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PubMed1998

Bone healing capacity of titanium plasma-sprayed and hydroxylapatite-coated oral implants.

The influence of surface quality, in particular surface topography and implant material, was evaluated by inserting titanium- and hydroxylapatite plasma-sprayed coated implants into the maxilla of 10 goats. Three types of plasma-spray coatings were applied to tapered, screw shaped implants; titanium plasma-spray coating (TPS), titanium plasma-spray coating with additional acid passivation (TPSA) and a bilayered coating (TPS/HA) consisting of titanium plasma-spray coating (TPS) and a hydroxylapatite part (HA). In addition, as-machined implants (TiM) were used as control. A total of 40 implants were inserted according a balanced split plot design. At the end of a 3-month healing period, it appeared that 5 implants (2 TPS, 1 TPSA, 1 TPS/HA and 1 TiM) were lost. Histological examination revealed a stronger bone response to TPS/HA coated implants. Even the TPS/HA coated implants induced bone formation on the part of the implant inserted into the sinus. No signs of delamination of the TPS coatings were visible. The HA part of the dual coating showed signs of degradation. Histomorphometrical analysis confirmed these findings. A significant difference in bone contact (P < 0.05) was measured between the TPS/HA coated implants and the other types of implants. Linear regression (r = 0.27) showed no correlation between the inscrew values at the base line and the bone contact measurements 3 months after healing. On the basis of these results, we can conclude that the chemical composition of the HA coating has a positive influence on the bone reaction. The influence of roughness is less evident.

Alveolar Process↗
PubMed1999

Chemical treatment of machined titanium surfaces. An in vitro study.

Microbial plaque accumulation on titanium dental implant surfaces can result in an inflammatory condition of the surrounding tissues. Cleaning of such a contaminated surface, in vivo, by means of a solution of amino-alcohol, following surgical exposure, has been proposed. However, the tissue healing following treatment resulted in formation of a fibrous capsule at the tissue-implant interface, i.e. improper implant re-integration. The present experiment was designed to investigate the possible influence of an amino-alcohol solution on machined titanium surface properties. Titanium samples with topography and chemical composition similar to the clinically used Brånemark implant surfaces were used in this experimental in-vitro study to investigate the adsorption of amino-alcohol to such surfaces, and the possibilities to chemically remove the adsorbed alcohols in order to recover a pristine titanium surface. The amino-alcohol solution was supplied to the sample surfaces and four different methods were subsequently used in order to remove the adsorbed alcohol molecules. It was shown that rinsing in water, saline solution, and 5% H2O2 did not remove the amino-alcohol from the surface. However, exposure to ozone produced by using a commercial mercury lamp in ambient air resulted in complete removal of the adsorbed amino-alcohol. The results show that the amino-alcohol used forms a stable and dense film at the implant surface in vitro. Presence of such a film most likely prevents re-integration to occur at the implant-tissue interface in vivo.

Adsorption↗
PubMed2001

Early endosseous integration enhanced by dual acid etching of titanium: a torque removal study in the rabbit.

