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Three-dimensional bone response to commercially pure titanium, hydroxyapatite, and calcium-ion-mixing titanium in rabbits.

Three-dimensional bone response to 3 biomaterials--commercially pure titanium (Ti), hydroxyapatite (HA), and calcium-ion-mixing titanium (Ca-Ti)--embedded in the tibiae of rabbits was examined chronologically. The rabbits were sacrificed at 2, 4, and 8 weeks after implantation, and the percent bone volume around each implant was calculated from the implant surface to each of 4 measurements: 36 microns, 0.25 mm, 0.5 mm, and 1.0 mm in 2 regions (cortical bone and bone marrow regions). Percent bone volume in the cortical bone was consistent, whereas in the bone marrow region, the percent bone volume varied according to implant material, implantation period, and distance from the implant surface. With Ti implants the percent increased gradually up to 8 weeks at each distance, whereas in HA and Ca-Ti implants the percent was largest at 4 weeks and increased closer to the surface. The percent with Ti implants was largest at 36 microns to 0.25 mm. Aspect of bone response to Ca-Ti was its position intermediate between those of HA and Ti. The decrease of the percent at 8 weeks was smaller than HA.

Analysis of Variance↗

Titanium implants enhance pulmonary nitric oxide production and lung injury in rats exposed to endotoxin.

An increase in levels of elemental Ti in the blood and lung of rats with a Ti alloy implant has been demonstrated. However, the pathophysiological role of the elevated elemental Ti level in the circulation remains unclear. Rats were implanted with Ti alloy discs for 4 weeks. The levels of elemental Ti in the blood and lung were especially increased compared with other tissues. The Ti alloy implant enhanced lung injury related to endotoxin from Gram-negative bacteria (lipopolysaccharide, LPS), which was characterized by lung edema and other histological changes such as recruitment of neutrophils, interstitial edema, and alveolar hemorrhage in the lung. In the presence of endotoxin, an increase of nitrite production was shown in the plasma and bronchoalveolar lavage fluid of rats implanted with a Ti alloy. Moreover, the Ti alloy implant further enhanced the induction of inducible nitric oxide (NO) synthase (iNOS) protein expression induced by LPS in the lung. These endotoxin-related responses in the presence or absence of the Ti alloy implant could be inhibited by aminoguanidine (an iNOS inhibitor). These results provide the first experimental evidence that circulating Ti released from Ti alloy implants has an ability to affect pulmonary iNOS protein expression, and enhance the pathogenesis of acute lung injury during endotoxemia.

Alloys↗

Preliminary study on HA coating percutaneously implanted in bone.

A comparative investigation on the possibility of hydroxyapatite (HA) coating and pure Ti column to form biological sealing with skin tissue was completed in this study. HA coating and pure Ti column were percutaneously implanted in the tibia of rabbits. Compared with titanium (Ti) implant, HA coating forms epithelial sealing with skin tissue at 6 weeks postoperatively, while the Ti implant may loosen from the implanted site and be lost. The Ti column loosing rate at this time was 50%. However, once the Ti implant becomes fixed with the bone tissue, it can form epithelial sealing with skin tissue just like the HA coating, at 8 weeks postoperatively. At 8 weeks postoperatively, the epithelial sealing is not destroyed in spite of the fact that the HA coating is biodegraded. Our results show that the HA coating can become fixed with the bone faster than the Ti, which is beneficial for epithelial sealing formation. The main role of HA coating for epithelial sealing is beneficial for sealing at the initial period after it is implanted.

Animals↗

Systemic metal-protein binding associated with total joint replacement arthroplasty.

