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PubMed2006

In vitro comparison of bioresorbable and titanium anterior cervical plates in the immediate postoperative condition.

Bioresorbable plates have recently been used with anterior cervical discectomy and fusion (ACDF). Compared with metallic plates, bioresorbable plates provide segmental stabilization with minimal imaging artifact, eventual resorption, and increased load sharing. The objectives of the present study were to determine whether a bioresorbable plate can withstand simulated physiologic static and cyclic loading, to compare the reduction in flexibility provided by bioresorbable and titanium plates, and to quantify load sharing between the plate and spine with graft. Sixteen human cervical motion segments were tested to +/-2.5 Nm in flexion-extension, lateral bending, and axial rotation. Range of motion (ROM) was measured (1) in the intact state, (2) with ACDF without plating, (3) after addition of either a bioresorbable or titanium plate, and (4) after 500 cycles of combined flexion-extension and axial torsion. Load sharing was evaluated by applying the same fixed rotation both without and with the plate, and was calculated as the moment resisted by the uninstrumented ACDF expressed as a percentage of the plated ACDF state. No plate failures or graft migration occurred during testing. Compared with the uninstrumented ACDF, bioresorbable plates reduced mean ROM by 49% in flexion-extension and 25% in lateral bending, with very little change in torsion. Titanium plates reduced uninstrumented ACDF ROM by 69% in flexion-extension, 45% in lateral bending, and 27% in torsion. Differences between bioresorbable and titanium plates were significant in flexion-extension and lateral bending. Cyclic loading did not significantly change ROM for either plate. More moment was shared in lateral bending by the spine/graft with bioresorbable plates (78%) compared with titanium plating (63%). Bioresorbable plates contained an intervertebral graft, provided some stabilization, remained intact throughout the simulated immediate postoperative loading, and shared more load with the graft and osteoligamentous spine than titanium plates.

Absorbable Implants↗

PubMedDate not supplied

Development of a flexible inflow cannula with titanium inflow tip for the NEDO biventricular assist device.

A newly designed flexible inflow cannula has been developed for a biventricular assist device (BVAD). The inflow tip was designed for long-term ventricle drainage. Considering the anatomic differences between the right and left ventricles, a flexible inflow cannula, as a mass production model with a titanium tip, was developed and investigated in chronic BVAD animal experiments using the NEDO permanently implantable centrifugal blood pump. These flexible inflow cannulae consist of flexible plastic tubing with wire supported, titanium left and right tips. The right titanium inflow tip was designed with inner and outer stoppers to be inserted into the right ventricle wall and a beak shape to avoid sucking. The left tip was designed to be inserted into the left ventricle cavity. Five chronic BVAD bovine studies were performed to investigate the new beak shaped titanium tip. In these studies, the new beak shaped titanium tip and cannula prevented stenosis by a proliferation of pseudoneointimal, and supplied adequate blood flow to the pump without sucking. This newly designed inflow cannula with the beak shaped titanium tip was successfully implanted for 90 days.

Animals↗

PubMed1999

Infrared gold alloy brazing on titanium and Ti-6Al-4V alloy surfaces and its application to removable prosthodontics.

PURPOSE: This study investigated the area size of the flow of a gold braze alloy on commercially pure titanium and Ti-6Al-4V alloy plates, and elemental composition at the interface was determined. In the second part of this study, the tensile strengths of titanium plates brazed using a gold alloy were investigated. MATERIALS AND METHODS: Chips of Type IV gold alloy and silver braze alloys were melted onto commercially pure titanium and Ti-6Al-4V surfaces in a dental infrared radiation unit. Flow area of each braze alloy was measured using a digital image analyzer. Tensile specimens (n = 5) were also prepared by infrared brazing using the braze alloys. Five specimens for each combination of the two titanium plates and the two braze alloys were subjected to tensile loading using a Universal testing machine. Electronprobe microanalysis of x-rays at cross-section of the brazed joints to determine elemental composition across the interface, as well as scanning electron microscopic observation at the fracture surfaces, were also conducted. RESULTS: The braze alloys flowed well and spread over the Ti and Ti-6Al-4V plates. Braze alloy type significantly influenced flow, and the gold alloy flowed less on the titanium materials. The mean tensile strengths of Ti and Ti-6Al-4V plates brazed using the gold braze alloy were 219 MPa and 417 MPa, respectively. The fracture surfaces of Ti-6Al-4V specimens with the gold braze alloy exhibited typical ductile behavior. Ti with the same braze alloy showed brittle surfaces. A greater concentration of Cu was found at the Ti with gold braze interface. CONCLUSION: The flow and the tensile strength of the gold alloy coating on titanium surface by means of an infrared brazing is adequate for dental use.

