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Objective: The influence of radiation backscatter from titanium on DNA damage and migration capacity of human osteoblasts (OBs) and mesenchymal stem cells (MSCs) may be critical for the osseointegration of dental implants placed prior to radiotherapy. In order to evaluate effects of radiation backscatter, the immediate DNA damage and migration capacity of OBs and MSCs cultured on titanium or plastic were compared after exposure to ionizing irradiation. Materials and methods: Human OBs and MSCs were seeded on machined titanium, moderately rough fluoride-modified titanium, or tissue culture polystyrene, and irradiated with nominal doses of 2, 6, 10, or 14 Gy. Comet assay was performed immediately after irradiation, while a scratch wound healing assay was initiated 24 h post-irradiation. Fluorescent live cell imaging documented the migration. Results: DNA damage increased with higher dose and with backscatter from titanium, and MSCs were significantly more affected than OBs. All doses of radiation accelerated the cell migration on plastic, while only the highest dose of 10 Gy inhibited the migration of both cell types on titanium. Conclusions: High doses (10 Gy) of radiation inhibited the migration capacity of both cell types on titanium, whereas lower doses (2 and 6 Gy) did not affect the migration of either OBs or MSCs. Clinical relevance: Fractionated doses of 2 Gy/day, as distributed in conventional radiotherapy, appear not to cause severe DNA damage or disturb the migration of OBs or MSCs during osseointegration of dental implants. [ABSTRACT FROM AUTHOR]

A double acid corrosion and subsequent hydrothermal treatment were used to fabricate a micro–nano-structured Ti substrates (Ti–M–N). Afterward, the mesoporous polydopamine (MPDA) nanoparticles as photothermal agent were prepared and immobilized on the surface of Ti–M–N samples, in order to obtain Ti–M–N-MPDA sample. Unique micro–nanostructure properties and the photothermal effect of the modified Ti implant caused physical stress on the bacteria and the bacterial membrane damage, and eventually led to bacteria death. More importantly, based on excellent bioactivity and cytocompatibility of mussel-inspired materials, MPDA promoted adhesion, proliferation and osteogenic differentiation of mesenchymal stem cells in vitro. Furthermore, animal experiments in vivo further confirmed that the modified Ti implants could enhance osseointegration. 摘要: 使用双酸腐蚀和随后的水热处理来制造微纳米结构的 Ti 衬底 (Ti-M-N)。 随后, 制备了作为光热剂的介孔聚多巴胺 (MPDA) 纳米颗粒并将其固定在 Ti-M-N 样品的表面, 以获得 Ti-M-N-MPDA 样品。 独特的微纳米结构特性和改性钛植入物的光热效应对细菌造成物理压力和细菌膜损伤, 最终导致细菌死亡。 更重要的是, 基于贻贝材料优异的生物活性和细胞相容性, MPDA在体外促进间充质干细胞的粘附、增殖和成骨分化。 此外, 体内动物实验进一步证实, 改性钛植入物可以增强骨整合 [ABSTRACT FROM AUTHOR]

Background: Implant-associated infections (IAI) remain a challenging complication in osteosynthesis. There is no consensus or clear evidence whether titanium offers a relevant clinical benefit over stainless steel. Purpose: In this systematic review, we sought to determine whether the implant properties of titanium reduce the susceptibility to IAI compared to stainless steel in fracture management. Methods: A systematic literature search in German and English was performed using specific search terms and limits. Studies published between 1995 and 1st June 2020 in the Cochrane library, MEDLINE and Web of Science databases were included. Only clinical studies comparing titanium and stainless steel implants regarding the susceptibility to infections were selected for detailed review. Results: Five studies out of 384 papers were identified and reviewed. From the studies meeting inclusion criteria one study was a systematic review, two studies were randomized controlled studies (RCT) and two studies were of retrospective comparative nature of level IV evidence. Conclusion: Our results show that currently, no proven advantage for titanium implants in respect to IAI can be seen in contemporary literature. Implants preserving periosteal blood-flow and minimising soft-tissue trauma show statistically significant benefits in reducing the incidence of IAI. Clinical studies providing reliable evidence regarding the influence of titanium implants on IAI and investigating the susceptibility of titanium to infection are necessary [ABSTRACT FROM AUTHOR]

Titanium implant success is compromised by microbial biofilms and aseptic loosening. This research aimed to develop robust multifunctional class II organic-inorganic hybrid coatings for implants with osteoconductive and antibacterial properties. 3-Glycidoxypropyltrimethoxysilane was coupled with organic polymer poly(ethylene) glycol-diamine (PEG-NH2) for integration into an inorganic sol backbone composed of tetraethoxysilane and calcium, which was sourced from newly synthesized calcium-2-ethoxyethoxide. Nuclear magnetic resonance and attenuated total reflectance Fourier transform infrared spectroscopy confirmed synthesis of precursors and the structure of coating constituents. Scanning electron microscopy and energy-dispersive X-ray spectroscopy (EDS) demonstrated homogenous coatings, micro-topographical surface features, and apatite-like ex vivo mineralization in simulated body fluid. Tensile adhesion testing demonstrated robust and highly adherent (15.1 ± 3.3 MPa) coatings on titanium substrates. Hybrid coatings imbedded with silver nanoparticles (nAg) significantly inhibited (P < 0.05) Staphylococcus aureus and Escherichia coli planktonic cultures and biofilm formation. These Si-Ca-PEG-nAg hybrid coatings for titanium implants offer robust multifunctional features. [ABSTRACT FROM AUTHOR]

