Bone-implant interface. Evaluation of osteoblastic cells behavior on nanopatterned titanium surfaces: an in vitro analysis

Protein-adsorption occurs immediately following implantation of biomaterials. It is unknown at which extent protein-adsorption impacts the cellular events at bone-implant interface. To investigate this question, we compared the in-vitro outcome of osteoblastic cells grown onto titanium substrates and glass as control, by modulating the exposure to serum-derived proteins. Substrates consisted of 1) polished titanium disks; 2) polished disks nanotextured with H2SO4/H2O2; 3) glass. In the pre-adsorption phase, substrates were treated for 1h with αMEM alone (M-noFBS) or supplemented with 10%-foetal-bovine-serum (M-FBS). MC3T3-osteoblastic-cells were cultured on the pre-treated substrates for 3h and 24h, in M-noFBS and M-FBS. Subsequently, the culture medium was replaced with M-FBS and cultures maintained for 3 and 7days. Cell-number was evaluated by: Alamar-Blue and MTT assay. Mitotic- and osteogenic-activities were evaluated through fluorescence-optical-microscope by immunolabeling for Ki-67 nuclear-protein and Osteopontin. Cellular morphology was evaluated by SEM-imaging. Data were statistically analyzed using ANOVA-test, (p<0.05). At day3 and day7, the presence or absence of serum-derived proteins during the pre-adsorption phase had not significant effect on cell-number. Only the absence of FBS during 24h of culture significantly affected cell-number (p<0.0001). Titanium surfaces performed better than glass, (p<0.01). The growth rate of cells between day3 and 7 was not affected by the initial absence of FBS. Immunolabeling for Ki-67 and Osteopontin showed that the mitotic- and osteogenic- activity were ongoing at 72h. SEM-analysis revealed that the absence of FBS had no major influence on cell-shape. • Physico-chemical interactions without mediation by proteins are sufficient to sustain the initial phase of culture and guide osteogenic-cells toward differentiation. • The challenge is avoiding adsorption of ‘undesirables’ molecules that negatively impact on the cueing cells receive from surface. This may not be a problem in healthy patients, but may have an important role in medically-compromised-individuals in whom the composition of tissue-fluids is altered.

Design of cell adhesive and angiogenic titanium surfaces for cellular stimulation

