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Determining optimal dose of laser therapy for attachment and proliferation of human oral fibroblasts cultured on titanium implant material.

The purpose of this study was to investigate the influence of single or multiple doses of low-level laser therapy (LLLT) on attachment and proliferation of human gingival fibroblasts in a standardized, reproducible in vitro model. Titanium discs were randomly allotted to one of three groups: group I served as a control, group II was exposed to a single laser dose of 3 J/cm2, and the three subgroups in group III were exposed to laser doses of 0.75, 1.5, and 3 J/cm2. To examine the possible thermal effects of laser exposure on the cell culture, the temperature in the Petri dish was measured for every dose used, before and during irradiation. For attachment assays, groups II and III were exposed to laser irradiation and then seeded onto titanium discs. In group III, the exposures were repeated after 3 and 6 h. Cells were cultured for 6 and 24 h and stained with Hoechst and Propidium. Attached cells were counted under a light microscope. To investigate the effect of LLLT on cell proliferation after 48 h, 72 h, and 7 days, cells were cultured on titanium discs for 24 h and then exposed to laser irradiation for 1 day and 3 consecutive days, respectively. Cell proliferation was determined by counting cells under the microscope and by a cell proliferation enzyme-linked immunosorbent assay system. No increase of temperature of the cell cultures occurred before or during laser exposure at any of the doses tested. Both single and multiple doses of LLLT significantly enhanced cellular attachment (p<0.05). The proliferation assays showed higher cell proliferation (p<0.05) in group III at doses of 1.5 and 3 J/cm2 after 72 h and 7 days, with agreement between staining and enzyme-linked immunosorbent assay. It is concluded that, in this cellular model, the attachment and proliferation of human gingival fibroblasts are enhanced by LLLT in a dose-dependent manner.

Cell Adhesion↗

Enhancing surface free energy and hydrophilicity through chemical modification of microstructured titanium implant surfaces.

Roughness-induced hydrophobicity, well-known from natural plant surfaces and intensively studied toward superhydrophobic surfaces, has currently been identified on microstructured titanium implant surfaces. Studies indicate that microstructuring by sandblasting and acid etching (SLA) enhances the osteogenic properties of titanium. The undesired initial hydrophobicity, however, presumably decelerates primary interactions with the aqueous biosystem. To improve the initial wettability and to retain SLA microstructure, a novel surface modification was tested. This modification differs from SLA by its preparation after acid etching, which was done under protective gas conditions following liquid instead of dry storage. We hypothesized that this modification should have increased wettability due to the prevention of contaminations that occurs during air contact. The main outcome of dynamic wettability measurements was that the novel modification shows increased surface free energy (SFE) and increased hydrophilicity with initial water contact angles of 0 degrees compared to 139.9 degrees for SLA. This hydrophilization was kept even after any drying. Reduced hydrocarbon contaminations were identified to play a possible role in altered surface thermodynamics. Such surfaces aim to retain the hydrophilicity and natural high surface energy of the Ti dioxide surface until surgical implants' insertion and are compared in this in vitro study with structural surface variants of titanium to compare roughness and chemically induced wettability.

Acids↗

The effects of titanium and polymethylmethacrylate particles on osteoblast phenotypic stability.

Wear particles generated following total joint arthroplasty interact with cells at the periprosthetic margin and induce an inflammatory response that contributes to osteolysis, aseptic loosening, and implant failure. This study examined the long-term effects of particles from two commonly implanted materials, titanium (Ti) and polymethylmethacrylate (PMMA), on cell viability and metabolism over a 21-day time course, using the human osteoblast-like cell line MG-63. Addition of particles was not associated with increased cell death or nitric oxide production at the particle concentration chosen. Collagen production was increased with exposure to titanium particles, whereas alkaline phosphatase and osteocalcin expression remained unchanged following exposure to both types of particles. The data show that titanium but not PMMA particles shifts bone cell metabolism to preferentially produce fibrous tissue rather than bone.

Biocompatible Materials↗

Collagen I-coated titanium surfaces: mesenchymal cell adhesion and in vivo evaluation in trabecular bone implants.

The goal of the study was the evaluation of the effect of modification of titanium implants by acrylic acid surface grafting-collagen I coupling. Tests were performed on titanium samples treated by galvanostatic anodization to create a porous surface topography. Surface characterization by X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM) confirms the biochemical modification of the surface and shows a surface topography characterized by pores mostly below 1 mum diameter. In vitro evaluation involving human mesenchymal cells shows enhanced cell growth on collagen coated surfaces as compared to titanium ones. Four weeks in vivo evaluation of implants in rabbit femur trabecular bone shows improvements of bone-to-implant contact, while improvement of bone ingrowth is slightly not significant (p = 0.056), when compared to the control. Overall, these data indicate that integration in trabecular, or cancellous, bone can be enhanced by the surface collagen layer, confirming previous findings obtained by modification of machined surfaces by the same approach in cortical bone implants.

