Osseointegration of implant surfaces in metabolic syndrome and type-2 diabetes mellitus

This in vivo study evaluated the bone healing response around endosteal implants with varying surface topography/chemistry in a preclinical, large transitional model induced with metabolic syndrome (MS) and type-2 diabetes mellitus (T2DM). Fifteen Göttingen minipigs were randomly distributed into two groups: (i) control (normal diet, n = 5) and (ii) O/MS (cafeteria diet for obesity induction, n = 10). Following obesity induction, five minipigs from the obese/metabolic syndrome (O/MS) group were further allocated, randomly, into the third experimental group: (iii) T2DM (cafeteria diet + streptozotocin). Implants with different surface topography/chemistry: (i) dual acid-etched (DAE) and (ii) nano-hydroxyapatite coating over the DAE surface (NANO), were placed into the right ilium of the subjects and allowed to heal for 4 weeks. Histomorphometric evaluation of bone-to-implant contact (%BIC) and bone area fraction occupancy (%BAFO) within implant threads were performed using histomicrographs. Implants with NANO surface presented significantly higher %BIC (~26%) and %BAFO (~35%) relative to implants with DAE surface (%BIC = ~14% and %BAFO = ~28%, p < .025). Data as a function of systemic condition presented significantly higher %BIC (~28%) and %BAFO (~42%) in the control group compared with the metabolically compromised groups (O/MS: %BIC = 14.35% and %BAFO = 26.24%, p < .021; T2DM: %BIC = 17.91% and %BAFO = 26.12%, p < .021) with no significant difference between O/MS and T2DM (p > .05). Statistical evaluation considering both factors demonstrated significantly higher %BIC and %BAFO for the NANO surface relative to DAE implant, independent of systemic condition (p < .05). The gain increase of %BIC and %BAFO for the NANO compared with DAE was more pronounced in O/MS and T2DM subjects. Osseointegration parameters were significantly reduced in metabolically compromised subjects compared with healthy subjects. Nanostructured hydroxyapatite-coated surfaces improved osseointegration relative to DAE, regardless of systemic condition.

Nanoengineering and Surface Modifications of Dental Implants

Dental implants are one of the most important and successful advancements in modern dentistry. One aspect of dental implant design that influences the rate and degree of osseointegration is implant surface features. Nano-engineering techniques are anticipated to improve titanium dentistry implants' surface characteristics, which in turn promote peri-implant osteogenesis. In this paper, we review the recent advances in nanosurface engineering techniques for enhancing the bioactivity of dental implants.

Nanohydroxyapatite in dentistry: A comprehensive review

Enamel, being the hardest and the highest mineralized tissue of the human body, contains nearly 96% inorganic components and 4% organic compounds and water. Dentin contains 65% inorganic components and 35% organic and water content. The translucency and white appearance of enamel are attributed to Hydroxyapatite (HA), which constitutes the major part of the inorganic component of dental hard tissue. With the advent of nanotechnology, the application of Nanohydroxyapatite (nHA) has piqued interest in dentistry due to its excellent mechanical, physical, and chemical properties. Compared to HA, nHA is found to have superior properties such as increased solubility, high surface energy and better biocompatibility. This is due to the morphological and structural similarity of nanosized hydroxyapatite particles to tooth hydroxyapatite crystals. These nanoparticles have been incorporated into various dental formulations for different applications to ensure comprehensive oral healthcare. To prevent dental caries, several nHA based dentifrices, mouth rinsing solutions and remineralizing pastes have been developed. nHA-based materials, such as nanocomposites, nano impression materials, and nanoceramics, have proven to be very effective in restoring tooth deformities (decay, fracture, and tooth loss). The nHA coating on the surface of the dental implant helps it bind to the bone by forming a biomimetic coating. A recent innovative strategy involves using nHA to reduce dentinal hypersensitivity and to reconstruct periodontal bone defects. The purpose of the present review is to discuss the different applications of nHA in dentistry, especially in preventive and restorative dentistry, dental implantology, bleaching and dentine hypersensitivity management.

Bone healing around implants placed in subjects with metabolically compromised systemic conditions

The aim of this study was to evaluate the bone healing of tight-fit implants placed in the maxilla and mandible of subjects compromised with metabolic syndrome (MS) and type-2 Diabetes Mellitus (T2DM). Eighteen Göttingen minipigs were randomly distributed into three groups: (i) control (normal diet), (ii) MS (cafeteria diet for obesity induction), (iii) T2DM (cafeteria diet for obesity induction + Streptozotocin for T2DM induction). Maxillary and mandibular premolars and molar were extracted. After 8 weeks of healing, implants with progressive small buttress threads were placed, and allowed to integrate for 6 weeks after which the implant/bone blocks were retrieved for histological processing. Qualitative and quantitative histomorphometric analyses (percentage of bone-to-implant contact, %BIC, and bone area fraction occupancy within implant threads, %BAFO) were performed. The bone healing process around the implant occurred predominantly through interfacial remodeling with subsequent bone apposition. Data as a function of systemic condition yielded significantly higher %BIC and %BAFO values for healthy and MS relative to T2DM. Data as a function of maxilla and mandible did not yield significant differences for either %BIC and %BAFO. When considering both factors, healthy and MS subjects had %BIC and %BAFO trend towards higher values in the mandible relative to maxilla, whereas T2DM yielded higher %BIC and %BAFO in the maxilla relative to mandible. All systemic conditions presented comparable levels of %BIC and %BAFO in the maxilla; healthy and MS presented significantly higher %BIC and %BAFO relative to T2DM in the mandible. T2DM presented lower amounts of bone formation around implants relative to MS and healthy. Implants placed in the maxilla and in the mandible showed comparable amounts of bone in proximity to implants.

Nanohydroxyapatite-Coated Titanium Surface Increases Vascular Endothelial Cells Distinct Signaling Responding to High Glucose Concentration

Aim: The success of dental implants depends on osseointegration can be compromised by well-known related adverse biological processes, such as infection and diabetes. Previously, nanohydroxyapatite-coated titanium surfaces (nHA_DAE) have been shown to contain properties that promote osteogenesis by enhancing osteoblast differentiation. In addition, it was hypothesized to drive angiogenesis in high-glucose microenvironments, mimicking diabetes mellitus (DM). On the other hand, the null hypothesis would be confirmed if no effect was observed in endothelial cells (ECs). Materials and methods: Titanium discs presenting the differential surfaces were previously incubated in an FBS-free cell culture medium for up to 24 h, which was, thereafter, supplemented with 30.5 mM of glucose to expose human umbilical vein endothelial cells (HUVECs, ECs) for 72 h. They were then harvested, and the sample was processed to provide molecular activity of specific genes related to EC survival and activity by using qPCR, and the conditioned medium by ECs was used to evaluate the activity of matrix metalloproteinases (MMPs). Results: Our data guaranteed better performance of this nanotechnology-involved titanium surface to this end once the adhesion and survival characteristics were ameliorated by promoting a higher involvement of β1-Integrin (~1.5-fold changes), Focal Adhesion Kinases (FAK; ~1.5-fold changes) and SRC (~2-fold changes) genes. This signaling pathway culminated with the cofilin involvement (~1.5-fold changes), which guaranteed cytoskeleton rearrangement. Furthermore, nHA_DAE triggered signaling that was able to drive the proliferation of endothelial cells once the cyclin-dependent kinase gene was higher in response to it, while the P15 gene was significantly down-regulated with an impact on the statement of angiogenesis. Conclusions: Altogether, our data show that a nanohydroxyapatite-coated titanium surface ameliorates the EC performance in a high-glucose model in vitro, suggesting its potential application in DM patients.

