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Photocatalytic inhibition of microbial adhesion by anodized titanium.

Biofouling is one of the concerns in the use of titanium for seawater cooled condensers of power plants. Earlier studies have shown that anodized titanium and its alloys with a thin film of anatase (TiO(2)) on its surface can inhibit attachment of Pseudomonas sp. when illuminated with near-UV light (350 - 380 nm). In the present study, a comparison of the photocatalytic inhibition of microbial attachment on titanium surfaces anodized at different voltages was carried out. Thin films of anatase of varying thickness were produced on titanium grade-2 by anodizing in dilute orthophosphoric acid solution at 30 V, 50 V and 100 V. The photocatalytic efficiency of these anodized surfaces was measured by the methylene blue degradation method. The anodised surfaces were exposed to liquid cultures of Gram-negative Pseudomonas sp., Gram-positive Micrococcus sp. and to a mixed algal culture. Photocatalytic inhibition of microbial attachment was maximum on the titanium surface anodized at 30 V, followed by the surface anodized at 50 V and then at 100 V. The photocatalytic inhibition of microbial attachment was also found to be dependent on the cell wall characteristics of the organism. The Gram-negative Pseudomonas sp. with a lipoproteinaceous outer membrane was the most susceptible to the photocatalytic effect, while the Gram-positive Micrococcus sp. with peptidoglycan cell wall showed moderate susceptibility and the algae with siliceous cell wall showed no susceptibility at all.

Anti-Bacterial Agents↗

Photo-assisted oxidation of chlorophenols in aqueous solutions using hydrogen peroxide and titanium dioxide.

In the present work, the efficiency of phenol and chlorophenol degradation under irradiation using hydrogen peroxide as oxidant and titanium dioxide powder as photo-catalyst was investigated. In the absence of titanium oxide, increased concentrations of hydrogen peroxide resulted in higher conversions. Generally, phenol was the most readily oxidized compound, whereas in excess of hydrogen peroxide, the more chlorine atoms were present in the ring, the less degradable the chlorophenol was, in terms of initial rate of oxidation. In the case of 4-chlorophenol, the catalytic photo-oxidation efficiency with hydrogen peroxide and titanium oxide was dependent on the catalyst concentration exhibiting a maximum at 0.025-0.05 g L(-1) titanium oxide. The combined use of titanium oxide and hydrogen peroxide resulted in higher degree of oxidation compared to results obtained when using hydrogen peroxide. Finally, the presence of Fe(III) proved to be beneficial for the photo-catalytic oxidation only in the presence of hydrogen peroxide.

Chlorophenols↗

Biodegradable and titanium plating in experimental craniotomies: a radiographic follow-up study.

Plain film radiography and computed tomography (CT) were evaluated in assessing the consolidation of experimental craniotomy lines covered with titanium miniplates or biodegradable self-reinforced poly-L-lactide (SR-PLLA) plates. Two sagittal (2.3-2.5 mm wide and 22 mm long) symmetrical craniotomy lines were made in the skulls of eight young sheep. One craniotomy line was covered with a biodegradable SR-PLLA plate and the other with a titanium miniplate. Both plates were fixed with four titanium miniscrews. Consolidation of the osteotomies was studied using plain film radiography and CT 6, 12, 20, and 52 weeks postoperatively. Microradiography and histology were used for reference. Plain film was not reliable in assessing osseous consolidation because false-positive results were obtained in three osteotomies. Osseous consolidation was more reliably assessed by CT, which showed consolidation on the SR-PLLA side within 20 weeks, whereas none of the titanium-plated lines was consolidated by 52 weeks. Superior consolidation under the resorbable plate was confirmed in histology and microradiography. The radiolucent SR-PLLA plates did not interfere with CT, whereas the titanium plates caused minor CT artifacts.

Animals↗

Various applications of titanium mesh screen implant to orbital wall fractures.

