Gallium and silver-doped titanium surfaces provide enhanced osteogenesis, reduce bone resorption and prevent bacterial infection in co-culture.

Bacterial infection remains a significant problem associated with orthopaedic surgeries leading to surgical site infection (SSI). This unmet medical need can become an even greater complication when surgery is due to malignant bone tumor. In the present study, we evaluated in vitro titanium (Ti) implants subjected to gallium (Ga) and silver (Ag)-doped thermochemical treatment as strategy to prevent SSI and improve osteointegration in bone defects caused by diseases such as osteoporosis, bone tumor, or bone metastasis. Firstly, as Ga has been reported to be an osteoinductive and anti-resorptive agent, its performance in the mixture was proved by studying human mesenchymal stem cells (hMSC) and pre-osteoclasts (RAW264.7) behaviour. Then, the antibacterial potential provided by Ag was assessed by resembling "The Race for the Surface" between hMSC and Pseudomonas aeruginosa in two co-culture methods. Moreover, the presence of quorum sensing molecules in the co-culture was evaluated. The results highlighted the suitability of the mixture to induce osteodifferentiation and reduce osteoclastogenesis in vitro. Furthermore, the GaAg surface promoted strong survival rate and retained osteoinduction potential of hMSCs even after bacterial inoculation. Therefore, GaAg-modified titanium may be an ideal candidate to repair bone defects caused by excessive bone resorption, in addition to preventing SSI. STATEMENT OF SIGNIFICANCE: This article provides important insights into titanium for fractures caused by osteoporosis or bone metastases with high incidence in surgical site infection (SSI) because in this situation bacterial infection can become a major disaster. In order to solve this unmet medical need, we propose a titanium implant modified with gallium and silver to improve osteointegration, reduce bone resorption and avoid bacterial infection. For that aim, we study osteoblast and osteoclast behavior with the main novelty focused on the antibacterial evaluation. In this work, we recreate "the race for the surface" in long-term experiments and study bacterial virulence factors (quorum sensing). Therefore, we believe that our article could be of great interest, providing a great impact on future orthopedic applications.

Influence of Narrow Titanium Dental Implant Diameter on Fatigue Behavior: A Comparison between Unitary and Splinted Implants.

Background: Scientific literature lacks strong support for using narrow diameter implants (NDI) in high masticatory force areas, especially in molars. Implant splinting in cases of multiple missing teeth reduces lateral forces, improves force distribution, and minimizes stress on implants. However, no studies have evaluated the fatigue load resistance of unitary or splinted implants. Methods: This in vitro study compares five groups of new metal alloy implants, including unitary and splinted implants with varying diameters. Mechanical characterization was assessed using a BIONIX 370 testing machine (MTS, Minneapolis, MN, USA) according to ISO 14801. For each of the five study sample groups, (n = 5) specimens underwent monotonic uniaxial compression at break testing and (n = 15) cyclic loading to determine the maximum force (Fmax) and the fatigue life (LF) values. Scanning electron microscopy (SEM) was employed for the fractographic analysis of the fractured samples. Results: The Fmax values for unitary samples ranged from 196 N to 246 N, whereas the two-splinted samples displayed significantly higher values, ranging from 2439 N to 3796 N. Similarly, the LF values for unitary samples ranged from 118 N to 230 N, while the two-splinted samples exhibited notably higher values, ranging from 488 N to 759 N. Conclusions: The observed resistance difference between sample groups in terms of Fmax and LF may be due to variations in effective cross-sectional area, determined by implant diameter and number. Additionally, this disparity may indicate a potential stiffening effect resulting from the splinting process. These findings have significant implications for dental clinical practice, suggesting the potential use of splinted sets of small-sized NDI as replacements for posterior dentition (premolars and molars) in cases of alveolar bone ridge deficiencies.

Effect of Functionalization of Texturized Polypropylene Surface by Silanization and HBII-RGD Attachment on Response of Primary Abdominal and Vaginal Fibroblasts.