In vivo osseointegration evaluation of implants coated with nanostructured hydroxyapatite in low density bone

OBJECTIVE

This in vivo study, aimed to biomechanically, histomorphometrically and histologically evaluate an implant surface coated with nanostructured hydroxyapatite using the wet chemical process (biomimetic deposition of calcium phosphate coating) when compared to a dual acid-etching surface.

MATERIAL AND METHODS

Ten sheep (2-4 years old) received 20 implants, 10 with nanostructured hydroxyapatite coating (HAnano), and 10 with dual acid-etching surface (DAA). The surfaces were characterized with scanning electron microscopy and energy dispersive spectroscopy; insertion torque values and resonance frequency analysis were measured to evaluate the primary stability of the implants. Bone-implant contact (BIC) and bone area fraction occupancy (BAFo) were evaluated 14 and 28 days after implant installation.

RESULTS

The HAnano and DAA groups showed no significant difference in insertion torque and resonance frequency analysis. The BIC and BAFo values increased significantly (p<0.05) over the experimental periods in both groups. This event was also observed in BIC value of HAnano group. The HAnano surface showed superior results compared to DAA after 28 days (BAFo, p = 0.007; BIC, p = 0.01).

CONCLUSION

The results suggest that the HAnano surface favors bone formation when compared to the DAA surface after 28 days in low-density bone in sheep.

Dental Implants and Implant Coatings: A Focus on Their Toxicity and Safety

Dental implants are medical devices that are surgically inserted into the patient's jawbone by an orthodontist to act as roots of missing teeth. After the implantation, the maxilla or mandible integrates with the surface of the dental implant. This process, called "osseointegration," is an important period to ensure the long-term use of dental implants and prevent implant failures. Metal implants are the most used implant materials. However, they have disadvantages such as corrosion, metal ion release from metal implant surfaces and associated toxicity. To avoid these adverse effects and improve osseointegration, alternative dental implant materials such as ceramics, polymers, composites, and novel surface modification technologies have been developed. The safety of these materials are also of concern for toxicologists. This review will give general information about dental implant materials, osseointegration and successful implantation process. Moreover, we will focus on the new surface coatings materials for of dental implants and their toxicity and safety concerns will be discussed.

Novel nano-hydroxyapatite coating of additively manufactured three-dimensional porous implants improves bone ingrowth and initial fixation

Electron beam melting (EBM) has been used to fabricate three-dimensional (3D) porous Ti-6Al-4V surfaces for acetabular cups in total hip arthroplasty. However, there are radiographic concerns regarding poor implant fixation and bone ingrowth around electron beam melted (EBMed) 3D porous cups. We hypothesize that nano-hydroxyapatite (nHA) coating can promote bone ingrowth and thus decrease the occurrence of radiolucent lines around EBMed 3D porous cups. This study aimed to investigate the effect of a novel nHA coating on the biological performance of EBMed 3D porous implants in a beagle transcortical model. Low-porosity (control) and high-porosity 3D porous Ti-6Al-4V implants were manufactured using EBM. Half of the high-porosity implants were coated with nHA without clogging the 3D pores. Implants were inserted into the femoral diaphysis of the beagles. The beagles were euthanized at 4, 8, and 12 weeks postoperatively, and push-out testing was performed. Bone ingrowth was evaluated by histological analysis. Although the increase in porosity alone had no effect on biological behavior, the addition of nHA to high-porosity 3D implants significantly improved early bone fixation and bone ingrowth into the deep region of porous structures compared to low-porosity implants. This is the first report of a novel nHA coating that improved bone ingrowth into the deeper regions of 3D porous implants, which can prevent the occurrence of radiolucent lines around EBMed 3D porous cups.

Evaluation of Bone Response to a Nano HA Implant Surface on Sinus Lifting Procedures: Study in Rabbits

The aim of this study was to evaluate the bone response to two different implant surfaces on sinus lift procedures in rabbits. Bilateral sinus lifting with inorganic bovine bone associated with collagen membrane and immediate implantation were performed in 16 rabbits. Custom mini-implants were randomly installed in the prepared sites: one side received a double acid-etched (DAE) surface and the other a nano-hydroxyapatite (NHA) surface. The animals were euthanized 30 and 60 days after surgery, and biopsies were collected for microtomographic and histomorphometric analysis. After 30 days, no intra- and inter-group statistical differences were observed in microtomographic analysis, while at 60 days, bone analysis showed statistically significant differences between groups (p < 0.05) for all the evaluated parameters. Histomorphometric analysis showed, after 30 days, mean % of Bone-to-Implant Contact (BIC) for DAE and NHA of 31.70 ± 10.42% vs. 40.60 ± 10.22% (p > 0.05), respectively; for % of Bone Area Fraction Occupancy (BAFO), mean values were 45.43 ± 3.597% for DAE and 57.04 ± 5.537% for NHA (p < 0.05). After 60 days, mean %BIC and %BAFO for DAE and NHA implants were statistically significant (p < 0.05). The NHA surface showed superior biological features compared to the DAE treatment, promoting higher bone formation around the implants in an experimental model of bone repair in a grafted area.

The shape-effect of calcium phosphate nanoparticle based films on their osteogenic properties

Calcium phosphates (CaPs) in the form of hydroxyapatite (HA) have been extensively studied in the context of bone regeneration due to their chemical similarity to natural bone mineral. While HA is known to promote osteogenic differentiation, the structural properties of the ceramic have been shown to affect the extent of this effect; several studies have suggested that nanostructured HA can improve the bioactivity. However, the role shape plays in the osteogenic potential is more elusive. Here we studied the effect of HA nanoparticle shape on the ability to induce osteogenesis in human mesenchymal stromal cells (hMSCs) by developing nanoparticle films using needle-, rice- and spherical-shaped HA. We showed that the HA films made from all three shapes of nanoparticles induced increased levels of osteogenic markers (i.e. runt-related transcription factor 2 (RUNX2), bone morphogenetic protein 2 (BMP2), alkaline phosphatase (ALP), osteopontin (OPN), osteocalcin (OCN) on protein and gene level in comparison to hMSCs cultured on cover glass slides. Furthermore, their expression levels and profiles differed significantly as a function of nanoparticle shape. We also showed that nanoparticle films were more efficient in inducing osteogenic gene expression in hMSCs compared to adding nanoparticles to hMSCs in culture media. Finally, we demonstrated that hMSC morphology upon adhesion to the HA nanoparticle films is dependent on nanoparticle shape, with hMSCs exhibiting a more spread morphology on needle-shaped nanoparticle films compared to hMSCs seeded on rice- and spherical-shaped nanoparticle films. Our data suggests that HA nanoparticle films are efficient in inducing hMSC osteogenesis in basic cell culture conditions and that nanoparticle shape plays a vital role in cell adhesion and morphology and extent of induction of osteogenic differentiation.

