Surface characteristics of dental implants: A review.

OBJECTIVES: During the last decades, several changes of paradigm have modified our view on how biomaterials' surface characteristics influence the bioresponse. After becoming aware of the role of a certain microroughness for improved cellular contact and osseointegration of dental titanium implants, the likewise important role of surface energy and wettability was increasingly strengthened. Very recently, synergistic effects of nanoscaled topographical features and hydrophilicity at the implant/bone interface have been reported. METHODS: Questions arise about which surface roughness and wetting data are capable to predict the bioresponse and, ultimately, the clinical performance. Current methods and approaches applied for topographical, wetting and surface energetic analyses are highlighted. Current knowledge of possible mechanisms explaining the influence of roughness and hydrophilicity at the biological interface is presented. RESULTS: Most marketed and experimental surfaces are based on commonly available additive or subtractive surface modifying methods such as blasting, etching or anodizing. Different height, spatial, hybrid and functional roughness parameters have been identified as possible candidates able to predict the outcome at hard and soft tissue interfaces. Likewise, hydrophilic implants have been proven to improve the initial blood contact, to support the wound healing and thereby accelerating the osseointegration. SIGNIFICANCE: There is clear relevance for the influence of topographical and wetting characteristics on a macromolecular and cellular level at endosseous implant/biosystem interfaces. However, we are still far away from designing sophisticated implant surfaces with the best possible, selective functionality for each specific tissue or cavity interface. Firstly, because our knowledge of the respective surface related reactions is at best fragmentary. Secondly, because manufacturing of multi-scaled complex surfaces including distinct nanotopographies, wetting properties, and stable cleanliness is still a technical challenge and far away from being reproducibly transferred to implant surfaces.

Comparative evaluation of topographical data of dental implant surfaces applying optical interferometry and scanning electron microscopy.

OBJECTIVE: Comparability of topographical data of implant surfaces in literature is low and their clinical relevance often equivocal. The aim of this study was to investigate the ability of scanning electron microscopy and optical interferometry to assess statistically similar 3-dimensional roughness parameter results and to evaluate these data based on predefined criteria regarded relevant for a favorable biological response. METHODS: Four different commercial dental screw-type implants (NanoTite Certain Prevail, TiUnite Brånemark Mk III, XiVE S Plus and SLA Standard Plus) were analyzed by stereo scanning electron microscopy and white light interferometry. Surface height, spatial and hybrid roughness parameters (Sa, Sz, Ssk, Sku, Sal, Str, Sdr) were assessed from raw and filtered data (Gaussian 50µm and 5µm cut-off-filters), respectively. Data were statistically compared by one-way ANOVA and Tukey-Kramer post-hoc test. For a clinically relevant interpretation, a categorizing evaluation approach was used based on predefined threshold criteria for each roughness parameter. RESULTS: The two methods exhibited predominantly statistical differences. Dependent on roughness parameters and filter settings, both methods showed variations in rankings of the implant surfaces and differed in their ability to discriminate the different topographies. Overall, the analyses revealed scale-dependent roughness data. Compared to the pure statistical approach, the categorizing evaluation resulted in much more similarities between the two methods. SIGNIFICANCE: This study suggests to reconsider current approaches for the topographical evaluation of implant surfaces and to further seek after proper experimental settings. Furthermore, the specific role of different roughness parameters for the bioresponse has to be studied in detail in order to better define clinically relevant, scale-dependent and parameter-specific thresholds and ranges.

Peri-implantitis cleaning instrumentation influences the integrity of photoactive nanocoatings.

OBJECTIVE: To determine in vitro the loss of integrity caused on photocatalytic anatase coated implant surfaces by clinical instrumentation through changes in surface topography and loss of functionality. METHODS: Anatase-coated titanium discs were treated with diamond burs, polishers, plastic and metal hand instruments, air scaler and air flow devices. The pressure exerted through instrumentation was measured online. Surface topography was evaluated through scanning electron microscopy and contact profilometry, surface function through hydrophilization capacity upon UV-A activation. RESULTS: Treatment with diamond burs and instruments with metal tips resulted in an increase of roughness. Use of silicone polishers led to smoothening, which was more pronounced on the anatase surface. Plastic instruments, the air abrasive system and rubber cups left the surfaces intact. Functionality was partially lost on surfaces subjected to hand instruments and completely lost upon diamond burs and silicone polishers. SIGNIFICANCE: The integrity of functional nanocoatings depends on the applied instrumentation. Air flow device, rubber cup with polishing paste and plastic tipped instruments prevent damage on these nanosurfaces and may be preferably used when decontaminating anatase and other nanocoatings in a clinical setting.