Background: Calcium (Ca) is a well-known element in bone metabolism and blood coagulation. Here, we investigate the link between the protein adsorption pattern and the in vivo responses of surfaces modified with calcium ions (Ca-ion) as compared to standard titanium implant surfaces (control). We used LC–MS/MS to identify the proteins adhered to the surfaces after incubation with human serum and performed bilateral surgeries in the medial section of the femoral condyles of 18 New Zealand white rabbits to test osseointegration at 2 and 8 weeks post-implantation (n=9). Results: Ca-ion surfaces adsorbed 181.42 times more FA10 and 3.85 times less FA12 (p<0.001), which are factors of the common and the intrinsic coagulation pathways respectively. We also detected differences in A1AT, PLMN, FA12, KNG1, HEP2, LYSC, PIP, SAMP, VTNC, SAA4, and CFAH (p<0.01). At 2 and 8 weeks post-implantation, the mean bone implant contact (BIC) with Ca-ion surfaces was respectively 1.52 and 1.25 times higher, and the mean bone volume density (BVD) was respectively 1.35 and 1.13 times higher. Differences were statistically significant for BIC at 2 and 8 weeks and for BVD at 2 weeks (p<0.05). Conclusions: The strong thrombogenic protein adsorption pattern at Ca-ion surfaces correlated with significantly higher levels of implant osseointegration. More effective implant surfaces combined with smaller implants enable less invasive surgeries, shorter healing times, and overall lower intervention costs, especially in cases of low quantity or quality of bone. [ABSTRACT FROM AUTHOR]

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Bioactive coatings on implants affect osteogenic differentiation of mesenchymal stem cells (MSC). We studied the morphofunctional state of bone marrow MSC cultured on the surface of calcium phosphate coatings on titanium formed by plasma electrolytic oxidation (PEO). The biocompatible properties of the coatings manifested in the absence of the cytotoxic effect on cells. High expression of receptors (CD90, CD29, and CD106), enhanced synthesis of osteocalcin and osteopontin, and changes in surface architectonics of MSC adherent to the samples confirmed osteoinductive properties of the calcium phosphate PEO coating. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate the modulating effect of ionizing radiation, blood cytokine levels, and bone remodeling of the interface around the implant to understand the radiation mechanisms which can impair the implants receptor site. Material and methods: Sixty rats were submitted to grade V titanium implants in the femurs and were divided into the following groups: no-irradiation (N-Ir): control group with implant only; early-irradiation (E-Ir): implant + irradiation after 24 h; late-irradiation (L-Ir): implant + irradiation after 4 weeks; and previous-irradiation (P-Ir): irradiation + implant after 4 weeks. The animals in the E-Ir, L-Ir, and P-Ir groups were irradiated in two fractional stages of 15 Gy. At 3 days, 2 weeks, and 7 weeks after the final procedure, five animals were randomly euthanized per group. Serum levels of TNF-ɑ, IL-1β, TGF-β, IL-6, M-CSF, and IL-10 were measured from blood collected prior to euthanasia using the ELISA test. The pieces containing the implants were subjected to immunohistochemical labeling using the tartrate acid resistant to phosphatase, osteocalcin, and caspase-3 markers and mCT. The ANOVA test was used for statistical analysis, and the Tukey multiple comparison test (p < 0.05) was applied. Results: The results indicated that ionizing radiation modifies the production of pro- and anti-inflammatory serum cytokines, the expression of proteins involved in bone remodeling and cellular apoptosis, as well as changes in bone formation. Conclusions: The results suggests that a longer period between radiotherapy and implant placement surgery when irradiation occurs prior to implant installation would allow the recovery and renewal of bone cells and avoid future failures in osseointegration. Clinical relevance: The search for modifications caused by ionizing irradiation in bone tissue can indicate the ideal period for implant placement without affecting the osseointegration process. [ABSTRACT FROM AUTHOR]

Purpose: Frontal bone deformities can be acquired due to trauma or ablative tumor resection surgeries and osteomyelitis. It may also occur due to congenital malformations. Repair of these defects have long been a challenge to oral and maxillofacial surgeons. We report our experience in the reconstruction of acquired frontal bone defects by titanium mesh implant.Patients and Methods: Titanium mesh was used for reconstruction in 35 patients (18-55 years age-group) (34 males and 01 females) of acquired frontal bone defects secondary to trauma (RTA). All these patients have been referred to author by Department of Neurosurgery of the institute of Affiliation.Results: All these cases acquired defects as a result of trauma. Follow-up ranged from 12 to 18 months after the reconstruction. Patients were followed up for the progress of healing, stability of implants, infection, wound dehiscence, discharging sinus, exposure of implants, collections, patient satisfaction regarding esthetics and reaction to thermal changes. No postoperative complications were found.Conclusion: In reconstruction of frontal bone defects, titanium mesh gives satisfactory results. [ABSTRACT FROM AUTHOR]

Objective: Staphylococcus epidermidis, as a primary colonizer, is strongly associated with infections of (dental) implants (i.e., peri-implantitis), but little is known about the surface proteome of this bacterium. For the identification of bacterial adhesins, this study investigated the surface proteome of S. epidermidis adhering directly to titanium implant substrata.Materials and methods: S. epidermidis strain ATTC 35984 was cultured either planktonically or on titanium implant specimens. The surface proteomes were isolated by mutanolysin digestion, and proteins were separated by 2D gel electrophoreses to reveal highly expressed proteins only. Protein spots were visualized by silver staining and proteins were identified by mass spectrometry.Results: Surface proteome analyses of S. epidermidis on titanium identified six expressed proteins. Three proteins were highly expressed on the titanium implants including accumulation-associated protein Q8CQD9. These specific proteins could be potential pathogenicity factors of bacteria in peri-implant biofilms.Conclusion: For the first time, our study identified S. epidermidis surface proteins, which are expressed after adhesion to titanium implant materials.Clinical relevance: Our study reveals possible candidates for a newly protein-based vaccine against peri-implantitis. [ABSTRACT FROM AUTHOR]

