A novel effect of sandblasting on titanium surface: static charge generation

Recent advances in biomaterials’ research suggest that electrical charges on a dental implant surface significantly improve its osseointegration to living bone, as a result of selective osteoblast activation and fibroblast inhibition. This study aims at investigating the possibility of using sandblasting to modify the electrical charges on the surface of titanium materials. Our experiments used Al₂O₃ grits to blast on CP2 titanium plates, for durations between 3 and 30?s. After sandblasting, Ti surfaces were measured for their electrostatic voltage. The results indicate a novel finding, i.e. negative static charges are generated on the titanium surface, which may stimulate osteoblast activity to promote osseointegration around dental implant surface. This finding may at least partially explain the good osseointegration results of sandblasted titanium dental implants, in addition to other known reasons, such as topological changes on the implant’s surface. However, the static charges accumulated on the titanium surface during sandblasting decayed to a lower level with time. It remains a challenging task to seek ways to retain these charges after quantification of desired level of negative charges needed to promote osteoblast activity for osseointegration around dental implants.     

UV Light-Generated Superhydrophilicity of a Titanium Surface Enhances the Transfer,Diffusion and Adsorption of Osteogenic Factors from a Collagen Sponge

It is a significant challenge for a titanium implant, which is a bio-inert material, to recruit osteogenic factors, such as osteoblasts, proteins and blood effectively when these are contained in a biomaterial. The objective of this study was to examine the effect of ultraviolet (UV)-treatment of titanium on surface wettability and the recruitment of osteogenic factors when they are contained in an atelocollagen sponge. UV treatment of a dental implant made of commercially pure titanium was performed with UV-light for 12 min immediately prior to the experiments. Superhydrophilicity on dental implant surfaces was generated with UV-treatment. The collagen sponge containing blood, osteoblasts, or albumin was directly placed on the dental implant. Untreated implants absorbed only a little blood from the collagen sponge, while the UV-treated implants absorbed blood rapidly and allowed it to spread widely, almost over the entire implant surface. Blood coverage was 3.5 times greater for the UV-treated implants (p < 0.001). Only 6% of the osteoblasts transferred from the collagen sponge to the untreated implants, whereas 16% of the osteoblasts transferred to the UV-treated implants (p < 0.001). In addition, a weight ratio between transferred albumin on the implant and measured albumin adsorbed on the implant was 17.3% in untreated implants and 38.5% in UV-treated implants (p < 0.05). These results indicated that UV treatment converts a titanium surface into a superhydrophilic and bio-active material, which could recruite osteogenic factors even when they were contained in a collagen sponge. The transfer and subsequent diffusion and adsorption efficacy of UV-treated titanium surfaces could be useful for bone formation when titanium surfaces and osteogenic factors are intervened with a biomaterial.     

Direct observation of bone coherence with dental implants

A newly developed gentle ion beam polishing technique was established for preparing of cross sections of dental implants feasible for high resolution scanning electron microscope investigation. This approach was applied to investigate the interfacial microstructure between newly formed bone and dental implants with modified surfaces extracted after in vivo test in adult miniature pigs. The results obtained so far reveal that it has become possible to analyze the bone coherence to implants besides measuring the bone coverage. The amount and density of the mineralized extra cellular matrix has found to be different in different sub-microscopic regions around the implant. From our observations, it can be seen that new bone grows from the existing bone and advances towards the implant surface by in growth mechanism. The images also reveal that new bone is formed directly at the implant surface; we propose a deposition mechanism to explain this. Eventually the in grown and the deposited bone connect to give a good anchorage of the implant. This achievement bears implication for understanding osseointegration at microscopic level.     

