Assessment of a novel electrochemically deposited smart bioactive trabecular coating (SBTC®): a randomized controlled clinical trial

OBJECTIVES

A randomized controlled clinical trial of dental implants was conducted to compare the clinical properties of a novel electrochemically deposited calcium phosphate coating to those of a common marketed surface treatment.

MATERIAL AND METHODS

Forty implants of the same brand and type were placed in 20 fully edentulous participants requiring mandibular implantation. The two study groups were defined by the surface treatment of the implants. 20 implants in the control group were coated via a commercial electrochemical surface treatment that forms a mixture of brushite and hydroxyapatite, while the remaining 20 in the test group were coated with a novel electrochemical Smart Bioactive Trabecular Coating (SBTC®). A split-mouth design was employed, with each participants receiving one control implant in one mandibular side and a test implant in the other. To mitigate potential operator-handedness bias, control and test implants were randomly assigned to mandibular sides. All cases underwent digital planning, implant placement with a static surgical guide, and participants received locator-anchored full-arch dentures. The primary outcome was implant stability (measured using Osstell ISQ) assessed at insertion, loading, and then 3 months, 9 months, and 2 years post-insertion. The secondary outcome was bone level change (in millimeters) over the 2-year observation period. Oral health-related quality of life (OHRQL) was monitored using the OHIP-14 questionnaire. Complications and adverse events were recorded.

RESULTS

Successful osseointegration and implant stability were achieved in all cases, allowing loading. ISQ values steadily increased throughout the observation period. While no significant differences were observed between the SBTC® and control coatings, the test group exhibited a higher ISQ gain. Bone resorption was somewhat lower in the SBTC® but not significantly so. Patients' OHRQL significantly improved after denture delivery and remained stable throughout the follow-up. No complications or adverse events were observed.

CONCLUSIONS

Based on the study results, we conclude that the new surface treatment is a safe alternative to the widely used control surface, demonstrating similar osseointegrative properties and time-dependent bone level changes. Further research may explore the broader implications of these findings.

TRIAL REGISTRATION

The study is registered on clinicaltrials.gov under the identifier ID: NCT06034171.

Near-Atomic-Scale Perspective on the Oxidation of Ti3 C2 Tx MXenes: Insights from Atom Probe Tomography

MXenes are a family of 2D transition metal carbides and nitrides with remarkable properties, bearing great potential for energy storage and catalysis applications. However, their oxidation behavior is not yet fully understood, and there are still open questions regarding the spatial distribution and precise quantification of surface terminations, intercalated ions, and possible uncontrolled impurities incorporated during synthesis and processing. Here, atom probe tomography (APT) analysis of as-synthesized Ti3 C2 Tx MXenes reveals the presence of alkali (Li, Na) and halogen (Cl, F) elements as well as unetched Al. Following oxidation of the colloidal solution of MXenes, it is observed that the alkalis are enriched in TiO2 nanowires. Although these elements are tolerated through the incorporation by wet chemical synthesis, they are often overlooked when the activity of these materials is considered, particularly during catalytic testing. This work demonstrates how the capability of APT to image these elements in 3D at the near-atomic scale can help to better understand the activity and degradation of MXenes, in order to guide their synthesis for superior functional properties.

Vat Polymerization by Three-Dimensional Printing and Curing of Antibacterial Zinc Oxide Nanoparticles Embedded in Poly(ethylene glycol) Diacrylate for Biomedical Applications

Digital light processing (DLP) is a vat photopolymerization 3D printing technique with increasingly broad application prospects, particularly in personalized medicine, such as the creation of medical devices. Different resins and printing parameters affect the functionality of these devices. One of the many problems that biomedical implants encounter is inflammation and bacteria growth. For this reason, many studies turn to the addition of antibacterial agents to either the bulk material or as a coating. Zinc oxide nanoparticles (ZnO NPs) have shown desirable properties, including antibacterial activity with negligible toxicity to the human body, allowing their use in a wide range of applications. In this project, we developed a resin of poly(ethylene glycol) diacrylate (PEGDA), a cross-linker known for its excellent mechanical properties and high biocompatibility in a 4:1 weight ratio of monomers to water. The material's mechanical properties (Young's modulus, maximum elongation, and ultimate tensile strength) were found similar to those of human cartilage. Furthermore, the ZnO NPs embedding matrix showed strong antibacterial activity against Escherichia coli (E. coli) and Staphylococcus aureus (S.A.). As the ZnO NPs ratio was changed, only a minor effect on the mechanical properties of the material was observed, whereas strong antibacterial properties against both bacteria were achieved in the case of 1.5 wt.% NPs.