Textured implant surfaces are thought to enhance endosseous integration. Torque removal forces have been used as a biomechanical measure of anchorage, or endosseous integration, in which the greater forces required to remove implants may be interpreted as an increase in the strength of bony integration. The purpose of this study was to compare the torque resistance to removal of screw-shaped titanium implants having a dual acid-etched surface (Osseotite) with implants having either a machined surface, or a titanium plasma spray surface that exhibited a significantly more complex surface topography. Three custom screw-shaped implant types - machined, dual acid-etched (DAE), and titanium plasma sprayed (TPS) - were used in this study. Each implant surface was characterized by scanning electron microscopy and optical profilometry. One DAE implant was placed into each distal femur of eighteen adult New Zealand White rabbits along with one of the other implant types. Thus, each rabbit received two DAE implants and one each of the machined, or TPS, implants. All implants measured 3.25 mm in diameter x 4.00 mm in length without holes, grooves or slots to resist rotation. Eighteen rabbits were used for reverse torque measurements. Groups of six rabbits were sacrificed following one, two and three month healing periods. Implants were removed by reverse torque rotation with a digital torque-measuring device. Three implants with the machined surface preparation failed to achieve endosseous integration. All other implants were anchored by bone. Mean torque values for machined, DAE and TPS implants at one, two and three months were 6.00+/-0.64 N-cm, 9.07+/-0.67 N-cm and 6.73+/-0.95 N-cm; 21.86+/-1.37 N-cm, 27.63+/-3.41 N-cm and 27.40+/-3.89 N-cm; and 27.48+/-1.61 N-cm, 44.28+/-4.53 N-cm and 59.23+/-3.88 N-cm, respectively. Clearly, at the earliest time point the stability of DAE implants was comparable to that of TPS implants, while that of the machined implants was an order of magnitude lower. The TPS implants increased resistance to reverse torque removal over the three-month period. The results of this study confirm our previous results that demonstrated enhanced bony anchorage to dual acid-etched implants as compared to machined implants. Furthermore, the present results indicate that dual acid etching of titanium enhances early endosseous integration to a level which is comparable to that achieved by the topographically more complex TPS surfaces.

Analysis of Variance↗
PubMed2001

Determining optimal surface roughness of TiO(2) blasted titanium implant material for attachment, proliferation and differentiation of cells derived from human mandibular alveolar bone.

In the complex process of bone formation at the implant-tissue interface, implant surface roughness is an important factor modulating osteoblastic function. In this study, primary cultures of osteoblast-like cells, derived from human mandibular bone, were used. The aim was to examine the effect of varying surface roughness of titanium implant material on cellular attachment, proliferation and differentiation. A recognized method of increasing surface roughness and enlarging the surface area of titanium implants is by blasting with titanium dioxide particles: the four specimen types in the study comprised surfaces which were machine-turned only, or blasted after turning, with 63-90 microm, 106-180 microm, or 180-300 microm TiO(2) particles, respectively. The specimens were analyzed by scanning electron microscopy and confocal laser scanning. The turned samples had the smoothest surfaces: average height deviation (S(a)) of 0.20 microm. The roughest were those blasted with 180-300 microm particles, S(a) value 1.38 microm. Blasting with intermediate particle sizes yielded S(a) values of 0.72 microm and 1.30 microm, respectively. Cell profile areas were measured using a semiautomatic interactive image analyzer. Figures were expressed as percentage of attachment. DNA synthesis was estimated by measuring the amount of [(3)H]-thymidine incorporation into trichloroacetic acid (TCA) insoluble cell precipitates. The specific activity of alkaline phosphatase was assayed using p-nitrophenylphosphate as a substrate. The ability of the cells to synthesize osteocalcin was investigated in serum-free culture medium using the ELSA-OST-NAT immunoradiometric kit. After 3 h of culture, the percentage of cellular attachment did not differ significantly between specimens blasted with 180-300 micromparticles and the turned specimens. All blasted surfaces showed significantly higher [(3)H]-thymidine incorporation than the turned surfaces (P<0.05), with the highest on the surfaces blasted with 180-300 microm particles. Osteocalcin synthesis by the cells in response to stimulation by 1,25(OH)2D3, was also significantly greater (P<0.05) on the surfaces blasted with TiO(2) particles. However, analysis of alkaline phosphatase activity disclosed no significant differences among the four surface modifications. It is concluded that in this cellular model, the proliferation and differentiation of cells derived from human mandibular bone is enhanced by surface roughness of the titanium implant. However, increasing the size of the blasting particles to 300 microm does not further increase the initial attachment of the cells compared to turned surfaces and those blasted with 63-90 microm particles.

Adolescent↗
PubMed2003

Enamel matrix derivative and titanium implants.