The distribution of titanium [Ti] and chromium [Cr] in serum protein fractions of patients with and without total joint replacements containing Cr and Ti was studied. Three groups were evaluated: 10 patients with cobalt-chromium [CoCr] alloy prostheses and known elevated levels of Cr; 10 patients with Ti containing implants and known elevated levels of Ti; and 10 age matched controls without prostheses. Metal-protein binding was also examined by adding various concentrations of Cr(+3) (CrCl(3)) to control serum. Cr and Ti were bound to serum proteins within specific molecular weight ranges in both patient groups. Two molecular weight ranges were found to bind Cr (at approximately 70 and approximately 180 kDa) in patients with CoCr alloy prostheses, whereas a single molecular weight range (at approximately 70 kDa) was found to bind Ti in patients with Ti alloy implants. This metal-protein binding was reproduced in vitro by adding CrCl(3) at concentrations of approximately 100 and 1000 ppb Cr, which is orders of magnitude higher than that contained in the serum of patients with CoCr alloy implants ( approximately 3 ppb Cr). This suggests that protein binding is initiated in the periprosthetic space where metal concentrations are typically 2-3 orders of magnitude higher than that observed systemically in the serum. In vitro, high molecular weight proteins including immunoglobulins demonstrated the highest affinity to Cr. Determination of specific protein carriers of metal degradation products is an essential component in the assessment of the long-term biological affects of total joint replacement devices.

Adult↗

Effects of hydrosyapatite coating on Ti-6A1-4V implant-site infection in a rabbit tibial model.

To investigate the effect of implant type after direct contamination, a hydroxyapatite-coated or noncoated Ti-6A1-4V implant was inserted into both tibiae of 32 New Zealand White rabbits. Prior to implantation, the left tibia was contaminated with increasing concentrations of Staphylococcus aureus (10(2)-10(5) colony-forming units), ranging from very low (10(2)) to relatively high (10(5)). Four weeks after implantation, half of the tibial bone adjacent to the implant was harvested for bacteriological examination. Bacterial counts were quantified by plating serial dilutions. For the histological evaluation, sections of the implant with the remaining tibia were examined by semiquantitative scoring of infection parameters. The bacteriological data showed the inoculum dose and implant type to have a significant effect on the culture outcome: more bacteria were retrieved from the hydroxyapatite-coated implants than from the noncoated titanium implants. Histological evaluation showed an increased score for the infected left tibiae compared with their contralateral control. In addition, with increasing inoculum dosage, the difference between the two types of implant increased. We demonstrated that infections can occur with biocompatible, noncemented implants and that they are related to the dose of the original inoculum. Bacteria were more likely to grow onto or next to the hydroxyapatite implants than on titanium implants and resulted in a more severe histopathological characterization of infection.

Aluminum↗

Preparation and analysis of macroporous TiO2 films on Ti surfaces for bone-tissue implants.

This article describes the preparation and analysis of macroporous TiO2 films on Ti surfaces, for application in bone tissue-Ti implant interfaces. These TiO2 bioceramic films have a macroporous structure consisting of monodisperse, three-dimensional, spherical, interconnected pores adjustable in the micron size range. Micron-sized polystyrene (PS) bead templates are used to precisely define the pore size, creating macroporous TiO2 films with 0.50, 16, and 50 microm diameter pores, as shown by scanning electron microscopy. X-ray photoelectron spectroscopy shows the films to be predominantly composed of TiO2, with approximately 10% carbon. X-ray diffraction reveal rutile as the main phase when fired to the optimal temperature of 950 degrees C. Preliminary experiments find that the in vitro proliferation of human bone-derived cells (HBDC) is similar on all three pore sizes. However, higher [3H]thymidine incorporation by the HBDC is observed when they are grown on 0.50- and 16-microm pores compared to the 50-microm pores, suggesting an enhanced cell proliferation for the smaller pores.

Biocompatible Materials↗

Detachment of titanium and fluorohydroxyapatite particles in unloaded endosseous implants.