As the number of high velocity injuries increases, orbital wall fractures that involve other facial bone fractures, especially those showing multiple crushed fractures have become increasingly common. However, owing to its complex anatomic structure, our inability to visualize details and relatively thin orbital wall, corrective restorations and fixations are very difficult. Recently several reports have claimed good results using titanium implants to repair orbital fracture. Over a period of 36 months, Titanium mesh screen 1.0 (SYNTHES) were applied to the repair of orbital fracture in various ways, taking 39 examples of orbital wall fracture patients requiring operating treatment. A titanium mesh screen 1.0 was used either as an onlay implant after it was shaped to fit the anatomical shape of the fracture portion, or as cover implant to fix bony pieces after repairing a severely crushed fracture on the orbital rim or maxillary wall segments. 1.3-mm micro-screws were used to fix the titanium mesh screen when needed. The titanium mesh screen 1.0 was rigid, yet malleable enough to get the desired shape. It could be folded and screwed easily, and was also easy for follow-up with fewer artifacts on the CT findings. Therefore, we could restore and fix much easier and faster even crushed tiny bony pieces without loss and achieve more accurate three-dimensional anatomical reconstruction of orbital wall fracture.

Adolescent↗

Radiographic assessment of anterior titanium mesh cages.

Carbon fiber and titanium cage implantation for anterior column support during spinal fusions is an alternative to the use of more traditional structural allografts and autografts. The authors report instrumentation and cage failure for patients who underwent spinal fusion with structural titanium mesh cages implanted into the anterior column a minimum of 2 years after surgery. They wanted to determine whether plain radiographic techniques can be used to critically assess disk space and corpectomy fusions after implantation of these radioopaque cages. Fifty patients having undergone spinal fusions using structural titanium mesh cages in the anterior column had 99 anterior levels fused with at least 1 (maximum of 2) titanium mesh cage, resulting in a total of 131 cages used. The cages were examined for evidence of settling, migration, or failure. The anterior and posterior instrumentation was assessed for evidence of failure, and the spine was examined for evidence of successful fusion. Radiographic cage settling (>2 mm) into the vertebral body end plates was observed, but cage migration or failure were not. An average lordotic correction of 10 degrees was observed, with loss of correction into kyphosis from immediately after operation to final follow-up averaging 2 degrees. As an average of all reviewers, using a strict radiographic fusion assessment, definite or probable anterior fusion was graded at 81% of the levels, probably not or no at 5% of the levels, and could not be assessed at 14% of the levels. Definite or probable posterior fusion as an average of all reviewers was graded at 44% of the posterior fusion levels, questionable at 4%, no at 5%, and could not be assessed at 47%. The use of anterior-only, posterior-only, or anterior and posterior instrumentation with structural titanium mesh cages in the anterior spine along with proper autogenous bone grafting techniques provided anterior column support with a low rate of radiographic complications. Acceptable anterior spinal fusion rates, as assessed by a consensus agreement of reviewers, were observed primarily by evaluation of the fusion mass around the cages (extracage fusion), because intracage fusion was difficult to assess.

Adolescent↗

Biomechanical comparison of stainless steel and titanium nails for fixation of simulated femoral fractures.

Flexible intramedullary nails are commonly used to treat femoral fractures in children. This study evaluated the biomechanical differences between stainless steel and titanium nails when securing transverse and comminuted fractures in a synthetic femur model. Retrograde flexible stainless steel and titanium nails placed in a divergent "C" pattern were mechanically tested, and axial rotation and compression stiffness were analyzed with a two-way ANOVA. Rotational stability was significantly greater for titanium nails than stainless steel nails for both fracture patterns. Axial compression stiffness was significantly greater for titanium nails than stainless steel nails for both fracture patterns. There was no statistical difference between materials for axial "failure" load that produced 5 mm of shortening. Titanium intramedullary nails were more stable than stainless steel nails in torsion and axial compression. Both materials stabilized simulated fractures at levels beyond physiologic non-weight-bearing loads without permanent deformation.

Biomechanical Phenomena↗

Artifacts and thresholding in X-ray CT of a cortical bone and titanium composite.