Measurement of the Anisotropic Dynamic Elastic Constants of Additive Manufactured and Wrought Ti6Al4V Alloys

Additively manufactured (AM) materials and hot rolled materials are typically orthotropic, and exhibit anisotropic elastic properties. This paper elucidates the anisotropic elastic properties (Young's modulus, shear modulus, and Poisson's ratio) of Ti6Al4V alloy in four different conditions: three AM (by selective laser melting, SLM, electron beam melting, EBM, and directed energy deposition, DED, processes) and one wrought alloy (for comparison). A specially designed polygon sample allowed measurement of 12 sound wave velocities (SWVs), employing the dynamic pulse-echo ultrasonic technique. In conjunction with the measured density values, these SWVs enabled deriving of the tensor of elastic constants (C_ij) and the three-dimensional (3D) Young's moduli maps. Electron backscatter diffraction (EBSD) and micro-computed tomography (μCT) were employed to characterize the grain size and orientation as well as porosity and other defects which could explain the difference in the measured elastic constants of the four materials. All three types of AM materials showed only minor anisotropy. The wrought (hot rolled) alloy exhibited the highest density, virtually pore-free μCT images, and the highest ultrasonic anisotropy and polarity behavior. EBSD analysis revealed that a thin β-phase layer that formed along the elongated grain boundaries caused the ultrasonic polarity behavior. The finding that the elastic properties depend on the manufacturing process and on the angle relative to either the rolling direction or the AM build direction should be taken into account in the design of products. The data reported herein is valuable for materials selection and finite element analyses in mechanical design. The pulse-echo measurement procedure employed in this study may be further adapted and used for quality control of AM materials and parts.

Design of a high-throughput bio-ferrograph for isolation of cancer cells from whole blood

Enumeration and morphological characterization of circulating tumor cells (CTCs) can be useful in diagnosis and prognosis of metastatic cancer patients. The bio-ferrograph (BF) with its five flow channels, which was developed in the late 1990s for magnetic isolation of biological cells and tissue fragments from fluids, is a modification of the analytical ferrograph. Its use for isolation of rare CTCs from human whole blood (HWB) is a novel approach for the detection of cancer at a cellular level. The isolation process is facilitated by the interaction of specifically magnetized cells with a strong external magnetic field, yielding high recovery rates with no morphological alternation of cells that are isolated on a coverslip glass slide, thus allowing complementary microscopic, chemical, biological, and mechanical analyses. Here, a full mechanical and magnetostatic design of a novel high-throughput BF is presented. The system design is based on an optimized procedure for bio-ferrographic isolation of CTCs from HWB. It incorporates a semi-automated CTC separation system consisting of sample preparation, labeling, and staining; magnetic isolation; and system recovery. The design process was optimized based on experimental feasibility tests and finite element analyses. The novel bench-top system consists of 100 flow channels, allowing simultaneous analysis of multiple samples from 20 patients in each run, with the potential to become a decision-making tool for medical doctors when monitoring patients in a hospital setting. It opens a new route for early diagnosis, prognosis, and treatment of cancers, as well as other diseases, such as osteoarthritis.

Comparative Quality Control of Titanium Alloy Ti-6Al-4V, 17-4 PH Stainless Steel, and Aluminum Alloy 4047 Either Manufactured or Repaired by Laser Engineered Net Shaping (LENS)

Additive manufacturing attracts much interest for manufacturing and repair of structural parts for the aerospace industry. This paper presents comparative characterization of aircraft items made of Al 4047 alloy, Ti-6Al-4V alloy, and 17-4 precipitation hardened (PH) (AISI 630) stainless steel, either manufactured or repaired by laser engineered net shaping (LENS). Chemical analysis, density, and surface roughness measurements, X-ray micro-computed tomography (μ-CT) analysis, metallography, and micro-hardness testing were conducted. In all three materials, microstructures typical of rapid solidification were observed, along with high density, chemical composition, and hardness comparable to those of the counterpart wrought alloys (even in hard condition). High standard deviation in hardness values, anisotropic geometrical distortion, and overbuild at top edges were observed. The detected defects included partially melted and unmelted powder particles, porosity, and interlayer lack of fusion, in particular at the interface between the substrate plate and the build. There was a fairly good match between the density values measured by μ-CT and those measured by the Archimedes method; there was also good correlation between the type of defects detected by both techniques. Surface roughness, density of partially melted powder particles, and the content of bulk defects were significantly higher in Al 4047 than in 17-4 PH stainless steel and Ti-6Al-4V alloy. Optical gaging can be used reliably for surface roughness measurements. The implications of these findings are discussed.

The Effect of POSS Type on the Shape Memory Properties of Epoxy-Based Nanocomposites

Thermally activated shape memory polymers (SMPs) can memorize a temporary shape at low temperature and return to their permanent shape at higher temperature. These materials can be used for light and compact space deployment mechanisms. The control of transition temperature and thermomechanical properties of epoxy-based SMPs can be done using functionalized polyhedral oligomeric silsesquioxane (POSS) additives, which are also known to improve the durability to atomic oxygen in the space environment. In this study, the influence of varying amounts of two types of POSS added to epoxy-based SMPs on the shape memory effect (SME) were studied. The first type contained amine groups, whereas the second type contained epoxide groups. The curing conditions were defined using differential scanning calorimetry and glass transition temperature (T_g) measurements. Thermomechanical and SME properties were characterized using dynamic mechanical analysis. It was found that SMPs containing amine-based POSS show higher T_g, better shape fixity and faster recovery speed, while SMPs containing epoxide-based POSS have higher crosslinking density and show superior thermomechanical properties above T_g. This work demonstrates how the T_g and SME of SMPs can be controlled by the type and amount of POSS in an epoxy-based SMP nanocomposite for future space applications.