The shape, surface composition and morphology of orthopaedic and endosseous dental titanium implants are key factors to achieve post-surgical and long-term mechanical stability and enhance implant osteointegration. In this study a comparison was made between 12 titanium screws, plasma-spray-coated with titanium powders (TPS), and 12 screws with an additional coating of fluorohydroxyapatite (FHA-Ti). Screws were implanted in the femoral and tibial diaphyses of two mongrel sheep and removed with peri-implant tissues 12 weeks after surgery. The vibrational spectroscopic, ultrastructural and morphological analyses showed good osteointegration for both types of implants in host cortical bone. The portion of the FHA-Ti implants in contact with the medullary canal showed a wider area of newly formed peri-implant bone than that of the TPS implants. Morphological and EDAX analyses demonstrated the presence of small titanium debris in the bone medullary spaces near the TPS surface, presumably due to the friction between the host bone and the implant during insertion. Few traces of titanium were detected around FHA-Ti implants, even if smaller FHA debris were present. The present findings suggest that the FHA coating may act as a barrier against the detachment of titanium debris stored in the medullary spaces near the implant surface.

Animals↗

In vivo characterization of titanium implants coated with synthetic hydroxyapatite by electrophoresis.

This study compared in vivo the performances of commercially pure titanium (cp Ti) screw dental implants either uncoated or coated with synthetic hydroxyapatite (HA) by electrophoresis. The HA coating was characterized by scanning electron microscopy, energy dispersive spectroscopy (EDS) and Fourier-transform infrared (FT-IR) spectroscopy. Well-adhered carbonated-hydroxyapatite layers (4- to-8-microm-thick) were obtained. In vivo tests were carried out by insertion of both uncoated and HA-coated implants into rabbit tibiae for 8 or 12 weeks. Histomorphometric analysis was performed by scanning electron microscopy with the aid of image-processing software. Results showed significantly greater bone-implant contact for HA-coated implants (p<0.05) than cp Ti implants. Comparison of bone content inside the screw implants showed no significant differences (p>0.05) between both types of implants, although cp Ti had numerically higher percentage of bone content than HA-coated implants. In conclusion, the HA-coated implants had better performance regarding the bone-implant contact area than the uncoated implants; coating by electrophoresis proved to be a valuable process to coat metallic implants with an osteoconductive material such as hydroxyapatite.

Animals↗

Microstructure and mechanical properties of Ti-Ta/alumina and Ti-Nb/alumina joints for dental implants.

The microstructure of Ti-Ta and Ti-Nb alloys diffusion bonded to a 99.7 wt% Al2O3 ceremic for dental implants is subdivided into a reaction double layer containing the phases TiAl and Ti3Al, a transition region of coarse alpha-Ti plates in beta-Ti, and the unaffected bulk metal, the alpha-Ti/beta-Ti structure of which can be refined by annealing at 800 degrees C for 1 hour after bonding. Optimized joints fabricated by diffusion bonding in a high vacuum at 1,200 degrees C from a 99.7 wt% Al2O3 ceramic and Ti-Ta alloys fitted in their thermal contraction behavior to that of the ceramic by the addition of 30 to 40 wt% Ta showed a fracture resistance of 2.3 MN/m3/2. Approximately 80% of the bend test specimens notched at the Ti-Ta/alumina interface failed by crack extension parallel to the interface within the ceramic, which is typical for a metal-ceramic bond of high to medium interfacial strength.

Aluminum Oxide↗

Ion implantation of surgical Ti-6Al-4V for improved resistance to wear-accelerated corrosion.

The influence of nitrogen-ion implantation on the wear-accelerated corrosion behavior of surgical Ti-6Al-4V was studied. Nonpassivated and prepassivated unimplanted Ti-6Al-4V specimens were employed as controls for comparison. Corrosion rates as a function of time at open-circuit corrosion potentials were electrochemically measured in saline and serum solutions under both static and wear conditions. The wear parameters simulated those of a total artificial hip under average walking conditions. The results indicated that prepassivation of the control material was beneficial under static-corrosion conditions, but not under wear-corrosion conditions. The nitrogen-ion implantation process was found to significantly improve the material's resistance to wear-accelerated corrosion in both saline and serum solutions.