Histological and Nanomechanical Properties of a New Nanometric Hydroxiapatite Implant Surface. An In Vivo Study in Diabetic Rats

Implant therapy is a predictable treatment to replace missing teeth. However, the osseointegration process may be negatively influenced by systemic conditions, such as diabetes mellitus (DM). Microtopography and implant surface developments are strategies associated to better bone repair. This study aimed to evaluate, in healthy and diabetic rats, histomorphometric (bone to implant contact = %BIC; and bone area fraction occupancy = %BAFO) and nanomechanical (elastic modulus = EM; and hardness = H) bone parameters, in response to a nanometric hydroxyapatite implant surface. Mini implants (machined = MAC; double acid etched = DAE, and with addition of nano-hydroxyapatite = NANO) were installed in tibias of healthy and diabetic rats. The animals were euthanized at 7 and 30 days. NANO surface presented higher %BIC and %BAFO when compared to MAC and DAE (data evaluated as a function of implant surface). NANO surface presented higher %BIC and %BAFO, with statistically significant differences (data as a function of time and implant surface). NANO surface depicted higher EM and H values, when compared to machined and DAE surfaces (data as a function of time and implant surface). Nano-hydroxyapatite coated implants presented promising biomechanical results and could be an important tool to compensate impaired bone healing reported in diabetics.

Influence of Nanotopography on Early Bone Healing during Controlled Implant Loading

Nanoscale surface modifications influence peri-implant cell fate decisions and implant loading generates local tissue deformation, both of which will invariably impact bone healing. The objective of this study is to determine how loading affects healing around implants with nanotopography. Implants with a nanoporous surface were placed in over-sized osteotomies in rat tibiae and held stable by a system that permits controlled loading. Three regimens were applied: (a) no loading, (b) one daily loading session with a force of 1.5N, and (c) two such daily sessions. At 7 days post implantation, animals were sacrificed for histomorphometric and DNA microarray analyses. Implants subjected to no loading or only one daily loading session achieved high bone-implant contact (BIC), bone-implant distance (BID) and bone formation area near the implant (BFAt) values, while those subjected to two daily loading sessions showed less BFAt and BIC and more BID. Gene expression profiles differed between all groups mainly in unidentified genes, and no modulation of genes associated with inflammatory pathways was detected. These results indicate that implants with nanotopography can achieve a high level of bone formation even under micromotion and limit the inflammatory response to the implant surface.

Clinical, histological, and nanomechanical parameters of implants placed in healthy and metabolically compromised patients

OBJECTIVES

To evaluate the clinical outcomes, histological parameters, and bone nanomechanical properties around implants retrieved from healthy and metabolic syndrome (MS) patients.

METHODS

Twenty-four patients with edentulous mandibles (12/condition), received four implants between the mental foramina. An additional implant prototype was placed for retrieval histology. The following clinical outcomes were evaluated: insertion torque (IT), implant stability quotient (ISQ) values at baseline and after 60 days of healing, and implant survival. The prototype was retrieved after the healing and histologically processed for bone morphometric evaluation of bone-to-implant contact (%BIC) and bone area fraction occupancy (%BAFO), and bone nanoindentation to determine the elastic modulus (Em) and hardness (H). Descriptive statistical procedures and survival tests were used to analyze the data.

RESULTS

The final study population was comprised of 10 women and 11 men (∼64 years). A total of 105 implants were placed, 21 retrieved for histology. Implant survival rates were similar between groups (>99 %). Similarly, IT and ISQ analyses showed no significant association with systemic condition (p > 0.216). Histological micrographs depicted similar bone morphology, woven bone, for both conditions. While MS (33 ± 5.3 %) and healthy (39 ± 6.5 %) individuals showed no significant difference for %BIC (p = 0.116), significantly higher %BAFO was observed for healthy (45 ± 4.6 %) relative to MS (30 ± 3.8 %) (p < 0.001). No significant differences on bone nanomechanical properties was observed (p > 0.804).

CONCLUSIONS

Although no significant influence on clinical parameters and bone nanomechanical properties was observed, MS significantly reduced bone formation in the peri-implant area in the short-term.

CLINICAL SIGNIFICANCE

A lower amount of bone formation in the peri-implant area was observed in comparison to healthy patients, although the other short-term clinical outcomes were not significantly different. Considering the escalating prevalence of MS patients in need for implant treatment, it becomes crucial to understand bone-to-implant response to determine the ideal loading time in this population.

Inhibitory Effect of 5-Aminoimidazole-4-Carbohydrazonamides Derivatives Against Candida spp. Biofilm on Nanohydroxyapatite Substrate

Candida can adhere and form biofilm on biomaterials commonly used in medical devices which is a key attribute that enhances its ability to cause infections in humans. Furthermore, biomaterial-related infections represent a major therapeutic challenge since Candida biofilms are implicated in antifungal therapies failure. The goals of the present work were to investigate the effect of three 5-aminoimidazole-4-carbohydrazonamides, namely (Z)-5-amino-1-methyl-N'-aryl-1H-imidazole-4-carbohydrazonamides [aryl = phenyl (1a), 4-fluorophenyl (1b), 3-fluorophenyl (1c)], on Candida albicans and Candida krusei biofilm on nanohydroxyapatite substrate, a well-known bioactive ceramic material. To address these goals, both quantitative methods (by cultivable cell numbers) and qualitative evaluation (by scanning electron microscopy) were used. Compounds cytocompatibility towards osteoblast-like cells was also evaluated after 24 h of exposure, through resazurin assay. The three tested compounds displayed a strong inhibitory effect on biofilm development of both Candida species as potent in vitro activity against C. albicans sessile cells. Regarding cytocompatibility, a concentration-dependent effect was observed. Together, these findings indicated that the potent activity of imidazole derivatives on Candida spp. biofilms on nanohydroxyapatite substrate, in particular compound 1c, is worth further investigating.

Cell Therapy: Effect of Locally Injected Mesenchymal Stromal Cells Derived from Bone Marrow or Adipose Tissue on Bone Regeneration of Rat Calvarial Defects

Treatment of large bone defects is a challenging clinical situation that may be benefited from cell therapies based on regenerative medicine. This study was conducted to evaluate the effect of local injection of bone marrow-derived mesenchymal stromal cells (BM-MSCs) or adipose tissue-derived MSCs (AT-MSCs) on the regeneration of rat calvarial defects. BM-MSCs and AT-MSCs were characterized based on their expression of specific surface markers; cell viability was evaluated after injection with a 21-G needle. Defects measuring 5 mm that were created in rat calvaria were injected with BM-MSCs, AT-MSCs, or vehicle-phosphate-buffered saline (Control) 2 weeks post-defect creation. Cells were tracked by bioluminescence, and 4 weeks post-injection, the newly formed bone was evaluated by µCT, histology, nanoindentation, and gene expression of bone markers. BM-MSCs and AT-MSCs exhibited the characteristics of MSCs and maintained their viability after passing through the 21-G needle. Injection of both BM-MSCs and AT-MSCs resulted in increased bone formation compared to that in Control and with similar mechanical properties as those of native bone. The expression of genes associated with bone formation was higher in the newly formed bone induced by BM-MSCs, whereas the expression of genes involved in bone resorption was higher in the AT-MSC group. Cell therapy based on local injection of BM-MSCs or AT-MSCs is effective in delivering cells that induced a significant improvement in bone healing. Despite differences observed in molecular cues between BM-MSCs and AT-MSCs, both cells had the ability to induce bone tissue formation at comparable amounts and properties. These results may drive new cell therapy approaches toward complete bone regeneration.