Advances in Polyimide-Based Materials for Space Applications

The space environment raises many challenges for new materials development and ground characterization. These environmental hazards in space include solar radiation, energetic particles, vacuum, micrometeoroids and debris, and space plasma. In low Earth orbits, there is also a significant concentration of highly reactive atomic oxygen (AO). This Progress Report focuses on the development of space-durable polyimide (PI)-based materials and nanocomposites and their testing under simulated space environment. Commercial PIs suffer from AO-induced erosion and surface electric charging. Modified PIs and PI-based nanocomposites are developed and tested to resist degradation in space. The durability of PIs in AO is successfully increased by addition of polyhedral oligomeric silsesquioxane. Conductive materials are prepared based on composites of PI and either carbon nanotube (CNT) sheets or 3D-graphene structures. 3D PI structures, which can expand PI space applications, made by either additive manufacturing (AM) or thermoforming, are presented. The selection of AM-processable engineering polymers in general, and PIs in particular, is relatively limited. Here, innovative preliminary results of a PI-based material processed by the PolyJet technology are presented.

Corrosion of Metallic Biomaterials: A Review

Metallic biomaterials are used in medical devices in humans more than any other family of materials. The corrosion resistance of an implant material affects its functionality and durability and is a prime factor governing biocompatibility. The fundamental paradigm of metallic biomaterials, except biodegradable metals, has been "the more corrosion resistant, the more biocompatible." The body environment is harsh and raises several challenges with respect to corrosion control. In this invited review paper, the body environment is analysed in detail and the possible effects of the corrosion of different biomaterials on biocompatibility are discussed. Then, the kinetics of corrosion, passivity, its breakdown and regeneration in vivo are conferred. Next, the mostly used metallic biomaterials and their corrosion performance are reviewed. These biomaterials include stainless steels, cobalt-chromium alloys, titanium and its alloys, Nitinol shape memory alloy, dental amalgams, gold, metallic glasses and biodegradable metals. Then, the principles of implant failure, retrieval and failure analysis are highlighted, followed by description of the most common corrosion processes in vivo. Finally, approaches to control the corrosion of metallic biomaterials are highlighted.

Atomically resolved calcium phosphate coating on a gold substrate

Some articles have revealed that the electrodeposition of calcium phosphate (CaP) coatings entails a precursor phase, similarly to biomineralization in vivo. The chemical composition of the initial layer and its thickness are, however, still arguable, to the best of our knowledge. Moreover, while CaP and electrodeposition of metal coatings have been studied utilizing atom-probe tomography (APT), the electrodeposition of CaP ceramics has not been heretofore studied. Herein, we present an investigation of the CaP deposition on a gold substrate. Using APT and transmission electron microscopy (TEM) it is found that a mixture of phases, which could serve as transient precursor phases to hydroxyapatite (HAp), can be detected. The thickness of these phases is tens of nanometers, and they consist of amorphous CaP (ACP), dibasic calcium phosphate dihydrate (DCPD), and octacalcium phosphate (OCP). This demonstrates the value of using atomic-resolved characterization techniques for identifying the precursor phases. It also indicates that the kinetics of their transformation into the more stable HAp is not too fast to enable their observation. The coating gradually displays higher Ca/P atomic ratios, a porous nature, and concomitantly a change in its density.

Templated and self-limiting calcite formation directed by coccolith organic macromolecules

The formation of intricately shaped crystalline minerals by organisms is orchestrated by specialized biomacromolecules. The macromolecules associated with coccoliths, nanometer-sized calcite crystal arrays produced by marine microalgae, can form a distinct calcium-rich phase via macromolecular recognition. Here, we show that this calcium-rich phase can be mineralized into a thin film of single-crystalline calcite by the balanced addition of carbonate ions. Such a crystallization process provides a strategy to direct crystalline products via local interactions between soluble macromolecules and compatible templates.

