Fiber-reinforced Composite as Oral Implant Material. Experimental studies of glass fiber and bioactive glass in vitro and in vivo

Fiber-reinforced composite as oral implant material: Experimental studies of glass fiber and bioactive glass in vitro and in vivo Department of Prosthetic Dentistry and Biomaterials Science, Institute of Dentistry, University of Turku, Turku, Finland 2008. Biocompatibility and mechanical properties are important variables that need to be determined when new materials are considered for medical implants. Special emphasis was placed on these characteristics in the present work, which aimed to investigate the potential of fiber-reinforced composite (FRC) material as an oral implant. Furthermore, the purpose of this study was to explore the effect of bioactive glass (BAG) on osseointegration of FRC implants. The biocompatibility and mechanical properties of FRC implants were studied both in vitro and in vivo. The mechanical properties of the bulk FRC implant were tested with a cantilever bending test, torsional test and push-out test. The biocompatibility was first evaluated with osteoblast cells cultured on FRC substrates. Bone bonding was determined with the mechanical push-out test and histological as well as histomorplanimetric evaluation. Implant surface was characterized with SEM and EDS analysis. The results of these studies showed that FRC implants can withstand the static load values comparably to titanium. Threaded FRC implants had significantly higher push-out strength than the threaded titanium implants. Cell culture study revealed no cytotoxic effect of FRC materials on the osteoblast-like-cells. Addition of BAG particles enhanced cell proliferation and mineralization of the FRC substrates The in vivo study showed that FRC implants can withstand static loading until failure without fracture. The results also suggest that the FRC implant is biocompatible in bone. The biological behavior of FRC was comparable to that of titanium after 4 and 12 weeks of implantation. Furthermore, addition of BAG to FRC implant increases peri-implant osteogenesis and bone maturation.

Coatings on Composites

Polymer based composite materials coated with thin layers of wear resistant materials have been proposed as replacements for steel components for certain applications with the advantage of reduced mass. Magnetron sputtered coatings can be successfully deposited on composite materials. Nevertheless there are number of issues which must be addressed such as limited temperature, which the composite can withstand because of the epoxy binder which is used, the adhesion of the coating to the composite and the limited mechanical support, the hard coating can obtain from the relatively soft epoxy. We have investigated the deposition of chromium nitride, titanium carbide and titanium doped DLC coatings on carbon fibre reinforced composites and various polymers. The adhesion of the coatings has been studied by the pull-off adhesion tester. In general, the failure mechanism has been noticed to be due to the cohesive failure for a wide range of conditions. The wear behavior of the coatings has been noticed to be complicated. Wear tests on coated composites have shown that where the reinforcing fibres are near the surface, the composite samples do not perform well due to breakage of the fibres from the polymer matrix. A fibre free surface has been noticed to improve the wear resistance.

Surface Modification of Ceramics

Ceramics are widely used in industrial applications due to their advantageous thermal and mechanical stability. Corrosion of ceramics is a great problem resulting in significant costs. Coating is one method of reducing adversities of corrosion. There are several different thin film deposition processes available such as sol-gel, Physical and Chemical Vapour Deposition (PVD and CVD). One of the CVD processes, called Atomic Layer Deposition (ALD) stands out for its excellent controllability, accuracy and wide process capability. The most commonly mentioned disadvantage of this method is its slowness which is partly compensated by its capability of processing large areas at once. Several factors affect the ALD process. Such factors include temperature, the grade of precursors, pulse-purge times and flux of precursors as well as the substrate used. Wrongly chosen process factors may cause loss of self-limiting growth and thus, non-uniformities in the deposited film. Porous substrates require longer pulse times than flat surfaces. The goal of this thesis was to examine the effects of ALD films on surface properties of a porous ceramic material. The analyses applied were for permeability, bubble point pressure and isoelectric point. In addition, effects of the films on corrosion resistance of the substrate in aqueous environment were investigated. After being exposured to different corrosive media the ceramics and liquid samples collected were analysed both mechanically and chemically. Visual and contentual differences between the exposed and coated ceramics versus the untreated and uncoated ones were analysed by scanning electron microscope. Two ALD film materials, dialuminium trioxide and titanium dioxide were deposited on the ceramic substrate using different pulse times. The results of both film materials indicated that surface properties of the ceramic material can be modified to some extent by the ALD method. The effect of the titanium oxide film on the corrosion resistance of the ceramic samples was observed to be fairly small regardless of the pulse time.

