Porous Titanium Implants Research Articles

A porous bioactive titanium implant for spinal interbody fusion: an experimental study using a canine model

Object Porous biomaterials with adequate pore structure and appropriate mechanical properties are expected to provide a new generation of devices for spinal interbody fusion because of their potential to eliminate bone grafting. The purpose of this study was to evaluate the fusion characteristics of porous bioactive titanium implants using a canine anterior interbody fusion model. Methods Porous titanium implants sintered with volatile spacer particles (porosity 50%, average pore size 303 μm, compressive strength 116.3 MPa) were subjected to chemical and thermal treatments that give a bioactive microporous titania layer on the titanium surface (BT implant). Ten adult female beagle dogs underwent anterior lumbar interbody fusion at L6–7 using either BT implants or nontreated (NT) implants, followed by posterior spinous process wiring and facet screw fixation. Radiographic evaluations were performed at 1, 2, and 3 months postoperatively using X-ray fluoroscopy. Animals were killed 3 months postoperatively, and fusion status was evaluated by manual palpation and histological examination. Results Interbody fusion was confirmed in all five dogs in the BT group and three of five dogs in the NT group. Histological examination demonstrated a large amount of new bone formation with marrowlike tissue in the BT implants and primarily fibrous tissue formation in the NT implants. Conclusions Bioactive treatment effectively enhanced the fusion ability of the porous titanium implants. These findings, coupled with the appropriate mechanical properties in load-bearing conditions, indicate that these porous bioactive titanium implants represent a new generation of biomaterial for spinal interbody fusion.

A porous bioactive titanium implant for spinal interbody fusion: an experimental study using a canine model

Porous biomaterials with adequate pore structure and appropriate mechanical properties are expected to provide a new generation of devices for spinal interbody fusion because of their potential to eliminate bone grafting. The purpose of this study was to evaluate the fusion characteristics of porous bioactive titanium implants using a canine anterior interbody fusion model. Porous titanium implants sintered with volatile spacer particles (porosity 50%, average pore size 303 microm, compressive strength 116.3 MPa) were subjected to chemical and thermal treatments that give a bioactive microporous titania layer on the titanium surface (BT implant). Ten adult female beagle dogs underwent anterior lumbar interbody fusion at L6-7 using either BT implants or nontreated (NT) implants, followed by posterior spinous process wiring and facet screw fixation. Radiographic evaluations were performed at 1, 2, and 3 months postoperatively using X-ray fluoroscopy. Animals were killed 3 months postoperatively, and fusion status was evaluated by manual palpation and histological examination. Interbody fusion was confirmed in all five dogs in the BT group and three of five dogs in the NT group. Histological examination demonstrated a large amount of new bone formation with marrowlike tissue in the BT implants and primarily fibrous tissue formation in the NT implants. Bioactive treatment effectively enhanced the fusion ability of the porous titanium implants. These findings, coupled with the appropriate mechanical properties in load-bearing conditions, indicate that these porous bioactive titanium implants represent a new generation of biomaterial for spinal interbody fusion.

Bone growth in rapid prototyped porous titanium implants

Two porous titanium implants with a pore size diameter of 800 and 1200 microm (Ti800 and Ti1200) and an interconnected network were manufactured using rapid prototyping. Their dimensions and structure matched those of the computer assisted design. The porosity of the implants was around 60%. Their compressive strength and Young's modulus were around 80 MPa and 2.7 GPa, respectively. These values are comparable to those of cortical bone. The implants were implanted bilaterally in the femoral epiphysis of 15 New Zealand White rabbits. After 3 and 8 weeks, abundant bone formation was found inside the rapid prototyped porous titanium implants. For the Ti1200 implants, bone ingrowth was (23.9 +/- 3.5)% and (10.3 +/- 2.8)%, respectively. A significant statistical difference (p < 0.05) was found for bone ingrowth in the Ti1200 between the two delays. The percentage of bone directly apposited on titanium was (35.8 +/- 5.4)% and (30.5 +/- 5.0)%. No significant difference was found for bone-implant contact between the different time periods and pore sizes. This work demonstrates that manufacturing macroporous titanium implants with controlled shape and porosity using a rapid prototyping method is possible and that this technique is a good candidate for orthopedic and maxillofacial applications.

