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Upon the osteoporotic condition, sluggish osteogenesis, excessive bone resorption, and chronic inflammation make the osseointegration of bioinert titanium (Ti) implants with surrounding bone tissues difficult, often lead to prosthesis loosening, bone collapse, and implant failure. In this study, we firstly designed clickable mussel-inspired peptides (DOPA-N3) and grafted them onto the surfaces of Ti materials through robust catechol-TiO2 coordinative interactions. Then, two dibenzylcyclooctyne (DBCO)-capped bioactive peptides RGD and BMP-2 bioactive domain (BMP-2) were clicked onto the DOPA-N3-coated Ti material surfaces via bio-orthogonal reaction. We characterized the surface morphology and biocompatibility of the Ti substrates and optimized the osteogenic capacity of Ti surfaces through adjusting the ideal ratios of BMP-2/RGD at 3:1. In vitro, the dual-functionalized Ti substrates exhibited excellent promotion on adhesion and osteogenesis of mesenchymal stem cells (MSCs), and conspicuous immunopolarization-regulation to shift macrophages to alternative (M2) phenotypes and inhibit inflammation, as well as enhancement of osseointegration and mechanical stability in osteoporotic rats. In summary, our biomimetic surface modification strategy by bio-orthogonal reaction provided a convenient and feasible method to resolve the bioinertia and clinical complications of Ti-based implants, which was conducive to the long-term success of Ti implants, especially in the osteoporotic or inflammatory conditions., Graphical abstract Mussel-inspired adhesion and bio-orthogonal reactions are combined for surface modification of Ti-based implants with RGD peptide and BMP-2 peptide. Dual-functionalized Ti-based implants can enhance osteogenesis and osseointegration through promoting BMSCs adhesion and osteodifferentiation, as well as modulate macrophage polarization in the osteoporotic rats.Image 1, Highlight • A clickable mussel-inspired peptide and two DBCO-capped bioactive peptides for facile decoration of Ti prostheses via robust catechol/TiO2 coordinative interactions and click chemical reaction. • Dual functionalized Ti-based surface can improve cell anchoring and osteogenicitity by rationally adjusting the grafting ratio of BMP-2 and RGD peptides. • Dual functionalized Ti-based surface synergistically achieve M2 shifting and efficient inflammation inhibition for osseointegration.

Titanium (Ti) surface, with an essentially bioinert character, is not easy to actively initiate interactions with surrounding biological tissue. In this study, we developed a novel surface modification to enhance the osteogenic response to Ti surface in orthopedic and dental implant applications. The proposed surface modification combined alkaline treatment and type I collagen immobilization through using a natural cross-linker genipin. A variety of experiments were used to characterize the resulting surfaces in terms of morphology, chemistry, roughness, hydrophilicity, and bioactivity. We also assessed the responses of human bone marrow mesenchymal stem cells (hMSCs) to Ti surfaces in terms of adhesion, migration, proliferation, mineralization, and differentiation. Results showed that the modified Ti surfaces revealed a hydrophilic (water and diiodomethane contact angles

Titanium particles as a product of degradation have been detected in periimplant oral tissues and it has been assumed that implants were the source of these particles. Periimplantitis sites had higher concentrations of particles in comparison to healthy implant sites. Several factors have been identified in the degradation of dental implant surface, such as mechanical wear, contact with chemical agents, and the effects of biofilm adhesion. Titanium particles silently prompt the immune-system activation and generate a pro-inflammatory response in macrophages, T lymphocytes and monocytes. During the activation, inflammatory cytokines are released including, granulocyte–macrophage colony-stimulating factor (GM-CSF), prostaglandin, and TNF-α, IL-1β, IL-6. The nanoparticles depict unique features such as high level of biological reactivity and potentially harmful compared to microparticles since they have a relatively greater surface area to volume ratio. Allergic response to titanium as a cause of implant failure has not been well documented. Evidence demonstrating biological complication due to titanium particles release includes peri-implant tissue inflammation that lead terminally to implant loss. There is a biological probability for a relation between the presence of titanium particles and ions, biological complication, and corrosion, but there is no justifiable evidence for unidirectional series of causative actions.

In this paper, the collagen (Col)@minerals (Sr, Mg, Ce) substituted hydroxyapatite (MHA1)-halloysite nanotubes - single-walled carbon nanotubes (SWCNT) (Col@MHA1-HNT-SWCNT) nanocomposite was coated on the titanium (Ti) implant was investigated using the electrophoretic deposition (EPD) method. The phase and microstructure analysis of the coated samples were characterized using XRD, and SEM-EDAX, respectively. The Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) strains were tested for antimicrobial activity. The zone of inhibition shows that the Col@MHA1-HNT-SWCNT nanocomposite coating was effective at inhibiting pathogens. The analysis of blood compatibility revealed that the hemolytic ratio was less than 5%, confirming that the nanocomposite were naturally hemocompatible. Furthermore, the cell viability assay using osteoblast-like cells showed excellent cell proliferation and attachments on prepared samples. According to the findings of this research, the Col@MHA1-HNT-SWCNT nanocomposite coating supports bioactivity through fast osteo-compatibility and has greater bacterial resistance, making it necessary for the required biomedical applications.

