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Selective laser melting (SLM) is an additive manufacturing technique with the ability to produce metallic scaffolds with accurately controlled pore size, porosity, and interconnectivity for orthopedic applications. However, the optimal pore structure of porous titanium manufactured by SLM remains unclear. In this study, we evaluated the effect of pore size with constant porosity on in vivo bone ingrowth in rabbits into porous titanium implants manufactured by SLM. Three porous titanium implants (with an intended porosity of 65% and pore sizes of 300, 600, and 900μm, designated the P300, P600, and P900 implants, respectively) were manufactured by SLM. A diamond lattice was adapted as the basic structure. Their porous structures were evaluated and verified using microfocus X-ray computed tomography. Their bone-implant fixation ability was evaluated by their implantation as porous-surfaced titanium plates into the cortical bone of the rabbit tibia. Bone ingrowth was evaluated by their implantation as cylindrical porous titanium implants into the cancellous bone of the rabbit femur for 2, 4, and 8weeks. The average pore sizes of the P300, P600, and P900 implants were 309, 632, and 956μm, respectively. The P600 implant demonstrated a significantly higher fixation ability at 2weeks than the other implants. After 4weeks, all models had sufficiently high fixation ability in a detaching test. Bone ingrowth into the P300 implant was lower than into the other implants at 4weeks. Because of its appropriate mechanical strength, high fixation ability, and rapid bone ingrowth, our results indicate that the pore structure of the P600 implant is a suitable porous structure for orthopedic implants manufactured by SLM., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Alkali and heat (AH) treatment forming sodium titanate has been shown to connect bioinert Ti metal and bone tissue. Artificial joints treated with this method have achieved extensive clinical application. Recently a new chemical treatment of Alkali-Calcium-Heat-Water (ACaHW) treatment forming calcium titanate was proposed. Notably, the apatite-forming ability of this treatment is greater than that of AH treatment, as verified in vitro. However, the early bone-bonding abilities of the two treatments have not been compared in vivo. To simulate clinical application, we treated a commercially pure Ti (Cp-Ti) mesh implant with AH or ACaHW. Then, using mechanical and histological methods, we compared the bone-bonding abilities of the two treatments early during the implantation process (2-4 weeks); untreated Cp-Ti mesh was used as a control. Because the mesh structure might influence bone-bonding ability, we compared these bonding abilities with values obtained at 4 and 8 weeks using a Cp-Ti implant with a plate structure. In the mesh group, histological comparisons at 2 and 3 weeks indicated that ACaHW treatment resulted in a bone-bonding ability similar to that of AH treatment; ACaHW exhibited a greater bonding ability than AH at 4 weeks. However, in tests of the plate group at later time points, such differences were not apparent. The results obtained here indicate that during the early stage of embedment, ACaHW treatment of Cp-Ti mesh implants yields a higher bone-bonding ability than AH treatment, thus providing a positive reference for future clinical applications.

The gum metal with composition Ti-36Nb-2Ta-3Zr-0.3O, is free from cytotoxic elements and exhibits a low elastic modulus as well as high mechanical strength. We have previously demonstrated that this gum metal, once subjected to a series of surface treatments--immersion in 1 M NaOH (alkali treatment) and then 100 mM CaCl2, before heating at 700 °C (sample: ACaH-GM), with an optional final hot water immersion (sample: ACaHW-GM)--has apatite-forming ability in simulated body fluid. To confirm the in vivo bioactivity of these treated alloys, failure loads between implants and bone at 4, 8, 16, and 26 weeks after implantation in rabbits' tibiae were measured for untreated gum metal (UT-GM), ACaH-GM and ACaHW-GM, as well as pure titanium plates after alkali and heat treatment (AH-Ti). The ACaH-GM and UT-GM plates showed almost no bonding, whereas ACaHW-GM and AH-Ti plates showed successful bonding by 4 weeks, and their failure loads subsequently increased with time. The histological findings showed a large amount of new bone in contact with the surface of ACaHW-GM and AH-Ti plates, suggesting that the ACaHW treatment could impart bone-bonding bioactivity to a gum metal in vivo. Thus, with this improved bioactive treatment, these advantageous gum metals become useful candidates for orthopedic and dental devices.

Bioactive chitosan microparticles can be prepared successfully by treating them with a calcium silicate solution and then subsequently soaking them in simulated body fluid (SBF). Such a combination enables the development of bioactive microparticles that can be used for several applications in the medical field, including injectable biomaterial systems and tissue engineering carrier systems. Chitosan microparticles, 0.6microm in average size, were soaked either for 12h in fresh calcium silicate solution (condition I) or for 1h in calcium silicate solution that had been aged for 24h before use (condition II). Afterwards, they were dried in air at 60 degrees C for 24h. The samples were then soaked in SBF for 1, 3 and 7 days. After the condition I calcium silicate treatment and the subsequent soaking in SBF, the microparticles formed a dense apatite layer after only 7 days of immersion, which is believed to be due to the formation of silanol (Si-OH) groups effective for apatite formation. For condition II, the microparticles successfully formed an apatite layer on their surfaces in SBF within only 1 day of immersion.

A rectangular specimen of polyethylene terephthalate (PET) was soaked in a titania solution composed of titanium isopropoxide, water, ethanol and nitric acid at 25 degrees C for 1 h. An amorphous titanium oxide was formed uniformly on the surface of PET specimen, but did not form an apatite on its surface in a simulated body fluid (SBF) within 3 d. The PET plate formed with the amorphous titanium oxide was subsequently soaked in water or HCl solutions with different concentrations at 80 degrees C for different periods of time. The titanium oxide on PET was transformed into nano-sized anatase by the water treatment and into nano-sized brookite by 0.10 M HCl treatment at 80 degrees C for 8 d. The former did not form the apatite on its surface in SBF within 3 d, whereas the latter formed the apatite uniformly on its surface. Adhesive strength of the titanium oxide and apatite layers to PET plate was increased by pre-treatment of PET with 2 wt% NaOH solution at 40 degrees C for 2 h. A two-dimensional fabric of PET fibers 24 microm in diameter was subjected to the NaOH pre-treatment at 40 degrees C, titania solution treatment at 25 degrees C and subsequent 0.10 M HCl treatment at 80 degrees C. Thus treated PET fabric formed the apatite uniformly on surfaces of individual fibers constituting the fabric in SBF within 3 d. Two or three dimensional PET fabrics modified with the nano-sized brookite on surfaces of the individual fibers constituting the fabric by the present method are believed to be useful as flexible bone substitutes, since they could be integrated with living bone through the apatite formed on their constituent fibers.