Recombinant human bone morphogenetic protein-2 with an additional s-tag domain (s-tag-BMP-2) synthesized in E. coli is characterized by higher solubility and activity than the protein without additional s-tag domain, which increases the yield during purification and simplifies protein introduction into the osteoplastic materials. The high osteoinductivity of the demineralized bone matrix with s-tag-BMP-2 was shown on the model of regeneration of cranial defects of a critical size in mice and on the model of implantation of porous titanium matrix into defects of femoral and tibial bones in rabbits. [ABSTRACT FROM AUTHOR]

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Surface modification techniques have been applied to generate titanium implant surfaces that promote osseointegration for the implants in cementless arthroplasty. However, its effect is not sufficient for osteoporotic bone. Strontium (Sr) promotes osteoblast proliferation and inhibits osteoclast proliferation and positively affects bone regeneration. The aim of this study was to confirm the effects of strontium-substituted hydroxyapatite (Sr-HA) coating via electrochemical deposition on implant's osseointegration in the osteoporotic condition. Female Sprague Dawley rats were used for this study. Twelve weeks after bilateral ovariectomy, all animals were randomly divided into four groups: group HA; group 5 % Sr-HA; group 10 % Sr-HA; and group 20 % Sr-HA. Afterward, all rats from groups HA, 5 % Sr-HA, 10 % Sr-HA, and 20 % Sr-HA received implants with hydroxyapatite coating containing 0, 5, 10, and 20 % Sr. Implants were inserted bilaterally in all animals until death at 12 weeks. The bilateral femurs of rats were harvested for evaluation. All treatment groups increased new bone formation around the surface of titanium rods and push-out force; group 20 % Sr-HA showed the strongest effects on new bone formation and biomechanical strength. Additionally, these are significant differences in bone formation and push-out force was observed between groups 5 % Sr-HA and 10 % Sr-HA. This finding suggests that Sr-HA coating can improve implant osseointegration, and the 20 % Sr coating exhibited the best properties for implant osseointegration among the tested coatings in osteoporosis rats. [ABSTRACT FROM AUTHOR]

Surface topography of Titanium (Ti) dental implants strongly influences osseointegration. In the present work, we have analyzed the influence of two Ti implant surfaces characterized by similar microtopography but different nanotopography and chemistry on the osteoblastic phenotype of Dental Pulp Stem Cells (DPSCs). The effect on osteogenic differentiation, extracellular matrix (ECM) and cell adhesion molecules production have been evaluated by means of molecular biology analyses. The morphology of the cells grown onto these surfaces has been analyzed with SEM and immunofluorescence (IF), and the safety of the surfaces has been tested by using karyotype analysis, Ames test and hemocompatibility assay. Results showed that starting from 15 days of DPSCs culture, a substantial expression of osteoblast specific markers and a strong increase of cell adhesion molecules can be detected. In particular, when DPSCs are seeded on the Ti implants expression of microRNA (miRNA)-196a, which is involved in osteoblastic commitment of stem cells, and of Vascular Cell Adhesion Molecule 1 (VCAM1), a factor involved in angiogenesis, is strongly enhanced. [ABSTRACT FROM AUTHOR]

Objective: Although an extensive amount of research has demonstrated the positive effects of an enamel matrix derivative (EMD) on soft tissue wound healing around intrabony defects, little information is available describing its effect on peri-implant soft tissues, an area that has recently gained tremendous awareness due to the increasing prevalence of peri-implantitis. The aim of the present study was to assess the role of EMD when gingival fibroblasts were cultured on titanium surface with different surface topographies. Methods: Human primary gingival fibroblasts were cultured on pickled (PT) and sand-blasted with large grit followed by acid etching (SLA) surfaces and assessed for cell adhesion at 2, 4, and 8 h, cell morphology at 2, 4, 8, and 24 h as well as cell proliferation at 1, 3, and 5 days post-seeding. Furthermore, genes encoding collagen 1a1, vascular endothelial growth factor-A (VEGF-A), and fibronectin were assessed by real-time PCR. Human gingival fibroblasts were also quantified for their ability to synthesize a collagen matrix on the various titanium surfaces with and without EMD by immunofluorescence staining. Results: The results from the present study demonstrate that EMD significantly increased cell spreading at 2, 4, 8, and 24 h on PT surfaces and 4, 8, and 24 h on SLA surfaces. Furthermore, proliferation at 5 days on PT surfaces and 3 and 5 days on SLA surfaces was also increased for groups containing EMD. Real-time PCR results demonstrated that the culture of gingival fibroblasts with EMD significantly increased extracellular matrix synthesis of collagen 1 as well as improved mRNA levels of VEGF-A and fibronectin. Collagen1 immuno-fluorescent staining revealed a significantly higher area of staining for cells seeded on PT + EMD at 7 and 14 days and 14 days for SLA + EMD when compared to control samples. Conclusion: The results from the present study favor the use of EMD for colonization of gingival fibroblasts on titanium surfaces by increasing cell growth, spreading, and synthesis of an extracellular matrix. The improvements were primarily irrespective of surface topography. Future animal and human studies are necessary to fully characterize the beneficial effects of incorporating EMD during soft tissue regeneration of implant protocols. Clinical relevance: The use of EMD may speed up the quality of soft tissue integration around dental implants by facilitating gingival cell attachment, proliferation, and matrix synthesis of collagen 1. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to analyze the capacity of a new modified laser surface to stimulate calvarial osteoblasts isolated from neonatal mouse bones to differentiate and form mineralized nodules. Methods: Titanium discs were subjectezd or not to laser irradiation according to specific parameters and characterized. Osteoblasts isolated from neonatal mouse calvaria were cultured over the discs, and the capacity of these cells to proliferate (MTT assay), form mineralized nodules (Alizarin red assay), and enhance alkaline phosphatase activity (ALPase activity) was analyzed. Real-time PCR was used for quantification of gene expression. Results: Laser-irradiated titanium discs (L) presented a rough nano-to-micrometric oxidized surface contrasting with the smooth pattern on polished discs (P). The R on the micrometric level increased from 0.32 ± 0.01 μm on P surfaces to 10.57 ± 0.39 μm on L surfaces. When compared with P, L promoted changes in osteoblast morphology, increased mineralized nodule formation in osteoblasts cultured on the surfaces for 14 days, and enhanced ALPase activity at days 7 and 14. Transcription factors triggering osteoblast differentiation ( Runx2 and Sp7) and genes encoding the bone extracellular matrix proteins collagen type-1 ( Col1a1), osteopontin ( Spp1), and osteocalcin ( Bglap) were upregulated in cells on L surfaces compared with those on P surfaces at days 1-14. Conclusion: Laser treatment of titanium surfaces created a rough surface that stimulated osteoblast differentiation. Clinical relevance: Laser treatment of titanium generates a reproducible and efficient surface triggering osteoblast differentiation that can be of importance for osteointegration. [ABSTRACT FROM AUTHOR]

