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PubMed2003

Autologous osteoblasts enhance osseointegration of porous titanium implants.

The goal of this study was to assess the osseointegration of porous titanium implants by means of coating with autologous osteoblasts. Titanium implants (8 x 5 x 4 mm) having drill channels with diameters of 400, 500, and 600 microm were coated with autologous osteoblasts obtained from spongiosa chips. The implants were inserted into the distal femora of 17 adult Chinchilla Bastard rabbits (group I). Uncoated implants were inserted as controls in the contralateral femur (group II). The animals were sacrificed after 5, 11, and 42 days. Intravital fluorochrome labeling and microradiography were used for the assessment of bone ingrowth into the titanium channels. In both groups, no bone tissue was formed in the channels up to day 5. On day 11, group I exhibited significantly more (p<0.05) bone tissue (19.8+/-14.0% vs. 5.8+/-9.1%) with greater bone-implant contact (13.3+/-15.1% vs. 5.7+/-5.3%, p<0.05) at the channel mouths than group II. Bone tissue was formed mainly between day 15 and 30 in group I, in group II between day 25 and 40. Six weeks after implantation, bone tissue filled on an average 68.8+/-15.1% of the mouths of the drill channels in implants in group I, the filling for group II was 49.8+/-18.1% (p<0.05). The average bone-implant contact at the channel mouths after six weeks was 56.5+/-13.5% in group I, 40.2+/-21.9% in group II (p<0.05). 600-microm channels showed at this time point the best osseous integration (p<0.05). Coating with autologous osteoblasts accelerates and enhances the osseointegration of titanium implants and could be a successful biotechnology for future clinical applications.

Animals↗
PubMed1997

Wear analysis of a retrieved hip implant with titanium nitride coating.

There is increasing interest in using surface modification technology to improve the wear properties of titanium alloy and limit articular surface wear of metal and polyethylene components. This report details the in vivo wear performance of titanium nitride coating on a retrieved hip implant obtained postmortem from a low demand patient 1 year after total hip arthroplasty. Analysis of the well-functioning implant revealed that wear debris can originate from a titanium nitride coated femoral head, as delaminated surface asperities, and manifest as adhesive wear on the articular surface. The wear observed on this implant indicates that rigorous testing and evaluation of titanium nitride coating technology should be conducted prior to widespread use on total joint implants.

Acetabulum↗
PubMed2003

Factors associated with the stability of titanium screws placed in the posterior region for orthodontic anchorage.

Recently, implant anchors such as titanium screws have been used for absolute anchorage during edgewise treatment. However, there have been few human studies reporting on the stability of implant anchors placed in the posterior region. The purpose of this study was to examine the success rates and to find the factors associated with the stability of titanium screws placed into the buccal alveolar bone of the posterior region. Fifty-one patients with malocclusions, 134 titanium screws of 3 types, and 17 miniplates were retrospectively examined in relation to clinical characteristics. The 1-year success rate of screws with 1.0-mm diameter was significantly less than that of other screws with 1.5-mm or 2.3-mm diameter or than that of miniplates. Flap surgery was associated with the patient's discomfort. A high mandibular plane angle and inflammation of peri-implant tissue after implantation were risk factors for mobility of screws. However, we could not detect a significant association between the success rate and the following variables: screw length, kind of placement surgery, immediate loading, location of implantation, age, gender, crowding of teeth, anteroposterior jaw base relationship, controlled periodontitis, and temporomandibular disorder symptoms. We concluded that the diameter of a screw of 1.0 mm or less, inflammation of the peri-implant tissue, and a high mandibular plane angle (ie, thin cortical bone), were associated with the mobility (ie, failure) of the titanium screw placed into the buccal alveolar bone of the posterior region for orthodontic anchorage.

Adult↗
PubMed1999

Comparison of load transmission and bracket deformation between titanium and stainless steel brackets.