Differential inflammatory landscape stimulus during titanium surfaces obtained osteogenic phenotype

Molecular mechanism governing inflammatory scenario in response to titanium (Ti)-nanotexturing surfaces needs to be better addressed. Thus, we subjected pre-osteoblast to different Ti-texturing surfaces, as follows: machined (Mac), double acid-etching (DAE), and nanoscaled hydroxyapatite-blasted titanium surface (nHA), considering the cells chronically responding either directly (when the cells were cultured onto the surfaces) or indirectly (when the cells were challenged with the conditioned medium by the surfaces), up to 10 days. Our results showed that there is a dynamic requirement of inflammatory-related genes activation in response to nHA by up expressing IL1ß, IL6, IL10, and IL33 (direct condition) and IL6, IL10, IL18 (indirect condition). Importantly, our data show that there is inflammasome involvement, once NLRP3, ASC1, and CASP1 genes were also required. As we found a strong signal of IL10, an anti-inflammatory cytokine, we further investigated Sonic Hedgehog (Shh) signaling cascade. Surprisingly, Shh ligand and Smoothened (Smo) genes were up-modulated in response to nHA, while Patched (Ptc) was down-modulated. Finally, an interactome was built using bioinformatics reinforcing Shh signaling cascade on modulating IL10 transcripts by Src mediating this process and this prevalence of anti-inflammatory picture might explain the low profile of RANKL transcripts in response to nHA, compromising the osteoclastogenesis surrounding the implants. Taking our results into account, our data show that the inflammatory landscape promoted by nHA is strictly modulated by Shh signaling promoted anti-inflammatory pathways. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1597-1604, 2019.

Mesoporous and hollow hydroxyapatite nanostructured particles as a drug delivery vehicle for the local release of ibuprofen

The high risk of infection caused by implantation of orthopedic bio-metals is still a daunting challenge for surgeons as it can lead to implant failure. One approach to overcome this issue is the local release of antibacterial drug through coating on the surface of a metallic implant. One ideal carrier for this purpose is hydroxyapatite (HA) particles which are bioactive, biodegradable, biocompatible and have the potential to bond to bone. In the current study, highly crystalline mesoporous HA nanostructure particles were successfully synthesized in a low-temperature solvent process with the aid of an inorganic CaCO₃ template and then fully characterized. The specific surface area and the average size of the cavities of the nanostructured mesoporous HA particles were 85 m²/g and 20 nm, respectively. The feasibility of the prepared HA mesoporous nanostructures for drug delivery, using ibuprofen as a model drug, was also investigated. The as-prepared HA mesoporous nanostructures showed a high drug-loading capacity, as well as sustained drug release in a phosphate buffered saline (PBS) at a pH of 7.4. Overall, results show that HA mesoporous nanostructures gave great potential in bone regeneration and local delivery of either drugs or biomolecules.

A short view on nanohydroxyapatite as coating of dental implants

INTRODUCTION

Titanium based (Ti-based) materials have been used as dental implants due to their high biocompatibility, good mechanical strength and ideal osseointegration properties. Osseointegration of an implant is dependent on surface characteristics such as surface chemistry and topography. Nanotechnology has presented new and interesting applications in dentistry in recent years. The presence of nanoparticles on the implant surface can affect both the topography and surface chemistry, leading to different and outstanding specifications for implant.

METHOD

A literature review was performed in electronic databases by means of MeSH keywords to collect relevant published literature in English about the effect of nanohydroxyapatite on osseointegration of titanium implants. No limitations on publication date were imposed. Data regarding titanium implants; nanotechnology; nanohydroxyapatite; osseointegration and cell attachment were collected and reviewed.

RESULTS AND CONCLUSION

According to reviewed literature, nanohydroxyapatites have a nanostructured surface with higher surface area and then higher reactivity, letting them to bind to bone creating a biomimetic coating on implants. However, more studies are needed on the cell-substrate interface to develop an effective implant due to the interaction of the cells and the biomaterial surface after the implantation.

Comparing the effect of strontium-functionalized and fluoride-modified surfaces on early osseointegration

BACKGROUND

Studies have shown that medical devices comprising strontium contribute to bone healing and osseointegration. The aim of this study was to evaluate the in vivo performance of surface-functionalized implants (Ti-Sr-O) showing predictable release characteristics of strontium and compare it to performance a commercially available fluoride-modified surface.

METHODS

Ti-Sr-O functionalized, fluoride-modified,  Grade 4 titanium implants were inserted in the femoral condyle of adult male New Zealand white rabbits. Atomic absorption spectrometry (AAS) was utilized to monitor strontium blood serum levels. Two weeks after insertion, histomorphometric evaluation was performed with respect to bone-to-implant contact (BIC%) and bone formation (BF%) using defined regions of interest.

RESULTS

Mean values for BIC% showed a comparable degree of osseointegration for Ti-Sr-O and the fluoride-modified surface, while BF% revealed a significant difference in increased BF with Ti-Sr-O. AAS measurements did not indicate any influence of the Ti-Sr-O modified implants on the strontium blood serum concentrations.

CONCLUSIONS

Within the limitations of this study, it was shown that the Ti-Sr-O coating, with sustained release characteristics of strontium, enhanced bone apposition and, thus, could find practical applications, e.g., within the field of medical implantology.

Enhanced Bone Bonding to Nanotextured Implant Surfaces at a Short Healing Period: A Biomechanical Tensile Testing in the Rat Femur

PURPOSE

To compare the bone bonding capabilities of 2 different surface treatments at an early healing period. Titanium alloy (Ti6Al4V) custom-made rectangular plates (1.4 × 2.4 × 4 mm) were either dual acid etched (Ti6Al4V-DAE) or DAE/nanotextured blasted (Ti6Al4V-NTB).

MATERIALS AND METHODS

Implants were placed in the distal femurs of 10 Wistar rats and were allowed to heal for 9 days. After euthanasia, the bone immediately proximal and distal to the implant was removed to test the bone bonding force with a universal testing machine. Ultrastructure of the bone/implant interface was assessed by scanning electron microscopy.

RESULTS

Ti6Al4V-NTB samples exhibited significantly greater bond strength than Ti6Al4V-DAE samples. Morphologically, the Ti6Al4V-NTB surfaces presented intimate interaction with bone, whereas little interaction between the Ti6Al4V-DAE surface and bone was observed.