Single point incremental forming (SPIF) is a relatively new manufacturing process that has been recently used to form medical grade titanium sheets for implant devices. However, one limitation of the SPIF process may be characterized by dimensional inaccuracies of the final part as compared with the original designed part model. Elimination of these inaccuracies is critical to forming medical implants to meet required tolerances. Prior work on accuracy characterization has shown that feature behavior is important in predicting accuracy. In this study, a set of basic geometric shapes consisting of ruled and freeform features were formed using SPIF to characterize the dimensional inaccuracies of grade 1 titanium sheet parts. Response surface functions using multivariate adaptive regression splines (MARS) are then generated to model the deviations at individual vertices of the STL model of the part as a function of geometric shape parameters such as curvature, depth, distance to feature borders, wall angle, etc. The generated response functions are further used to predict dimensional deviations in a specific clinical implant case where the curvatures in the part lie between that of ruled features and freeform features. It is shown that a mixed-MARS response surface model using a weighted average of the ruled and freeform surface models can be used for such a case to improve the mean prediction accuracy within ±0.5 mm. The predicted deviations show a reasonable match with the actual formed shape for the implant case and are used to generate optimized tool paths for minimized shape and dimensional inaccuracy. Further, an implant part is then made using the accuracy characterization functions for improved accuracy. The results show an improvement in shape and dimensional accuracy of incrementally formed titanium medical implants. [ABSTRACT FROM AUTHOR]

Summary: We established a chronic kidney disease (CKD) mouse model with estrogen deficiency and inserted titanium implants into the femur of such mice to investigate the fixation of the implants. Both the histomorphometry and implant resistance indicated that estrogen deficiency impaired the fixation of titanium implants inserted into such mice. Introduction: CKD has been regarded as a worldwide public health problem. Estrogen is a critical factor for both renal protection and bone remodeling. A previous study demonstrated that CKD impairs the early healing of titanium implants. However, the combined effect of estrogen deficiency and CKD on the fixation of titanium implants is largely unknown. Methods: Forty 9-week-old female C57BL mice were randomly divided into sham, ovariectomy (OVX), CKD, and CKD + OVX groups. Uremia and estrogen deficiency were induced by 5/6 nephrectomy and OVX, respectively. Experimental titanium implants were inserted into the distal end of the femur. Bone-implant contact (BIC) ratio and bone volume (BV/TV) around the implants were histomorphometrically analyzed. The fixation strength of the implant was measured by a biomechanical push-in resistance test. Results: Serum measurement confirmed a significant increase in serum blood urea nitrogen (BUN) in the CKD group, which was further increased by OVX. Estrogen deficiency led to significant decreases in the BIC ratio, BV/TV, and the push-in resistance in CKD animals. There was a significant interaction between the effects of OVX and CKD, with OVX exacerbating the effects of CKD on BIC ratio and push-in resistance. Conclusions: The results indicated that estrogen deficiency exerts a synergistic effect with CKD and further impairs the fixation of titanium implants in CKD mice. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluates two basic hypotheses: (1) the risk of an isolated dorsal approach to ventral lumbar spondylodiscitis based on clinical and radiographic results and (2) the risk of anterior radical debridement due to using a titanium implant in the site of bone infection. Methods: Group A consisting of 23 patients was treated only by a dorsal transmuscular approach and group B consisting of eight patients was treated by two-stage posteroanterior surgery. Both evaluated groups were assessed before surgery, six weeks and one year after surgery with the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) and Kirkaldy-Willis functional criteria. To evaluate the sagittal balance restoration, measurement by the Cobb modified angle of the affected segment was performed. Results: Differences ( p < 0.001) in group A were found between JOA values before surgery (average 9.30) and at six weeks after surgery (average 11.82) and 12 months after surgery (13.27) and VAS differences before surgery (average 7.39), six weeks after surgery (average 3.82) and 12 months after surgery (average 2.36) in group A. According to the Kirkaldy-Willis functional criteria, 11 patients were evaluated as excellent, nine patients as good and two patients as poor. The values of the JOA score in group B showed an improvement compared with the JOA values before surgery (average 9.38) at six weeks after surgery (average 11.75) and 12 months after surgery (average 13.63), and the VAS score before surgery (average 7.38) was found to have improved six weeks after surgery (average 4.63) and 12 months after surgery (average 2.25). The functional evaluation according to the Kirkaldy-Willis functional criteria assessed three patients as excellent, four patients as good and one patient as fair. Radiographic examinations of group A revealed the following findings before surgery (average 1.75), six months after surgery (average −3.73) and 12 months after surgery (average −0.79) and in group B before surgery (average 3.71), six weeks after surgery (average −8.21) and 12 months after surgery (average −6.45). Conclusions: The results demonstrate the minimum serious surgical complications and greater loss of sagittal balance without clinical correlation in group A. We did not find any relapse or persistence of the infection in the post-operative period in group B. [ABSTRACT FROM AUTHOR]