Composite materials consisting of TiO(2) nanoparticles and high-density polyethylene (HDPE), designated hereafter as TiO(2)/HDPE, were prepared by a kneading and forming process. The effect of TiO(2) content on the mechanical properties and apatite forming ability of these materials was studied. Increased TiO(2) content resulted in an increase in bending strength, yield strength, Young's modulus and compressive strength (bending strength = 68 MPa, yield strength = 54 MPa, Young's modulus = 7 GPa, and compressive strength = 82 MPa) at 50 vol% TiO(2). The composite with 50 vol% TiO(2) shows a similar strength and Young's modulus to human cortical bone. The TiO(2)/HDPE composites with different TiO(2) contents were soaked at 36.5 degrees C for up to 14 days in a simulated body fluid (SBF) whose ion concentrations were nearly equal to those of human blood plasma. The apatite forming ability, which is indicative of bioactivity, increased with TiO(2) content. Little apatite formation was observed for the TiO(2)/HDPE composite with 20 vol% content. However, in the case of 40 vol% TiO(2) content and higher, the apatite layers were formed on the surface of the composites within 7 days. The most potent TiO(2) content for a bone-repairing material was 50 vol%, judging from the mechanical and biological results. This kind of bioactive material with similar mechanical properties to human cortical bone is expected to be useful as a load bearing bone substitute in areas such as the vertebra and cranium.

Dense hydroxyapatite (HA) ceramics are useful bone substitutes, but they degrade minimally. One solution is to incorporate degradable materials in the HA. In this study, we manufactured glass-containing HA and investigated whether the degradability and bone-bonding ability of the HA were improved. The glass-containing HA was manufactured from a mixture of HA powder and 1.0 wt% glass powder. The control HA was manufactured from pure HA powder. In vitro degradability was evaluated by soaking in physiological saline, and a rabbit model was used to evaluate in vivo degradability and bone-bonding ability. Detaching tests were performed for all removed samples to quantify bone-bonding ability of each type of HA. The glass-containing HA showed higher degradability than the control HA, both in vitro and in vivo. The detaching failure load of the glass-containing HA was rapidly elevated after implantation and was higher than that of the control HA. Our results suggest that the dissolution of the added glass made the glass-containing HA degradable and that the detaching failure load of the glass-containing HA was elevated by reinforcement of the mechanical locking at the roughened interface. Incorporation of glass additives into HA can be concluded to be a good candidate for producing a bone substitute that can partially degrade and bond to bone firmly and rapidly.

The bone-bonding ability of a material is often evaluated by examining the ability of apatite to form on its surface in a simulated body fluid (SBF) with ion concentrations nearly equal to those of human blood plasma. However, the validity of this method for evaluating bone-bonding ability has not been assessed systematically. Here, the history of SBF, correlation of the ability of apatite to form on various materials in SBF with their in vivo bone bioactivities, and some examples of the development of novel bioactive materials based on apatite formation in SBF are reviewed. It was concluded that examination of apatite formation on a material in SBF is useful for predicting the in vivo bone bioactivity of a material, and the number of animals used in and the duration of animal experiments can be reduced remarkably by using this method.

Polyethylene terephthalate (PET), ethylene-vinyl alcohol copolymer (EVOH) and Nylon 6 in plate form were treated with silane-coupling agents, a titanium alkoxide-alcohol solution and a hot HCl solution to form a thin crystalline titanium oxide layer. When placed in a simulated body fluid with ion concentrations nearly equal to those of the human blood plasma, nanosized bone-like apatite formed uniformly on the surfaces of these treated polymers: within 2 days for PET and Nylon 6, and 7 days for EVOH. This indicates that such titania-modified polymers might form bone-like apatite in the living body, and bond to living bone through this apatite layer. Three-dimensional fabrics of these polymer fibers, with open spaces in various sizes, are expected to be useful as bone substitutes, as they will be integrated with the natural bone.

Three types of bioactive polymethylmethacrylate (PMMA)-based bone cement containing nano-sized titania (TiO2) particles were prepared, and their mechanical properties and osteoconductivity are evaluated. The three types of bioactive bone cement were T50c, ST50c, and ST60c, which contained 50 wt% TiO2, and 50 and 60 wt% silanized TiO2, respectively. Commercially available PMMA cement (PMMAc) was used as a control. The cements were inserted into rat tibiae and allowed to solidify in situ. After 6 and 12 weeks, tibiae were removed for evaluation of osteoconductivity using scanning electron microscopy (SEM), contact microradiography (CMR), and Giemsa surface staining. SEM revealed that ST60c and ST50c were directly apposed to bone while T50c and PMMAc were not. The osteoconduction of ST60c was significantly better than that of the other cements at each time interval, and the osteoconduction of T50c was no better than that of PMMAc. The compressive strength of ST60c was equivalent to that of PMMAc. These results show that ST60c is a promising material for use as a bone substitute.

Porous bioactive titanium implants (porosity of 40%) were produced by a plasma-spray method and subsequent chemical and thermal treatments of immersion in a 5M aqueous NaOH solution at 60 degrees C for 24 h, immersion in distilled water at 40 degrees C for 48 h, and heating to 600 degrees C for 1 h. Compression strength and bending strength were 280 MPa (0.2% offset yield strength 85.2 MPa) and 101 MPa, respectively. For in vivo analysis, bioactive and nontreated porous titanium cylinders were implanted into 6mm diameter holes in rabbit femoral condyles. The percentage of bone-implant contact (affinity index) of the bioactive implants (BGs) was significantly larger than for the nontreated implants (CGs) at all postimplantation times (13.5 versus 10.5, 16.7 versus 12.7, 17.7 versus 10.2, 19.1 versus 7.8 at 2, 4, 8 and 16 weeks, respectively). The percentage of bone area ingrowth showed a significant increase with the BGs, whereas with the CGs it appeared to decrease after 4 weeks (10.7 versus 9.9, 12.3 versus 13.1, 15.2 versus 9.8, 20.6 versus 8.7 at 2, 4, 8 and 16 weeks, respectively). These results suggest that porous bioactive titanium has sufficient mechanical properties and biocompatibility for clinical use under load-bearing conditions.