This study measures the load transmitted and structural integrity of stainless steel and titanium brackets on application of torsional forces. Both 0.018 and 0.022 inch slot size edgewise brackets were tested in a specially designed apparatus that applied a torque value of 45 degrees. The load generated was measured by an Instron Universal Testing Machine at intervals of 15 degrees, 30 degrees, and 45 degrees of torque application. The structural stability of the brackets was evaluated by measuring the bracket slot width with a traveling stereoscopic microscope before and after the brackets were subjected to torsional forces. The specimen population was composed of 80 brackets and 80 wire specimens. An independent sample t test was used for comparison of mean load generated at 45 degrees of torque application. Repeated measures ANOVA (one-way) comparison was used to evaluate changes in load at different torque levels for the stainless steel and titanium brackets. A paired t test (two-tail) was used to determine the difference between initial and final bracket slot width at 45 degrees of torque applied for the two bracket types. The titanium brackets transmitted higher loads at 15 degrees and 30 degrees torque and lower load at 45 degrees torque on application of torsional forces in comparison to stainless steel brackets. The titanium brackets demonstrated superior dimensional stability compared to stainless steel brackets (P < .0001).

Analysis of Variance↗
PubMed2002

The effect of titanium stabilization rods on spinal cord radiation dose.

The purpose of this study was to investigate the dosimetric effect of a titanium-rod spinal stabilization system on surrounding tissue, especially the spinal cord. Ion chamber dosimetry was performed for 6- and 18-MV photon beams in a water phantom containing a titanium-rod spinal stabilization system. Isodose curves were obtained in the phantom with and without rods. To assess the ability of a treatment planning system to reproduce the effects of the stabilization system on the radiation dose delivered to surrounding tissue, dose distributions were calculated after appropriate modifications were made in the computed tomography number-to-density conversion table to account for the increased density of the titanium rods. The resultant heterogeneity-corrected plans were compared with uncorrected plans. At a 7-cm depth in the water phantom, corresponding to the depth of the spinal cord, the beam was attenuated by 4% under the rods alone and by 13% rods under the rods with screws for the 6-MV photon beam as compared with curves generated in the absence of rods. The beam was attenuated by 3% and 11%, respectively, for the 18-MV beam. Using anteroposterior (18-MV) and posteroanterior (6-MV) photon beams, with and without heterogeneity correction for the rods, the corrected isodose plan showed an approximately 2% beam attenuation 4 cm anterior to the rods as compared with the uncorrected plan. No significant difference in the spinal cord dose was observed between the 2 plans, however. The titanium-rod spinal stabilization system tested in this study caused a decrease in the dose delivered distal to the rods but did not significantly affect the dose delivered to the spinal cord.

Humans↗
PubMed2000

The effect of surface treatments of nickel-titanium files on wear and cutting efficiency.

OBJECTIVES: This study was designed to verify whether nitridation treatment of the cutting surfaces resulted in surface or subsurface changes that produced an increase in the resistance to wear in nickel titanium (NiTi) endodontic files. STUDY DESIGN: Some experimental samples were exposed to ionic implantation by using 150 keV of nitrogen ions and doses of 1 x 10(17) ions per cm(2). Other samples were exposed to thermal nitridation processes performed for 480 minutes at 500 degrees C temperature. Control samples were not exposed to any process. The chemical composition of the surface layers of each sample was determined by means of x-ray photoelectron spectroscopy. The cutting efficiency was tested on an endotraining bloc. RESULTS: The experimental instruments showed in-depth distributions of chemical composition that were different from those seen in the control group; thermal-nitridated instruments demonstrated a surface ratio of nickel to titanium of 0.5. Implanted samples had a higher N/Ti ratio (1.2); this ratio may be due to the presence of a layer of titanium nitride. Samples in the experimental groups showed an increase in cutting ability as compared with the controls. CONCLUSIONS: Thermal nitridation and nitrogen-ionic implantation treatment of nickel-titanium files produced a higher wear resistance and an increased cutting capacity.

Dental Alloys↗
PubMed1999

Effect of sterilization on the cutting efficiency of rotary nickel-titanium endodontic files.