The structure of the surface of steam-heat-deposited oxide coatings on medical implants from biologically inert titanium alloy VT6 is studied by the methods of microprocessor profilometry, light microscopy, and computer processing of microimages. The capacity of the coatings for integrative interaction with bone tissue is determined. [ABSTRACT FROM AUTHOR]

Objectives: The main purpose of this work was to assess the short-term bone regenerative potential of new osteoconductive implants. The novelty of the study lies in the analysis of the effectiveness of a novel two-step treatment which combines shot-blasting with a thermo-chemical treatment, at very short times after implant placement in a minipig model. Materials and methods: Three hundred twenty implants with four different surface treatments, namely bioactivated surfaces, micro-rough grit-blasted, micro-rough acid-etched and smooth as-machined titanium implants were placed into the bone of 20 minipigs. The percent of bone-to-implant contact was determined 3 days, 1, 2, 3 and 10 weeks after implant placement by histomorphometric analysis. Surface composition, topography and wettability of the implant specimens were analysed. Results: The combination of shot-blasting and thermo-chemical treatment accelerated bone regeneration at early stages in comparison with all other treatments between day 3 and week 3 ( p < 0.05). The value of osseointegration attained at week 2 was maintained until the end of the experiment without any significant changes (percent direct contact ≈ 85 %). This was mostly attributed to the ability of these implants to form in vivo a layer of apatitic mineral that coated the implant and could rapidly stimulate bone nucleation and growth from the implant surface. Conclusions: The surface quality resulting from this treatment on cpTi provided dental implants with a unique ability of rapid bone regeneration and osseointegration. Clinical relevance: This treatment represents a step forward in the direction of reducing the time prior to implant loading. [ABSTRACT FROM AUTHOR]

Microbial colonization and biofilm formation on implanted devices represent an important complication in orthopaedic and dental surgery and may result in implant failure. Controlled release of antibacterial agents directly at the implant site may represent an effective approach to treat these chronic complications. Resistance to conventional antibiotics by pathogenic bacteria has emerged in recent years as a major problem of public health. In order to overcome this problem, non-conventional antimicrobial agents have been under investigation. In this study, polyacrylate-based hydrogel thin coatings have been electrosynthesised on titanium substrates starting from poly(ethylene glycol diacrylate)- co-acrylic acid. Silver nanoparticles (AgNPs) with a narrow size distribution have been synthesized using a 'green' procedure and immobilized on Ti implant surfaces exploiting hydrogel coatings' swelling capabilities. The coatings have been characterized by XPS and SEM/EDX, while their silver release performances have been monitored by ICP-MS. The antibacterial activity of these AgNP-modified hydrogel coatings was tested evaluating in vitro inhibition growth of Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli, among the most common pathogens in orthopaedic infections . Moreover, a preliminary investigation of the biocompatibility of silver-loaded coatings versus MG63 human osteoblast-like cells has been performed. An important point of strength of this paper, in fact, is the concern about the effect of silver species on the surrounding cell system in implanted medical devices. Silver ion release has been properly tuned in order to assure antibacterial activity while preserving osteoblasts' response at the implant interface. [Figure not available: see fulltext.] [ABSTRACT FROM AUTHOR]

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Pulsed laser deposition (PLD) has emerged as an acceptable technique to coat hydroxyapatite on titanium-based permanent implants for the use in orthopedics and dentistry. It requires substrate temperature higher than 400°C to form coatings of good adhesion and crystallinity. As this range of temperatures is likely to affect the bulk mechanical properties of the implant, lowering the substrate temperature during the coating process is crucial for the long-term performance of the implant. In the present study, hydroxyapatite target was ablated using a pulsed Nd:YAG laser (355 nm) onto commercially pure titanium substrates kept at 200°C. The coating thus obtained has been subjected to hydrothermal treatment at 200°C in an alkaline medium. The coatings were analysed using microscratch test, optical profilometry, scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), X-ray diffraction (XRD) and infrared spectroscopy (FTIR). XRD, EDS and FTIR showed that the as-deposited coating contained amorphous calcium phosphate and the hydrothermal treatment converted it into crystalline hydroxyapatite. The micro-morphology was granular, with an average size of 1 micron. In the micro-scratch test, a remarkable increase in adhesion with the substrate was seen as a result of the treatment. The plasma plume during the deposition has been analysed using optical emission spectroscopy, which revealed atomic and ionic species of calcium, phosphorous and oxygen. The outcomes demonstrate the possibility of obtaining adherent and crystalline hydroxyapatite on titanium substrate at 200°C through pulsed laser deposition and subsequent hydrothermal treatment. [ABSTRACT FROM AUTHOR]