The surfaces of two hydroxyapatites (HA), which have been sintered at different temperatures of 800 and 1200 degrees C, was investigated as a function of soaking time in simulated body fluid (SBF) using transmission electron microscopy (TEM) attached with energy-dispersive spectrometry (EDX) and laser electrophoresis spectroscopy. The TEM-EDX indicated that after soaking in SBF, both the HAs form bonelike apatite by undergoing the same surface structural change, i.e., formations of a Ca-rich amorphous or nano-crystalline calcium phosphate (ACP) and a Ca-poor ACP, which eventually crystallized into bonelike apatite. Zeta potential characterized by the electrophoresis indicated that during exposure to SBF, the HA surfaces reveal negative surface charge, thereby interacting with the positive calcium ions in the fluid to form the Ca-rich ACP, which gains positive surface charge. The Ca-rich ACP on the HAs then interacts with the negative phosphate ions in the fluid to form the Ca-poor ACP, which stabilizes by being crystallized into bonelike apatite with a low solubility in the SBF. The exposure times for formations of these phases of the Ca-rich ACP, the Ca-poor ACP as well as the apatite were, however, all late on HA sintered at 1200 degrees C, compared with the HA sintered at 800 degrees C. This phenomenon was attributed to a lower initial negative surface charge of the HA sintered at 800 degrees C than of that one sintered at 1200 degrees C, owing to poverty in surface hydroxyl and phosphate groups which are responsible for the surface negativity of the HA. These indicate that sintered temperature of HA might influence not in terms of the process but in terms of the rate of formation of biologically active bonelike apatite on its surface, through which the HA integrates with living bone.

The mechanism of biomineralization of bone-like apatite on synthetic hydroxyapatite (HA) has been investigated in vitro, in which the HA surface was surveyed as a function of soaking time in simulated body fluid (SBF). In terms of surface structure by transmission electron microscopy with energy-dispersive X-ray spectrometry, the HA whose Ca/P atomic ratio was 1.67 revealed three different characteristic soaking periods in SBF, i.e. the first soaking period, in which the HA surface increased the Ca/P ratio up to 1.83 to form an amorphous phase of Ca-rich calcium phosphate; the second soaking period, in which the HA surface decreased the Ca/P ratio up to 1.47 to form an amorphous phase of Ca-poor calcium phosphate; and the third soaking period, in which the HA surface gradually increased the Ca/P ratio up to 1.65 to eventually produce the bone-like nano-cerystallites of apatite, which grew forming complex crystal assemblies with a further increase in immersion time. Analysis using electrophoresis spectroscopy indicated that, immediately after immersion in SBF, the HA revealed a highly negative surface potential, which increased to reach a maximum positive value in the first soaking period. The surface potential then decreased to again reach a negative value in the second soaking period and thereafter converge to a constant negative value in the third soaking period. This implies that the HA induces biomineralization of apatite by smartly varying its surface potential to trigger an electrostatic interaction, first with positive calcium ions and second with negative phosphate ions in the SBF.

Calcium alginate fibers were prepared by extruding an aqueous sodium alginate solution into an aqueous calcium chloride solution. The fibers were treated with a saturated aqueous calcium hydroxide solution for various periods and their apatite-forming ability was examined in a simulated body fluid (SBF). The calcium alginate fibers were treated with the aqueous calcium hydroxide solution for periods longer than five days formed apatite on their surfaces in SBF, and their apatite-forming ability improved with increasing calcium hydroxide treatment time. The amount of calcium ions released from the fibers also increased with increasing calcium hydroxide treatment time, resulting in acceleration of nucleation and growth of apatite on the fiber surfaces. The resultant apatite-alginate fiber composite is expected to be useful as a flexible bioactive bone-repairing material.

Glass-ceramic apatite-wollastonite (A-W)/high-density polyethylene composite (AWPEX) materials have been designed to match the mechanical strength of human cortical bone and to provide favourable bioactivity, with potential use in many orthopaedic applications. To better understand AWPEX properties, the effects of surface finish and ceramic filler size and content on osteoblast-like cell attachment, proliferation, and differentiation were examined. Glass-ceramic content was tested at 30 and 50 vol% and median particle size at 4.5 and 7.7 microm. Samples were prepared as 1 x 10 x 10 mm(3) tiles with polished or rough surfaces, sterilized by gamma irradiation (2.5 Mrad), and characterized by scanning electron microscopy (SEM) and surface profilometry. Saos-2 human osteoblast-like cells were cultured on each surface at an initial concentration of 4500 cells/cm(2) for 1, 3, or 7 days. At each time point, adenosine triphosphate and alkaline phosphatase levels were measured to assess cell number and osteoblast differentiation. SEM imaging of cells on the composite surfaces showed preferential cell attachment to filler particles within the polymer matrix. Significant biochemical assay differences were found at 7 days, confirmed by ANOVA post-hoc testing using Bonferroni's correction. Overall, increased exposure of the glass-ceramic A-W phase in AWPEX through surface polishing, higher volume fraction and/or larger particle size was found to lead to an improved cell response.

Metallic materials implanted into bone defects are generally encapsulated by a fibrous tissue. Some metallic materials such as titanium and tantalum, however, have been revealed to bond to the living bone without forming the fibrous tissue, when they were subjected to NaOH solution and heat treatments. Thus treated metals form bone tissue around them even in muscle, when they take a porous form. This kind of osteoconductive and osteoinductive properties are attributed to sodium titanate or tantalate layer on their surfaces formed by the NaOH and heat treatments. These layers induce the deposition of bonelike apatite on the surface of the metals in the living body. This kind of bioactive metals are useful as bone substitutes even highly loaded portions, such as hip joint, spine and tooth root.

Composites which comprise a bioactive filler and ductile polymer matrix are desirable as implant materials since both their biological and mechanical properties can be tailored for a given application. In the present study three-point bending was used to characterise biomedical materials composed of glass-ceramic apatite-wollastonite (A-W) particulate reinforced polyethylene (PE) (denoted as AWPEX). The effects of filler volume fraction, varied from 10 to 50 vol%, and average particle size, 4.4 and 6.7 microm, on the bending strength, yield strength, mode of fracture, Young's modulus and strain to failure were investigated. HAPEX, a commercially used composite of hydroxyapatite and polyethylene, with a 40 vol% filler content, was used for comparison. Increasing the filler content caused an increase in Young's modulus, yield strength and bending strength, and a decreased strain to failure. When filler particle size was increased, the Young's modulus, yield and bending strengths were found to be slightly reduced. A transition in fracture behaviour from ductile to brittle behaviour was observed in samples containing between 30 and 40 vol% filler.

