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PubMed2006

Evaluation of transitional implant stabilized overdentures: a case series report.

Transitional implants (TI) can immediately improve the stability and retention of existing unstable mandibular complete dentures. This study evaluated the improvement of mandibular complete denture stability and retention with the use of TI. Three TIs were placed in the intraforaminal region of the edentulous mandible of seven patients (three men, four women; mean age 69.7 years). The patients' existing mandibular complete dentures were immediately modified to TI-stabilized overdentures. Their masticatory movements (mandibular movements during mastication) were measured using a commercially available tracking device (BioPACK, Bioresearch, Japan), both before TI placement and about 1 month after delivery of the TI-stabilized overdentures. The mean time of each chewing phase (opening, closing, and occluding) and coefficients of variation were calculated. The patients also completed a questionnaire about the foods they could chew and indicated on a 100 mm Visual Analog Scale (VAS) their personal levels of comfort, ease of chewing, speech, and stability. For masticatory movements, there were no significant differences (P > 0.05) between the TI-stabilized overdentures and existing complete dentures. However, the number of foods that could be chewed increased, and the stability and comfort were reported as improved with the TI-stabilized overdentures. Using TIs, the stability and comfort of the existing mandibular complete dentures studied in this report could be immediately improved.

Aged↗

PubMed2003

Biologic effects of surface roughness and fluorhydroxyapatite coating on osteointegration in external fixation systems: an in vivo experimental study.

The concomitant influence of surface roughness and fluorhydroxyapatite (FHA) coating of titanium (Ti) implants on bone response was investigated. For this purpose, titanium screw-shaped implants with a lower degree (Y371) and a higher degree (TiPore300) of surface roughness, coated with FHA and uncoated, were transversally inserted into the diaphyses of sheep tibiae for 12 weeks. Four sheep received Y371 (group A) and Y371 + FHA (group B) screws and four sheep received TiPore300 (group C) and TiPore300 + FHA (group D) screws. For each type of material, the morphology and microstructure of implant-facing bone were evaluated. The host bone of each tibia was used as a control. In all groups the bone tissue did not reach a complete maturation. The higher degree of roughness, perhaps due to an excessive irregularity of the surface, induced the worst osteointegration: a fibrous tissue layer between screw and new bone tissue was often present. Nevertheless, as viewed by XRD, no crystallographic change of the apatite lattice was observed in any of the implants. In contrast, the microhardness value, an index of bone mineralization, was higher in the uncoated screws and decreased progressively in the following order: group C > group A > group B > group D. The association of plasma spraying with roughness treatment constitutes a complex system that seems to interfere with bone mineralization. A chemical change of the surface, perhaps with more Ti release or more coating degradation, could be responsible for such impairment. The authors emphasize the necessity for simultaneous evaluation of surface topography and chemistry as well as an improvement in plasma-spraying and post-processing techniques and in standard procedures for materials characterization.

Animals↗

PubMed2001

Cellular reactions and bone apposition to titanium surfaces with different surface roughness and oxide thickness cleaned by oxidation.

Titanium surfaces with three different surface characteristics were exposed to an intraperitoneal milieu in mouse or rat, or inserted into rabbit bone. The cleaning regimen of the TiO2 surfaces in this study included oxidation by heat or acid and a final rinsing and storage in water. Intraperitoneal exposure ranged from 1 to 64 min and the healing period in bone was 6 weeks. Cell recruitment to the surfaces was quantified by acridine orange staining and specific antibodies directed against cell membrane antigens. Removal torque, bone-to-metal contact, total bone area and histological evaluations were used to evaluate fixture stability and the healing-in of the implants. After the healing period of 6 weeks only a transient significant difference was seen in the total number of cells adherent on the surfaces. No significant differences were observed between any of the surfaces for removal torque, bone-to-metal contact, or bone area. The areas lacking bone-to-metal contact were filled with normal vascularised connective tissue with no signs of fibrous capsule formation or giant cells. These findings differ from findings published earlier of Ti implants that underwent a cleaning regimen with alcohol as the final rinsing step. The tissues around the implants were richly vascularised and there was continued bone growth toward the surfaces. The bone-to-metal contact in this study was lower than that seen with alcohol-cleaned TiO2.