Synthesis, coating, and drug-release of hydroxyapatite nanoparticles loaded with antibiotics

Post-surgery infections are considered the most challenging complication in the orthopedic and dental field. The local release of antibiotics is evidently highly efficient in delivering the drug to the vicinity of the infected area without the risk of systemic toxicity. Bioactive materials, such as hydroxyapatite (HAp) among other calcium phosphates, are reputed as superior antibiotic vehicles, and combine drug-delivery properties and enhanced osteoconductivity. Here, we report on the single-step electrophoretic deposition (EPD) of drug-loaded HAp nanoparticles (NPs) on titanium implants. This approach provides a purely bioactive coating with drug delivery properties in a simple, economic, and fast process. We synthesized pure HAp NPs with 12.5% and 12.8% loading weight percentages of gentamicin sulfate (Gs) and ciprofloxacin (Cip), and electrophoretically deposited them on a titanium substrate. Furthermore, we co-deposited Gs-HAp and Cip-HAp in one-step to yield a drug-loaded system consisting of two types of antibiotics. The drug-loaded NPs as well as the coatings were carefully characterized. The release profiles of the Gs-HAp and Cip-HAp NP coatings showed prolonged release of up to 10 and 25 days, respectively. The bioactivity test revealed superior bioactivity with enhanced precipitation of HAp crystals along with inorganic minerals, such as Mg²⁺, Na⁺, and Cl^-. The antibacterial in vitro tests of the Cip and Gs-HAp coatings showed efficient inhibition of Pseudomonas aeruginosa bacteria.

Calcium Phosphate Bioceramics: A Review of Their History, Structure, Properties, Coating Technologies and Biomedical Applications

Calcium phosphate (CaP) bioceramics are widely used in the field of bone regeneration, both in orthopedics and in dentistry, due to their good biocompatibility, osseointegration and osteoconduction. The aim of this article is to review the history, structure, properties and clinical applications of these materials, whether they are in the form of bone cements, paste, scaffolds, or coatings. Major analytical techniques for characterization of CaPs, in vitro and in vivo tests, and the requirements of the US Food and Drug Administration (FDA) and international standards from CaP coatings on orthopedic and dental endosseous implants, are also summarized, along with the possible effect of sterilization on these materials. CaP coating technologies are summarized, with a focus on electrochemical processes. Theories on the formation of transient precursor phases in biomineralization, the dissolution and reprecipitation as bone of CaPs are discussed. A wide variety of CaPs are presented, from the individual phases to nano-CaP, biphasic and triphasic CaP formulations, composite CaP coatings and cements, functionally graded materials (FGMs), and antibacterial CaPs. We conclude by foreseeing the future of CaPs.

Assisted deposition of nano-hydroxyapatite onto exfoliated carbon nanotube oxide scaffolds

Electrodeposited nano-hydroxyapatite (nHAp) is more similar to biological apatite in terms of microstructure and dimension than apatites prepared by other processes. Reinforcement with carbon nanotubes (CNTs) enhances its mechanical properties and increases adhesion of osteoblasts. Here, we carefully studied nHAp deposited onto vertically aligned multi-walled CNT (VAMWCNT) scaffolds by electrodeposition and soaking in a simulated body fluid (SBF). VAMWCNTs are porous biocompatible scaffolds with nanometric porosity and exceptional mechanical and chemical properties. The VAMWCNT films were prepared on a Ti substrate by a microwave plasma chemical vapour deposition method, and then oxidized and exfoliated by oxygen plasma etching (OPE) to produce graphene oxide (GO) at the VAMWCNT tips. The attachment of oxygen functional groups was found to be crucial for nHAp nucleation during electrodeposition. A thin layer of plate-like and needle-like nHAp with high crystallinity was formed without any need for thermal treatment. This composite (henceforth referred to as nHAp-VAMWCNT-GO) served as the scaffold for in vitro biomineralization when soaked in the SBF, resulting in the formation of both carbonate-rich and carbonate-poor globular-like nHAp. Different steps in the deposition of biological apatite onto VAMWCNT-GO and during the short-term biomineralization process were analysed. Due to their unique structure and properties, such nano-bio-composites may become useful in accelerating in vivo bone regeneration processes.

Isolating EGFR Overexpressing Carcinoma Cells from Human Whole Blood by Bio-Ferrography

Background: The epidermal growth factor receptor (EGFR) is overexpressed in carcinoma. In some cases, including in colorectal cancer, it is used as a therapeutic target. Bio-Ferrography is a non-destructive method for isolating magnetized cells and tissues from a fluid onto a glass slide based on their interaction with an external, strong and focused magnetic field. Methods: Here, we implement Bio-Ferrography to separate EGFR positive cancer cells from EGFR negative non-cancer cells, mixed at a ratio of 1 to 1 × 106 , from either PBS or human whole blood (HWB). Incubation of the cells with an anti-EGFR antibody and magnetic microbeads coupled to a secondary antibody was used to magnetize the target cells prior to the ferrographic analysis. Results: A procedure was developed for "a proof of concept" isolation. Recovery values as high as 78% for 1 mL PBS, and 53% for 1 mL HWB, with a limit of detection (LOD) of 30 and 100 target cells, respectively, were achieved. Conclusions: These capture efficiency values are considered significant and therefore warrant further study on isolation of real circulating tumor cells (CTCs) from blood samples of patients, aiming at early diagnosis of EGFR overexpressing tumor types. This article is protected by copyright. All rights reserved.