Tailoring Additively Manufactured Titanium Implants for Short-Time Pediatric Implantations with Enhanced Bactericidal Activity

Paediatric titanium (Ti) implants are used for the short-term fixation of fractures, after which they are removed. However, bone overgrowth on the implant surface can complicate their removal. The current Ti implants research focuses on improving their osseointegration and antibacterial properties for long-term use while overlooking the requirements of temporary implants. This paper presents the engineering of additively manufactured Ti implants with antibacterial properties and prevention of bone cell overgrowth. 3D-printed implants were fabricated followed by electrochemical anodization to generate vertically aligned titania nanotubes (TNTs) on the surface with specific diameters (∼100 nm) to reduce cell attachment and proliferation. To achieve enhanced antibacterial performance, TNTs were coated with gallium nitrate as antibacterial agent. The physicochemical characteristics of these implants assessed by the attachment, growth and viability of osteoblastic MG-63 cells showed significantly reduced cell attachment and proliferation, confirming the ability of TNTs surface to avoid cell overgrowth. Gallium coated TNTs showed strong antibacterial activity against S. aureus and P. aeruginosa with reduced bacterial attachment and high rates of bacterial death. Thus a new approach for the engineering of temporary Ti implants with enhanced bactericidal properties with reduced bone cell attachment is demonstrated as a new strategy toward a new generation of short-term implants in paediatrics.     

Antibacterial Titanium Implants Biofunctionalized by Plasma Electrolytic Oxidation with Silver,Zinc, and Copper: A Systematic Review

Patients receiving orthopedic implants are at risk of implant-associated infections (IAI). A growing number of antibiotic-resistant bacteria threaten to hamper the treatment of IAI. The focus has, therefore, shifted towards the development of implants with intrinsic antibacterial activity to prevent the occurrence of infection. The use of Ag, Cu, and Zn has gained momentum as these elements display strong antibacterial behavior and target a wide spectrum of bacteria. In order to incorporate these elements into the surface of titanium-based bone implants, plasma electrolytic oxidation (PEO) has been widely investigated as a single-step process that can biofunctionalize these (highly porous) implant surfaces. Here, we present a systematic review of the studies published between 2009 until 2020 on the biomaterial properties, antibacterial behavior, and biocompatibility of titanium implants biofunctionalized by PEO using Ag, Cu, and Zn. We observed that 100% of surfaces bearing Ag (Ag-surfaces), 93% of surfaces bearing Cu (Cu-surfaces), 73% of surfaces bearing Zn (Zn-surfaces), and 100% of surfaces combining Ag, Cu, and Zn resulted in a significant (i.e., >50%) reduction of bacterial load, while 13% of Ag-surfaces, 10% of Cu-surfaces, and none of Zn or combined Ag, Cu, and Zn surfaces reported cytotoxicity against osteoblasts, stem cells, and immune cells. A majority of the studies investigated the antibacterial activity against S. aureus. Important areas for future research include the biofunctionalization of additively manufactured porous implants and surfaces combining Ag, Cu, and Zn. Furthermore, the antibacterial activity of such implants should be determined in assays focused on prevention, rather than the treatment of IAIs. These implants should be tested using appropriate in vivo bone infection models capable of assessing whether titanium implants biofunctionalized by PEO with Ag, Cu, and Zn can contribute to protect patients against IAI.     

A review of surface topographical modification strategies of 3Y-TZP: Effect in the physicochemical properties,microstructure, mechanical reliability,and biological response

The development of zirconia dental implants has become increasingly popular over the last years due to the outstanding mechanical properties, superior aesthetic appearance and high biocompatibility of this material. However, premature implant failure as a result of an incomplete osseointegration still represents a major concern. In this sense, surface modifications have been applied to dental zirconia to improve the biological interactions of the implant with the surrounding tissue. Nevertheless, surface modification of zirconia is challenging due to the formation of a monoclinic phase associated with ageing and loss of mechanical integrity. This review focuses on the most common surface topographical modification strategies currently applied to zirconia, namely grinding, sandblasting, chemical etching and laser treatment. A comprehensive and comparative analysis has been performed to assess the effects of these techniques on the physicochemical properties, mechanical performance, hydrothermal degradation behavior and biological response of the modified surfaces.     

