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PubMed2000

Adhesive bonding of titanium with a thione-phosphate dual functional primer and self-curing luting agents.

A consistent bond between the metal framework and the luting agent is desired when resin-bonded prostheses are constructed with titanium. The purpose of this study was to evaluate three different metal primers on titanium bonding. Two sources of titanium (machined 99.9% titanium and cast Titan Ingot JS2) were used. Disk specimens were bonded with eight combinations of three primers and two luting agents (Panavia 21 and Super-Bond C&B), including two controls. Shear bond strengths were determined after 24-h water storage and after 10,000 cycles of thermocycling. Bond strengths were influenced by thermocycling, primer, luting agent and their combinations, but no significant differences were found between the machined 99.9% titanium and the cast ingot. The thione-phosphate dual functional primer (Alloy Primer) was comparable to the phosphate primer (Cesead II Opaque Primer) and the thiophosphate primer (Metal Primer II) for bonding the titanium metals examined. The most durable bond was obtained in three combinations of these primers and one luting agent (Super-Bond C&B).

Analysis of Variance↗
PubMed2005

Primary placement of a titanium sleeve in hydroxyapatite orbital implants.

BACKGROUND: To study a new surgical option of primary placement of a titanium sleeve into hydroxyapatite implants during enucleation or evisceration. METHODS: A standard enucleation or cornea preserved evisceration was performed, followed by preplacement of a titanium sleeve into the hydroxyapatite implant by a hand drill sleeve driver. Care must be taken to ensure that the titanium sleeve is positioned centrally when the implant is put inside the orbital socket or eviscerated shell. The Tenon capsule and conjunctiva were meticulously closed with minimal tension. Complications such as sleeve exposure, coralline exposure, and infection of the titanium sleeve were closely observed. RESULTS: In all, 30 patients were treated in the above fashion with 10 enucleation and 20 evisceration procedures. The follow-up period ranged from 9 to 24 months. Three of the sleeves were found to have exposed spontaneously at 5 and 7 weeks following original surgery. They had no further complication except one sleeve loosening. The remaining 27 sleeves that did not spontaneously expose pursued secondary exposure of the titanium sleeve and peg insertion by conjunctival cutdown procedure 3 months after original surgery. Two sleeves were found to be oblique positioned after the conjunctival cutdown procedure. Fortunately, all the 30 patients were successfully fit with a peg-coupled prosthesis with good motility. CONCLUSION: Primary placement of a titanium sleeve into hydroxyapatite implants has several advantages, including high patient acceptance, technical simplicity, and office-based conjunctival cutdown pegging procedure. By avoiding the expense of postoperative imaging study and additional prosthetic modification, a more rapid and efficient rehabilitation is possible.

Adult↗
PubMed2001

Sensitivity of titanium brackets to the corrosive influence of fluoride-containing toothpaste and tea.

Titanium brackets are used in orthodontic patients with an allergy to nickel and other specific substances. In recent studies, the corrosive properties of fluoride-containing toothpastes with different pH values were investigated. The present in vivo study tested how the surfaces of titanium brackets react to the corrosive influence of acidic fluoride-containing toothpaste during orthodontic treatment. Molar bands were placed on 18 orthodontic patients. In these same patients, titanium brackets were bonded on the left quadrants and stainless steel brackets on the right quadrants of the upper and lower arches. Fifteen patients used Gel Kam containing soluble tin fluoride (pH 3.2), whereas 3 used fluoride-free toothpaste. The brackets were removed for evaluation by light microscopy and scanning microscopy 5.5 to 7.0 months and 7.5 to 17 months after bonding. The quality and quantity of elements present were measured by scanning microscopy. Macroscopic evaluation showed the matte gray color of titanium brackets dominating over the silver gleam of the steel brackets. The plaque accumulation on titanium brackets is high because of the very rough surface. Pitting and crevices were observed in only 3 of the 165 brackets tested. The present in vivo investigation confirms the results of in vitro studies, but the changes are so minor that titanium brackets can safely be used for up to 18 months. Wing surfaces should be improved by modifying the manufacturing process.

Adult↗
PubMed2000

Corrosion resistance of a magnetic stainless steel ion-plated with titanium nitride.