Preparation and characterization of alkylphosphonic acid self-assembled monolayers on titanium alloy by chemisorption and electrochemical deposition

Ti-6Al-4V alloy is the most commonly used alloy for dental and orthopedic implants. In order to improve osseointegration, different surface modification methods are usually employed, including self-assembled monolayers (SAMs). This study presents an investigation of both active (electroassisted) and passive (adsorption) approaches for the modification of Ti-6Al-4V using alkylphosphonic acid. The monolayers were characterized by cyclic voltammetry, double-layer capacitance, contact angle measurements, X-ray photoelectron spectroscopy, polarization modulation infrared reflection adsorption spectroscopy, electrochemical impedance spectroscopy, and corrosion potentiodynamic polarization measurements. It is shown that the electrochemically assisted monolayers, which are assembled faster, exhibit better control over surface properties, a superior degree of order, and a somewhat higher packing density. The electrosorbed SAMs also exhibit better blockage of electron transfer across the interface and thus have better corrosion resistance.

Long-term evaluation of a compliant cushion form acetabular bearing for hip joint replacement: a 20 million cycles wear simulation

Soft bearing materials that aim to reproduce the tribological function of the natural joint are gaining popularity as an alternative concept to conventional hard bearing materials in the hip and knee. However, it has not been proven so far that an elastic cushion bearing can be sufficiently durable as a long term (∼20 years) articulating joint prosthesis. The use of new bearing materials should be supported by accurate descriptions of the implant following usage and of the number, volume, and type of wear particles generated. We report on a long-term 20 million cycle (Mc) wear study of a commercial hip replacement system composed of a compliant polycarbonate-urethane (PCU) acetabular liner coupled to a cobalt-chromium alloy femoral head. The PCU liner showed excellent wear characteristics in terms of its low and steady volumetric wear rate (5.8-7.7 mm(3)/Mc) and low particle generation rate (2-3 × 10(6) particles/Mc). The latter is 5-6 orders of magnitude lower than that of highly cross-linked polyethylene and 6-8 orders of magnitude lower than that of metal-on-metal bearings. Microscopic analysis of the implants after the simulation demonstrated a low damage level to the implants' articulating surfaces. Thus, the compliant PCU bearing may provide a substantial advantage over traditional bearing materials.

The effect of surface treatments on the adhesion of electrochemically deposited hydroxyapatite coating to titanium and on its interaction with cells and bacteria

The effect of different mechanical and chemical pre-treatments on the adhesion strength of hydroxyapatite (HAp) coating on a commercially pure titanium (CP-Ti) substrate was studied by means of a standard tensile test followed by microscopic and chemical analysis to determine the locus of fracture. In addition, the effects of either these pre-treatments or post-treatment by low-energy electron irradiation, which allowed tuning the wettability of the surface, on both osteoblast progenitor attachment and S. aureus bacteria attachment were investigated. A dedicated program was developed for unambiguous identification and count of stained cells. A single-phase HAp coating was formed by electrodeposition. A series of surface pre-treatments consisted of grinding down to P1000, etching in HNO₃/HF solution, grit blast, soaking in NaOH and subsequent heat treatment provided the highest adhesion strength to the HAp coating. Osteoblast progenitors derived from rats may be attached preferentially to a hydrophilic surface (post-treatment to θ = 30°), while the bacteria seemed to be less attached to hydrophobic surfaces (post-treatment to θ = 105°). However, the results were not statistically different. The bacteria seemed to be less attached to the smoother, uncoated surfaces.

Design and Characterization of New Ti-Ag and Ti-Ag-Sn Alloys for Cranio-Maxillo-Facial Prostheses Made by Three-Dimensional Printing

new Ti-5Ag and Ti-5Ag-35Sn (wt.%) alloys were designed and synthesized by threedimensionalprinting (3DP). The identification of an appropriate binder, densificationtechnique, and densification parameters for fabricating cranio-maxillo-facial prostheses wasundertaken using microscopic observations, x-ray diffraction tests, microhardness testing, linearshrinkage and wettability measurements. Moreover, electrochemical tests and surface analysiswere used to evaluate the corrosion resistance and passivation behavior of the materials ofinterest. Silver nitrate was found to be an appropriate inorganic reactive binder for atomizedtitanium powder. The optimal temperature for densification of as-printed parts using sinteringwas determined for Ti-Ag alloys. In addition, the type of infiltrant material and use ofhomogenization in liquid-Sn infiltration was explored for Ti-Ag-Sn alloys. While the Ti-Agalloy exhibited superior corrosion and mechanical behavior to the Ti-Ag-Sn alloy, the lattershowed better dimensional stability.

