The roles of surface chemistry and topography in the strength and rate of osseointegration of titanium implants in bone

The present study investigated the effects of surface chemistry and topography on the strength and rate of osseointegration of titanium implants in bone. Three groups of implants were compared: (1) machine-turned implants (turned implants), (2) machine-turned and aluminum oxide-blasted implants (blasted implants), and (3) implants that were machine-turned, aluminum oxide-blasted, and processed with the micro-arc oxidation method (Mg implants). Three and six weeks after implant insertion in rabbit tibiae, the implant osseointegration strength and rate were evaluated. Surface chemistry revealed characteristic differences of nine at.% Mg for Mg implants and 11 at.% Al for blasted implants. In terms of surface roughness, there was no difference between Mg implants and blasted implants in developed surface ratio (Sdr; p = 0.69) or summit density (Sds; p = 0.96), but Mg implants had a significantly lower arithmetic average height deviation (Sa) value than blasted implants (p = 0.007). At both 3 and 6 weeks, Mg implants demonstrated significantly higher osseointegration strength compared with turned (p = 0.0001, p = 0.0001) and blasted (p = 0.0001, p = 0.035) implants, whereas blasted implants showed significantly higher osseointegration than turned implants at 6 weeks (p = 0.02) but not at 3 weeks (p = 0.199). The present results not only support the hypothesis that biochemical bonding facilitates rapid and strong integration of implants in bone, but also provide evidence for biochemical bonding theory previously proposed by Sul.     

Bone formation after 4 weeks around blood-plasma-modified titanium implants with varying surface topographies: an in vivo study

The aim of the present study was to investigate and compare the stability and bone ingrowth capacity to screw-shaped titanium implants with five different surface treatments. The implants were: (1) standard turned with a thin blood plasma coat (TP), (2) NaOH-etched dito with pore size 0.2-0.3 microm (E), (3) NaOH-etched with pore size 0.2-0.3 microm and a thin blood plasma coat (EP), (4) electrochemically oxidised with pore size 1-2 microm (O), (5) electrochemically oxidised with pore size 1-2 microm and a thin blood plasma coat (OP). A total of 66 implants were divided into the above-described five groups and inserted for 4 weeks into tibia and femur of 11 rabbits. The implants were evaluated by resonance frequency (RF) measurements at the time of insertion and removal, and analysed histomorphometrically at removal. The RF measurements showed that the implant stability was lower in soft bone compared to dense and increased with time. No significant differences were observed between the different surface modifications. The histomorphometric analysis revealed no statistically significant differences between the implants regarding bone-to-metal contact (BMC) and bone area inside the threads (BA). The above results indicate that thin blood plasma-coated and non-coated screw-shaped titanium implants with turned, NaOH-etched and electrochemically etched surface profiles integrate similarly to bone at 1 month of implantation.     

In vivo expression of osteogenic markers and bone mineral density at the surface of fluoride-modified titanium implants

The aim of the present study was to investigate the biological mechanisms of the functional attachment of fluoride-modified titanium implants to cortical bone by studying the association of the pull-out test results with gene expression of osteoblast (runx2, osteocalcin, collagen-I and IGF-I), osteoclast (TRAP, H(+)-ATPase and calcitonin receptor) and inflammation (TNF-alpha, IL-6 and IL-10) markers from peri-implant bone tissue using real-time RT-PCR, following a 4- and 8-week healing period. After implant detachment, wound fluid from the implant site was collected for LDH and ALP activity analysis. A new method to study volumetric bone mineral density (vBMD) of sub-implant cortical bone was developed using micro-computed tomography. Our results show lower LDH activity and TRAP mRNA levels in fluoride implants after 4 weeks of healing, yet no differences were found either on the pull-out force or expression of bone formation marker genes. After 8 weeks of healing, both pull-out, vBMD and osteocalcin, runx2 and collage type I gene expression were higher in fluoride implants. In conclusion, fluoride-modified implants seem to modulate both inflammation and bone resorption/formation events at the bone-implant interface, suggesting that these biological effects are an intrinsic part of the clinical performance of this surface.     