Design and implementation of a multipurpose reactor for scale-up studies

In the theoretical part, the different polymerisation catalysts are introduced and the phenomena related to mixing in the stirred tank reactor are presented. Also the advantages and challenges related to scale-up are discussed. The aim of the applied part was to design and implement an intermediate-sized reactor useful for scale-up studies. The reactor setting was tested making one batch of Ziegler–Natta polypropylene catalyst. The catalyst preparation with a designed equipment setting succeeded and the catalyst was analysed. The analyses of the catalyst were done, because the properties of the catalyst were compared to the normal properties of Ziegler–Natta polypropylene catalyst. The total titanium content of the catalyst was slightly higher than in normal Ziegler–Natta polypropylene catalyst, but the magnesium and aluminium content of the catalyst were in the normal level. By adjusting the siphonation tube and adding one washing step the titanium content of the catalyst could be decreased. The particle size of the catalyst was small, but the activity was in a normal range. The size of the catalyst particles could be increased by decreasing the stirring speed. During the test run, it was noticed that some improvements for the designed equipment setting could be done. For example more valves for the chemical feed line need to be added to ensure inert conditions during the catalyst preparation. Also nitrogen for the reactor needs to separate from other nitrogen line. With this change the pressure in the reactor can be kept as desired during the catalyst preparation. The proposals for improvements are presented in the applied part. After these improvements are done, the equipment setting is ready for start-up. The computational fluid dynamics model for the designed reactor was provided by cooperation with Lappeenranta University of Technology. The experiments showed that for adequate mixing with one impeller, stirring speed of 600 rpm is needed. The computational fluid dynamics model with two impellers showed that there was no difference in the mixing efficiency if the upper impeller were pumping downwards or upwards.

Pretreatment in membrane filtration of wood hydrolysate

Interest in recovery of valuable components from process streams has increased in recent years. Purpose of biorefinery is to utilize components that otherwise would go to waste. Hemicelluloses, for example, could be utilized in production of many valuable products. One possible way to separate and fractionate hemicelluloses is membrane filtration. In the literature part of this work membrane fouling in filtration processes of pulp and paper process- and wastewaters was investigated. Especially purpose was to find out the possible fouling compounds, after which facilities to remove or modify such components less harmful were studied. In the experimental part different pretreatment methods, mainly to remove or degrade lignin from wood hydrolysate, were studied. In addition, concentration of hemicelluloses and separation from lignin were examined with two ultrafiltration membranes; UFX5 and RC70PP. Changes in feed solution, filtration capacity and fouling of membranes were used to evaluate the effects of pretreatment methods. Changes in hydrolysate composition were observed with different analysis methods. Filtration of hydrolysate proved to be challenging, especially with the UFX5 membrane. The more hydrophilic RC70PP membrane did not seem to be fouled as severely as the UFX5 membrane, according to pure water flux measurements. The UFX5 membrane retained hemicelluloses rather well, but problems arose from rapid flux decline resulting from concentration polarization and fouling of membrane. Most effective pretreatment methods in the case with the UFX5 membrane proved to be prefiltration with the RC70PP membrane, activated carbon adsorption and photocatalytic oxidation using titanium dioxide and UV radiation. An additional experiment with PHW extract showed that pulsed corona discharge treatment degraded lignin quite efficiently and thus improved filtration capacity remarkably, even over six times compared to the filtration with untreated extract.

Fotokatalyyttinen kalvonpesu

Fotokatalyysillä tarkoitetaan spontaania kemiallista reaktiota, joka tapahtuu fotokatalyytin absorboidessa valoa. Reaktio voi tapahtua joko katalyytin pinnalla tai sen läheisyydessä, mutta fotokatalyytti pysyy reaktiossa muuttumattomana. Ominaisuuksiltaan paras ja eniten tutkittu fotokatalyyttinen materiaali on titaanidioksidi, jolla on säteilytettynä kyky hajottaa orgaanisia molekyylejä hiilidioksidiksi ja vedeksi. Fotokatalyysin käyttömahdollisuuksia tutkitaan membraanikalvojen puhdistamisessa kalvojen käyttöiän ja erotustehokkuuden parantamiseksi. Nykyisin kalvojen puhdistamiseen käytetään useimmiten kemiallista pesua, jonka tuloksena on usein haitallisia yhdisteitä sisältävä liuos. Fotokatalyyttinen puhdistus voisi olla ratkaisu ongelmaan, sillä sen avulla voitaisiin puhdistamisessa käytettävien kemikaalien ja siinä muodostuvien jätteiden määrää vähentää. Tämän työn kokeellisessa osassa tutkittiin polyvinyylideenifluoridikalvon (PVDF) kestävyyttä ja puhdistumista fotokatalyyttisissä reaktioissa. PVDF:n on todettu olevan erinomainen kalvomateriaali, koska se on termisesti stabiili ja se kestää hyvin kemikaaleja, kuten orgaanisia liuottimia, happoja ja emäksiä. Työssä todettiin PVDF-kalvon puhdistuvan UV/TiO2-käsittelyn avulla. Kalvo puhdistui parhaiten, kun käytettiin 0,425 m- % TiO2-liuosta. Puhdistumista havainnoitiin sekä puhtaan veden vuon mittauksilla että värjäämällä käsiteltyjä kalvoja ja mittaamalla niiden värinintensiteetti.