Titania with specific structures of anatase and rutile was found to induce apatite formation in vitro. In this study, anodic oxidation in H(2)SO(4) solution, which could form anatase and rutile on titanium metal surface by conditioning the process, was employed to modify the structure and bioactivity of biomedical titanium. After the titanium metal was subjected to anodic oxidation treatment, thin film X-ray diffraction and scanning electron microscopy results showed the titanium metals surfaces were covered by porous titania of anatase and/or rutile. In simulated body fluid (SBF), the titanium anodically oxidized under the conditions with spark-discharge could induce apatite formation on its surface. The induction period of apatite formation was decreased with increasing amount of either anatase or rutile by conditioning the anodic oxidation. After the titanium metal, anodically oxidized under the conditions without spark-discharge, was subjected to heat treatment at 600 degrees C for 1 h, it could also induce apatite formation in SBF because the amount of anatase and/or rutile was increased by the heat treatment. Our results showed that induction of apatite-forming ability on titanium metal could be attained by anodic oxidation conjoined with heat treatment. So it was believed that anodic oxidation in H(2)SO(4) solution was an effective way to prepare bioactive titanium.

This is the first report of bone induction in a non-osseous site by titanium metal, which has long been recognized as a non-bioactive material. After undergoing specific chemical and thermal treatments, porous bioactive titanium induced bone formation without the need of additional osteogenic cells or osteoinductive agents. Four types of titanium implants were implanted in the dorsal muscles of mature beagle dogs, and were examined histologically after periods of 3 and 12 months. Chemically and thermally treated titanium, as well as pure titanium, was implanted either as porous blocks or as fibre mesh cylinders. Bone formation was found only in the chemically and thermally treated porous block implants removed after 12 months. The present study shows that even a non-soluble metal that contains no calcium or phosphorus can be an osteoinductive material when treated to form an appropriate macrostructure and microstructure. This finding may elucidate the nature of osteoinduction, and lead to the advent of epochal osteoinductive biomaterials for tissue regeneration.

Some ceramics, such as Bioglass, sintered hydroxyapatite, and glass-ceramic A-W, spontaneously form a bone-like apatite layer on their surface in the living body, and bond to bone through the apatite layer. These materials are called bioactive ceramics, and are clinically important for use as bone-repairing materials. However, they cannot be used at high-load sites, such as is found in femoral and tibial bones, because their fracture toughness values are not as high as that of human cortical bone. Titanium metal and its alloys have high fracture toughness, and form a sodium titanate layer on its surface when soaked in a 5 M-NaOH solution at 60 degrees C for 24 h, followed by a heat treatment at 600 degrees C for 1 h. On moving toward the metal interior, the sodium titanate layer gradually changes into the pure metal within a distance of 1 microm from the surface. The mechanical strength of the titanium metal or a titanium alloy is not adversely affected by these chemical and thermal treatments. The titanium metal and its alloys resulting from the above treatment can release Na+ ions from its surface into a surrounding body fluid via an ion exchange reaction with H3O+ ions, resulting in many Ti-OH groups forming on its surface. These Ti-OH groups initially combine with Ca2+ ions to form amorphous calcium titanate in the body environment, and later the calcium titanate combines with phosphate ions to form amorphous calcium phosphate. The amorphous calcium phosphate eventually transforms into bone-like apatite, and by this process the titanium metals are soon tightly bonded to the surrounding living bone through the bone-like apatite layer. The treated metals have already been subjected to clinical trials for applications in artificial total hip joints. Metallic tantalum has also been found to bond to living bone after it has been subjected to the NaOH and heat treatment to form a sodium tantalate layer on its surface.

Hydrolysis and polycondensation of triethoxysilane end-capped Poly (tetramethylene oxide) (Si-PTMO), tetraethoxysilane (TEOS), tetraisopropyltitanate (TiPT) and calcium nitrate (Ca(NO(3))(2)) gave transparent monolithics of PTMO-modified CaO-SiO(2)-TiO(2) hybrids. The samples with (TiPT)/(TEOS+TiPT) molar ratios from 0 to 0.20 under constant ratio of (Si-PTMO)/(TEOS+TiPT) of 2/3 in weight were prepared. It was found that the incorporation of TiO(2) component into a PTMO-CaO-SiO(2) hybrid results in an increase in the apatite-forming ability in a simulated body fluid: the hybrids with (TiPT)/(TEOS+TiPT) of 0.10 and 0.20 in mol formed an apatite on their surfaces within only 0.5 day. It seemed that, within the range of compositions studied, the TiO(2) content little affects the overall mechanical properties: Young's modulus were 52-55MPa, tensile strength, 7-9MPa, and strain at failure, about 30%. Thus, the organic-inorganic hybrids exhibiting both fairly high apatite-forming ability and high capability for deformation were obtained. These hybrid materials may be useful as new kind of bioactive bone-repairing materials.

Bioactive glass-ceramic apatite-wollastonite (A-W) has been incorporated into polyethylene in particulate form to create new bioactive composites for potential maxillofacial applications. The effects of varying the volume fraction of glass-ceramic A-W filler and the glass-ceramic A-W particle size were investigated by measuring the bonding strength of the bonelike apatite layer formed on the surface of glass-ceramic A-W-polyethylene composites. The bonding strength was evaluated via a modified ASTM C-333 standard in which a tensile stress was applied to the substrate and the strength of the bioactive layer was compared with that formed on commercially available hydroxyapatite-polyethylene composite samples, HAPEX. The composites demonstrated greater bonding strength with increased filler content and reduced filler particle size (maximum 6.9 +/- 0.5 MPa) and a marginally greater bonding strength as compared with HAPEX (2.8 +/- 0.5 MPa), when glass-ceramic A-W-polyethylene composite samples with the same filler content were tested. The higher bonding strength of the apatite layer formed on the A-W-polyethylene composite samples suggests that, in addition to maxillofacial applications, these composites might also be utilized in applications involving higher levels of load bearing., (Copyright 2003 Wiley Periodicals, Inc. J Biomed Mater Res 67A: 952-959, 2003)

