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PubMed2004

Clinical experiences of computer numeric control-milled titanium frameworks supported by implants in the edentulous jaw: a 5-year prospective study.

BACKGROUND: Few long-term follow-up studies on treatment concepts using computer numeric control-milled titanium frameworks have been conducted. OBJECTIVE: To evaluate the clinical and radiographic performance of implant-supported prostheses provided with computer numeric control-milled titanium frameworks in the edentulous jaw and to compare their performance during the first 5 years of function with that of prostheses provided with conventional cast gold alloy frameworks. MATERIALS AND METHODS: A consecutive group of 126 edentulous patients were randomly provided with 67 prostheses with titanium frameworks (test group) in 23 upper jaws and 44 lower jaws and with 62 conventional prostheses with gold alloy castings (control group) in 31 upper jaws and 31 lower jaws. Clinical and radiographic 5-year data were collected for the test and control groups. RESULTS: The frequency of problems was low, and clinical and radiologic performances were similar in both groups. In the test group, the 5-year cumulative survival rates (CSRs) were 94.9% and 98.3% for implants and titanium prostheses, respectively. The respective corresponding CSRs for the control group were 97.9% and 98.2%. More loaded implants were lost in the maxillas in the test group (p < .01), but this difference was not significant on the patient/prosthesis level (p > .05). Smokers lost more implants than nonsmokers lost (p < .01). Similar survival rates were observed for implants in the mandible. One prosthesis was lost in each group because of the loss of implants. Metal fractures were seen only in the control group, and resin veneer fractures were more frequent in the maxilla in the gold alloy group (p < .05). In the test group, the mean marginal bone loss was 0.5 mm (SD, 0.44) in the maxilla and 0.4 mm (SD, 0.50) in the mandible. A similar pattern of bone reaction was observed in the control group. Mean marginal bone loss was similar for smokers and nonsmokers (p > .05). CONCLUSION: Computer numeric control-milled titanium frameworks are a viable alternative to gold alloy castings in the edentulous jaw and present clinical and radiologic performances similar to those of conventional gold alloy frameworks during the first 5 years of function.

Aged↗
PubMed2002

A comparison of stainless steel hand and rotary nickel-titanium instrumentation using a silicone impression technique.

BACKGROUND: Root canal preparation using rotary nickel-titanium instruments has been reported to be superior to hand instrumentation in terms of root canal shape, centring and frequency of procedural errors. The purpose of this study was to evaluate canal preparations using a sequential silicone impression technique to assess root canal morphology. METHODS: Pre-operative canal impressions were obtained from 24 extracted single-rooted premolars. Canals were randomly assigned to be firstly, instrumented with stainless steel K-type files or rotary nickel-titanium instruments (Profile), then further apically enlarged with rotary nickel-titanium instruments (Profile or Lightspeed). Post instrumentation impressions were taken and digitally photographed in a bucco-lingual and mesio-distal orientation at low-power magnification. Images were evaluated for procedural defects, changes in canal curvature, canal enlargement and canal rounding at 1, 3 and 7mm from the working length. RESULTS: Silicone impressions could accurately reproduce the detailed root canal morphology of single-canal premolars. Repeated impressions of each canal using a standardized procedure allowed a detailed comparison of instrumentation techniques at various stages. Hand instrumentation incurred more errors than rotary nickel-titanium instrumentation (Profile). Further apical enlargement using Lightspeed instruments incurred fewer errors than with Profile instruments. Differences among techniques were highly significant (p<0.005). All techniques resulted in slight canal straightening, as well as rounder and enlarged canals particularly in the apical third. CONCLUSIONS: Rotary nickel-titanium instrumentation, especially Lightspeed, may produce better canal shape by reducing procedural errors.

Analysis of Variance↗
PubMed2005

Modulation of bone ingrowth of rabbit femur titanium implants by in vivo axial micromechanical loading.

