Chandler-Loop surveyed blood compatibility and dynamic blood triggered degradation behavior of Zn-4Cu alloy and Zn.

Zinc (Zn) and its alloys have been considered promising absorbable metals for medical implants. However, the dynamic interaction between Zn-based materials and human blood after implantation remains unclear. In this study, a modified Chandler-Loop system was applied to assess the blood compatibility and initial degradation behavior of a Zn-4.0Cu (wt%) alloy (Zn-4Cu) and Zn with human peripheral blood under circulation conditions. In this dynamic in vitro model, the Zn-4Cu and Zn showed sufficient blood compatibility. The numbers of erythrocytes, platelets, and leukocytes were not significantly altered, and appropriate activations of the coagulation and complement system were observed. Concerning initial degradation behavior, the product layers formed on the surfaces comprise a mixture of organic and inorganic compounds while the inorganic constituents decrease toward the outer surface. Considering the corrosion morphology and electrochemical behaviors, Zn-4Cu exhibited milder and more uniform degradation than Zn. Additionally, long-term degradation tests of 28 days in human peripheral blood, human serum, and Dulbecco's phosphate-buffered saline (DPBS) demonstrated that the Zn-4Cu showed relatively uniform degradation in blood and serum. On the contrary, in DPBS, severe localized corrosion appeared along the grain boundary of the secondary phase, which was likely attributed to the acceleration of galvanic corrosion. The Zn was found with localized corrosion impeded in the blood albeit with apparently developed deep pitting holes in the serum and DPBS.

Correction: Li, P. et al. Mechanical Characteristics, In Vitro Degradation, Cytotoxicity, and Antibacterial Evaluation of Zn-4.0Ag Alloy as a Biodegradable Material. Int. J. Mol. Sci. 2018, 19, 755.

The authors wish to make the following corrections to this paper [...].

Application of totarol as natural antibacterial coating on dental implants for prevention of peri-implantitis.

Peri-implantitis is the most important issue threatening the long-term survival rate of dental implants. Various efforts have been made to reduce implant surface plaque formation, which is one of the essential causes of peri-implantitis. In our study, we applied the natural antibacterial agent totarol as a coating on experimental silicon wafer and titanium implant surfaces. To analyze the interaction between the totarol coating and the oral primary colonizer S. gordonii and isolates of mixed oral bacteria, samples were incubated in a model system simulating the oral environment and analyzed by Live/Dead staining, crystal violet staining and scanning electron microscopy (SEM). After 4 d, 8 d, 12 d, 16 d, and 24 d salivary incubation, the stability and antibacterial efficiency of totarol coating was evaluated through SEM. The results indicated that totarol coatings on both silicon wafer and Ti surfaces caused efficient contact killing and an inhibition effect towards S. gordonii and mixed oral bacterial film growth after 4 h, 8 h, 24 h, and 48 h incubation. After longtime salivary incubation of 12 d, the bactericidal effect started to weaken, but the anti-adhesion and inhibition effect to biofilm development still exist after 24 d of salivary incubation. The application of a totarol coating on implant or abutment surfaces is a promising potential prophylactic approach against peri-implantitis.

Response of human periosteal cells to degradation products of zinc and its alloy.

Zinc (Zn) and its alloys are proposed as promising resorbable materials for osteosynthesis implants. Detailed studies should be undertaken to clarify their properties in terms of degradability, biocompatibility and osteoinductivity. Degradation products of Zn alloys might affect directly adjacent cellular and tissue responses. Periosteal stem cells are responsible for participating in intramembranous ossification during fracture healing. The present study aims at examining possible effects emanating from Zn or Zn-4Ag (wt%) alloy degradation products on cell viability and osteogenic differentiation of a human immortalized cranial periosteal cell line (TAg cells). Therefore, a modified extraction method was used to investigate the degradation behavior of Zn and Zn-4Ag alloys under cell culture conditions. Compared with pure Zn, Zn-4Ag alloy showed almost fourfold higher degradation rates under cell culture conditions, while the associated degradation products had no adverse effects on cell viability. Osteogenic induction of TAg cells revealed that high concentration extracts significantly reduced calcium deposition of TAg cells, while low concentration extracts enhanced calcium deposition, indicating a dose-dependent effect of Zn ions. Our results give evidence that the observed cytotoxicity effects were determined by the released degradation products of Zn and Zn-4Ag alloys, rather than by degradation rates calculated by weight loss. Extracellular Zn ion concentration was found to modulate osteogenic differentiation of TAg cells. These findings provide significant implications and guidance for the development of Zn-based alloys with an optimized degradation behavior for Zn-based osteosynthesis implants.