Interface shear strength of titanium implants with a sandblasted and acid-etched surface: a biomechanical study in the maxilla of miniature pigs.

The purpose of the present study was to evaluate the interface shear strength of unloaded titanium implants with a sandblasted and acid-etched (SLA) surface in the maxilla of miniature pigs. The two best documented surfaces in implant dentistry, the machined and the titanium plasma-sprayed (TPS) surfaces served as controls. After 4, 8, and 12 weeks of healing, removal torque testing was performed to evaluate the interface shear strength of each implant type. The results revealed statistically significant differences between the machined and the two rough titanium surfaces (p <.00001). The machined surface demonstrated mean removal torque values (RTV) between 0.13 and 0.26 Nm, whereas the RTV of the two rough surfaces ranged between 1.14 and 1.56 Nm. At 4 weeks of healing, the SLA implants yielded a higher mean RTV than the TPS implants (1.39 vs. 1. 14 Nm) without reaching statistical significance. At 8 and 12 weeks of healing, the two rough surfaces showed similar mean RTVs. The implant position also had a significant influence on removal torques for each implant type primarily owing to differences in density in the periimplant bone structure. It can be concluded that the interface shear strength of titanium implants is significantly influenced by their surface characteristics, since the machined titanium surface demonstrated significantly lower RTV in the maxilla of miniature pigs compared with the TPS and SLA surfaces.     

Mechanical and histomorphometric evaluations of titanium implants with different surface treatments inserted in sheep cortical bone

Improvement of the implant-bone interface is still an open problem and the interest in chemical modification of implant surfaces for cementless fixation has grown steadily over the past decade. Mechanical and histomorphometric investigations were performed at different times on implants inserted into sheep femoral cortical bone to compare the in vivo osseointegration of titanium screws ( X 3.5 x 7 mm length) with different surface treatments. After 8 weeks of implantation, the push-out force of anodized and hydrothermally treated implants (ANODIC) was significantly higher than that of machined implants (MACH) (36%, p<0.0005), whereas a decrease of 39% was observed for acid-etched implants (HF) when compared to other surface treatments. After 12 weeks of implantation, the push-out force values of HF implants were still significantly lower than those observed for MACH (-19%, p<0.01) and hydroxyapatite vacuum plasma-sprayed implants (HAVPS, -25%, p<0.0005), and the highest push-out force was found in HAVPS (p<0.001) implants. After 8 and 12 weeks of implantation, the AI of HF implants was significantly (p<0.05) lower ( approximately -25%) than that of MACH, HAVPS and ANODIC implants. In conclusion, results appear to confirm that there are no specific differences between ANODIC and HAVPS implants in terms of behavior. Moreover, although MACH implants show some surface contaminating agents, they appear to ensure good osseointegration within 12 weeks both mechanically and histomorphometrically, as do ANODIC and HAVPS implants. However, further studies are required to investigate bone hardness and mineralization around implants.     

Histomorphometric and microhardness assessments of sheep cortical bone surrounding titanium implants with different surface treatments

Several factors influence the healing process and the long-term mechanical stability of cementless fixed implants, such as bone remodeling and mineralization processes. Histomorphometric and bone hardness measurements were taken in implants inserted in sheep femoral cortical bone at different times to compare the in vivo osseointegration of titanium screws (diam.; 3.5 x 7 mm length) with the following surface treatments: machined (Ti-MA); acid-etched (Ti-HF); HA vacuum plasma spray (Ti-HA); and Ca-P anodization followed by a hydrothermal treatment (Ti-AM/HA). Ti-MA and Ti-AM/HA implants presented the lowest (Ra = 0.20 +/- 0.01 microm) and highest (Ra = 1.97 +/- 0.64 microm) significant (p < 0.0005) roughness value, respectively. Bone-to-implant contact of Ti-HF was lower than that of the other surface treatments at both experimental times (8 weeks: -20%, ns; 12 weeks: -30%, p < 0.01). Significant differences in MAR (mineral apposition rate) were also found between the different experimental times for Ti-MA (115%, p < 0.01) and Ti-HF (57%, p < 0.01), demonstrating that bone growth had slowed inside the screw threads of Ti-HA and Ti-AM/HA after 12 weeks. No bone microhardness changes in preexisting host bone were found, while Ti-MA showed the lowest value for the inner thread area at 8 weeks (HV(200 microm)= 49.8 +/- 3.8 HV). These findings confirm that osseointegration may be accelerated by adequate surface roughness and bioactive ceramic coating such as Ca-P anodization followed by a hydrothermal treatment, which enhance bone interlocking and mineralization.     