Alloys↗

Adverse tissue reactions to wear particles from Co-alloy articulations, increased by alumina-blasting particle contamination from cementless Ti-based total hip implants. A report of seven revisions with early failure.

We revised seven alumina-blasted cementless hip prostheses (Ti-alloy stems, cp Ti threaded sockets) with low- or high-carbon Co-alloy bearings at a mean of 20.1 months after implantation because of pain and loosening. Histological examination of the retrieved periprosthetic tissues from two cases in which the implant was stable and three in which the socket was loose showed macrophages with basophilic granules containing metal and alumina wear particles and lymph-cell infiltrates. In one of the two cases of stem loosening the thickened neocapsule also contained definite lymphatic follicles and gross lymphocyte/plasma-cell infiltrates. Spectrometric determination of the concentration of elements in periprosthetic tissues from six cases was compared with that of joint capsules from five control patients undergoing primary hip surgery. In the revisions the mean concentration of implant-relevant elements was 693.85 microg/g dry tissue. In addition to Cr (15.2%), Co (4.3%), and Ti (10.3%), Al was predominant (68.1%) and all concentrations were significantly higher (p < 0.001) than those in the control tissues. The annual rates of linear wear were calculated for six implants. The mean value was 11.1 microm (heads 6.25 microm, inserts 4.82 microm). SEM/EDXA showed numerous fine scratches and deep furrows containing alumina particles in loosened sockets, and stems showed contamination with adhering or impacted alumina particles of between 2 and 50 microm in size.

Aged↗

A histological evaluation of TiO2-gritblasted and Ca-P magnetron sputter coated implants placed into the trabecular bone of the goat: Part 2.

The aim of this study was to investigate the synergetic influence of surface topography and chemical composition of oral implant materials on bone response. For the experiment screw designed implants were used. The implants were grit-blasted with TiO2 particles. The implants were left uncoated (Ti) or provided with three different amorphous/crystalline Ca-P magnetron sputter coatings, resp. 0.1 micron (CaP-0.1), 1 micron (CaP-1) and 4 microns (CaP-4), in thickness. The implants were inserted in the medial femoral condyles of 12 goats. Each femur received 2 implants. After implantation periods of 6 and 12 weeks the implants were retrieved and prepared for histological and histomorphometrical evaluation (bone contact and bone mass). The light microscopy revealed that bone response to CaP-4 and CaP-1 implants was similar. For example, after 12 weeks, screw threads were almost completely covered with bone. In contrast to CaP-0.1 and Ti implants, where bone apposition was less pronounced. Histomorphometry demonstrated that the bone-to-implant contact for the CaP-1 and CaP-4 implants was significantly higher (P < 0.05) than for the CaP-0.1 and Ti implants. This difference existed already after 6 weeks and was even enhanced after 12 weeks. The bone mass measurements revealed that only at 12 weeks CaP-4 implants had significantly more bone contact inside the screw threads than non-coated Ti-implants (P < 0.05). Supported by our findings, we conclude that the additional application of a 1-4 microns thick Ca-P magnetron sputter coating can further improve the healing response to surface roughened oral implants placed into trabecular bone.

Analysis of Variance↗

The effect of titanium plasma-sprayed implants on trabecular bone healing in the goat.