Animals↗

Enhancement of in vitro osteogenesis on titanium by chemically produced nanotopography.

The surface characteristics of biomaterials can influence protein adsorption, cellular functions, and ultimately tissue formation. Controlled chemical oxidation of titanium-based surfaces with a mixture of H(2)SO(4)/H(2)O(2) creates a nanopatterned surface that has been shown to affect early osteogenic events. The objective of this study was to evaluate the effect over time of this nanopattern on various key parameters of osteogenesis, and determine whether these effects ultimately translate into more mineralized matrix production. Osteogenic cells were obtained by enzymatic digestion of newborn rat calvaria and grown on treated and untreated titanium discs for periods of up to 14 days. Alkaline phosphatase activity peaked earlier and cell number was higher as of day 7 on the nanopatterned discs. Immunofluorescence showed that the treated surface favored early bone sialoprotein and osteopontin secretion, and fibronectin accumulation. Alizarin red staining revealed that, at days 10 and 14, there were significantly more mineralized nodules on treated than on untreated discs. These results demonstrate that simple chemical treatment of titanium with H(2)SO(4)/H(2)O(2) accelerates the in vitro osteogenic potential of calvaria-derived cells. They also suggest that this treatment may represent an advantageous approach for producing "intelligent surfaces" that stimulate bone formation and enhance bone-implant contact.

Animals↗

Use of injectable calcium-phosphate cement for the fixation of titanium implants: an experimental study in goats.

This in vivo study evaluated the fixation of two types of titanium implants with the use of an injectable calcium-phosphate (CaP) cement. The cement was either used to create a cement mantle (Type A implant) or as an additive to press-fit placed titanium plasma sprayed implants (Type B implant). The implants were placed in trabecular bone of the medial femoral condyle of goats and left in place for 2 and 10 weeks. Mechanical evaluation of the implant fixation was done by torque testing. This showed that for the Type A implants the calcium-phosphate cement's performance was significantly inferior (P < 0.05) to that of polymethylmethacrylate cement fixation. For the two-week Type B implants a significant increase (P < 0.05) in failure load was found for calcium-phosphate cemented implants compared with just press-fitted Type B implants. Histological evaluation revealed that for Type A implants, failure during torque testing occurred at the implant-cement interface. In contrast, for Type B implants, failure occurred in the bone-implant interface for press-fit-placed devices and in the cement layer for CaP-cemented devices. Further, the CaP cement was found to be overgrown with new formed bone already after 2 weeks of implantation. The cement showed resorption due to regular bone remodeling. On the basis of these observations, it was concluded that the use of injectable CaP cement might facilitate earlier loading of press-fit inserted titanium implants. Nevertheless, the results have to be confirmed in dynamical mechanical as well as loaded in vivo studies.

Animals↗

Porous titanium-nickel for intervertebral fusion in a sheep model: part 2. Surface analysis and nickel release assessment.

Porous titanium-nickel (PTN) devices represent an alternative to traditional cage implants. PTN materials possess an interconnecting network of pores with capillarity properties that may promote bone ingrowth, long-term fixation, and intervertebral fusion without the need for bone grafting. However, their considerable surface area and nickel content may elicit concerns over sensitization potential. Therefore, PTN surface corrosion and nickel release resistance must be carefully studied. To evaluate this possibility, a PTN interbody fusion device (IFD) was compared to a conventional nonporous cage made of TiAlV, a well-known biocompatible biomaterial, in a sheep model. PTN and TiAlV IFDs were inserted at two non-contiguous lumbar sites for 3, 6, and 12 months postsurgery. Their surface was then evaluated by scanning electron microscopy (SEM) combined with backscattered electron analysis (BSE). No evidence of surface corrosion was observed either pre- or postimplantation, regardless of device type. Dosage of nickel ions was also performed with the use of inductively coupled plasma-mass spectrometry (ICP-MS). Blood nickel levels were observed to be within acceptable levels at all postinstrumentation times. Nickel content in PTN-adjacent tissue, as well as in detoxification and remote organs, was equivalent both in PTN-treated and control sheep. Therefore, porous titanium-nickel demonstrated resistance to both in vivo surface corrosion and nickel ion release and compared very well with a conventional titanium implant in the course of a 12-month sheep study.