Animals↗

PubMedDate not supplied

Analysis of Ti-6Al-4V implants placed with fibroblast growth factor 1 in rat tibiae.

Titanium-aluminum-vanadium (Ti-6Al-4V) implants were placed in the tibiae of 32 rats (male Sprague-Dawley, 350 g) to examine healing and bone response. Half of the implants were treated with fibroblast growth factor 1 (FGF-1) delivered in an activated fibrinogen matrix. Animals were injected with a radiopharmaceutical imaging agent, technetium-99m-methylene diphosphonate (Tc-99m-MDP), which concentrates in bone, especially in areas of higher osteoblastic activity. Binding of Tc-99m-MDP to the implant was detected in vivo by Anger gamma camera imaging. Fourteen days after implant surgery, specimens were recovered and prepared for histomorphometric analysis. Histologic examination revealed that samples treated with FGF-1 demonstrated significantly greater amounts of bone-to-implant contact (P < .05) compared to controls. Also, FGF-1-treated samples showed significantly greater amounts of bone (percent volume) adjacent to implants (P < .005). These findings were supported by analyses of the non-invasive Tc-99m-MDP images, which demonstrated significantly greater uptake of Tc-99m-MDP adjacent to FGF-1-treated implants (P < .05). Results of the experiments supported the hypothesis that FGF-1 could increase bone production around implants in a rat model.

Alloys↗

PubMed2002

[Bone regeneration in oral surgery].

Bone regeneration is the technique of choice in order to repair small and medium sized bone defects in maxillary. It is used as an auxiliary medical treatment for dental implants. In this work, we show the different state of the art techniques used in bone lesions repair, and we also show experimental results obtained in our research group using bone morphogenetic protein BMP-2. This protein has been expressed in an E. Coli strain previously modified with the protein nucleotide sequence. We also show a carrier developed in our laboratory that is able to bind the rhBMP-2 and to liberate it in its active form. The mechanical properties of the carrier can be chemically modified. We have tested Ti implants covered with films of this material activated with rhBMP-2. The experimental in vivo results obtained with this kind of implants has been impressive.

Activin Receptors, Type I↗

PubMed2004

[Surface analysis of interaction between titan implants treated with anod oxidation and the human organism].

UNLABELLED: The examination of interaction between the titan implants treated with anod oxidation and the human organism carried out with surface analytical methods. The favourable properties of metallic titanium have led to its widespread use as an implant material. These properties can be further improved by surface treatment. We have been using anodically oxidized titanium plates for purposes of osteosynthesis for more than 15 years. A specially produced surface oxide layer (TiO2) improves the properties of the metal considerably, increasing the physical and chemical resistance of the plates to the aggressive effects of the organism. Thanks to this, it is now very rare for the plates to have to be removed after the bone healing. The present aim was to use XPS, SIMS and AES surface analytical methods to study the extent to which the positive charactheristics of the TiO2 coating are altered by the aggressive action of the organism during the years following implantation. In practice, we sought to establish the length of time during which the good properties of the plates do not change, and to determine when, it at all, the plates need to removed. MATERIAL AND METHODS: In our present work we studied titanium (ostheosynthesis) plates, removed from 3 patients, with XPS, AES and SIMS method. RESULTS: It was observed that the basic metal remained covered by a TiO2 layer. In consequence of the osseintegration, the Ca and P contents of this layer had increased, which may be explained by incorporation from the organism. CONCLUSION: The Ti implant with is modified surface was covered by a TiO2 layer 120-150 nm thick, which exhibited a homogeneous oxygen distribution. During many years, this had provided protection against the chemical and physical effects of the organism.