PURPOSE: X-Ray CT has the potential to provide precise and accurate data from which the mechanical properties of bone can be calculated. Such data would be useful in understanding the response of bone tissue to implants. Various artifacts can, however, degrade accuracy of the data. The aim of this study was to measure the artifactual errors produced in CT of a simulated femoral bone-titanium composite and to propose a method to correct for them. METHOD: A composite phantom that simulates cortical bone and a titanium implant was designed and constructed. The phantom was scanned and the image data were analyzed over a range of thresholds with image analysis software developed for this study. The outer (OD) and inner (ID) diameter and the CT number of the cortical bone, with and without titanium, were measured over a range of cortical thicknesses. RESULTS: While ID can be accurately measured by choosing the proper threshold (800 HU), OD, even at optimal threshold, will be underestimated by approximately 2%. If a proper threshold is selected, CT number can also be accurately determined. Errors of up to 5%, however, are produced by titanium unless corrected by proper threshold selection. CONCLUSION: Intramedullary titanium is not a deterrent to obtaining accurate measurements of cortical bone dimensions and properties. Proper choice of thresholds for image analysis of CT scan data can yield accuracy and precision of < or = 2%.

Artifacts↗

Comparison of nickel-titanium and stainless-steel spreader penetration and accessory cone fit in curved canals.

The purpose of this study was to compare nickel-titanium and stainless-steel spreader penetration in curved canals. Twenty prepared plastic blocks with a 30 degrees curvature were used for each part of the study. In part 1, the force required to insert each spreader to within 1 mm of working length in an empty canal was measured. In part 2, the force required to insert each spreader to within 3 mm of working length was measured in a canal containing a master cone. In part 3, the depth of penetration of each spreader with a master cone in place using a 1.5 kg force was measured. Additionally, in part 3, the depth of penetration of the first accessory cone was measured. The results from part 1 showed that a nickel-titanium spreader required significantly less force than a stainless-steel spreader (0.30 kg vs. 0.59 kg). In part 2, a nickel-titanium spreader required significantly less force than a stainless-steel spreader (1.56 kg vs. 2.42 kg). In part 3, a nickel-titanium spreader penetrated significantly deeper than a stainless-steel spreader (15.0 mm vs. 14.0 mm). There was no significant difference in the depth of penetration of the first accessory cone used after either spreader (0.8 mm vs. 0.7 mm). Therefore, the potential for vertical root fracture in curved canals during lateral condensation may be minimized by using nickel-titanium spreaders.

Dental Instruments↗

Tympano-ossiculoplasty utilizing the Spiggle and Theis titanium total ossicular replacement prosthesis.

OBJECTIVE: Since 1993, titanium prostheses have been used in Europe as a biocompatible implant for ossicular reconstruction. More recently, the titanium ossicular prosthesis has become more widely available in the United States as a newer means of surgical restoration of hearing. We will review the hearing results of patients who have undergone tympano-ossiculoplasty using a titanium total ossicular replacement prosthesis (TOP). We will compare these results to our previously published results using the porous polyethylene TOP. METHODS: Retrospective review in a tertiary otologic practice. RESULTS: Eighteen patients underwent tympano-ossiculoplasty with a titanium TOP. Among these patients, 10 cases involved revision of a previously placed ossicular prosthesis. Hearing results showed that 16 of 18 patients (89%) had closure of the postoperative air-bone gap to within 20 dB, and the average air-bone gap improvement was 23 dB. The average follow-up time was 8 months (range, 2-21 months). The results of this initial evaluation compare favorably with the results that we obtained using a porous polyethylene TOP in which 67% of 133 patients closed the air-bone gap to within 20 dB. CONCLUSION: We have recently begun using the titanium TOP, which has resulted in improved postoperative hearing when compared with the porous polyethylene TOP. In the future, longer follow-up and increased patient numbers will strengthen our conclusions.

Adolescent↗

Titanium wire internal fixation for stabilization of injury of the cervical spine: clinical results and postoperative magnetic resonance imaging of the spinal cord.