This in vitro study evaluated the corrosion resistance of a titanium nitride (TiN) ion-plated magnetic stainless steel (447J1) for the purpose of applying a magnetic attachment system to implant-supported prostheses made of titanium. The surface hardness of the TiN ion-plated 447J1 alloy with varying TiN thickness was determined prior to the corrosion testing, and 2 micrometers thickness was confirmed to be appropriate. Ions released from the 447J1 alloy, TiN ion-plated 447J1 alloy, and titanium into a 2% lactic acid aqueous solution and 0.1 mol/L phosphate buffered saline (PBS) were determined by means of an inductively coupled plasma atomic emission spectroscopy (ICP-AES). Long-term corrosion behaviour was evaluated using a multisweep cyclic voltammetry. The ICP-AES results revealed that the 447J1 alloy released ferric ions into both media, and that the amount of released ions increased when the alloy was coupled with titanium. Although both titanium and the TiN-plated 447J1 alloy released titanium ions into lactic acid solution, ferric and chromium ions were not released from the alloy specimen for all conditions. Cyclic voltamograms indicated that the long-term corrosion resistance of the 447J1 alloy was considerably improved by ion-plating with TiN.

Coated Materials, Biocompatible↗
PubMed2002

[Titanium as a material for ossicular replacement - basic aspects and clinical application].

BACKGROUND: The use of titanium as a biomaterial in ossicular chain reconstruction is increasing. The situation for integration of biomaterials is more difficult in the semiopen implantation site middle ear than in other parts of the body. Important for integration is the contact of the biomaterial's surface toward proteins. Studies of the integration in living tissue still have to be performed in animal experiments. Morphological examinations of explanted prostheses after clinical use complete the picture of an ossicular replacement material. METHODS: Preclinical studies where performed to compare the adsorption behaviour of titanium, stainless steel and aluminum oxide toward radioactive marked albumin and native collagen type I. An animal model in the rabbit was performed to study the integration of titanium in the middle ear morphologically. Middle ear prostheses removed during revision surgery were studied as well. RESULTS: Titanium showed an adsorption amount of 360 microgram/cm(2), stainless steel of 230 microgram/cm(2) and aluminum oxide of 500 microgram/cm(2) out of an albumin solution of 400 mg/ml. Comparing desorption the mean loss was 16 % for titanium, 21 % for stainless steel and 23 % for aluminium oxide. Reassembled collagen fibrils could be detected after adsorption in collagen type I solution by means of scanning electron microscopy. Morphological studies in animal experiments showed regular healing after implantation. Explanted prostheses from humans did not show any cellular signs of repulsion. CONCLUSION: The results of preclinical studies and clinical use demonstrate titanium as a useful material for ossicular reconstruction in middle ear surgery.

Absorption↗
PubMed2001

Torsional properties of commercial nickel-titanium wires during activation and deactivation.

This study evaluated torsional moments on activation and deactivation in commercial, nickel-titanium wires that are intended for use in the initial phases of orthodontic treatment. Nine commercial, rectangular nickel-titanium wires (0.017 x 0.025 in) were tested in torsion. One wire was conventional nickel-titanium, and the others were superelastic nickel-titanium wires. The specimens were tested in a torsiometer for rotations between 10 and 40 degrees in activation and deactivation. Wires E27, RF and R had the highest moments during activation and deactivation, without evidence of the plateau typical of the superelastic effect. Plateaus of constant moment were observed for wires C27, C35, E35, MO, NS, and NI. Torsional moments varied among superelastic nickel-titanium wires, even with wires that had the same transition temperature range. Some superelastic wires had torsional moments that were comparable with conventional nickel-titanium wires.

Dental Alloys↗
PubMed2004

Reconstruction of mastoidectomy defect with titanium mesh.

