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PubMed2000

Effects of titanium prosthesis, offset and size of field of view on bone mineral density measurements using quantitative computed tomography.

To estimate the accuracy of quantitative computed tomography (QCT) as a method to measure bone mineral density (BMD) in the vicinity of a titanium prosthesis, we investigated the effects of (1) titanium prosthesis, (2) offset of the longitudinal axis of the bone to be examined from that of the gantry of the CT scanner, (3) size of the field of view (FOV) and (4) the combination of these effects on CT based measurements of mineral density of cortical and cancellous bone specimens. 14 bovine cortical bone parallelepipeds and 14 bovine cancellous bone parallelepipeds were used in this investigation. The bone specimens were scanned with and without a titanium prosthesis, when centered in the gantry of the CT scanner and offset from the axis of the gantry of the CT scanner at a distance of 14 cm. Image data were then reconstructed separately with a FOV of 10 cm and 30 cm. All BMD values taken from CT images obtained under different scanning condition were compared with the BMD values of the corresponding bone parallelepiped obtained under standard condition (centered in the gantry of the CT scanner, 10 cm FOV, without titanium prosthesis). When centered in the gantry of the CT scanner, the mean relative difference of BMD measurements caused by the presence of the titanium prosthesis was less than 1% for both cortical bone and cancellous bone. Size of the FOV had a negligible effect on BMD measurements. Offset at 14 cm, however, caused a significant difference in BMD measurements (p < 0.001). It was concluded that titanium prosthesis did not interfere with BMD measurements of cortical and cancellous bone when both the specimen and prosthesis were centered in the gantry of the CT scanner. However, the effect on BMD measurements of offset at 14 cm combined with the presence of a titanium prosthesis in bone was significant.

Animals↗
PubMed1991

Titanium endosseous implant-soft tissue interface: a literature review.

Background information about normal periodontal anatomy and titanium used in endosseous implant fabrication is provided. Literature is reviewed concerning epithelial and connective tissue attachment to titanium. Information about the adequacy of cell attachment to implants, possible mechanisms of cell attachment formation, and the effect of implant surface properties on attachment is presented. A chemical attachment between titanium implant surface oxide layer and epithelium has been demonstrated in vitro and in vivo. This attachment is mediated by a glycoprotein similar to that seen between epithelium and natural tooth surfaces. While only minimal histological evidence exists, connective tissue fibers adjacent to titanium implanted surfaces may bring the tissue in tight apposition to the implant without an absolute biologic attachment between the implant and connective tissue. Alteration of the titanium surface morphology may selectively enhance the attachment of either epithelial cells or fibroblasts, theoretically enhancing the formation of a biologic seal between the implanted titanium surface and its adjacent tissue. A greater understanding of the mechanisms of attachment and of the factors which enhance the integrity of the biologic seal between implant and soft tissues should permit an improved prognosis for functioning titanium implants.

Dental Implantation, Endosseous↗
PubMed2004

Loaded custom-made zirconia and titanium implants show similar osseointegration: an animal experiment.

BACKGROUND: Zirconia might be an alternative material to titanium for dental implant fabrication. The aim of the present study was to investigate the histological behavior (osseointegration) of loaded zirconia implants in an animal model and to compare it with the behavior of titanium implants. METHODS: Five months after extraction of the upper anterior teeth, 12 custom-made titanium implants (control group) and 12 custom-made zirconia implants (test group) were inserted in the extraction sites in six monkeys. Before insertion, the titanium implant surfaces were sandblasted with Al2O3 and subsequently acid-etched. The zirconia implants were only sandblasted. Six months following implant insertion, impressions were taken for the fabrication of single crowns. A further 3 months later, nonprecious metal crowns were inserted. Five months after insertion of the crowns, the implants with the surrounding hard and soft tissues were harvested, histologically prepared, and evaluated under the light microscope regarding the peri-implant soft tissue dimensions and mineralized bone-to-implant contact. RESULTS: No implant was lost during the investigational period. The mean height of the soft peri-implant tissue cuff was 5 mm around the titanium implants and 4.5 mm around the zirconia implants. No statistically significant differences were found in the extent of the different soft tissue compartments. The mean mineralized bone-to-implant contact after 9 months of healing and 5 months of loading amounted to 72.9% (SD: 14%) for the titanium implants and to 67.4% (SD: 17%) for the zirconia implants. There was no statistically significant difference between the different implant materials. CONCLUSION: Within the limits of this animal experiment, it can be concluded that the custom-made zirconia implants osseointegrated to the same extent as custom-made titanium control implants and show the same peri-implant soft tissue dimensions.