AIM: The aim of present study was to evaluate if an enamel matrix derivative (Emdogain) may enhance bone formation and osseointegration of titanium implants, using a well-documented rabbit model. MATERIAL AND METHODS: Thirty-six threaded commercially pure titanium (cp.ti.) implants were inserted in six New Zealand white rabbits. One implant was placed in each femur and two in each tibia. Prior to implant insertion approximately 0.5 mL of Emdogain (EMD) (test) or the vehicle gel (PGA: propylene glycol alginate) (control) was injected into the surgically prepared implant site. The follow-up time was 6 weeks. Biomechanical evaluations by resonance frequency analysis (RFA) and removal torque measurements (RTQ) were performed. Histomorphometrical quantifications were made on ground sections by measurements of the percentage of bone-to-metal contact, bone area inside the threads as well as outside the threads (mirror image). Bone lengths along the implant surface were also measured and used for shear strength calculations. RESULTS: The results demonstrated no beneficial effects from the EMD treatment on bone formation around titanium implants in any of the tested parameters. Significant differences were demonstrated with removal torque test and shear force calculations for the control implants. No other parameter demonstrated a statistically significant difference. CONCLUSION: The results of the present study may indicate that EMD does not contribute to bone formation around titanium implants. This observation may indicate that the bone formation that occurs after EMD treatment in periodontal defects is the result of functional adaptation. However, further research is required to evaluate the effect of EMD treatment on bone formation.

Animals↗
PubMed2004

High-aspect-ratio bulk micromachining of titanium.

Recent process developments have permitted the highly anisotropic bulk micromachining of titanium microelectromechanical systems (MEMS). By using the metal anisotropic reactive ion etching with oxidation (MARIO) process, arbitrarily high-aspect-ratio structures with straight sidewalls and micrometre-scale features have been bulk micromachined into titanium substrates of various thicknesses, ranging from 0.5-mm sheet down to 10-microm free-standing titanium foils. Bulk micromachined structures are generally free of residual stresses and are preferred when large, rigid, flat and/or high-force actuators are desired. However, so far there has been a limited ability to select materials on the basis of specific application in bulk micromachining, primarily because of the predominance of MEMS processes dedicated to single-crystal silicon, such as silicon deep reactive ion etching. The MARIO process permits the creation of bulk titanium MEMS, which offers potential for the use of a set of material properties beyond those provided by traditional semiconductor-based MEMS. Consequently, the MARIO process enables the fabrication of novel devices that capitalize on these assets to yield enhanced functionalities that would not be possible with traditional micromechanical material systems.

Manufactured Materials↗
PubMed1998

Effects of sodium hypochlorite on nickel-titanium Lightspeed instruments.

Sodium hypochlorite is a major irrigant in endodontics, and nickel-titanium instruments are gaining in popularity. This paper investigated the corrosion of nickel-titanium Lightspeed instruments in 1% and 5% NaOCl solutions. The instruments were immersed in ultrasonicated NaOCl solutions for varying times up to 1 h. Corrosion was determined by electrothermal absorption spectrometry in 100 microL aliquots of NaOCl. Background contamination of nickel in the 1% and 5% NaOCl solutions used was low, but high enough to interfere in detecting any increases in nickel after immersing the instruments. The amounts of titanium recorded in the 1% NaOCl solutions were insignificant. However, a statistically significant amount of titanium was detected from the Lightspeed instruments after immersion times of 30 and 60 min in 5% NaOCl. Clinically such instruments do not have an 'in situ' time of 30 min, and this corrosion may be considered irrelevant clinically.

Analysis of Variance↗
PubMed1998

The effect of sprue design on the marginal accuracy of titanium castings.

The purpose of this study was to measure the effects of sprue number and position on cast titanium crown margins. Twenty-four complete veneer crown wax patterns were fabricated on a stainless steel die with a 30 degrees bevel finish line. Twelve wax patterns were sprued with one 8-gauge wax sprue and the remaining 12-gauge double sprued. All patterns were invested with a phosphate bonded investment. Castings were made with a titanium casting machine following the manufacturer's instructions and using commercially pure titanium (> 99.5%) ingots. The castings were than carefully cleansed and the margins were examined with indirect impression technique. Data were analysed with an ANOVA and the Student's t-test with confidence level at 95%. The results revealed that the marginal discrepancy for the double sprueing group (32.1 +/- 12.8 microm) has significantly less discrepancy (P < 0.001) than the single sprueing group (49.8 +/- 16.4 microm). There was no statistically significant differences in marginal discrepancy between locations within the sprueing techniques (P > 0.05). An improvement in the degree of casting accuracy of titanium crown was indicated by the double sprue design used in this investigation.