Development of porous glass-fiber reinforced composite for bone implants. Evaluation of antimicrobial effect and implant fixation

Cranial bone reconstructions are necessary for correcting large skull bone defects due to trauma, tumors, infections and craniotomies. Traditional synthetic implant materials include solid or mesh titanium, various plastics and ceramics. Recently, biostable glass-fiber reinforced composites (FRC), which are based on bifunctional methacrylate resin, were introduced as novel implant solution. FRCs were originally developed and clinically used in dental applications. As a result of further in vitro and in vivo testing, these composites were also approved for clinical use in cranial surgery. To date, reconstructions of large bone defects were performed in 35 patients. This thesis is dedicated to the development of a novel FRC-based implant for cranial reconstructions. The proposed multi-component implant consists of three main parts: (i) porous FRC structure; (ii) bioactive glass granules embedded between FRC layers and (iii) a silver-polysaccharide nanocomposite coating. The porosity of the FRC structure should allow bone ingrowth. Bioactive glass as an osteopromotive material is expected to stimulate the formation of new bone. The polysaccharide coating is expected to prevent bacterial colonization of the implant. The FRC implants developed in this study are based on the porous network of randomly-oriented E-glass fibers bound together by non-resorbable photopolymerizable methacrylate resin. These structures had a total porosity of 10–70 volume %, of which > 70% were open pores. The pore sizes > 100 μm were in the biologically-relevant range (50-400 μm), which is essential for vascularization and bone ingrowth. Bone ingrowth into these structures was simulated by imbedding of porous FRC specimens in gypsum. Results of push-out tests indicated the increase in the shear strength and fracture toughness of the interface with the increase in the total porosity of FRC specimens. The osteopromotive effect of bioactive glass is based on its dissolution in the physiological environment. Here, calcium and phosphate ions, released from the glass, precipitated on the glass surface and its proximity (the FRC) and formed bone-like apatite. The biomineralization of the FRC structure, due to the bioactive glass reactions, was studied in Simulated Body Fluid (SBF) in static and dynamic conditions. An antimicrobial, non-cytotoxic polysaccharide coating, containing silver nanoparticles, was obtained through strong electrostatic interactions with the surface of FRC. In in vitro conditions the lactose-modified chitosan (chitlac) coating showed no signs of degradation within seven days of exposure to lysozyme or one day to hydrogen peroxide (H2O2). The antimicrobial efficacy of the coating was tested against Staphylococcus aureus and Pseudomonas aeruginosa. The contact-active coating had an excellent short time antimicrobial effect. The coating neither affected the initial adhesion of microorganisms to the implant surface nor the biofilm formation after 24 h and 72 h of incubation. Silver ions released to the aqueous environment led to a reduction of bacterial growth in the culture medium.

Computational modeling of the properties of TiO2 nanoparticles

In this study we discuss the electronic, structural, and optical properties of titanium dioxide nanoparticles, and also the properties of Ni(II) diimine dithiolato complexes as dyes in dye-sensitized TiO2 based solar cells. The abovementioned properties have been modeled by using computational codes based on the density functional theory. The results achieved show slight evidence on the structure-dependent band gap broadening, and clear blue-shifts in absorption spectra and refractive index functions of ultra-small TiO2 particles. It is also shown that these properties are strongly dependent on the shape of the nanoparticles. Regarding the Ni(II) diimine dithiolato complexes as dyes in dye-sensitized TiO2 based solar cells, it is shown that based on the experimental electrochemical investigation and DFT studies all studied diimine derivatives could serve as potential candidates for the light harvesting, but the e ciencies of the dyes studied are not very promising.