Acid Etching, Dental↗
PubMed1996

Increased levels of tumor necrosis factor-alpha and interleukin-6 protein and messenger RNA in human peripheral blood monocytes due to titanium particles.

Cytokines produced by macrophages in the periprosthetic membranes surrounding joint replacements have been implicated as causal agents in osteolysis and prosthetic loosening. The present study characterizes the response of human peripheral blood monocytes to titanium particles. Monocytes were obtained from volunteers and blood that had been donated to the American Red Cross and were cultured in the presence of titanium particles (one to three micrometers in diameter). There were consistent dose-dependent increases in the production of TNF-alpha (tumor necrosis factor-alpha) and IL-6 (interleukin-6) protein, with the greatest stimulation generally observed with a concentration of 6 x 10(5) to 6 x 10(6) particles of titanium per milliliter. The level of TNF-alpha was the greatest (fifty to 1000 times greater than the control level) after eight hours of exposure to titanium particles; the level of IL-6 was two to five times greater than the control level after sixteen hours of exposure. These increases were similar to those observed after stimulation with lipopolysaccharide and depended on de novo synthesis rather than on release from intracellular stores. The production of TNF-alpha was inhibited in a dose-dependent manner by the translational inhibitor cycloheximide and the transcriptional inhibitor actinomycin D, indicating the requirement for both mRNA (messenger RNA) and protein synthesis for the induction of cytokine synthesis by titanium particles. Although the increase in the levels of cytokine mRNA in response to titanium was rapid (thirty to ninety minutes), the increase in the level of TNF-alpha mRNA preceded that of IL-6 mRNA. The level of TNF-alpha mRNA was the greatest at ninety minutes and the level of IL-6 mRNA was the greatest at three hours. After stimulation with titanium particles, the level of TNF-alpha mRNA was increased as much as fivefold and the level of IL-6 mRNA, as much as twelvefold.

Cells, Cultured↗
PubMed1981

Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man.

A total of 2895 threaded, cylindrical titanium implants have been inserted into the mandible or the maxilla and 124 similar implants have been installed in the tibial, temporal or iliac bones in man for various bone restorative procedures. The titanium screws were implanted without the use of cement, using a meticulous technique aiming at osseointegration--a direct contact between living bone and implant. Thirty-eight stable and integrated screws were removed for various reasons from 18 patients. The interface zone between bone and implant was investigated using X-rays, SEM, TEM and histology. The SEM study showed a very close spatial relationship between titanium and bone. The pattern of the anchorage of collagen filaments to titanium appeared to be similar to that of Sharpey's fibres to bone. No wear products were seen in the bone or soft tissues in spite of implant loading times up to 90 months. The soft tissues were also closely adhered to the titanium implant, thereby forming a biological seal, preventing microorganism infiltration along the implant. The implants in many cases had been allowed to permanently penetrate the gingiva and skin. This caused no adverse tissue effects. An intact bone-implant interface was analyzed by TEM, revealing a direct bone-to-implant interface contact also at the electron microscopic level, thereby suggesting the possibility of a direct chemical bonding between bone and titanium. It is concluded that the technique of osseointegration is a reliable type of cement-free bone anchorage for permanent prosthetic tissue substitutes. At present, this technique is being tried in clinical joint reconstruction. In order to achieve and to maintain such a direct contact between living bone and implant, threaded, unalloyed titanium screws of defined finish and geometry were inserted using a delicate surgical technique and were allowed to heal in situ, without loading, for a period of at least 3--4 months.

Adult↗
PubMed1998

Tensile bond between bone and titanium: a reappraisal of osseointegration.