Analysis of Variance↗
PubMed2000

Titanium for removable denture bases.

The aim of the present study was to compare titanium-base and resin-base maxillary complete dentures. In 13 patients with a maxillary complete denture with a titanium base (group I) and in 12 patients with a maxillary complete denture with a resin base (group II), the (a) patient's adaptation to the denture, (b) denture retention and (c) appearance of the mucosa under the denture were evaluated. In all cases, the adaptation was assessed with a questionnaire, while the retention and the appearance of the mucosa were assessed by clinical examination. None of the three measures considered (adaptation, retention and mucosa appearance) differed significantly between patients with titanium-base dentures and patients with resin-base dentures. Titanium bases are suitable for dentures likely to be subject to severe mechanical stresses (as in the case of maxillary complete dentures opposing natural teeth), and in patients who show hypersensitivity responses to other materials.

Acrylic Resins↗
PubMed2001

Preprosthetic vertical distraction osteogenesis of the mandible using an L-shaped osteotomy and titanium membranes for guided bone regeneration.

PURPOSE: Vertical osteodistraction is a new alternative method for alveolar ridge augmentation of the mandible. The purpose of this article is describe a technique using an L-shaped osteotomy and titanium membranes for guided bone regeneration (GBR) in the distraction gap. PATIENTS AND METHODS: Ten patients with severe atrophy of the edentulous molar region of the mandible underwent vertical callus distraction in 13 sites using intraoral microplate distractors. An L-shaped osteotomy with a short vertical part mesially and a longer horizontal part ending in the retromolar region was made, and the osteotomized segment was fixed to the mandibular ramus at its distal edge by a microplate, which became the center of rotation when distraction began. In this way, more callus generation could be achieved mesially than in the distal molar region. Follow-up computed tomography (CT) scans reconstructed axially to the axis of the mandible revealed semilunar excavations of the generated bone buccally in the distraction gap in the first cases. Clinical inspection on removal of the distractors showed fibrous connective tissue in the gap. Therefore, to prevent this from happening, titanium membranes covering the distraction gap were applied in subsequent cases. RESULTS: Ten patients (13 sites) were treated by vertical callus distraction. In 4 cases, GBR was achieved using titanium membranes. In all cases, the increase in alveolar height was sufficient to make dental implantation possible. In 1 patient, a fracture of the distractor occurred, and dehiscence was observed in 2 cases. These complications did not change the plan of therapy nor did they influence the results. The CT scans showed a homogenous surface on the regenerated mandible in the cases of GBR application. CONCLUSION: Both an L-shaped osteotomy and the application of titanium membranes for GBR in the distraction gap are of great value for mandibular augmentation, producing a physiologically shaped alveolar ridge.

Adult↗
PubMed2002

Titanium mesh and hydroxyapatite cement cranioplasty: a report of 20 cases.

PURPOSE: This article describes the use of titanium mesh and hydroxyapatite cement constructs for the treatment of large through-and-through calvarial defects. PATIENTS AND METHODS: Twenty consecutive calvarial defects (10 to 156 cm(2)) that resulted from surgical removal of neoplasms or were secondary to trauma were reviewed retrospectively after reconstruction with titanium mesh and hydroxyapatite cement. All patients were followed up by clinical examination and periodic radiographic studies for a minimum of 6 months (range, 6 months to 3 years). Three patients underwent biopsy of the construct at various points during their follow-up. RESULTS: There was no evidence of adverse healing, wound infection, or implant exposure or extrusion in any of the patients reviewed. Adequate 3-dimensional aesthetic restoration of calvarial contour was noted in each case. There was evidence of osseous ingrowth into the titanium mesh and hydroxyapatite cement construct in all 3 patients who underwent biopsy. CONCLUSION: Titanium mesh and hydroxyapatite cement cranioplasty appears to be a reasonable method for the reconstruction of significant calvarial defects.