Soft tissue defects, such as incisional hernia or pelvic organ prolapse, are prevalent pathologies characterized by a tissue microenvironment rich in fragile and dysfunctional fibroblasts. Precision medicine could improve their surgical repair, currently based on polymeric materials. Nonetheless, biomaterial-triggered interventions need first a better understanding of the cell-material interfaces that truly consider the patients' biology. Few tools are available to study the interactions between polymers and dysfunctional soft tissue cells in vitro. Here, we propose polypropylene (PP) as a matrix to create microscale surfaces w/wo functionalization with an HBII-RGD molecule, a fibronectin fragment modified to include an RGD sequence for promoting cell attachment and differentiation. Metal mold surfaces were roughened by shot blasting with aluminum oxide, and polypropylene plates were obtained by injection molding. HBII-RGD was covalently attached by silanization. As a proof of concept, primary abdominal and vaginal wall fasciae fibroblasts from control patients were grown on the new surfaces. Tissue-specific significant differences in cell morphology, early adhesion and cytoskeletal structure were observed. Roughness and biofunctionalization parameters exerted unique and combinatorial effects that need further investigation. We conclude that the proposed model is effective and provides a new framework to inform the design of smart materials for the treatment of clinically compromised tissues.

Gallium-doped thermochemically treated titanium reduces osteoclastogenesis and improves osteodifferentiation.

Excessive bone resorption is one of the main causes of bone homeostasis alterations, resulting in an imbalance in the natural remodeling cycle. This imbalance can cause diseases such as osteoporosis, or it can be exacerbated in bone cancer processes. In such cases, there is an increased risk of fractures requiring a prosthesis. In the present study, a titanium implant subjected to gallium (Ga)-doped thermochemical treatment was evaluated as a strategy to reduce bone resorption and improve osteodifferentiation. The suitability of the material to reduce bone resorption was proven by inducing macrophages (RAW 264.7) to differentiate to osteoclasts on Ga-containing surfaces. In addition, the behavior of human mesenchymal stem cells (hMSCs) was studied in terms of cell adhesion, morphology, proliferation, and differentiation. The results proved that the Ga-containing calcium titanate layer is capable of inhibiting osteoclastogenesis, hypothetically by inducing ferroptosis. Furthermore, Ga-containing surfaces promote the differentiation of hMSCs into osteoblasts. Therefore, Ga-containing calcium titanate may be a promising strategy for patients with fractures resulting from an excessive bone resorption disease.

Titanium Boston keratoprosthesis with corneal cell adhesive and bactericidal dual coating.

The Boston keratoprosthesis (BKPro) is a medical device used to restore vision in complicated cases of corneal blindness. This device is composed by a front plate of polymethylmethacrylate (PMMA) and a backplate usually made of titanium (Ti). Ti is an excellent biomaterial with numerous applications, although there are not many studies that address its interaction with ocular cells. In this regard, despite the good retention rates of the BKPro, two main complications compromise patients' vision and the viability of the prosthesis: imperfect adhesion of the corneal tissue to the upside of the backplate and infections. Thus, in this work, two topographies (smooth and rough) were generated on Ti samples and tested with or without functionalization with a dual peptide platform. This molecule consists of a branched structure that links two peptide moieties to address the main complications associated with BKPro: the well-known RGD peptide in its cyclic version (cRGD) as cell pro-adherent motif and the first 11 residues of lactoferrin (LF1-11) as antibacterial motif. Samples were physicochemically characterized, and their biological response was evaluated in vitro with human corneal keratocytes (HCKs) and against the gram-negative bacterial strain Pseudomonas aeruginosa. The physicochemical characterization allowed to verify the functionalization in a qualitative and quantitative manner. A higher amount of peptide was anchored to the rough surfaces. The studies performed using HCKs showed increased long-term proliferation on the functionalized samples. Gene expression was affected by topography and peptide functionalization. Roughness promoted α-smooth muscle actin (α-SMA) overexpression, and the coating notably increased the expression of extracellular matrix components (ECM). Such changes may favour the development of unwanted fibrosis, and thus, corneal haze. In contrast, the combination of the coating with a rough topography decreased the expression of α-SMA and ECM components, which would be desirable for the long-term success of the prosthesis. Regarding the antibacterial activity, the functionalized smooth and rough surfaces promoted the death of bacteria, as well as a perturbation in their wall definition and cellular morphology. Bacterial killing values were 58 % for smooth functionalised and 68 % for rough functionalised samples. In summary, this study suggests that the use of the dual peptide platform with cRGD and LF1-11 could be a good strategy to improve the in vitro and in vivo performance of the rough topography used in the commercial BKPro.

