increase in the mean compressive strength without significant changes in the pore architectural parameters of TiO2 scaffolds. Further ZrO2 additions resulted in reduction of compressive strength in comparison to containing no ZrO2. The appearance of zirconium titanate (ZrTiO4) phase was found to hinder the densification of the ceramic material during sintering resulting in poor intergranular connections and thus significantly reducing the compressive strength of the highly porous ceramic foam scaffolds.