Evaluation of a Zn-2Ag-1.8Au-0.2V Alloy for Absorbable Biocompatible Materials.

Zinc (Zn) and Zn-based alloys have been proposed as a new generation of absorbable metals mainly owing to the moderate degradation behavior of zinc between magnesium and iron. Nonetheless, mechanical strength of pure Zn is relatively poor, making it insufficient for the majority of clinical applications. In this study, a novel Zn-2Ag-1.8Au-0.2V (wt.%) alloy (Zn-Ag-Au-V) was fabricated and investigated for use as a potential absorbable biocompatible material. Microstructural characterization indicated an effective grain-refining effect on the Zn alloy after a thermomechanical treatment. Compared to pure Zn, the Zn-Ag-Au-V alloy showed significantly enhanced mechanical properties, with a yield strength of 168 MPa, an ultimate tensile strength of 233 MPa, and an elongation of 17%. Immersion test indicated that the degradation rate of the Zn-Ag-Au-V alloy in Dulbecco's phosphate buffered saline was approximately 7.34 ± 0.64 µm/year, thus being slightly lower than that of pure Zn. Biocompatibility tests with L929 and Saos-2 cells showed a moderate cytotoxicity, alloy extracts at 16.7%, and 10% concentration did not affect metabolic activity and cell proliferation. Plaque formation in vitro was reduced, the Zn-Ag-Au-V surface inhibited adhesion and biofilm formation by the early oral colonizer Streptococcus gordonii, indicating antibacterial properties of the alloy.

Investigation of zinc­copper alloys as potential materials for craniomaxillofacial osteosynthesis implants.

In this study, zinc­copper (ZnCu) alloys were investigated regarding their feasibility as absorbable metals for osteosynthesis implants, especially in the craniomaxillofacial area. Mechanical properties and in vitro corrosion behavior of as-rolled Zn-xCu (x = 1, 2 and 4 wt%) alloys were systematically evaluated and screened. The as-rolled Zn4Cu alloy had mechanical properties that were superior to the most absorbable craniomaxillofacial osteosynthesis materials recently reported. The addition of Cu to Zn showed to have no apparent effect on the corrosion rates of the samples. The rolling process on Zn and Zn1Cu resulted in more uniform corrosion than on as-cast counterparts after 28 days immersion. Furthermore, the Zn4Cu alloys exhibited no apparent cytotoxic effect towards L929, TAg or Saos-2 cells. Proliferation rates of TAg and Saos-2 cells were shown to be activated by specific Zn ion concentrations in the as-rolled Zn4Cu alloy extracts. Analysis of in vitro antibacterial properties revealed that the as-rolled Zn4Cu alloy possessed the potential to inhibit biofilm formation of mixed oral bacteria. We conclude that the as-rolled Zn4Cu alloy might be a promising material for fabrication of craniomaxillofacial osteosynthesis implants.

An In Vitro Study of Osteoblast Response on Fused-Filament Fabrication 3D Printed PEEK for Dental and Cranio-Maxillofacial Implants.

Polyetheretherketone (PEEK) is a prime candidate to replace metallic implants and prostheses in orthopedic, spine and cranio-maxillofacial surgeries. Fused-filament fabrication (FFF) is an economical and efficient three-dimensional (3D) printing method to fabricate PEEK implants. However, studies pertaining to the bioactivity of FFF 3D printed PEEK are still lacking. In this study, FFF 3D printed PEEK samples were fabricated and modified with polishing and grit-blasting (three alumina sizes: 50, 120, and 250 µm) to achieve varying levels of surface roughness. In vitro cellular response of a human osteosarcoma cell line (SAOS-2 osteoblasts, cell adhesion, metabolic activity, and proliferation) on different sample surfaces of untreated, polished, and grit-blasted PEEK were evaluated. The results revealed that the initial cell adhesion on different sample surfaces was similar. However, after 5 days the untreated FFF 3D printed PEEK surfaces exhibited a significant increase in cell metabolic activity and proliferation with a higher density of osteoblasts compared with the polished and grit-blasted groups (p < 0.05). Therefore, untreated FFF 3D printed PEEK with high surface roughness and optimal printing structures might have great potential as an appropriate alloplastic biomaterial for reconstructive cranio-maxillofacial surgeries.