OBJECTIVE: Nickel-titanium instruments that offer greater flexibility than instruments made of other metallic materials have been developed. This study evaluated the behavior in vitro of nickel-titanium rotary instruments under repeated sterilization cycles. STUDY DESIGN: To investigate changes in cutting ability and superficial alterations, 36 ProFile instruments, 18 with a taper of .04 and 18 with a taper of .06, were exposed to different sterilization cycles. Samples were divided into 3 groups of 12 files each. The 12 group A samples were exposed to 14 cycles of sterilization for 30 minutes; the 12 group B samples were exposed to 7 cycles of sterilization for 30 minutes; the 12 group C samples were not sterilized and served as a control group. Chemical compositions of the near surface layers of samples of each group were determined by means of Auger spectroscopy. RESULTS: The instruments that underwent the greatest number of sterilizations (group A) showed in-depth distributions of chemical composition that were different from those seen in the control group; this was the result of greater amounts of titanium oxide on the surfaces of the sterilized instruments. The files of group A showed a decrease in cutting efficiency in comparison with those of the control group. CONCLUSIONS: On the basis of this research on nickel-titanium files, we determined that repeated sterilizations under autoclave alter the superficial structure of such instruments.

Dental Instruments↗
PubMedDate not supplied

Biocompatibility studies of titanium-based alloy pedicle screw and rod system: histological aspects.

BACKGROUND CONTEXT: Few histological studies of pedicle screw and rod systems have been done, and spinal surgery with pedicle screw and rod system is increasing. PURPOSE: To know the biocompatibility of pedicle screw and rod systems histologically. STUDY DESIGN/SETTING: Titanium-based alloy pedicle screws were removed from 20 patients. Histological studies of the tissue response to the screws were performed by light microscopy. PATIENT SAMPLE: Twenty patients, who were diagnosed with burst type spinal fracture, spondylolysis, spondylolisthesis, and lumbar disc herniation. OUTCOME MEASURES: All slides were observed by light microscopy, and inflammation, fibrous tissue formation, and wear debris were evaluated using a subjective scale. METHODS: Before the surgery, plain radiographs were taken to confirm the solid arthrodesis. Histological analysis was divided into four areas and studied using light microscopy. RESULTS: Inflammation and fibrous tissue formation were the main tissue reactions to the implants. No tissue surrounding the implants showed irreversible changes. Fibrous tissue was often observed at the bone-screw interface without direct contact of screw and bone at the muscle-screw interface histologically. Although some titanium debris was observed in both interfaces, no debris of inflammatory cells were seen at 1 cm distance from the screws. The inflammatory response to the screw debris was localized. CONCLUSIONS: Titanium-based alloy pedicle screws produced some metal debris and caused localized inflammation. No adverse tissue reaction was observed around the screws and rods. Direct contact without any fibrous tissue formation at the bone-screw interface was observed in some patients. A titanium-based alloy pedicle screw and rod system is considered biocompatible histologically.

Adult↗
PubMedDate not supplied

Anterior lumbar interbody fusion with titanium mesh cages, coralline hydroxyapatite, and demineralized bone matrix as part of a circumferential fusion.

BACKGROUND CONTEXT: Anterior lumbar interbody fusion (ALIF) has become one of the primary choices for eliminating motion between vertebral segments in patients with severe discogenic pain and other lumbar pathologies. Autograft is the gold standard for spinal fusion. However, multiple authors have reported complication and morbidity rates associated with iliac crest harvesting to be as high as 25%. Drawbacks to the use of allograft in the anterior column include slower incorporation rates, the possibility for disease transmission, increasing cost resulting from stringent processing and unavailability on a worldwide basis resulting from religious and economic concerns. PURPOSE: To determine the clinical and arthrodesis efficacy of coralline hydroxyapatite as an osteoconductive bone graft substitute in the anterior lumbar spine using a titanium mesh cage. STUDY DESIGN: A series of 50 patients returning for long-term prospective follow-up, implanted with titanium mesh cages filled with coralline hydroxyapatite and demineralized bone matrix for ALIF as part of a circumferential fusion. PATIENT SAMPLE: Long-term clinical and radiographic follow-up were examined for the first 50 patients undergoing this technique by one surgeon. OUTCOME MEASURES: Pain was measured with a visual analog scale and function was measured with the Oswestry Disability Index. METHODS: All 50 patients underwent successful ALIF with titanium mesh cages, coralline hydroxyapatite and demineralized bone matrix, as well as an autologous posterolateral fusion with rigid posterior instrumentation. Patients filled out follow-up questionnaires and appropriate radiographs were taken. RESULTS: A solid fusion rate of 96% was achieved. Mean pain decrease was 60% overall. A total of 70% of all patients either returned to work or to full home activities at a mean of 8 months after surgery. Ninety percent felt the surgery was successful. CONCLUSIONS: The combination of titanium mesh cages, coralline hydroxyapatite and demineralized bone matrix is effective for anterior interbody fusion of the lumbar spine when used as part of a rigidly instrumented circumferential fusion.

