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Composite titanium dental implant fabricated by electro-discharge compaction.

An electro-discharge compaction (EDC) fabrication window was established for producing commercially pure porous titanium dental implants of 4 mm diameter and 7 mm length with a solid titanium cap. The optimum input energy was in the range of 0.58-0.87 kJ g-1 for a powder column of 0.500 g. Input energy greater than 0.58 kJ g-1 resulted in an implant torque strength exceeding 30 N-cm (the retaining screw tightening torque), while input energy greater than 0.72 kJ g-1 exceeded 46.7 N-cm torque strength (at this level the retaining screw failed prior to the implant). The integrity of the internally threaded hole and hexagonal head of the cap were maintained throughout the EDC process. The EDC process did not after the strength and/or microstructure of the components, and the bead-cap interface was stronger than the bead-bead interface. EDC implants produced within the aforementioned window have sufficient compressive strengths and other physical properties to meet the requirement for titanium dental implants.

Biocompatible Materials↗

alpha-Amylase and salivary albumin adsorption onto titanium, enamel and dentin: an in vivo study.

In vivo adsorption of salivary albumin and alpha-amylase onto titanium, enamel and dentin was analysed following their exposure to the oral cavity for 2h. Oral appliances in six adults served as a platform for carrying 4-mm discs of the three materials. Adherent proteins were eluted from the discs and the amounts of salivary albumin and alpha-amylase were measured by an enzyme-linked immunosorbent assay. While significant difference between the adsorption of albumin and alpha-amylase onto enamel as compared with dentin was observed, adsorption onto titanium was significantly lower. A sample of whole saliva was also collected from each participant. The mean total amounts of albumin and alpha-amylase in the participants' whole saliva were 0.03 and 0.54 mg ml-1, respectively. Titanium adsorbed significantly less (4.43%) of the total albumin than did enamel (14.30%) or dentin (18.80%). No significant difference was found in the relative amounts of alpha-amylase adsorbed by the three materials. This significantly selective adsorption of proteins may enable the attachment of specific bacteria and thus alter the composition of the dental plaque and its potential pathogenicity.

Adsorption↗

Apatite deposition on titanium surfaces--the role of albumin adsorption.

Titanium implant surfaces are known to spontaneously nucleate apatite layers when in contact with simulated body fluids. However, adsorption of proteins may influence the process of apatite layer formation. In this study the role of bovine serum albumin (BSA) adsorption in the process of apatite deposition on titanium substrates is investigated. Deposition of calcium phosphate was induced by immersing titanium substrates in a Hank's balanced salt solution (HBSS) for times ranging from 1 to 23 days. The resulting substrates were studied by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), X-ray photoelectron spectroscopy (XPS), wettability measurements and electrochemical impedance determinations. All these methods indicate the presence of a calcium phosphate layer. The same procedure was repeated substituting HBSS with a solution of BSA in HBSS. Although SEM, EDS and electrochemical impedance spectra do not reveal the presence of an apatite layer, XPS analysis strongly indicates that the inhibition of apatite formation by BSA is only partial. The competition between BSA adsorption and apatite deposition seems to lead to a mixed film where the protein co-exists with calcium phosphate. Wettability studies suggest that this surface film is heterogeneous and porous, similar to the thicker films formed in albumin-free HBSS.

Adsorption↗

In vitro corrosion of titanium.

Titanium is used in dentistry for implants and frame work because of its sufficient chemical, physical and biological properties. The corrosion behaviour is from high interest to value biocompatibility. A static immersion test was undertaken with a titanium test specimen (30 mm x 10 mm x 1 mm, immersion time = 4 x 1 w, n = 3 for each series). The following parameters were investigated: specimen preparation, grinding, pH-value, different casting systems, comparison with CAD/CAM, influence of: chloride, thiocyanate, fluoride, lactate, citrate, oxalate, acetate. Atomic absorption spectroscopy was used to analyse the solutions weekly. The course of corrosion was investigated photometrically. Titanium reveals ion releases [(0.01-0.1) microg/(cm2 x d)] in the magnitude of gold alloys. There is little influence of grinding and casting systems in comparison with organic acids or pH value. The ion release increases extreme (up to 500 microg/(cm2 x d)) in the presence of fluoride. Low pH values accelerate this effect even more. Clinically, no corrosion effects were observed. Nevertheless it is recommended that it is best to avoid the presence of fluoride or to reduce contact time. In prophylactic fluoridation of teeth, a varnish should be used.