Bone Cements↗
PubMed2002

A comparison of cemented and cementless titanium femoral components used for primary total hip arthroplasty: a radiographic and survivorship study.

Titanium has a low modulus of elasticity that makes it an attractive metal for femoral hip components. We directly compared 2 similar titanium stems, one cemented (n = 102 hips) and the other cementless (n = 78 hips), controlling for the most important surgical variables. The average radiographic follow-up was 6.7 and 7.0 years. Osteolysis below the joint line, zones 2 through 6, was 12.7% (13 of 102) in the cemented group and 0% in the cementless group (P<.001). There were 17 acetabular revisions in each study group. The cementless group had no femoral revisions, whereas 9 acetabular revisions in the cemented group had a simultaneous femoral revision (P=.005). Survivorship, defined as revision of the femur, was 84% for the cemented group and 100% for the cementless group at 10 years. Cementless titanium stems are more resistant to osteolysis and mechanical failure compared with similar cemented titanium stems.

Acetabulum↗
PubMed2000

Treatment of complex mandibular fractures using titanium mesh.

INTRODUCTION: The treatment of complex fractures with miniplates is often difficult and unsatisfactory. Such fractures include extremely atrophic mandibles, discontinuity defects, and marked comminuted fractures. AIM: With this paper we want to call to mind once more that titanium mesh is useful for the treatment of such fractures and its use can reduce the number of complications. PATIENTS: Between January 1996 and December 1998 we treated with titanium mesh 17 patients with fractures of extremely atrophic mandibles, mandibular discontinuity defects or comminuted fractures. RESULTS: Union occurred without complication in 70% of fractures treated with titanium mesh. In 20% there were minor complications such as postoperative haematoma. In only one case did infection occur, a more severe complication. CONCLUSION: Because of its geometry and the excellent physical and biomechanical properties, titanium mesh helps to achieve better stabilization of complex mandibular fractures than conventional miniplates do. Complications such as infection and non union can largely be avoided and bony continuity of the mandible can be restored.

Adolescent↗
PubMed2005

[Improved fixation of finger prostheses by means of intramedullary titanium anchors and magnets].

BACKGROUND: A small series of patients with traumatic amputation of fingers have undergone treatment with a new technique using endomedullar osseointegrated titanium implant device that magnetically holds the finger prosthesis. METHODS: A two-stage reconstruction procedure with endomedullar osseointegrated titanium implants was performed to attach a finger prosthesis to the proximal, middle and distal phalanx. The first stage included implantation of the titanium fixture into the medullary cavity canal of the phalanx. After a 2-month rest period to allow the fixture to firmly osseointegrate with the phalanx of the bone, a skin-penetrating titan-magnetic abutment was placed on top of the fixture, to which the prosthesis was firmly attached. RESULTS: Good stability could be achieved using an endomedullar osseointegrated prosthesis. Easy handling is possible with the magnetic connection between finger and prosthesis. In the clinical use were no complications observed. We observed no infections and no problems with the soft tissue. CONCLUSIONS: The combination of osseointegrated titanium implants and magnetics for finger prosthetics provides several advantages. Such as stable fixation of the prosthetic finger to the bone, restoration of some sensory feedback with better osseoperception as well as an excellent cosmetic result.

Adult↗
PubMed1996

[Replacement of ear ossicles with titanium prostheses].

BACKGROUND: Titanium has been a well established implant material for many years. New material processing techniques now permit the manufacture of small implants for ossicular chain reconstruction. METHODS: Between November 1994 and September 1995, 100 titanium middle ear implants (55 PORP, 45 TORP) were used for reconstruction of the ossicular chain. A range of five different sizes for partial and total protheses suits all implantation needs. The shape of the implants can be altered by bending. Time consuming intraoperative shaping and trimming is avoided. RESULTS: At a follow-up time of three months (33 patients) and six months (17 patients), no adverse reactions or extrusions occurred. Biologic fixation between the foot of the partial prothesis and the head of the stapes was found eight months after implantation. A hearing result of 0-20 dB residual air-bone gap was achieved in 79%. CONCLUSION: Titanium middle ear implants show good bio-compatibility and are readily integrated into the ossicular chain. Although delicate in shape, they offer excellent mechanical properties in respect to sound conduction and implantation. Initial results show Titanium to be a perfect implant material for middle ear prostheses, although long-term results are not yet available.