CONCLUSION

The results of this study indicated a significant increase in bone bonding for the DAE/nanotextured blasted surface, which is suggested to be the outcome of the nanotexturing.

Evaluation of Bioabsorbable Multiamino Acid Copolymer/Nanohydroxyapatite/Calcium Sulfate Cage in a Goat Spine Model

BACKGROUND

Currently, polylactide is the most popular material used to made bioabsorbable cages but too-quick degradation and osteolysis around the cage have been reported in the literature. This study evaluated the fusion effect, biomechanical stability, and histologic characteristics of a novel bioabsorbable multiamino acid copolymer/nanohydroxyapatite/calcium sulfate (MAACP/n-HA/CS) interbody cage in a goat model of anterior cervical discectomy and fusion.

METHODS

A total of 24 goats underwent C3/C4 discectomy and fusion with 3 groups of intervertebral implants: MAACP/n-HA/CS cage group (n = 8), titanium cage group (n = 8), and autologous tricortical iliac crest bone group (n = 8). Disc space height and lordosis angle were measured pre- and postoperatively and after 4, 12, and 24 weeks. Range of motion (ROM) was evaluated through biomechanical testing. Histologic analysis was performed to evaluate fusion status and to detect any foreign body reactions associated with the bioabsorbable cages.

RESULTS

At 12 and 24 weeks, disc space height in MAACP/n-HA/CS cage group was greater than that of titanium cage group and tricortical iliac crest group (P < 0.05). Lordosis angle in MAACP/n-HA/CS cage group and titanium cage group were lower than that of tricortical iliac crest group (P < 0.05). Biomechanical test showed that ROM did not differ significantly between MAACP/n-HA/CS cage group and titanium cage group, whereas the value of ROM in bone graft group was the largest. Histologic evaluation showed a better interbody fusion in the MAACP/n-HA/CS cage group than in the other 2 groups. MAACP/n-HA/CS cage surface degraded and was absorbed at 24 weeks. All MAACP/n-HA/CS cages showed excellent biocompatibility.

CONCLUSIONS

MAACP/n-HA/CS cages can provide good fusion effect, enough biomechanical stability, and integrate closely with the surrounding bone.

Bone regenerating effect of surface-functionalized titanium implants with sustained-release characteristics of strontium in ovariectomized rats

Since strontium (Sr) is known for its anabolic and anticatabolic effect on bone, research has been focused on its potential impact on osseointegration. The objective of this study was to investigate the performance of nanotopographic implants with a Sr-functionalized titanium (Ti) coating (Ti–Sr–O) with respect to osseointegration in osteoporotic bone. The trial was designed to examine the effect of sustained-release characteristics of Sr in poor-quality bone. Three Ti–Sr–O groups, which differed from each other in coating thickness, Sr contents, and Sr release, were examined. These were prepared by a magnetron sputtering process and compared to uncoated grade 4 Ti. Composition, morphology, and mechanical stability of the coatings were analyzed, and Sr release data were gained from in vitro washout experiments. In vivo investigation was carried out in an osteoporotic rat model and analyzed histologically, 6 weeks and 12 weeks after implantation. Median values of bone-to-implant contact and new bone formation after 6 weeks were found to be 84.7% and 54.9% (best performing Sr group) as compared to 65.2% and 23.8% (grade 4 Ti reference), respectively. The 12-week observation period revealed 84.3% and 56.5% (best performing Sr group) and 81.3% and 39.4% (grade 4 Ti reference), respectively, for the same measurements. The increase in new bone formation was found to correlate with the amount of Sr released in vitro. The results indicate that sputtered nanostructured Ti–Sr–O coatings showed sustained release of Sr and accelerate osseointegration even in poor-quality bone, and thus, may have impact on practical applications for medical implants.

Mechanical properties of bone tissues surrounding dental implant systems with different treatments and healing periods

OBJECTIVES

The objective of the current study was to examine whether the nanoindentation parameters can assess the alteration of bone quality resulting from different degrees of bone remodeling between bone tissue ages around the dental implant interface with different treatments and healing periods.

MATERIALS AND METHODS

Dental implants were placed in mandibles of six male dogs. Treatment groups included: resorbable blast media-treated titanium (Ti) implants, alumina-blasted zirconia implants (ATZ), alumina-blasted zirconia implants applied with demineralized bone matrix (ATZ-D), and alumina-blasted zirconia implants applied with rhBMP-2 (ATZ-B). Nanoindentation modulus (E), hardness (H), viscosity (η), and viscoelastic creep (Creep/P _max) were measured for new and old bone tissues adjacent to the implants at 3 and 6 weeks of post-implantation. A total of 945 indentations were conducted for 32 implant systems.

RESULTS

Significantly lower E, H, and η but higher Creep/P _max were measured for new bone tissues than old bone tissues, independent of treatments at both healing periods (p < 0.001). All nanoindentation parameters were not significantly different between healing periods (p > 0.568). ATZ-D and ATZ-B implants had the stiffer slope of correlation between E and Creep/P _max of the new bone tissue than Ti implant (p < 0.039).

CONCLUSIONS

Current results indicated that, in addition to elastic modulus and plastic hardness, measurement of viscoelastic properties of bone tissue surrounding the implant can provide more detailed information to understand mechanical behavior of an implant system.

CLINICAL RELEVANCE

Ability of energy absorption in the interfacial bone tissue can play a significant role in the long-term success of a dental implant system.

Differences between buccal and lingual bone quality and quantity of peri-implant regions

The objective of the current study was to examine whether peri-implant bone tissue properties are different between the buccal and lingual regions treated by growth factors. Four dental implant groups were used: titanium (Ti) implants, alumina-blasted zirconia implants (ATZ-N), alumina-blasted zirconia implants with demineralized bone matrix (DBM) (ATZ-D), and alumina-blasted zirconia implants with rhBMP-2 (ATZ-B). These implants were placed in mandibles of six male dogs. Nanoindentation elastic modulus (E) and plastic hardness (H) were measured for the buccal and lingual bone tissues adjacent and away from the implants at 3 and 6 weeks post-implantation. A total of 2281 indentations were conducted for 48 placed implants. The peri-implant buccal region had less bone quantity resulting from lower height and narrower width of bone tissue than the lingual region. Buccal bone tissues had significant greater mean values of E and H than lingual bone tissues at each distance and healing period (p<0.007). Nearly all implant treatment groups displayed lower mean values of the E at the lingual bone tissues than at the buccal bone tissues (p<0.046) although the difference was not significant for the Ti implant group (p=0.758). The DBM and rhBMP-2 treatments stimulated more peri-implant bone remodeling at the lingual region, producing more immature new bone tissues with lower E than at the buccal region. This finding suggests that the growth factor treatments to the zirconia implant system may help balance the quantity and quality differences between the peri-implant bone tissues.