The influence of surface bioactivated modification on titanium percutaneous implants anchored in bone

In order to achieve biological sealing and resist mechanical damage of load-bearing percutaneous devices, Ti with excellent mechanical properties was anodic-oxidized to be endowed with bioactivity, with plasma-sprayed hydroxyapatite coated Ti as control. Similar to previous works, hydroxyapatite coating could bond tightly with living tissues, resulting in implant stability for whole implantation periods. Meanwhile, when anodic-oxidized bioactivated Ti was implanted percutaneously in vivo, it could induce a layer of calcium phosphate at the interface of tissues/implant. This layer of Ca-P not only induced the fibrous tissue or collagen ingrowth in its structure, but also improved the osteointegration between the bone and the implant. There was no significant biological response difference for the anodic-oxidized Ti and HA coated Ti at different implantation period with histological statistical analysis (p>0.05). Accordingly, suitable bioactivated modified surface of Ti by anodic-oxidized method could not only obtain the same results as the HA coating, but also might avoid some drawbacks of plasma-sprayed HA coatings to achieve biological sealing for a long period in vivo.     

The shear strength between bone and porous ceramic root implants in the guinea pig incisor socket

Porous alumina and apatite implants have been placed in 67 guinea pig incisor tooth sockets after tooth extraction under anaesthetic. Bone readily grew into the spaces of the implant, and reduced the fibrous connective tissue between implant and bone. 'Pushout' tests have monitored the shear strength of the interlock between bone and implant. Despite considerable variation in the interlock strength, apatite produced the strongest bone interlock. The interlock with alumina tended to be more fibrous. The relative merits of fibrous and bone interlocks in immediate root implants are considered for the augmentation of the alveolar ridge and prosthetic treatment.     

The bisphosphonate pamidronate on the surface of titanium stimulates bone formation around tibial implants in rats

Many materials with differing surfaces have been developed for clinical implant therapy in dentistry and orthopedics. We analyzed the quantity of new bone formed in vivo around calcium-immobilized titanium implants with surfaces modified using pamidronate (PAM), a nitrogen-containing bisphosphonate (N-BP), implants of pure titanium, and titanium implants immobilized with calcium ions. New bone formation was visualized using fluorescent labeling (calcein blue and alizarin complexone) with intravenous injection at 1 and 3 weeks after implantation. After 4 weeks, undecalcified sections were prepared, and new bone formation around the implants was examined by morphometry using confocal laser scanning microscopy images. After 1 week, more new bone formed around the PAM-immobilized implant than around the calcium-immobilized and pure titanium implants. This was also seen with the new bone formation after 3 weeks. After 4 weeks, significantly more new bones were formed around the BP-immobilized implant than around the calcium ion-implanted and pure titanium implants. The new N-BP-modified titanium surface stimulates new bone formation around the implant, which might contribute to the success of implant therapy.     

Prospects of using titanium nickelide implants with modified surface in dental implantology

Corrosion resistance and biocompatibility of 60 specimens of titanium nickelide with modified surfaces implanted into spongy bone were studied in rabbit experiments. Specimens modified by molybdenum ions exhibited high inertness and favorable tissue reaction. No accumulation of nickel and titanium ions in animal organs was detected. __________ Translated from Byulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 145, No. 6, pp. 707–713, June, 2008     

Electron beam-melted, free-form-fabricated titanium alloy implants: Material surface characterization and early bone response in rabbits