Die Förderung der Zelladhäsion durch sogenannte biomimetische Oberflächen wird in der Medizin als vielversprechender Ansatz gesehen, um Komplikationen wie z. B. Fremdkörperreaktionen nach der Implantation entgegenzuwirken. Neben der Immobilisierung einzelner Biomoleküle wie z. B. dem RGD-Peptid, Proteinen und Wachstumsfaktoren auf verschiedenen Materialien, konzentriert man sich derzeit in der Forschung auf die Co-Immobilisierung zweier Moleküle gleichzeitig. Hierbei werden die funktionellen Gruppen z. B. von Kollagen unter Verwendung von nur einer Kopplungschemie verwendet, wodurch die Kopplungseffizienz der einzelnen Komponenten nur begrenzt kontrollierbar ist. Das Ziel der vorliegenden Arbeit war die Entwicklung eines Immobilisierungsverfahrens, welches die unabhängige Kopplung zweier Faktoren kontrolliert ermöglicht. Dabei sollten exemplarisch das adhäsionsfördernde RGD-Peptid (Arginin-Glycin-Asparaginsäure) zusammen mit dem Wachstumsfaktor VEGF (Vascular Endothelial Growth Factor) auf Titan gebunden werden. In weiteren Experimenten sollten dann die pro-adhäsiven Faktoren Fibronektin, Kollagen, Laminin und Osteopontin immobilisiert und untersucht werden. rnDie Aminofunktionalisierung von Titan durch plasma polymerisierte Allylaminschichten wurde als Grundlage für die Entwicklung des nasschemischen Co-immobilisierungsverfahren verwendet. Für eine unabhängige und getrennte Anbindung der verschiedenen Biomoleküle stand in diesem Zusammenhang die Entwicklung eines geeigneten Crosslinker Systems im Vordergrund. Die Oberflächencharakterisierung der entwickelten Oberflächen erfolgte mittels Infrarot Spektroskopie, Surface Plasmon Resonance Spektroskopie (SPR), Kontaktwinkelmessungen, Step Profiling und X-Ray Photoelectron Spektroskopie (XPS). Zur Analyse der Anbindungsprozesse in Echtzeit wurden SPR-Kinetik Messungen durchgeführt. Die biologische Funktionalität der modifizierten Oberflächen wurde in vitro an Endothelzellen (HUVECs) und Osteoblasten (HOBs) und in vivo in einem Tiermodell-System an der Tibia von Kaninchen untersucht.rnDie Ergebnisse zeigen, dass alle genannten Biomoleküle sowohl einzeln auf Titan kovalent gekoppelt als auch am Bespiel von RGD und VEGF in einem getrennten Zwei-Schritt-Verfahren co-immobilisiert werden können. Des Weiteren wurde die biologische Funktionalität der gebundenen Faktoren nachgewiesen. Im Falle der RGD modifizierten Oberflächen wurde nach 7 Tagen eine geförderte Zelladhäsion von HUVECs mit einer signifikant erhöhten Zellbesiedlungsdichte von 28,5 % (p<0,05) gezeigt, wohingegen auf reinem Titan Werte von nur 13 % beobachtet wurden. Sowohl VEGF als auch RGD/VEGF modifizierte Proben wiesen im Vergleich zu Titan schon nach 24 Stunden eine geförderte Zelladhäsion und eine signifikant erhöhte Zellbesiedlungsdichte auf. Bei einer Besiedlung von 7,4 % auf Titan, zeigten VEGF modifizierte Proben mit 32,3 % (p<0,001) eine deutlichere Wirkung auf HUVECs als RGD/VEGF modifizierte Proben mit 13,2 % (p<0,01). Die pro-adhäsiven Faktoren zeigten eine deutliche Stimulation der Zelladhäsion von HUVECs und HOBs im Vergleich zu reinem Titan. Die deutlich höchsten Besiedlungsdichten von HUVECs konnten auf Fibronektin mit 44,6 % (p<0,001) und Kollagen mit 39,9 % (p<0,001) nach 24 Stunden beobachtet werden. Laminin zeigte keine und Osteopontin nur eine sehr geringe Wirkung auf HUVECs. Bei Osteoblasten konnten signifikant erhöhte Besiedlungsdichten im Falle aller pro-adhäsiven Faktoren beobachtet werden, jedoch wurden die höchsten Werte nach 7 Tagen auf Kollagen mit 90,6 % (p<0,001) und Laminin mit 86,5 % (p<0,001) im Vergleich zu Titan mit 32,3 % beobachtet. Die Auswertung der Tierexperimente ergab, dass die VEGF modifizierten Osteosyntheseplatten, im Vergleich zu den reinen Titankontrollen, eine gesteigerte Knochenneubildung auslösten. Eine solche Wirkung konnte für RGD/VEGF modifizierte Implantate nicht beobachtet werden. rnInsgesamt konnte gezeigt werden, dass mittels plasmapolymerisierten Allylamin Schichten die genannten Biomoleküle sowohl einzeln gebunden als auch getrennt und kontrolliert co-immobilisiert werden können. Des Weiteren konnte eine biologische Funktionalität für alle Faktoren nach erfolgter Kopplung in vitro gezeigt werden. Wider Erwarten konnte jedoch kein zusätzlicher biologischer Effekt durch die Co-immobilisierung von RGD und VEGF im Vergleich zu den einzeln immobilisierten Faktoren gezeigt werden. Um zu einer klinischen Anwendung zu gelangen, ist es nun notwendig, das entwickelte Verfahren in Bezug auf die immobilisierten Mengen der verschiedenen Faktoren hin zu optimieren. rn