Bone Plates↗

PubMed2001

Calcium-phosphate surface coating by casting to improve bioactivity of titanium.

In order to improve the bioactivity of titanium, an original surface treatment was attempted with the use of a casting technique was attempted. Pure titanium was cast into a special graphite mold in which the cavity wall was coated with hydroxyapatite (HA) powder. According to analyses of X-ray diffraction and EDX, the existence of HA and CaO and uptake of Ca and P on the surface of the titanium castings were identified. By immersing the specimen in Hank's solution, the concentrations of Ca and P on the surface increased with immersion time, and the formation of a thin layer with characteristics of spherical HA precipitates was observed after 1 week. The concentrations of Ca and P elements and the Ca/P ratio on the HA layer increased with immersion time. The formation of the HA layer on the titanium cast by this treatment was significantly accelerated compared with pure titanium. The present surface treatment of Ti is expected to improve early bone fixation of Ti implants.

Biocompatible Materials↗

PubMed2005

Growth of nano-scale hydroxyapatite using chemically treated titanium oxide nanotubes.

A vertically aligned nanotube array of titanium oxide was fabricated on the surface of titanium substrate by anodization. The nanotubes were then treated with NaOH solution to make them bioactive, and to induce growth of hydroxyapatite (bone-like calcium phosphate) in a simulated body fluid. It is shown that the presence of TiO2 nanotubes induces the growth of a "nano-inspired nanostructure", i.e., extremely fine-scale (approximately 8 nm feature) nanofibers of bioactive sodium titanate structure on the top edge of the approximately 15 nm thick nanotube wall. During the subsequent in-vitro immersion in a simulated body fluid, the nano-scale sodium titanate, in turn, induced the nucleation and growth nano-dimensioned hydroxyapatite (HAp) phase. The kinetics of HAp formation is significantly accelerated by the presence of the nanostructures. Such TiO2 nanotube arrays and associated nanostructures can be useful as a well-adhered bioactive surface layer on Ti implant metals for orthopaedic and dental implants, as well as for photocatalysts and other sensor applications.

Coated Materials, Biocompatible↗

PubMed1999

Analysis of bovine serum albumin adsorption on calcium phosphate and titanium surfaces.

The protein adsorption behavior of thin films of calcium phosphate (CaP) bioceramic and titanium (Ti) was studied in this research. The thin films were produced with an ion beam sputter deposition technique using targets of hydroxyapatite (HA), fluorapatite (FA) and titanium (Ti). Fourier transform infrared spectroscopy (FTIR) with attenuated total internal reflectance (ATR) was used to evaluate protein adsorption on these surfaces. This study showed that surface composition and structure influenced the kinetics of protein adsorption and the structure of adsorbed protein. CaP surfaces adsorbed greater amount of protein than the Ti surface, and caused more alteration of the structure of adsorbed BSA than did the Ti surface. The differences in protein adsorption behavior could result in very different initial cellular behavior on CaP and Ti implant surfaces.

Adsorption↗

PubMed2000

Chemical gradient in plasma-sprayed HA coatings.

The microstructure and inhomogeneous features of plasma-sprayed hydroxyapatite coatings on titanium substrates have been examined using the time-of-flight secondary ion mass spectroscopy (ToF-SIMS), micro-Raman spectroscopy and nano-indentation techniques. The crystalline and amorphous areas in coatings can be identified by the elastic modulus difference. The concentration gradient of O and OH ions was detected in the through-thickness direction of coatings. Lack of O and OH ions near the titanium interface implies the existence of phases other than HA, and might result in excessive adsorption of the coatings near the interface in HA-coated Ti implants.

Alloys↗

PubMed2000

Surface induced reactivity for titanium by ion implantation.