When Branemark in the 1970s established the term osseointegration, this implied a direct chemical bond between a titanium implant and bone. However, ultrastructural studies seemed not to support this idea, and osseointegration came to be defined as the absence of interfering fibrous tissue. Titanium was therefore described as bioinert rather than bioactive. We now demonstrate mechanically a chemical bond between bone and titanium, using unloaded cp titanium plates, similar to those used in previous studies on prosthetic loosening. Tensile force can be transmitted only by chemical bonds. Bone-bonding was therefore evaluated by a detachment test. The plates were developed so that a flat titanium surface touched traumatized bone and the rest of the detachable part had no contact with surrounding tissue. The titanium plates were either polished and sterilized in an autoclave or treated in 4 M NaOH and then heated to 600 degrees C according to Yan et al. (1996). After 4 weeks, the plates were separated from the bone by a perpendicular traction force. The detaching load of the untreated titanium plates never exceeded 0.03 MPa, whereas with treatment it increased to median 0.8 MPa, with bone remaining attached to parts of the plates after detachment. Our findings confirm that a chemical bond can be obtained within 4 weeks with the described pretreatment. It may occur also without treatment, after a longer implantation time.

Animals↗
PubMed1996

Titanium in dentistry: development and research in the U.S.A.

Titanium has received a great deal of attention from dental researchers and clinicians. In the United States, the history of the application of titanium as a biomaterial started as early as 1940 when experiments with titanium implants were done using laboratory animals. It appears that in 1959, two American researchers were the first to suggest casting titanium to fabricate implant posts. The use of cast titanium for dental prostheses in the U.S. was first reported in 1977. The present survey revealed that during the last decade, the number of research projects on the applications of titanium to dentistry that were presented at annual IADR/AADR meetings has steadily increased. The majority of these presentations have been made by American researchers, and 59% of these were related to dental implantology. The numbers of reports on casting and prosthodontic applications have steadily increased, but they are still more limited. The purpose of this review was to provide information on the development and the current status of research on titanium in dentistry in the U.S.

Dental Casting Technique↗
PubMed2001

Exposure to titanium dioxide and risk of lung cancer in a population-based study from Montreal.

OBJECTIVES: This study assessed the lung cancer risk from exposure to titanium dioxide, an important pigment with limited evidence of carcinogenicity in experimental animals but sparse data for humans. METHODS: The risk of lung cancer among residents in Montreal, Canada, was analyzed, including 857 histologically confirmed cases of lung cancer diagnosed during 1979-1985 among men aged 35-70 years and a group of referents comprising 533 randomly selected, healthy residents and 533 persons with cancer in organs other than the lung. Exposure to titanium dioxide and other titanium compounds was assessed by a team of industrial hygienists on the basis of a detailed occupational questionnaire. RESULTS: Thirty-three cases and 43 referents were classified as exposed to titanium dioxide. The odds ratio was 0.9 [95% confidence interval (95% CI) 0.5-1.5]. No trend was apparent according to the estimated frequency, level, or duration of exposure. The odds ratio was 1.0 (95% CI 0.3-2.7) for medium or high exposure for at least 5 years. Few subjects were classified as exposed to titanium dioxide fumes or to other titanium compounds, but the risk of lung cancer was nonsignificantly increased for exposure to these agents. CONCLUSIONS: Although misclassification of exposure and low exposure prevalence might have resulted in false negative results, this study does not suggest that occupational exposure to titanium dioxide increases the risk of lung cancer.

Adult↗
PubMedDate not supplied

Clinical experiences with laser-welded titanium frameworks supported by implants in the edentulous mandible: a 5-year follow-up study.

PURPOSE: The purpose of this study was to report the 5-year clinical performance of implant-supported prostheses with laser-welded titanium frameworks and to compare their performance with that of prostheses provided with conventional cast frameworks. MATERIALS AND METHODS: On a routine basis, a consecutive group of 824 edentulous patients were provided with fixed prostheses supported by implants in the edentulous mandible. In addition to conventional gold-alloy castings, patients were at random provided with 2 kinds of laser-welded titanium frameworks. In all, 155 patients were included in the 2 titanium framework groups. A control group of 53 randomly selected patients with conventional gold-alloy castings was used for comparison. Clinical and radiographic 5-year data was collected for the 3 groups. RESULTS: All followed patients still had fixed prostheses in the mandible after 5 years. The overall cumulative success rates were 95.9% and 99.7% for titanium-framework prostheses and implants, respectively. The corresponding success rates for the control group were 100% and 99.6%, respectively. Bone loss was 0.5 mm on average during the 5-year follow-up period. The most common complications for titanium frameworks were resin or tooth fractures, gingival inflammation, and fractures of the metal frames (10%). One of the cast frameworks fractured and was resoldered. Loose and fractured implant screw components were few (< 1%). CONCLUSION: Even though the cast frameworks had a higher success rate, the overall titanium framework treatment result was well in accordance with the result of the control group. The test groups performed better after clinicians had gained some experience with the technique, and laser-welded titanium frameworks seem to be a viable alternative to conventional castings in the edentulous mandible.