Biomimetic Hydroxyapatite Coating on Metal Implants

The combination of the high mechanical strength of metals with the osteoconductive properties of calcium phosphates make hydroxyapatite coatings on titanium implants widely used in orthopedic surgery. However, the most popular coating method, plasma spraying, exhibits some important drawbacks: the inability to cover porous implants and to incorporate biologically active agents, delamination, and particle release. The aim of this study was to elaborate a dense, strong, and thick calcium-phosphate coating on titanium and porous-tantalum implants using a two-step biomimetic procedure. In the first step, the implants were soaked in a solution that was 5 times more concentrated than regular simulated body fluid (SBF-A solution). A thin but uniform amorphous calcium-phosphate coating was deposited on the metal. Then, the implants were immersed in the SBF-B solution, which had a similar composition as the SBF-A solution, but with decreased contents of crystal growth inhibitors (i.e., Mg²⁺ and HCO₃⁻). This resulted in the fast precipitation of a 30 μm thick crystalline calcium-phosphate coating. The pH of the SBF-B solution and the thickness of the crystalline coating layer were studied as a function of time. The Fourier transform infrared spectra and X-ray diffraction patterns showed that this new coating closely resembles bone mineral. Our biomimetic coating should facilitate rapid bone formation around the implant, reducing therewith the patient's recovery time after surgery.     

Cell Adhesion and in Vivo Osseointegration of Sandblasted/Acid Etched/Anodized Dental Implants

The authors describe a new type of titanium (Ti) implant as a Modi-anodized (ANO) Ti implant, the surface of which was treated by sandblasting, acid etching (SLA), and anodized techniques. The aim of the present study was to evaluate the adhesion of MG-63 cells to Modi-ANO surface treated Ti in vitro and to investigate its osseointegration characteristics in vivo. Four different types of Ti implants were examined, that is, machined Ti (control), SLA, anodized, and Modi-ANO Ti. In the cell adhesion study, Modi-ANO Ti showed higher initial MG-63 cell adhesion and induced greater filopodia growth than other groups. In vivo study in a beagle model revealed the bone-to-implant contact (BIC) of Modi-ANO Ti (74.20% ± 10.89%) was much greater than those of machined (33.58% ± 8.63%), SLA (58.47% ± 12.89), or ANO Ti (59.62% ± 18.30%). In conclusion, this study demonstrates that Modi-ANO Ti implants produced by sandblasting, acid etching, and anodizing improve cell adhesion and bone ongrowth as compared with machined, SLA, or ANO Ti implants. These findings suggest that the application of Modi-ANO surface treatment could improve the osseointegration of dental implant.     

Porous titanium and nitinol implants synthesized by SHS/SLS: Microstructural and histomorphological analyses of tissue reactions

The comparative microstructural analyses and histomorphological studies of tissue reactions to porous titanium and nitinol implants synthesized by Selective Laser Sintering (SLS) are presented for a rat model for bone implants. It was discovered that the surface of porous pegs of titanium and nitinol made by SHS/SLS has a significantly favorable structure to the mechanical interlocking with bone and soft tissues. Histological analysis of decalcified paraffin sections after implant removal could only show that trabecular bone structures and marrow cavities were observed around the porous implants. In the connective tissue of the remaining implant beds the following cells: macrophages, fibroblasts, adipocytes and lymphocytes are discernible. It was shown that the nitinol synthesized by combined SHS/SLS technique has a developed and ordered microstructure.     

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

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

Osseointegration of Sandblasted and Acid-Etched Implant Surfaces. A Histological and Histomorphometric Study in the Rabbit

Titanium surface is an important factor in achieving osseointegration during the early wound healing of dental implants in alveolar bone. The purpose of this study was to evaluate sandblasted-etched surface implants to investigate the osseointegration. In the present study, we used two different types of sandblasted-etched surface implants, an SLA™ surface and a Nanoblast Plus™ surface. Roughness and chemical composition were evaluated by a white light interferometer microscope and X-ray photoelectron spectroscopy, respectively. The SLA™ surface exhibited the higher values (Ra 3.05 μm) of rugosity compared to the Nanoblast Plus™ surface (Ra 1.78 μm). Both types of implants were inserted in the femoral condyles of ten New Zealand white rabbits. After 12 weeks, histological and histomorphometric analysis was performed. All the implants were osseointegrated and no signs of infection were observed. Histomorphometric analysis revealed that the bone–implant contact % (BIC) ratio was similar around the SLA™ implants (63.74 ± 13.61) than around the Nanoblast Plus™ implants (62.83 ± 9.91). Both implant surfaces demonstrated a favorable bone response, confirming the relevance of the sandblasted-etched surface on implant osseointegration.     