Alloys↗

PubMed1991

Immunolocalization of proteins specific for adhaerens junctions in human gingival epithelial cells grown on differently processed titanium surfaces.

The localization of desmoplakins 1 and 2 (DP 1&2), components of desmosomes, vinculin, and actin, was studied in gingival epithelial cells grown on cell culture glass and on titanium plates with various surface topography. The results showed that epithelial cells attached and spread more readily on smooth than on rough, sandblasted titanium surfaces. Moreover, the cells appeared to develop more granular DP 1&2 immunoreactivity at their ventral surfaces when grown on smooth or etched titanium as compared to glass. In cells grown on sandblasted titanium surfaces, DP 1&2-specific immunoreactivity was primarily located at cell-cell contacts. Cells grown on smooth titanium surfaces harbored a fine network of actin filaments with apparent cell-to-cell organization. Vinculin was confined to cell-cell contact areas. No vinculin-containing focal adhesions could be detected, suggesting that the cells adhere either by means of close contacts, extracellular matrix contacts, or by means of hemidesmosomes. The findings suggest that smooth of finely grooved titanium surfaces could be optimal in maintaining the adhesion and specialized phenotype of gingival epithelial cells.

Actins↗

PubMed1996

Torsional and bending properties of stainless steel and nickel titanium Canal Master U and Flexogate instruments.

The purpose of this study was to assess and to compare the torsional and bending properties of the Canal Master U (CMU) and Flexogate instruments made of stainless steel and nickel titanium. The bending moment, the torsional moment and angular deflection were measured according to ANSI/ADA specification number 28 and ISO reference number 3630. Ten instruments of each size, sizes 25 to 40 were used for each test. Nickel titanium instruments were significantly more flexible than stainless steel files. With regard to the torsional moment, values obtained were below the standards in all sizes except stainless steel CMU sizes 25, 35 and 40, and nickel titanium CMU size 25. Nickel titanium instrument also showed the highest angular deflection values. There were statistically significant differences between nickel titanium files and stainless steel Flexogates and between stainless steel Flexogates and stainless steel CMU. Based on these findings, the use of nickel titanium CMU and Flexogates is encouraged. Given the perceived advantages of both CMU and Flexogate instruments over conventional files for canal preparation, it would appear desirable to have the torque resistance of these instruments improved.

Dental Instruments↗

PubMed1999

Clinical experiences of implant-supported prostheses with laser-welded titanium frameworks in the partially edentulous jaw: a 5-year follow-up study.

BACKGROUND: Titanium frameworks have been used in the endentulous implant patient for the last 10 years. However, knowledge of titanium frameworks for the partially dentate patient is limited. PURPOSE: To report the 5-year clinical performance of implant-supported prostheses with laser-welded titanium frameworks in the partially edentulous jaw. MATERIALS AND METHODS: A consecutive group of 383 partially edentulous patients were, on a routine basis, provided with fixed partial prostheses supported by Brånemark implants in the mandible or maxilla. Besides conventional frameworks in cast gold alloy, 58 patients were provided with titanium frameworks with three different veneering techniques, and clinical and radiographic 5-year data were collected for this group. RESULTS: The overall cumulative survival rate was 95.6% for titanium-framework prostheses and 93.6% for implants. Average bone loss during the follow-up period was 0.4 mm. The most common complications were minor veneering fractures. Loose and fractured implant screw components were fewer than 2%. An observation was that patients on medications for cardiovascular problems may lose more implants than others (p < .05). CONCLUSIONS: The clinical performance of prostheses with implant-supported laser-welded titanium frameworks was similar to that reported for conventional cast frames in partially edentulous jaws. Low-fusing porcelain veneers also showed clinical performance comparable to that reported for conventional porcelain-fused-to-metal techniques.