Summary: This study evaluates the effect of zoledronic acid (ZOL) on the osseointegration of titanium implants in rabbits with glucocorticoid (GC)-induced bone loss, and our findings demonstrated that a single dose of ZOL is able to reverse the detrimental effects of GCs on the osseointegration of titanium implants. Introduction: The purpose of this study is to evaluate the effect of ZOL on the osseointegration of titanium implants in rabbits with GC-induced bone loss. Methods: Three groups of six NZW rabbits were treated for 18 weeks with saline (SALINE), GC (methylprednisolone, 0.35 mg/kg three times a week), or GC + ZOL (methylprednisolone + single dose of ZOL, 0.1 mg/kg). The animals received a titanium implant in the left tibia after 6 weeks and were killed at the 18th week. Bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry at baseline, eighth week (W8), and 18th week (W18) after treatment to determine the change upon treatment (∆BMD). Histomorphometric and serum bone alkaline phosphatase analysis (BAP) were also performed. Results: At W8, GC group had a significant reduction in lumbar spine and tibia BMD compared with SALINE ( p = 0.003 and p = 0.000), as also observed for GC + ZOL group ( p = 0.014 and p = 0.003) just 2 weeks after ZOL treatment. In contrast, at W18, the GC + ZOL had an evident BMD rescue with similar lumbar spine and tibia ∆BMD compared with SALINE (0.043 ± 0.006 vs. 0.055 ± 0.009 g/cm, p = 0.457 and 0.027 ± 0.003 vs. 0.041 ± 0.011 g/cm, p = 0.232) and a significantly higher ∆BMD compared with the GC ( p = 0.024 and p = 0.001). Histomorphometry revealed that osseointegration was significantly reduced in GC (tibia cortical thickness and diameter, bone-implant contact, total and peri-implant bone area) whereas GC + ZOL had these parameters similar to SALINE ( p > 0.05). Likewise, ZOL reversed the BAP alteration induced by GC. Conclusions: Our findings demonstrated that a single dose of ZOL is able to reverse the detrimental effects of glucocorticoids on the osseointegration of titanium implants, suggesting that ZOL therapy may improve the outcome of bone implants in patients with glucocorticoid-induced osteoporosis. [ABSTRACT FROM AUTHOR]

Titanium (Ti) has long been regarded as an inert and biocompatible metal, ideal for biomedical applications such as dental implants or joint replacements. However, concerns about the biocompatibility of Ti have lately arisen. Unfortunately, information on reliable Ti baseline physiological levels in blood and organ tissues is still pending and the real effects of physiological corrosion as opposed to wear processes of Ti or Ti alloys implants is controversial so far. In this work a previously developed and validated methodology, based on using double-focusing inductively coupled plasma mass spectrometry (DF-ICP-MS) has been used to establish Ti basal levels in blood and organs (heart, liver, spleen, kidneys, and lungs) of Wistar rats. These data were compared with the levels found in three Wistar rats implanted with a Ti wire embedded in their femur for 18 months, in order to assign possible Ti released purely due to non-wear physiological mechanisms. Results showed that Ti content in all the selected organ tissues and blood was higher than previously determined Ti basal levels, clearly showing both corrosion of the Ti implant and systemic Ti accumulation in target tissues. These results indicate that Ti metal corrosion occurs. This seems to be the only mechanism responsible in the long term for the observed passive dissolution of Ti of the implant in the absence of wear. A comparative study of the systemic distribution of the soluble and particulate Ti potentially released from Ti implants was also carried out by intraperitoneally injection of soluble Ti(citrate)3 and insoluble TiO2 particles, respectively. Different systemic Ti storage was observed. Whereas soluble Ti was rapidly transported to all distal organs under study, TiO2 particles were only accumulated in lung tissue. [ABSTRACT FROM AUTHOR]

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The purpose of the present study was to investigate the effects of an enamel matrix protein derivative (EMD) on attachment, proliferation, and viability of human SaOs2 osteoblasts on titanium implants. A total of 220 sand-blasted and acid-etched (SLA) titanium discs were placed into 24-well culture plates. Before cell inoculation, McCoy’s 5A medium (MCM) containing EMD at 25 µg/ml, 50 µg/ml, 100 µg/ml, and 200 µg/ml was added, and the culture plates were incubated for 30 min. As control, MCM alone was used. Human osteoblast-like cells (SaOs2) (2×104 cells, fourth passage) were suspended in MCM containing 1% penicillin/streptomycin and 10% fetal bovine serum and then inoculated into the well chambers. The medium was changed after 3 days without the addition of EMD. At days 1, 3, and 6, DNA content of the cells was assessed using the CyQuant cell proliferation assay kit, and mitochondrial activity of the cells was measured using a CellTiter-Glo luminescent cell viability assay. The presence of EMD on the titanium discs at days 1 and 6 was evaluated using immunofluorescence stain (IFS) by means of polyclonal antibodies against amelogenin. Additionally, cell morphology was investigated using scanning electron microscopy. Enamel matrix derivative at 25 µg/ml, 50 µg/ml, 100 µg/ml, and 200 µg/ml demonstrated similar increases in cell proliferation as the control medium at days 3 and 6 (P>0.05 between groups, respectively). Proliferation, however, appeared to be ameliorated with increasing EMD concentrations. At 25 µg/ml and 50 µg/ml, EMD also demonstrated an increase in cell viability similar to the control medium at days 3 and 6 (P>0.05 between groups, respectively), while EMD at 100 µg/ml and 200 µg/ml resulted in statistically significant higher increase in cell viability than in the control medium at day 6 (P<0.001 between groups, respectively). In all test groups, IFS at day 6 was markedly lower than at day 1. Scanning electron microscopy revealed comparable cell morphology in all groups. Within the limits of the present study, it was concluded that EMD enhanced cell proliferation and viability of human SaOs2 osteoblasts on SLA titanium implants in a concentration-dependent manner. [ABSTRACT FROM AUTHOR]