Early loading at 21 days of non-submerged titanium implants with a chemically modified sandblasted and acid-etched surface: 3-year results of a prospective study in the posterior mandible

BACKGROUND: This study evaluates 3-year success rates of titanium screw-type implants with a chemically modified sandblasted and acid-etched surface (mod SLA), which were functionally loaded after 3 weeks of healing. METHODS: A total of 56 implants, inserted in the posterior mandibles of 39 partially edentulous patients, underwent undisturbed healing for 3 weeks. At day 21, the implants were fully loaded with provisional crowns. Definitive metal ceramic restorations were fabricated after 6 months of healing. Clinical measurements regarding soft tissue parameters and radiographs were obtained at different time points up to 36 months after implant placement. The soft tissue and radiographic parameters for the mod SLA implants after 3 years in function were compared to a historic control group of implants with an SLA surface using an early loading protocol after 6 weeks. RESULTS: None of the implants failed to integrate. However, two implants were considered "spinners" at day 21 and were left unloaded for an extended period. Therefore, 96.4% of the inserted implants were loaded according to the protocol tested. All 56 implants, including the "spinners," showed favorable clinical and radiographic findings at the 3-year follow-up examination. All 56 implants were considered successfully integrated, resulting in a 3-year survival and success rate of 100%. Dental implants with a mod SLA surface demonstrated statistically significant differences for probing depths and clinical attachment level values compared to the historic control group, with the mod SLA surface implants having overall lower probing depths and clinical attachment level scores. CONCLUSION: This prospective study using an early loading protocol demonstrates that titanium implants with the mod SLA surface can achieve and maintain successful tissue integration over a period of 3 years.

Early loading after 21 days of healing of nonsubmerged titanium implants with a chemically modified sandblasted and acid-etched surface: two-year results of a prospective two-center study

PURPOSE: The aim of this two-center study was to evaluate screw-type titanium implants with a chemically modified, sandblasted and acid-etched surface when placed in the posterior maxilla or mandible, and loaded 21 days after placement. MATERIAL AND METHODS: All 56 patients met strict inclusion criteria and provided informed consent. Each patient displayed either a single-tooth gap, an extended edentulous space, or a distal extension situation in the posterior mandible or maxilla. Eighty-nine dental implants (SLActive, Institut Straumann AG, Basel, Switzerland) were inserted according to an established nonsubmerged protocol and underwent undisturbed healing for a period of 21 days. Where appropriate, the implants were loaded after 21 days of healing with provisional restorations in full occlusion. Definitive metal ceramic restorations were fabricated and positioned on each implant after 6 months of healing. Clinical measurements regarding soft tissue parameters and radiographs were obtained at different time points up to 24 months after implant placement. RESULTS: Of the 89 inserted implants, two (2.2%) implants failed to integrate and were removed during healing, and two (2.2%) additional implants required a prolonged healing time. A total of 85 (95.6%) implants were therefore loaded without incident after 21 days of healing. No additional implant was lost throughout the study period, whereas one implant was lost to follow-up and therefore left unaccounted for further analysis. The remaining 86 implants all exhibited favorable radiographic and clinical findings. Based on strict success criteria, these implants were considered successfully integrated 2 years after insertion, resulting in a 2-year success rate of 97.7%. CONCLUSION: The results of this prospective two-center study demonstrate that titanium implants with a modified SLA surface can predictably achieve successful tissue integration when loaded in full occlusion 21 days after placement. Integration could be maintained without incident for at least 2 years of follow-up.

