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Titanium (Ti) implants are widely used in dentistry and orthopedics owing to their excellent corrosion resistance, biocompatibility, and mechanical properties, which have gained increasing attention from the viewpoints of fundamental research and practical applications. Also, numerous studies have been carried out to fine-tune the micro/nanostructures of Ti and/or incorporate chemical elements to improve overall implant performance. Zinc oxide nanoparticles (nano-ZnO) are well-known for their good antibacterial properties and low cytotoxicity along with their ability to synergize with a variety of substances, which have received increasingly widespread attention as biomodification materials for implants. In this review, we summarize recent research progress on nano-ZnO modified Ti-implants. Their preparation methods of nano-ZnO modified Ti-implants are introduced, followed by a further presentation of the antibacterial, osteogenic, and anti-corrosion properties of these implants. Finally, challenges and future opportunities for nano-ZnO modified Ti-implants are proposed. Graphical Abstract

The impact of new anodization modification on titanium interaction with human osteoblasts and fibroblasts (in vitro). To compare the behavior of osteoblast and fibroblast cells, as well as the surface characteristics, of modified anodized titanium surfaces at different voltages with sandblasted and acid-etched titanium surfaces. Twenty titanium discs were fabricated and subjected to 4 types of surface treatments: machined surface, sandblasted and acid-etched surface (SLA), modified anodized A surface at 30V DC and modified anodized B surface at 70V DC. Surface roughness and contact angle were measured. Osteoblast cells were seeded onto titanium discs and evaluated for cell proliferation, Alkaline phosphatase (ALP) activity, Alizarin red staining, and cell morphology with SEM imaging. Immunofluorescent staining was performed to assessed cell adhesion of both osteoblast and fibroblast cells. Statistic analysis was conducted using ANOVA with Tukey post hoc multiple comparisons. The topography and osteoblast cell spreading on both modified anodized titanium surfaces differed significantly from machined and SLA surfaces (p < 0.05). However, there was no significant difference in osteoblast cell spreading between modified anodized surfaces A and B. In addition, anodized surfaces A and B showed significantly higher ALP activity and Alizarin red staining than both SLA and machined surfaces (p < 0.05). For human gingival fibroblast cells, the modified anodized surfaces exhibited significantly higher cell adherence (p < 0.05), followed by the machined surface, with SLA surfaces showing the least adherence. The modified anodized surfaces showed superior biocompatibility, enhancing attachment of both osteoblast and fibroblast cells, whereas the SLA surfaces exhibited the least fibroblast cell adherence.

Improvement of wear, corrosion, and heat-resistant properties of coatings to expand the operational capabilities of metals and alloys is an urgent problem for modern enterprises. Diffusion titanium, chromium, and aluminum-based coatings are widely used to solve this challenge. The article aims to obtain the corrosion-electrochemical properties and increase the microhardness of the obtained coatings compared with the initial Ti-6Al-4V alloy. For this purpose, corrosion resistance, massometric tests, and microstructural analysis were applied, considering various aggressive environments (acids, sodium carbonate, and hydrogen peroxide) at different concentrations, treatment temperatures, and saturation times. As a result, corrosion rates, polarization curves, and X-ray microstructures of the uncoated and coated Ti-6Al-4V titanium alloy samples were obtained. Histograms of corrosion inhibition ratio for the chromium–aluminum coatings in various environments were discussed. Overall, the microhardness of the obtained coatings was increased 2.3 times compared with the initial Ti-6Al-4V alloy. The corrosion-resistant chromaluminizing alloy in aqueous solutions of organic acids and hydrogen peroxide was recommended for practical application in conditions of exposure to titanium products.

Excessive production of reactive oxygen species (ROS) around titanium implants under diabetic conditions causes persistent inflammation, leading to poor osseointegration and even implant failure. Surface modification is an effective way to promote ROS clearance, alleviate inflammation, and stimulate bone formation. In this study, a multifunctional coating is fabricated by introducing cerium (Ce)-containing mesoporous bioactive glass nanoparticles (Ce-MBGNs) onto the titanium surface via an electrophoretic deposition method. The incorporation of Ce-MBGNs remarkably improves surface hydrophilicity by increasing the surface areas. The bioactive ions are appropriately released, thereby promoting mesenchymal stem cell proliferation and differentiation under diabetic conditions. The conversion between Ce(III) and Ce(IV) endows Ce-MBGNs coating with antioxidative nanoenzymes properties to scavenge diabetes-induced ROS, resultin g in macrophage polarization towards the anti-inflammatory phenotype. The therapeutic effect of Ce-MBGNs-modified titanium implants is also verified in diabetic rats by inhibiting inflammatory responses and accelerating early osseointegration. Taken together, the findings reveal that the ROS-scavenging and immunomodulation activity of the Ce-MBGNs coating contributes to enhanced osseointegration, and provides a novel implant surface for diabetic patients.