Aims The use of 3D-printed titanium implant (DT) can effectively guide bone regeneration. DT triggers a continuous host immune reaction, including macrophage type 1 polarization, that resists osseointegration. Interleukin 4 (IL4) is a specific cytokine modulating osteogenic capability that switches macrophage polarization type 1 to type 2, and this switch favours bone regeneration. Methods IL4 at concentrations of 0, 30, and 100 ng/ml was used at day 3 to create a biomimetic environment for bone marrow mesenchymal stromal cell (BMMSC) osteogenesis and macrophage polarization on the DT. The osteogenic and immune responses of BMMSCs and macrophages were evaluated respectively. Results DT plus 30 ng/ml of IL4 (DT + 30 IL4) from day 3 to day 7 significantly (p < 0.01) enhanced macrophage type 2 polarization and BMMSC osteogenesis compared with the other groups. Local injection of IL4 enhanced new bone formation surrounding the DT. Conclusion DT + 30 IL4 may switch macrophage polarization at the appropriate timepoints to promote bone regeneration. Cite this article: Bone Joint Res 2021;10(7):411–424.

Background The identification of biocomposites that improve cell adhesion and reduce bone integration time is a great challenge for implantology and bone reconstruction. Aim Our aim was to evaluate a new method of chemisorption deposition (CD) for improving the biointegration of hydroxyapatite-coated titanium (HApTi) implants. CD method was used to prepare a calcium fructoborate (CaFb) coating on a HApTi (HApTiCaFb) implant followed by evaluation of histological features related to bone healing at the interface of a bioceramic material in an animal model. Methods The coating composition was investigated by high-performance thin-layer chromatography/mass spectrometry. The surface morphology of the coating was studied by scanning electron microscopy (SEM), before and after the in vitro study. We implanted two types of bioceramic cylinders, HApTi and HApTiCaFb, in the femur of 10 New Zealand White (NZW) rabbits. Results The release of CaFb from HApTiCaFb occurred rapidly within the first three days after phosphate-buffered saline immersion; there was then a linear release for up to 14 days. SEM analysis showed similar morphology and particle size diameter for both implants. Around the porous HApTiCaFb implant, fibrosis and inflammation were not highlighted. Conclusions Easily applied using CD method, CaFb coatings promote HApTi implant osseointegration in the femur of NZW rabbits.

Biomedical titanium alloys with elastic moduli close to that of cortical bone have gained great attention in the field of bone implantation. A low modulus is desirable in an implant to prevent stress shielding, which usually leads to critical clinical issues, such as bone resorption and implant loosening. The use of β-type titanium with nontoxic alloying elements, such as niobium, as a novel candidate of implant material for replacing failed hard tissues has shown great potential. This review describes a titanium implant application alloyed with niobium and the mechanical properties and bioactivity of various titanium alloys sintered at different temperatures.

Since the presentation of the cell adhesion concept, properties of the contact surface between osteoblasts and titanium implant and possible methods to enhance related characteristics have attracted much attention in orthopedic investigations. The creation of microtextures on the titanium implant is an important method to improve cell adhesion. This research includes the employment of Ultrasonic Assisted Turning (UAT) to create special microtextures on the titanium implant. Also, the developed interfacial ratio (Sdr) are analyzed to understand the effect of main surface characteristics on the adhesion behavior and parameters. Moreover, the effects of ultrasonic vibrations on Sdr are presented by theoretical relation and graphical modeling. Results showed micro dimples (textures) depth and width were a function of ultrasonic characteristics (amplitude and direction) and cutting speed of turning. Developed interfacial ratio (Sdr) was another surface parameter that improved by UAT (about 20% in geometrical simulations) while surface roughness did not change significantly by the application of UAT. SEM images show larger integrin and extended fibronectin of osteoblast which adhered to the textured surfaces. This result demonstrated the abilities of UAT to fabricate titanium implants with enhanced adhesion properties for osteoblast cells.

Using the templates preliminarily made by 3D design and prototyping methods, defects in the lateral area of the lower jaw of sheep were created using the piezosurgical technique. The defects were replaced by plastic implants obtained by the method of layer-by-layer fusion of the FDM printing–fusing deposition modeling and fixation with titanium screws to the jaw body. In the time interval, plastic implants are replaced by titanium implants obtained by selective laser sintering (SLS) using a 3D printer. To study the processes of reparative osteogenesis, microsamples of tissues of the preimplantation zone were analyzed. As a result, signs of osteo- and fibro-osseointegration were identified. The obtained data are regarded as a prerequisite for further clinical trials of the developed protocols for the sequential replacement of jaw defects using 3D printing.

Titanium dental implant surface does not remain unaltered but may corrode and release ions or particles which trigger soft and hard tissue damage. Titanium may induce clinically relevant hypersensitivity in patients chronically exposed. A 56-year-old female patient presented peri-implantitis around a single titanium implant positioned three years earlier. Despite nonsurgical therapy, a rapid bone loss associated with pain and swelling occurred, and adjacent teeth presented external resorption. Compromised teeth were removed, and three titanium implants were inserted. Six months later, the patient complained about high mucosa sensitivity and implant exposure. At clinical and radiographic examinations, tissue inflammation and vertical bone loss involved the new implants and the process of external resorption affected the teeth. The blood test confirmed titanium hypersensitivity. Titanium implants were removed, and 5 zirconia implants were placed. No sign of bone loss or tooth resorption was recorded at clinical and radiographic control during 18 months of follow-up.

Direct contact between bone and implant materials is required for dental implants. Titanium is used for the implant material owing to its mechanical and biological properties. The anodisation as the surface treatment was employed to enhance osteogenesis around titanium. Moreover, carbon nanohorn (CNH), a type of nanometer-sized carbon material, was reported to promote the bone formation. Thus, it is expected that if the surface of anodised Ti (AnTi) is modified with CNHs, Ti-bone contact would be enhanced. In this study, the Ti surface was modified with CNHs by electrophoresis and obtained anodised titanium coated with CNHs (CNH/AnTi).