Adult↗
PubMed1999

Titanium is a highly thrombogenic biomaterial: possible implications for osteogenesis.

Titanium has superior osteointegrating properties compared to other biomaterials. The mechanism for this is unknown. During the initial phase of bone implantation the biomaterial comes into direct contact with whole blood. In this study we use a newly developed in vitro chamber model to compare different commonly used biomaterials in contact with whole blood. These materials were selected with respect to their different osteointegrating properties in order to correlate these properties with the response to whole blood. In the presence of 3 IU/ml of heparin only titanium induced macroscopic clotting. This was reflected by the generation of thrombin-antithrombin which was much increased in blood in contact with titanium compared with steel and PVC. The coagulation activation caused by titanium was triggered by the intrinsic pathway because the generation of FXIIa-AT/C1 esterase inhibitor paralleled that of thrombin-antithrombin, and both thrombin-antithrombin complex and FXIIa-AT/C1 esterase inhibitor generation were abrogated by corn trypsin inhibitor, which is a specific inhibitor of FXIIa. The binding of platelets was increased on the titanium surface compared to the other biomaterial surfaces and the state of platelet activation was much more pronounced as reflected by the levels of beta-thromboglobulin and PDGF. This study indicates that titanium is unsuitable as a biomaterial in devices which are in direct contact with blood for a prolonged period. Furthermore, PDGF and other alpha-granule proteins e.g. TGF-beta, are known to be potent promotors of osteogenesis which suggests that the pronounced thrombogenic properties of titanium might contribute to the good osteointegrating properties.

Blood Coagulation↗
PubMed1998

[The study of biocompatibility of titanium in middle ear cave of guinea-pig].

In order to supply full objective basis about tympanoplasty with titanium, 30 middle ear caves of guinea-pigs were implanted titanium ring in accordance with different time groups. Both before and after titanium ring were implanted, the guinea-pigs were detected in biochemical criterion of blood, titanium content of the hair, the changing of auditory threshold, tissue structural of middle ear and inner ear by energy spectrometry, electro-physiology, microscopy and scanning electron microscopy. The results showed that function of hepatorenal and titanium content of hair haven't significant change between pre- and postimplantation of titanium ring. Only 10 days group, it appeared the rising of auditory threshold and inverting of cilia by ABR and scanning electron microscopy. In 10 days and 1 month groups, there were blood stain and inflammatory cells under mucosa. The results suggested that titanium is good biocompatibility and no toxic for organism and mucosa.

Animals↗
PubMed2000

[The study of tarnish induced by Actinobacillus actinomycetemcomitans serotype b (Aay4) on titanium and Ti-75 alloys].

OBJECTIVE: To study the tarnish induced by Aay4 on titanium and Ti-75 alloys. METHODS: Pure titanium and Ti-75 alloys were machined into size of 10 mm x 10 mm x 1 mm in tablets(30 of pure titanium; 60 of Ti-75 alloys). Thirty specimens sampled randomly from Ti-75 alloy together with 30 specimens of titanium were subjected to chemical passivation treatment. 30 specimens of the pure titanium, depassivation Ti-75 alloy and passivation Ti-75 alloy were randomly divided into three groups (blank control group, media control group and inoculated media group) respectively, every group contains 10 specimens. Under the anaerobic conditions, the surfaces of the modified GAM media were inoculated with Aay4. The labeled specimens surfaces were then aseptically placed on top of the media surface for 10 weeks with one generation time per week. The specimens were removed after 10 weeks of incubation, immersed in 0.05% glutaradehyde solution to eliminate Aay4, rinsed with distilled water. After 2 weeks, the specimens were removed and observed visually or examined by MINOLTA CR-100 color apparatus. RESULTS: Visual evaluation: Aay4 caused significant tarnish on specimens exposed to inoculated media, all the specimens surface changed into yellow color. Color apparatus evaluation: this result showed that comparing with the blank control, media control has no influence on all the specimens L*a*b* values (P > 0.05). Aay4 caused significant tarnish on specimens exposed to inoculated media, the result showed that there was significant difference between media control group and blank control group with inoculated media group on all the specimens L*a*b* values (P < 0.05). CONCLUSION: Aay4 caused significant tarnish on pure titanium, depassivation Ti-75 alloys and passivation Ti-75 alloys by naked eyes and color apparatus, according CIE1976L*a*b* color system reading, the color of titanium and Ti-75 alloys changed from the yellow-green ranges to red-yellow ranges.

