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Magnesium-based biodegradable metals (BMs) as bone implants have better mechanical properties than biodegradable polymers, yet their strength is roughly less than 350 MPa. In this work, binary Zn alloys with alloying elements Mg, Ca, Sr, Li, Mn, Fe, Cu, and Ag respectively, are screened systemically by in vitro and in vivo studies. Li exhibits the most effective strengthening role in Zn, followed by Mg. Alloying leads to accelerated degradation, but adequate mechanical integrity can be expected for Zn alloys when considering bone fracture healing. Adding elements Mg, Ca, Sr and Li into Zn can improve the cytocompatibility, osteogenesis, and osseointegration. Further optimization of the ternary Zn-Li alloy system results in Zn-0.8Li-0.4Mg alloy with the ultimate tensile strength 646.69 ± 12.79 MPa and Zn-0.8Li-0.8Mn alloy with elongation 103.27 ± 20%. In summary, biocompatible Zn-based BMs with strength close to pure Ti are promising candidates in orthopedics for load-bearing applications. Biodegradable implants are of great interest in orthopaedic applications but have been limited by low mechanical strength. Here, the authors examine systematically in detail the strengthening of biodegradable zinc by alloying with beneficial elements using mechanical, biodegradability and biocompatibility testing.

This study aimed to analyze the morphology of bone graft granules, the presence of granule demineralization, and bone morphology in retrieved human maxillary sinus bone graft biopsies. Healthy patients underwent sinus bone augmentation using lateral access. Two different dimensions of the antrostomy were performed, a 4 mm or 8 mm height. After 6 months, all sites received one implant using a flap technique, crestal positioning, and submerged healing. Implant biopsies were retrieved after 3 months and were histologically processed. The ESEM analysis was performed on the entire portion of the peri-implant bone (up to 750 µm from the implant thread). Three different regions of interest (ROIs) were selected: the coronal, middle, and apical portions of the implant. In these areas, EDX was performed, and calcium (Ca), phosphate (P), nitrogen (N), and their atomic ratios (Ca/P, Ca/N, and P/N) were calculated. Different bone tissue electron-dense areas were detected through grayscale intensity quantification of ESEM images with different organic (N) or inorganic (Ca,P) compositions. A total of 16 biopsies from 16 healthy patients were analyzed. Bone graft granules were mostly detected in the apical ROI. New bone tissue bridges were detected in the apical and middle ROI. These structures, with lower Ca/N and P/N ratios, were connected and enveloped the bone graft granules. Cortical ROI revealed the most mineralized bone tissue. Conclusions: After 9 months, bone graft resorption was only partially completed and new bone tissue appeared less mineralized in the middle and apical ROI than in the coronal ROI.

Osseointegrated implants inserted in the temporal bone are a vital component of bone-anchored hearing systems (BAHS). Despite low implant failure levels, early loading protocols and simplified procedures necessitate the application of implants which promote bone formation, bone bonding and biomechanical stability. Here, screw-shaped, commercially pure titanium implants were selectively laser ablated within the thread valley using an Nd:YAG laser to produce a microtopography with a superimposed nanotexture and a thickened surface oxide layer. State-of-the-art machined implants served as controls. After eight weeks' implantation in rabbit tibiae, resonance frequency analysis (RFA) values increased from insertion to retrieval for both implant types, while removal torque (RTQ) measurements showed 153% higher biomechanical anchorage of the laser-modified implants. Comparably high bone area (BA) and bone-implant contact (BIC) were recorded for both implant types but with distinctly different failure patterns following biomechanical testing. Fracture lines appeared within the bone ~30-50 μm from the laser-modified surface, while separation occurred at the bone-implant interface for the machined surface. Strong correlations were found between RTQ and BIC and between RFA at retrieval and BA. In the endosteal threads, where all the bone had formed de novo, the extracellular matrix composition, the mineralised bone area and osteocyte densities were comparable for the two types of implant. Using resin cast etching, osteocyte canaliculi were observed directly approaching the laser-modified implant surface. Transmission electron microscopy showed canaliculi in close proximity to the laser-modified surface, in addition to a highly ordered arrangement of collagen fibrils aligned parallel to the implant surface contour. It is concluded that the physico-chemical surface properties of laser-modified surfaces (thicker oxide, micro- and nanoscale texture) promote bone bonding which may be of benefit in situations where large demands are imposed on biomechanically stable interfaces, such as in early loading and in compromised conditions.