Microrobotized blasting improves the bone-to-textured implant response. A preclinical in vivo biomechanical study

This study evaluated the effect of microrobotized blasting of titanium endosteal implants relative to their manually blasted counterparts. Two different implant systems were utilized presenting two different implant surfaces. Control surfaces (Manual) were fabricated by manually grit blasting the implant surfaces while experimental surfaces (Microblasted) were fabricated through a microrobotized system that provided a one pass grit blasting routine. Both surfaces were created with the same ~50µm average particle size alumina powder at ~310KPa. Surfaces were then etched with 37% HCl for 20min, washed, and packaged through standard industry procedures. The surfaces were characterized through scanning electron microscopy (SEM) and optical interferometry, and were then placed in a beagle dog radius model remaining in vivo for 3 and 6 weeks. The implant removal torque was recorded and statistical analysis evaluated implant system and surface type torque levels as a function of time in vivo. Histologic sections were qualitatively evaluated for tissue response. Electron microscopy depicted textured surfaces for both manual and microblasted surfaces. Optical interferometry showed significantly higher Sa, Sq, values for the microblasted surface and no significant difference for Sds and Sdr values between surfaces. In vivo results depicted that statistically significant gains in biomechanical fixation were obtained for both implant systems tested at 6 weeks in vivo, while only one system presented significant biomechanical gain at 3 weeks. Histologic sections showed qualitative higher amounts of new bone forming around microblasted implants relative to the manually blasted group. Microrobotized blasting resulted in higher biomechanical fixation of endosteal dental implants and should be considered as an alternative for impant surface manufacturing.

Calcium orthophosphate deposits: Preparation, properties and biomedical applications

Since various interactions among cells, surrounding tissues and implanted biomaterials always occur at their interfaces, the surface properties of potential implants appear to be of paramount importance for the clinical success. In view of the fact that a limited amount of materials appear to be tolerated by living organisms, a special discipline called surface engineering was developed to initiate the desirable changes to the exterior properties of various materials but still maintaining their useful bulk performances. In 1975, this approach resulted in the introduction of a special class of artificial bone grafts, composed of various mechanically stable (consequently, suitable for load bearing applications) implantable biomaterials and/or bio-devices covered by calcium orthophosphates (CaPO4) to both improve biocompatibility and provide an adequate bonding to the adjacent bones. Over 5000 publications on this topic were published since then. Therefore, a thorough analysis of the available literature has been performed and about 50 (this number is doubled, if all possible modifications are counted) deposition techniques of CaPO4 have been revealed, systematized and described. These CaPO4 deposits (coatings, films and layers) used to improve the surface properties of various types of artificial implants are the topic of this review.

Osseointegration of titanium implants functionalised with phosphoserine-tethered poly(epsilon-lysine) dendrons: a comparative study with traditional surface treatments in sheep

The aim of this study was to analyse the osseointegrative potential of phosphoserine-tethered dendrons when applied as surface functionalisation molecules on titanium implants in a sheep model after 2 and 8 weeks of implantation. Uncoated and dendron-coated implants were implanted in six sheep. Sandblasted and etched (SE) or porous additive manufactured (AM) implants with and without additional dendron functionalisation (SE-PSD; AM-PSD) were placed in the pelvic bone. Three implants per group were examined histologically and six implants were tested biomechanically. After 2 and 8 weeks the bone-to-implant contact (BIC) total values of SE implants (43.7±12.2; 53.3±9.0%) and SE-PSD (46.7±4.5; 61.7±4.9%) as well as AM implants (20.49±5.1; 43.9±9.7%) and AM-PSD implants (19.7±3.5; 48.3±15.6%) showed no statistically significant differences. For SE-PSD and AM-PSD a separate analysis of only the cancellous BIC demonstrated a statistically significant difference after 2 and 8 weeks. Biomechanical findings proved the overall increased stability of the porous implants after 8 weeks. Overall, the great effect of implant macro design on osseointegration was further supported by additional phosphoserine-tethered dendrons for SE and AM implants.

Osseointegration: hierarchical designing encompassing the macrometer, micrometer, and nanometer length scales

OBJECTIVE

Osseointegration has been a proven concept in implant dentistry and orthopedics for decades. Substantial efforts for engineering implants for reduced treatment time frames have focused on micrometer and most recently on nanometer length scale alterations with negligible attention devoted to the effect of both macrometer design alterations and surgical instrumentation on osseointegration. This manuscript revisits osseointegration addressing the individual and combined role of alterations on the macrometer, micrometer, and nanometer length scales on the basis of cell culture, preclinical in vivo studies, and clinical evidence.

METHODS

A critical appraisal of the literature was performed regarding the impact of dental implant designing on osseointegration. Results from studies with different methodological approaches and the commonly observed inconsistencies are discussed.

RESULTS

It is a consensus that implant surface topographical and chemical alterations can hasten osseointegration. However, the tailored combination between multiple length scale design parameters that provides maximal host response is yet to be determined.

SIGNIFICANCE

In spite of the overabundant literature on osseointegration, a proportional inconsistency in findings hitherto encountered warrants a call for appropriate multivariable study designing to ensure that adequate data collection will enable osseointegration maximization and/or optimization, which will possibly lead to the engineering of endosteal implant designs that can be immediately placed/loaded regardless of patient dependent conditions.

Improved osseointegration and interlocking capacity with dual acid-treated implants: a rabbit study

AIM

To investigate how osseointegration is affected by different nano- and microstructures. The hypothesis was that the surface structure created by dual acid treatment (AT-1), applied on a reduced topography, might achieve equivalent biomechanical performance as a rougher surface treated with hydrofluoric acid (HF).

MATERIALS AND METHODS

In a preclinical rabbit study, three groups (I, II, and III) comprised of test and control implants were inserted in 30 rabbits. The microstructures of the test implants were either produced by blasting with coarse (I) or fine (II) titanium particles or remained turned (III). All test implants were thereafter treated with AT-1 resulting in three different test surfaces. The microstructure of the control implants was produced by blasting with coarse titanium particles thereafter treated with HF. The surface topography was characterized by interferometry. Biomechanical (removal torque) and histomorphometric (bone-implant contact; bone area) performances were measured after 4 or 12 weeks of healing.

RESULTS

Removal torque measurement demonstrated that test implants in group I had an enhanced biomechanical performance compared to that of the control despite similar surface roughness value (Sa ). At 4 weeks of healing, group II test implants showed equivalent biomechanical performance to that of the control, despite a decreased Sa value. Group III test implants showed decreased biomechanical performance to that of the control.

CONCLUSIONS

The results of the present study suggest that nano- and microstructure alteration by AT-1 on a blasted implant might enhance the initial biomechanical performance, while for longer healing time, the surface interlocking capacity seems to be more important.

Bone tissue engineering via nanostructured calcium phosphate biomaterials and stem cells

Tissue engineering is promising to meet the increasing need for bone regeneration. Nanostructured calcium phosphate (CaP) biomaterials/scaffolds are of special interest as they share chemical/crystallographic similarities to inorganic components of bone. Three applications of nano-CaP are discussed in this review: nanostructured calcium phosphate cement (CPC); nano-CaP composites; and nano-CaP coatings. The interactions between stem cells and nano-CaP are highlighted, including cell attachment, orientation/morphology, differentiation and in vivo bone regeneration. Several trends can be seen: (i) nano-CaP biomaterials support stem cell attachment/proliferation and induce osteogenic differentiation, in some cases even without osteogenic supplements; (ii) the influence of nano-CaP surface patterns on cell alignment is not prominent due to non-uniform distribution of nano-crystals; (iii) nano-CaP can achieve better bone regeneration than conventional CaP biomaterials; (iv) combining stem cells with nano-CaP accelerates bone regeneration, the effect of which can be further enhanced by growth factors; and (v) cell microencapsulation in nano-CaP scaffolds is promising for bone tissue engineering. These understandings would help researchers to further uncover the underlying mechanisms and interactions in nano-CaP stem cell constructs in vitro and in vivo, tailor nano-CaP composite construct design and stem cell type selection to enhance cell function and bone regeneration, and translate laboratory findings to clinical treatments.