Selection of extraction medium influences cytotoxicity of zinc and its alloys.

Zinc (Zn) alloys have been considered as promising absorbable metals, mainly due to their moderate degradation rates ranging between magnesium alloys and iron alloys. The degradation behavior depends on the specific physiological environment. Released metallic ions and corrosion products directly influence biocompatibility. The initial contact of orthopedic implants or vascular stents after implantation will be with blood. In this study, fetal bovine serum (FBS) was used as a model system of blood components. We investigated the influence of FBS on in vitro degradation behavior and cytotoxicity of pure Zn, and Zn-4Ag and Zn-2Ag-1.8Au-0.2 V (wt%) alloys. The initial degradation rates in FBS were assessed and compared with the degradation and toxicity in four other common physiological model systems: DMEM cell culture medium ±â€¯FBS and McCoy's 5A medium ±â€¯FBS. Test samples in pure FBS showed the highest initial degradation rates, and accordingly, FBS supplemented media accelerated the degradation process as well. Moreover, an extract test according to ISO 10993-5 and -12 with L929 and Saos-2 cells was performed to investigate the role of FBS in the extraction medium. The cytotoxic effects observed in the tests were correlated with FBS-mediated Zn2+ release. These findings have significant implications regarding the selection of appropriate media for in vitro degradation and cytotoxicity evaluation of Zn and its alloys. STATEMENT OF SIGNIFICANCE: Metallic zinc and its alloys have been considered as promising biodegradable metals, mainly due to their moderate degradation rates. However, in vitro cytotoxicity tests according to the current ISO 10993 standard series are not suitable to predict biocompatibility of Zn alloys due to the inconsistent correlation between in vitro and in vitro biocompatibility. In this study, we show that the outcomes of standardized in vitro cytotoxicity tests of Zn and Zn alloys are influenced by fetal bovine serum in the extraction vehicle because FBS promotes Zn2+ release during the extraction process. The results of the study provide significant information for selection of appropriate model systems to evaluate in vitro degradation behavior and cytotoxicity.

Carbon Fiber Reinforced PEEK Composites Based on 3D-Printing Technology for Orthopedic and Dental Applications.

Fused deposition modeling (FDM) is a rapidly growing three-dimensional (3D) printing technology and has great potential in medicine. Polyether-ether-ketone (PEEK) is a biocompatible high-performance polymer, which is suitable to be used as an orthopedic/dental implant material. However, the mechanical properties and biocompatibility of FDM-printed PEEK and its composites are still not clear. In this study, FDM-printed pure PEEK and carbon fiber reinforced PEEK (CFR-PEEK) composite were successfully fabricated by FDM and characterized by mechanical tests. Moreover, the sample surfaces were modified with polishing and sandblasting methods to analyze the influence of surface roughness and topography on general biocompatibility (cytotoxicity) and cell adhesion. The results indicated that the printed CFR-PEEK samples had significantly higher general mechanical strengths than the printed pure PEEK (even though there was no statistical difference in compressive strength). Both PEEK and CFR-PEEK materials showed good biocompatibility with and without surface modification. Cell densities on the "as-printed" PEEK and the CFR-PEEK sample surfaces were significantly higher than on the corresponding polished and sandblasted samples. Therefore, the FDM-printed CFR-PEEK composite with proper mechanical strengths has potential as a biomaterial for bone grafting and tissue engineering applications.

Saliva-coated titanium biosensor detects specific bacterial adhesion and bactericide caused mass loading upon cell death.

Bacteria adhering to implanted medical devices can cause invasive microbial infections, of e.g. skin, lung or blood. In dentistry, Streptococcus gordonii is an early oral colonizer initiating dental biofilm formation and also being involved in life-threatening infective endocarditis. To treat oral biofilms, antibacterial mouth rinses are commonly used. Such initial biomaterial-bacteria interactions and the influence of antibacterial treatments are poorly understood and investigated here in situ by quartz crystal microbalance with dissipation monitoring (QCM-D). A saliva-coated titanium (Ti) biosensor is applied to analyze possible specific signal patterns indicating microbial binding mechanisms and bactericide-caused changes in bacterial film rigidity or cell leakage caused by a clinically relevant antibacterial agent (ABA), i.e., a mouth rinse comprising chlorhexidine (CHX) and cetylpyridinium chloride (CPC). Apparent missing mass effects during the formation of microscopically proven dense and vital bacterial films indicate punctual, specific binding of S. gordonii to the saliva-coated biosensor, compared to unspecific adhesion to pure Ti. Coincidentally to ABA-induced killing of surface-adhered bacteria, an increase of adsorbed dissipative mass can be sensed, contrary to the prior mass-loss. This suggests the acoustic sensing of the leakage of cellular content caused by bacterial cell wall rupturing and membrane damage upon the bactericidal attack. The results have significant implications for testing bacterial adhesion mechanisms and cellular integrity during interaction with antibacterial agents.