Nanofractal surface structure under laser sintering of titanium and nitinol for bone tissue engineering

Comparative microanalysis and histological studies of porous titanium and nitinol (NiTi) implants fabricated by selective laser sintering are carried out. Sintered Ti and NiTi nanoporous structures are developed with grain sizes ranging from dozens to several hundreds nanometer and their formation is discussed. Dependence of the surface morphology of the implant on laser processing parameters (laser power, scanning velocity and beam diameter) is observed by analyzing the fractal-type nanostructure and its self-organization from the nano- to the macro-passing through the microlevel. It is shown that functional characteristics of the synthesized medical implants depend on the pores size distribution and their relative location as well as on the nanostructural morphology of the sintered surface.

Fabrication and Bioactivity of Porous Titanium Implant

The aim of this study is to fabricate an implant framework for tissue engineering by sintering titanium beads and coating with hydroxyapatite and test its biocompatibility and bioactivity in vitro. The porous titanium with and without hydroxyapatite coating were involved in study groups. Osteoblastic proliferation, activity of alkaline phosphatase, mRNA of osteocalcin and bone sialoprotein were detected by MTT-assay, ALP test and real-time polymerase chain reaction respectively. The results indicated that the porous titanium material with/without HA coating could promote osteoblastic proliferation significantly contrast to the control group. However, only porous titanium with HA coating increased alkaline phosphatase, osteocalcin and bone sialoprotein gene expression apparently and had statistically differences with the other two groups. Abstract no. is TE-Po-044

Cytokines and Growth Factors Involved in the Osseointegration of Oral Titanium Implants Positioned Using Piezoelectric Bone Surgery Versus a Drill Technique: A Pilot Study in Minipigs

Most dental implants are positioned using a drilling surgery technique. However, dentistry recently experienced the implementation of piezoelectric surgery. This technique was introduced to overcome some of the limitations involving rotating instruments in bone surgery. This study used biomolecular and histologic analyses to compare the osseointegration of porous implants positioned using traditional drills versus the piezoelectric bone surgery technique. Porous titanium implants were inserted into minipig tibias. Histomorphology and levels of bone morphogenetic protein (BMP)-4, transforming growth factor (TGF)-beta2, tumor necrosis factor-alpha, and interleukin-1beta and -10 were evaluated in the peri-implant osseous samples. Histomorphological analyses demonstrated that more inflammatory cells were present in samples from drilled sites. Also, neo-osteogenesis was consistently more active in bone samples from the implant sites that were prepared using piezoelectric bone surgery. Moreover, bone around the implants treated with the piezoelectric bone surgery technique showed an earlier increase in BMP-4 and TGF-beta2 proteins as well as a reduction in proinflammatory cytokines. Piezoelectric bone surgery appears to be more efficient in the first phases of bone healing; it induced an earlier increase in BMPs, controlled the inflammatory process better, and stimulated bone remodeling as early as 56 days post-treatment.

Novel Micro-CT Based 3-Dimentional Structural Analyses of Porous Biomaterials

A porous structure comprises pores and pore throats with a complex three-dimensional network structure, and many investigators have described the relationship between average pore size and the amount of bone ingrowth. However, the influence of network structure or pore throats for tissue ingrowth has rarely been discussed. Bioactive porous titanium implants with 48% porosity were analyzed using specific algorithms for three-dimensional analysis of interconnectivity based on a micro focus X-ray computed tomography system. In vivo histological analysis was performed using the very same implants implanted into the femoral condyles of male rabbits for 6 weeks. This matching study revealed that more poorly differentiated pores tended to have narrow pore throats, especially in their shorter routes to the outside. Data obtained suggest that this sort of novel analysis is useful for evaluating bone and tissue ingrowth into porous biomaterials.