Pulsed electric field assisted sol-gel preparation of TiO2 particles and their photocatalytic properties

The objective of this thesis was to study the effect of pulsed electric field on the preparation of TiO2 nanoparticles via sol-gel method. The literature part deals with properties of different TiO2 crystal forms, principles of photocatalysis, sol-gel method and pulsed electric field processing. It was expected that the pulsed electric field would have an influence on crystallite size, specific surface area, polymorphism and photocatalytic activity of produced particles. TiO2 samples were prepared by using different frequencies and treatment times of pulsed electric field. The properties of produced TiO2 particles were examined X-ray diffraction (XRD), Raman spectroscopy and BET surface area analysis. The photocatalytic activities of produced TiO2 particles were determined by using them as photocatalysts for the degradation of formic acid under UVA-light. The photocatalytic activities of samples produced with sol-gel method were also compared with the commercial TiO2 powder Aeroxide® (Evonic Degussa GmbH). Pulsed electric field did not have an effect on the morphology of particles. Results from XRD and Raman analysis showed that all produced TiO2 samples were pure anatase. However, pulsed electric field did have an effect on crystallite size, specific surface area and photocatalytic activity of TiO2 particles. Generally, the crystallite sizes were smaller, specific surface areas larger and initial formic acid degradation rates higher for samples that were produced by applying the pulsed electric field. The higher photocatalytic activities were attributed to larger surface areas and smaller crystallite sizes. Though, with all of the TiO2 samples produced by the sol-gel method the initial formic acid degradation rates were significantly slower than with the commercial TiO2 powder.

Relationship between Daily Habits, Oral Microbiota and Caries with Special Reference to Xylitol

Caries is a plaque-associated multifactorial chronic disease. Oral hygiene habits, sugar, and oral micobiota interactions are important for caries to occur. Xylitol has been shown to reduce caries mainly due to its effects on mutans streptococci (MS). The purpose of this study was to evaluate the relationship of daily oral health habits and bacterial level on the caries occurrence and to study the effect of xylitol on the composition of oral microflora. A total of 192, 10-12 years old, male school children had been screened for salivary MS. Healthy subjects with high MS counts participated in two parallel double-blinded, randomised, controlled trials. In the first 5-week trial, subjects were assigned into xylitol (n=35) and sorbitol gum (n=38) groups. At baseline, children were examined using International Caries Detection and Assessment System (ICDAS) criteria and interviewed for oral health habits. In the second 4-week trial, subjects were assigned into xylitol (n=25) and saccharine mouthrinse (n=25) groups. In the end of both interventions, saliva samples were collected. The samples were analysed for changes in MS counts and changes in the composition of the oral microbiota assessed by the Human Oral Microbe Identification Microarray (HOMIM). Relationships between daily habits, bacterial levels and caries were evaluated. Daily use of sweets and soft drinks were the habits significantly associated with caries severity measured by ICDAS Caries Index (CI), while toothbrushing was the only habit associated with the low caries severity. Abiotrophia defectiva and Actinomyces meyeri/ A. odontolyticus were significantly higher in caries-affected children while Shuttleworthia satelles was significantly higher in caries-free children. Xylitol showed significant reduction in salivary levels of MS in both trials. No significant effects on other members of the microbiota were found when evaluated by HOMIM. In conclusion, other members of oral microbiota than MS may be associated with caries occurrence or absence. The use of xylitol had significant effect on MS with no effects on the other members of the salivary microbiota.

Photocatalysis Studies under Visible Light Irradiation with TiO2 Obtained by Pulsed Electric Field Assisted Sol-Gel Method

The objective of this thesis was to study the effect of pulsed electric field on the preparation of TiO2 nanoparticles via sol-gel method under the visible light irradiation. The literature part introduces properties of different TiO2 crystal forms and principle of photocatalysis. It was expected that pulsed electric field would have an influence on degradation for oxalic acid and formic acid. TiO2 samples were prepared by using three frequencies (50Hz, 294Hz, and 963Hz) and two treatment times (12 minutes and 24 minutes) of pulsed electric field. The photocatalytic activities of TiO2 samples produced with sol-gel method were also compared with the TiO2 particles made by previous study and with the commercial TiO2 powder Aeroxide® (Evonic Degussa GmbH) at the same condition. Results show that pulsed electric field does have an effect on degradation for oxalic acid and formic acid. Generally, higher photocatalytic activities for oxalic acid and formic acid were obtained with lower frequency and longer treatment time of pulsed electric field.