Comparison of the Antibacterial Effect of Silver Nanoparticles and a Multifunctional Antimicrobial Peptide on Titanium Surface.

Titanium implantation success may be compromised by Staphylococcus aureus surface colonization and posterior infection. To avoid this issue, different strategies have been investigated to promote an antibacterial character to titanium. In this work, two antibacterial agents (silver nanoparticles and a multifunctional antimicrobial peptide) were used to coat titanium surfaces. The modulation of the nanoparticle (≈32.1 ± 9.4 nm) density on titanium could be optimized, and a sequential functionalization with both agents was achieved through a two-step functionalization method by means of surface silanization. The antibacterial character of the coating agents was assessed individually as well as combined. The results have shown that a reduction in bacteria after 4 h of incubation can be achieved on all the coated surfaces. After 24 h of incubation, however, the individual antimicrobial peptide coating was more effective than the silver nanoparticles or their combination against Staphylococcus aureus. All tested coatings were non-cytotoxic for eukaryotic cells.

Dual-Action Effect of Gallium and Silver Providing Osseointegration and Antibacterial Properties to Calcium Titanate Coatings on Porous Titanium Implants.

Previously, functional coatings on 3D-printed titanium implants were developed to improve their biointegration by separately incorporating Ga and Ag on the biomaterial surface. Now, a thermochemical treatment modification is proposed to study the effect of their simultaneous incorporation. Different concentrations of AgNO3 and Ga(NO3)3 are evaluated, and the obtained surfaces are completely characterized. Ion release, cytotoxicity, and bioactivity studies complement the characterization. The provided antibacterial effect of the surfaces is analyzed, and cell response is assessed by the study of SaOS-2 cell adhesion, proliferation, and differentiation. The Ti surface doping is confirmed by the formation of Ga-containing Ca titanates and nanoparticles of metallic Ag within the titanate coating. The surfaces generated with all combinations of AgNO3 and Ga(NO3)3 concentrations show bioactivity. The bacterial assay confirms a strong bactericidal impact achieved by the effect of both Ga and Ag present on the surface, especially for Pseudomonas aeruginosa, one of the main pathogens involved in orthopedic implant failures. SaOS-2 cells adhere and proliferate on the Ga/Ag-doped Ti surfaces, and the presence of gallium favors cell differentiation. The dual effect of both metallic agents doping the titanium surface provides bioactivity while protecting the biomaterial from the most frequent pathogens in implantology.

Guiding Fibroblast Activation Using an RGD-Mutated Heparin Binding II Fragment of Fibronectin for Gingival Titanium Integration.

The formation of a biological seal around the neck of titanium (Ti) implants is critical for ensuring integration at the gingival site and for preventing bacterial colonization that may lead to periimplantitis. This process is guided by activated fibroblasts, named myofibroblasts, which secrete extracellular matrix (ECM) proteins and ECM-degrading enzymes resolving the wound. However, in some cases, Ti is not able to attract and activate fibroblasts to a sufficient extent, which may compromise the success of the implant. Fibronectin (FN) is an ECM component found in wounds that is able to guide soft tissue healing through the adhesion of cells and attraction of growth factors (GFs). However, clinical use of FN functionalized Ti implants is problematic because FN is difficult to obtain, and is sensitive to degradation. Herein, functionalizing Ti with a modified recombinant heparin binding II (HBII) domain of FN, mutated to include an Arg-Gly-Asp (RGD) sequence for promoting both fibroblast adhesion and GF attraction, is aimed at. The HBII-RGD domain is able to stimulate fibroblast adhesion, spreading, proliferation, migration, and activation to a greater extent than the native HBII, reaching values closer to those of full-length FN suggesting that it might induce the formation of a biological sealing.

Functionalization of 3D-Printed Titanium Scaffolds with Elastin-like Recombinamers to Improve Cell Colonization and Osteoinduction.