Recent trends in biomedical research have focused on the design and development of biomaterials with multi-functional properties. These biomaterials with multi-functional properties can offer a successful path to the regeneration of soft or hard tissue. They can deliver therapeutic drugs to infected bone to repair osteomyelitis, osteosarcoma, etc. Here, to improve bone healing and generate bacterial inhibition potential, we fabricated a novel osteoconductive and antibacterial scaffold containing a ceramic composite loaded with a combination of novel traditional (a mixture of garlic and ginger paste extract (GGe)) and modern (gentamicin (GTN)) antibiotics. The ceramic composite was made up of minerals (Zn2+ and La3+) substituted hydroxyapatite (MHAP) and chrysin (ChN) molecules. The novel MHAP/ChN/GGe/GTN composite prepared in-situ was then electrophoretically deposited on a surface-treated Ti plate at 50 V for 20 min. Various methods, such as FT-IR, XRD, SEM, and HR-TEM analysis, zeta potential and Vickers microhardness measurements, and immersion in SBF solution, were used to identify the physicochemical properties, mechanical strength, and bioactivity of the composites. The responses of all the prepared composites to bacteriostatic pathogens were evaluated via an agar disc diffusion method against MRSA and E. coli strains. The tested composite MHAP/ChN/GGe/GTN shows a better ZoI value against E. coli pathogens than composites loaded with a single antibiotic. In vitro biocompatibility studies were carried out on human osteoblast-like MG-63 cells for 1, 4, and 7 days. Analysis of the growth of MG-63 cells on the MHAP/ChN/GGe/GTN composite via MTT and ALP assays and ARS staining shows the non-toxic and osteoblastic nature of the composite. However, numerous studies, such as in vivo testing and clinical trials, are needed to commercialize this MHAP/ChN/GGe/GTN-composite-coated Ti implant.

In this work, samples of titanium dental implants in salivary environment in the presence of certain foods were studied. 24 samples were prepared and subjected to the reactivity of certain foods for 6, 5, 6 and 7 weeks. The ICP-MS technique was used to analyze the prepared samples. The results obtained showed no corrosion of the titanium alone in an artificial salivary medium. Significant corrosion was observed in the presence of food, which is manifested by the presence of traces of titanium in the samples.

In current scenario, the engineering materials are profound their application towards Bio-Medical field. The human implants caught the eye of researchers in the field of materials and metallurgy. After meeting the accidents, aged people’s bone crack, and other factors for replacing bones is a major problem faced by the medical society. Considering the fact, researchers have found some viable alternative for the bone material which are positive towards biocompatibility. Now-a-days the human implants are available commercially but for particular length, and the implants are not patient specific. To overcome the current issue, machining the materials have been using as the conventional methods to make them into patients’ specific implants. While machining the implants, complex shapes cannot be machined by traditional approach, on the other hand, the biocompatibility of the material have been spoiled. In the commercial market both stainless steel and the titanium-based implants play a vital role in the replacement of the bone. The commercial grade of titanium implant is not pure titanium but the alloy of titanium. Due to the lack of biocompatibility the machined implant material cannot resist the bio-corrosion, eventually, it leads to the lack in the growth of the human cells. Usually the implants are placed in the human body, which is in contact with the live tissue containing the fibroblast cells (Skin cells). Lack of biocompatibility of the human implants reflects on the growth of the fibroblast cells, healing the surgery wound, further it may also lead to allergy to the patient.

Background: The present study focused on assessing the level of titanium in submucosal plaque in the peri-implant area with peri-implantitis in comparison to healthy implants. Methodology: Sixty patients with titanium dental implants were recruited. The degree of titanium in submucosal plaque around peri-implantitis and healthy implants was estimated using inductively coupled plasma mass spectrometry. Results: The mean ± standard deviation probing depth in Group I was 3.12 ± 1.1 and in Group II was 7.2 ± 2.5; gingival index was 0.64 ± 0.3 and 1.64 ± 0.8 in Group I and Group II, respectively. The plaque index was 0.82 ± 0.2 in Group I and 1.5 ± 0.6 in Group II. The mean plaque mass in Group I was 24.1 ± 3.8 ng/ul and 49.3 ± 6.4 ng/ul in Group II. The mean titanium level in Group I was 0.08 ± 0.02 μg and in Group II was 0.91 ± 0.04 μg. A highly significant difference between both groups was found (P < 0.05). Conclusion: There was a significantly higher titanium level in submucosal plaque around dental implants with signs of peri-implantitis as compared to healthy dental implants.