Comparative Analysis of Mechanical Properties and Metal-Ceramic Bond Strength of Co-Cr Dental Alloy Fabricated by Different Manufacturing Processes.

Cobalt-chromium (Co-Cr) alloy is a widely used base material for dental fixed prostheses. These restorations can be produced through casting technique, subtractive or additive manufacturing technologies. However, limited information is available regarding the influence of manufacturing techniques on the properties of Co-Cr alloy since most studies used different chemical compositions of Co-Cr alloy for different manufacturing methods. This study compares the mechanical properties, metal-ceramic bond strength, and microstructures of specimens produced by casting, milling, and selective laser melting (SLM) from one single Co-Cr alloy composition. The mechanical properties of the alloy were investigated by tensile and Vickers hardness tests, and metal-ceramic bond strength was determined by three-point bending. Scanning electron microscopy (SEM) with backscattered electron (BSE) images and optical microphotographs were used to analyze the surface microstructures. Compared with the casting and milling techniques, SLM Co-Cr alloy specimens indicated enhanced mechanical properties and comparable metal-ceramic bond strength. Besides, the microstructures of the SLM specimens showed finer grains with more second phase particles than the casting and milling specimens. The results of our study indicate that SLM might be superior to traditional techniques for the manufacturing of fixed dental restorations.

Mechanical Characteristics, In Vitro Degradation, Cytotoxicity, and Antibacterial Evaluation of Zn-4.0Ag Alloy as a Biodegradable Material.

Zn-based biodegradable metallic materials have been regarded as new potential biomaterials for use as biodegradable implants, mainly because of the ideal degradation rate compared with those of Mg-based alloys and Fe-based alloys. In this study, we developed and investigated a novel Zn-4 wt % Ag alloy as a potential biodegradable metal. A thermomechanical treatment was applied to refine the microstructure and, consequently, to improve the mechanical properties, compared to pure Zn. The yield strength (YS), ultimate tensile strength (UTS) and elongation of the Zn-4Ag alloy are 157 MPa, 261 MPa, and 37%, respectively. The corrosion rate of Zn-4Ag calculated from released Zn ions in DMEM extracts is approximately 10.75 ± 0.16 µg cm-2 day-1, which is higher than that of pure Zn [corrected]. In vitro cytotoxicity tests showed that the Zn-4Ag alloy exhibits acceptable toxicity to L929 and Saos-2 cells, and could effectively inhibit initial bacteria adhesion. This study shows that the Zn-4Ag exhibits excellent mechanical properties, predictable degradation behavior, acceptable biocompatibility, and effective antibacterial properties, which make it a candidate biodegradable material.

Effect of surface modification of zirconia on cell adhesion, metabolic activity and proliferation of human osteoblasts.

Titanium dental implants with sandblasted and/or acid-etched surfaces have shown clinical superiority in comparison to their smooth, machined counterparts, and are now state of the art. Sandblasting of finished, sintered zirconia implants, however, will damage the surface structure and affect the mechanical properties. To improve osseointegration of zirconia dental implants without impairing the original mechanical strength by crack initiation and partial phase transformation from tetragonal to monoclinic, roughening of the zirconia surface by sandblasting before the final sintering step was employed. Impact of the treatments on cellular reactions of SAOS-2 human osteoblast-like cells was investigated. Sandblasting of Yttrium-stabilized zirconia (Y-TZP) with 120 µm and 250 µm Al2O3 enhanced average roughness (Sa) from 0.28 µm to 4.1 µm and 5.72 µm, respectively. Cell adhesion of SAOS-2 osteoblasts was enhanced up to 175% on sandblasted surfaces, compared to the machined zirconia reference (100%). Metabolic activity and proliferation in the logarithmic growth phase (24-48 h) were not significantly affected. Sample surface coverage by the cells after prolonged incubation (72 h) was markedly decreased on the roughened samples, indicating a shift towards increased differentiation on these surfaces. The approach investigated here to roughen zirconia implants by sandblasting before sintering shows potential to improve the clinical performance of ceramic dental implants.