Coating of ß-tricalcium phosphate scaffolds-a comparison between graphene oxide and poly-lactic-co-glycolic acid.

Bone regeneration in critical size defects is a major challenge in oral and maxillofacial surgery, and the gold standard for bone reconstruction still requires the use of autologous tissue. To overcome the need for a second intervention and to minimize morbidity, the development of new biomaterials with osteoinductive features is the focus of current research. As a scaffolding material, ß-tricalcium phosphate (ß-TCP) is suitable for bone regeneration purposes, although it does not carry any functional groups for the covalent immobilization of molecules. The aim of the present study was to establish effective coating variants for ß-TCP constructs to enable the biofunctionalization of anorganic blocks with different osteogenic molecules in future studies. We established working protocols for thin surface coatings consisting of polylactic-co-glycolic acid (PLGA) and graphene oxide (GO) by varying parameters. Surface properties such as the angularity and topography of the developed scaffolds were analyzed. To examine biological functionality, the adhesion and proliferation behavior of jaw periosteal cells (JPCs) were tested on the coated constructs. Our results suggest that PLGA is the superior material for surface coating of ß-TCP matrices, leading to higher JPC proliferation rates and providing a more suitable basis for further biofunctionalization in the field of bone tissue engineering.

Time-resolved IR spectroscopy of a trinuclear palladium complex in solution.

This paper presents a combined spectroscopic and theoretical analysis of a trinuclear [Pd3{Si(mt(Me))3}2] complex (mt(Me) = methimazole) which has been demonstrated to be a potential catalyst for coupling reactions. It is a highly symmetric model system (D3 in the electronic ground state) for the investigation of electronic states and the structure of polynuclear transition metal complexes. Different time-resolved IR spectroscopic methods covering the femtosecond up to the microsecond range as well as density functional computations are performed to unravel the structure and character of this complex in the electronically excited state. These are the first time-resolved IR studies on a trinuclear Pd complex. Based on the interplay between the computational results and those from the IR studies a (3)A state is identified as the lowest lying triplet state which has C2 symmetry.

In-depth exploration of the photophysics of a trinuclear palladium complex.

A detailed theoretical and spectroscopic study on the electronically excited states of a trinuclear palladium complex is presented both in the gas phase and solution. The application of DFT and TDDFT methods as well as a variety of spectroscopic methods to the chosen complex [Pd3{Si(mt(Me))3}2] (1, mt(Me) = methimazole) leads to the first detailed analysis of the photophysics of a symmetric trinuclear complex. In combination with the calculations, energies, structures and lifetimes of the excited electronic states (with an (3)A1 state as the lowest one) are characterized by applying the resonant-2-photon-ionization method in a molecular beam experiment as well as luminescence, time-correlated single photon counting and excited state femtosecond absorption spectroscopy in solution. These investigations are of fundamental interest to analyze photophysical properties of metal containing complexes on a molecular level.

Comparison of different in vitro tests for biocompatibility screening of Mg alloys.

Standard cell culture tests according to ISO 10993 have only limited value for the biocompatibility screening of degradable biomaterials such as Mg alloys. The correlation between in vitro and in vivo results is poor. Standard cytotoxicity tests mimic the clinical situation to only a limited extent, since in vivo proteins and macromolecules in the blood and interstitial liquid will influence the corrosion behaviour and, hence, biocompatibility of Mg alloys to a significant extent. We therefore developed a modified cytotoxicity test simulating the in vivo conditions by use of bovine serum as the extraction vehicle instead of the cell culture medium routinely used in standard cytotoxicity testing according to ISO 10993-5. The modified extraction test was applied to eight experimental Mg alloys. Cytotoxicity was assayed by inhibition of cell metabolic activity (XTT test). When extraction of the alloy samples was performed in serum instead of cell culture medium the metabolic activity was significantly less inhibited for six of the eight alloys. The reduction in apparent cytotoxicity under serum extraction conditions was most pronounced for MgZn1 (109% relative metabolic activity with serum extracts vs. 26% in Dulbecco's modified Eagle's medium (DMEM)), for MgY4 (103% in serum vs. 32% in DMEM) and for MgAl3Zn1 (84% vs. 17%), resulting in a completely different cytotoxicity ranking of the tested materials when serum extraction was used. We suppose that this test system has the potential to enhance the predictability of in vivo corrosion behaviour and biocompatibility of Mg-based materials for biodegradable medical devices.

Formation and photocatalytic decomposition of a pellicle on anatase surfaces.