OBJECTIVE: Intact-canal-wall mastoidectomy procedures leave an unsightly depression in the postauricular area. Until now, there have been few reports of successful reconstruction of mastoidectomy defects, and none using titanium mesh. When secondary mastoidectomy is not anticipated, as in endolymphatic sac shunt procedures, the postauricular defect resulting from mastoidectomy can be eliminated by reconstruction using titanium mesh. This is a retrospective study of 14 patients who underwent reconstruction of a mastoidectomy defect with titanium mesh. MATERIAL AND METHODS: All 14 patients underwent mastoidectomy as part of endolymphatic sac shunt procedures for Ménière's disease. All of the patients had mastoid bones free of chronic infection or cholesteatoma. At the time of mastoidectomy, a large piece of cortical bone was removed and saved instead of being drilled away. After the main procedure was completed, and before closing the postauricular skin, a piece of 1.3-mm titanium mesh was cut to cover the mastoidectomy defect. The mesh was then attached to the mastoid bone at the four corners using 4- or 6-mm screws. The piece of cortical bone removed at the beginning of the mastoidectomy was attached under the mesh and across the mastoid defect. Patients were followed for a period of 6 months to 3 years. The outcome was considered successful when there was no depression at the mastoidectomy site and no evidence of any infection. RESULTS: All patients who underwent reconstruction of a mastoidectomy defect with titanium mesh maintained a normal contour of the mastoid bone without depression or infection. There were no failures. CONCLUSIONS: Mastoidectomy defect reconstruction with titanium mesh is a reliable method for preventing an unsightly depression at the mastoidectomy site. This method is ideal when repeat mastoidectomy is not expected.

Biocompatible Materials↗
PubMed1996

In vitro studies on the role of titanium in aseptic loosening.

This study was designed to define the role titanium debris plays in aseptic loosening. Macrophages exposed to commercially pure titanium (1-3 microns) exhibit the same mediator profile as those exposed to polymethylmethacrylate. This response consists of increased release of tumor necrosis factor but not prostaglandin E 2 or interleukin-1. Osteoblasts increase production of prostaglandin E 2 when exposed to media from titanium stimulated macrophages but not interleukin-6 or granulocyte macrophage colony stimulating factor. Media from macrophages exposed to titanium did not lead to bone resorption, as measured by calcium 45 release, in organ culture. The cellular response to titanium is characterized by release of tumor necrosis factor from macrophages and prostaglandin E 2 from osteoblasts exposed to the macrophage conditioned medium. A comparison of the results of this study with those of others involving exposure of macrophages in tissue culture suggests that titanium may not be as inflammatory as other particles in the aseptically loose joint.

Animals↗
PubMed2002

Effect of physical vapor deposition on cutting efficiency of nickel-titanium files.

The purpose of this study was to investigate possible changes in cutting efficiency of nickel-titanium K-files that had undergone physical vapor deposition coating. Titanium nitride coatings were deposited using different process parameters. A total of 84 nickel-titanium K-files (size 35) were randomly divided into 7 groups of 12 instruments each. Groups A to F (experimental): instruments were coated with titanium nitride using different process parameters regarding substrate temperature, applied voltage, coating thickness, and ion bombardment. Group K (control): samples were not coated with titanium nitride. The cutting efficiency of all instruments was determined in a rotary working motion by means of a computer-driven testing device. Special plastic samples with a cylindrical canal were used, and the maximum penetration depth of the instruments into the lumen was the criterion for cutting efficiency. Instruments of groups A, F, and C achieved significantly greater penetration depths than the uncoated instruments of the control group (p < 0.05). Cutting efficiency of physical vapor deposition-coated nickel-titanium files was increased by up to 26.2% in comparison with uncoated instruments.

Analysis of Variance↗
PubMed1997

Effect of stainless steel and titanium low-contact dynamic compression plate application on the vascularity and mechanical properties of cortical bone after fracture.

OBJECTIVES: Comparison of the effect of stainless steel and titanium low-contact dynamic compression plate application on the vascularity and mechanical properties of cortical bone after fracture. DESIGN: Randomized, prospective. SETTING: Orthopaedic research laboratory. ANIMALS: Ten large (greater than twenty-five kilogram) adult dogs. INTERVENTION: A short, midshaft spiral tibial fracture was created, followed by lag screw fixation and neutralization with an eight-hole, 3.5-millimeter, low-contact dynamic compression plate (LCDCP) made of either 316L stainless steel (n = five) or commercially pure titanium (n = five). After surgery, animals were kept with unrestricted weight-bearing in individual stalls for ten weeks. MAIN OUTCOME MEASUREMENTS: Cortical bone blood flow was assessed by laser Doppler flowmetry using a standard metalshafted probe (Periflux Pf303, Perimed, Jarfalla, Sweden) applied through holes in the custom-made LCDCPs at five sites. Bone blood flow was determined at four times: (a) prefracture, (b) postfracture, (c) postplating, and (d) ten weeks postplating. After the dogs were killed, the implant was removed and both the treated tibia and contralateral tibia were tested for bending stiffness and load to failure. RESULTS: Fracture creation decreased cortical perfusion in both groups at the fracture site (p = 0.02). The application of neither stainless steel nor titanium LCDCPs further decreased cortical bone blood flow after fracture creation. However, at ten weeks postplating, cortical perfusion significantly increased compared with acute postplating levels in the stainless steel (p = 0.003) and titanium (p = 0.001) groups. Cortical bone blood flow ten weeks postplating was not significantly different between the titanium group and the stainless steel group. Biomechanical tests performed on the tibiae with the plates removed did not reveal any differences in bending stiffness nor load required to cause failure between the two groups. CONCLUSIONS: Both titanium and stainless steel LCDCPs were equally effective in allowing revascularization, and neither provided a significant advantage in biomechanical properties of fracture healing at ten weeks.