The 3D printing of titanium (Ti) offers countless possibilities for the development of personalized implants with suitable mechanical properties for different medical applications. However, the poor bioactivity of Ti is still a challenge that needs to be addressed to promote scaffold osseointegration. The aim of the present study was to functionalize Ti scaffolds with genetically modified elastin-like recombinamers (ELRs), synthetic polymeric proteins containing the elastin epitopes responsible for their mechanical properties and for promoting mesenchymal stem cell (MSC) recruitment, proliferation, and differentiation to ultimately increase scaffold osseointegration. To this end, ELRs containing specific cell-adhesive (RGD) and/or osteoinductive (SNA15) moieties were covalently attached to Ti scaffolds. Cell adhesion, proliferation, and colonization were enhanced on those scaffolds functionalized with RGD-ELR, while differentiation was promoted on those with SNA15-ELR. The combination of both RGD and SNA15 into the same ELR stimulated cell adhesion, proliferation, and differentiation, although at lower levels than those for every single moiety. These results suggest that biofunctionalization with SNA15-ELRs could modulate the cellular response to improve the osseointegration of Ti implants. Further investigation on the amount and distribution of RGD and SNA15 moieties in ELRs could improve cell adhesion, proliferation, and differentiation compared to the present study.

Surface competition between osteoblasts and bacteria on silver-doped bioactive titanium implant.

The rapid integration in the bone tissue and the prevention of bacterial infection are key for the success of the implant. In this regard, a silver (Ag)-doped thermochemical treatment that generate an Ag-doped calcium titanate layer on titanium (Ti) implants was previously developed by our group to improve the bone-bonding ability and provide antibacterial activity. In the present study, the biological and antibacterial potential of this coating has been further studied. In order to prove that the Ag-doped layer has an antibacterial effect with no detrimental effect on the bone cells, the behavior of osteoblast-like cells in terms of cell adhesion, morphology, proliferation and differentiation was evaluated, and the biofilm inhibition capacity was assessed. Moreover, the competition by the surface between cell and bacteria was carried out in two different co-culture methods. Finally, the treatment was applied to porous Ti implants to study in vivo osteointegration. The results show that the incorporation of Ag inhibits the biofilm formation and has no effect on the performance of osteoblast-like cells. Therefore, it can be concluded that the Ag-doped surface is capable of preventing bone bacterial infection and providing suitable osseointegration.

Laser-Deposited Beta Type Ti-42Nb Alloy with Anisotropic Mechanical Properties for Pioneering Biomedical Implants with a Very Low Elastic Modulus.

Present commercial titanium alloy implants have an elastic modulus higher than 100 GPa, whereas that of the cortical bone is much smaller (17−28 GPa). This elastic modulus mismatch produces a stress shielding effect and the resorption of the bone surrounding the implant. In the present work, a <100> fiber texture is developed in ß type Ti-42Nb (wt%) alloy ingots generated by laser-directed energy deposition (LDED) in order to achieve anisotropic mechanical properties. In addition, we demonstrate that laser-deposited ß type Ti-42Nb alloy ingots with an intense <100> fiber texture exhibit a very low elastic modulus in the building direction (Ez < 50 GPa) and high yield (σ0.2z > 700 MPa) and tensile (UTSz > 700 MPa) strengths. Laser-deposited Ti-42Nb alloy enhances the osteoinductive effect, promoting the adhesion, proliferation, and spreading of human osteoblast-like cells. Hence, we propose that laser-deposited ß type Ti-42Nb alloy is a potentially promising candidate for the manufacturing of pioneering biomedical implants with a very low elastic modulus that can suppress stress shielding.

Mechanical Characterization of Dental Prostheses Manufactured with PMMA-Graphene Composites.