Adult↗
PubMedDate not supplied

Single stage anterior cervical reconstruction with titanium mesh cages, local bone graft, and anterior plating.

BACKGROUND CONTEXT: After cervical corpectomy, the use of tricortical autologous bone to fill the large defect is biomechanically and structurally inadequate and may lead to excessive donor site pain and morbidity. The major alternative, fibular strut allograft, has inherent problems that lead to lower rates of solid arthrodesis and graft migration. Majd et al. reported on 34 cases with a 97% solid fusion rate using titanium mesh cages and local bone graft to fill the cervical corpectomy defect. PURPOSE: With long-term results, to confirm the results previously reported by Majd et al. STUDY DESIGN/SETTING: Retrospective chart and radiological review. PATIENT SAMPLE: The first 26 patients in the senior author's practice eligible for a minimum 2-year follow-up, having had cervical corpectomy reconstructed with titanium mesh cages, local bone graft and anterior plating. OUTCOME MEASURES: Odom's criteria were used to assess clinical outcome. Anteroposterior, lateral and lateral flexion and extension radiographs were used to assess fusion. METHODS: Twenty-six patients with multilevel cervical pathology underwent successful corpectomy, decompression and fusion with titanium mesh cages filled with local bone graft. Rigid anterior plating was applied across the corpectomy defect. Preoperative, operative and postoperative chart data were collected retrospectively. Radiographic assessment included a minimum 2-year follow-up. RESULTS: Follow-up ranged from 24 to 64 months. Clinically, 21 of 26 (80.7%) had an excellent or good clinical outcome. No radiolucencies or motion were detected on radiographic analysis, yielding a fusion rate of 100% (26 of 26). Broken or pulled out screws were identified in two patients, one of whom had plate revision. All cages remained intact with no evidence of cage settling or collapse. CONCLUSIONS: The use of titanium mesh cages in conjunction with local bone graft, and rigid anterior plating is effective for cervical reconstruction after corpectomy and a viable alternative to the use of fibular strut allograft. These results confirm those previously reported by Majd et al.

Adult↗
PubMed1990

Titanium grommets: a trial to assess function and extrusion rates.

Titanium grommets have been promoted as having the advantage of a slower extrusion rate than other types of ventilation tube. A prospective trial was therefore designed to compare the function and extrusion rates of these grommets with those of the widely used Shepard design of Teflon grommet in a single group of patients. Thirty-one children had one type of grommet inserted in one ear and the other type in the opposite ear. After eight months there were significantly more Titanium grommets still functioning (p less than 0.05) but after 12 and after 16 months there was no significant difference in the extrusion rates of the two types of grommet. There was a higher incidence of infection with granulation tissue formation around the Titanium grommet. Accordingly it is concluded that the extra expense of the Titanium grommet is not justified, particularly as the long-term effects of these grommets on the tympanic membrane are not known.

Adolescent↗
PubMed2003

A new dinuclear Ti(IV)-peroxo-citrate complex from aqueous solutions. Synthetic, structural, and spectroscopic studies in relevance to aqueous titanium(IV)-peroxo-citrate speciation.