Analysis of Variance↗
PubMed1996

Titanium aneurysm clips: Part I--Mechanical, radiological, and biocompatibility testing.

Most aneurysm clips are made of cobalt-based alloys. Although these clips are nonferromagnetic, they still produce artifact that degrades the quality of magnetic resonance (MR) images. A new aneurysm clip of pure titanium was developed to minimize artifact on postoperative MR images. We evaluated these clips in a series of mechanical tests in vitro, biocompatibility tests in rabbits, and radiological tests in greyhound dogs. The clip sizes and shapes matched those of conventional aneurysm clips. The average closing forces ranged between 151.6 and 181.8 g and were not diminished by repeated sterilization or stress. After > 20 million cycles of high-pressure and high-frequency pulsations, the clips did not open and the closing forces were not reduced. Titanium aneurysm clips implanted in the subarachnoid space of 12 rabbits for 1 or 6 months produced mild gliosis identical to that produced by implantation of cobalt alloy clips in 12 control rabbits. Based on pre- and postoperative weights and electron microscopic scans, the titanium implants did not corrode. The artifact on computed tomographic and MR imaging produced by a titanium clip placed on the internal carotid artery of a greyhound was less than that produced by an identical cobalt-chrome alloy clip by a factor of two to three. This study demonstrated that titanium aneurysm clips are mechanically equivalent to conventional clips, biocompatible, and corrosion resistant. Furthermore, titanium clips have superior imaging characteristics, creating less computed tomographic and MR imaging artifact and permitting better resolution of anatomic structures than cobalt alloy clips.

Animals↗
PubMed1996

Titanium aneurysm clips: Part III--Clinical application in 16 patients with subarachnoid hemorrhage.

This report describes the first clinical use of newly developed titanium clips in the treatment of 16 patients with subarachnoid hemorrhage. There were no immediate or delayed complications related to the titanium clips. Thirteen patients had good outcomes, and one patient had moderate disabilities (mean follow-up, 5.4 mo). Two patients with Hunt and Hess Grade IV hemorrhages died postoperatively. The average cross-sectional areas of clip artifact on postoperative magnetic resonance imaging studies was 0.96, 1.36, and 1.05 cm2 on T1-, T2-, and intermediate-weighted images, respectively. In comparison, a matched control group with cobalt alloy clips had average cross-sectional areas of 3.13, 3.70, and 2.81 cm2 on T1-, T2-, and intermediate-weighted images, respectively. The average artifact volumes on gradient echo magnetic resonance images for titanium and cobalt alloy clips were 1.8 and 10.1 cm3, respectively. In addition, the gap on magnetic resonance imaging angiograms from clip artifacts was 0.9 cm with titanium and 2.6 cm with cobalt alloy clips. In conclusion, titanium aneurysm clips seem to be safe and effective and seem to reduce clip artifacts on magnetic resonance imaging threefold, compared with commercially available cobalt alloy clips. Because of this important advantage over conventional clips, titanium clips should be considered for routine use in aneurysm surgery.

Adult↗
PubMed2002

Healing of autologous bone in a titanium mesh cage used in anterior column reconstruction after total spondylectomy.