Morphology,Composition, and Bioactivity of Strontium-Doped Brushite Coatings Deposited on Titanium Implants via Electrochemical Deposition

Surface modification techniques have been applied to generate titanium implant surfaces that promote osseointegration for use in dental applications. In this study, strontium-doped brushite coatings were deposited on titanium by electrochemical deposition. The phase composition of the coating was investigated by energy dispersive X-ray spectroscopy and X-ray diffraction. The surface morphologies of the coatings were studied through scanning electron microscopy, and the cytocompatibility and bioactivity of the strontium-doped brushite coatings were evaluated using cultured osteoblasts. Osteoblast proliferation was enhanced by the addition of strontium, suggesting a possible mechanism by which strontium incorporation in brushite coatings increased bone formation surrounding the implants. Cell growth was also strongly influenced by the composition of the deposited coatings, with a 10% Sr-doped brushite coating inducing the greatest amount of bone formation among the tested materials.     

Recombinant human bone morphogenetic protein-2 loaded porous β-tricalcium phosphate microsphere-hyaluronic acid composites promoted osseointegration around titanium implants

We fabricated two β-tricalcium phosphates (β-TCP) microsphere-hyaluronic acid composites and evaluate their efficacy as recombinant human bone morphogenetic protein-2 (rhBMP-2) carriers when combined with titanium implants in rabbit tibial diaphysis. After 4 weeks, the new bone formation was observed with plain radiographs and histology and was analyzed via micro-CT. Micro-CT analyses results showed the composites with hydrogel and BMP had a significantly higher bone to implant contact ratios and new bone formation than the other groups did. Our results indicated that rhBMP-2 loaded β-TCP/hydrogel composites could significantly elevate osteogenesis and osseointegration of the titanium implants in rabbit tibia medullary space.     

Endpoints and survival analysis for successful osseointegration of dental implants

We review and adapt modern survival analysis adapted for evaluating the success of dental implants is reviewed. A defined composite success criterion is a valuable tool for assessing new developments of dental implants. However, several inaccuracies are detected in the relevant dental literature. The Kaplan-Meier estimator is distinguished from ad-hoc life table methods and crude cumulative percentages, and generally, the usage of confidence intervals is emphasized. This article reviews the definition of implant success also. For the example of longitudinal measurements of the peri-implant bone level, it is shown how to derive success probabilities by time-to-event analysis. It is concluded that advanced statistical methods and well-defined endpoints are needed to achieve meaningful and comparable results. The article is illustrated using the data of a familiar implant system (TPS-SteriOss).     

Early Bone Healing on Hydroxyapatite-Coated and Chemically-Modified Hydrophilic Implant Surfaces in an Ovine Model

Implant topography affects early peri-implant bone healing by changing the osteoconduction rate in the surrounding biological environment. Implant surfaces have been designed to promote faster and stronger bone formation for rapid and stable prosthesis loading. Early peri-implant bone healing has been observed with a sandblasted, acid-etched implant that was chemically modified to be hydrophilic (cmSLA). The present study investigates whether early peri-implant bone healing extends to a rough surface implant with a high crystalline hydroxyapatite surface (TSV MP-1 HA). Three implants were randomly placed in porous trabecular bone within both medial femoral condyles of 10 sheep. Early peri-implant bone stability was measured at 3- and 6-weeks healing time following implant insertion. Results indicated a similar implant stability quotient between the implants at insertion and over time. The significant increase over time of reverse torque values with respect to insertion torque (p < 0.001) did not differ between the implants. However, the bone-to-implant contact of TSV MP-1 HA was significantly higher than that of cmSLA implants at 6 weeks (p < 0.01). These data validate previous findings of a hydrophilic implant surface and extend the observation of early osseointegration to a rough surface implant in porous trabecular bone.     

Plasma sputtering of bioactive coatings on medical implants and endoprostheses

Consideration is given to the advantages offered by plasma sputtering of bioactive calcium-phosphate coatings onto medical titanium implants and endoprostheses. It is shown that with this deposition process the substrate material is not embrittled and its surface is not oxidized. The bond strength is mainly governed by the contact processes upon impact, deformation, solidification, and cooling of the particles. This serves to produce a porous structure so that bone cells can readily grow into the implant material. Translated from Steklo i Keramika, No. 1, pp. 25–27, January, 1997.     