Calcium and phosphorus storage in a thin layer of titanium surface was achieved by ion implantation. We study the reactivity of this surface in response to a hydrothermal treatment. The incipient implanted species are observed to convert to Ca(2+) and PO(4)(3-), the precursors for generating calcium phosphate polymorphs. Hydroxyapatite is formed from these precursors by an interface-liquid mediated mineralization preceded by the hydrolysis of oxygen compounds of Ca and P from the solid phase. The morphology and organization of apatite mineral is controlled by the fluid dynamics reflecting the surface remodeling to adapt to the available local environment. Exposed to calcium and phosphate ion containing solution, the hydrothermally treated surface templates hydroxyapatite deposition. Ca and P implanted Ti surface was shown to be chemically and morphologically actively involved in the interfacial reactions.

Journal Article↗

PubMed1996

Proliferation, differentiation, and protein synthesis of human osteoblast-like cells (MG63) cultured on previously used titanium surfaces.

This study compared osteoblasts proliferation, differentiation, and protein synthesis on new and used titanium (Ti) disks to test the hypothesis that cleaning and resterilization of previously used Ti disks does not alter cell response to a particular surface. Ti disks of varying roughness were prepared by one of five different treatment regimens. Standard tissue culture plastic was used as a control. Human osteoblast-like cells (MG63) were cultured on the Ti disks and cell proliferation, cell differentiation, RNA synthesis and matrix production (collagen and noncollagen protein; proteoglycans) measured. After their first use, the disks were cleaned, resterilized by autoclaving, and MG63 cells cultured on them as before. At confluence, the same parameters were measured and cell behavior on new and used disks compared. When confluent cultures of cells on plastic were compared to those cultured on new Ti surfaces, cell number was reduced on the roughest surfaces and equivalent to plastic on the other surfaces. Cell number was further reduced when disks with the roughest surfaces were re-used; no differences in cell number could be discerned after cleaning and resterilization. Cell proliferation was inversely related to surface roughness and was less than seen on tissue culture plastic. Re-use of the Ti disks resulted in no change in cell proliferation rate. Alkaline phosphatase specific activity in isolated cells was lowest on the rougher surfaces; no differences between new and used disks were observed. Similarly, enzyme activity in the cell layer was decreased in cultures grown on rougher surfaces, with no effect of prior disk use being noted. RNA synthesis was decreased with respect to plastic in cultures on smoother surfaces and increased on rougher surfaces; prior disk use did not alter RNA synthesis. Collagen production by the cells was decreased on smoother surfaces, but was comparable to tissue culture plastic when grown on rougher surfaces. Non-collagen protein production was unaffected by culture surface and whether or not the disk had been previously used. Proteoglycan synthesis by cells was decreased on all surfaces studied and comparable on both new and used disks. The results of this study indicate that Ti implant surfaces are unaffected by cleaning and resterilization, although rougher surfaces may require more extensive cleaning than smoother ones. This suggests the possibility that implants, in the same patient, could be safely reused. In vivo studies in animals, however, need to be performed before clinical application can be considered.

Alkaline Phosphatase↗

PubMed2001

Efficacy of etanercept for wear debris-induced osteolysis.

A major limitation of total joint arthroplasty is that up to 20% of patients require revision surgery to correct prosthetic loosening. Aseptic loosening is believed to result from the phagocytosis of wear debris particles by macrophages, which secrete proinflammatory cytokines that stimulate osteolysis. Tumor necrosis factor alpha (TNF-alpha) has been shown to be one of the prominent cytokines in this cascade and to be involved critically in the generation of particle-induced osteolysis. Etanercept is a soluble inhibitor of TNF-alpha, which is widely used for the treatment of rheumatoid arthritis. Here, we show this agent's ability to prevent wear debris-induced osteolysis. In vitro we show that Etanercept can inhibit directly osteoclastic bone resorption in a bone wafer pit assay, as well as cytokine production from titanium (Ti)-stimulated macrophages. Using a quantitative in vivo model of wear debris-induced osteolysis, we show that Etanercept prevents bone resorption and osteoclastogenesis. In mice treated with Etanercept at the time of osteolysis induction, bone resorption and osteoclast numbers were reduced to background levels in both normal and human TNF-alpha (hTNF-alpha) transgenic mice. In an effort to evaluate its effect on established osteolysis, Etanercept was administered 5 days after Ti implantation, and we observed that further osteolysis was prevented. These data support the concept that TNF-alpha is involved critically in osteoclastogenesis and bone resorption during periprosthetic osteolysis and suggest that soluble TNF-alpha inhibitors may be useful as therapeutic agents for the treatment of prosthetic loosening in humans.