Titanium implants commonly used in orthopedics and dentistry integrate into host bone by a complex and coordinated process. Despite increasingly well illustrated molecular healing processes, mechanical modulation of implant bone ingrowth is poorly understood. The objective of the present study was to determine whether micromechanical forces applied axially to titanium implants modulate bone ingrowth surrounding intraosseous titanium implants. We hypothesized that small doses of micromechanical forces delivered daily to the bone-implant interface enhance implant bone ingrowth. Small titanium implants were placed transcortically in the lateral aspect of the proximal femur in 15 New Zealand White rabbits under general anesthesia and allowed to integrate with the surrounding bone for 6 wk. Micromechanical forces at 200 mN and 1 Hz were delivered axially to the right femur implants for 10 min/day over 12 consecutive days, whereas the left femur implants served as controls. The average bone volume 1 mm from mechanically loaded implants (n = 15) was 73 +/- 12%, which was significantly greater than the average bone volume (52 +/- 21%) of the contralateral controls (n = 15) (P < 0.01). The average number of osteoblast-like cells per endocortical bone surface was 55 +/- 8 cells/mm(2) for mechanically loaded implants, which was significantly greater than the contralateral controls (35 +/- 6 cells/mm(2)) (P < 0.01). Dynamic histomorphometry showed a significant increase in mineral apposition rate and bone-formation rate of mechanically stressed implants (3.8 +/- 1.2 microm/day and 2.4 +/- 1.0 microm(3).microm(-2).day(-1), respectively) than contralateral controls (2.2 +/- 0.92 microm/day and 1.2 +/- 0.60 microm(3).microm(-2).day(-1), respectively; P < 0.01). Collectively, these data suggest that micromechanical forces delivered axially on intraosseous titanium implants may have anabolic effects on implant bone ingrowth.

Animals↗
PubMed2001

Synergistic effect of titanium alloy and collagen type I on cell adhesion, proliferation and differentiation of osteoblast-like cells.

A number of studies have demonstrated the pivotal role of collagen in modulating cell growth and differentiation. In bone, where the extracellular matrix is composed of approximately 85% type I collagen, cellular interaction with matrix components has been shown to be important in the regulation of the osteoblast phenotype. Preservation or enhancement of normal osteoblast function and appositional bone formation after implant placement represents a strategy that can be useful for the purpose of improving osseointegration. In order to further improve biocompatibility, we combined two known favorable compounds, namely the titanium alloy, Ti6A14V, with type I collagen. We assessed the in vitro behavior of primary osteoblasts grown on both fibrillar collagen-coated and tropocollagen-coated Ti6A14V in comparison with uncoated titanium alloy, using an improved adsorption procedure. As parameters of biocompatibility, a variety of processes, including cell attachment, spreading, cytoskeletal organization, focal contact formation, proliferation and expression of a differentiated phenotype, were investigated. Our results demonstrated for the first time that in comparison to uncoated titanium alloy, collagen-coated alloy enhanced spreading and resulted in a more rapid formation of focal adhesions and their associated stress fibers. Growing on collagen-coated Ti6A14V, osteoblasts had a higher proliferative capacity and the intracellular expression of osteopontin was upregulated compared to uncoated titanium alloy. Type I collagen-coated titanium alloy exhibits favorable effects on the initial adhesion and growth activities of osteoblasts, which is encouraging for its potential use as bone graft material. Moreover, collagen type I may serve as an excellent biocompatible carrier for osteotropic factors such as cell adhesion molecules (e.g. fibronectin) or bone-specific growth factors.

Alloys↗
PubMed1991

Induction of calcium phosphate precipitation by titanium dioxide.

Titanium powder and various titanium dioxides were tested for their capacity to reduce the induction time for calcium phosphate precipitation from supersaturated solutions. Only after a pretreatment aimed at increasing its oxide surface layer was titanium powder found to accelerate the precipitation from solutions containing 2 mmol/L CaCl2, 2 mmol/L KH2PO4, 50 mmol/L Hepes, pH 7.2, and to induce precipitation from metastable solutions containing 1.2 mmol/L CaCl2, 1.2 mmol/L KH2PO4, 50 mmol/L Hepes, pH 7.2, at 37 degrees C. Even stronger effects were found when suspensions of the titanium dioxides anatase or rutile (10-50 micrograms/mL) were added to these solutions. TiO2 appeared to serve as a reactive substrate for secondary nucleation at a wide range of calcium-to-phosphate ratios and concentrations, even in the presence of 40 mg/mL bovine serum albumin, which completely inhibited precipitation in control incubations. These results suggest that the oxide surface layer of titanium implants may induce calcium phosphate precipitation in the metal-to-bone interface, which may play a role in the integration of such implants in bone.