Aggregatibacter actinomycetemcomitans↗
PubMed2001

[A study on the bond interface between low-fusing dental porcelain and pure titanium].

OBJECTIVE: To evaluate the bond interface between low fusing dental porcelain and pure titanium by observing the topography and detecting the ionic diffusion in the interface area. METHODS: The low fusing-porcelain La-porcelain produced by the authors or Vita Titankeramik porcelain was fused to the surfaces of pure titanium. The topography of the interface between pure titanium and porcelain, and the structure of experimental materials were observed with SEM. The state of ionic diffusion in the interface area was investigated with EPMA. RESULTS: Excellent permeation and diffusion of La-porcelain were observed on the surfaces of pure titanium. The diffusion of ions of stannum and silicon was discovered in the interface area. The microstructure of La-porcelain to pure titanium bond interface was finer than that of Vita Titankeramik porcelain. CONCLUSION: Excellent bond can be produced in the interface between La-porcelain and pure titanium. The bonding mechanism may involve mechanical bond and chemical bond. The ionic diffusion of stannum plays an important role in the bonding of porcelain to pure titanium.

Dental Alloys↗
PubMed2002

[Evaluation of peribulbar soft tissue reactions to titanium mesh in experimental tests in animals].

Orbital fractures are often accompanied by periosteal rupture and oculomotor muscle injury from the orbital fissure (blowout fracture). During reconstruction, substitute material (biomaterial) restoring the orbit is placed on a bony shelf and brought into direct contact with muscles and indirect contact with the eyeball, optic nerve and lacrimal gland. Histological examination of orbital tissues following reconstruction with titanium mesh, not possible in humans, can be performed in a rat model. In spite of different anatomy, the rats orbit was found satisfactory for the purpose of this study. The eyeball is supported by oculomotor muscles, lying partly on the malar bone. The aim was to follow the reaction of periorbital soft tissues to titanium mesh in a rat model of inferior orbital wall injury simulating orbital muscle lesions in man caused by blowout fracture. Insertion of titanium mesh directly in contact with muscles reproduced the situation in the human orbit. The following soft tissues and organs were studied: striated oculomotor muscle (inferior rectus), sclera, choroid, optic nerve and lacrimal gland. The results were compared with sham-operated animals (titanium mesh not implanted). Two questions were addressed: Is the process of healing of orbital muscle injury affected by the titanium mesh? Is there any evidence of adverse effect on periorbital soft tissues or eye of titanium wear particles produced by contraction of orbital muscles? Buffalo rats of the 38th generation and smooth titanium mesh (Ti-6AI-4V alloy) measuring 0.2 x 8 x 8 mm were used.

Animals↗
PubMed1992

Effect of titanium endoprostheses on bone mineral density measurements, using quantitative computed tomography.

Quantitative computed tomography has been used extensively to measure bone mineral density; particularly in the vertebral column and in the proximal portion of the femur in human beings with osteoporosis. Other potential applications of this technique include evaluation of bone adjacent to metallic endoprostheses and evaluation of fractures as they heal. Unfortunately, metal causes severe image degradation, principally seen as starburst streaking. One method used to decrease these artifacts is by imaging less-attenuating materials, such as titanium alloy. Titanium decreases image degradation sufficiently to allow accurate determination of the geometric properties of cadaveric bone. In our study, the effect of a titanium segmental endoprosthesis on bone mineral density measurement was determined by use of bone specimens from dogs and calibration standards. Titanium decreased the bone mineral density of calibration solutions from 6.8 (500 mg/cm3) to 17.7% (250 mg/cm3), and increased bone mineral density of cortical bone by 5.3%. Titanium did not affect the repeatability of these scans, indicating that the error caused by titanium was systematic and can be corrected. Our data were suggestive that quantitative computed tomography can be used to measure bone mineral density of cortical bone adjacent to titanium endoprostheses, with a predictable increase in density measurement.