Animals↗

PubMed2003

Deposition of highly adhesive ZrO(2) coating on Ti and CoCrMo implant materials using plasma spraying.

ZrO(2) (4% CeO(2)) and ZrO(2) (3% Y(2)O(3)) coatings were deposited on titanium (Ti) and CoCrMo implants using plasma spraying and the adhesive, morphological and structural properties of the plasma-sprayed coatings were evaluated. Characterization of these coatings was performed using X-ray diffraction (XRD), scanning electron microscopy (SEM), surface roughness, hardness, and adhesive strength. XRD patterns showed that both the coatings appeared to be primitive tetragonal phase. SEM observations showed that both the ZrO(2) coatings appeared to be rough, porous and melted. The cross-section surface morphology of the coatings, coating-substrate interfaces and substrates without acid etching was very dense and smooth. After acid etching, as compared to the dense ZrO(2) coating-CoCrMo substrate interfaces, the thin gaps appeared within the ZrO(2) coating-Ti substrate interfaces. It is suggested that plasma spraying probably formed an amorphous Ti layer in the coating-Ti substrate interface that can be removed by acid etching. The average surface roughness of ZrO(2) (3% Y(2)O(3)) and ZrO(2) (4% CeO(2)) coatings was correlated to the starting powder size and substrates. No significant difference between the hardness of all coatings and substrates was observed. The adhesive strengths of ZrO(2) (4% CeO(2)) coating to Ti and CoCrMo substrates were higher than 68MPa and significantly greater than that of ZrO(2) (3% Y(2)O(3)) coatings.

Ceramics↗

PubMedDate not supplied

Effect of surface chemistry on the rate of osseointegration of sintered porous-surfaced Ti-6Al-4V implants.

PURPOSE: The effect of adding a thin sol-gel-formed calcium phosphate (CaP) coating to sintered porous-surfaced titanium alloy (Ti-6Al-4V) implants on rates of initial bone ingrowth was investigated. MATERIALS AND METHODS: Control implants (as manufactured) and similar implants with sol-gel CaP coatings were randomly placed in distal femoral rabbit condyles (1 implant/leg). After healing for 6, 9, 12, and 16 days, 8 of 10 rabbits in each time group were assessed for maximum implant pullout force (N) and interface stiffness (N/mm). Selected extracted implants also were examined by secondary electron imaging to characterize affected surfaces. The implants of the remaining 2 rabbits in each group were examined by backscattered scanning electron microscopy (BSEM). RESULTS: Significantly greater pullout forces and interface stiffness were found for CaP-coated implants at 6 and 9 days. At 6 days, BSEM revealed bone ingrowth on CaP-coated implants but not on control implants. Secondary electron imaging and BSEM observations also suggested greater bone ingrowth with CaP-coated porous implants at 9, 12, and 16 days. DISCUSSION: Sol-gel-formed CaP surface films significantly enhance rates of bone ingrowth into sintered porous-surfaced implants. CONCLUSION: This surface treatment may have a number of clinical benefits, including shortening the period prior to functional loading of such implants and improving treatment outcomes in situations of poor bone quality and/or quantity. (More than 50 references).

Alloys↗

PubMed2005

Effects of calcium ion implantation on human bone cell interaction with titanium.