STUDY DESIGN: Autologous bone inside a titanium mesh cage, used as an anterior strut in a reconstruction after total spondylectomy, was histologically examined in a postmortem specimen. OBJECTIVES: To determine whether the autologous bone inside the titanium mesh cage attained fusion and remodeling in a combined reconstruction, consisting of an anterior titanium mesh cage with posterior multilevel instrumentation, after total spondylectomy. SUMMARY OF BACKGROUND DATA: There are few previous reports on the histologic analysis of the bone inside a titanium mesh cage when it is used clinically as an anterior column support in a spinal fusion. Attaining biologic bony fusion is desirable for long-term stability after total spondylectomy. METHODS: A postmortem specimen from a 16-year-old boy with Ewing's sarcoma at T6, who died of lung metastasis 16 months after total spondylectomy and combined reconstruction, was analyzed. RESULTS: Histologic examination revealed many viable cells and normal lamella of trabecular bone formation in the grafted bone inside the mesh. Consecutive trabecular cancellous bony fusion between the grafted bone and the adjacent vertebral bodies was achieved. CONCLUSION: Remodeling and fusion of the grafted bone inside the titanium mesh cage was observed. Combined reconstruction using an anterior titanium mesh cage with posterior multilevel instrumentation after total spondylectomy makes it possible to achieve biologic fusion of the bone inside the mesh cage with the adjacent vertebral bodies.

Adolescent↗
PubMed1997

Surface roughness of titanium on bone morphogenetic protein-2 treated osteoblast cells in vitro.

Surface topography plays a critical role in the interaction of dental implants with adjacent tissues. No statistical differences in oxide composition and surface contamination were observed between 600 grit and polished titanium surfaces. The expression of osteoblast phenotype was enhanced when osteoblast progenitor cells (2T9) were stimulated with bone morphogenetic protein-2 on polished and 600 grit titanium surfaces. Bone morphogenetic protein-2 stimulated phenotypic expression on 600 grit titanium surfaces was marked by prolonged alkaline phosphatase specific activity and more rapid osteocalcin production as compared with the polished titanium surfaces. Because the surface area of the 600 grit titanium surface was shown to be 8 percent greater than that of the polished titanium surface, it is possible that increased surface area played a role in the enhanced expression of the osteoblast phenotype.

Alkaline Phosphatase↗
PubMed1992

Epidemiologic study of lung cancer mortality in workers exposed to titanium tetrachloride.

A study was done to examine whether workers exposed to titanium tetrachloride had significantly higher risks of lung cancer, chronic respiratory disease, pleural thickening/plaques, or pulmonary fibrosis than referent groups. A total of 2477 employees from two titanium dioxide plants were studied. Of that group, 969 employees exposed to titanium tetrachloride were observed from 1956 through 1985 for cancer and chronic respiratory disease incidence and from 1935 through 1983 for mortality. A cross-sectional sample of 398 employees was evaluated for chest roentgenogram abnormalities. Cohort analyses showed that the risk of developing lung cancer and other fatal respiratory diseases was not statistically significantly higher for the titanium tetrachloride-exposed workers than for the referent group. Nested case-control analyses found no statistically significant association between titanium tetrachloride exposure and risk of lung cancer, chronic respiratory disease, and chest roentgenogram abnormalities. No cases of pulmonary fibrosis were observed among titanium tetrachloride-exposed employees. Smoking was found to be a strong predictor of lung cancer mortality in the nonexposed employees with an increased risk of dying from lung cancer up to 7-fold higher in current smokers than in nonsmokers.

Case-Control Studies↗
PubMed2003

Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection.