The purpose of this study was to histologically and mechanically investigate the in vivo bone-bonding ability of anodically oxidized titanium (AO Ti) with an anatase crystal layer on its surface. AO Ti plates, anodically oxidized at 155 V in 1 M H2SO4, were implanted into the proximal metaphyses of mature rabbit tibiae for 4, 8, 16, and 24 weeks and investigated by light microscopy, scanning electron microscopy and detaching test. High bone-bonding ability, comparable to our previous study data of the bioactive titanium produced by sodium-free alkali and heat treatment, was observed at the early stages of implantation. However, no substantial increase was demonstrated. AO Ti plates bonded to bone directly, with no intervening soft tissue layer, and no breakage of the AO Ti layer was observed. The AO Ti layer was porous through to the titanium substrate, while the porosity was low. Apatite-like deposition into the pores of the AO layer was observed only in the superficial zone. The lack of improvement of bone-bonding ability in the later stages of implantation may be attributed to the low porosity and to the superficial ingrowths of apatite-like deposits into the pores of the AO Ti layer.

Carboxymethylated chitin, gellan gum, and curdlan gels were soaked in a simulated body fluid (SBF) having ion concentrations nearly equal to those of human blood plasma. Some of the gels had been soaked in a saturated Ca(OH)(2) solution, while others had not. The carboxymethylated chitin and gellan gum gels have carboxyl groups, while the curdlan gel has hydroxyl groups. None of the gels formed apatite on their surfaces in the SBF when they had not been subjected to the Ca(OH)(2) treatment, whereas the carboxymethylated chitin and gellan gum gels formed apatite on their surfaces when they had been subjected to the Ca(OH)(2) treatment. The curdlan gel did not form an apatite deposit even after the Ca(OH)(2) treatment. Apatite formation on the carboxymethylated chitin and gellan gum gels was attributed to the catalytic effect of their carboxyl groups for apatite nucleation, and acceleration of apatite nucleation from released Ca(2+) ions. This result provides a guiding principle for obtaining apatite-organic polymer fiber composites. This composite is expected to have an analogous structure to that of natural bone.

Some ceramics, such as Bioglass, sintered hydroxyapatite, and glass-ceramic A-W, spontaneously bond to living bone. They are called bioactive materials and are already clinically used as important bone substitutes. However, compared with human cortical bone, they have lower fracture toughness and higher elastic moduli. Therefore, it is desirable to develop bioactive materials with improved mechanical properties. All the bioactive materials mentioned above form a bone-like apatite layer on their surfaces in the living body, and bond to bone through this apatite layer. The formation of bone-like apatite on artificial material is induced by functional groups, such as Si-OH, Ti-OH, Zr-OH, Nb-OH, Ta-OH, -COOH, and PO(4)H(2). These groups have specific structures revealing negatively charge, and induce apatite formation via formations of an amorphous calcium compound, e.g., calcium silicate, calcium titanate, and amorphous calcium phosphate. These fundamental findings provide methods for preparing new bioactive materials with different mechanical properties. Tough bioactive materials can be prepared by the chemical treatment of metals and ceramics that have high fracture toughness, e.g., by the NaOH and heat treatments of titanium metal, titanium alloys, and tantalum metal, and by H(3)PO(4) treatment of tetragonal zirconia. Soft bioactive materials can be synthesized by the sol-gel process, in which the bioactive silica or titania is polymerized with a flexible polymer, such as polydimethylsiloxane or polytetramethyloxide, at the molecular level to form an inorganic-organic nano-hybrid. The biomimetic process has been used to deposit nano-sized bone-like apatite on fine polymer fibers, which were textured into a three-dimensional knit framework. This strategy is expected to ultimately lead to bioactive composites that have a bone-like structure and, hence, bone-like mechanical properties.

An ethylene-vinyl alcohol copolymer (EVOH) was treated with a silane coupling agent and calcium silicate solutions, and then soaked in a simulated body fluid (SBF) with ion concentrations approximately equal to those of human blood plasma. A smooth and uniform bonelike apatite layer was successfully formed on both the EVOH plate and the EVOH-knitted fibers in SBF within 2 days. Part of the structure of the resulting apatite-EVOH fiber composite was similar to that of natural bone. If this kind of composite can be fabricated into a three-dimensional structure similar to natural bone, the resultant composite is expected to exhibit both mechanical properties analogous to those of natural bone and bone-bonding ability. Hence, it has great potential as a bone substitute., (Copyright 2003 Elsevier Science Ltd.)

This study compared in vivo bioactivity with the in vitro apatite-forming ability of biomaterials. Granules of five kinds of P(2)O(5)-free Na(2)O-CaO-SiO(2) glasses, showing different apatite-forming ability in simulated body fluid (SBF), were implanted into a defect on the femoral condyle of rabbits. Bone ingrowth was evaluated using scanning electron microscopy among five kinds of glasses at 1, 2, 3, 6, and 12 weeks. Quantitative analysis was performed measuring the depth of new bone ingrowth from the periphery. In addition, the total areas of newly formed bone among glass particles were examined at 3 and 6 weeks using confocal laser scanning microscopy (CLSM) after weekly administration of fluorescent calcein. The depth of bone ingrowth among glass particles increased in proportion to their apatite-forming ability in vitro. The CLSM study showed a correlation between the quantities of labeled newly formed bone and in vitro apatite-forming ability. In the P(2)O(5)-free Na(2)O-CaO-SiO(2) glasses, the periods within 3-6 days for inducing apatite in SBF considered a necessary condition to convey bioactivity in vivo, and in vivo evaluations at 2-3 weeks is important to determine this. The in vivo bioactivity was precisely reproduced by apatite-forming ability in SBF. Therefore, evaluating apatite formation in SBF is a good screening test for the in vivo bioactivity of materials, resulting in reduction of the need for animal sacrifices and savings in experimental time., (Copyright 2002 Elsevier Science Ltd.)