Calcium Phosphates↗
PubMed1998

RGD peptides regulate the specific adhesion scheme of osteoblasts to hydroxyapatite but not to titanium.

Hydroxyapatite (HA) is a bioactive dental implant material which accelerates bone formation on its surface. The mechanism of this acceleration is not clear. The elucidation of the cell adhesion might be the key to the understanding of the bioactive mechanism of HA. In this study, we analyzed the adhesion of HOS human osteoblasts onto HA and titanium to find the particular adhesion to HA. In short-term cultures in fetal bovine serum-pre-coated materials, a significantly higher number of cells adhered to HA than to titanium. In addition, serum-free conditions with phosphate-buffered saline pre-coating or bovine serum albumin pre-coating materials were tested. The results were nearly the same among all pre-coating conditions, suggesting that the quantity of cell adhesion was not affected by serum components. However, in the morphological observations by SEM, the form of adhesion was found to differ among pre-coating conditions. The osteoblasts tightly adhered and spread onto both HA and titanium with serum pre-coating, whereas the cells loosely adhered and did not spread without serum. To evaluate the Arg-Gly-Asp (RGD) sequence-specific adhesion, we used synthetic RGD peptides for a competitive inhibition test. The results showed that RGD peptides remarkably inhibited the tight adhesion and spreading of osteoblasts onto HA, whereas they did not strongly inhibit adhesion and spreading onto titanium. These results demonstrate that the regulation of cell adhesion to HA is different from that to titanium. Our study suggests that the RGD-containing serum proteins might have a major role in regulating the specific adhesion of osteoblasts to HA, and in inducing enhanced cell growth and differentiation.

Amino Acid Sequence↗
PubMedDate not supplied

Initial fixation strength of bioabsorbable and titanium interference screws in anterior cruciate ligament reconstruction. Biomechanical evaluation by single cycle and cyclic loading.

We evaluated the initial bone-patellar tendon-bone graft fixation strength of bioabsorbable as compared with titanium interference screws in anterior cruciate ligament reconstruction using matched pairs of porcine knees. Ten pairs underwent single-cycle failure loading at a rate of 50 mm/min, and 10 pairs underwent cyclic loading at half-hertz frequency. The cyclic loading started with 100 load cycles between 50 and 150 N. We then progressively increased loads in 50-N increments after each set of 100 cycles. After 100 cycles at 850 N, the specimens were loaded to failure at a rate of 50 mm/min. In the single-cycle failure loading test, the mean ultimate failure loads (+/-SD) for the bioabsorbable (837 +/- 260 N) and titanium interference screws (863 +/- 192 N) were not significantly different, nor were the mean yield loads or the stiffness of the fixation. In the cyclic loading test, the yield loads were 605 +/- 142 N and 585 +/- 103 N for the bioabsorbable and titanium interference screws, respectively (no significant difference). Although there was no significant difference in the ultimate failure load, more bone block fractures were found in the grafts fixed with a titanium interference screw. Bioabsorbable interference screw fixation thus seems to provide a reasonable alternative to titanium screws.

Absorbable Implants↗
PubMed2006

Tribological characterization of surface-treated commercially pure titanium for femoral heads in total hip replacement: a feasibility study.