Anions↗

Titanium containing amorphous hydrogenated carbon films (a-C: H/Ti): surface analysis and evaluation of cellular reactions using bone marrow cell cultures in vitro.

Amorphous hydrogenated carbon (a-C : H) coatings, also called diamond-like carbon (DLC), have many properties required for a protective coating material in biomedical applications. The purpose of this study is to evaluate a new surface coating for bone-related implants by combining the hardness and inertness of a-C : H films with the biological acceptance of titanium. For this purpose, different amounts of titanium were incorporated into a-C : H films by a combined radio frequency (rf) and magnetron sputtering set-up. The X-ray photoelectron spectroscopy (XPS) of air-exposed a-C : H/titanium (a-C : H/Ti) films revealed that the films were composed of TiO2 and TiC embedded in and connected to an a-C : H matrix. Cell culture tests using primary adult rat bone marrow cell cultures (BMC) were performed to determine effects on cell number and on osteoblast and osteoclast differentiation. By adding titanium to the carbon matrix, cellular reactions such as increased proliferation and reduced osteoclast-like cell activity could be obtained, while these reactions were not seen on pure a-C : H films and on glass control samples. In summary, a-C : H/Ti could be a valuable coating for bone implants, by supporting bone cell proliferation while reducing osteoclast-like cell activation.

Analysis of Variance↗

Titanium dioxide ceramics control the differentiated phenotype of cardiac muscle cells in culture.

A new approach, the cultivation of heart muscle cells on biocompatible scaffolds made from titanium dioxide ceramics was established to provide a mechanism for in vitro engineering of a vital heart tissue. Terminally differentiated ventricular myocytes isolated from hearts of adult rats were kept in primary culture for long periods of time and used as an experimental model. The microenvironmental properties of titanium dioxide ceramics helped to maintain the tissue-like structural organisation of the cardiac cells in vitro. Coating of the cell substrata with fine-grained titanium dioxide ceramics imitating cell surface topography favoured the formation of focal adhesion complexes in the ventral plasma membrane of cardiomyocytes. It also promoted the cellular expression of vinculin, a protein that connects the ECM integrin receptors to the network of cytoplasmic filaments, which define cell shape. This topographical reinforcement of cell-material interactions led to stabilisation of the molecular linkage between the extracellular contacts and the intracellular cytoskeleton and thus assisted the preservation and maintenance of the heart muscle cell differentiated phenotype in long-term primary culture. The results of this work demonstrate a promising pathway for the regulation of cellular organisation in vitro by local geometric control.

Animals↗

The machinability of cast titanium and Ti-6Al-4V.

This study investigated the machinability (ease of metal removal) of commercially pure (CP) titanium and Ti-6Al-4V alloy. Both CP Ti and Ti-6Al-4V were cast into magnesia molds. Two types of specimens (with alpha-case and without alpha-case) were made for CP Ti and Ti-6Al-4V. Machinability (n = 5) was evaluated as volume loss (mm3) by cutting/grinding the 3.0 mm surface using fissure burs and silicon carbide (SiC) under two machining conditions: (1) two machining forces (100 or 300 gf) at two rotational speeds (15000 or 30000 rpm) for 1 min, and (2) constant machining force of 100 gf and rotational speed of 15000 rpm for 1, 2, 5, 10, and 30 min. As controls, conventionally cast Co-Cr and Type IV gold alloys were evaluated in the same manner as the titanium. When fissure burs were used, there was a significant difference in the machinability between CP titanium with alpha-case and without alpha-case. On the other hand, there was no appreciable difference in the amount of metal removed for each tested metal when using the SiC points.