The use of calcium ion (Ca) implantation of titanium (Ti), previously reported to encourage osseointegration in vivo, has been investigated using an in vitro model in order to understand the basic mechanisms involved in the response of target cells to such surfaces. Polished Ti discs were implanted with high, medium and low (1x10(17), 1x10(16), 1x10(15)ionscm-2) doses of Ca ions at 40 keV. The effects of different levels of Ca implantation on morphology, attachment and spreading of MG-63 cells seeded on the surface of control (non-implanted) Ti and Ca-Ti discs were assessed. Further, to understand cell-material interactions at a molecular level, the expression of beta1 and alpha5beta1 integrins and the formation of vinculin-positive focal adhesion plaques were examined. In addition, the effects of pre-immersion of the Ca (high)-Ti in tissue culture medium on cell attachment were measured and correlated with specific chemical changes at the Ti surface. Our findings suggest that Ca implantation can affect the adhesion of MG-63 cells both qualitatively and quantitatively. However, this effect appears to depend on the level at which Ca ions are implanted. Results showed that although cell adhesion on Ca (high)-Ti was initially reduced, it nevertheless was not only restored but substantially increased with progressing culture times. In addition, a significantly enhanced cell spreading, formation of focal adhesion plaques and expression of integrins were measured on this particular surface. In contrast, no marked differences were observed in cell behaviour on Ca-Ti (low and medium). Pre-immersion studies indicated that the decrease in cell attachment to Ca (high)-Ti at early time periods may be linked to the presence of Ca- and P-rich particles on the surface. The absence of these particles at 24 h was consistent with a significant increase in cell attachment.

Calcium↗

PubMed1990

A parametric study of the factors affecting the fatigue strength of porous coated Ti-6A1-4V implant alloy.

The high cycle fatigue strength of porous coated Ti-6A1-4V is approximately 75% less than the fatigue strength of uncoated Ti-6A1-4V. This study separates the effects of three parameters thought to be responsible for this reduction: interfacial geometry, microstructure, and surface alterations brought about by sintering. To achieve the goal of one parameter variations, hydrogen-alloying treatments, which refined the lamellar microstructure of beta-annealed and porous coated Ti-6A1-4V, were formulated. The fatigue strength of smooth-surfaced Ti-6A1-4V subjected to hydrogen-alloying treatments is 643-669 MPa, significantly greater than the fatigue strength of beta-annealed Ti-6A1-4V (497 MPa) and also greater than the fatigue strength of pre-annealed, equiaxed Ti-6A1-4V (590 MPa). The fatigue strength of porous coated Ti-6A1-4V, however, is independent of microstructure. This leads to the conclusion that the notch effect of the surface porosity does not allow the material to take advantage of the superior fatigue crack initiation resistance of a refined alpha-grain size. Thus, sinternecks acts as initiated microcracks and fatigue of porous coated Ti-6A1-4V is propagation controlled.

Alloys↗

PubMed2004

[Experiences with a new plate-like implant system (Ti-Epiplating System) for rehabilitation of orbital and midfacial defects].

BACKGROUND: Since Tjellstrom introduced in 1977 percutaneous osseointegration, the importance of osseointegrated implants has increased in the head and neck region. Implants and craniofacial surgery technology have been permanently improved and the use of extraoral osseointegration has expanded considerably. The surgical reconstruction of the exenterated orbit provides often only poor aesthetic results. Therefore the rehabilitation of complex midfacial structures is an indication for osseointegrated retained facial prostheses. METHODS AND MATERIAL: The international literature has been reviewed concerning the topic of osseointegration for the retention of orbital and midfacial prostheses. A new plate-like implant system is introduced. We report about our experiences with the "Ti-Epiplating System". DISCUSSION: The "Ti-Epiplating System" is available since 2001. For every location in the head and neck there exists a specially shaped plate. The "Ti-Epiplating System" is fixed subperiostally with normal bone screws, the same as used in traumatology. In cases of extended resections with less bone substance left, the application is simplified. The osseointegration time is reduced to a minimum of 6 weeks. Postoperative radiation is possible. CONCLUSION: The improved application of the "Ti-Epiplating System" is beneficial in the reconstruction of extended craniofacial defects with osseointegrated implants.

Bone Plates↗