The acquired dental pellicle plays a critical role in the adhesion and detachment of dental plaque bacteria. It has been reported that titanium dioxide biomaterials decompose single-protein films by photocatalysis. However, it is not known whether this can also be achieved with complex structured pellicle films. This in vitro study investigated in real-time the formation and photocatalytic decomposition of human pellicle at anatase-saliva interfaces. Nanostructured polycrystalline anatase layers were deposited on titanium-coated quartz crystals by magnetron-sputtering, serving as a model for titanium implant surfaces. The quartz crystals were used as acoustic sensors in a quartz-crystal microbalance (QCM) system with dissipation. In situ UV irradiation of pellicle-covered anatase caused a statistically significant decrease of the adsorbed salivary mass. In contrast, photocatalytic decomposition of pellicle could not be observed on reference titanium surfaces. Wettability characterization revealed superhydrophilicity of anatase upon UV irradiation, whereas titanium was unaffected. XPS measurements provide further information concerning the decomposition of the salivary films. The results suggest that the photocatalytic activity of polycrystalline anatase-modified biomaterial surfaces is able to decompose complex structured macromolecular pellicle films. Therefore, this study opens the way to surface modifications supporting therapeutic approaches of biofilm removal.

Combined theoretical and experimental study of spin and charge dynamics on the homodinuclear complex [Ni2(II)(L-N4Me2)(emb)].

We present a combined theoretical and experimental study of spin and charge dynamics on the homodinuclear compound [Ni2(II)(L-N4Me2)(emb)]. The theoretically calculated oscillator strengths of the ground-state absorption spectrum show an acceptable agreement with experiment. We predict a local ultrafast laser-induced spin-flip scenario, which involves charge-transfer states. Experimentally, we observe charge dynamics on two different time scales. The two relevant, transient electronic states and their electronic properties are also theoretically characterized. These results provide a joint investigation of the homodinuclear complex and suggest a realistic scenario for ultrafast spin dynamics and other optical-related manipulations.

Multifunctional nature of UV-irradiated nanocrystalline anatase thin films for biomedical applications.

Anatase is known to decompose organic material by photocatalysis and to enhance surface wettability once irradiated by ultraviolet (UV) light. In this study, pulse magnetron-sputtered anatase thin films were investigated for their suitability with respect to specific biomedical applications, namely superhydrophilic and biofilm degrading implant surfaces. UV-induced hydrophilicity was quantified by static and dynamic contact angle analysis. Photocatalytic protein decomposition was analyzed by quartz crystal microbalance with dissipation. The surfaces were characterized by X-ray diffraction, atomic force microscopy, scanning electron microscopy and X-ray photoelectron spectroscopy. The radical formation on anatase, responsible for photocatalytic effects, was analyzed by electron spin resonance spectroscopy. Results have shown that the nanocrystalline anatase films, in contrast to reference titanium surfaces, were sensitive to UV irradiation and showed rapid switching towards superhydrophilicity. The observed decrease in carbon adsorbents and the increase in the fraction of surface hydroxyl groups upon UV irradiation might contribute to this hydrophilic behavior. UV irradiation of anatase pre-conditioned with albumin protein layers induces the photocatalytic decomposition of these model biofilms. The observed degradation is mainly caused by hydroxyl radicals. It is concluded that nanocrystalline anatase films offer different functions at implant interfaces, e.g. bedside hydrophilization of anatase-coated implants for improved osseointegration or the in situ decomposition of conditioning films forming the basal layer of biofilms in the oral cavity.

Biomechanical evaluation of the interfacial strength of a chemically modified sandblasted and acid-etched titanium surface.

The functional capacity of osseointegrated dental implants to bear load is largely dependent on the quality of the interface between the bone and implant. Sandblasted and acid-etched (SLA) surfaces have been previously shown to enhance bone apposition. In this study, the SLA has been compared with a chemically modified SLA (modSLA) surface. The increased wettability of the modSLA surface in a protein solution was verified by dynamic contact angle analysis. Using a well-established animal model with a split-mouth experimental design, implant removal torque testing was performed to determine the biomechanical properties of the bone-implant interface. All implants had an identical cylindrical shape with a standard thread configuration. Removal torque testing was performed after 2, 4, and 8 weeks of bone healing (n = 9 animals per healing period, three implants per surface type per animal) to evaluate the interfacial shear strength of each surface type. Results showed that the modSLA surface was more effective in enhancing the interfacial shear strength of implants in comparison with the conventional SLA surface during early stages of bone healing. Removal torque values of the modSLA-surfaced implants were 8-21% higher than those of the SLA implants (p = 0.003). The mean removal torque values for the modSLA implants were 1.485 N m at 2 weeks, 1.709 N m at 4 weeks, and 1.345 N m at 8 weeks; and correspondingly, 1.231 N m, 1.585 N m, and 1.143 N m for the SLA implants. The bone-implant interfacial stiffness calculated from the torque-rotation curve was on average 9-14% higher for the modSLA implants when compared with the SLA implants (p = 0.038). It can be concluded that the modSLA surface achieves a better bone anchorage during early stages of bone healing than the SLA surface; chemical modification of the standard SLA surface likely enhances bone apposition and this has a beneficial effect on the interfacial shear strength.