Alloys↗

Broad spectrum anti-RNA virus activities of titanium and vanadium substituted polyoxotungstates.

Seven polyoxotungstates substituted with vanadium or titanium atoms were examined for their activity against Flaviviridae (Dengue fever virus, DFV), Orthomyxoviridae (influenza virus type A, fluV-A), Paramyxoviridae (respiratory syncytial virus, RSV, parainfluenza virus type 2, PfluV-2 and canine distemper virus, CDV) and Lentiviridae (human immunodeficiency virus type 1, HIV-1) families. Among the seven polyoxotungstates examined, PM-43 [K(5)[SiVW(11)O(40)]], PM-47 [K(7)[BVW(11)O(40)]], and PM-1001 [K(10)Na(VO)(3)(SbW(9)O(33))(2)]26H(2)O contained vanadium. PM-1002 had the same core structure of (VO)(3)(SbW(9)O(33))(2) as PM-1001; however, three V atoms of PM-1001 consisted of two V(IV) and one V(V) and those of PM-1002 consisted of three V(IV). On the other hand, PM-518 [[Et(2)NH(2)](7)[PTi(2)W(10)O(40)]], PM-520 [Pri(2)NH(2)](5)[PTiW(11)O(40)] and PM-523 [PriNH(3)](6)H[PTi(2)W(10)O(38)(O(2))(2)]H(2)O all contained titanium. All compounds showed broad spectrum antiviral activity against all viruses examined except for PMs-43, -518 and -523 which did not exhibit inhibitory activity at >/=50 microM against PfluV-2, CDV and DFV, respectively. All compounds were inhibitory against HIV replication at an EC(50) of less than 2.0 microM. Among them, PMs-1001 and -1002 showed the most potent inhibition. The compounds were not toxic for MDCK, HEp-2 and Vero cells at a concentration of 200 microM. For the exponentially growing MT-4 cells, the vanadium containing polyoxometalates (PMs-43, 47, 1001, 1002) showed toxicity at concentrations between 41 and 47 microM. On the other hand, titanium containing polyoxometalates (PMs-518, -520, -523) were not toxic at 100 microM. The mechanism of anti-HIV action of PM-1001 was analyzed: it affected the binding of HIV to the cell membrane and syncytium formation between HIV-infected and uninfected cells.

Animals↗

An investigation of debonding between heat-cured PMMA and titanium alloy (Ti-6A1-4V).

OBJECTIVES: The bonding of acrylic resin to dental prostheses constructed from metal has been the subject of extensive research in recent years, much of it between base-metal alloys such as Ni-Cr alloys and dental composite. The development of techniques for the manufacture of dental appliances from titanium and titanium alloys has opened new avenues for investigation of the metal/acrylic resin bond. METHODS: In this study, a bond strength comparison between two PMMA products, Trevalon and Metadent, and discs of titanium alloy, Ti-6A1-4V, was investigated using a four-point bend test configuration. Trevalon is a standard, commercially available, heat-cured acrylic resin, while Metadent is an acrylic resin incorporating a chemical bonding agent, 4-META. A comparison was made between two processes that are routinely used to enhance the bond between metal and acrylic, namely sandblasting of the metal surface and using the Silicoater system following sandblasting. Each of the samples was paired, thus allowing a further comparison to be made between samples that had undergone thermocycling in a water bath, with those that had been held at a constant temperature. RESULTS: The study revealed that a superior metal/acrylic bond was achieved by the use of the silicoating system when either Trevalon or Metadent was used both before and after thermocycling. Reduced debonding loads were recorded for all samples that had undergone thermocycling. CONCLUSIONS: Highest bond strengths were recorded for Trevalon or Metadent processed against a silicoated Ti-alloy surface.