Adult↗

PubMed2000

Re-establishment of the atomic composition and the oxide structure of contaminated titanium surfaces by means of carbon dioxide laser and hydrogen peroxide: an in vitro study.

BACKGROUND: In clinical situations with peri-implant bone resorption, re-integration of the exposed implant surface is sometimes preferable, which requires a clean surface. Previous investigations have shown that cleaning of contaminated titanium surfaces using chemical and abrasive methods is difficult. PURPOSE: The aim of this investigation was to evaluate the efficacy of different combinations of chemical and physical methods (citric acid, hydrogen peroxide, and carbon dioxide [CO2] laser irradiation) for removal of contaminants and subsequent reconstruction of the surface oxide of intraorally contaminated titanium foils. MATERIALS AND METHODS: Commercially pure titanium foils (99.6%, 5 x 5 mm in size) were contaminated by placement on dentures in volunteering patients, simulating a peri-implantitis situation. The contaminated foils and clean control foils were treated by seven and six combinations of citric acid, hydrogen peroxide, and CO2 laser irradiation, respectively. The effect of the cleaning procedures was evaluated by x-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM). RESULTS: The initial elemental composition of the contaminated foils was 70% carbon (C), 20% oxygen (O), 10% nitrogen (N), and only traces of titanium (Ti) (< 1%). One treatment proved to be more effective than the others: irradiations by 5-second cycles of superpulsed CO2 laser at a power of 7 W, 10-millisecond pulse width, and with an 80-Hz frequency on a wet surface, followed by repeated application of supersaturated citric acid for 30 seconds, each time followed by rinsing with ultrapure water until all tissue remnants had been removed. Finally, hydrogen peroxide of 10-mM concentration was added to the implant surface and evaporated by CO2 laser at the same settings. This treatment protocol resulted in 10% Ti, 45% O, 41% C, and 2 to 3% N, a composition comparable to that of unused foils: 9% Ti, 40% O, 48% C, and traces of N and chlorine (CI). X-ray photoelectron spectroscopy profiles showed that the thickness of the surface oxide was restored and even augmented with this protocol for treatment of contaminated titanium. CONCLUSION: A combination of citric acid, hydrogen peroxide, and CO2 laser irradiation seems to be effective for cleaning and reestablishment of the atomic composition and oxide structure of contaminated titanium surfaces.

Carbon↗

PubMed2002

Clinical experience of CNC-milled titanium frameworks supported by implants in the edentulous jaw: a 3-year interim report.

BACKGROUND: The use of computer numeric controlled (CNC)-milled titanium frameworks is a new technique for framework fabrication, and few clinical reports have been made on this treatment modality. PURPOSE: The goal of this study was to report the clinical performance of implant-supported prostheses with CNC-milled titanium frameworks in the edentulous jaw and to compare the results with prostheses provided with conventional cast frameworks during the first 3 years of function. MATERIALS AND METHODS: A consecutive group of 126 edentulous patients were provided by random distribution with 67 prostheses with CNC-milled titanium frameworks in 23 upper and 44 lower jaws and 62 conventional prostheses with gold-alloy castings in 31 upper and 31 lower jaws. Radiographic 1-year data and clinical 3-year data were collected for both the titanium and control group. RESULTS: One prosthesis was lost in each group owing to loss of implants, and the overall 3-year prosthesis cumulative survival rate was 98.2% for both groups. Patients with smoking habits experienced significantly more implant failures than nonsmokers (p =.006). Few problems were observed. No metal fractures were seen in the test group, whereas two frameworks and one abutment screw fractured in the control group. Resin veneer fractures were the most common complication, with a slightly higher incidence observed in the control group. CONCLUSIONS: Computer numeric controlled-milled titanium frameworks can be used as an alternative to conventional castings in the edentulous jaw, presenting clinical performance similar to that of conventional cast frameworks during the first 3 years of function. key words: computer numeric controlled, implant supported, prostheses, titanium

Computer-Aided Design↗

PubMed1989

Vena caval filter splaying: potential complication of use of the titanium Greenfield filter.