Influence Of Hydrogen On The Thermal Stability Of Zr-Based Quasicrystals

The high number of tetrahedrally coordinated sites for interstitial hydrogen and the favorable hydrogen-metal chemistry make quasicrystalline Zr-Cu-Ni-Al alloys a candidate for hydrogen storage applications. The icosahedral phase in Zr69.5Cu12Ni11Al7.5 has been shown to absorb electrochemically hydrogen up to H/M = 1.6. Only partially desorption of hydrogen was observed by TDA at about 500°C. Since hydrogen desorption seems to be hindered by a surface barrier, the hydrogen remains in the quasicrystal thus influencing their thermal stability. Such effects of hydrogen were studied by DSC and microstructural investigations. With increasing hydrogen content the decomposition of icosahedral Zr69.5. Cu12Ni11A17.5 is shifted to lower temperatures. Quasicrystals decompose by a discontinous transformation into the tetragonal Zr2Cu phase, the tetragonal Zr2Ni and the hexagonal Zr6NiAl2. Hydrogenation does not influence the phases formed during decomposition, but leds to the formation of a finer microstructure. We assume that the defects formed during the hydrogenation accelerate the nucleation of the stable crystalline phase.

Hydrogenation and Crystallization of Zr-Cu-Ni-Al Glasses

Zr-Cu-Ni-Al belongs to the best glass forming systems known. Hydrogen charging was performed electrochemically in a 2:1 glycerin-phosphoric acid electrolyte. In comparison to binary Zr-Ni glasses the absorption kinetics in amorphous Zr-Cu-Ni-Al were found to be slower, but the storage capacity is similar. Desorption is hindered by the formation of thin ZrO2 layers. Partial replacement of Ni by Pd in an amorphous Zr68 5Cu13Ni11Al7.5 alloy was found to change the absorption behavior to a faster kinetic and to improve the desorption. The influence of hydrogen on the thermal stability was studied by DSC as well as by xray diffraction and TEM. Hydrogen was observed to play an important role. With increasing H/M ratio amorphous Zr69.5Cu12Ni11Al7.5 was found to transform during annealing above the glass transition temperature into a quasicrystalline structure with decreasing grain size until a nanocrystalline microstructure is achieved. Above a hydrogen content of H/M = 0.05 instead of quasicrystals a tetragonal phase with lattice parameters close to those of Zr2Ni is formed. At very high hydrogen contents phase separation is assumed to take place followed by the formation of nanocrystalline ZrH2 and other phases with reduced Zr content.

Fracture of cementless femoral stems at the mid-stem junction in modular revision hip arthroplasty systems

BACKGROUND

Mechanical failure of femoral stems at the modular junction of revision hip arthroplasty systems has been reported only infrequently. In the current study, the cause of six stem fractures, which occurred in vivo, was analyzed with use of clinical data and failure analysis.

METHODS

Six patients with a fracture at the mid-stem junction of a modular revision hip implant were identified in our database of patients who had undergone revision arthroplasty. The characteristics of the patients with a fractured stem were compared with those of 165 patients from the same prospective database who had a modular stem implanted, had at least two years of follow-up, and had not had a fracture of the stem. Failure analysis of three implants (six fracture surfaces) was carried out, with use of microscopic, chemical, and microhardness characterization techniques.

RESULTS

Patients with a fractured stem had significantly higher body mass indices than patients without a stem fracture. Radiographs demonstrated that these femoral implants lacked adequate osseous support of the junction area of the stem. All stems failed approximately 1 to 2 mm proximal to the body-stem junction, thus indicating the presence of a bending moment. The chemical composition and microhardness matched those of Ti-6Al-4V. Evidence of wear and fatigue were found on the fracture surface. A wear strip was also observed along the circumference of the stem near the junction.

CONCLUSIONS

We concluded that the stem failure was initiated by a fretting fatigue mechanism and was propagated by a pure bending fatigue mechanism. Risk factors for fractures of the modular junction include excessive body weight and inadequate proximal osseous support because of trochanteric osteotomy, reduced preoperative bone stock, osteolysis, loosening, and/or implant undersizing. Surgeons should consider the use of implants with strengthened junctions when using modular stems in such patients.

Strain driven transport for bone modeling at the periosteal surface

Bone modeling and remodeling has been the subject of extensive experimental studies. There have been several mathematical models proposed to explain the observed behavior, as well. A different approach is taken here in which the bone is treated from a macroscopic view point. In this investigation, a one-dimensional analytical model is used to shed light on the factors which play the greatest role in modeling or growth of cortical bone at the periosteal surface. It is presumed that bone growth is promoted when increased amounts of bone nutrients, such as nitric oxide synthase (NOS) or messenger molecules, such as prostaglandin E2 (PGE2), seep out to the periosteal surface of cortical bone and are absorbed by osteoblasts. The transport of the bone nutrients is assumed to be a strain controlled process. Equations for the flux of these nutrients are written for a one-dimensional model of a long bone. The obtained partial differential equation is linearized and solved analytically. Based upon the seepage of nutrients out of the bone, the effect of loading frequency, number of cycles and strain level is examined for several experiments that were found in the literature. It is seen that bone nutrient seepage is greatest on the tensile side of the bone; this location coincides with the greatest amount of bone modeling.