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Over a period of eight years, we implanted a total of 76 cementless hip prostheses in patients with rheumatoid arthritis. The clinical results of 47 patients (70 hips) increased from a mean Harris Hip Score of 33 to 85 after an average of 49 months (range 1–11 years). One threaded cup has had to be revised because of loosening, and one stem because of femoral fracture. At the latest follow-up, 88% of Hofer-Imhof threaded cups had complete bone ingrowth (Type 0); 10% had near-complete bone ingrowth with minimal radiolucency in one third of the bone contact area (Type 1), and 2% had radiolucency in two thirds of the bone contact area (Type 2). Hemispherical push-in cups showed significantly more radiolucency around the cup. For the stems (Uni, Zweymüller SL), 83% showed no radiolucency (Type 0); 17% had radiolucency only very proximally (Type 1). Minor remodelling (Type 1) occurred in 60% of the femoral shafts; 30% had moderate femoral density loss (Type 2), and 10% had severe bone loss and cortical thinning (Type 3). There was no correlation between marked shaft atrophy and clinical symptoms. With regard to radiolucency and remodelling, there was no significant difference between the two types of stem used. Cementless hip arthroplasty using titanium implants has an excellent outcome in the medium term. [ABSTRACT FROM AUTHOR]

Our experience using the low volume titanium mini-fragment system ”Profile Titan” is presented retrospectively. The system contains self-tapping miniscrews with countersinking heads and very small adaptable plates with rounded edges. The study consists of 53 patients who underwent osteosynthesis, arthrodesis, or corrective osteotomy of the hand skeleton from 1 January 1994 to 31 March 1995. Functional results were evaluated and standard postoperative X-rays were taken at 1, 2, and 4 weeks after injury. Fifty-three patients with 56 fractures were treated. Results show that 78% of patients regained complete recovery of active range of motion. Fractures with and without negative prognostic factors were compared. There were three major postoperative complications not related to the type of implant. Compared to the AO mini system this system has several advantages. [ABSTRACT FROM AUTHOR]