Most noncemented total hip replacements combine a titanium alloy stem, a CoCrMo femoral head and an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. In spite of its nickel content of up to 1% and the resulting biocompatibility issues in some clinical situations, the higher cost and some difficulties in machining, CoCrMo alloy is preferred to titanium alloys thanks to its outstanding tribological properties, higher hardness and elastic modulus. Nowadays most of the heads of hip prostheses use CoCrMo as bearing material. The present study investigates the effect of various surface treatments and combinations of treatments, such as electrochemical oxidation (anodization), laser surface melting and barrel polishing, on the tribological properties of commercially pure grade 2 titanium. The aim of the study was to characterize surface treatments capable of improving the tribological properties of titanium surface to the same extent as CoCrMo. The tribological properties were characterized by multidirectional pin-on-flat screening wear tests, using UHMWPE pins as bearing surface. The experiments showed the possibility of improving the wear resistance of titanium to the degree of CoCrMo. Although further efforts will be required to optimize the treatments studied, the results are encouraging enough to warrant pursuing this direction of investigation.

Arthroplasty, Replacement, Hip↗
PubMed1996

Surface modification of titanium based biomaterials by ion beam.

Ion beam enhanced deposition (IBED) was adopted to synthesize biocompatible titanium oxide film. Structure characteristics of titanium oxide film were investigated by RBS, AES, and XRD. The blood compatibility of the titanium oxide film was studied by measurements of blood clotting time and platelet adhesion. The results show that the anticoagulation property of titanium oxide film is improved significantly. The mechanism of anticoagulation of the titanium oxide film was discussed.

Animals↗
PubMed2006

Evaluation of scatter dose of dental titanium implants exposed to photon beams of different energies and irradiation angles in head and neck radiotherapy.

OBJECTIVES: In this study, quantification of backscatter doses between scattering titanium dental implant and the thermoluminescent dosimeter (TLD(100)) radiation detector at axial beam irradiation-angle range of 0-90 degrees in head and neck radiotherapy is done to evaluate irradiation angle dependency of dose enhancement contributing to osteoradionecrosis. METHODS: A cylindrical titanium dental implant with diameter of 4 mm and length of 9 mm was implanted into a specially-designed human mandible phantom with a TLD100 chip placed on the buccal site and irradiated with 6 MV X, 25 MV X and Co-60 gamma sources at 19 different irradiation angles. RESULTS: Dose enhancement on a buccal site of the titanium implant depends on the incident beam angle. At angles of 65 degrees, 60 degrees and 40 degrees the maximum detected scatter doses over the titanium implant are 36%, 32% and 23% for Co-60 gamma, 6 MV X-ray and 25 MV X-ray, respectively. The dose enhancement at different beam angles was less pronounced in 25 MV X and more pronounced in Co-60 gamma irradiation. CONCLUSIONS: For the different radiation beams studied, the irradiation angle between scattering titanium dental implants and the central axis does not significantly affect the total dose that may lead to osteoradionecrosis of the mandible.

Cranial Irradiation↗
PubMed1981

The advantages of titanium alloy over stainless steel plates for the internal fixation of fractures. An experimental study in dogs.

An experimental study is reported of fracture healing in the femora of 36 Beagle dogs, comparing the results of using stainless steel plates with those of using less rigid titanium alloy plates. The alloy plates led to the appearance of a small amount of periosteal callus without any histological evidence of fracture instability, thus allowing the radiological assessment of fracture union. This also produced less bone loss during the remodelling phase. Radiological measurements 24 weeks after osteotomy showed cortical thickness to be reduced by six per cent under titanium alloy and by 19 per cent under stainless steel, while histological measurements showed a total bone loss of 3.7 per cent under titanium alloy and of 11 per cent under stainless steel plates. Removal of the titanium alloy plates after eight weeks followed by a recovery period of 16 weeks produced an increase of cortical thickness of 69 per cent and a gain in total bone mass of 30 per cent. Titanium alloy plates also produced less soft-tissue reaction than stainless steel plates. It is concluded that this alloy is a promising material for internal fixation devices.

Alloys↗
PubMed1997

In vitro human monocyte response to wear particles of titanium alloy containing vanadium or niobium.