Titanium-6aluminum-4vanadium implants (Ti6Al4V) were prepared by free-form-fabrication (FFF) and were used either as produced or after machining and compared with wrought machined Ti6Al4V. Auger electron spectroscopy (AES), depth profiles, and interferometry were used to analyze the surface properties. The tissue response after 6-weeks in rabbit femur and tibia was evaluated using light microscopy and histomorphometry. The results revealed that the bulk chemical and mechanical properties of the reference material and the electron beam-melted (EBM) material were within the ASTM F136 specifications. The as-produced EBM Ti6Al4V implants had increased surface roughness, thicker surface oxide and, with the exception of a higher content of Fe, a similar surface chemical composition compared with machined EBM Ti6Al4V and machined, wrought Ti6Al4V implants. The two latter implants did not differ with respect to surface properties. The general tissue response was similar for all three implant types. Histomorphometry revealed a high degree of bone-to-implant contact (no statistically significant differences) for all the three implant types. The present results show that the surface properties of EBM Ti6Al4V display biological short-term behavior in bone equal to that of conventional wrought titanium alloy. The opportunity to engineer geometric properties provides new and additional benefits which justify further studies.     

Influence of surface characteristics on bone integration of titanium implants. A histomorphometric study in miniature pigs

The purpose of the present study was to evaluate the influence of different surface characteristics on bone integration of titanium implants. Hollow-cylinder implants with six different surfaces were placed in the metaphyses of the tibia and femur in six miniature pigs. After 3 and 6 weeks, the implants with surrounding bone were removed and analyzed in undecalcified transverse sections. The histologic examination revealed direct bone-implant contact for all implants. However, the morphometric analyses demonstrated significant differences in the percentage of bone-implant contact, when measured in cancellous bone. Electropolished as well as the sandblasted and acid pickled (medium grit; HF/HNO3) implant surfaces had the lowest percentage of bone contact with mean values ranging between 20 and 25%. Sandblasted implants with a large grit and titanium plasma-sprayed implants demonstrated 30-40% mean bone contact. The highest extent of bone-implant interface was observed in sandblasted and acid attacked surfaces (large grit; HCl/H2SO4) with mean values of 50-60%, and hydroxylapatite (HA)-coated implants with 60-70%. However, the HA coating consistently revealed signs of resorption. It can be concluded that the extent of bone-implant interface is positively correlated with an increasing roughness of the implant surface.     

Effect of nicotine in matrix mineralization by human bone marrow and Saos-2 cells cultured on the surface of plasma-sprayed titanium implants

Smoking has an established negative impact in the clinical outcome of dental implants. This work analyses the response of human osteoblastic cells to nicotine, at the surface of plasma-sprayed commercial titanium implants. Human bone marrow (HBM) and Saos-2 cells, seeded on the surface of titanium implants and cultured in experimental conditions favoring osteoblastic differentiation, were exposed continuously to nicotine (0.0001 to 0.5 mg mL(-1)) and characterized for cell proliferation and function. Exposure of HBM cells resulted in increased cell proliferation, higher alkaline phosphatase (ALP) activity, and earlier onset of matrix mineralization at levels up to 0.2 mg mL(-1), an initial inhibitory effect in cell growth and functional activity followed by a recovery in the presence of 0.3 mg mL(-1) and a dose-dependent deleterious effect at higher levels. By contrast, exposure to nicotine did not affect cell proliferation of Saos-2 cells at levels up to 0.2 mg mL(-1), and caused only a small positive effect in ALP activity in the presence of 0.05 and 0.1 mg mL(-1); however, matrix mineralization by Saos-2 cells also occurred earlier in the cultures exposed to levels of nicotine up to 0.1 mg mL(-1). Higher concentrations caused dose-dependent inhibitory effects. Considering the high diffusion potential of nicotine, results suggest a local role of nicotine in modulating bone formation events at the implant surface.     