Significant structural and mechanical differences exist between the titanium and stainless steel versions of the Greenfield filter (GF). The titanium GF has a longer leg length (49 mm vs 43 mm), a greater span (38.5 mm vs 28.0 mm), and a larger hook angle (41 degrees vs 23.5 degrees). In vitro tests demonstrated approximately sevenfold greater filter length shortening (a measure of filter splaying) for the titanium GF in response to a given applied load. These differences resulted in marked filter splaying and inferior vena cava (IVC) perforation in three patients in whom a titanium GF had been inserted. The aorta was penetrated by a filter leg in one patient, and abdominal or back pain was present in all three patients. In vitro tests involving thrombosis within a latex balloon revealed that the titanium GF, but not the stainless steel GF, remained splayed even in the face of clot retraction. Design modifications, possibly using shorter, thicker filter legs and using reduced hook angles, should be made in the titanium GF to decrease the risk of filter splaying and IVC perforation before widespread use of this device.

Adult↗

PubMed2004

Cellular reactions of osteoblasts to micron- and submicron-scale porous structures of titanium surfaces.

Osteoblast reactions to topographic structures of titanium play a key role in host tissue responses and the final osseointegration. Since it is difficult to fabricate micro- and nano-scale structures on titanium surfaces, little is known about the mechanism whereby the topography of titanium surfaces exerts its effects on cell behavior at the cellular level. In the present study, the titanium surface was structured in micron- and submicron-scale ranges by anodic oxidation in either 0.2 M H3PO4 or 0.03 M calcium glycerophosphate with 0.15 calcium acetate. The average dimensions of pores in the structured surface were about 0.5 and 2 microm in diameter, with roughness averaging at 0.2 and 0.4 microm, respectively. Enhanced attachment of cells (SaOS-2) was shown on micron- and submicron-scale structures. Initial cell reactions to different titanium surfaces, e.g. the development of the actin-containing structures, are determined by the different morphology of the surfaces. It is demonstrated that on either micron- or submicron-structured surfaces, many well-developed filopodia were observed to be primary adhesion structures in cell-substrate interactions, and some of them entered pores using their distinct tips or points along their length for initial attachment. Therefore, porous structures at either micro- or submicrometre scale supply positive guidance cues for anchorage-dependent cells to attach, leading to enhanced cell attachment. In contrast, the cells attached to a smooth titanium surface by focal contacts around their periphery as predominant adhesion structures, since repulsive signals from the environment led to retraction of the filopodia back to the cell bodies. These cells showed well-organized stress fibres, which exert tension across the cell body, resulting in flattened cells.

Biocompatible Materials↗

PubMed1992

Enhanced extracellular matrix production and mineralization by osteoblasts cultured on titanium surfaces in vitro.

Long-term stability of orthopaedic and dental implants depends on the integration of the artificial material into the surrounding bone tissue. The physical and chemical properties of implants, including those made of metals such as titanium, are thought to influence osseointegration. Despite the known importance of this interface, little is known about the factors that promote its formation. In this study, chick embryonic calvarial osteoblasts were cultured in vitro on smooth, rough-textured and porous-coated titanium surfaces and examined for morphology, biosynthesis of extracellular matrix and mineralization as a function of culture time. Scanning electron microscopy revealed that osteoblasts adhered securely to the titanium surface and frequently bridged the uneven surface by means of cellular processes. The osteoblast phenotype was retained in the cell cultures on titanium. In addition, the synthesis of extracellular matrix and subsequent mineralization were both substantially enhanced in the cultures on rough-textured and porous-coated titanium. These results strongly suggest that porous or rough titanium implant surfaces may act like "natural" substrata to permit microscopic tissue/cell ingrowth to improve clinical implant fixation.

Animals↗

PubMed1991

Sensitivity to titanium. A cause of implant failure?

Tissues from five patients who underwent revision operations for failed total hip replacements were found to contain large quantities of particulate titanium. In four cases this metal must have come from titanium alloy screws used to fix the acetabular component; in the fifth case it may also have originated from a titanium alloy femoral head. Monoclonal antibody labelling showed abundant macrophages and T-lymphocytes, in the absence of B-lymphocytes, suggesting sensitisation to titanium. Skin patch testing with dilute solutions of titanium salts gave negative results in all five patients. However, two of them had a positive skin test to a titanium-containing ointment.

Antibodies, Monoclonal↗

PubMed2005

Low protein intake is associated with impaired titanium implant osseointegration.