Study Design: Surface finish of titanium patient-specific craniofacial implants is known to affect their acceptability and durability and relevant literature still inconclusive on the best surface finishing protocol. Objectives: This study investigated surface topography of three-dimensionally (3D) printed and conventionally manufactured craniofacial titanium implants following non-contact 3D laser profile-meter analysis. Methods: Seven groups of titanium specimens (n = 10) were prepared and their surfaces were treated differently and included sole or combined treatment of mechanical polishing, gritting with 50 micron AL2O3, cold acid treatment using nitric acid for 20 hours (70% w/w), etching using acidic solution (69% nitric and 48% hydrofluoric acids) for 10 minutes and then electro-chemically anodized in another acidic solution (85% orthophosphoric and 98%sulphuric acid). Eighth group included specimens that were 3D printed. 3D micro-roughness parameters Sa, Sp, Sv, and Sz were determined (μm) for each specimen. Data was analyzed using one way ANOVA and Dunett T3 post-hoc tests (p < 0.05). Results: There were statistically significant effects of surface finishing protocols (p < 0.05). Sa values were 2.72-13.75 and specimens which were electroplated or mechanically polished and acid treated were the smoothest (p < 0.05). Sp was in the range 9.07-43.56 as sandblasting significantly roughened surfaces (p < 0.05). The same inferior effect was evident for the Sv (p < 0.05). The Sz values were 19.46-107.05 and was the highest for sandblasted surfaces (p < 0.05) and the lowest for surfaces of electro-chemical treatment (p < 0.05). Conclusion: Titanium surfaces are affected by the finishing procedure and electro-chemical treatment or mechanical polishing combined with acid treatment produced clinically-favorable smooth surfaces.

Cell-selective toxic titanium is highly desired in clinical dental practice. Herein, based on the in situ conversion of ZnO to ZnO@ZnS, nanorod-array structured coatings with a controllable release features of zinc (Zn), has been successfully fabricated by a two-step hydrothermal method to endow titanium surface with cell-selectivity, i.e. boosting the functions (attachment and migration) of human gingival fibroblasts (HGnFs) while acting against the invasion of pathogenic bacteria. The improved functions of HGnFs over the ZnO@ZnS nanorod-array were attributed to the material’s optimized zinc release, which was decreased from an order of 3.5 mg L−1 to about 0.3 mg L−1 (within the first week). But more importantly, this concentration still had a high antibacterial efficacy up to 100% (against both the S. aureus and E. coli, 107 CFU mL−1). This study demonstrated that a ZnO@ZnS nanorod-array coating could be a promising strategy to endow titanium dental implants with improved soft tissue sealing and effectively reduce peri-implantitis.

Objective The aim of this study was to histologically examine the effects of a nonsteroidal anti-inflammatory drug, namely diclofenac sodium (DCS), on the extent of the bone–implant contact (BIC) of titanium implants after four weeks of osseointegration period in a rodent model. Material & methods Fourteen female Sprague-Dawley rats were divided into two groups: the control (n = 7) and experimental (DCS) groups. Fourteen machine-surfaced titanium implants were placed in the right tibial bones of the rats. The DCS (2 mg/kg) was administered by means of oral gavage to the experimental group for 14 days after four weeks of osseointegration. No medication was administered to the control group throughout the six-week study period. At the end of the study, the rodents were sacrificed and block sections were obtained for histologic evaluation. Results The mean BIC ratios for the control and DCS groups were 64.15 ± 6.31% and 61.10 ± 6.08%, respectively. No statistically significant difference in terms of the BIC ratios was found between the two groups. Conclusion The results of this study demonstrate that DCS did not impair the BIC of the implants after four weeks of osseointegration.

Hydrogen peroxide treatment is a cost-effective and simple method to improve the bioactivity of titanium implants. In this study, the effects of chloride ion concentration and temperature of hydrogen peroxide on the surface treatment of titanium were investigated using X-ray diffractometry (XRD), Field Emission-Scanning Electron Microscopy (FESEM), and tests in order to determine wettability and apatite forming ability. The results showed that at the lower temperatures of treatment (60°C), hydrogen peroxide corroded the formed titania layer and the post-heat treatment resulted in rutile formation on the surface of titanium. At higher temperatures of treatment (100°C), a uniform and crack-free anatase layer was formed on the surface of titanium, leading to the improvement of superhydrophilicity and the apatite forming ability of titanium. However, these properties were affected by increasing the chloride concentration of hydrogen peroxide. At appropriate conditions, titanium dental implant surfaces could be treated effectively using hydrogen peroxide, such that the time of treatment could be reduced to 5h., Journal of Materials Research and Technology, 9(6), pp.13312-13319; 2020

he surface treatment is important for titanium and its alloys as promising candidates for dental implantation due to their bioinert surface. Titanium surface samples were modified using H2O2 solution at different times up to 72 h to boost their bioactivity. According to the results of the field emission scanning electron microscopy test, some nanostructures are formed on the surface of treated titanium samples and increased in size by increasing the time of treatment up to 24 h. After 24 h of application, the sharpness of nanostructures decreased and the micro-cracks and discontinuity in the coating surface increased. The results of the X-ray diffraction study and Raman spectroscopy revealed that anatase (TiO2) was formed on the surface of treated titanium samples. The peak intensity of Raman spectroscopy increased with an improvement in treatment time of up to 24 h and then decreased due to the discontinuity of the coating. Full wettability and ability to form apatite were reached at 6 h of treatment. It is clear that the treatment time has a significant effect on the surface treatment of titanium using the H2O2 solution., International Journal of Minerals, Metallurgy and Materials, 27(9), pp.1281-1286; 2020

Titanium and its alloys are mainly used in manufacturing dental implants. The fact that titanium implants are immunologically very effective, new methods are being experimented to achieve utmost success rate as a biomaterial. One fundamental indicator for clinical achievement of implant is the decision of composition decided for the implant with the objective to improve osseointegration. The main objective of this study was to explore literature on dental materials used for implants, contrast them with titanium dental implants, with the aim to improve osseointegration and mechanical quality using Ti–Ga–Si dental implant.