Development of tantalum metal with bone-bonding ability is paid much attention because of its attractive features such as high fracture toughness, high workability and its achievement on clinical usage. Formation of bonelike apatite is an essential prerequisite for artificial materials to make direct bond to living bone. The apatite formation can be assessed in vitro using a simulated body fluid (SBF) that has almost equal compositions of inorganic ions to human blood plasma. The present authors previously showed that the apatite formation on tantalum metal in SBF was remarkably accelerated by treatment with NaOH aqueous solution and subsequent firing at 300 degrees C, while untreated tantalum metal spontaneously forms the apatite after a long soaking period. The purpose of the present study is to clarify the reason why the NaOH and heat treatments accelerate the apatite formation on tantalum metal. X-ray photoelectron spectroscopy was used to analyze changes in surface structure of the tantalum metal at an initial stage after immersion in SBF. Untreated tantalum metal had tantalum oxide passive layer on its surface, while amorphous sodium tantalate was formed on the surface of the tantalum metal by the NaOH and heat treatments. After soaking in SBF, the untreated tantalum metal sluggishly formed small amount of Ta-OH groups by a hydration of the tantalum oxide passive layer on its surface. In contrast, the treated tantalum metal rapidly formed Ta-OH groups by exchange of Na+ ion in the amorphous sodium tantalate on its surface with H3O+ ion in SBF. Both the formed Ta-OH groups combined with Ca2+ ion to form a kind of calcium tantalate, and then with phosphate ion, followed by combination with large amount of Ca2+ ions and phosphate ions to build up apatite layer. The formation rate of Ta-OH groups on the treated tantalum metal predominates the following process including adsorption of Ca2+ ion and phosphate ion on the surface. It is concluded that the acceleration of the apatite nucleation on the tantalum metal in SBF by the NaOH and heat treatments was attributed to the fast formation of Ta-OH group, followed by combination of the Ta-OH groups with Ca2+ and phosphate ions.

We have developed a bioactive bone cement that consists of apatite and wollastonite containing glass-ceramic (AW-GC) powder and bisphenol-a-glycidyl dimethacrylate (Bis-GMA)-based resin. In this study, we made three types of composite (designated AWC, HAC, and TCPC) consisting of AW-GC, hydroxyapatite (HA,) or beta-tricalcium phosphate (beta-TCP) powder as the inorganic filler and Bis-GMA-based resin as the organic matrix. The proportion by weight of the filler mixed into the cement was 70%. Rectangular plates (10 x 15 x 2 mm) of each composite were made and abraded with 2000 alumina powder. These composites were implanted into tibial metaphyses of rabbits. Specimens were prepared 10 and 25 weeks after implantation and examined using transmission electron microscopy (TEM). AWC was in direct contact with bone 10 weeks after implantation, and AW-GC particles were partially absorbed at the surface. HAC was in contact with partially mineralized extracellular matrix 10 weeks after implantation. In TCPC-implanted specimens, randomly oriented mineral was observed 10 weeks after implantation; however, collagenous extracellular matrix rarely was observed. In 25-week specimens, AW-GC particles were completely absorbed and replaced by new bone, and there was no intervening soft tissue. Both HAC and TCPC were in contact with bone at 25 weeks. These results indicate that AWC has higher bioactivity than either HAC or TCPC.

As reported previously, bioactive titanium is prepared by simple alkali and heat treatment, and can bond to living bone directly. The purpose of this study was to accelerate the bioactivity of bioactive titanium in vivo. In in vitro study, sodium removal by hot water immersion enhanced the apatite-forming ability of bioactive titanium in simulated body fluid dramatically. The specific anatase structure of titania gel was effective for apatite formation in vitro. In the current study, we investigated the in vivo effect of sodium removal on the bone-bonding strength of bioactive titanium. Sodium-free bioactive titanium plates were prepared by immersion in an aqueous solution of 5 M NaOH at 60 degrees C for 24 h, followed by immersion in distilled water at 40 degrees C for 48 h before heating them at 600 degrees C for 1 h. Three kinds of titanium plates were inserted into rabbit tibiae, including untreated cp-Ti, conventional alkali- and heat-treated Ti, and sodium-free alkali- and heat-treated Ti. In vivo bioactive performance was examined mechanically and histologically after 4, 8, 16, and 24 weeks. Sodium removal enhanced the bone-bonding strength of bioactive titanium at 4 and 8 weeks postoperatively; however, its bone-bonding strength was inferior to that of conventional alkali- and heat-treated titanium at 16 and 24 weeks. Histological examinations after the detaching test revealed breakage of the treated layer in the sodium-free alkali- and heat-treated titanium group. In conclusion, sodium removal accelerated the in vivo bioactivity of bioactive titanium and achieved faster bone-bonding because of its anatase surface structure, but the loss of the surface's graded structure due to the complete removal of sodium decreased the adhesive strength of the treated layer to the titanium substrate. Further investigations are required to determine the optimum conditions for preparation of bioactive titanium., (Copyright 2001 John Wiley & Sons, Inc. J Biomed Mater Res 56: 562--570, 2001)

A photografting technique to produce functional groups of silanol able to induce apatite nucleation was attempted on polyethylene substrate for biomimetic formation of bone-mineral-like apatite layer on its surface. The polyethylene surface was subjected to vapor-phase photografting of vinyltrimethoxysilane and subsequently to hydrolysis. The photografting formed methoxysilyl groups on the polyethylene substrate, which was changed into silanol groups successively by the hydrolysis in a hydrochloric solution. The polyethylene modified in this way formed a dense and homogeneous bone-mineral-like apatite layer in a solution with ion concentrations 1.5 times that of human blood plasma. This result indicates that the biomimetic process in combination with a polymeric grafting technique might provide a homogeneous bone-mineral-like apatite coating even on polymer fibers to be woven into an apatite-polymer composite with three-dimensional structure analogous to that of natural bone.

This study was carried out to investigate the effects of the alkali and heat treatments on the bone-bonding behavior of porous titanium implants. Porous titanium implants had a 4.6 mm solid core and a 0.7 mm thick porous outer layer using pure titanium plasma-spray technique. Three types of porous implants were prepared from these pieces: 1.control implant (CL implant) as manufactured 2.AW-glass ceramic bottom-coated implant (AW implant) in which AW-glass ceramic was coated on only the bottom of the pore of the implant 3.alkali- and heat-treated implant (AH implant), where implants were immersed in 5 mol/L NaOH solution at 60 degrees C for 24 h and subsequently heated at 600 degrees C for 1 h. The implants were inserted into bilateral femora of six dogs hemi-transcortically in a randomized manner. At 4 weeks, push-out tests revealed that the mean shear strengths of the CL, AW, and AH implants were about 10.8, 12.7, and 15.0 MPa, respectively. At 12 weeks there was no significant difference between the bonding strengths of the three types of the porous implants (16.0-16.7 MPa). Histologically and histomorphologically, direct bone contact with the implant surface was significantly higher in the AH implants than the CL and AW implants both at 4 and 12 weeks. Thus, the higher bonding strength between bone and alkali- and heat-treated titanium implants was attributed to the direct bonding between bone and titanium surface. In conclusion, alkali and heat treatments can provide porous titanium implants with earlier stable fixation., (Copyright 2000 John Wiley & Sons, Inc.)