The wide use of titanium in applied materials has prompted pertinent studies targeting the requisite chemistry of that metal's biological interactions. In order to understand such interactions as well as the requisite titanium aqueous speciation, we launched investigations on the synthesis and spectroscopic and structural characterization of Ti(IV) species with the physiological citric acid. Aqueous reactions of TiCl(4) with citric acid in the presence of H(2)O(2) and neutralizing ammonia afforded expediently the red crystalline material (NH(4))(4)[Ti(2)(O(2))(2)(C(6)H(4)O(7))(2)].2H(2)O (1). Complex 1 was further characterized by UV-vis, FT-IR, FT- and laser-Raman, NMR, and finally by X-ray crystallography. Compound 1 crystallizes in the monoclinic space group P2(1)/n, with a = 10.360(4) A, b = 10.226(4) A, c = 11.478(6) A, beta = 107.99(2) degrees, V = 1156.6(9) A(3), and Z = 2. The X-ray structure of 1 reveals a dinuclear anionic complex containing a Ti(IV)(2)O(2) core. In that central unit, two fully deprotonated citrate ligands are coordinated to the metal ions through their carboxylate moieties in a monodentate fashion. The central alkoxides serve as bridges to the two titanium ions. Also attached to the Ti(IV)(2)O(2) core are two peroxo ligands each bound in a side-on fashion to the respective metal ions. NH(4)(+) ions neutralize the 4- charge of the anion in 1, further contributing to the stability of the derived lattice through H-bond formation. The structural similarities and differences with congener vanadium(V)-peroxo-citrate complexes may point out potential implications in the chemistry of titanium with physiological ligands, when the former is present in a biologically relevant medium.

Citrates↗
PubMed2005

Interactions between titanium dioxide and phosphatidyl serine-containing liposomes: formation and patterning of supported phospholipid bilayers on the surface of a medically relevant material.

Titanium is widely used in biomedical applications. Its mechanical properties and biocompatibility, conferred by a layer of oxide present on its surface, make titanium the material of choice for various implants (artificial hip and knee joints, dental prosthetics, vascular stents, heart valves). Furthermore, the high refractive index of titanium oxide is advantageous in biosensor applications based on optical detection methods. In both of the above fields of application, novel surface modification strategies leading to biointeractive interfaces (that trigger specific responses in biological systems) are continuously sought. In this report, we investigate the interactions between TiO2 and phosphatidyl serine-containing liposomes, present a novel approach for preparing supported phospholipid bilayers (SPBs) of various compositions on TiO2, and use the unique ability of liposomes to distinguish between different surfaces to create SPB corrals on SiO2/TiO2 structured substrates. These results represent an important first step toward the design of biointeractive interfaces on titanium oxide surfaces that are based on a cell membrane-like environment.

Adsorption↗
PubMed2004

Staphylococcus aureus adhesion to different treated titanium surfaces.

Staphylococcus aureus is a major pathogen, associated with medical-device related infections. Converting biomaterial surfaces into non-interactive surfaces requires a specific surface/interface design. One approach is to polish the surface, and a second is to coat the surface with an antimicrobial or protein resistant coating. This study showed that polishing a titanium surface or coating titanium with various treatments that decreased the surface's coefficient of friction, had no significant effect on minimising S. aureus adhesion to these surfaces under static conditions in comparison to standard medical grade titanium. The cell promoting coating, TAST, was found to increase the S. aureus density on its surface as expected. The only coating that significantly decreased the density of adhering S. aureus was the titanium surface coated with sodium hyaluronate. Thus such a coating could have potential use as a coating for ostoesynthesis, orthopaedic or dental implants.

Anti-Bacterial Agents↗
PubMed1992

Histomorphometric and removal torque analysis for TiO2-blasted titanium implants. An experimental study on dogs.

The aim of the present study was to compare the anchorage of TiO2-blasted screw and cylindrical implants with conventionally used machine-produced screw and cylindrical implants inserted immediately in extraction sockets on dogs. 6 adult mongrel dogs had 3rd and 4th mandibular premolars extracted bilaterally and 24 commercial pure titanium implants were placed immediately in extraction sockets and covered with mucoperiosteum. Each dog had inserted 4 implants: 1 screw implant and 1 cylindrical implant blasted with titanium-dioxide-particles; 1 screw implant and 1 cylindrical implant with machine-produced (m.p.) surface (controls). After a healing period of 12 weeks, 16 implants from 4 animals were used for removal torque test, which demonstrated that significantly higher removal torque force was needed to unscrew the implants blasted with titanium-dioxide-particles, than the normal m.p. implants. The medians for the TiO2-blasted screw and cylindrical implants were > 150 Ncm and 105 Ncm, respectively, while the values for the m.p. implants were 60 Ncm and 35 Ncm, respectively. The SEM investigation demonstrated a high irregularity of the TiO2-blasted surface compared to the machined surface. The Ra and Rz values for surface roughness were higher for the TiO2-blasted implants than for the normal m.p. implants. Histomorphometrically, the arithmetic mean of the direct bone-implant contact fraction was 69%. There was no significant difference in direct bone-implant contact length fraction between TiO2-blasted implants and the control implants. The implants blasted with titanium-dioxide-particles in this study showed a better anchorage than implants with a machine-produced surface. The screw implants showed a better anchorage than the cylindrical implants.