Our aim was to determine whether in vitro studies would detect differences in the cellular response to wear particles of two titanium alloys commonly used in the manufacture of joint replacement prostheses. Particles were of the order of 1 microm in diameter representative of those found adjacent to failed prostheses. Exposure of human monocytes to titanium 6-aluminium 4- vanadium (TiAlV) at concentrations of 4 x 10(7) particles/ml produced a mean prostaglandin E2 release of 2627.6 pM; this was significantly higher than the 317.4 pM induced by titanium 6-aluminium 7-niobium alloy (TiAlNb) particles (p = 0.006). Commercially-pure titanium particles induced a release of 347.8 pM. In addition, TiAlV stimulated significantly more release of the other cell mediators, interleukin-1, tumour necrosis factor and interleukin-6. At lower concentrations of particles there was less mediator release and less obvious differences between materials. None of the materials caused significant toxicity. The levels of inflammatory mediators released by phagocytic cells in response to wear particles may influence the amount of periprosthetic bone loss. Our findings have shown that in vitro studies can detect differences in cellular response induced by particles of similar titanium alloys in common clinical use, although in vivo studies have shown little difference. While in vitro studies should not be used as the only form of assessment, they must be considered when assessing the relative biocompatibility of different implant materials.

Alloys↗
PubMed1995

Pulmonary alveolar proteinosis in a painter with elevated pulmonary concentrations of titanium.

We present the case of a professional painter who developed pulmonary alveolar proteinosis (PAP) with severe respiratory failure. He required total bilateral pulmonary lavage on two separate occasions, 3 months apart. Quantitative analysis of particles found in lung tissues obtained by open lung biopsies demonstrated the presence of titanium (60-129 million particles of titanium per cm3 of lung tissue). This report extends previous results from animal studies that demonstrated development of alveolar proteinosis in rats following exposure to titanium. It has been proposed that the overwhelming impairment of the normal clearance mechanisms of the lung by particles of titanium is one of the possible mechanisms responsible for the development of this lung disease. We suggest that a similar mechanism occurred in our patient and that titanium should be recognized as a potential cause of PAP in humans.

Adult↗
PubMed2006

Titanium serum levels may remain elevated despite hip revision surgery for wear-through of an acetabular component.

A 62-year-old female patient showed radiographic signs of severe linear wear of the acetabular component six years after cementless total hip arthroplasty. This suggested wear-through of the acetabular liner with secondary wear of the titanium shell. At revision surgery wear-through of both the inlay and the acetabular shell were confirmed. Despite meticulous debridement serum titanium levels remained elevated for more than 12 months. Wear-through of a polyethylene acetabular liner with secondary wear of the titanium shell can lead to increased titanium serum levels. Titanium serum levels can remain highly elevated despite revision surgery.

Acetabulum↗
PubMed2004

Oxidation of titanium, RGD peptide attachment, and matrix mineralization rat bone marrow stromal cells.

The aim of this study was to compare the efficacy of attachment of arginine-glycine-aspartic acid (RGD) peptide to titanium surfaces oxidized by different methods. Titanium surfaces were treated as follows: (1) treatment A: passivation in nitric acid, (2) treatment B: heated in air at 400 degrees C for 1 hour, (3) treatment C: immersed in 8.8 M H2O2/0.1 M HCl at 80 degrees C for 30 minutes, and (4) treatment D: treated as in treatment C and then heated at 400 degrees C for 1 hour. RGD was attached to titanium samples treated as in treatments A through D. The quantity of attached RGD was determined by an enzyme-linked immunoabsorbent assay. Mineralization of a rat bone marrow stromal cell (RMSC) culture on the titanium surfaces after 21 days was determined y atomic absorption spectroscopy. The treatments were ranked according to quantity of RGD attached as C, A, B, and D. Twenty-one days after RMSC culture, the degree of mineralization was significantly higher for treatment C than for treatments A, B, and D and for controls. The efficacy of RGD attachment varies with the oxidation treatment given to titanium. Oxidation in H2O2/0.1 M HCl at 80 degrees C provided the best overall surface for RGD attachment as well as calcified matrix formation of RMSCs.