Pooled analysis of trials comparing titanium-nitride-oxide-coated stents with paclitaxel-eluting stents in patients undergoing coronary stenting

We performed a pooled analysis of three trials comparing titanium-nitride-oxide-coated bioactive stents (BAS) with paclitaxel-eluting stents (PES) in 1,774 patients. All patients were followed for 12 months. The primary outcomes of interest were recurrent myocardial infarction (MI), death and target lesion revascularization (TLR). Secondary endpoints were stent thrombosis (ST) and major adverse cardiac events (MACE) including MI, death and TLR. There were 922 patients in the BAS group and 852 in the PES group. BAS significantly reduced the risk of recurrent MI (2.7% vs. 5.6%; risk ratio 0.50, 95% CI 0.31-0.81; p = 0.004) and MACE (8.9% vs. 12.6%; risk ratio 0.71, 95% CI 0.54-0.94; p = 0.02) during the 12 months of follow up. In contrast, the differences between BAS and PES were not statistically significant with respect to TLR (risk ratio 0.98, 95% CI 0.68-1.41), death (risk ratio 0.96, 95% CI 0.61-1.51) and definite ST (risk ratio 0.28, 95% CI 0.05-1.47). In conclusion, the results of this analysis suggest that BAS is effective in reducing TLR and improves clinical outcomes by reducing MI and MACE compared with PES.

Randomised comparison of titanium-nitride-oxide coated stents with bare metal stents: five year follow-up of the TiNOX trial

Revascularisation with Titanium-Nitride-Oxide (TiNOX) coated stents is safe and effective in patients with de novo native coronary artery lesions. In the TiNOX trial there was a reduction in restenosis and major adverse cardiac events as compared with stainless steel stents of otherwise identical design. The purpose of the present study was to evaluate the long-term outcome of these patients over five years.

Generation and characterization of stable, highly concentrated titanium dioxide nanoparticle aerosols for rodent inhalation studies

The intensive use of nano-sized titanium dioxide (TiO2) particles in many different applications necessitates studies on their risk assessment as there are still open questions on their safe handling and utilization. For reliable risk assessment, the interaction of TiO2 nanoparticles (NP) with biological systems ideally needs to be investigated using physico-chemically uniform and well-characterized NP. In this article, we describe the reproducible production of TiO2 NP aerosols using spark ignition technology. Because currently no data are available on inhaled NP in the 10–50 nm diameter range, the emphasis was to generate NP as small as 20 nm for inhalation studies in rodents. For anticipated in vivo dosimetry analyses, TiO2 NP were radiolabeled with 48V by proton irradiation of the titanium electrodes of the spark generator. The dissolution rate of the 48V label was about 1% within the first day. The highly concentrated, polydisperse TiO2 NP aerosol (3–6 × 106 cm−3) proved to be constant over several hours in terms of its count median mobility diameter, its geometric standard deviation, and number concentration. Extensive characterization of NP chemical composition, physical structure, morphology, and specific surface area was performed. The originally generated amorphous TiO2 NP were converted into crystalline anatase TiO2 NP by thermal annealing at 950 °C. Both crystalline and amorphous 20-nm TiO2 NP were chain agglomerated/aggregated, consisting of primary particles in the range of 5 nm. Disintegration of the deposited TiO2 NP in lung tissue was not detectable within 24 h.

Expansive nasopalatine duct cysts with nasal involvement mimicking apical lesions of endodontic origin: a report of two cases

The nasopalatine duct cyst (NPDC) is the most frequent nonodontogenic cyst of the jaws and can be misinterpreted as an apical lesion of endodontic origin.

Precision of endodontic working length measurements: a pilot investigation comparing cone-beam computed tomography scanning with standard measurement techniques

The objective of this pilot investigation was to evaluate the utility and precision of already existing limited cone-beam computed tomography (CBCT) scans in measuring the endodontic working length, and to compare it with standard clinical procedures.