The bone response to different titanium plasma-sprayed implants was evaluated in a goat model. Therefore, beam-shaped implants were installed into the trabecular femoral condyles of 10 goats. These implants were provided with three different titanium plasma-sprayed coatings (Ti2, Ti3 and Ti4) with a Ra of 16.5, 21.4 and 37.9 microm, respectively. An Al2O3 grit-blasted implant (Ti-un) with a Ra of 4.7 microm was used as control. After an implantation period of 3 months, the implants were evaluated histologically and histomorphometrically. Only one implant (Ti3) was not recovered after the evaluation period. Light microscopy showed a limited amount of bone for the various implants. Most of the implants showed a different degree of fibrous tissue alternating with direct bone contact. Complete fibrous encapsulation of the implants was observed in some of the sections. No signs of delamination of the plasma-sprayed coating was visible. No significant difference in bone contact were measured between the different types of implants (P > 0.05). Histomorphometrical analysis revealed significantly higher bone mass close to the implant (0-500 microm) for the Ti3, Ti4 and Ti-un implants placed in the medial femoral condyle and the Ti4 implants placed in the lateral condyle. At distance (500-1500 microm), no difference in bone mass measurements between the different implants was observed (P > 0.05).

Aluminum Oxide↗

A study of histological responses from Ti-6Al-7Nb alloy dental implants with and without plasma-sprayed hydroxyapatite coating in dogs.

Titanium alloys are hoped to be used much more for applications as implant materials in the medical and dental fields because of their basic properties, such as biocompatibility, corrosion resistance and specific strength compared with other metallic implant materials. Thus, the Ti-6Al-7Nb alloy that has recently been developed for biomedical use, that is, primarily developed for orthopaedic use, is to be studied in this paper, for application in dental implants. The biocompatibility test in vivo was carried out in dogs and the osseointegration was verified through histological analysis of the samples of the Ti-6Al-7Nb alloy with and without hydroxyapatite coating that were inserted in the alveoli. Within the controlled conditions the samples did not show any toxic effects on the cells.

Journal Article↗

[Experimental study of Ti-75(AlMoZrTi alloy) dental implants in dog mandible].

OBJECTIVE: The purpose of this study was to investigate the biocompatibility of Ti-75(AlMoZrTi Alloy) dental implants. METHODS: Four 6.5 to 16 kg dogs were used,after mandibular cuspids and premolar extraction, 16 implants were placed and left for six or twelve months. All of the dental implants were made of Ti-75 (AlMoZrTi Alloy) and they were manufactured in two types-nonsubmerged and submerged threaded implants. RESULTS: The survival rate of the implants was 100% (submerged implants) and 91.7% (nonsubmerged implants). Histologically,all survival implants showed some degree of intimate bone to implant contact, but one of the nonsubmerged implants showed periimplantitis. No implants were observed to be mobile. The periotest values of the dental implants were near the periotest values of the nature teeth. CONCLUSION: This study demonstrated Ti-75 is a biocompatible material and periotest is worthy of detection of osseointegration.

English Abstract↗

The fatigue strength of porous-coated Ti-6%Al-4%V implant alloy.

The fatigue behaviour of Ti-6Al-4V (extra low interstital) alloy coated with Ti-6Al-4V powder was investigated using rotating bending fatigue testing. It was found that the high cycle fatigue strength of porous coated specimens exhibited a substantial decrease compared to uncoated specimens of the same microstructure. Chemical analysis of the sintered surface revealed significant increases of interstitials compared to the bulk analysis, but it is concluded that this would not adversely affect the fatigue strength. Scanning electron microscopy revealed crack initiation close to particle/substrate contact interfaces and it is concluded that stress intensification due to these interface regions are major sources of weakness with respect to fatigue strength. Finally it was found that subjecting a polished Ti-6Al-4V specimen to the heat treatment required for sintering resulted in delineation of prior beta grain boundaries and it is suggested that this also contributes to the inferior fatigue strength of porous coated Ti-6Al-4V.

Absorption↗

Hydroxyapatite ceramic coating for bone implant fixation. Mechanical and histological studies in dogs.