Nine patients with dislocation of the cervical spinal with posterior ligamentous damage were treated with posterior internal fixation using a twisted pair of 22-gauge titanium wires and iliac crest bone fusion. Fixation using the titanium wire was compared with fixation using stainless steel wire for differences in surgical insertion, long term stability of bony fusion, and postoperative magnetic resonance imaging (MRI) artifacts near the implanted wire. MRI of the cervical spine is valuable for diagnosing the acute and chronic consequences of traumatic cervical spinal injury by providing anatomic evaluation of both the spinal cord and the supporting bony/ligamentous structures in the neck. Because MRI is an accurate and sensitive noninvasive test, it is especially useful for the long-term serial assessment of the region near the cervical dislocation site to detect the sequelae of spinal cord injury, including syrinx, arachnoid cyst, cord tethering, and persistent mechanical impingement on the spinal cord or spinal roots. Previous attempts at our institution to obtain useful MRI scans of the cervical region adjacent to stainless steel wires after posterior wire fixation have failed due to marked imaging artifacts from the ferromagnetic properties of these wires. Our substitution of biocompatible titanium wire (Titanium 6 A1-4V ELI alloy, Specialty Steel and Forge, Leonia, New Jersey) for stainless steel wire produced identical immediate stabilization and ultimate bony fusion of the fracture and yielded minimal MRI artifacts overlying the immediately adjacent spinal cord and neural canal; however, the installation was technically more difficult, because of the titanium wire's greater stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Internal fixation of the spine using a braided titanium cable: clinical results and postoperative magnetic resonance imaging.

Segmental spinal fixation using sublaminar or interspinous stainless steel wire has been successfully used for many years. Stainless steel cables have been developed that are stronger and more flexible, allowing for shorter operative time and decreased risk of neurological deficit. However, stainless steel implants create significant artifact on magnetic resonance imaging (MRI), reducing the postoperative usefulness of this imaging modality. Titanium instrumentation has the advantage of producing minimal MRI artifact. Recently, a braided titanium cable has been developed that has the advantages of strength and flexibility as well as minimal production of MRI artifact. We present a series of 50 patients who underwent internal fixation of the spine using a braided titanium cable either alone or in combination with supplementary titanium instrumentation. No instrument failures have occurred to date. Postoperative MRI scans have revealed minimal implant-related artifact, allowing for high-resolution, noninvasive postoperative imaging of the neuraxis. We conclude that braided titanium cable has significant advantages over stainless steel cable or monofilament wire and is a valuable instrument for segmental spine fixation.

Adolescent↗

Titanium aneurysm clips: Part II--Seizure and electroencephalographic studies in implanted rabbits.

Because titanium is widely used in neurosurgical procedures, we compared spontaneous and induced epileptiform activity in 12 rabbits with titanium clips implanted in the subarachnoid space with 12 rabbits with cobalt alloy clips and 6 rabbits that were not operated on that served as controls. Beginning 1 week after surgery, 30-minute electroencephalographic recordings were made at monthly intervals for 6 months. Recordings were scored by an electroencephalographer unaware of which treatment group was being recorded. In 48 recordings made during 6 months, no epileptiform activity was observed in any animal. Seizure threshold was evaluated by continuous intravenous injection of the convulsant drug, pentylenetetrazole (2 mg/kg/min), with continuous electroencephalographic recording. Time to spiking for the nonsurgical control group was 327 mean seconds +/- 181 standard deviation (SD), 216 mean seconds +/- 135 SD for the titanium group, and 389 mean seconds +/- 290 SD for the cobalt group. There were no significant differences among the groups (P = 0.17). Latency to behavioral tonicoclonic seizure was 1031 seconds +/- 537 SD for the group not operated on, 875 seconds +/- 334 SD for the titanium group, and 1267 seconds +/- 764 SD for the cobalt group. This study suggests that titanium clips are well tolerated within the brain and will not induce seizures.

Animals↗

A new technique for cranioplasty with L-shaped titanium plates and combination ceramic implants composed of hydroxyapatite and tricalcium phosphate (Ceratite).