Acrylic Resins↗

Influence of surface oxidation of titanium on adhesion.

OBJECTIVES: The adhesive bonding of titanium was investigated using a methacrylate-phosphate primer and a luting agent. The present study investigates the influence of heat oxidation as well as a suitable durable bonding method for treating the surface of titanium. METHODS: Two groups of disc specimens were fabricated by milling and casting, respectively. Machine-milled specimens were subjected to heat treatment, and three groups of cast metal specimens underwent following respective treatments: (1) as-cast, (2) emery-polishing, (3) alumina-blasting after emery-polishing. The primer contained 10-methacryloyloxydecyl dihydrogen phosphate (MDP); the luting agent was based on methyl methacrylate (MMA), and was initiated with tri-n-butylborane derivative (TBB). Each specimen was primed and bonded to an acrylic rod. Shear bond strengths were determined before and after thermocycling. RESULTS: The mean bond strength of the machine-milled emery-polished group was 32.5 MPa after 5000 thermocycles with only a slight decrease in bond strength. A decrease in the bond strength occurred when the heat-treatment temperature was above 400 degrees C. Although both emery-polishing and alumina-blasting were effective, the minimum decrease in bond strength was obtained with alumina-blasting. CONCLUSIONS: The excess surface oxide layer may be of great concern as a possible cause of decreased bonding durability. Sufficient bonding durability for clinical use was obtained when the titanium was alumina-blasted.

Adhesiveness↗

Self-tapping versus standard tapped titanium screw fixation in the upper extremity.

Most screws used in fracture fixation necessitate a separate step for tapping of the screw hole. Titanium screw systems have been developed in which the screws can be inserted directly after a drill hole is made. These self-tapping screws thereby eliminate an operative step. A retrospective study was conducted that evaluated all wrist and hand procedures performed between January 1992 and December 1994 by 1 surgeon using screw fixation. The results of 39 cases treated with standard tapped titanium screws were compared with 28 cases treated with self-tapping titanium screws. Nearly identical union and complication rates were obtained in each group. Comparable results can be obtained with self-tapping screw fixation, which limits the number of instruments needed, eliminates an operative step, and thereby may diminish operative risk and shorten operative time.

Adolescent↗

Adherent endotoxin mediates biological responses of titanium particles without stimulating their phagocytosis.

Aseptic loosening of orthopaedic implants is thought to be primarily due to stimulation of cytokine production by wear particles from the implants. The cytokines increase osteoclast differentiation, leading to osteolysis and implant loosening. Accumulating evidence indicates that adherent endotoxin mediates the biological responses induced by the wear particles. One mechanism by which adherent endotoxin may act is by increasing phagocytosis of the wear particles. To test this hypothesis, the effect of adherent endotoxin on phagocytosis of titanium particles was determined. First, we developed reliable confocal and fluorescence microscopy methods to examine both the attachment and internalization steps of phagocytosis. Use of these methods showed that adherent endotoxin does not detectably alter the rate or the extent of phagocytosis of titanium particles by RAW 264.7 cells. Despite this lack of an effect on phagocytosis, adherent endotoxin dramatically increases the ability of RAW 264.7 cells to produce TNF-alpha and induce osteoclast differentiation. Thus, adherent endotoxin mediates these biological responses by a mechanism that does not rely on increased phagocytosis. These results also demonstrate that phagocytosis is not sufficient to induce cytokine production and osteoclast differentiation but do not rule out the possibility that phagocytosis is required for induction of these responses by titanium particles with adherent endotoxin.

Animals↗

New insight into the mechanism of hip prosthesis loosening: effect of titanium debris size on osteoblast function.