Hydrolysis and polycondensation of poly(dimethylsiloxane) (PDMS), tetraethoxysilane (TEOS), tetraisopropyltitanate (TiPT), and calcium nitrate gave essentially pore- and crack-free transparent monolithics of PDMS-modified CaO-SiO(2)-TiO(2) hybrids, when PDMS/(TEOS + TiPT) was larger than 26:74 in weight, under constant ratios of TEOS/TiPT of 9:1 in mol and Ca/(TEOS + TiPT) of 0.15 in mol. Their apatite-forming abilities in a simulated body fluid, which is indicative of bioactivity, increased with decreasing PDMS/(TEOS + TiPT). Their extensibility and Young's modulus decreased and increased, respectively, with decreasing PDMS/(TEOS + TiPT). The hybrids with PDMS/(TEOS + TiPT) of about 30:70 in weight showed fairly high apatite-forming ability, high extensibilities, and Young's moduli almost equal to those of the human cancellous bones. These new kind of bioactive materials with unique mechanical properties may be useful as bone-repairing materials.

A new bioactive bone cement (designated GBC) consisting of polymethyl methacrylate (PMMA) as an organic matrix and bioactive glass beads as an inorganic filler has been developed. The bioactive beads, consisting of MgO-CaO-SiO(2)-P(2)O(5)-CaF(2) glass, have been newly designed, and a novel PMMA powder was selected. The purpose of the present study was to compare this new bone cement GBC's mechanical properties in vitro and its osteoconductivity in vivo with cements consisting of the same matrix as GBC and either apatite- and wollastonite-containing glass-ceramic (AW-GC) powder (designated AWC) or sintered hydroxyapatite (HA) powder (HAC). Each filler added to the cements amounted to 70 wt %. The bending strength of GBC was significantly higher than that of AWC and HAC (p < 0.0001). Cements were packed into intramedullar canals of rat tibiae in order to evaluate osteoconductivity as determined by an affinity index. Rats were sacrificed at 2, 4, and 8 weeks after operation. An affinity index, which equaled the length of bone in direct contact with the cement expressed as a percentage of the total length of the cement surface, was calculated for each cement. At each time interval studied, GBC showed a significantly higher affinity index than AWC or HAC up to 8 weeks after implantation (p < 0.03). The value for GBC increased significantly with time up to 8 weeks (p < 0.006). The handling property of GBC was comparable with that of PMMA bone cement. Our study revealed that the higher osteoconductivity of GBC was due to the higher bioactivity of the bioactive glass beads at the cement surface and the lower solubility of the new PMMA powder to MMA monomer. In addition, it was found that the smaller spherical shape and glassy phase of the glass beads gave GBC strong enough mechanical properties to be useful under weight-bearing conditions. GBC shows promise as an alternative with improved properties to the conventionally used PMMA bone cement., (Copyright 2000 John Wiley & Sons, Inc.)

In this study we have investigated the behavior of fetal rat osteoblasts, cultured up to 23 days, on a bioactive apatite-wollastonite (AW) glass-ceramic and on the same material on which a carbonated apatite layer had been formed by a biomimetic process (AWa). At the last day of culture, the specific activity of alkaline phosphatase activity, as determined biochemically, was about 30% greater on AWa compared with AW disks. After the cell layers had been scraped off, scanning electron microscopic (SEM) observations of the materials' surfaces revealed that mineralized bone nodules remained attached to both surfaces but in larger amounts on AWa. X-ray microanalysis indicated the presence of calcium (Ca) and phosphorus (P) in the bone tissue throughout the AWa surface and Ca, P, and silicon (Si) on the AW surface. The AW/ and AWa/bone interfaces also were analyzed after fracturing of the disks. The interfacial analysis showed firm bone bonding to the AW and AWa surfaces, confirmed by the X-ray microanalytic mappings. These results indicate the importance of surface composition in supporting differentiation of osteogenic cells and the subsequent apposition of bone matrix, which allows a strong bond of the bioactive materials to the bone. Furthermore, prefabrication of a biologic apatite layer by a method that mimics biomineralization could find application to bone-repairing materials., (Copyright 2000 John Wiley & Sons, Inc.)

We analyzed the mechanisms of the efficient bone formation on the osteoconductive surface of apatite- and wollastonite-containing glass-ceramic (AW) by using an in vitro system. AW releases Ca ions and bonds to bone via a submicron-thick hydroxycarbonate apatite (HCA) layer. AW disks were conditioned with simulated body fluid (SBF) to grow HCA layers, and the amount of released Ca ion was regulated by modulating the conditioning time from 24 to 240 h. Surface-transformed AW disks increased alkaline phosphatase (AP) activity in osteoblastic ROS17/2.8 cells by 1.5- to threefold over unconditioned disks. AW disks conditioned for 24 h [AW(24)], which had a homogeneous, submicron-thick apatite layer and increased extracellular ionized Ca concentration ([Ca(2+)](e)) in the culture medium to the greatest extent, enhanced the AP activity the most. High [Ca(2+)](e) promoted osteogenic differentiation in ROS17/2.8 cells: It increased AP activity in a dose-dependent manner by up to 1.6-fold, and up-regulated the expression of AP, osteocalcin (OC), and transforming growth factor-beta1 mRNAs in dose- and time-dependent manners. AW(24) enhanced AP activity in ROS17/2.8 cells as much as AW disks conditioned with SBF containing serum to exhibit in vivo surface-structure changes. AW(24) increased AP activity in ROS17/2.8 cells by 1.6-fold and enhanced the expression of AP and OC mRNAs significantly, compared with sintered hydroxyapatite (HA). After implantation of AW and HA in the distal metaphyses of rabbit femurs, thin, newly formed bone lined with cuboidal, osteoblast-like cells was characteristically observed adjacent to the AW surface within 8 days. These results provide evidence for the hypothesis that AW stimulates bone formation on its surface by increasing [Ca(2+)](e) to promote the HCA layer formation and the differentiation of osteogenic cells., (Copyright 1999 John Wiley & Sons, Inc.)