Hip bone mineral density is improved by high-impact aerobic exercise in postmenopausal women and men over 50 years

Fifteen men and women (six men) between the ages of 50 and 73 years were recruited to begin keep-fit classes. They were matched for sex, age, menopausal status and mass to 15 non-exercising controls. The keepfit classes were two to three times a week and included high-impact exercise, including step and jumping exercises specifically to load the proximal femur and spine. Proximal femur, lumbar spine and total body bone mineral density (BMD) were measured at 0 and 12 months. Urinary pyridinoline (Pyr) and deoxypyridinoline (dPyr) crosslinks were measured every 6 months to assess bone resorption. Quadriceps isometric strength was measured every 6 months. BMD increased non-significantly at the femoral neck [1.57 (0.8%] and Wards triangle [1.97 (1.4%], and significantly at the greater trochanter 2.21 (0.9)% (P=0.02) in the exercise group. Femoral neck BMD decreased by −1.9(0.8)% (P=0.049) in the control group, which was significantly different from the change in the exercise group (P=0.009). BMD did not change at the Wards triangle or trochanter in the controls. Lumbar spine BMD did not change in either group. Total body BMD did not change in the exercise group, but decreased by −0.79 (0.3)% (P=0.02) in the controls. Follwing 6 months of the exercise classes, Pyr and dPyr crosslinks were significantly reduced [−19.0 (7.2)%;P=0.0019 and −20.0 (7.7)%;P=0.021 respectively]. There was no significant change in crosslinks after 1 year, and no change at any time in the controls. Quadriceps strength changed by 5.4 (3.7)% in the exercise group and by −6.9 (2.5)% (P=0.01) in the control group after 12 months, being significant between groups (P=0.008). This study suggests that high-impact, aerobic exercise in postmenopausal women and men over 50 years old is feasible and effective at maintaining muscle strength and increasing proximal femur BMD but not spine or total body BMD.     

Peri-implant bone formation and implant integration strength of peptide-modified p(AAM-co-EG/AAC) interpenetrating polymer network-coated titanium implants

Interpenetrating polymer networks (IPNs) of poly (acrylamide-co-ethylene glycol/acrylic acid) functionalized with an -Arg-Gly-Asp- (RGD) containing 15 amino acid peptides, derived from rat bone sialoprotein (bsp-RGD(15), were grafted to titanium implants in an effort to modulate bone formation in the peri-implant region in the rat femoral ablation model. Bone-implant contact (BIC) and bone formation within the medullary canal were determined using microcomputed tomography at 2 and 4 weeks postimplantation. BIC for bsp-RGD(15)-IPN implants was enhanced relative to hydroxyapatite tricalcium phosphate (HA-TCP) coated implants, but was similar to all other groups. Aggregate bone formation neither indicated a dose-dependent effect of bsp-RGD(15) nor a meaningful trend. Mechanical testing of implant fixation revealed that only the HA-TCP coated implants supported significant (>1 MPa) interfacial shear strength, despite exhibiting lower overall BIC, an indication that bone ingrowth into the rougher coating was the primary mode of implant fixation. While no evidence was found to support the hypothesis that bsp-RGD(15)-modified IPN coated implants significantly impacted bone-implant bonding, these results point to the lack of correlation between in vitro studies employing primary osteoblasts and in vivo wound healing in the peri-implant region.     

Low handgrip strength is associated with low bone mineral density and fragility fractures in postmenopausal healthy Korean women

Osteoporosis is a widely recognized health problem in postmenopausal women. Osteoporotic fractures reduce independency, limit daily living activities, and increase the mortality rate. Epidemiological studies have demonstrated that low handgrip strength is a risk factor for functional limitations and disabilities, and all-cause mortality. We investigated the relationship between handgrip strength and bone mineral density (BMD) of the spine, femur neck, and total hip, as well the relationship between handgrip strength and previous fragility fractures in 337 healthy postmenopausal Korean women (mean age of 59.5 ± 6.8 yr) who were free of diseases or medications affecting bone metabolism. Age and handgrip strength were associated with BMD of the spine, femur neck, and total hip in multiple regression models. Low handgrip strength (odds ratio [OR], 0.925; range, 0.877 to 0.975; P = 0.004) and low femur neck BMD (OR, 0.019; range, 0.001 to 0.354; P = 0.008) were independent predictors of previous fragility fractures in a multiple regression model. Our results demonstrate that low handgrip strength is associated with low BMD of the spine, femur neck, and total hip, and with increased risk of previous fragility fractures.     