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.

High surface energy enhances cell response to titanium substrate microstructure.

Titanium (Ti) is used for implantable devices because of its biocompatible oxide surface layer. TiO2 surfaces that have a complex microtopography increase bone-to-implant contact and removal torque forces in vivo and induce osteoblast differentiation in vitro. Studies examining osteoblast response to controlled surface chemistries indicate that hydrophilic surfaces are osteogenic, but TiO2 surfaces produced until now exhibit low surface energy because of adsorbed hydrocarbons and carbonates from the ambient atmosphere or roughness induced hydrophobicity. Novel hydroxylated/hydrated Ti surfaces were used to retain high surface energy of TiO2. Osteoblasts grown on this modified surface exhibited a more differentiated phenotype characterized by increased alkaline phosphatase activity and osteocalcin and generated an osteogenic microenvironment through higher production of PGE2 and TGF-beta1. Moreover, 1alpha,25OH2D3 increased these effects in a manner that was synergistic with high surface energy. This suggests that increased bone formation observed on modified Ti surfaces in vivo is due in part to stimulatory effects of high surface energy on osteoblasts.

Identification of a novel insulin-like growth factor binding protein gene homologue with tumor suppressor like properties.

Here we report the identification of a new insulin-like growth factor binding protein homologue, provisionally designated insulin-like growth factor binding related protein-4 (IGFBP-rP4). IGFBP-rP4 was found to be most closely related to IGFBP-7 with 52% amino acid homology and 43% amino acid identity, and shares a similar domain structure. Semi-quantitative RT-PCR expression analysis demonstrated a pattern of downregulation of this gene in multiple tumor samples including lung and colon cancer, compared to matched adjacent normal tissue. Western blotting revealed a protein of approximately 38kDa expressed in both the cell pellet and secreted into the supernatant of transiently transfected Cos-7 cells. Cos-7 supernatants containing IGFBP-RP4 protein were observed to suppress the growth of HeLa cells in culture compared to vector controls. IGFBP-RP4 directly transiently transfected into HeLa cells also further confirmed the growth suppressive properties of this protein. Together these data suggest that IGFBP-RP4 may be a novel putative tumor suppressor protein.

Roughness induced dynamic changes of wettability of acid etched titanium implant modifications.

Dynamic contact angle analysis (DCA) was used to investigate time-dependent wettability changes of sandblasted and acid-etched commercially pure (cp) titanium (Ti) implant modifications during their initial contact with aqueous systems compared to a macrostructured reference surface. Surface topography was analyzed by scanning electron microscopy and by contact stylus profilometry. The microstructured Ti surfaces were found to be initially extremely hydrophobic. This hydrophobic configuration can shift to a completely wettable surface behavior with water contact angles of 0 degrees after the first emersion loop during DCA experiments. It is suggested that a hierarchically structured surface topography could be responsible for this unexpected wetting phenomenon. Roughness spatial and hybrid parameters could describe topographical features interfering with dynamic wettability significantly better than roughness height parameters. The Ti modifications which shift very sudden from a hydrophobic to a hydrophilic state adsorbed the highest amount of immunologically assayed fibronectin. The results suggest that microstructuring greatly influences both the dynamic wettability of Ti implant surfaces during the initial host contact and the initial biological response of plasma protein adsorption. The microstructured surfaces, once in the totally wettable configuration, may improve the initial contact with host tissue after implantation, due to the drastically increased hydrophilicity.

Adsorption/desorption phenomena on pure and Teflon AF-coated titania surfaces studied by dynamic contact angle analysis.