Animals↗
PubMed1992

Putative periodontal pathogens on titanium implants and teeth in experimental gingivitis and periodontitis in beagle dogs.

The microflora around titanium implants and teeth in 4 beagle dogs was analyzed in order to follow the longitudinal development from healthy conditions to experimental gingivitis and periodontitis. A 2-month plaque control program was performed to establish healthy conditions on titanium implants and control teeth (baseline, day 0). Subgingival bacterial samples and radiographs were obtained. The plaque control was ceased and all measurements were repeated on day 21 (gingivitis). A new period of plaque control was initiated to re-establish healthy conditions (day 49). A cotton ligature was placed subgingivally around the implants and the control teeth to induce tissue breakdown. The ligatures were removed on day 91. The study was completed with registrations on day 121 (periodontitis). No significant microbiological difference was found between titanium implants and teeth in healthy conditions and in gingivitis and periodontitis. The mean total viable count increased 10 times on implants as well as on teeth. Streptococci were dominating at baseline: 40.2% on implants and 60.6% on teeth and decreased in gingivitis to 11.7% and 5.4%. When periodontitis had developed, the proportion of streptococci was < 1%. At baseline few Porphyromonas gingivalis and Prevotella intermedia were detected. They increased at gingivitis to 37.4% and 21.0%; when periodontitis developed, they comprised about 25.0%. Microbial colonization and establishment on titanium implants with healthy gingiva, experimental gingivitis and periodontitis follow the same pattern as on teeth.

Animals↗
PubMed1992

Healing-in of root analogue titanium implants placed in extraction sockets. An experimental study in the beagle dog.

The aim of these animal experiments was to characterize and evaluate the healing-in of root analogue titanium implants fitting with high precision to the alveolar wall. Four beagle dogs were used in the study. The roots of the 3rd and 4th mandibular premolars in both quadrants of 3 dogs and in 1 quadrant of 1 dog (dog 4) were extracted after hemisection. Each root was machine-copied to 1 titanium analogue. In dog 4, however, 2 titanium analogues were fabricated from each of the 4 extracted roots. This enabled insertion of analogues also into the contralateral sockets obtained by extraction of the corresponding roots immediately before implant installation, which was undertaken 2 weeks after the first extractions. Thus, in all, 32 analogues were implanted in their respective (or contralateral) sockets following ridge incision and elevation of mucoperiosteal flaps. The analogues were carefully covered by the repositioned flaps. In dog 4, 2 analogues from the immediate sockets and 2 from the 2-week sockets were surgically exposed and supplied with titanium crowns after a healing period of 2 months. The healing after implantation was evaluated by clinical, radiographic and histological measures after 2, 12 or 36 months. Two analogues (6%) were lost due to early (during the 1st week) exposure to the oral cavity. Another 2 analogues (6%) were, although not exposed, encapsulated by soft tissue and were easily removed with a surgical forceps. Twenty-eight analogues (88%) were healed-in by contact between bone and implant (osseointegration).(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Process↗
PubMed1997

Bioactive glass and calcium carbonate granules as filler material around titanium and bioactive glass implants in the medullar space of the rabbit tibia.

The effect of bioactive glass (BG) and calcium carbonate (CC) granules on bone formation around titanium and BG implants projecting into the medullary space of rabbit tibia was studied. The bone marrow tissue was removed and the medullary space was filled either with BG or CC (Biocoral) granules (phi 630-800 microns). Conical titanium and BG implants were inserted into the holes drilled in compact bone using the press fit-technique. Histomorphometry was used to measure the bone-biomaterial area in a 1.0 mm wide zone around the head of the implant and the contact between formed bone and implant. Significantly larger bone-biomaterial area was obtained around titanium implants using BG than CC granules while no difference was found in connection of BG implants. Better bone-implant contact was achieved with BG implants than with titanium implants regardless of the type of granules used. The results indicate that BG may prove to be useful as filler and coating material in connection of implants projecting into bone cavities.

Animals↗