Relevance . The main goals of successful prosthesis remain ensuring the osseointegration and infectious safety of implants. The purpose of the study — the comparative analysis of osseointegration of titanium and steel additive manufactured implants in the rabbit tibia under additional fixation by Ilizarov apparatus. Materials and Methods . The study was performed on 20 chinchilla male rabbits. The animals of the first group (n = 8 ) were implanted a stainless steel product EOS PH1 (EOS, Germany), the animals of the second group (n = 12) — a titanium alloy Ti6Al4V product. The implant was additionally fixed by Ilizarov apparatus. The implants were processed with additive technology by selective laser fusion at the EOSINT M 280 installation (EOS, Germany). The survival and safety of the implants were assessed using clinical, histological, laboratory and statistical methods. Results . The implant fall due to chronic inflammation was found in 2 animals of group 1 and none in group 2. The formation of weakly mineralized bone tissue on the surface of the implant was noted in 3 weeks in all cases. The bone became more mineralized by the 12 th week of the experiment. However, in group 2, the calcium content and Ca / P ratio of the newly formed bone tissue at the 3 rd and 12 th week after implantation were significantly higher than in the animals of group 1. This indicated the greater maturity of the bone tissue in animals of group 2 at all stages of the experiment. In group 1, the compact plate osteoporosis and calcium-phosphorus balance disturbance were greater. Conclusion . The results of the study indicate that the survival rate (osseointegration) and safety of the product made of the titanium alloy were higher compared with the stainless steel product.

Qingfan Li,1,2 Zuolin Wang1,2 1Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, People’s Republic of China; 2Department of Oral Implant, School of Stomatology, Hospital of Stomatology, Tongji University, Shanghai, People’s Republic of ChinaCorrespondence: Zuolin WangShanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Oral Implant, School of Stomatology, Tongji University, 399 Yanchang Road, Shanghai 200072, People’s Republic of ChinaTel +86-21-66313725Fax +86-21-66524025Email zuolin@tongji.edu.cnBackground: Titanium implants are widely used in dental and orthopedic medicine. Nevertheless, there is limited osteoinductive capability of titanium leading to a poor or delayed osseointegration, which might cause the failure of the implant therapy. Therefore, appropriate modification on the titanium surface for promoting osseointegration of existing implants is still pursued.Purpose: Graphene oxide (GO) is a promising candidate to perform implant surface biofunctionalization for modulating the interactions between implant surface and cells. So the objective of this study was to fabricate a bioactive GO-modified titanium implant surface with excellent osteoinductive potential and further investigate the underlying biological mechanisms.Materials and Methods: The large particle sandblasting and acid etching (SLA, commonly used in clinical practice) surface as a control group was first developed and then the nano-GO was deposited on the SLA surface via an ultrasonic atomization spraying technique to create the SLA/GO group. Their effects on rat bone marrow mesenchymal stem cells (BMSCs) responsive behaviors were assessed in vitro, and the underlying biological mechanisms were further systematically investigated. Moreover, the osteogenesis performance in vivo was also evaluated.Results: The results showed that GO coating was fabricated on the titanium substrates successfully, which endowed SLA surface with the improved hydrophilicity and protein adsorption capacity. Compared with the SLA surface, the GO-modified surface favored cell adhesion and spreading, and significantly improved cell proliferation and osteogenic differentiation of BMSCs in vitro. Furthermore, the FAK/P38 signaling pathways were proven to be involved in the enhanced osteogenic differentiation of BMSCs, accompanied by the upregulated expression of focal adhesion (vinculin) on the GO coated surface. The enhanced bone regeneration ability of GO-modified implants when inserted into rat femurs was also observed and confirmed that the GO coating induced accelerated osseointegration and osteogenesis in vivo.Conclusion: GO modification on titanium implant surface has potential applications for achieving rapid bone-implant integration through the mediation of FAK/P38 signaling pathways.Keywords: graphene oxide, SLA, titanium implant, osteogenic differentiation, osseointegration, cell signaling pathways

Purpose: This systematic review was carried out to investigate the effects of keratin and chitosan hydrogel preparations on dental implant osseointegration. Materials and Methods: The electronic search was conducted on five databases: Scopus, EBSCOhost MEDLINE, EBSCOhost Dentistry and Oral Science, PubMed, and Web of Science. Studies that determined the in vitro or in vivo efficacy of keratin and chitosan hydrogel on osseointegration were included in the review. Results: Of the 760 studies initially gathered, nine met the inclusion criteria. These studies demonstrated that dental implants coated with keratin and chitosan hydrogels resulted in improved biological properties. It was also concluded that the inclusion of chitosan in keratin hydrogels improves the mechanical strength and helps increase durability through ameliorating degradation and swelling characters. Both the polymers increased bone-implant contact and new bone formation in animal models. Conclusion: This systematic review demonstrates that keratin and chitosan hydrogel, is effective in initiating osteogenesis, reinforcing the currently available evidence that these polymers could be a substrate in dental implant treatment.

It has been demonstrated that the osteoconductivity, hydrophilicity, and biological capacity of titanium decreases over time, and this phenomenon was described as the biological aging of titanium. The aim of this study was to evaluate whether the age of sand-blasted and acid-etched (SLA) titanium dental implants (duration from the production date until the date of dental implant surgery) affects marginal bone resorption and implant survival. This nonrandom convenience-sample retrospective pilot study was carried out in 200 implants of 64 patients. Radiographic measurements were performed on intraoral periapical radiographs. Implants were divided into 2 age groups; group 1 = 0–3 months and group 2 = 36–41 months. A P value < .05 was considered statistically significant. Of the implants, 41% (n = 82) were between 0 and 3 months old, and 59% (n = 118) were between 36 and 41 months old. All (n = 200) of the implants survived and maintained their function. The mean mesial marginal resorption measurement was 0.60 ± 0.65 mm, and the mean distal marginal resorption was 0.77 ± 1.07 mm. There was no statistically significant difference between the amount of mesial and distal marginal bone resorption according to implant age (P > .05). In SLA surface titanium implants with adequate initial primary stability and a 3-month osseointegration period before loading, biological aging of titanium did not affect implant survival and marginal bone resorption.