Bone ingrowth in porous titanium implants produced by 3D fiber deposition

3D fiber deposition is a technique that allows the development of metallic scaffolds with accurately controlled pore size, porosity and interconnecting pore size, which in turn permits a more precise investigation of the effect of structural properties on the in vivo behavior of biomaterials. This study analyzed the in vivo performance of titanium alloy scaffolds fabricated using 3D fiber deposition. The titanium alloy scaffolds with different structural properties, such as pore size, porosity and interconnecting pore size were implanted on the decorticated transverse processes of the posterior lumbar spine of 10 goats. Prior to implantation, implant structure and permeability were characterized. To monitor the bone formation over time, fluorochrome markers were administered at 3, 6 and 9 weeks and the animals were sacrificed at 12 weeks after implantation. Bone formation in the scaffolds was investigated by histology and histomorphometry of non-decalcified sections using traditional light- and epifluorescent microscopy. In vivo results showed that increase of porosity and pore size, and thus increase of permeability of titanium alloy implants positively influenced their osteoconductive properties.

Development of tracheal prostheses made of porous titanium: a study on sheep

Authors report the development of a biomaterial to be used for tracheal and laryngeal reconstruction. This experimentation follows the replacement of trachea in rats with porous titanium implants. The aim of the study is to test this type of prosthesis on sheep, whose trachea is of comparable size to that of humans. Six ewes were implanted with porous titanium implants after resection of 5 cm of trachea. The planned period for the implantation was from 3 to 6 months before the sacrifice of the animals for histological analysis. After a simple immediate postoperative course, the implantations developed complications of tracheal patency, responsible for four deaths (tracheal obstruction by mucous plug n = 2, inferior necrosis of trachea n = 1, pneumopathy n = 1). The two remaining sheep presented no complications. The mechanical performance of the prostheses was good. The histological results showed an inflammatory stenosis of the tracheo-prosthetic junctions, which was not the direct result of death. The protheses were integrated by the surrounding tissue, but endoprosthetic colonisation by pseudostratified ciliated columnar epithelium was low or nil. The absence of endoprosthetic lining was responsible for the complications. The biocompatibility of the biomaterial is not in question, but the surgical procedure will have to be modified by an endoprosthetic mucous graft before implantation so as to accelerate healing process.

Pore throat size and connectivity determine bone and tissue ingrowth into porous implants: Three-dimensional micro-CT based structural analyses of porous bioactive titanium implants

A porous structure comprises pores and pore throats with a complex three-dimensional (3D) network structure, and many investigators have described the relationship between average pore size and the amount of bone ingrowth. However, the influence of network structure or pore throats for tissue ingrowth has rarely been discussed. Four types of bioactive porous titanium implants with different pore sizes and porosities (6mm in diameter and 15 mm long) were analyzed using specific algorithms for 3D analysis of interconnectivity based on a micro focus X-ray computed tomography system. In vivo histomorphometric analysis was performed using the very same implants implanted into the femoral condyles of male rabbits for 6 and 12 weeks. This matching study revealed that more poorly differentiated pores tended to have narrow pore throats, especially in their shorter routes to the outside. In addition, for assessment of the entire implant, we proposed new two indices that represent the degree of bone and tissue ingrowth into an implant by considering the effect of narrow pore throats. Data obtained suggest that this sort of novel analysis is useful for evaluating bone and tissue ingrowth into porous biomaterials.

In vivo assessment of the osteointegrative potential of phosphatidylserine-based coatings

The successful implantation of titanium-based implants for orthopaedic and dental applications is often hindered because of their mobility, which arises because of a lack of direct binding of the metal surface to the mineral phase of the surrounding bone. Ceramic coatings, although ensuring the integration of the implant within the tissue, are unstable and carry risks of delamination and of failure. Recently, a novel biomimetic approach has been developed where porous titanium implants are coated with calcium-binding phospholipids able to catalyse the nucleation of discrete apatite crystals after only 30 min incubation in simulated body fluids. The present work assesses the osteointegrative potential of this new class of coatings in an in vivo rabbit model and compares its performance with those of bare porous titanium and hydroxyapatite-coated titanium. The data obtained show that phosphatidylserine-based coatings, whilst resorbing, drive the growing bone into apposition with the metal surface. This is in contrast to the case of bare titanium.