Investigation of 3D printed biodegradable PLA orthopedic screw and surface modified with nanocomposites (Ti–Zr) for biocompatibility

The orthopedic implants were fabricated using stainless steel and titanium alloys, which provide the strength necessary to support the mechanical movements of a bone. The usage of the non-biodegradable material as the medical implant requires post-surgically removal and replacement after a certain period of time. There is a need for the production of orthopedic implants that are based on biocompatible and biodegradable materials. To solve this problem biodegradable material, PLA Poly (lactic acid) was introduced to make an implant, which has a high degradation property and good biocompatibility with the human body. The orthopedic implant (degradable screws) was designed using Solidworks software. Mechanical simulation studies were done in Ansys software for the designed orthopedic implant (degradable screws) and the 3D models were printed using a 3D printer with PLA material. To improve the mechanical and biological properties of the implant, the surface was modified with nanocomposites (TiO₂+ZrO₂) by the dip-coating method. The confirmation of the presence of nanocomposites and substrate elements was done by various characterization techniques X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FTIR). The morphological and elemental changes of the implant surface were analyzed by Field emission scanning electron microscopy (FESEM) with an Energy-dispersive Spectrometer (EDS). In vitro, the osteointegration of implants was investigated using cell viability and Hank's Balanced Salt Solution (HBSS). The viability of the cells shows that osteointegration improved as the number of days of treatment was prolonged, and recommended to use as an orthopedic implant in biomedical applications.     

Evaluation of Osseointegration of Titanium Alloyed Implants Modified by Plasma Polymerization

By means of plasma polymerization, positively charged, nanometre-thin coatings can be applied to implant surfaces. The aim of the present study was to quantify the adhesion of human bone cells in vitro and to evaluate the bone ongrowth in vivo, on titanium surfaces modified by plasma polymer coatings. Different implant surface configurations were examined: titanium alloy (Ti6Al4V) coated with plasma-polymerized allylamine (PPAAm) and plasma-polymerized ethylenediamine (PPEDA) versus uncoated. Shear stress on human osteoblast-like MG-63 cells was investigated in vitro using a spinning disc device. Furthermore, bone-to-implant contact (BIC) was evaluated in vivo. Custom-made conical titanium implants were inserted at the medial tibia of female Sprague-Dawley rats. After a follow-up of six weeks, the BIC was determined by means of histomorphometry. The quantification of cell adhesion showed a significantly higher shear stress for MG-63 cells on PPAAm and PPEDA compared to uncoated Ti6Al4V. Uncoated titanium alloyed implants showed the lowest BIC (40.4%). Implants with PPAAm coating revealed a clear but not significant increase of the BIC (58.5%) and implants with PPEDA a significantly increased BIC (63.7%). In conclusion, plasma polymer coatings demonstrate enhanced cell adhesion and bone ongrowth compared to uncoated titanium surfaces.     

Biological and mechanical enhancement of zirconium dioxide for medical applications

Extensive research in global biomedical industry has been driven rapidly due to problems faced in bone implants such as loosening of implants in knee and hip prosthesis as well as short service life of orthopaedic implants. Advances in biomedical engineering have resulted in formation of various materials utilized for orthopaedic transplants and artificial implants. Among the various available materials zirconium dioxide is observed as potential material for biomedical application due to its superior biocompatibility, good compression resistance (2000 MPa), good viability of cell culture, good opacity, and radiopacifying capacity showcasing it's diverse applications in bone and tissue regeneration, orthopaedic implants as well as bone resorption. Bone tissue regenerative modifications is accompanied with coating of zirconium dioxide on metal alloys or 316 L SS substrate, composite formation with silica carbide or organic acids (usnic acid), surface propargylation achieved using chemical treatment of propargyl bromide, electrochemical treatment of zirconium dioxide to evaluate corrosion resistance, etc. Zirconium dioxide is also recorded for exhibiting enhanced mechanical properties as well as biocompatibility in hip arthroplasty as well as bone implants; it also serves application in bone cement to provide adhesion between the biomedical implants. The review paper majorly focuses on effective utilization of zirconium dioxide with various additive materials and functionalization techniques used for enhancement of properties, enabling the application of material in orthopaedic implants as well as bone tissue applications. The mechanical and biological performance analysis of various orthopaedic implants containing zirconium dioxide has been elaborately discussed along with possible measures implemented to enlarge the life of biomedical implant.