Animals↗
PubMed2003

[Adsorption of chondroitin sulfate-A to the surface of titanium].

To elucidate the adsorption mechanism of CS-A to the surface of titanium, 5 ml solutions of the CS-A were reacted with 2 g of native and 2 g of calcium-treated titanium powder for 48 h at 37 degrees C. Residual CS-A was detected by the carbazole elaborate method. The results showed that no CS-A attached to native titanium. Comparatively, titanium treated with calcium produced a significant adsorption of CS-A. At concentration of 60 micrograms/ml, the adsorption of CA-A to calcium-treated titanium powder attained the maximum, 83 micrograms/g. Only EDTA can liberate the bound CS-A from titanium surface. These findings suggest that calcium ion is necessary for the adsorption of CS-A to titanium.

Adsorption↗
PubMedDate not supplied

Hydroxyapatite coating on a titanium metal substrate by a discharging method in modified artificial body fluid.

PURPOSE: The aim of this study was to evaluate the formation of a hydroxyapatite coating on titanium plate by discharging in typical and modified artificial body fluids. MATERIALS AND METHODS: Japanese Industrial Standard Grade 2 titanium plates were used as specimens. Discharging was performed on the specimens in each solution, and the surface topography of each coating was observed with a scanning electron microscope. The Ca/P atomic ratio and surface characterization of each coating were evaluated by x-ray photoelectron spectroscopy, and crystal phases of each coating were analyzed by Fourier transform infrared spectroscopy and x-ray diffraction. RESULTS: Tricalcium phosphate formed on the titanium surface in a 1.5 Ca/P solution with high ion concentrations of calcium (2.5 mmol/L) and phosphorous (1.67 mmol/L). Crystalline HA was formed on the titanium surface in a 1.5 Ca/P solution (Hanks' balanced salt solution without organic molecules) with low ion concentrations of calcium (1.26 mmol/L) and phosphorus (0.83 mmol/L). DISCUSSION: A solution containing organic pH buffer was insufficient to form stable coatings on the titanium surface. Coating properties strongly depended on the Ca/P chemical ratio of the applied solution. A Ca/P ratio of 1.5 was appropriate for preparing a calcium phosphate coating on a titanium surface, whereas a Ca/P ratio of 2.5 was excessively high. CONCLUSION: These findings suggest that Hanks' balanced salt solution without organic molecules is the most suitable solution for forming crystalline hydroxyapatite coatings on titanium surfaces by the discharging method.

Body Fluids↗
PubMed2004

[Applicability of titanium in preparing dental prostheses for allergic patients].

Owing to its excellent biocompatibility, titanium has been used in health care, including dental care, for a long time. The unalloyed light metal is a non-allergic one, it resists corrosion, has low heat conducting ability, it tastes neutral and is relatively cheap to apply. Titanium's biocompatibility may be associated with its fast oxidizing capacity, which can inhibit its binding with proteins. Due to titanium's oxidizing capacity, its applicability in dentistry is difficult, because such prostheses are not easy to cover with ceramics, which is essential for aesthetic reasons. The bond between the ceramic, developed specially for titanium, and the metal surface is weaker than in the case of NiCr alloys or alloys of noble alloys. The strength of the bond, however, meets ISO requirements, and, according to the latest literature, it can be further strengthened by surface treatment techniques and new bond systems. These solutions are aimed at stopping cavity formation on the titanium surface and in the oxide phase (which would lead to the disjunction of the oxide phase at the interface). Comparative studies have mentioned problems with right marginal closure and precision of fitting, still they have found titanium-based prostheses acceptable. According to data in the literature the ceramic fused to titanium, and removed partial dentures are artificial dental structures which may offer an inexpensive, still aesthetically and functionally acceptable solution for certain patients suffering from metal allergy.

Biocompatible Materials↗