The incidence of rheumatoid arthritis and osteoarthritis is on the rise due to our expanding elderly population. Total joint arthroplasty is the most successful, prevalent treatment modality for these and other degenerative hip conditions. Despite the wide array of prosthetic devices commercially available, hip prostheses share a common problem with a gradual and then accelerating loss of bone tissue and bone-implant interface integrity, followed by implant instability and loosening. Implant failure is largely the result of inevitable wear of the device and generation of wear debris. To provide information for the development of improved prosthetic wear characteristics, we examined the effects of size-separated titanium particles on bone forming cell populations. We demonstrate unequivocally that particle size is a critical factor in the function, proliferation, and viability of bone-forming osteoblasts in vitro. In addition, we have elucidated the time-dependent distribution of the phagocytosed particles within the osteoblast, indicating an accumulation of particles in the perinuclear area of the affected cells. The report finds that particle size is a critical factor in changes in the bone formation-related functions of osteoblasts exposed to simulate wear debris, and that 1.5-4 microm titanium particles have the greatest effect on osteoblast proliferation and viability in vitro. The size of titanium particles generated through wear of a prosthetic device may be an important consideration in the development of superior implant technology.

Animals↗

Biomechanical comparison between BioScrew and titanium alloy interference screws for bone-patellar tendon-bone graft fixation in anterior cruciate ligament reconstruction.

This investigation compared the maximum load at failure of BioScrew (Linvatec Corp, Largo, FL) and titanium alloy interference screw femoral fixation using a human cadaveric model that approximated the anatomical orientation and physiological strain rate of in vivo bone-patellar tendon-bone (BPTB) graft loading following anterior cruciate ligament reconstruction. Eighteen fresh-frozen human BPTB allografts (10-mm wide, 10-mm thick, 25-mm long bone plugs) with either BioScrew or titanium alloy (Ti 6A14V) screw (7 x 25 mm) fixation were compared for maximum load at failure at a strain rate of 20 mm/minute. Nine cadaver femurs with bone mineral densities of 0.88 +/- 0.18 g/cm2 (anterior/posterior) and 1.3 +/- 0.24 g/cm2 (lateral) received the allografts. No statistical differences were observed in maximum load at failure (P = .95) or failure mode (P = .11) between specimens fixed with either screw type. When biomechanically tested with anatomic orientation and at functionally relevant strain rates, the BioScrew provided maximum load at failure equal to a titanium alloy screw.

Absorption↗

Thirteen year results of total hip arthroplasty using a tapered titanium femoral component inserted without cement in patients with type C bone.

Although cementless arthroplasty with a tapered titanium femoral component has proven reliable in young patients with excellent bone quality, studies involving patients with poor bone quality are lacking. The present study evaluates the results of total hip arthroplasty (THA) using such a femoral component in patients with Type C femoral bone. Ninety-two THAs were performed in 81 patients aged 65 years and older using a tapered titanium cementless femoral component. Follow-up in 62 patients (72 hips) averaged 13.2 years (minimum, 10 years); 19 patients were lost to follow-up. According to Door's criteria, 20 femora were classified as Type A, 19 as Type B, and 33 as Type C. No stem was revised because of stem instability, thigh pain, or osteolysis. One stem was removed because of sepsis. Six acetabula were revised because of polyethylene wear and periacetabular osteolysis. Four patients reported mild thigh pain. Radiologic signs of osseous integration for cylindrical extensively porous coated cobalt-chrome femoral components are not valid for tapered titanium designs.

Adolescent↗

Host-bone response to porous-coated cobalt-chrome and hydroxyapatite-coated titanium femoral components in hip arthroplasty. Dual-energy x-ray absorptiometry analysis of paired bilateral cases at 5 to 7 years.