Wear rate evaluation of a novel polycarbonate-urethane cushion form bearing for artificial hip joints

There is growing interest in the use of compliant materials as an alternative to hard bearing materials such as polyethylene, metal and ceramics in artificial joints. Cushion form bearings based on polycarbonate-urethane (PCU) mimic the natural synovial joint more closely by promoting fluid-film lubrication. In the current study, we used a physiological simulator to evaluate the wear characteristics of a compliant PCU acetabular buffer, coupled against a cobalt-chrome femoral head. The wear rate was evaluated over 8 million cycles gravimetrically, as well as by wear particle isolation using filtration and bio-ferrography (BF). The gravimetric and BF methods showed a wear rate of 9.9-12.5mg per million cycles, whereas filtration resulted in a lower wear rate of 5.8mg per million cycles. Bio-ferrography was proven to be an effective method for the determination of wear characteristics of the PCU acetabular buffer. Specifically, it was found to be more sensitive towards the detection of wear particles compared to the conventional filtration method, and less prone to environmental fluctuations than the gravimetric method. PCU demonstrated a low particle generation rate (1-5×10⁶ particles per million cycles), with the majority (96.6%) of wear particle mass lying above the biologically active range, 0.2-10μm. Thus, PCU offers a substantial advantage over traditional bearing materials, not only in its low wear rate, but also in its osteolytic potential.

Magnetic isolation of particles suspended in synovial fluid for diagnostics of natural joint chondropathies

Millions of people are stricken with the degenerative joint disease known as osteoarthritis. Osteoarthritis is associated with biochemical and mechanical processes, and is characterized by loss of articular cartilage and hypertrophy of bone. As cartilage and bone particles are released into the synovial fluid, a variety of biomarkers have been suggested for the analysis of this fluid. Here we have developed a method for isolating bone and cartilage wear particles suspended in the synovial fluid of the hip, knee and ankle joints of humans, based on specific magnetization of collagens I and II. Bio-ferrography is used to capture the particles on glass slides, allowing microscopic, chemical and statistical analyses. The relations between the level of the disease and the number, dimensions, shape and chemical composition of the particles were established. The method, which was found to be sensitive and reliable, can easily be extended to other applications, such as diagnosis of cancer and infectious diseases, determination of the efficacy of drugs or optimization of implants.

The effect of surface treatment on the surface texture and contact angle of electrochemically deposited hydroxyapatite coating and on its interaction with bone-forming cells

This work demonstrates the effects of both surface preparation and surface post-treatment by exposure to electron beam on the surface texture, contact angle and the interaction with bone-forming cells of electrochemically deposited hydroxyapatite (HAp) coating. Both the surface texture and the contact angle of the ground titanium substrate changed as a result of either heat treatment following soaking in NaOH solution or soaking in H(2)O(2) solution. Consequently, the shape of the current transients during potentiostatic deposition of HAp changed, and the resulting coatings exhibited different surface textures and contact angles. The developed interfacial area ratio Sdr and the core fluid retention index Sci were found more reliable than the mean roughness R(a) and the root-mean-square roughness Z(rms) in correlating the adhesion of the coating to the metal substrate and the cellular response with surface texture. The NaOH pretreatment provided the highest surface area and induced the highest cell attachment, even though the H(2)O(2) treatment provided the highest hydrophilicity to the metal substrate. Electrodeposition at pH 6 was found preferable compared to electrodeposition at pH 4.2. The ability to modify the cellular response by exposure to unique electron-beam surface treatment was demonstrated. The very high hydrophilicity of the as-deposited HAp coating enhanced its bioactivity.

Autosomal dominant isolated question mark ear

Question mark (Cosman) ear is an auricular abnormality characterized by a cleft between the lobule and the lower part of the helix, sometimes accompanied by a prominent or deficient upper part of the helix, shallow skin dimple on the posterior surface of the ear, or transposition of the ear lobe/antitragus. It can be inherited as an autosomal dominant trait. Only two families with more than one member with Question mark ear have been reported previously. Here we report on a female infant with bilateral isolated Question mark ear. The family history revealed a similar abnormality in her father and paternal grandfather. The similarity of the Question mark ear to the ear abnormalities described in auriculo-condylar syndrome (ACS) is discussed.

POSS-Polyimide Nanocomposite Films: Simulated Hypervelocity Space Debris and Atomic Oxygen Effects

The combined effect of hypervelocity space debris impact and atomic oxygen (AO) attack on the degradation of reinforced polyhedral oligomeric silsesquioxanes (POSS)-polyimide films was studied. A laser-driven flyer (LDF) system was used to accelerate aluminum flyers to impact velocities of up to 3 km s -1. The impacted films were exposed to an RF-plasma source, which was used to simulate the effect of AO in the low Earth orbit. Scanning electron microscopy (SEM) was used to characterize the fracture morphology. The extent of damage in POSS-polyimide impacted films was found to be much smaller compared to POSS-free films, insinuating on a toughening mechanism developed due to POSS incorporation. When exposed to air RF-plasma, the impacted POSS-free film revealed a synergistic effect associated with a large increase in the erosion rate while impacted POSS-containing samples showed improved erosion resistance. The increased erosion rate of the impacted POSS-free film is explained by formation of residual stresses that affect the oxidation mainly by increasing the diffusivity of oxygen.