A study was conducted to evaluate the osteoconductivity and bone-bonding ability of two types of bioactive bone cement, both consisting of apatite and wollastonite containing glass-ceramic powder (AW-P), fused silica glass powder (SG-P), submicron fumed silica as an inorganic filler, and bisphenol-a-glycidyl methacrylate (Bis-GMA) based resin as an organic matrix. The cements had two kinds of formulas: one (dough-type cement; designated DTC) composed of 85% (w/w) filler and 15% resin, which was developed for fixation of the acetabular component in total hip arthroplasty and could be handled manually; and one (injection-type cement; designated ITC) composed of 79% (w/w) filler and 21% resin. ITC was developed for fixation of the femoral component and, because it had a lower viscosity than DTC, could be injected. The DTC and ITC both contained 73% AW-P, 25% SG-P, and 2% fumed silica in the weight ratio of the filler component. Two other types of cement, both of which consisted of 83.3% AW-P or SG-P, 1.7% fumed silica, and 15% resin, were used as reference material (designated AWC or SGC) for a detaching test. Following the packing of bone defects in the rat tibiae with either DTC or ITC, histological examination revealed that the DTC and ITC had both directly contacted the bone and were almost completely surrounded by bone by 16 weeks after the surgery and that no marked biodegradation had occurred at 52 weeks postimplantation. Rectangular plates (2 x 10 x 15 mm) of AWC, DTC, ITC, and SGC were implanted into the metaphysis of the tibia of male rabbits and the failure load was measured by a detaching test at 10 and 25 weeks after implantation. The failure loads of AWC, DTC, ITC, and SGC were 3.65, 2.21, 2.44, and 0.04 kgf at 10 weeks and 4.87, 2. 81, 2.82, and 0.13 kgf at 25 weeks, respectively. Observation of the bone-implant interface by scanning electron microscopy and energy dispersive X-ray microanalysis revealed that all the samples except SGC formed direct contact with the bone and that only AWC-implanted tibiae had a layer of a low calcium and phosphorus level at the bone-implant interface. Results showed that DTC and ITC have excellent osteoconductivity and bone-bonding ability under non-weight-bearing conditions., (Copyright 1999 John Wiley & Sons, Inc.)

The purpose of this study is to evaluate the bone-bonding ability of alkali- and heat-treated titanium alloys. Smoothed-surface rectangular plates of Ti6Al4V, Ti6Al2Nb1Ta, and Ti15Mo5Zr3Al were prepared. The plates were inserted transcortically into the proximal metaphyses of bilateral rabbit tibiae, with alkali- and heat-treated plates inserted on the right side, and untreated plates on the left. The tensile failure loads between the implants and the bones were measured after 8, 16, and 24 weeks by a detaching test. The untreated implants showed almost no bonding even at 16 weeks, and only weak bonding at 24 weeks. In contrast, treated implants showed bonding to bone at all time periods. Histological examination showed that alkali- and heat-treated alloys bonded directly to the bone. Conversely, the untreated implants had an intervening layer of fibrous tissue between the bone and the plate, or only partial direct contact with the bone. This study demonstrates that alkali and heat treatments enhance the bone-bonding strength of these titanium alloys. Although in this study even tentative conditions of the treatments enhance the bonding strength of the titanium alloys, further work is required to determine the optimum conditions for treatment to give the highest bonding strength. These new bioactive titanium alloys are available for weight-bearing and bone-bonding orthopedic devices., (Copyright 1999 John Wiley & Sons, Inc.)

We have investigated the applicability of a simple and inexpensive osteoclastic assay system using bone-like apatite-coated polyethyleneterephthalate (PET) disks. A 1 microm thick apatite layer, uniform and homogeneous bone-mineral-like with no organic components, was made on PET disks using a biomimetic process. As substrates for an osteoclastic assay, these coated disks were compared with dentine as well as with bone-like or heat-treated apatite of various thicknesses on apatite- and wollastonite-containing glass ceramic (A-W GC) disks. The unfractionated bone cells, including osteoclasts, of a neonatal rabbit were seeded onto these substrates. By scanning electron microscopic examination, the resorption lacunae of the thick bone-like apatite clearly showed track-like shapes at various depths, similar to those of dentine although the border between the A-W GC and the apatite was unclear. In contrast, those of heat-treated apatite showed small and shallow shapes with irregular margins, quite different from those of dentine. By reducing the thickness of bone-like apatite to 1 microm as well as using PET as its substrate, the margins of the resorption lacunae became quite clear, and with the use of phase-contrast microscopy during culture, osteoclasts and resorption pits could be precisely observed. The resorbed area, easily measured with the aid of bright-field microscopy and an image analyzer, was found to have increased in a time-dependent manner and at the end of 4 days of culture was not statistically different from that of dentine.

Bioactive and ferrimagnetic glass-ceramics are useful as thermoseeds for hyperthermia treatment of cancer. A heat treatment of a 40(FeO, Fe2O3)-60CaO x SiO2 wt% glass gives a ferrimagnetic glass-ceramic containing 36 wt% magnetite in a CaO x SiO2 matrix. However, it does not show bioactivity since a small amount of iron ion remains in the matrix. In the present study, bioactivities of ferrimagnetic glass-ceramics which were prepared by heat treatment of glasses of the composition 40(FeO, Fe2O3)-60CaO x SiO2 (wt%) with various components added at 100:3 weight ratio were evaluated in vitro by examining bone-like apatite formation on their surfaces in a simulated body fluid. It was found that glass-ceramics with Na2O or B2O3 added in combination with P2O5 show bioactivity.

Our previous study showed that titanium metal forms a bonelike apatite layer on its surface in simulated body fluid when it was subjected to NaOH and heat treatments to form a sodium titanate hydrogel or amorphous sodium titanate surface layer. In the present study, bonding strength of the apatite layer formed on the titanium metals to the substrates were examined under tensile stress, in comparison with those of the apatite layers formed on Bioglass 45S5-type glass, dense sintered hydroxyapatite, and glass-ceramic A-W, which are already clinically used. The NaOH-treated titanium metals showed higher bonding strength of the apatite layer to the substrates, which was maximized by heat treatments at 500 and 600 degrees C, than all the examined bioactive ceramics. It is believed that bioactive metals thus obtained are useful as bone substitutes, even under load-bearing conditions.