Immune response and new tissue formation are important aspects of tissue repair. However, only a single aspect is generally considered in previous biomedical interventions, and the synergistic effect is unclear. Here, a dual-effect coating with immobilized immunomodulatory metal ions (e.g., Zn 2+ ) and osteoinductive growth factors (e.g., BMP-2 peptide) is designed via mussel adhesion-mediated ion coordination and molecular clicking strategy. Compared to the bare TiO 2 group, Zn 2+ can increase M2 macrophage recruitment by up to 92.5% in vivo and upregulate the expression of M2 cytokine IL-10 by 84.5%; while the dual-effect of Zn 2+ and BMP-2 peptide can increase M2 macrophages recruitment by up to 124.7% in vivo and upregulate the expression of M2 cytokine IL-10 by 171%. These benefits eventually significantly enhance bone-implant mechanical fixation (203.3 N) and new bone ingrowth (82.1%) compared to the bare TiO 2 (98.6 N and 45.1%, respectively). Taken together, the dual-effect coating can be utilized to synergistically modulate the osteoimmune microenvironment at the bone-implant interface, enhancing bone regeneration for successful implantation. Immune response and new tissue formation are important aspects of tissue repair but often only one aspect is considered in biomedical interventions. Here, the authors report on the use of a mussel-like surface coating to immobilize immune modulating metal ions and growth factors and demonstrated improved in vivo outcomes.

Successful osseointegration of press-fit implants depends on the initial stability, often measured by the micromotions between the implant and bone. A good primary stability can be achieved by optimizing the compressive and frictional forces acting at the bone-implant interface. The frictional properties of the implant-bone interface, which depend on the roughness and porosity of the implant surface coating, can affect the primary stability. Several reversible (elastic) and non-reversible (permanent) deformation processes take place during frictional loading of the implant-bone interface. In case of a rough coating, the asperities of the implant surface are compressed into the bone leading to mechanical interlocking. To optimize fixation of orthopaedic implants it is crucial to understand these complex interactions between coating and bone. The objective of the current study was to gain more insight into the reversible and non-reversible processes acting at the implant-bone interface. Tribological experiments were performed with two types of porous coatings against human cadaveric bone. The results indicated that the coefficient of friction depended on the coating roughness (0.86, 0.95, and 0.45 for an Ra roughness of 41.2, 53.0, and a polished surface, respectively). Larger elastic and permanent displacements were found for the rougher coating, resulting in a lower interface stiffness. The experiments furthermore revealed that relative displacements of up to 35 µm can occur without sliding at the interface. These findings have implications for micromotion thresholds that currently are assumed for osseointegration, and suggest that bone ingrowth actually occurs in the absence of relative sliding at the implant-bone interface.

Musculoskeletal disorders are becoming an ever-growing societal burden and, as a result, millions of bone replacements surgeries are performed per year worldwide. Despite total joint replacements being recognized among the most successful surgeries of the last century, implant failure rates exceeding 10% are still reported. These numbers highlight the necessity of technologies to provide an accurate monitoring of the bone–implant interface state. This study provides a detailed review of the most relevant methodologies and technologies already proposed to monitor the loosening states of endoprosthetic implants, as well as their performance and experimental validation. A total of forty-two papers describing both intracorporeal and extracorporeal technologies for cemented or cementless fixation were thoroughly analyzed. Thirty-eight technologies were identified, which are categorized into five methodologies: vibrometric, acoustic, bioelectric impedance, magnetic induction, and strain. Research efforts were mainly focused on vibrometric and acoustic technologies. Differently, approaches based on bioelectric impedance, magnetic induction and strain have been less explored. Although most technologies are noninvasive and are able to monitor different loosening stages of endoprosthetic implants, they are not able to provide effective monitoring during daily living of patients.

This in vivo animal study aimed to evaluate the diagnostic reliability of a damping capacity assessment by correlating dental implant stability with peri-implant bone loss in a beagle dog model. Thirty-two bone-level implants were immediately placed in four beagle dogs without bone grafting. Implants were divided into platform switching and platform matching groups. Each implant was loaded with a superstructure after a 4-week healing period, followed by 8 weeks of functional loading. Damping capacity assessment and resonance frequency analysis were performed every 4 weeks. Peri-implant bone loss, supporting bone volume, and bone-to-implant contact were assessed using micro-CT and histological analysis. Two implants in the platform switching group failed during the study. Among the remaining 30 implants, final implant stability indices by damping capacity assessment ranged from 44 to 80. Peri-implant bone loss varied from 0.25 mm to 6.96 mm. A strong negative correlation was found between final stability indices and bone loss ( r = − 0.745; p  ≤ 0.0001). Supporting bone volume and bone-to-implant contact ratio showed significant positive correlations with implant stability. Damping capacity assessment demonstrated diagnostic relevance by reflecting peri-implant bone loss and the degree of osseointegration. However, its ability to detect early bone resorption is uncertain.