Bioengineered periodontal tissue formed on titanium dental implants

The ability to use autologous dental progenitor cells (DPCs) to form organized periodontal tissues on titanium implants would be a significant improvement over current implant therapies. Based on prior experimental results, we hypothesized that rat periodontal ligament (PDL)-derived DPCs can be used to bioengineer PDL tissues on titanium implants in a novel, in vivo rat maxillary molar implant model. Analyses of recovered implants revealed organized PDL tissues surrounding titanium implant surfaces in PDL-cell-seeded, and not in unseeded control, implants. Rat PDL DPCs also exhibited differentiative potential characteristic of stem cells. These proof-of-principle findings suggest that PDL DPCs can organize periodontal tissues in the jaw, at the site of previously lost teeth, indicating that this method holds potential as an alternative approach to osseointegrated dental implants. Further refinement of this approach will facilitate the development of clinically relevant methods for autologous PDL regeneration on titanium implants in humans.

Influence of a machined collar on crestal bone changes around titanium implants: a histometric study in the canine mandible

It has been shown that peri-implant crestal bone reactions are influenced by both a rough-smooth implant border in one-piece, non-submerged, as well as an interface (microgap [MG] between implant/abutment) in two-piece butt-joint, submerged and non-submerged implants being placed at different levels in relation to the crest of the bone. According to standard surgical procedures, the rough-smooth implant border for implants with a smooth collar should be aligned with the crest of the bone exhibiting a smooth collar adjacent to peri-implant soft tissues. No data, however, are available for implants exhibiting a sandblasted, large-grit and acid-etched (SLA) surface all the way to the top of a non-submerged implant. Thus, the purpose of this study is to histometrically examine crestal bone changes around machined versus SLA-surfaced implant collars in a side-by-side comparison.

Self-assembly of focal point oligo-catechol ethylene glycol dendrons on titanium oxide surfaces: adsorption kinetics, surface characterization, and nonfouling properties

This work covers the synthesis of second-generation, ethylene glycol dendrons covalently linked to a surface anchor that contains two, three, or four catechol groups, the molecular assembly in aqueous buffer on titanium oxide surfaces, and the evaluation of the resistance of the monomolecular adlayers against nonspecific protein adsorption in contact with full blood serum. The results were compared to those of a linear poly(ethylene glycol) (PEG) analogue with the same molecular weight. The adsorption kinetics as well as resulting surface coverages were monitored by ex situ spectroscopic ellipsometry (VASE), in situ optical waveguide lightmode spectroscopy (OWLS), and quartz crystal microbalance with dissipation (QCM-D) investigations. The expected compositions of the macromolecular films were verified by X-ray photoelectron spectroscopy (XPS). The results of the adsorption study, performed in a high ionic strength ("cloud-point") buffer at room temperature, demonstrate that the adsorption kinetics increase with increasing number of catechol binding moieties and exceed the values found for the linear PEG analogue. This is attributed to the comparatively smaller and more confined molecular volume of the dendritic macromolecules in solution, the improved presentation of the catechol anchor, and/or their much lower cloud-point in the chosen buffer (close to room temperature). Interestingly, in terms of mechanistic aspects of "nonfouling" surface properties, the dendron films were found to be much stiffer and considerably less hydrated in comparison to the linear PEG brush surface, closer in their physicochemical properties to oligo(ethylene glycol) alkanethiol self-assembled monolayers than to conventional brush surfaces. Despite these differences, both types of polymer architectures at saturation coverage proved to be highly resistant toward protein adsorption. Although associated with higher synthesis costs, dendritic macromolecules are considered to be an attractive alternative to linear polymers for surface (bio)functionalization in view of their spontaneous formation of ultrathin, confluent, and nonfouling monolayers at room temperature and their outstanding ability to present functional ligands (coupled to the termini of the dendritic structure) at high surface densities.

Low-profile titanium mesh in the use of orbital reconstruction: A pilot study

The purpose of this study was to share our clinical experience in the use and accuracy of a newly designed, low-profile titanium mesh (Modus OPS 1.5; Medartis, Basel, Switzerland) for primary internal orbital reconstruction.