The success of bone ingrowth into porous coated implants depends on several factors which can be separated into five main groups: implant related factors, such as design of implant, surface structure and pore characteristics. status of host bone bed, such as underlying disease (rheumatoid arthritis, osteoporosis), available bone stock, use of drugs and surgical technique. mechanical stabilization and loading conditions applied on the implant. adjuvant therapies such as bone grafting and HA coating which might enhance the amount of bone ingrowth. remodeling of periprosthetic bone. Once bone ingrowth has occurred, maintenance of bony anchorage depends on bone remodeling at the interface. The present series of studies were performed in order to investigate the effect of some of these factors on bone ingrowth in relation to hydroxyapatite (HA) and titanium alloy (Ti) coating when subjected to pathological and mechanical conditions mimicking the clinical situation. HA- and Ti-coated implants were inserted into the femoral condyles of mature dogs. The observation period ranged from 4 to 16 weeks, and the results were evaluated by mechanical push-out testing, histomorphometric analysis, polarized light microscopy, UV fluorescence microscopy, collagen analysis and transmission electron microscopy (microanalysis). There were no complications related to the operative procedures and all dogs were terminated according to the original time schedule. Host bone related factors were studied in the initial experiments. First, the effect of a gap between bone and implant was studied and compared with press-fit insertion. The HA-coating yielded superior effect on bone ingrowth compared to Ti in situations where the implant was surrounded by a gap and also where the implants were inserted in press-fit. Gaps of 1 mm and 2 mm around the implant were bridged by bone around HA implants whereas significantly less amounts of bone filled the gap around Ti implants. The gap-healing capacity of bone was increased even at a relatively great distance (400 microns) from the HA surface. This finding indicates that the osteoconductive effect of HA is not limited to the bone forming capacity on the surface of the implant. A positive gradient of newly formed bone was found towards the HA-coating, this gradient not being found towards the Ti-coating. In order to investigate the significance of arthritic bone changes (osteopenia) on fixation of porous coated implants we adopted the Carragheenin-induced gonarthritis model resulting in substantial bone loss as determined by CT-scanning.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Effects of guided bone regeneration around commercially pure titanium and hydroxyapatite-coated dental implants. I. Radiographic analysis.

The purpose of this study was to determine which treatment of a large osseous defect adjacent to an endosseous dental implant would produce the greatest regeneration of bone and degree of osseointegration: barrier membrane therapy plus demineralized freeze-dried bone allograft (DFDBA), membrane therapy alone, or no treatment. The current study assessed radiographic density changes in bone within the healed peri-implant osseous defect. In a split-mouth design, 6 implants were placed in edentulous mandibular ridges of 10 mongrel dogs after preparation of 6 cylindrical mid-crestal defects, 5 mm in depth and 9.525 mm in diameter. An implant site was then prepared in the center of each defect to a depth of 5 mm beyond the apical extent of the defect. One mandibular quadrant received three commercially pure titanium (Ti) screw implants (3.75 X 10 mm), while the contralateral side received three hydroxyapatite (HA) coated root-form implants (3.3 X 10 mm). Consequently, the coronal 5 mm of each implant was surrounded by a circumferential defect approximately 3 mm wide and 5 mm deep. The three dental implants in each quadrant received either DFDBA (canine source) and an expanded polytetrafluoroethylene membrane (ePTFE), ePTFE membrane alone, or no treatment (control). Standardized radiographs were taken at 1 week and 4 months post-implant placement. Computer-assisted densitometric image analysis (CADIA) was performed at 6 areas of interest (coronal, middle, and apical defect areas mesial and distal to each implant) for each of the implant sites. Significantly greater increase in bone density was obtained using DFDBA/ePTFE compared to ePTFE alone or the controls; likewise, ePTFE alone resulted in greater bone density change than the controls. There were no significant differences in radiographic bone density adjacent to Ti versus HA-coated implants. When 3 dogs having postoperative membrane complications were eliminated from the analysis, the results were similar with the exception that defects adjacent to Ti implants had significantly less density gain when compared to HA-coated implants. The results of this study indicate the use of DFDBA/ePTFE in large surgically-created defects promotes a denser healing of bone adjacent to implants when measured radiographically than either ePTFE alone or no treatment.

Absorptiometry, Photon↗