Uncemented porous-coated cobalt-chrome femoral stems have produced satisfactory short-term clinical results, although slightly inferior to the results of cemented total hip arthroplasty. Proximal femoral bone resorption, osteolysis and fibrous ingrowth have been reported with porous-coated stems. Hydroxyapatite-coated stems and titanium stems have been introduced to avoid these findings through improved fixation. Dual-energy x-ray absorptiometry allows quantitative examination of bone density changes after uncemented total hip arthroplasty. This study examines the host-bone response to hydroxyapatite-coated titanium and porous-coated cobalt-chrome stems of identical geometry in three paired bilateral cases at 5 to 7 years. Distinctly different patterns of femoral bone mineral density changes were observed with the two stem designs. The authors conclude that dual-energy x-ray absorptiometry is a promising technique allowing noninvasive analysis of uncemented stem fixation, and that the data from this study suggest improved fixation and stress transfer with hydroxyapatite-coated titanium stems.

Absorptiometry, Photon↗

Temperature-modulated DSC provides new insight about nickel-titanium wire transformations.

Differential scanning calorimetry (DSC) is a well-known method for investigating phase transformations in nickel-titanium orthodontic wires; the microstructural phases and phase transformations in these wires have central importance for their clinical performance. The purpose of this study was to use the more recently developed technique of temperature-modulated DSC (TMDSC) to gain insight into transformations in 3 nickel-titanium orthodontic wires: Neo Sentalloy (GAC International, Islandia, NY), 35 degrees C Copper Ni-Ti (Ormco, Glendora, Calif) and Nitinol SE (3M Unitek, Monrovia, Calif). In the oral environment, the first 2 superelastic wires have shape memory, and the third wire has superelastic behavior but not shape memory. All wires had cross-section dimensions of 0.016 x 0.022 in. Archwires in the as-received condition and after bending 135 degrees were cut into 5 or 6 segments for test specimens. TMDSC analyses (Model 2910 DSC, TA Instruments, Wilmington, Del) were conducted between -125 degrees C and 100 degrees C, using a linear heating and cooling rate of 2 degrees C per min, an oscillation amplitude of 0.318 degrees C with a period of 60 seconds, and helium as the purge gas. For all 3 wire alloys, strong low-temperature martensitic transformations, resolved on the nonreversing heat-flow curves, were not present on the reversing heat-flow curves, and bending appeared to increase the enthalpy change for these peaks in some cases. For Neo Sentalloy, TMDSC showed that transformation between martensitic and austenitic nickel-titanium, suggested as occurring directly in the forward and reverse directions by conventional DSC, was instead a 2-step process involving the R-phase. Two-step transformations in the forward and reverse directions were also found for 35 degrees C Copper Ni-Ti and Nitinol SE. The TMDSC results show that structural transformations in these wires are complex. Some possible clinical implications of these observations are discussed.

Calorimetry, Differential Scanning↗

Short-term temperature changes influence the force exerted by superelastic nickel-titanium archwires activated in orthodontic bending.

BACKGROUND: Alterations in mouth temperature may lead to changes in the force exerted by an activated superelastic wire. It has been assumed that variations in archwire stiffness associated with short-term cooling or heating are transient. This investigation studied the effect of short-term cooling or heating on the bending force exerted by nickel-titanium archwire. MATERIAL AND METHODS: Six rectangular superelastic wires and one conventional nickel-titanium wire were tested in bending at 37 degrees C. The test specimens were deflected 0.5 mm, and the bending force was measured continually. The activated specimens were subjected to cold (10 degrees C) or hot (80 degrees C) water under constant deflection, simulating an inserted archwire that is subjected to cold or hot drinks or food during a meal. RESULTS: The conventional nickel-titanium wire was marginally affected by brief cooling or heating. In contrast, some of the superelastic wires were strongly affected by short-time application of cold or hot water. Whereas the effect of brief heating disappeared quickly, some wires continued to exert sub-baseline bending forces (up to 32% less) after short-time application of cold water and showed little or no tendencies toward increase even after 30 minutes of postexposure restitution (up to 43% less). CONCLUSIONS: Short-term exposures to hot liquid increased the bending force exerted for a given deflection transiently. The effect of short-term exposures to cold liquid was not always transient; the bending force remained sub-baseline for a number of the thermosensitive wires tested for a prolonged time.

Dental Alloys↗