Safety and outcome of coronary interventions with special reference to anticoagulation and stent type

University of Turku, Faculty of Medicine, Department of Cardiology and Cardiovascular Medicine, Doctoral Programme of Clinical Investigation, Heart Center, Turku University Hospital, Turku, Finland Division of Internal Medicine, Department of Cardiology, Seinäjoki Central Hospital, Seinäjoki, Finland Heart Center, Satakunta Central Hospital, Pori, Finland Annales Universitatis Turkuensis Painosalama Oy, Turku, Finland 2015 Antithrombotic therapy during and after coronary procedures always entails the challenging establishment of a balance between bleeding and thrombotic complications. It has been generally recommended to patients on long-term warfarin therapy to discontinue warfarin a few days prior to elective coronary angiography or intervention to prevent bleeding complications. Bridging therapy with heparin is recommended for patients at an increased risk of thromboembolism who require the interruption of anticoagulation for elective surgery or an invasive procedure. In study I, consecutive patients on warfarin therapy referred for diagnostic coronary angiography were compared to control patients with a similar disease presentation without warfarin. The strategy of performing coronary angiography during uninterrupted therapeutic warfarin anticoagulation appeared to be a relatively safe alternative to bridging therapy, if the international normalized ratio level was not on a supratherapeutic level. In-stent restenosis remains an important reason for failure of long-term success after a percutaneous coronary intervention (PCI). Drug-eluting stents (DES) reduce the problem of restenosis inherent to bare metal stents (BMS). However, a longer delay in arterial healing may extend the risk of stent thrombosis (ST) far beyond 30 days after the DES implantation. Early discontinuation of antiplatelet therapy has been the most important predisposing factor for ST. In study II, patients on long-term oral anticoagulant (OAC) underwent DES or BMS stenting with a median of 3.5 years’follow-up. The selective use of DESs with a short triple therapy seemed to be safe in OAC patients, since late STs were rare even without long clopidogrel treatment. Major bleeding and cardiac events were common in this patient group irrespective of stent type. In order to help to predict the bleeding risk in patients on OAC, several different bleeding risk scorings have been developed. Risk scoring systems have also been used also in the setting of patients undergoing a PCI. In study III, the predictive value of an outpatient bleeding risk index (OBRI) to identify patients at high risk of bleeding was analysed. The bleeding risk seemed not to modify periprocedural or long-term treatment choices in patients on OAC after a percutaneous coronary intervention. Patients with a high OBRI often had major bleeding episodes, and the OBRI may be suitable for risk evaluation in this patient group. Optical coherence tomography (OCT) is a novel technology for imaging intravascular coronary arteries. OCT is a light-based imaging modality that enables a 12–18 µm tissue axial resolution to visualize plaques in the vessel, possible dissections and thrombi as well as, stent strut appositions and coverage, and to measure the vessel lumen and lesions. In study IV, 30 days after titanium-nitride-oxide (TITANOX)-coated stent implantation, the binary stent strut coverage was satisfactory and the prevalence of malapposed struts was low as evaluated by OCT. Long-term clinical events in patients treated with (TITANOX)-coated bio-active stents (BAS) and paclitaxel-eluting stents (PES) in routine clinical practice were examined in study V. At the 3-year follow-up, BAS resulted in better long-term outcome when compared with PES with an infrequent need for target vessel revascularization. Keywords: anticoagulation, restenosis, thrombosis, bleeding, optical coherence tomography, titanium

Vascular Healing after Coronary Stenting Evaluated by Optical Coherence Tomography

Optical coherence tomography (OCT) is a novel intracoronary imaging application for the assessment of native lesions and coronary stents. The purpose of this thesis was to evaluate the safety and feasibility of frequency-domain OCT (FD-OCT) based on experiences of the Satakunta Central Hospital (I). Early vascular healing was evaluated after implantation of endothelial progenitor cell capturing (II) and bio-active titanium-nitride-oxide coated stents (III) in two studies, each with 20 patients. Vascular healing was also compared after implantation of bio-active and everolimus-eluting stents on 28 patients after 9-month follow-up (IV). Long-term vascular healing of bio-active and paclitaxel-eluting stents was assessed in the last study with 18 patients (V). The results indicate that FD-OCT is safe and feasible (I). Both bio-active and endothelial progenitor cell capturing stents showed near-complete endothelialisation after one-month follow-up, which is desirable when prolonged dual anti-platelet therapy needs to be avoided after stenting (II and III). Endothelialisation of bio-active stents showed a predictable pattern at mid-term and long-term follow up (IV and V). Endothelialisation of everolimus-eluting stents was not complete at 9 months follow-up, which may suggest that interruption of dual antiplatelet therapy at this time point may not be safe (IV). Finally, delayed vascular healing may be present in patients treated with paclitaxel-eluting stents as long as 4 years from implantation, which reinforces the previously raised concerns on the long-term safety of this device (V).