Alloys↗

Characteristics of titanium-coated polyester prostheses in the animal model.

Commercially available polyester vascular prostheses (n = 6) in the control group (CG) and titanium-coated vascular prostheses (TP; n = 7) were interposed within the infrarenal aorta of pigs. The respective healing characteristics and patency rates were compared after 3 months. For evaluation purposes, macroscopic, histological, and immunohistochemical criteria were applied. The macroscopic evaluation revealed complete healing of the TP in comparison with the CG. Extraluminal inspection revealed prominent firm cicatricial tissue in the prosthesis bed of the TP group. All TP were occluded. In the CG, occlusion of the prostheses occurred in n = 1 (16 %). On average, neointimal hyperplasia (NIH) in the proximal part of the anastomosis was not significantly different to the CG. The extraluminal proliferation index (Ki67) was reduced in the TP group (p = 0.002). The immunohistochemical analysis of intraluminal changes revealed no significant differences between CG and TP. All of the titanium-coated polyester vascular prostheses were found to be occluded. The additional coating of polyester prostheses with titanium would not appear to be of any particular benefit.

Animals↗

In vivo performance of two different hydroxyapatite coatings on titanium prepared by discharging in electrolytes.

This study reports a discharging method for bone-like carbonated HA (cHA)-coating (Ca/P 1.71) and stoichiometric HA (sHA)-coating (Ca/P 1.67) with micrometer order thicknesses on titanium plates, using modified body fluid and acidic calcium phosphate solutions, respectively. In vivo histological performance of the HA coatings prepared by discharging in electrolytes was evaluated. Bone-contact indexes of HA coatings were measured microscopically. Additionally, bone-coating interface was analyzed by scanning electron microscopy and the use of an electron probe microanalyzer. Results demonstrated that there was no significant difference in contact index between HA coatings. However, the cHA coating was practically replaced by immature bone, and the titanium metal substrate was directly connected to the bone structure whereas the sHA coating layer remained and was partially detached from the titanium metal substrate. Since detached coating particles are pathogens, and can cause peri-implantitis, the cHA coating was more favorable than the sHA coating even if contact index was equivalent to that of the sHA coating. It is thought that coating thickness and chemical composition of coatings are important for biological stability of implants. In conclusion, since bone-like thin cHA coating showed high osteoconductivity and bone replacement, bone-like HA is superior to sHA coating for use in dental implants.

Coated Materials, Biocompatible↗

Bone response to hydroxyapatite-coated and commercially pure titanium implants in the human arthritic knee.

Rough and smooth commercially pure (c.p.) titanium implants and hydroxyapatite-coated (HA-C) implants were inserted in arthritic human knees and left in situ in order to compare the response of bone to these three implants. Radiographic examination alone could not determine if bone apposition had occurred. After 3 and 6 months, histomorphometric analyses of undecalcified sections, 10 microns thick, revealed a statistical significance in the amount of bone apposition to rough-surfaced and HA-C implants as compared with smooth uncoated implants. Most of the rough-surfaced c.p. titanium implants and the HA-C implants had achieved bone apposition on the order of 50%. No statistically significant differences in apposition were seen between the rough-surfaced and HA-C implants. The smooth c.p. titanium implants were mostly encapsulated in fibrous tissue.

Arthritis↗

Migration of press-fit cups fixed with poly-L-lactic acid or titanium screws: a randomized study using radiostereometry.

The early migration of porous acetabular cups was studied in 43 patients with osteoarthrosis. The patients were randomly allocated to additional fixation of the cup with either biodegradable poly-L-lactic acid screws or titanium screws. Radiostereometric evaluation was done during the first 2 years after the procedure in 43 hips (23 with poly-L-lactic acid screws and 20 with titanium screws). At the 2-year follow-up, cups fixed with poly-L-lactic acid screws had migrated significantly more in the proximal-distal (p < 0.05) and medial-lateral (p < 0.05) directions. Cups with titanium screws displayed more pronounced rotations around the longitudinal axis (p < 0.05). Postoperatively, on the lateral view, there was an increased occurrence of radiolucencies at the dome of the cups fixed with poly-L-lactic acid screws (p < 0.05). The clinical result did not differ between the two groups. Inferior implant-bone contact in the poly-L-lactic acid group, local changes of the bone quality, and diminishing support of the poly-L-lactic acid screws caused by their degradation with time could be reasons for the different pattern of migration observed.

Acetabulum↗

Human monocyte/macrophage response to cobalt-chromium corrosion products and titanium particles in patients with total joint replacements.