Enhanced dissolution and stability of Tanshinone IIA base by solid dispersion system with nano-hydroxyapatite

Background:

Tanshinone IIA (TSIIA) exhibits a variety of cardiovascular effects; however, it has low solubility in water. The preparation of poorly soluble drugs for oral delivery is one of the greatest challenges in the field of formulation research. Among the approaches available, solid dispersion (SD) technique has proven to be one of the most commonly used these methods for improving dissolution and bioavailability of drugs, because of its relative simplicity and economy in terms of both preparation and evaluation.

Objective:

This study was aimed at investigating the dissolution behavior and physical stability of SDs of TSIIA by employing nano-hydroxyapatite (n-HAp).

Materials and Methods:

The TSIIA SDs was prepared to use a spray-drying method. First, an in vitro dissolution test was performed to assess dissolution characteristics. Next, a set of complementary techniques (differential scanning calorimetry, scanning electron microscopy, X-ray powder diffraction, and Fourier transform infrared spectroscopy) was used to monitor the physicochemical properties of the SDs. The SDs was stored at 40°C/75% relative humidity for 6 months, after which their stability was assessed.

Results:

TSIIA dissolution remarkably improved because of the formulation of the SDs with n-HAp particles. Comparisons with the corresponding physical mixtures revealed changes in the SDs and explained the formation of the amorphous phase. In the stability test, virtually no time-dependent decrease was observed in either in vitro drug dissolution or drug content.

Conclusion:

SD formulation with n-HAp may be a promising approach for enhancing the dissolution and stability of TSIIA.

Nanometer-scale features on micrometer-scale surface texturing: a bone histological, gene expression, and nanomechanical study

Micro- and nanoscale surface modifications have been the focus of multiple studies in the pursuit of accelerating bone apposition or osseointegration at the implant surface. Here, we evaluated histological and nanomechanical properties, and gene expression, for a microblasted surface presenting nanometer-scale texture within a micrometer-scale texture (MB) (Ossean Surface, Intra-Lock International, Boca Raton, FL) versus a dual-acid etched surface presenting texture at the micrometer-scale only (AA), in a rodent femur model for 1, 2, 4, and 8weeks in vivo. Following animal sacrifice, samples were evaluated in terms of histomorphometry, biomechanical properties through nanoindentation, and gene expression by real-time quantitative reverse transcription polymerase chain reaction analysis. Although the histomorphometric, and gene expression analysis results were not significantly different between MB and AA at 4 and 8 weeks, significant differences were seen at 1 and 2 weeks. The expression of the genes encoding collagen type I (COL-1), and osteopontin (OPN) was significantly higher for MB than for AA at 1 week, indicating up-regulated osteoprogenitor and osteoblast differentiation. At 2 weeks, significantly up-regulated expression of the genes for COL-1, runt-related transcription factor 2 (RUNX-2), osterix, and osteocalcin (OCN) indicated progressive mineralization in newly formed bone. The nanomechanical properties tested by the nanoindentation presented significantly higher-rank hardness and elastic modulus for the MB compared to AA at all time points tested. In conclusion, the nanotopographical featured surfaces presented an overall higher host-to-implant response compared to the microtextured only surfaces. The statistical differences observed in some of the osteogenic gene expression between the two groups may shed some insight into the role of surface texture and its extent in the observed bone healing mechanisms.

Enhanced bone healing around nanohydroxyapatite-coated polyetheretherketone implants: An experimental study in rabbit bone

Objective

To investigate the bone response to threaded polyetheretherketone (PEEK) implants coated with nanohydroxyapatite.

Materials and methods

A total of 39 PEEK implants were coated with nanocrystalline hydroxyapatite and 39 uncoated implants were used as controls. The implant surface was characterized by optical interferometry and scanning electron microscope. The implants were inserted in the tibia and femur of 13 rabbits. After 6 weeks of healing, quantitative and qualitative analyses were performed.

Results

The test implants showed significantly higher removal torque test values compared with the control group. Histomorphometric evaluation demonstrated higher bone-to-implant contact for the test implants; however, there were no differences in bone area between the groups. Qualitative histological analyses demonstrated inflammatory cellular reactions in close vicinity of both implant surfaces. A two-cell layer of foreign body giant cells was observed irrespective of sample type.

Conclusion

Our findings demonstrate that implants with a threaded design render good stability to PEEK in both coated and uncoated implants. Nanohydroxyapatite-coated PEEK implants demonstrated improved bone formation compared with uncoated controls.

Nanometer scale titanium surface texturing are detected by signaling pathways involving transient FAK and Src activations

Background

It is known that physico/chemical alterations on biomaterial surfaces have the capability to modulate cellular behavior, affecting early tissue repair. Such surface modifications are aimed to improve early healing response and, clinically, offer the possibility to shorten the time from implant placement to functional loading. Since FAK and Src are intracellular proteins able to predict the quality of osteoblast adhesion, this study evaluated the osteoblast behavior in response to nanometer scale titanium surface texturing by monitoring FAK and Src phosphorylations.

Methodology

Four engineered titanium surfaces were used for the study: machined (M), dual acid-etched (DAA), resorbable media microblasted and acid-etched (MBAA), and acid-etch microblasted (AAMB). Surfaces were characterized by scanning electron microscopy, interferometry, atomic force microscopy, x-ray photoelectron spectroscopy and energy dispersive X-ray spectroscopy. Thereafter, those 4 samples were used to evaluate their cytotoxicity and interference on FAK and Src phosphorylations. Both Src and FAK were investigated by using specific antibody against specific phosphorylation sites.

Principal Findings

The results showed that both FAK and Src activations were differently modulated as a function of titanium surfaces physico/chemical configuration and protein adsorption.

Conclusions

It can be suggested that signaling pathways involving both FAK and Src could provide biomarkers to predict osteoblast adhesion onto different surfaces.