The osseointegrated system developed by Brånemark was used in twenty-two patients to anchor ear and orbital prostheses. The clinical experience with special attention to the stability of the implants, skin conditions and patient satisfaction is presented and discussed from the point of the plastic surgeon. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effect of cone-beam computed tomography (CBCT) tube current (mA) on the magnitude of artefacts at different distances from titanium or zirconia implants, with and without activation of a proprietary metal artefact reduction (MAR).Human mandibles were scanned on an OP300 Maxio CBCT unit (Instrumentarium, Tuusula, Finland) before and after the installation of dental implants, with four different tube currents (4 mA, 6.3 mA, 8 mA and 10 mA), with and without activation of proprietary MAR. The effect of mA on the standard deviation (SD) of gray values and contrast to noise ratio (CNR) were assessed in regions of interest located 1.5 cm, 2.5 cm, and 3.5 cm from implants.In the presence of titanium implants, a significant decrease in SD was found by increasing tube current from 4 mA to 6.3 mA or 8 mA. For zirconia implants, 8 mA yielded better results for all distances. MAR improved CNR in the presence of zirconia implants at all distances, whereas no differences were observed with the use of MAR for titanium implants.Increased tube current can improve overall image quality in the presence of implants, at all the distances tested. When a zirconia implant is present, such increase in mA should be higher in comparison to that for examinations with titanium implants. Activation of OP300 Maxio proprietary MAR improved image quality only among examinations with zirconia implants.Artefact-generating implants are common in the field of view of CBCT examinations. Optimal exposure parameters, such as tube current, ensure high image quality with lowest possible radiation exposure.Material and methods: To evaluate the effect of cone-beam computed tomography (CBCT) tube current (mA) on the magnitude of artefacts at different distances from titanium or zirconia implants, with and without activation of a proprietary metal artefact reduction (MAR).Human mandibles were scanned on an OP300 Maxio CBCT unit (Instrumentarium, Tuusula, Finland) before and after the installation of dental implants, with four different tube currents (4 mA, 6.3 mA, 8 mA and 10 mA), with and without activation of proprietary MAR. The effect of mA on the standard deviation (SD) of gray values and contrast to noise ratio (CNR) were assessed in regions of interest located 1.5 cm, 2.5 cm, and 3.5 cm from implants.In the presence of titanium implants, a significant decrease in SD was found by increasing tube current from 4 mA to 6.3 mA or 8 mA. For zirconia implants, 8 mA yielded better results for all distances. MAR improved CNR in the presence of zirconia implants at all distances, whereas no differences were observed with the use of MAR for titanium implants.Increased tube current can improve overall image quality in the presence of implants, at all the distances tested. When a zirconia implant is present, such increase in mA should be higher in comparison to that for examinations with titanium implants. Activation of OP300 Maxio proprietary MAR improved image quality only among examinations with zirconia implants.Artefact-generating implants are common in the field of view of CBCT examinations. Optimal exposure parameters, such as tube current, ensure high image quality with lowest possible radiation exposure.Results: To evaluate the effect of cone-beam computed tomography (CBCT) tube current (mA) on the magnitude of artefacts at different distances from titanium or zirconia implants, with and without activation of a proprietary metal artefact reduction (MAR).Human mandibles were scanned on an OP300 Maxio CBCT unit (Instrumentarium, Tuusula, Finland) before and after the installation of dental implants, with four different tube currents (4 mA, 6.3 mA, 8 mA and 10 mA), with and without activation of proprietary MAR. The effect of mA on the standard deviation (SD) of gray values and contrast to noise ratio (CNR) were assessed in regions of interest located 1.5 cm, 2.5 cm, and 3.5 cm from implants.In the presence of titanium implants, a significant decrease in SD was found by increasing tube current from 4 mA to 6.3 mA or 8 mA. For zirconia implants, 8 mA yielded better results for all distances. MAR improved CNR in the presence of zirconia implants at all distances, whereas no differences were observed with the use of MAR for titanium implants.Increased tube current can improve overall image quality in the presence of implants, at all the distances tested. When a zirconia implant is present, such increase in mA should be higher in comparison to that for examinations with titanium implants. Activation of OP300 Maxio proprietary MAR improved image quality only among examinations with zirconia implants.Artefact-generating implants are common in the field of view of CBCT examinations. Optimal exposure parameters, such as tube current, ensure high image quality with lowest possible radiation exposure.Conclusion: To evaluate the effect of cone-beam computed tomography (CBCT) tube current (mA) on the magnitude of artefacts at different distances from titanium or zirconia implants, with and without activation of a proprietary metal artefact reduction (MAR).Human mandibles were scanned on an OP300 Maxio CBCT unit (Instrumentarium, Tuusula, Finland) before and after the installation of dental implants, with four different tube currents (4 mA, 6.3 mA, 8 mA and 10 mA), with and without activation of proprietary MAR. The effect of mA on the standard deviation (SD) of gray values and contrast to noise ratio (CNR) were assessed in regions of interest located 1.5 cm, 2.5 cm, and 3.5 cm from implants.In the presence of titanium implants, a significant decrease in SD was found by increasing tube current from 4 mA to 6.3 mA or 8 mA. For zirconia implants, 8 mA yielded better results for all distances. MAR improved CNR in the presence of zirconia implants at all distances, whereas no differences were observed with the use of MAR for titanium implants.Increased tube current can improve overall image quality in the presence of implants, at all the distances tested. When a zirconia implant is present, such increase in mA should be higher in comparison to that for examinations with titanium implants. Activation of OP300 Maxio proprietary MAR improved image quality only among examinations with zirconia implants.Artefact-generating implants are common in the field of view of CBCT examinations. Optimal exposure parameters, such as tube current, ensure high image quality with lowest possible radiation exposure.Clinical relevance: To evaluate the effect of cone-beam computed tomography (CBCT) tube current (mA) on the magnitude of artefacts at different distances from titanium or zirconia implants, with and without activation of a proprietary metal artefact reduction (MAR).Human mandibles were scanned on an OP300 Maxio CBCT unit (Instrumentarium, Tuusula, Finland) before and after the installation of dental implants, with four different tube currents (4 mA, 6.3 mA, 8 mA and 10 mA), with and without activation of proprietary MAR. The effect of mA on the standard deviation (SD) of gray values and contrast to noise ratio (CNR) were assessed in regions of interest located 1.5 cm, 2.5 cm, and 3.5 cm from implants.In the presence of titanium implants, a significant decrease in SD was found by increasing tube current from 4 mA to 6.3 mA or 8 mA. For zirconia implants, 8 mA yielded better results for all distances. MAR improved CNR in the presence of zirconia implants at all distances, whereas no differences were observed with the use of MAR for titanium implants.Increased tube current can improve overall image quality in the presence of implants, at all the distances tested. When a zirconia implant is present, such increase in mA should be higher in comparison to that for examinations with titanium implants. Activation of OP300 Maxio proprietary MAR improved image quality only among examinations with zirconia implants.Artefact-generating implants are common in the field of view of CBCT examinations. Optimal exposure parameters, such as tube current, ensure high image quality with lowest possible radiation exposure. [ABSTRACT FROM AUTHOR]

Background: To explore the effects of topographical modification of titanium substrates at submicron level by oxalic acid treatment on bone quality and quantity around dental implants in rabbit tibiae. Methods: A total of 60 blasted CP-grade IV titanium dental implants were used. Twenty-eight control implant surfaces were treated with a mixture of HCl/H2SO4, whereas 28 other test implant surfaces were treated with oxalic acid following HCl/H2SO4 treatment. Two randomly selected sets of control or test implants were placed in randomly selected proximal tibiae of 14 female Japanese white rabbits. Euthanasia was performed 4 and 8 weeks post-implant placement. Bone to implant contact (BIC), bone area fraction (BAF), ratios of mature and immature bone to total bone, and the amount and types of collagen fibers were evaluated quantitatively. Two control and two test implants were used to analyze surface characteristics. Results: Treatment by oxalic acid significantly decreased Sa and increased Ra of test implant surfaces. BIC in test implants was increased without alteration of BAF and collagen contents at 4 and 8 weeks after implant placement when compared with control implants. The ratios of immature and mature bone to total bone differed significantly between groups at 4 weeks post-implantation. Treatment by oxalic acid increased type I collagen and decreased type III collagen in bone matrices around test implants when compared with control implants at 8 weeks after implant placement. The effects of topographical changes of implant surfaces induced by oxalic acid on BAF, mature bone, collagen contents, and type I collagen were significantly promoted with decreased immature bone formation and type III collagen in the later 4 weeks post-implantation. Conclusions: Treatment of implant surfaces with oxalic acid rapidly increases osseointegration from the early stages after implantation. Moreover, submicron topographical changes of dental implants induced by oxalic acid improve bone quality based on bone maturation and increased production of type I collagen surrounding dental implants in the late stage after implant placement. [ABSTRACT FROM AUTHOR]