TiNb coatings were obtained by the electro-explosive doping on the surface of a titanium dental implant (VT6 alloy). The elemental and phase composition was determined by the methods of scanning and transmission electron microscopy and by X-ray structural analysis. The morphology and defective substructure of the coating were studied. Hardness and Young's modulus, friction coefficient and wear resistance of the formed coating were determined. It has been established that the electro-explosive coating is multi-element and multi-phase and possesses submicro-and nanocrystalline structure, high strength and tribological properties. It was found, that the formation of TiNb coating is accompanied by a multiple (more than 2 times) decrease in the wear parameter, i.e. wear resistance increase of the surface layer, an increase in the friction coefficient by 1.5 times, significant increase in hardness (1.5 times) and Young's modulus (1.3 times).

Titanium remains the material of choice in the manufacturing of dental implants because of its exceptional biologic and mechanical properties. However, cases of allergy to titanium have been reported in the literature causing skin, mucosal reactions, systemic symptoms, and eventually implant exfoliation. Although the frequency of these cases varied between 0.6% and 5%, undiagnosed or misdiagnosed cases may possibly increase this percentage significantly. Epicutaneous, intradermal inoculation of the allergen or blood tests (LTT, MELISA, IL1β, IL-6, TNF-α, IL-10) have been used with various degrees of sensitivity and specificity to assess Ti allergy. This case report demonstrated that titanium dental implant allergy caused rapid implant loss following an acute inflammatory reaction and its successful replacement by a one-piece zirconium implant.

Introduction: Implant surface modification methods have recently involved laser treatment to achieve the desired implant surface characteristics. Meanwhile, surface modification could potentially introduce foreign elements to the implant surface during the manufacturing process. Objectives: The study aimed to investigate the surface chemistry and topography of commercially available laser-modified titanium implants, together with evaluating the cell morphology and cell adhesion of human fetal osteoblast (hFOB) seeded onto the same implants. Method: Six (6) samples of commercially available laser-modified titanium implants were investigated. These implants were manufactured by two different companies. Three (3) implants were made from commercially pure grade 4 Titanium (Brand X); and three were made from grade 5 Ti6Al4V (Brand Y). The surface topography of these implants was analyzed by scanning electron microscope (SEM) and the surface chemistry was evaluated with electron dispersive x-ray spectroscopy(EDS). Human fetal osteoblasts were seeded onto the implant fixtures to investigate the biocompatibility and adhesion. Results & Discussion: Brand X displayed dark areas under SEM while it was rarely found on brand Y. These dark areas were consistent with their organic matter. The hFOB cell experiments revealed cell adhesion with filopodia on Brand X samples which is consistent with cell maturation. The cells on Brand Y were morphologically round and lacked projections, one sample was devoid of any noticeable cells under SEM. Cell adhesion was observed early at 48 hrs in laser-irradiated titanium fixtures from both the brands. Conclusion: The presence of organic impurities in Brand X should not be overlooked because disruption of the osseointegration process may occur due to the rejection of the biomaterial in an in-vivo model. Nevertheless, there was insufficient evidence to link implant failure directly with carbon contaminated implant surfaces. Further studies to determine the toxicity of Vanadium from Ti6Al4V in an in-vivo environment should indicate the reason for different cell maturation.

To evaluate the crestal bone response to a two-piece zirconia implant compared with a control titanium implant using periapical radiographs (PAs) and histometry. Thirty zirconia and 30 titanium implants were placed in healed posterior mandibles of five canines. Full-ceramic single-tooth restorations were cemented after 6 weeks of healing. Three observers measured the distance between the implant shoulder and the crestal bone (DIB) at placement, loading, and harvesting after 4 or 16 weeks in function. The influence of implant material and loading time on DIB as well as the inter-observer agreement were analyzed. Additionally, histometric distance between implant shoulder and most coronal bone-to-implant contact (IS-cBIC) was compared with DIB. Mean DIB values increased between 4 and 16 weeks of loading for both zirconia (from 1.66 to 2.25 mm; P

The aim of the present systematic review was to analyse studies using inorganic implant coatings and, in a meta-analysis, the effect of specifically tricalcium phosphate (TCP) and hydroxyapatite (HA) implant surface coatings on bone formation according to the PRISMA criteria. Inclusion criteria were the comparison to rough surfaced titanium implants in large animal studies at different time points of healing. Forty studies met the inclusion criteria for the systematic review. Fifteen of these analyzed the bone-to-implant contact (BIC) around the most investigated inorganic titanium implant coatings, namely TCP and HA, and were included in the meta-analysis. The results of the TCP group show after 14 days a BIC being 3.48% points lower compared with the reference surface. This difference in BIC decreases to 0.85% points after 21-28 days. After 42-84 days, the difference in BIC of 13.79% points is in favor of the TCP-coatings. However, the results are not statistically significant, in part due to the fact that the variability between the studies increased over time. The results of the HA group show a significant difference in mean BIC of 6.94% points after 14 days in favor of the reference surface. After 21-28 days and 42-84 days the difference in BIC is slightly in favor of the test group with 1.53% points and 1.57% points, respectively, lacking significance. In large animals, there does not seem to be much effect of TCP-coated or HA-coated implants over uncoated rough titanium implants in the short term.