The use of a PMMA composite with graphene is being commercialized for application as dental prostheses. The different proportions of fibers provide a wide range of colors that favors dental esthetics in prostheses. However, there are no studies that have explained the influence that graphene has on the mechanical properties. In this contribution, we studied the PMMA and PMMA material with graphene fibers (PMMA-G) in the form of discs as supplied for machining. The presence of graphene fibers has been studied by Raman spectroscopy and the Shore hardness and Vickers micro hardness were determined. Mechanical compression tests were carried out to obtain the values of maximum strength and Young's modulus (E) and by means of pin-on-disc wear tests, the specific wear rate and the friction coefficients were determined following the established international standards. Finally, the samples were characterized by field emission scanning electron microscopy (FESEM) to characterize the graphene's morphology inside the PMMA. The results showed the presence of graphene in PMMA and was estimated in an amount of 0.1027% by weight in G-PMMA. The Shore hardness and Vickers microhardness values did not show statistically significant differences. Differences were observed in the compression maximum strength (129.43 MPa for PMMA and 140.23 for PMMA-G) and E values (2.01 for PMMA and 2.89 GPa for PMMA-G) as well as in the lower wear rate for the G-PMMA samples (1.93 × 10−7 for PMMA and 1.33 × 10−7 mm3/N·m) with a p < 0.005. The coefficients of friction for PMMA-G decreased from 0.4032 for PMMA to 0.4001 for PMMA-G. From the results obtained, a slight content in graphene produced a significant improvement in the mechanical properties that could be observed in the prosthesis material. Therefore, we can state that the main attraction of this material for dental prosthesis is its esthetics.

Citric Acid in the Passivation of Titanium Dental Implants: Corrosion Resistance and Bactericide Behavior.

The passivation of titanium dental implants is performed in order to clean the surface and obtain a thin layer of protective oxide (TiO2) on the surface of the material in order to improve its behavior against corrosion and prevent the release of ions into the physiological environment. The most common chemical agent for the passivation process is hydrochloric acid (HCl), and in this work we intend to determine the capacity of citric acid as a passivating and bactericidal agent. Discs of commercially pure titanium (c.p.Ti) grade 4 were used with different treatments: control (Ctr), passivated by HCl, passivated by citric acid at 20% at different immersion times (20, 30, and 40 min) and a higher concentration of citric acid (40%) for 20 min. Physical-chemical characterization of all of the treated surfaces has been carried out by scanning electronic microscopy (SEM), confocal microscopy, and the 'Sessile Drop' technique in order to obtain information about different parameters (topography, elemental composition, roughness, wettability, and surface energy) that are relevant to understand the biological response of the material. In order to evaluate the corrosion behavior of the different treatments under physiological conditions, open circuit potential and potentiodynamic tests have been carried out. Additionally, ion release tests were realized by means of ICP-MS. The antibacterial behavior has been evaluated by performing bacterial adhesion tests, in which two strains have been used: Pseudomonas aeruginosa (Gram-) and Streptococcus sanguinis (Gram+). After the adhesion test, a bacterial viability study has been carried out ('Life and Death') and the number of colony-forming units has been calculated with SEM images. The results obtained show that the passivation with citric acid improves the hydrophilic character, corrosion resistance, and presents a bactericide character in comparison with the HCl treatment. The increasing of citric acid concentration improves the bactericide effect but decreases the corrosion resistance parameters. Ion release levels at high citric acid concentrations increase very significantly. The effect of the immersion times studied do not present an effect on the properties.

Mineralization of Titanium Surfaces: Biomimetic Implants.

The surface modification by the formation of apatitic compounds, such as hydroxyapatite, improves biological fixation implants at an early stage after implantation. The structure, which is identical to mineral content of human bone, has the potential to be osteoinductive and/or osteoconductive materials. These calcium phosphates provoke the action of the cell signals that interact with the surface after implantation in order to quickly regenerate bone in contact with dental implants with mineral coating. A new generation of calcium phosphate coatings applied on the titanium surfaces of dental implants using laser, plasma-sprayed, laser-ablation, or electrochemical deposition processes produces that response. However, these modifications produce failures and bad responses in long-term behavior. Calcium phosphates films result in heterogeneous degradation due to the lack of crystallinity of the phosphates with a fast dissolution; conversely, the film presents cracks, which produce fractures in the coating. New thermochemical treatments have been developed to obtain biomimetic surfaces with calcium phosphate compounds that overcome the aforementioned problems. Among them, the chemical modification using biomineralization treatments has been extended to other materials, including composites, bioceramics, biopolymers, peptides, organic molecules, and other metallic materials, showing the potential for growing a calcium phosphate layer under biomimetic conditions.

Membrane perturbation, altered morphology and killing of Staphylococcus epidermidis upon contact with a cytocompatible peptide-based antibacterial surface.

