Abstract
The aim of the article is to present recent developments in material research with bisphenyl-polymer/carbon-fiber-reinforced composite that have produced highly influential results toward improving upon current titanium bone implant clinical osseointegration success. Titanium is now the standard intra-oral tooth root/bone implant material with biocompatible interface relationships that confer potential osseointegration. Titanium produces a TiO2 oxide surface layer reactively that can provide chemical bonding through various electron interactions as a possible explanation for biocompatibility. Nevertheless, titanium alloy implants produce corrosion particles and fail by mechanisms generally related to surface interaction on bone to promote an inflammation with fibrous aseptic loosening or infection that can require implant removal. Further, lowered oxygen concentrations from poor vasculature at a foreign metal surface interface promote a build-up of host-cell-related electrons as free radicals and proton acid that can encourage infection and inflammation to greatly influence implant failure. To provide improved osseointegration many different coating processes and alternate polymer matrix composite (PMC) solutions have been considered that supply new designing potential to possibly overcome problems with titanium bone implants. Now for important consideration, PMCs have decisive biofunctional fabrication possibilities while maintaining mechanical properties from addition of high-strengthening varied fiber-reinforcement and complex fillers/additives to include hydroxyapatite or antimicrobial incorporation through thermoset polymers that cure at low temperatures. Topics/issues reviewed in this manuscript include titanium corrosion, implant infection, coatings and the new epoxy/carbon-fiber implant results discussing osseointegration with biocompatibility related to nonpolar molecular attractions with secondary bonding, carbon fiber in vivo properties, electrical semiconductors, stress transfer, additives with low thermal PMC processing and new coating possibilities.
Highlights
Titanium alloys developed in the 1940s for aircraft were made available to orthopedic surgeons as biomaterials for bone implants approximately at the same time [1] and were tested earlier with cat femurs during the late 1930s [2]
Osseointegration and antimicrobial properties are repeatedly hard to realize with titanium/titanium alloy implants [4], probably because biocompatibility with function is difficult using metal [52]
Fiber-reinforced polymer matrix composite (PMC) compete with metals especially on a strength-to-weight basis in required mechanical properties
Summary
Titanium alloys developed in the 1940s for aircraft were made available to orthopedic surgeons as biomaterials for bone implants approximately at the same time [1] and were tested earlier with cat femurs during the late 1930s [2]. CPTi is generally reserved for dental applications due to an extremely stable oxide TiO2 thin surface layer that resists corrosion under physiologic conditions [1,2,3] and forms a fine interfacial direct metal to bone contact as osseointegration [1,2,3,4]. Ti-6Al-4V has been used for dental implants and stronger than CPTi, biocompatibility is a concern from aluminum and vanadium ions released [3]. Titanium failures occur and appear related to factors that discourage stabilized bone osseointegration such as trauma from overloading, micromotion and surgical burden [6] to support inflammation without proper healing and in a small percentage infection next to exposed metal surface as the final destructive mechanisms for implant loosening [4,7]. The healing response involves serum protein adhesion to the implant that can promote bacterial attachment to a biomaterial surface [7]
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