Amino Acid Sequence↗
PubMedDate not supplied

Titanium implants induce expression of matrix metalloproteinases in bone during osseointegration.

Implanted pure titanium fixtures are able to completely integrate with bone, in part because of the formation of a strong extracellular matrix (ECM) bond at the titanium-bone interface. In this study, we used a rodent femur model of intramedullary osseointegration to analyze the changes in immunoreactivity of ECM-controlling matrix metalloproteinases (MMPs), tissue inhibitor of metalloproteinase-3 (TIMP-3), and tumor necrosis factor alpha (TNF-alpha) during osseointegration. We observed dramatic increases in MMP-2, MMP-9, MMP-7, TIMP-3, and TNF-alpha in osteocytes, osteoclasts, haversian canals, and the interface matrix in bone ipsilateral to the titanium implant. An increase in TIMP-3, MMP-9, and MMP-7 in hypertrophied chondrocytes and the vascular component of the epiphysial growth plate was also observed in experimental bone. These findings were not seen in contralateral or sham-operated bone, where the titanium fixtures were threaded into the femur and immediately removed. Our data link titanium-induced bone remodeling to changes in expression and distribution of MMPs.

Animals↗
PubMed1990

The effects of scaling a titanium implant surface with metal and plastic instruments: an in vitro study.

The surface roughnesses of pure titanium implants were compared with scaling in vitro with curettes of dissimilar composition. Each of 10 transmucosal implant extensions (TIEs) was divided into three experimental surfaces and an untreated control surface. The three experimental surfaces were instrumented with either a titanium-alloy tipped curette, a curette of stainless steel, or a plastic curette. All experimental surfaces received 30 strokes with the designated curette within a 2 mm wide area. Alteration of the surfaces due to instrumentation was evaluated by a helium neon (HeNe) laser and reported as relative specular reflectance (RSR). Scanning electron microscopy (SEM) conformed the quantitative HeNe laser results. A significant decrease in mean RSR (greater roughness) was observed for surfaces treated by metal curettes compared to either untreated control surfaces (P less than 0.01) or surfaces treated by the plastic curette (P less than 0.01). No statistically significant difference was noted between untreated surfaces and those treated by the plastic curette. The titanium-alloy curette produced a significantly lower mean RSR (greater roughness) compared to those surfaces treated by the stainless steel curette (P less than 0.05). In summary, plastic instruments produced an insignificant alteration of the titanium implant surface following instrumentation, while metal instruments significantly altered the titanium surface.

Alloys↗
PubMed2000

Effects of diode and Nd:YAG laser irradiation on titanium discs: a scanning electron microscope examination.

BACKGROUND: Dental lasers have been recommended for uncovering submerged implants as well as decontaminating implant surfaces when treating peri-implantitis. The aim of this study was to show the possible alterations in titanium disc surfaces using an Nd:YAG or a diode laser. METHODS: Three different titanium discs were used (sandblasted, titanium plasma-sprayed [TPS], and hydroxyapatite [HA] coated) to determine the effects of laser irradiation on these surfaces using a scanning electron microscope (SEM). The discs were either irradiated with a pulsed Nd:YAG laser with a contact handpiece and power settings of 2.0, 4.0, and 6.0 W or with a diode laser at 5.0, 10.0, and 15.0 W power settings and continuous wave (cw) in the contact handpiece. Irradiated areas were compared with control titanium sites which were not lased. The specimens were prepared for SEM examination after the disc irradiation. RESULTS: The SEM examination demonstrated extensive melting in all of the Nd:YAG laser irradiated areas. Damage was seen in all TPS- and HA-coated discs even at the lowest power setting. Loss of porosity, coating microfractures, and a relatively smooth surface were observed. In contrast, the diode laser did not cause any damage or modify the disc surface. Regardless of the power setting, there was no visible difference between lased and non-lased surfaces after cw irradiation with the diode laser. CONCLUSIONS: From these findings, it was concluded that the diode laser (980 nm) does not damage titanium surfaces, which should be of value when uncovering submerged implants and treating peri-implantitis.

Lasers↗