Electrochemical processes of nucleation and growth of hydroxyapatite on titanium supported by real-time electrochemical atomic force microscopy

Recently, interest in electrochemical formation of hydroxyapatite has evolved. In this work, highly crystalline hydroxyapatite is electrodeposited on pure titanium and Ti-6Al-4V alloy. In situ and ex situ imaging, coupled with potentiostatic and potentiodynamic measurements, is conducted by means of electrochemical atomic force microscopy. This allows for a study of the nucleation and growth of hydroxyapatite as well as of its near-atomic structure. Electrodeposition of hydroxyapatite is shown to result from precipitation in solution, following two stages: (1) instantaneous nucleation, two-dimensional growth; (2) progressive nucleation, three-dimensional growth. Although some nucleation occurs already at -842 mV, potentials that are more negative than -1.26 V versus SCE are required for enhanced growth. Mass transport is found to have only secondary effect on the deposition process. The conclusions of this work have implications in optimization of coatings on implants as well as in enhancement of the understanding of bone mineralization in vivo.

Innovative processes for electropolishing of medical devices made of stainless steels

Currently, many medical devices are made of implantable metals such as 316LVM stainless steel. Electropolishing is a common process to obtain a smooth surface, free of contaminants and more passive, which allows for minimizing the foreign body response and cell adhesion. However, polishing of small implants with a highly complicated geometry and nonuniform metallurgy might result in unsatisfactory results. The objective of this work was to develop an electropolishing process effective for complex metallic implants such as artificial heart valve frames and miniature glaucoma implants. Polishing in an ultrasonic bath and pulsed voltage polishing processes were studied and compared to the standard ASTM process. Current-voltage curves were constructed for different solutions and bath temperatures. The polished parts were evaluated by stereomicroscopy, optical microscopy, atomic force microscopy, noncontact surface profilometry, and X-ray diffraction. Pulse polishing was found useful in eliminating the erosion effects of gas bubbles in solution. Electropolishing in an ultrasonic bath was found useful when a rough, patterned surface is needed, e.g. for osseointegration purposes. Preliminary animal studies followed by histopathology indicated that the polished surfaces stimulated only a moderate body reaction, as desired in such applications. The pronounced dependence of the measured roughness values on both the measurement technique and scanned area should inspire the preparation of a new test-method standard.

Early bone apposition in vivo on plasma-sprayed and electrochemically deposited hydroxyapatite coatings on titanium alloy

Three different implants, bare Ti-6Al-4V alloy, Ti-6Al-4V alloy coated with plasma-sprayed hydroxyapatite (PSHA), and Ti-6Al-4V alloy coated with electrochemically deposited hydroxyapatite (EDHA), were implanted into canine trabecular bone for 6 h, 7, and 14 days, respectively. Environmental scanning electron microscopy study showed that PSHA coatings had higher bone apposition ratios than those exhibited by bare Ti-6Al-4V and EDHA coatings after 7 days; however, at 14 days after implantation, EDHA and PSHA coatings exhibited similar bone apposition ratios, much higher than that for bare Ti-6Al-4V. The ultrastructure of the bone/implant interface observed by transmission electron microscope showed that the earliest mineralization (6 h-7 days) was in the form of nano-ribbon cluster mineral deposits with a Ca/P atomic ratio lower than that of hydroxyapatite. Later-stage mineralization (7-14 days) resulted in bone-like tissue with the characteristic templating of self-assembled collagen fibrils by HA platelets. Though adhesion of EDHA coatings to Ti-6Al-4V substrate proved problematical and clearly needs to be addressed through appropriate manipulation of electrodepositon parameters, the finely textured microstructure of EDHA coatings appears to provide significant advantage for the integration of mineralized bone tissue into the coatings.

A new Ti-5Ag alloy for customized prostheses by three-dimensional printing (3DP)

Three important considerations in the fabrication of customized cranio-maxillofacial prostheses are geometric precision, material strength, and biocompatibility. Three-dimensional printing (3DP) is a rapid part-fabrication process that can produce complex parts with high precision. The aim of this study was to design, synthesize by 3DP, and characterize a new Ti-5Ag (wt%) alloy. Silver nitrate was found to be an appropriate inorganic binder for the Ti powder-based skeleton, and the optimum sintering parameters for full densification were determined. The hardness of the Ti-5Ag alloy was shown to be much higher than that of a pure titanium sample. Potentiodynamic measurements, carried out in saline solution at body temperature, showed that the Ti-5Ag alloy had good passivation behavior, similar to that of pure titanium. It is concluded that the Ti-Ag system may be suitable for fabrication of customized prostheses by 3DP.