Increased bone remodelling around titanium implants coated with chondroitin sulfate in ovariectomized rats

Coating titanium implants with artificial extracellular matrices based on collagen and chondroitin sulfate (CS) has been shown to enhance bone remodelling and de novo bone formation in vivo. The aim of this study was to evaluate the effect of estrogen deficiency and hormone replacement therapy (HRT) on the osseointegration of CS-modified Ti implants. 30 adult female, ovariectomized Wistar rats were fed either with an ethinyl-estradiol-rich diet (E) to simulate a clinical relevant HRT or with a genistein-rich diet (G) to test an alternative therapy based on nutritionally relevant phytoestrogens. Controls (C) received an estrogen-free diet. Uncoated titanium pins (Ti) or pins coated with type-I collagen and CS (Ti/CS) were inserted 8weeks after ovarectomy into the tibia. Specimens were retrieved 28days after implantation. Both the amount of newly formed bone and the affinity index (P<0.05) were moderately higher around Ti/CS implants as compared to uncoated Ti. The highest values were measured in the G-Ti/CS and E-Ti/CS groups, the lowest values for the E-Ti and G-Ti controls. Quantitative synchrotron radiation micro-computed tomography (SRμCT) revealed the highest increase in total bone formation around G-Ti/CS as compared to C-Ti (P<0.01). The effects with respect to direct bone apposition were less pronounced with SRμCT. Using scanning nanoindentation, both the indentation modulus and the hardness of the newly formed bone were highest in the E-Ti/CS, G-Ti/CS and G-Ti groups as compared to C-Ti (P<0.05). Coatings with collagen and CS appear to improve both the quantity and quality of bone formed around Ti implants in ovarectomized rats. A simultaneous ethinyl estradiol- and genistein-rich diet seems to enhance these effects.

Odontogenic differentiation and dentin formation of dental pulp cells under nanobioactive glass induction

Bioactive glass (BG) has been widely used in bone regeneration; however, reports on the biological effects of BG on dental pulp cells are rare. This study aims to investigate the effects of nanoscale BG (n-BG) on odontogenic differentiation and dentin formation of dental pulp cells and to compare these effects with those of microscale BG (m-BG). Human dental pulp cells (hDPCs) from third molars were cultured directly with m-BG and n-BG in vitro. The cell proliferation increased at 0.1mgml(-1) BG, which also had a chemotactic effect on hDPCs. The mineralization capacity and expression of odontogenic-related proteins and genes (dentin sialophosphoprotein, dentin matrix protein 1 and collagen type I) of hDPCs were significantly up-regulated under BG induction, and were particularly higher in the n-BG group than in the control group. m-BG and n-BG combined with pulp tissues were transplanted into the dorsum of immunodeficient mice to observe their biological effects on dental pulp cells in vivo. A continuous layer of dentin-like tissue with uniform thickness, a well-organized dentinal tubule structure and polarizing odontoblast-like cells aligned along it was generated upon the n-BG layer, whereas some irregular sporadic osteodentin-like mineralized tissues were observed in the control group. This study reveals that BG, especially n-BG, induces the odontogenic differentiation and dentin formation of dental pulp cells and may serve as a potential material for pulp repair and dentin regeneration.

Nanosurface - the future of implants

Nanotechnology is a relatively newer field of science that is finding enormous scope in the dental & medical science. Use of endosseous dental implant surfaces having nano-scale topography is fast becoming part of modern implantology. The purpose of this review is to discuss and understand the role of nanoscale surface modification of titanium materials for the purpose of improving various phases of implantology including osseointegration. Nanotechnology equips bioengineers with newer ways of interacting with relevant biological processes. On the other hand, the field of nanotechnology provides means of understanding and achieving cell specific functions. An understanding of the role of nano-topography leads to the significant osseointegration modulations by nanoscale modification of the implants surface. Use of nanotechnology to modify the topography of titanium endosseous implant can drastically improve cellular and tissue responses that may benefit osseointegration and dental implant procedures.

Osteoconductive Potential of Mesoporous Titania Implant Surfaces Loaded with Magnesium: An Experimental Study in the Rabbit

BACKGROUND

Mesoporous coatings enable incorporation of functional substances and sustainedly release them at the implant site. One bioactive substance that can be incorporated in mesoporous is magnesium, which is strongly involved in bone metabolism and in osteoblast interaction.

PURPOSE

The aim of this experimental study was to evaluate the effect of incorporation of magnesium into mesoporous coatings of oral implants on early stages of osseointegration.

MATERIAL AND METHODS

Titanium implants were coated with thin films of mesoporous TiO2 having pore diameters of 6 nm and were loaded with magnesium. The implant surfaces were extensively characterized by means of interferometry, atomic force microscopy, scanning electron microscopy, and energy-dispersive spectroscopy and then placed in the tibiae of 10 rabbits. After 3 weeks of healing, osseointegration was evaluated by means of removal torque testing and histology and histomorphometry.

RESULTS

Histological and biomechanical analyses revealed no side effects and successful osseointegration of the implants. The biomechanical evaluation evidenced a significant effect of magnesium doping on strengthening the implant-bone interface.

CONCLUSIONS

A local release of magnesium from the implant surfaces enhances implant retention at the early stage of healing (3 weeks after implantation), which is highly desirable for early loading of the implant.

Significance of calcium phosphate coatings for the enhancement of new bone osteogenesis--a review

A systematic analysis of results available from in vitro, in vivo and clinical trials on the effects of biocompatible calcium phosphate (CaP) coatings is presented. An overview of the most frequently used methods to prepare CaP-based coatings was conducted. Dense, homogeneous, highly adherent and biocompatible CaP or hybrid organic/inorganic CaP coatings with tailored properties can be deposited. It has been demonstrated that CaP coatings have a significant effect on the bone regeneration process. In vitro experiments using different cells (e.g. SaOS-2, human mesenchymal stem cells and osteoblast-like cells) have revealed that CaP coatings enhance cellular adhesion, proliferation and differentiation to promote bone regeneration. However, in vivo, the exact mechanism of osteogenesis in response to CaP coatings is unclear; indeed, there are conflicting reports of the effectiveness of CaP coatings, with results ranging from highly effective to no significant or even negative effects. This review therefore highlights progress in CaP coatings for orthopaedic implants and discusses the future research and use of these devices. Currently, an exciting area of research is in bioactive hybrid composite CaP-based coatings containing both inorganic (CaP coating) and organic (collagen, bone morphogenetic proteins, arginylglycylaspartic acid etc.) components with the aim of promoting tissue ingrowth and vascularization. Further investigations are necessary to reveal the relative influences of implant design, surgical procedure, and coating characteristics (thickness, structure, topography, porosity, wettability etc.) on the long-term clinical effects of hybrid CaP coatings. In addition to commercially available plasma spraying, other effective routes for the fabrication of hybrid CaP coatings for clinical use still need to be determined and current progress is discussed.

The effect of hydroxyapatite nanocrystals on osseointegration of titanium implants: an in vivo rabbit study

Osseointegration is dependent on implant surface characteristics, including surface chemistry and topography. The presence of nanosized calcium phosphates on the implant surface is interesting to investigate since they affect both the nanotopography and surface chemistry, forming a bone mineral resembling surface. In this work, the osseointegration of titanium implants with and without the presence of hydroxyapatite (HA) nanocrystals has been evaluated in vivo. The integration was examined using removal torque measurements and real-time polymerase chain reaction (RT-PCR) analysis. The study was performed using two healing time points, 3 and 12 weeks. The results showed that the torque needed to remove the implants was insignificant between the non- and HA-coated implants, both at weeks 3 and 12. The RT-PCR, however, showed significant differences for osteoblast, osteoclast, and proinflammation markers when HA nanocrystals were present.