Generation of Large-Scale DNA Hydrogels with Excellent Blood and Cell Compatibility.

Hemocompatibility and cytocompatibility of biomaterials codetermine the success of tissue engineering applications. DNA, the natural component of our cells, is an auspicious biomaterial for the generation of designable scaffolds with tailorable characteristics. In this study, a combination of rolling circle amplification and multiprimed chain amplification is used to generate hydrogels at centimeter scale consisting solely of DNA. Using an in vitro rotation model and fresh human blood, the reaction of the hemostatic system on DNA hydrogels is analyzed. The measurements of hemolysis, platelets activation, and the activation of the complement, coagulation, and neutrophils using enzyme-linked immunosorbent assays demonstrate excellent hemocompatibility. In addition, the cytocompatibility of the DNA hydrogels is tested by indirect contact (agar diffusion tests) and material extract experiments with L929 murine fibroblasts according to the ISO 10993-5 specifications and no negative impact on the cell viability is detected. These results indicate the promising potential of DNA hydrogels as biomaterials for versatile applications in the field of regenerative medicine.

Photocatalytic antibacterial effects on TiO2-anatase upon UV-A and UV-A/VIS threshold irradiation.

Photocatalysis mediated by the anatase modification of titanium dioxide (TiO2) has shown antibacterial effects in medical applications. The aim of this study was to investigate the possibility of expanding the excitation wavelengths for photocatalytic antibacterial effects from ultraviolet (UV) into the visible light range. After deposition of salivary pellicle and adhesion of Streptococcus gordonii on anatase, different irradiation protocols were applied to induce photocatalysis: ultraviolet A (UV-A) > 320 nm; ultraviolet/visible (UV-A/VIS) light > 380 nm and > 390 nm; and VIS light 400-410 nm. A quartz crystal microbalance with dissipation (QCM-D) tests and microscopic examination were used to observe the photoinduced antibacterial effects. Salivary pellicle could be photocatalytically decomposed under all irradiation protocols. In contrast, effective photocatalytic attack of bacteria could be observed by UV-A as well as by UV-A/VIS at 380 nm < λ < 390 nm only. Wavelengths above 380 nm show promise for in situ therapeutic antifouling applications.

Influence of Different Framework Designs on the Fracture Properties of Ceria-Stabilized Tetragonal Zirconia/Alumina-Based All-Ceramic Crowns.

The aim of this study was to evaluate the fracture load and failure mode of all-ceramic crowns with different ceria-stabilized tetragonal zirconia/alumina nanocomposite (Ce-TZP/A) framework designs. Four frameworks (anatomical shape: AS, with a buccal or lingual supporting structure: BS and LS, or buccal and lingual supporting structures: BLS) were fabricated. All frameworks were veneered with porcelain to fabricate all-ceramic crowns followed by cementation to tooth analogs. The fracture load of each crown either without or with pre-loading (1.2 million cycles, 49 N) was measured. The failure mode was classified into partial or complete fracture. Differences were tested for significance (p < 0.05) by a two-way Analysis of Variance (ANOVA), followed by Tukey's test and by Fisher's exact test, respectively. Without pre-loading, supporting structures did not influence the fracture load or failure mode. Partial fractures were the most common failure mode. Pre-loading promoted the severity of the failure mode, although the fracture load among the framework designs was not influenced. In the AS group, prefailures were observed during pre-loading, and complete fractures were significantly increased after pre-loading. In contrast, the failure mode of the BLS group remained unchanged, showing only partial fracture even after pre-loading. This Ce-TZP/A framework design, comprised of an anatomical shape with additional buccal and lingual structures, has the potential to reduce the chipping of the veneering porcelain.

UV-A and UV-C light induced hydrophilization of dental implants.