STUDY DESIGN: A retrospective cohort study with cross-sectional outcome analysis of patients who underwent anterior column reconstruction with a titanium mesh cage after single-level or multilevel thoracic or lumbar vertebrectomy. OBJECTIVES: To radiographically evaluate the ability of titanium mesh cages to maintain alignment and facilitate osseous fusion after thoracolumbar vertebrectomy. Secondary objectives assessed complications and patient outcome. SUMMARY OF BACKGROUND DATA: Titanium mesh cages with cancellous autograft bone for postvertebrectomy reconstruction of the thoracolumbar spine avoid some of the potential problems associated with the acquisition or use of structural autograft or allograft. There is little in the literature that describes the efficacy or outcomes of using cylindrical mesh titanium cages for postvertebrectomy reconstruction. METHODS: The degree of kyphosis and the subsidence of the cage in relation to the vertebral endplates were measured in 43 of 57 (75%) patients available at a minimum of 2 years following titanium mesh cage reconstruction. Health-related quality of life and disability were assessed with various cross-sectional outcome measures. RESULTS: The average kyphosis of 25.4 degrees before surgery was reduced to 7.5 degrees immediately after surgery, and at final follow-up was measured to be 10.4 degrees. Cage subsidence averaged 0.28 and 0.20 cage fenestrations at the cephalad and caudal endplates, respectively. Osseous union (Grade 1 or 2) was identified in 93% of radiographs at the final follow-up. Thoracic reconstructions were significantly more likely to require surgical revision because of mechanical failure than thoracolumbar or lumbar reconstructions. CONCLUSION: The cylindrical mesh titanium cage is a successful adjunct in restoring and maintaining sagittal plane alignment after thoracolumbar vertebrectomy and, in this context, provides an effective method for anterior column reconstruction.

Adolescent↗
PubMed2004

A prospective, randomized controlled clinical trial of anterior lumbar interbody fusion using a titanium cylindrical threaded fusion device.

STUDY DESIGN: A prospective, randomized, controlled clinical trial comparing a cylindrical threaded titanium cage to a femoral ring allograft control for anterior lumbar interbody fusion. OBJECTIVE: To compare these two implants with regard to arthrodesis. Secondary outcome measures included pain relief, neurological status, and general health status. SUMMARY OF BACKGROUND DATA: Anterior lumbar interbody fusion is a well-accepted procedure using trapezoidal femoral ring allografts or cylindrical titanium cages. Clinical and biomechanical studies evaluating these two distinct constructs are numerous; however, no prospective, randomized study comparing them has been done. METHODS: A multicenter trial of 140 patients: 78 were randomized to the cylindrical threaded titanium cage device treatment arm and 62 patients randomized into the control group. All had autogenous iliac crest bone graft packed into the device. All patients had a single-level stand-alone anterior lumbar interbody fusion at either the L4-L5 or L5-S1 interspace for symptomatic degenerative disc disease. Radiographic fusion data were collected as well as multiple types of outcome data, including pain/disability scores, neurologic status, and overall health. RESULTS: At 12 months, 97% of the cylindrical threaded titanium cage device group and 40% of the control group demonstrated radiographic fusion. At 24 months, 97% of the cylindrical threaded titanium cage group and 52% of the control group showed radiographic fusion. These fusion rate differences are statistically significant (P < 0.001). The Oswestry and neurologic scores were not significantly different between groups. DISCUSSION: This is the first prospective, randomized, multicenter clinical trial that compares fusion cage results to control data. CONCLUSION: Cylindrical threaded titanium cages have a higher fusion rate, comparable improvements in clinical outcome (Oswestry, Low Back Pain Questionnaire, SF-36), and fewer secondary supplemental fixation procedures compared to the femoral ring allograft control.

Adolescent↗
PubMed2005

The memory properties of cold-worked titanium rods in scoliosis constructs.

STUDY DESIGN: Time series monitoring changes in titanium and stainless steel rod curvature kept at a constant temperature of 37 C as a function of time. OBJECTIVES: To assess the possibility of loss of curvature in titanium rods after scoliosis surgery. SUMMARY OF BACKGROUND DATA: Titanium rods have gained use in scoliosis surgery due to their excellent biocompatibility, while allowing medical personnel to obtain undistorted magnetic resonance imaging scans following surgery. However, the impression of several clinicians has been that when screw pullout and/or loss of sagittal balance occurs, it may be due to the rods losing some of their curvature. METHODS: Five 6-mm rods of differing compositions and lengths (titanium 300 and 100 mm, stainless steel 300 and 100 mm, prebent titanium 85 mm) were bent at room temperature with a 3-point rod bender, then placed in an incubator at 37 C. Digital photographs were taken every 2 weeks and analyzed to extract the radius of curvature of each rod. RESULTS: The Ti rods had a significantly decreasing curvature with time. The prebent Ti and stainless steel rods did not exhibit significant change in curvature. CONCLUSIONS: Titanium rods bent at room temperature and then exposed to body temperature over time tend to exhibit "metal memory"; they gradually revert to their original shape. This may result in loss of sagittal balance and/or proximal screw pullout.

Bone Nails↗