Electrical stimulation has shown to be a promising approach for promoting osseointegration in bone anchoring implants, where osseointegration defines the biological bonding between the implant surface and bone tissue. Bone-anchored implants are used in the rehabilitation of hearing and limb loss, and extensively in edentulous patients. Inadequate osseointegration is one of the major factors of implant failure that could be prevented by accelerating or enhancing the osseointegration process by artificial means. In this article, we reviewed the efforts to enhance the biofunctionality at the bone-implant interface with electrical stimulation using the implant as an electrode. We reviewed articles describing different electrode configurations, power sources, and waveform-dependent stimulation parameters tested in various in vitro and in vivo models. In total 55 English-language and peer-reviewed publications were identified until April 2020 using PubMed, Google Scholar, and the Chalmers University of Technology Library discovery system using the keywords: osseointegration, electrical stimulation, direct current and titanium implant. Thirteen of those publications were within the scope of this review. We reviewed and compared studies from the last 45 years and found nonuniform protocols with disparities in cell type and animal model, implant location, experimental timeline, implant material, evaluation assays, and type of electrical stimulation. The reporting of stimulation parameters was also found to be inconsistent and incomplete throughout the literature. Studies using in vitro models showed that osteoblasts were sensitive to the magnitude of the electric field and duration of exposure, and such variables similarly affected bone quantity around implants in in vivo investigations. Most studies showed benefits of electrical stimulation in the underlying processes leading to osseointegration, and therefore we found the idea of promoting osseointegration by using electric fields to be supported by the available evidence. However, such an effect has not been demonstrated conclusively nor optimally in humans. We found that optimal stimulation parameters have not been thoroughly investigated and this remains an important step towards the clinical translation of this concept. In addition, there is a need for reporting standards to enable meta-analysis for evidence-based treatments.

The major drawback associated with PEEK implants is their biologically inert surface, which caused unsatisfactory cellular response and poor adhesion between the implants and surrounding soft tissues against proper bone growth. In this study, polyetheretherketone (PEEK) was incorporated with calcium hydroxyapatite (cHAp) to fabricate a PEEK–cHAp biocomposite, using the fused deposition modeling (FDM) method and a surface treatment strategy to create microporous architectures onto the filaments of PEEK lattice scaffold. Also, nanostructure and morphological tests of the PEEK–cHAp biocomposite were modeled and analyzed on the FDM-printed PEEK–cHAp biocomposite sample to evaluate its mechanical and thermal strengths as well as in vitro cytotoxicity via a scanning electron microscope (SEM). A technique was used innovatively to create and investigate the porous nanostructure of the PEEK with controlled pore size and distribution to promote cell penetration and biological integration of the PEEK–cHAp into the tissue. In vivo tests demonstrated that the surface-treated micropores facilitated the adhesion of newly regenerated soft tissues to form tight implant–tissue interfacial bonding between the cHAp and PEEK. The results of the cell culture depicted that PEEK–cHAp exhibited better cell proliferation attachment spreading and higher alkaline phosphatase activity than PEEK alone. Apatite islands formed on the PEEK–cHAp composite after immersion in simulated body fluid of Dulbecco's modified Eagle medium (DMEM) for 14 days and grew continuously with more or extended periods. The microstructure treatment of the crystallinity of PEEK was comparatively and significantly different from the PEEK–cHAp sample, indicating a better treatment of PEEK–cHAp. The in vitro results obtained from the PEEK–cHAp biocomposite material showed its biodegradability and performance suitability for bone implants. This study has potential applications in the field of biomedical engineering to strengthen the conceptual knowledge of FDM and medical implants fabricated from PEEK–cHAp biocomposite materials.

This study aims to develop an innovative bilayered dental implant design featuring a titanium alloy core with a porous composite titanium (Ti) and hydroxyapatite (HA) outer layer to enhance implant stability and patient outcomes. Using SolidWorks 2017, 3D models of the implants and a mandibular bone segment were created. A Finite Element (FE) analysis was then conducted with ANSYS Workbench to assess the mechanical behavior under a 250 N axial compressive load, comparing the bilayered implant to a conventional titanium implant. Variables like porosity (ranging from 10 to 90% in 10% increments), HA content (ranging from 10 to 50% in 5% intervals), and outer layer thickness (2 mm, 1.5 mm and 1 mm) were systematically analyzed. Each configuration was evaluated based on von Mises stress distribution and interfacial strain in peri-implant bone. Results indicated that all porous designs of bilayered implants had significantly lower von Mises stress than traditional implant, with reductions ranging from approximately 69 to 94%, depending on HA/Ti composition and shell thickness. The non-porous bilayer configurations also showed clear stress reductions, with decreases from approximately 72 to 90%, depending on the HA/Ti composition and shell thickness. However, these reductions were slightly lower than those observed in porous designs, with maximal reductions occurring in the porous core of some 2 mm bilayered implant configurations. The combined evaluation of strain and von Mises stress analyses identified the 2 mm core diameter with a 2 mm porous shell as the optimal design, providing favorable microstrain, improved load transfer, and reduced stress concentrations. This modification promotes a more favorable mechanical interaction between the implant and surrounding bone. These findings underscore the potential of bilayered porous implants to improve stability and bone integration, marking a significant step forward in dental implant technology. Further research, including experimental validation, is encouraged to verify these results and investigate other loading conditions, promoting the development of more effective and sustainable dental implant solutions.