The responses of human peripheral blood monocytes of 10 normal volunteers and 14 patients with total hip replacements to particles of commercially pure titanium and chromium orthophosphate (a corrosion product from cobalt-chromium alloy implants) were studied. In addition, these phagocytosable particles were added to cultured mononuclear cells isolated from the interfacial membrane of 14 patients with failed implants. Peripheral blood monocytes from patients who had had a total hip replacement produced significantly higher levels of interleukin-1 (both interleukin-1 alpha and interleukin-1 beta) and prostaglandin E2 following particulate stimulation than those from normal volunteers. Supernatants from both titanium and chromium orthophosphate-stimulated peripheral blood monocytes from the volunteers and patients with total hip replacement induced bone resorption (assayed in organ cultures of newborn mouse calvariae) and the proliferation of human fibroblasts. The levels of bone resorption were significantly higher (p < 0.05) in patients with implants than in normal volunteers. There were no significant differences in the responses of cells between patients with focal osteolysis and those without osteolysis. Interfacial membrane mononuclear cells also produced high levels of interleukin-1 alpha, interleukin-1 beta, and prostaglandin E2 and expressed bone resorptive activities following stimulation with either titanium or chromium orthophosphate. More importantly, interfacial membrane mononuclear cells "spontaneously" produced high levels of prostaglandin E2 that were comparable with the response of peripheral blood monocytes stimulated with particulate wear debris. The clinical relevance of this study is 2-fold. First, mononuclear cells from patients with total hip replacement were some-how "sensitized" to metal particles in comparison with mononuclear cells from individuals without an implant. Second, the chromium orthophosphate corrosion product was a potent macrophage/monocyte activator and may contribute to macrophage-mediated osteolysis and aseptic loosening.

Adult↗

Rapid neurorrhaphy with titanium clips.

The purpose of this study was to evaluate the usefulness of titanium clips in the repair of transected peripheral nerves. The results of neurorrhaphy using titanium clips (VCS) were compared with the conventional technique of neurorrhaphy using nylon sutures. Transected sciatic nerves in 15 New Zealand white rabbits were repaired with VCS clips on one side and interrupted 9-0 nylon sutures on the other. The average time required for neurorrhaphy using the clip closure was 8.7 +/- 2.6 min, and this was shorter than the suture closure, which took 14.9 +/- 3.6 min (P < 0.01). Electromyographic studies revealed no significant differences in amplitudes of compound motor action potentials in both groups. Also, the number and extent of myelinizations of regenerated axons were not significantly different in both methods of nerorrhaphies. These results demonstrate that microscopic neurorrhaphy using titanium clips is a potential alternative to conventional neurorrhaphy using sutures.

Animals↗

Le Fort I miniplate osteosynthesis: a randomized, prospective study comparing resorbable PLLA/PGA with titanium.

The aim of this study was to compare the use of resorbable osteosynthesis material (LactoSorb) with titanium osteosynthesis for the fixation of Le Fort I osteotomies with respect to long-term stability and morbidity. To achieve exact cephalometric measures, five tantalum micro implants were inserted in the maxilla during surgery. A total of 60 patients undergoing a non-segmented Le Fort I osteotomy were randomized to one of the treatments and were followed for 1 year postoperatively. For the osteotomies fixated with LactoSorb, the lateral cephalometric analysis demonstrated a statistically significant difference in the vertical position of the maxilla after 6 weeks as the position became more superior compared with the postoperative situation (mean change of 0.6 mm). In the titanium group no significant changes in position were observed. There were no statistically significant changes in the position of the maxilla from 6 weeks to 12 months in either of the treatment groups. The changes in maxillary postion were not clinically noticeable in either of the treatment groups, and all treatments were completed with satisfactory results. There were two cases of infection and wound dehiscence in the LactoSorb group, whereas titanium osteosynthesis was more often palpable after 6-12 months and required surgical removal in three cases.

Absorbable Implants↗

Bone formation in porous implants of delrin and commercially pure titanium.

Clinicians have been using implants made by titanium or delrin with varying results. In this study dividable implants, bone growth chambers (BGC), of titanium and delrin were inserted into the rabbit tibia. The ingrowth of hard tissue into a canal in the implant was evaluated after 3 weeks by microradiography and numerically determined by computer analysis. Results showed that bone ingrowth into titanium implants was significantly larger than into delrin implants (P less than 0.005). The possible reasons for this are discussed.

Animals↗

In vitro evaluation of platinum, titanium and ruthenium metal complexes in cisplatin-sensitive and -resistant rat ovarian tumors.