UNLABELLED: Low protein intake is highly prevalent among orthopaedic elderly patients. We studied the effects of an isocaloric low protein diet on the resistance to pull-out of titanium rods implanted into rats proximal tibia. Isocaloric low protein intake impairs titanium implant osseointegration, with a decreased strength needed to completely loose the implant and altered bone microarchitecture in its vicinity. INTRODUCTION: Low protein intake is highly prevalent among elderly patients in orthopaedic wards and could retard fracture healing. It was previously shown that reduced protein intake decreases bone strength. Whether dietary protein intake could influence titanium implant osseointegration is unknown. We studied the effects of an isocaloric low protein diet on the resistance to pull-out of titanium rods implanted into rats proximal tibia. MATERIALS AND METHODS: Forty-eight 11-month-old female rats were fed isocaloric diets containing 2.5% (low protein) or 15% (normal protein) casein from 2 weeks before the implantation of a 1-mm-diameter cylindrical titanium rod in the proximal metaphysis of each tibia. Four, 6, and 8 weeks after implantation, the tibias were removed for microCT histomorphometry to quantify bone-to-implant contact and bone trabecular microarchitecture around the implant. Resistance to implant pull-out was tested by recording the maximal force necessary to completely loosen the implant. RESULTS: Pull-out strength was significantly lower in rats fed an isocaloric low protein diet by 6 and 8 weeks after implantation (-43%, p < 0.001 and -42%, p < 0.001, respectively) compared with rats fed a normal protein diet. Bone-to-implant contact was significantly lower in the low protein group 8 weeks after implantation (p < 0.05). Bone-to-implant contact and pull-out strength were correlated (r2= 0.57, p < 0.0001). BV/TV around the implant was 19.9 +/- 2.2% (SE) versus 31.8 +/- 3.3% (p < 0.05) at 6 weeks and 20.1 +/- 1.9% versus 29.8 +/- 3.2% (p < 0.05) at 8 weeks after implantation in the low protein and normal protein intake groups, respectively. Trabecular thickness was 96.2 +/- 3.7 versus 113.0 +/- 3.6 microm (p < 0.01) at 6 weeks and 101.4 +/- 2.7 versus 116.2 +/- 3.3 microm (p < 0.01) at 8 weeks in the corresponding groups. In a structure model index analysis, there was a significant shift to a more rod-like pattern in the low protein diet groups. All these changes were associated with lower plasma IGF-I levels. CONCLUSIONS: Isocaloric low protein intake impairs titanium implant osseointegration, with decreased strength needed to completely loosen the implant and altered bone microarchitecture in the vicinity of the implant.

Animals↗

PubMed2003

Titanium applications in dentistry.

BACKGROUND: The ADA Council on Scientific Affairs outlines the status of titanium and titanium alloys used in dentistry and provides its recommendations concerning their use in clinical practice. CONCLUSIONS: Titanium and titanium alloys, based on their physical and chemical properties, appear to be especially suitable for dental implants and prostheses. For the construction of endosseous implant devices, titanium and its alloys have become well-accepted and can be considered the materials of choice. CLINICAL IMPLICATIONS: For crown and bridge prostheses, dentists can consider titanium and its alloys as viable options to more traditional noble and base metal alloys, but careful selection of processing methods and laboratory skill are necessary to ensure success.

Crowns↗

PubMed2005

Recent advances in the design of titanium alloys for orthopedic applications.

To increase an orthopedic implant's lifetime, research trends have included the development of new titanium alloys made of nontoxic elements with suitable mechanical properties (low Young's modulus - high fatigue strength), good workability and corrosion resistance. In accordance with the background on titanium and metallic biomaterials, recent interesting developments in titanium-based biomaterials are reported in this review, with a special emphasis on the design of new metastable beta-titanium alloys for orthopedic applications. In addition, as the concept of titanium alloys can now be regarded as relatively old, having emerged at the beginning of the 1980s, the author suggests some future directions that would permit the emergence of a new generation of titanium implants.

Alloys↗

PubMed1990

The effects of scaling titanium implant surfaces with metal and plastic instruments on cell attachment.