As a result of inflammatory processes, plaque formation on dental titanium implants often leads to clinically pathogenic situations. This special biofilm formation on (bio)materials in contact with saliva is initiated by ionic and protein interactions. In this interfacial process, albumin becomes a main constituent of dental pellicle. Interfacial reactions change the surface characteristics. They determine the following steps of macromolecular adsorption and bacterial adhesion. This work focuses on the dynamic contact angle analysis (DCA), which is a tool for online measurements of dynamic changes of wettability without disturbing the interface during detection. Repeatability of the DCA method has been assessed according to the Bland and Altman method. The kinetics and equilibrium data of shifts in the wetting tension hysteresis indicate ionic influences at the titanium/bovine serum albumin (BSA) interface: the Ca-mediated increase of the BSA adsorption on titanium and the adsorption maximum at the isoelectric point (IEP) of BSA. Ti was surface modified by Teflon AF polymeric coatings. The result of the assessment gives reason to consider Teflon AF as a reference material for DCA repeatability studies. This surface modification caused drastic changes in the dynamic interfacial reactions. Shifts in the wetting tensions during DCA adsorption-desorption experiments clearly demonstrated the partially irreversible adsorption of BSA on Teflon AF. In contrast, reversible adsorption behavior was detected on pure Ti surfaces. These findings strengthen the hypothesis that the analysis of dynamic changes in wetting tension and wetting tension hysteresis is a sensitive analytical method for the detection of dynamic interfacial changes at biomaterial/biosystem interfaces during the initial steps of biofilm formation.

Physiological regulation of the immunological synapse by agrin.

T cell activation is dependent on both a primary signal delivered through the T cell receptor and a secondary costimulatory signal mediated by coreceptors. Although controversial, costimulation is thought to act through the specific redistribution and clustering of membrane and intracellular kinase-rich lipid raft microdomains at the contact site between T cells and antigen-presenting cells. This site has been termed the immunological synapse. Endogenous mediators of raft clustering in lymphocytes have not been identified, although they are essential for T cell activation. We now demonstrate that agrin, an aggregating protein crucial for formation of the neuromuscular junction, is also expressed in lymphocytes and is important in reorganization of membrane lipid microdomains and setting the threshold for T cell signaling. Our data show that agrin induces the aggregation of signaling proteins and the creation of signaling domains in both immune and nervous systems through a common lipid raft pathway.

Regulation of agrin expression in hippocampal neurons by cell contact and electrical activity.

Most synapses contain high concentrations of neurotransmitter receptors in the postsynaptic plasma membrane. Agrin (Ag) is an extracellular matrix protein necessary for the localization of acetylcholine receptors at the neuromuscular junction and for the differentiation of synapses in hippocampal neurons in vitro. The temporal pattern of agrin expression during the development of the central nervous system (CNS) is consistent with the notion that agrin expression is regulated during synaptogenesis. To identify the processes underlying this regulation, we have analyzed levels and alternative splicing of agrin mRNA in primary hippocampal neurons. Our results indicate that in the initial phases of synapse formation, contact-mediated processes and action potential-dependent neurotransmission regulate agrin mRNA expression, while secreted factors from glial cells, but not from hippocampal neurons, influence the alternative splicing of agrin mRNA. Previous studies have shown that specific agrin isoforms are able to induce the activation of a transcription factor and that secreted agrin associates with cellular surfaces. Therefore, we have tested whether agrin isoforms contribute to the contact-mediated induction of agrin expression in hippocampal neurons. None of the agrin isoforms tested in this study revealed this activity. Finally, we show that the role of evoked neural transmission in controlling agrin transcription changes during differentiation in vitro.

Agrin controls synaptic differentiation in hippocampal neurons.

Agrin controls the formation of the neuromuscular junction. Whether it regulates the differentiation of other types of synapses remains unclear. Therefore, we have studied the role of agrin in cultured hippocampal neurons. Synaptogenesis was severely compromised when agrin expression or function was suppressed by antisense oligonucleotides and specific antibodies. The effects of antisense oligonucleotides were found to be highly specific because they were reversed by adding recombinant agrin and could not be detected in cultures from agrin-deficient animals. Interestingly, the few synapses formed in reduced agrin conditions displayed diminished vesicular turnover, despite a normal appearance at the EM level. Thus, our results demonstrate the necessity of agrin for synaptogenesis in hippocampal neurons.

Spinal aneurysm of the lateral sacral artery. Case report.

Spinal aneurysms are rare, and those not associated with either an arteriovenous malformation or coarctation of the aorta are particularly rare. In this report, the authors present a case of spinal aneurysm involving the lateral sacral artery. The aneurysm presented as a cauda equina syndrome 6 years after the patient underwent a renal transplant contralateral to the side of the aneurysm parent vessel. To the authors' knowledge, only one similar case has been previously reported. They conclude that spinal aneurysms should be included in the differential diagnosis of an extramedullary spinal mass lesion.