The antitumor activity of eight new metal complexes (three platinum, one titanium, four ruthenium derivatives) was investigated in a cisplatin (DDP)--sensitive (O-342) and a DDP-resistant (O-342/DDP) ovarian tumor line using the bilayer soft-agar assay. A continuous exposure set up at logarithmically spaced concentrations was used to test the drugs; to uncover possible pharmacokinetic features, a short-term exposure was additionally included for selected compounds. DDP served as the reference drug. The following compounds were investigated: 18-crown-6-tetracarboxybis-diammineplatinum(II) (CTDP), cis-aminotrismethylenephosphonato-diammine-platinum(II) (ADP), cis-diamminecyclohexano-aminotrismethylenephosphonato-platin um(II) (DAP), diethoxybis(1-phenylbutane-1,3-dionato)titanium(IV) (DBT, budotitane), trans-imidazolium-bisimidazoletetrachlororuthenate(III) (ICR), trans-indazolium-tetrachlorobisindazoleruthenate(III) (IndCR), cis-triazolium-tetrachlorobis-triazoleruthenate(III) (TCR) and trans-pyrazolium-tetrachlorobispyrazoleruthenate(III) (PCR). Of the new metal complexes, CTDP was the most active compound in O-342, resulting in a percentage of control plating efficiency (+/- SE) of 1 +/- 1, 12 +/- 8 and 40 +/- 21 following continuous exposure to 10, 1 and 0.1 microM, respectively, and was thus comparable to DDP at equimolar concentrations. In the resistant line, 10 microM CTDP reduced colony growth to 18% +/- 8%, whereas an equimolar concentration of DDP effected a reduction to 26% +/- 9%. During short-term exposure. CTDP was inferior to DDP, which may be ascribed to the stability of the bis-dicarboxylate platinum ring system. The titanium compound DBT, in contrast, showed promising effects at its highest concentration (100 microM) during short-term exposure in both lines; at this concentration the activity in O-342/DDP was higher than that in O-342 (7% +/- 7% vs 34% +/- 17% of control plating efficiency at 100 microM). All ruthenium complexes showed higher activity in the resistant line O-342/DDP than in the sensitive counterpart. ICR was the most active compound. Following continuous exposure of O-342/DDP cells to 10 microM ICR, colony growth was reduced to 18% +/- 4% that of controls. Further studies should concentrate on CTDP and ICR for the following reasons; the activity of CTDP was equal to that of DDP at equimolar concentrations during continuous exposure; considering that the in vivo toxicity of DDP was 3-fold that of CTDP, an increase in the therapeutic index of CTDP would be expected. ICR showed the best effect of all ruthenium complexes; it was superior to DDP in the resistant line.

Animals↗

Titanium, silver, and tantalum clips in brain tissue.

The brain tissue reaction to a recently devised titanium haemoclip and to the conventional silver and tantalum clips were investigated in rabbit brain. Titanium, silver, and tantalum wires 5 X 0.5 X 0.5 mm in size were implanted into the white matter of the brain. After one and six months the brain specimens were sectioned, stained with haematoxylin eosin and with phosphotungstic acid Haematoxylin, and were studied by light microscopy. The examination revealed neither tissue reaction nor pigmentation in the case of titanium implant, while there was pigmentation surrounding the tantalum, and there was pigmentation as well as reactive gliosis around the silver wires.

Animals↗

[The shearing strength of titanium brackets depending on the coating procedure].

It has long been recognized that corrosion of the metal alloys used in the different fields of dentistry can cause intra-oral problems such as allergic reactions. Titanium, a metal all but impervious to corrosion, presents an alternative to the metal alloys used in the fabrication of orthodontic brackets. The purpose of this study was to test the bonding strength between titanium brackets treated with 5 different opaque and non-opaque coatings and a 2-phase adhesive. Five coating methods were tested: N1 (Dentaurum), N2 (Dentaurum), Rocatec (Espe), Sebond (Schütze), Silicoater Standard (Kulzer). After bonding the brackets with a mix adhesive, they were thermocycled and then the shear bonding strength established. Silicoated titanium bracket bases showed clinically acceptable bonding values with the exception of those coated with Sebond without opaquer layer. While the silicoating methods N1, N2, and Rocatec demonstrated minimum bonding strength using the opaquer Visio-Gem, the bonding strength of the bracket bases coated with Sebond MKV, Silicoater Standard and the opaquer appropriate to each was significant increased. Among all the coated surfaces, methods N1, N2, and Rocatec appear to establish the optimum bonding strength values. In addition, the thin opaquer layer (Visio-Gem) used together with these methods offers a good surface adaptation of the bracket to the tooth surface.

Dental Bonding↗