OBJECTIVE: The use of hydroxyapatite-based ceramics for cranioplasties has recently increased in Japan, because of the good cosmetic outcomes, biocompatibility, strength, osteoconductive properties, and lack of risk of disease transmission associated with these materials. However, miniplate fixation has not been possible for ceramic implants. We describe a new technique for miniplate fixation of ceramic implants. METHODS: Combination ceramic implants composed of hydroxyapatite and tricalcium phosphate (Ceratite; NGK Spark Plug Co., Aichi, Japan) were used for cranioplasties. A slot and a pair of holes were cut in each Ceratite implant, for use as a fixation unit. We have also developed a new L-shaped titanium plate (HOMS Engineering Inc., Nagano, Japan) that fits into the fixation unit. We first insert an L-shaped titanium plate through the slot from the back surface of the Ceratite implant. We then bend the plate outward at the front surface of the Ceratite implant and fix it to the cranium of the patient with titanium screws. The Ceratite implant is usually firmly fixed to the cranium of the patient with three L-shaped titanium plates. RESULTS: Using L-shaped titanium plates and Ceratite implants, we successfully performed cranioplasties for seven patients with cranial defects resulting from external decompression craniotomies. The Ceratite implant exactly fit the bone window for each patient. Surgical maneuvers were simple and easy for all patients, permitting shorter operating times. All Ceratite implants were firmly fixed, and no postoperative infections have occurred. CONCLUSION: Our new technique for cranioplasty is simple and allows rigid fixation of Ceratite implants.

Adolescent↗

Biomechanical evaluation of titanium, biodegradable plate and screw, and cyanoacrylate glue fixation systems in craniofacial surgery.

Choice of appropriate fixation after reduction of displaced bone fragments or advancement of osteotomized segments requires knowledge of the maximal force to which these segments can be subjected. The present study was performed to obtain a biomechanical comparison of a variety of resorbable fixation systems as an alternative to metal plates and screws. Sheep cadaver parietal bone segments were osteotomized and fixed with one of six methods of fixation: (A) titanium plates and screws consisting of (1) miniplates and 2.0-mm-diameter screws; (2) midface plates and 1.5-mm screws; (3) microplates and 1.0-mm screws; (B) resorbable systems consisting of combinations of butyl-2-cyanoacrylate glue and biodegradable polylactic acid/polyglycolic acid copolymer plates and 2.0-mm screws as follows: (1) direct glue fixation of segments; (2) resorbable plates fixed to bone segments with cyanoacrylate glue; (3) resorbable plates fixed with resorbable screws. Compression testing was performed upon bone segments advanced and fixed across a central gap, and distraction testing was performed on bone segments fixed in direct contact. Force to failure in both distraction and compression was significantly greater in bone segments fixed with titanium miniplates than with any other method of fixation. Segments fixed with plates and screws, either nonresorbable or resorbable, achieved stronger fixation in distraction than in compression for all plate sizes tested. Resorbable plate and screw fixation was as strong as standard titanium midface and microplating systems in distraction, and stronger than the latter techniques in compression. With compressive forces of relapse, fixation with glue and resorbable plates was as strong as standard titanium midface and microplating systems. However, with distractive forces of relapse, glue fixation of either the bone segments or resorbable plates was weaker than both titanium and resorbable alternatives in which plates and screws were used. These findings may have direct impact on the choice of fixation devices used to support osteotomized or fractured bone segments, which are subjected to persistent muscular and soft-tissue pull.

Animals↗

Local tissue of the lumbar spine response to titanium plate--screw system. Case reports.

STUDY DESIGN: This study reported the histopathologic findings of peri-implant tissue harvested from two patients with titanium plate-screw fixation in the lumbar spine. OBJECTIVES: To describe and discuss the histopathologic findings with regard to local tissue response to the titanium plate-screw system in the lumbar spine. SUMMARY OF BACKGROUND DATA: There are no reports about local tissue of the lumbar spine response to titanium plate-screw system in the literature. METHODS: Two patients who underwent titanium plate-screw fixation in the lumbar spine were evaluated for this study. Histopathologic evaluation of the specimens from these cases included soft tissue, bone, and cartilage from the areas around the screws and plates. RESULTS: The primary histopathologic changes of the two cases included fibrous scarring, accumulation of metallic debris, both free in the fibrous tissue and within macrophages, and mild histiocytic and epithelioid changes. CONCLUSIONS: The histopathologic findings of the two cases presented resulted in local tissue response of the lumbar spine to titanium similar to tissue response in other previously reported cases.

Aged↗

Strength and stability of posterior lumbar interbody fusion. Comparison of titanium fiber mesh implant and tricortical bone graft.