BACKGROUND Bone anchored hearing implants (BAHI) are widely used and highly successful, accompanied with a high level of patient satisfaction across most techniques. A large UK teaching hospital switched from the previously used wide diameter titanium fixture and drilling system to the novel minimally invasive technique and laser ablated titanium implant. Before this change the rates of fixture failure and skin problems necessitating abutment change were 1% each. METHODS Retrospective case note review of consecutive BAHI patients drawn from an electronic database between January 2015 and October 2016. RESULTS Data from a total of 118 procedures were reviewed, with different combinations of surgical techniques and implant types. Sixty procedures were performed via the novel minimally invasive technique with 21 failures (35%). Fourty-eight modified minimally invasive technique procedures were performed with seven failures. In 64 of the procedures, laser ablated titanium fixtures were placed with 21 failures (32.8%). In 54 procedures wide diameter titanium fixtures were placed with eight failures (5%). CONCLUSION Initial experience with the novel minimally invasive technique and laser ablated titanium fixture showed significantly higher failure rates than expected. This prompted a change to an open technique and subsequent abandonment of the laser ablated titanium fixture and custom drilling solution in our institution.

Peri-implantitis is an unsolved but critical problem with dental implants. It is postulated that creating a seal of gingival soft tissue around the implant neck is key to preventing peri-implantitis. The objective of this study was to determine the effect of UV surface treatment of titanium disks on the adhesion strength and retention time of oral connective tissues as well as on the adherence of mucosal fibroblasts. Titanium disks with a smooth machined surface were prepared and treated with UV light for 15 min. Keratinized mucosal tissue sections (3 × 3 mm) from rat palates were incubated for 24 h on the titanium disks. The adhered tissue sections were then mechanically detached by agitating the culture dishes. The tissue sections remained adherent for significantly longer (15.5 h) on the UV-treated disks than on the untreated control disks (7.5 h). A total of 94% of the tissue sections were adherent for 5 h or longer on the UV-treated disks, whereas only 50% of the sections remained on the control disks for 5 h. The adhesion strength of the tissue sections to the titanium disks, as measured by tensile testing, was six times greater after UV treatment. In the culture studies, mucosal fibroblasts extracted from rat palates were attached to titanium disks by incubating for 24, 48, or 96 h. The number of attached cells was consistently 15–30% greater on the UV-treated disks than on the control disks. The cells were then subjected to mechanical or chemical (trypsinization) detachment. After mechanical detachment, the residual cell rates on the UV-treated surfaces after 24 and 48 h of incubation were 35% and 25% higher, respectively, than those on the control surfaces. The remaining rate after chemical detachment was 74% on the control surface and 88% on the UV-treated surface for the cells cultured for 48 h. These trends were also confirmed in mouse embryonic fibroblasts, with an intense expression of vinculin, a focal adhesion protein, on the UV-treated disks even after detachment. The UV-treated titanium was superhydrophilic, whereas the control titanium was hydrophobic. X-ray photoelectron spectroscopy (XPS) chemical analysis revealed that the amount of carbon at the surface was significantly reduced after UV treatment, while the amount of TiOH molecules was increased. These ex vivo and in vitro results indicate that the UV treatment of titanium increases the adhesion and retention of oral mucosa connective tissue as a result of increased resistance of constituent fibroblasts against exogenous detachment, both mechanically and chemically, as well as UV-induced physicochemical changes of the titanium surface.

Peri-implantitis leads to implant failure and decreases long-term survival and success rates of implant-supported prostheses. The pathogenesis of this disease is complex but implant corrosion is believed to be one of the many factors which contributes to progression of this disease. A nanostructured titanium dioxide layer was introduced using anodization to improve the functionality of dental implants. In the present study, we evaluated the corrosion performance of silicon carbide (SiC) on anodized titanium dioxide nanotubes (ATO) using plasma-enhanced chemical vapor deposition (PECVD). This was investigated through a potentiodynamic polarization test and bacterial incubation for 30 days. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used to analyze surface morphologies of non-coated and SiC-coated nanotubes. Energy dispersive X-ray (EDX) was used to analyze the surface composition. In conclusion, SiC-coated ATO exhibited improved corrosion resistance and holds promise as an implant coating material.

Statement of problem High-power laser irradiation may be a promising treatment for titanium dental implant surfaces. However, systematic reviews of the influence of high-power laser irradiation on the different properties of titanium surfaces are lacking. Purpose The purpose of this systematic review was to analyze the influence of surface treatment by high-power laser irradiation on the surface properties of titanium and its alloys. Material and methods The PubMed, LILACS, COCHRANE library, and Science Direct databases were searched, and articles published in the last 10 years were included. Of the 725 articles initially identified, 27 were selected after full reading and the application of inclusion and exclusion criteria. Results The studies evaluated showed that laser irradiation treatment, depending on the settings and parameters used, promoted changes in the surface properties of titanium. In general, lower speed and a higher number of scans increased roughness. Laser surface treatment promoted the inclusion of more oxygen and improved the wetting capacity of titanium. Additionally, laser treatment improved the adherence of coatings. Conclusions Changes in the surface properties of titanium after laser treatment have been demonstrated. However, determining protocols with specific parameters is necessary to optimize the results.