One possibility to prevent prosthetic infections is to produce biomaterials resistant to bacterial colonization by anchoring membrane active antimicrobial peptides (AMPs) onto the implant surface. In this perspective, a deeper understanding of the mode of action of the immobilized peptides should improve the development of AMP-inspired infection-resistant biomaterials. The aim of the present study was to characterize the bactericidal mechanism against Staphylococcus epidermidis of the AMP BMAP27(1-18), immobilized on titanium disks and on a model resin support, by applying viability counts, Field Emission Scanning Electron Microscopy (FE-SEM), and a fluorescence microplate assay with a membrane potential-sensitive dye. The cytocompatibility to osteoblast-like MG-63 cells was investigated in monoculture and in co-culture with bacteria. The impact of peptide orientation was explored by using N- and C- anchored analogues. On titanium, the ∼50 % drop in bacteria viability and dramatically affected morphology indicate a contact-killing action exerted by the N- and C-immobilized peptides to the same extent. As further shown by the fluorescence assay with the resin-anchored peptides, the bactericidal effect was mediated by rapid membrane perturbation, similar to free peptides. However, at peptide MBC resin equivalents the C-oriented analogue proved more effective with more than 99 % killing and maximum fluorescence increase, compared to half-maximum fluorescence with more than 90 % killing produced by the N-orientation. Confocal microscopy analyses revealed 4-5 times better MG-63 cell adhesion on peptide-functionalized titanium both in monoculture and in co-culture with bacteria, regardless of peptide orientation, thus stimulating further studies on the effects of the immobilized BMAP27(1-18) on osteoblast cells.

Early Short-Term Postoperative Mechanical Failures of Current Ceramic-on-Ceramic Bearing Total Hip Arthroplasties.

Although ceramic-on-ceramic (CoC) bearings have been shown to produce the smallest amount of wear volume in vitro as well as in vivo studies when used for total hip arthroplasties (THA), concerns about the failure of these bearing surfaces persist due to early failures observed after short postoperative time. In this study, an exhaustive analysis of the early failure occurred on the new generation of ceramic bearings, consisting of a composite alumina matrix-based material reinforced with yttria-stabilized tetragonal zirconia (Y-TZP) particles, chromium dioxide, and strontium crystals, was performed. For this study, 118 CoC bearings from 117 patients were revised. This article describes a group of mechanical failure CoC-bearing BIOLOX THA hip prosthesis patients without trauma history. The retrieved samples were observed under scanning electron microscopy (SEM), composition was analyzed with energy dispersive X-ray spectroscopy (EDX), and damaged surfaces were analyzed by grazing-incidence X-ray diffraction (GI-XRD) and white light interferometry. In the short term, CoC articulations provided similar mechanical behavior and functional outcome to those in XLPE cases. However, 5% more early mechanical failures cases were observed for the ceramic components. Although the fracture rate of third generation CoC couples is low, the present study shows the need to further improve the third generation of CoC-bearing couples for THA. Despite the improved wear compared to other materials, stress concentrators are sources of initial crack propagation, such as those found in the bore-trunnion areas. Moreover, in view of the evidence observed in this study, the chipping observed was due to the presence of monoclinic phase of the Y-TZP instead of tetragonal, which presents better mechanical properties. The results showed that total safety after receiving a THA is still a goal to be pursued.

Covalent grafting of titanium with a cathelicidin peptide produces an osteoblast compatible surface with antistaphylococcal activity.

Bacterial infection of orthopaedic implants, often caused by Staphylococcus species, may ultimately lead to implant failure. The development of infection-resistant, osteoblast-compatible biomaterials could represent an effective strategy to prevent bacterial colonization of implants, reducing the need for antibiotics. In this study, the widely used biomaterial titanium was functionalized with BMAP27(1-18), an α-helical cathelicidin antimicrobial peptide that retains potent staphylocidal activity when immobilized on agarose beads. A derivative bearing a short spacer with a free thiol at the N-terminus was coupled to silanized titanium disks via thiol-maleimide chemistry. Tethering was successful, as assessed by Contact angle, Quartz Crystal Microbalance with Dissipation monitoring (QCM-D), and X-ray Photoelectron Spectroscopy (XPS), with an average surface mass density of 456 ng/cm2 and a layer thickness of 3 nm. The functionalized titanium displayed antimicrobial properties against a reference strain of Staphylococcus epidermidis with well-known biofilm forming capability. Reduction of bacterial counts and morphological alterations of adhering bacteria, upon 2 h incubation, indicate a rapid contact-killing effect. The immobilized peptide was not toxic to osteoblasts, which adhered and spread better on functionalized titanium when co-cultured with bacteria, compared to non-coated surfaces. Results suggest that functionalization of titanium with BMAP27(1-18) could be promising for prevention of bacterial colonization in bone graft applications.