Auditory Threshold↗
PubMedDate not supplied

[Experimental results of stepped titanium shafts for hip endoprostheses].

Among the materials which can be used for hip prostheses to be implanted without bone cement, ceramics and titanium possess the best overall properties for insuring long-term stability in the light of present knowledge. However, considered separately, the two materials are most suitable for different special requirements. Results of long-term animal experiments conducted by different working groups on functionally stressed hip and tooth-root implants made of bio-inert Al2O3 ceramic and titanium have furnished knowledge of the possibilities and limitations of the adaptation reaction of the bone tissue. The present authors investigated whether, by combining Al2O3 ceramic and titanium, a cement-free total hip replacement can be adapted to specific local stresses, taking biomechanical rules and anatomical factors into account. In recent experimental series it proved possible to limit the problems which had occurred in previous series, reported elsewhere. Positive results in dogs led to a human implant which has so far been used 15 times, with Al2O3 (FRIALIT) acetabula and heads, which have been implanted successfully for a number of years, in combination with the new stepped titanium shaft. In addition to a short review of follow-up findings thus far, the results of the experimental investigations are presented.

Animals↗
PubMed1999

Multilevel vertebral body replacement with a titanium mesh spacer for aneurysmal bone cyst: technical note.

A 64-year-old male presented with abrupt tetraparesis caused by a minor impact. Diagnostic images obtained on admission showed an aneurysmal bone cyst visible in the cervical spine at the fourth to upper sixth level, although the patient had been wearing a halo brace to diminish the symptoms. The vertebral body from the fourth to the sixth level was dissected, and this space was packed with a titanium cage filled with ceramic bone fragments mixed with fibrin glue. The combination of a titanium cage and an anterior locking plate can be made easily for anterior spinal fusion with enough rigidity to maintain the necessary space during fusion without any major support equipment. Both edges of the titanium mesh cage cut into the vertebral body to hold the cage in place. The other part, the titanium plate, makes it secure until ceramic bone fragments in the cage promote bony ingrowth for fusion.

Bone Cements↗
PubMed2001

Adhesion receptors of polymorphonuclear granulocytes on titanium in contact with whole blood.

Titanium sheets were exposed to whole blood, and the TiO(2) surface was investigated regarding the presence of cells, receptor expression on adherent polymorphonuclear (PMN) granulocytes, and the ability of these cells to mount a respiratory burst when challenged with opsonized zymosan. The techniques used were immunofluorescence with computer-aided image analysis and chemiluminescence. Surface coverage of erythrocytes (9% to 10%), granulocytes (9% to 14%), and platelets (1% to 4%) dominated during the first 2 hours of blood contact. PMN granulocyte adhesion to titanium was associated with a rapid decrease in L-selectin expression within 16 minutes. Initially FcgammaIII receptor (CD16) expression dominated on the adherent cells. After 30 minutes, a shift toward integrin expression (CD11b) was found on the adherent cells. All investigated receptors were down-regulated within 1 hour of blood-titanium contact. Attempts were made to inhibit the initial adhesion of PMN granulocytes to titanium by adding specific antibodies or 2,3-diphosphoglyceric acid (phospholipase D inhibitor) to blood before surface contact. Adding anti-CD16 resulted in a 67% reduction in cell adhesion, whereas a 35% reduction was found with 2,3-diphosphoglyceric acid. No spontaneous respiratory burst was detected from adherent PMN granulocytes residing on the TiO(2) surface. The cells were, however, able to mount a respiratory burst in response to opsonized zymosan.

Biocompatible Materials↗