Characterization of surface roughness in titanium dental implants measured with scanning tunnelling microscopy at atmospheric pressure

Characterization of the surface topography of implant materials is important for understanding tissue response. We have measured, for the first time, the topography of titanium surfaces used in osseointegrated dental implants. Scanning tunnellling microscopy (STM) which provides 3D real space images was used. In addition to clinical samples, electropolished and anodically oxidized surfaces were also measured. Clinical samples are rather inhomogeneous in character showing grooves and steps with a maximum depth of 0.11 μm. Micropores with an average diameter of about 30 nm are also present. Electropolished samples are rather homogeneous and very smooth, showing steps of 1 to 5 nm in height. The measurements were performed under atmospheric conditions at a resolution in the subnanometer range.     

Enhancement of adhesion strength and cellular stiffness of osteoblasts on mirror-polished titanium surface by UV-photofunctionalization

Ultraviolet (UV)-photofunctionalization of titanium substantially enhances the strength and quality of osseointegration by promoting osteogenic cellular attachment and proliferation. However, the mechanism underlying the initial interaction between the cells and the surface of the material remains to be elucidated, especially where the influence of surface roughness is excluded as a factor. The effect of UV-photofunctionalization on the adhesive strength and cellular stiffness of a single osteoblast and its association with the extent of cell spread, cytoskeletal development and focal adhesion assembly on a very smooth titanium surface was evaluated. Rat bone marrow-derived osteoblasts were cultured on UV-treated or untreated mirror-polished titanium disks. The mean critical shear force required to initiate detachment of a single osteoblast (n = 10) was >2000 nN on a UV-treated surface at 3 h incubation, which was 17 times greater than that on an untreated surface. The mean total energy required to complete the detachment of osteoblasts (n = 10) was consistently >60 pJ on a UV-treated titanium surface after 24 h culture, which was up to 42 times greater than that on an untreated surface. Cellular shear modulus, which represents cellular stiffness, was consistently greater on a UV-treated surface than on an untreated surface after 24 h incubation (n = 10). This strengthening of cell adhesion and cellular mechanical properties on UV-treated titanium was accompanied by enhanced cell spread and actin fiber development and increased levels of vinculin expression. These results indicate that UV-photofunctionalization substantially strengthens osteoblast retention on titanium bulk material with no topographical features, and that this is associated with enhancement of intracellular structural development during the cell adhesion process.     

Evaluation of corrosion on plasma sprayed and anodized titanium implants,both with and without bone cement

The corrosion behavior of titanium with vacuum plasma sprayed titanium coatings and with anodized surfaces, both with and without polymeric bone cement were evaluated. Electrochemical extraction tests were carried out with subsequent analysis of the electrolyte by ICP-MS in order to verify our hypothesis of the ionic permeability of the polymer cement. The complexity of the situation resides in the existence of two interfaces: electrolyte-polymer and polymer-metal. The surface preparation (treatment of the surface) plays an important role in the corrosion resistance of titanium. The electrochemical magnitudes that were examined reveal that the plasma spray surfaces have the lowest corrosion resistance. The cement, in spite of having reduced electrical conductivity in comparison to metal, is an ionic transporter, and therefore capable of participating in the corrosion process. In the present study, we observed in fact crevice corrosion at the metal-cement interface. In the case of plasma spray surfaces, a process of diffusion of titanium particles in the electrolyte could accompany the crevice corrosion. In this study, we have shown that there is a corrosion process at the surface of the titanium through the cement which has as a consequence on the one hand the formation of titanium cations and on the other hand the growth of a passive layer on the titanium. In conclusion, we identified two principal factors that influence the corrosion process: [1] the type of surface treatment for the titanium, and [2] the ionic conductivity of the cement. There is indeed ionic transport through the cement; as evidenced by the presence of titanium in the electrolyte solution (ICP-MS analysis) and chloride at the surface of the titanium sample (EDX analysis).We show that the polymer cement is an ionic conductor and participates in the corrosion of the embedded titanium. We cannot deduce from our results, however, whether the polymer itself possesses corrosive properties. Long-term experiments will be necessary to study the degradation behavior of the polymer cement.