Aim of the present study was to investigate the bacterial adhesion to titanium (Ti) implant surfaces, different for composition and topographic features. Grade 4 and 5 turned (T-4, T-5,) and mildly acid-etched (MA-4, MA-5) Ti 6 × 1 mm disks were topographically analyzed by scanning electronic microscopy and 3D profilometry. Bacterial cultures (Streptococcus sanguinis) were in vitro seeded and, after two and six hours, adherent bacteria were quantified by colony-forming unit (CFU) counting. Ti samples were also exposed to the oral environment of six periodontally healthy volunteers and, after 12 h, the formed biofilm was evaluated by CFU counting. Inter-group differences were tested by the Mann–Whitney U-Test (α = 0.05). MA surfaces were significantly rougher than T ones, whereas no difference between grade 4 and grade 5 disks was detected. Significantly higher in vitro bacterial adhesion for MA than T disks was shown at two and six hours. Significantly higher values of CFU counting for MA than T surfaces and for grade 5 than grade 4 disks were found at the 12 h-ex vivo test. Bacterial adhesion showed to be sensitive to both Ti surface topography and composition, with possible implications on peri-implant tissue health maintenance.

Objective Researchs of the effects of ankaferd blood stopper (ABS) on bone healing metabolism have revealed that it affects bone regeneration positively. The exact mechanism by which this positive effect on bone tissue metabolism is not known. The aim of this study is to biomechanic and biochemical analysis of the effects of the local ABS application on osseointegration of 3 different surfaced titanium implants. Material & Methods Spraque dawley rats were divided machined surfaced (MS) (n ​= ​10), sandblasted and large acid grid (SLA) (n ​= ​10) and resorbable blast material (RBM) (n ​= ​10) surfaced implants. ABS applied locally during the surgical application of the titanium implant before insertion in bone sockets. After 4 weeks experimental period the rats sacrificed and implants with surrounding bone tissues were removed to reverse torque analysis (Newton), blood samples collected to biochemical analysis (ALP, calcium, P) Results Biomechanic bone implant contact ratio detected higher in SLA surfaced implants compared with the RBM and controls (P ​< ​0,05). Phosphor levels detected lower in RBM implant group compared with the controls and SLA (P ​< ​0,05). Additionally; phosphor levels detected highly in controls compared with the RBM implants. Conclusion According the biomechanical parameters ABS may be more effective in SLA and RBM surfaced implants when locally applied.

Medical grade titanium alloy, Ti-6Al-4V, with TiO2 nanotubes (TiO2-NTs) grown on the surface and then decorated with silver nanoparticles (Ag NPs) is proposed to enhance the antimicrobial propertie...

This study aimed to investigate whether strontium (Sr) ion delivery to the surface of microstructured titanium (Ti) oral implants drives favorable osteoblast functions of mesenchymal stem cells (MS...

The main aim of this review study was to report the state of art on the nano-scale technological advancements of titanium implant surfaces to enhance the osseointegration process. Several methods of surface modification are chronologically described bridging ordinary methods (e.g. grit blasting and etching) and advanced physicochemical approaches such as 3D-laser texturing and biomimetic modification. Functionalization procedures by using proteins, peptides, and bioactive ceramics have provided an enhancement in wettability and bioactivity of implant surfaces. Furthermore, recent findings have revealed a combined beneficial effect of micro- and nano-scale modification and biomimetic functionalization of titanium surfaces. However, some technological developments of implant surfaces are not commercially available yet due to costs and a lack of clinical validation for such recent surfaces. Further in vitro and in vivo studies are required to endorse the use of enhanced biomimetic implant surfaces. STATEMENT OF SIGNIFICANCE: Grit-blasting followed by acid-etching is currently used for titanium implant modifications, although recent technological biomimetic physicochemical methods have revealed enhanced osteoconductive and anti-microbial outcomes. An improvement in wettability and bioactivity of titanium implant surfaces has been accomplished by combining micro and nano-scale modification and functionalization with protein, peptides, and bioactive compounds. Such morphological and chemical modification of the titanium surfaces induce the migration and differentiation of osteogenic cells followed by an enhancement of the mineral matrix formation that accelerate the osseointegration process. Additionally, the incorporation of bioactive molecules into the nanostructured surfaces is a promising strategy to avoid early and late implant failures induced by the biofilm accumulation.

The goal of this work is to evaluate a common final sterilization technique with EtO by measuring its effect on the physicochemical properties of PVD deposited TiN/TiO2 coatings on Ti-5Al-4V alloy. As the effectiveness of EtO sterilization corresponds to the operation parameters (temperature, duration, humidity, etc.), two different exposure cycles (cool (MS) at 37 °C for 220 min gas expose and warm (SS) at 55 °C for 100 min expose) were examined. SEM analysis revealed that the surface morphology of the coatings was not changed after both MS and SS treatments. In contrast to Ti 2p and O 1s peaks determined by XPS analysis, C 1s peak of TiO2 layer decreased with increasing sterilization temperature while the percentage contribution of Ti-OH in O 1s increased. This affected the surface hydrophilicity and free energy that increased from 47.37 for the control sample to 50.77 mJ m-2 in the case of SS specimen. Additionally, EtO sterilized samples demonstrated decreased values of corrosion and passivation current densities in simulated body fluid (pH 7.4) at 37 ± 0.05 °C as opposed to the control sample. The results indicate the suitability of both mild and severe EtO sterilization methods for improvement of the desired physicochemical properties of gradient TiN/TiO2 coatings.