Fracture and Fatigue of Titanium Narrow Dental Implants: New Trends in Order to Improve the Mechanical Response.

Sixty-four fractured commercially pure titanium (cp-Ti) narrow dental implants (NDIs) with similar macrogeometry and connection designs were studied after different implantation times in humans in order to determine their reliability and to evaluate the causes of the fracture. These NDIs were compared with other similar implants, made with alloyed titanium with 15% Zr and with 12% strained titanium. Original implants were tested under static and fatigue conditions, simulating the tri-axial loads in the mouth by means of a Bionix hydraulic test machine. Fractography was studied using field-emission scanning electron microscopy (FSEM). The results showed that cp-Ti NDI exhibits low strength for mechanical cycling, and the alloyed Ti and strained titanium increase the mechanical strength, guaranteeing long term mechanical behavior. NDIs fractured due to fatigue, and, in some cases, the presence of cracks in the original NDIs quickly led to fracture. These cracks were attributed to plastic deformation during machining were found to be exacerbated due to acid etching in the passivation process. All cases of fracture were cp-Ti dental implants due to the low fatigue limit. The results show that, when titanium is alloyed or cold-worked, the fatigue limit is higher than cp-Ti. This in vitro research will help clinicians to select a better NDI system for safer treatment.

Antimicrobial PHAs coatings for solid and porous tantalum implants.

Biomaterial-associated infections (BAI) are the major cause of failure of indwelling medical devices. The risk of BAI can end dramatically in the surgical removal of the affected device. Therefore, a major effort must be undertaken to guarantee the permanence of the implant. In this regard, we have developed antimicrobial coatings for tantalum (Ta) implants, using polyhydroxyalkanoates (PHAs) as matrices for carrying an active principle. The dip-coating technique was successfully used for covering solid Ta discs. An original PHA emulsion flow process was developed for the coating of porous Ta structures, specially for the inner surfaces. The complete characterization of the biopolymer coatings, their antibacterial properties, toxicity and biointegration were analyzed. Thus, non-toxic, well-biointegrated homogeneous biopolymer coatings were attained, which showed antibacterial properties. By using biodegradable PHAs, the resulting drug delivery system assured the protection of Ta against bacterial infections for a period of time.

Influence of the Elastic Modulus on the Osseointegration of Dental Implants.

The load transfer from metallic prosthesis to tissue plays an important role in the success of a designed device. From a mechanical behavior point of view, the load transfer will be favored when the elastic modulus between the metallic implant and the bone tissue are similar. Titanium and Ti-6Al-4V are the most commonly used metals and alloys in the field of dental implants, although they present high elastic moduli and hence trigger bone resorption. We propose the use of low-modulus ß-type titanium alloys that can improve the growth of new bone surrounding the implant. We designed dental implants with identical morphology and micro-roughness composed of: Ti-15Zr, Ti-19.1Nb-8.8Zr, Ti-41.2Nb-6.1Zr, and Ti-25Hf-25Ta. The commercially pure Ti cp and Ti-6Al-4V were used as control samples. The alloys were initially mechanically characterized with a tensile test using a universal testing machine. The results showed the lowest elastic modulus for the Ti-25Hf-25Ta alloy. We implanted a total of six implants in the mandible (3) and maxilla (3) for each titanium alloy in six minipigs and evaluated their bone index contact (i.e., the percentage of new bone in contact with the metal-BIC%) after 3 and 6 weeks of implantation. The results showed higher BIC% for the dental implants with lowest elastic modulus, showing the importance of decreasing the elastic modulus of alloys for the successful osseointegration of dental implants.