OBJECTIVES: Wettability is increasingly considered to be an important factor determining biological responses to implant materials. In this context, the purpose of this study was to compare the dynamic wettability of dental implants made from different bulk materials and modified by different surface modifications, and to analyze the respective changes of wettability upon irradiating these implants by UV-A or UV-C light. METHODS: Four original screw-type implants were investigated: One grit-blasted/acid-etched and one anodically oxidized titanium, one zirconia and one polyetheretherketone implant. Additionally, experimental, screwless, machined titanium cylinders were included in the study. Part of that cylinders and of blasted/etched implants were further modified by a magnetron-sputtered photocatalytic anatase thin film. Scanning electron microscopy was used to investigate the surface micro- and nanostructures. Samples were treated by UV-A (382nm, 25mWcm(-2)) and UV-C (260nm, 15mWcm(-2)) for entire 40min, respectively, and their wettability was quantified by dynamic contact angle (CA) analysis from multi-loop Wilhelmy experiments. RESULTS: All implants are characterized by submicron- and nanosized surface features. Unexposed implants were hydrophobic (CA>90°). Upon UV-A, solely the implants with anatase coating became superhydrophilic (CA<5°). Upon UV-C, the blasted/etched implants turned superhydrophilic, the anodized titanium and the zirconia implants were considerably (CA=34° and 27°, respectively) and the PEEK implants slightly (CA=79°) hydrophilized. SIGNIFICANCE: The wettability of implant surfaces can be improved by UV irradiation. The efficiency of UV-A and UV-C irradiation to lower the CA by photocatalysis or photolysis, however, is strongly dependent on the specific material and surface. Thus, attempts to photofunctionalize these surfaces by irradiation is expected to result in a different pattern of bioresponses.

Bacterial interactions with proteins and cells relevant to the development of life-threatening endocarditis studied by use of a quartz-crystal microbalance.

Implant-related infections are a major challenge in clinical routine because of severe complications, for example infective endocarditis (IE). The purpose of this study was to investigate the real-time interaction of S. gordonii with proteins and cells important in the development of IE, in a flow system, by use of a quartz-crystal microbalance (QCM). Acoustic sensors were biologically modified by preconditioning with sterile saliva, platelet-poor plasma (PPP), or platelet-rich plasma (PRP), followed then by perfusion of a bacterial suspension. After perfusion, additional fluorescence and scanning electron microscopic (SEM) studies were performed. The surface structure of S. gordonii was analyzed by atomic force microscopy (AFM). Compared with S. gordonii adhesion on the abiotic sensor surface following normal mass loading indicated by a frequency decrease, adhesion on saliva, PPP, or PRP-conditioned sensors resulted in an increase in frequency. Furthermore, adhesion induced slightly increased damping signals for saliva and PPP-coated sensors but a decrease upon bacterial adhesion to PRP, indicating the formation of a more rigid biofilm. Microscopic analysis confirmed the formation of dense and vital bacterial layers and the aggregation of platelets and bacteria. In conclusion, our study shows that the complex patterns of QCM output data observed are strongly dependent on the biological substrate and adhesion mechanisms of S. gordonii. Overall, QCM sheds new light on the pathways of such severe infections as IE.

A review on the wettability of dental implant surfaces II: Biological and clinical aspects.

Dental and orthopedic implants have been under continuous advancement to improve their interactions with bone and ensure a successful outcome for patients. Surface characteristics such as surface topography and surface chemistry can serve as design tools to enhance the biological response around the implant, with in vitro, in vivo and clinical studies confirming their effects. However, the comprehensive design of implants to promote early and long-term osseointegration requires a better understanding of the role of surface wettability and the mechanisms by which it affects the surrounding biological environment. This review provides a general overview of the available information about the contact angle values of experimental and of marketed implant surfaces, some of the techniques used to modify surface wettability of implants, and results from in vitro and clinical studies. We aim to expand the current understanding on the role of wettability of metallic implants at their interface with blood and the biological milieu, as well as with bacteria, and hard and soft tissues.

A review on the wettability of dental implant surfaces I: theoretical and experimental aspects.

The surface wettability of biomaterials determines the biological cascade of events at the biomaterial/host interface. Wettability is modulated by surface characteristics, such as surface chemistry and surface topography. However, the design of current implant surfaces focuses mainly on specific micro- and nanotopographical features, and is still far from predicting the concomitant wetting behavior. There is an increasing interest in understanding the wetting mechanisms of implant surfaces and the role of wettability in the biological response at the implant/bone or implant/soft tissue interface. Fundamental knowledge related to the influence of surface roughness (i.e. a quantification of surface topography) on titanium and titanium alloy surface wettability, and the different associated wetting regimes, can improve our understanding of the role of wettability of rough implant surfaces on the biological outcome. Such an approach has been applied to biomaterial surfaces only in a limited way. Focusing on titanium dental and orthopaedic implants, the present study reviews the current knowledge on the wettability of biomaterial surfaces, encompassing basic and applied aspects that include measurement techniques, thermodynamic aspects of wetting and models predicting topographical and roughness effects on the wetting behavior.