Vascularization plays a significant role in promoting the expedited process of bone regeneration while also enhancing the stability and viability of artificial bone implants. Although titanium alloy scaffolds were designed to mimic the porous structure of human bone tissues to facilitate vascularization in bone repair, their biological inertness restricted their broader utilization. The unique attribute of Metal-organic framework (MOF) MIL-53(Fe), known as “breathing”, can facilitate the efficient adsorption of extracellular matrix proteins and thus provide the possibility for efficient interaction between scaffolds and cell adhesion molecules, which helps improve the bioactivity of the titanium alloy scaffolds. In this study, MIL-53(Fe) was synthesized in situ on the scaffold after hydrothermal treatment. The MIL-53(Fe) endowed the scaffold with superior protein absorption ability and preferable biocompatibility. The scaffolds have been shown to possess favorable osteogenesis and angiogenesis inducibility. It was indicated that MIL-53(Fe) modulated the mechanotransduction process of endothelial cells and induced increased cell stiffness by promoting the adsorption of adhesion-mediating extracellular matrix proteins to the scaffold, such as laminin, fibronectin, and perlecan et al., which contributed to the activation of the endothelial tip cell phenotype at sprouting angiogenesis. Therefore, this study effectively leveraged the intrinsic “breathing” properties of MIL-53 (Fe) to enhance the interaction between titanium alloy scaffolds and vascular endothelial cells, thereby facilitating the vascularization inducibility of the scaffold, particularly during the sprouting angiogenesis phase. This study indicates that MIL-53(Fe) coating represents a promising strategy to facilitate accelerated and sufficient vascularization and uncovers the scaffold-vessel interaction from a biomechanical perspective. Graphical Abstract

Background Inflammatory osteolysis after total joint replacement (TJR) may cause implant failure, periprosthetic fractures, and be a severe threat to global public health. Our previous studies demonstrated that melatonin had a therapeutic effect on wear-particles induced osteolysis. Gut microbiota is closely related to bone homeostasis, and has been proven to be affected by melatonin. However, whether melatonin could play its anti-osteolysis effects through reprogramming gut microbiota remains elusive. Results Here, we demonstrated that melatonin could alleviate Ti-particles induced osteolysis, while this therapeutic effect was blocked by antibiotic cocktail treatment. Interestingly, transplantation of fecal microbiota from mice treated with melatonin reappeared the same beneficial effect. Analysis of the 16S rRNA revealed that melatonin could reverse dysbacteriosis triggered by osteolysis, and elevate the relative abundance of some short chain fatty acid (SCFA) producing bacteria. Moreover, butyrate was enriched by exogenous melatonin administration, while acetate and propionate did not show an evident difference. This was consistent with the results of the metagenomic approach (PICRUSt2) analysis, which revealed a general increase in the synthetic enzymes of butyrate. More importantly, direct supplementation of butyrate could also recapitulate the anti-osteolysis effect of melatonin. Further analysis identified that butyrate alleviated osteolysis via activating its receptor GPR109A, and thus to suppress the activation of NLRP3 inflammasome triggered by Ti-particles. Conclusions Taken together, our results suggested that the benefits of melatonin mainly depend on the ability of modulating gut microbiota and regulating butyrate production. Graphic Abstract

Background Interim restorations are crucial in dental implant procedures as they ensure patient’s comfort, maintain esthetic appearance, and restore function during the healing process. Optimizing retention of these restorations ensures their long-term success. This study aims to evaluate the shear bond strength (SBS) of nano-modified, additively manufactured resin-based interim materials to smooth and rough titanium surfaces. Methods Ninety-six specimens were prepared with a 3D printed resin (VarseoSmile Crown plus; Bego) and divided into 3 groups: group I (VS control) ( n  = 32), group II (VS 0.2%TiO 2 ) ( n  = 32), and group III (VS 0.4%TiO 2 ) ( n  = 32), then each group was divided into 2 subgroups according to bonded titanium surface: smooth ( n  = 16) and sandblasted ( n  = 16). The prepared resin samples underwent air abrasion followed by citric acid etching. Subsequently, surface roughness (Ra) values were measured by surface profilometer. Each specimen was bonded with a dual-cured adhesive resin cement for SBS testing using universal testing machine. Half of the specimens of each group were subjected to thermocycling (1000 cycles) then tested for SBS. Failure modes were determined using stereomicroscope. Surface roughness was compared using paired t-tests, while two-way ANOVA assessed filler type and surface treatment effects. Three-way ANOVA evaluated the impact of filler type, surface treatment, and thermocycling on SBS. Significance was set at P  < 0.05. Results Surface treatment showed a statistically significant increase in surface roughness of nanomodified composite specimens as well as titanium surfaces ( P  < 0.0001). The highest surface roughness was seen in group I (0.701 ± 0.113) followed by group III (0.690 ± 0.107), group II (0.653 ± 0.133) and rough titanium surface (0.548 ± 0.062). Regarding SBS values, before thermocycling, group I (8.85 ± 1.03) was the highest, followed by group III (8.29 ± 0.57) then group II (6.87 ± 0.53). After thermocycling, group III bonded to rough titanium surface showed the highest values (12.87 ± 0.77), while group II was the lowest (7.81 ± 0.94) ( P  < 0.0001). Conclusion Surface treatment significantly enhanced surface roughness and SBS of nanomodified composites to titanium surfaces. This improvement underscores the effectiveness of nanomodification and surface treatment in optimizing the adhesive interface, which is crucial for achieving durable bonding in dental restorations.

