Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis.

Titanium and titanium alloys are widely used in biomedical devices and components, especially as hard tissue replacements as well as in cardiac and cardiovascular applications, because of their desirable properties, such as relatively low modulus, good fatigue strength, formability, machinability, corrosion resistance, and biocompatibility. However, titanium and its alloys cannot meet all of the clinical requirements. Therefore, in order to improve the biological, chemical, and mechanical properties, surface modification is often performed. This article reviews the various surface modification technologies pertaining to titanium and titanium alloys including mechanical treatment, thermal spraying, sol–gel, chemical and electrochemical treatment, and ion implantation from the perspective of biomedical engineering. Recent work has shown that the wear resistance, corrosion resistance, and biological properties of titanium and titanium alloys can be improved selectively using the appropriate surface treatment techniques while the desirable bulk attributes of the materials are retained. The proper surface treatment expands the use of titanium and titanium alloys in the biomedical fields. Some of the recent applications are also discussed in this paper.

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Surface modification of titanium, titanium alloys, and related materials for biomedical applications

Surface treatments of titanium dental implants for rapid osseointegration

Background: From an ecological viewpoint, the oral cavity, in fact the oro-pharynx, is an ‘open growth system’. It undergoes an uninterrupted introduction and removal of both microorganisms and nutrients. In order to survive within the oro-pharyngeal area, bacteria need to adhere either to the soft or hard tissues in order to resist shear forces. The fast turn-over of the oral lining epithelia (shedding 3 ×/day) is an efficient defence mechanism as it prevents the accumulation of large masses of microorganisms. Teeth, dentures, or endosseous implants, however, providing non-shedding surfaces, allow the formation of thick biofilms. In general, the established biofilm maintains an equilibrium with the host. An uncontrolled accumulation and/or metabolism of bacteria on the hard surfaces forms, however, the primary cause of dental caries, gingivitis, periodontitis, peri-implantitis, and stomatitis.

Objectives: This systematic review aimed to evaluate critically the impact of surface characteristics (free energy, roughness, chemistry) on the de novo biofilm formation, especially in the supragingival and to a lesser extent in the subgingival areas.

Methods: An electronic Medline search (from 1966 until July 2005) was conducted applying the following search items: ‘biofilm formation and dental/oral implants/surface characteristics’, ‘surface characteristics and implants’, ‘biofilm formation and oral’, ‘plaque/biofilm and roughness’, ‘plaque/biofilm and surface free energy’, and ‘plaque formation and implants’. Only clinical studies within the oro-pharyngeal area were included.

Results: From a series of split-mouth studies, it could be concluded that both an increase in surface roughness above the Ra threshold of 0.2 μm and/or of the surface-free energy facilitates biofilm formation on restorative materials. When both surface characteristics interact with each other, surface roughness was found to be predominant. The biofilm formation is also influenced by the type (chemical composition) of biomaterial or the type of coating. Direct comparisons in biofilm formation on different transmucosal implant surfaces are scars.

Conclusions: Extrapolation of data from studies on different restorative materials seems to indicate that transmucosal implant surfaces with a higher surface roughness/surface free energy facilitate biofilm formation.

Effect of material characteristics and/or surface topography on biofilm development

Polymeric materials with antimicrobial activity

Influence of surface modifications to titanium on antibacterial activity in vitro.

Surface wettability is an important physicochemical property of biomaterials, and it would be more helpful for understanding this property if a wide range of wettability are employed. This study focused on the effect of surface wettability on fibroblast adhesion over a wide range of wettability using a single material without changing surface topography. Plasma polymerization with hexamethyldisiloxane followed by oxygen (O2)-plasma treatment was employed to modify the surfaces. The water contact angle of sample surfaces varied from 106 degrees (hydrophobicity) to almost 0 degrees (super-hydrophilicity). O2 functional groups were introduced on polymer surfaces during O2-plasma treatment. The cell attachment study confirmed that the more hydrophilic the surface, the more fibroblasts adhered in the initial stage that includes super-hydrophilic surfaces. Cells spread much more widely on the hydrophilic surfaces than on the hydrophobic surfaces. There was no significant difference in fibroblast proliferation, but cell spreading was much greater on the hydrophilic surfaces. The fibronectin adsorbed much more on a hydrophilic surface while albumin dominated on a hydrophobic surface in a competing mode. These findings suggest the importance of the surface wettability of biomaterials on initial cell attachment and spreading. The degree of wettability should be taken into account when a new biomaterial is to be employed.

https://ir.tdc.ac.jp/irucaa/bitstream/10130/63/1/jbm.b.30638.pdf

Adhesion of mouse fibroblasts on hexamethyldisiloxane surfaces with wide range of wettability.

Bone response to calcium phosphate-coated and bisphosphonate-immobilized titanium implants

The influence of surface modifications to titanium on the initial adherence of Porphyromonas gingivalis ATCC33277 and Actinobacillus actinomycetemcomitans ATCC43718 was evaluated. Surface modifications were performed with dry processes including ion implantation (Ca(+), N(+), F(+)), oxidation (anode oxidation, titania spraying), ion plating (TiN, alumina), and ion beam mixing (Ag, Sn, Zn, Pt) with Ar(+) on polished pure titanium plates. Comparatively large amounts of P. gingivalis and A. actinomycetemcomitans adhered to polished titanium plates. The degree of P. gingivalis adhesion showed a positive correlation with surface energy and the amount of calcium-ion adsorption. Adherence of both P. gingivalis and A. actinomycetemcomitans increased on calcium-implanted surfaces compared with polished titanium surfaces, whereas adherence of P. gingivalis was remarkably decreased on alumina-coated surfaces. These findings indicate that titanium implants exposed to the oral cavity require surface modification to inhibit the adherence of oral bacteria, and that surface modification with a dry process is useful in controlling the adhesion of oral bacteria as well as ensuring resistance against wear.

Yutaka Oda

Papers

Influence of surface modifications to titanium on antibacterial activity in vitro.

Adhesion of mouse fibroblasts on hexamethyldisiloxane surfaces with wide range of wettability.

Bone response to calcium phosphate-coated and bisphosphonate-immobilized titanium implants

Influence of surface modifications to titanium on oral bacterial adhesion in vitro.

Immobilization of bisphosphonates on surface modified titanium.