This study examined the ability of tissue culture fibroblasts to attach and colonize on the surface of pure titanium dental implants following instrumentation of the implant surface with curettes of dissimilar composition. Pure titanium dental implants were scaled with a plastic, titanium-alloy, or stainless steel curette and then immersed in a cell suspension of 3T3 fibroblasts. Counts of attached cells were made at 24 and 72 hours; the implants were then processed for scanning electron microscopy (SEM). At 24 hours, only surfaces scaled with a stainless steel curette showed a significant reduction in number of attached cells relative to untreated control surfaces. At 72 hours, both stainless steel and titanium-alloy curette instrumented surfaces showed significantly fewer attached cells than untreated control surfaces, with the greatest reduction in cell attachment observed on the stainless steel curette instrumented surfaces. SEM observations showed that fibroblasts on stainless steel instrumented surfaces tended to show a somewhat rounded morphology and a relatively reduced degree of spreading: while fibroblasts on untreated control, plastic, or titanium-alloy instrumented surfaces showed a well-spread, polygonal morphology, more typical of fibroblasts in favorable culture conditions. To the extent that such observations of cell attachment and morphology are indicative of in vivo biocompatibility, these findings could have clinical implications for the proper maintenance of titanium dental implants.

Alloys↗

PubMed1996

Effects of various hygiene procedures on the surface characteristics of titanium abutments.

The use of cleaning instruments on titanium implants may cause undesired surface alterations. In a qualitative and quantitative assessment of these alterations, 5 titanium implant abutments were treated with a steel curet, a prototype pure titanium curet, an air abrasive polishing system, and an ultrasonic system. Custom-made polymer templates, used to secure the curet to a vertical guide bar and a spring scale to maintain a constant instrument pressure, guaranteed a standardized procedure and reproducible results. The ultrasonic and the air abrasive polishing method were also standardized. Evaluation by scanning electron microscopy (SEM) revealed surface alterations for all instruments and systems except the plastic curet, which did not roughen the surface at all. The confocal laser-scanning microscope allows a 3-dimensional reproduction of these surface alterations and their direct measurement. The profilometric tracing was not sensitive enough to register the minor effects caused by the titanium curet and the air abrasive polishing system. Dimensions of the resulting surface microstructure could be determined with the laser-scanning microscope. Since the influence of such surface defects on the peri-implant tissue reaction is unpredictable, the titanium curet and the air abrasive system can only be recommended with restrictions. The steel curet and the ultrasonic system proved to be totally unsuitable for cleaning titanium implants.

Curettage↗

PubMed2006

Influence of an erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser on the reestablishment of the biocompatibility of contaminated titanium implant surfaces.

BACKGROUND: The aim of the present study was to evaluate the influence of an erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG laser [ERCL]) on 1) the surface structure and biocompatibility of titanium implants and 2) the removal of plaque biofilms and reestablishment of the biocompatibility of contaminated titanium surfaces. METHODS: Intraoral splints were used to collect an in vivo supragingival biofilm on sand-blasted and acid-etched titanium disks for 24 hours. ERCL was used at an energy output of 0.5, 1.0, 1.5, 2.0, and 2.5 W for the irradiation of 1) non-contaminated (20 and 25 Hz) and 2) plaque-contaminated (25 Hz) titanium disks. Unworn and untreated non-irradiated, sterile titanium disks served as untreated controls (UC). Specimens were incubated with SaOs-2 osteoblasts for 6 days. Treatment time, residual plaque biofilm (RPB) areas (%), mitochondrial cell activity (MA) (counts per second), and cell morphology/surface changes (scanning electron microscopy [SEM]) were assessed. RESULTS: 1) ERCL using either 0.5, 1.0, 1.5, 2.0, or 2.5 W at both 20 and 25 Hz resulted in comparable mean MA values as measured in the UC group. A monolayer of flattened SaOs-2 cells showing complete cytoplasmatic extensions and lamellopodia was observed in both ERCL and UC groups. 2) Mean RPB areas decreased significantly with increasing energy settings (53.8 +/- 2.2 at 0.5 W to 9.8 +/- 6.2 at 2.5 W). However, mean MA values were significantly higher in the UC group. CONCLUSION: Within the limits of the present study, it was concluded that even though ERCL exhibited a high efficiency to remove plaque biofilms in an energy-dependent manner, it failed to reestablish the biocompatibility of contaminated titanium surfaces.

Adult↗