Background This study aimed to investigate the influence of different titanium mesh thicknesses (0.1 mm, 0.2 mm, and 0.3 mm) on mechanical durability and stress distribution in guided bone regeneration using finite element analysis (FEA). Methods Three-dimensional mandibular bone models were reconstructed from cone-beam computed tomography (CBCT) data of a patient with a posterior alveolar defect. Custom titanium meshes with varying thicknesses were designed and virtually applied to the defect area. All models were subjected to a vertical force of 30 N to simulate masticatory loading. FEA simulations were performed using ALTAIR Hypermesh and OptiStruct software to evaluate von Mises stress distribution across the mesh, graft, and bone. Results The 0.1 mm mesh exhibited the highest stress concentrations (981.569 MPa), indicating a high risk of plastic deformation and potential graft damage (35.287 MPa). The 0.2 mm mesh provided moderate protection with improved stress distribution (mesh: 452.218 MPa, graft: 11.589 MPa). The 0.3 mm mesh showed the best mechanical performance, with the lowest stress values on both the mesh (226.205 MPa) and the graft (7.785 MPa). Bone stress remained below critical thresholds in all models. Conclusion Mesh thickness significantly affects the mechanical behavior and stress shielding capacity of titanium meshes in GBR applications. A thickness of 0.3 mm offers the most reliable mechanical performance. However, 0.2 mm meshes may serve as a viable alternative in cases requiring greater flexibility or lower cost, with caution toward borderline graft stress.

Background Establishing stable femoral component fixation in revision total hip arthroplasty (rTHA) remains challenging. Early monobloc tapered, fluted, titanium (TFT) designs were complicated by high rates of subsidence, while modular designs were complicated by taper corrosion and junctional fractures. Newer generation monobloc stems have been designed to minimize subsidence. Therefore, the aim of this study was to present the clinical and radio-graphic results of the most recent modular and monobloc TFT designs. Materials and Methods Patients undergoing rTHA in which TFT femoral stems were used, whether modular or monobloc, were included in this retrospective review. Included stems had the same design characteristics and were from the same manufacturer. The only difference was neck modularity. Radiographic analysis for stem subsidence was performed. Clinical outcomes including Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and re-revisions were collected. We examined survivorship for the endpoints of subsidence or re-revision for any reason. Results Ninety-four (66 monobloc, 28 modular) hips met inclusion criteria, with a median follow-up of 25.9 months. Mean stem subsidence was 1.9±0.2 mm in the modular group and 2.1±0.3 mm in the monobloc group (P=.56), with 90 of 94 (95%) stems subsiding less than 5 mm. Twelve hips (13%) required re-revision with no difference in survival between the groups. HHS and WOMAC scores significantly improved from preoperative to last recorded follow-up in both groups (P≤.01). Conclusion Advances in implant design including spline geometry and more aggressive tapers in monobloc TFT femoral components offer encouraging clinical outcomes with an overall low risk of clinically significant subsidence. [Orthopedics. 202x;4x(x):xx–xx.]

The augmentation of the alveolar crest after the loss of one or several teeth can be carried out using different bone augmentation techniques. These techniques include bone distraction, ridge expansion, bone block grafts, etc. Guided bone regeneration is an alternative to increase the volume of the hard tissues for the subsequent placement of the implants in the optimal three-dimensional position. The objective of this paper is to show a case report of the use of customized titanium mesh for posterior vertical bone regeneration. Case report and Results: A 59-year-old woman comes to rehabilitate edentulous spaces with implants. After taking the anamnesis and the intra and extraoral exploration, a vertical and horizontal bone defect is observed in the third quadrant. After the radiological study with CBCT, a bone height of 6.04 mm to the inferior alveolar nerve and a width of the bone crest of 3.95 mm was observed. It was decided to carry out a regeneration with a preformed titanium mesh (Avinent®, Santpedor, Spain) and four microscrews (Avinent®, Santpedor, Spain). The flap was closed without tension. Regular check-ups were performed without complications. At 7 months, the mesh was removed and two osteoingrated implants (Avinent®, Santpedor, Spain) were placed with a torque greater than 45 N/cm and an ISQ of 82 and 57 N/cm, respectively. The bone gain obtained was 1.84 and 1.92 mm in width and 4.2 and 3.78 mm in height for positions 3.5 and 3.6. The newly formed bone, obtained by trephine, was well-structured and histologically indistinguishable from the previous bone. Conclusion: The use of a customized pre-formed titanium mesh together with the mixture of autologous bone and xenograft is a feasible and predictable technique for vertical bone regeneration.