STUDY DESIGN: A paired comparison was done of the bending flexibility and compression strength of tricortical bone graft and titanium fiber mesh implants in a human cadaver model of posterior lumbar interbody fusion. OBJECTIVES: To test the hypothesis that a titanium fiber mesh implant and a tricortical bone graft provide adequate and equal mechanical strength and stability in posterior lumbar interbody fusion constructs. SUMMARY OF BACKGROUND DATA: Although studies of posterior lumbar interbody fusion constructs have been performed, the authors are unaware of any study in which the strength and stability of a titanium fiber mesh implant are compared with those of tricortical bone graft for posterior lumbar interbody fusion in the human cadaver lumbar spine. METHODS: Changes in neutral zone and range of motion were measured in a bending flexibility test before and after placement of posterior lumbar interbody fusion constructs. Tricortical bone graft and titanium fiber mesh implant construct stability than were compared in a paired analysis. The constructs than were loaded to failure to evaluate construct strength as a function of graft material and bone mineral density. RESULTS: The posterior lumbar interbody fusion procedure produced statistically significant decreases in neutral zone when compared with the intact spine. No statistically significant differences in neutral zone, range of motion, or strength were detected between the two implants. Construct strength correlated strongly with bone mineral density. CONCLUSIONS: Posterior lumbar interbody fusion procedures result in equal or improved acute stability for titanium fiber mesh implants and tricortical bone graft implants when used without additional posterior stabilization.

Aged↗

Anterior cervical reconstruction using titanium cages with anterior plating.

STUDY DESIGN: A preliminary outcome assessment study of titanium cage implants with anterior cervical plating in anterior cervical reconstruction. OBJECTIVES: To evaluate the efficacy and safety of using titanium cage implants and anterior plating in cervical reconstruction. SUMMARY OF BACKGROUND DATA: Anterior decompression and interbody fusion is a widely accepted surgical treatment for patients with cervical spondylosis. Tricortical iliac crest autograft has been the gold standard but is associated with morbidity at the bone graft donor site, whereas allograft fibula is associated with pseudarthrosis. Problems such as pseudarthrosis, graft collapse, and extrusion still persist with the accepted method of harvesting and implanting bone autografts. METHODS: Thirty-four patients were treated by channel corpectomy followed by placement of a titanium cage packed with autogenous bone graft from the vertebral bodies to reconstruct the anterior column. An anterior cervical plate was added in 30 of 34 cases that involved decompression of two or more levels. The follow-up period ranged from 24 to 56 months, with an average follow-up period of 32 months, and included examination and radiography. RESULTS: Six months after surgery, there was radiographic evidence of fusion in 97% of the patients. Eighty-eight percent of the patients (30 of 34) did not experience any complications (neither cage dislodgment nor hardware failure). Four patients had complications that included pseudarthrosis (1), extruded cage (1), cage in kyphosis (1), and radiculopathy (1). CONCLUSIONS: Titanium cages provide immediate strong anterior column support with minimum hardware complications and avoid bone graft-site morbidity. Titanium cages, with concomitant use of anterior plating, offer an effective and safe alternative to bone autografts.

Bone Plates↗

Early retropulsion of titanium-threaded cages after posterior lumbar interbody fusion: a report of two cases.

STUDY DESIGN: Two patients had postoperative posterior migration of titanium fusion cages after posterior lumbar interbody fusion. They underwent a repeat posterior procedure and posterior fusion with pedicle screws. OBJECTIVE: To suggest a treatment for posterior migration of titanium-threaded cages causing spinal stenosis after posterior lumbar interbody fusion. SUMMARY OF BACKGROUND DATA: The use of titanium fusion cages in posterior lumbar interbody fusion is gaining popularity as a technique for arthrodesis. The literature contains only a few reports concerning complications associated with their use. METHODS: Two patients had retropulsion of titanium threaded cages, ten days and 2 months after posterior lumbar interbody fusion. The retropulsed cages compressing the dura, caused sudden onset of back pain and radiating pain to the lower extremities. Both patients underwent repeat posterior procedure that included repositioning of the cages and posterior fusion with pedicle screws. RESULTS: Symptoms of back and leg pain subsided after repositioning of the cages and application of the pedicle screws. CONCLUSIONS: A repeat posterior approach and repositioning of the retropulsed titanium fusion cages in addition to posterior fusion with pedicle screws successfully managed this complication.

Adult↗