Studies by imaging TOF-SIMS of bone mineralization on porous titanium implants after 1 week in bone

Anodic oxidation was used to grow porous layers on titanium discs. Six different oxidation procedures were used producing six different surfaces. The implants were inserted in rat bone (tibia) for 7 days. After implant retrieval, mineralization (hydroxyapatite formation) on the implant surfaces was investigated using time-of-flight secondary ion mass spectrometry (TOF-SIMS). Bone tissue around the implants was sectioned and stained. The amount of bone in close apposition to the implant was calculated. The porosity showed great variation between the surfaces. Hydroxyapatite was detected on all surfaces. A slight positive correlation between porosity and mineralization was found, although the most porous surface was not the best mineralized one. Bone had formed around all implants after 7 days. The bone-to-metal contact for the porous implants did not differ significantly from the non-porous control. Porosity is known to influence cellular events. The results indicate that porosity could have an initial, positive influence on bone integration of implants, by stimulating the mineralization process. The methods used were found to be suitable tools for investigation of initial healing around implants in bone.

Bone Growth in Porous Titanium Implants Made by Rapid Prototyping

Two porous titanium implants with interconnected pore size of 800 and 1200 m in diameter, were fabricated by a rapid prototyping method. Their dimensions and structure accomplished the expected design with accuracy and reproducibility. The porosity of titanium was around 60%. The compressive strength and Young’s modulus were comparable to those of cortical bone with values around 80 MPa and 2.7 GPa, respectively. The implants were implanted bilaterally in the femoral epiphysis of 12 New Zealand Rabbits. After 3 and 8 weeks, abundant bone formation was found in the titanium porous structure. This work demonstrates that macroporous titanium with controlled shape and porosity is a good candidate for orthopaedic and maxilofacial applications.

3-D Analysis of Pore Structure of Porous Biomaterials Using Micro Focus X-Ray Computed Tomography

Generally, characterizations of pore structures of porous biomaterials are mainly based on 2-dimensional (2-D) analysis using cross sectional micrographs. However, interconnectivity of each pore may be more important factor, when tissue ingrowth into deeper pores is considered. In this paper, using micro-CT imaging with 3-D image processing software, analyses of porous material based on 3-demensional (3-D) geometrical considerations were successfully performed. Plasmasprayed porous titanium implant (PT) and four types of sintered porous titanium implants (ST50- 200, ST50-500, ST70-200, and ST70-500) that possess different porosities (50% and 70%) and pore sizes (200-500+m and 500-1500+m) were analyzed in this study. A micro focus X-ray computed tomography system was employed to acquire microstructural information from the porous implants. Using 3-D image processing software, we performed three types of 3-D analysis including detection of the dead space (% dead pore), analysis of interconnectivity by blocking the narrow pore throat with caliber less than 52 +m (% pore with narrow throat) and analysis of material construct by contracting thin strut with thickness less than 52 +m (% construct with thin strut). ST50S and ST50L possessed interconnected porous structure with thicker strut; however, pore throat was considered to be relatively narrow. On the other hand, PT implant possesses favorable interconnectivity despite its’ low porosity; however, relatively thin strut indicate the structural disadvantage for mechanical property. These results suggest that the 3-D analysis of pore and strut structure using micro focus X-ray computed tomography and 3-D image processing software will provide effective information to develop porous implant.

Enhanced Osteoinductivity of Porous Titanium Implant by Sodium Removal

The aim of this study was to optimize the surface treatment and to accelerate the osteoinductivity of porous bioactive titanium implant. Previous studies have reported that sodium removal with hot water treatment converts sodium titanate on the surface of an alkali-treated titanium plate into titania with a specific structure, which has better bioactivity than sodium titanate. We developed a dilute hydrochloric acid (HCl) treatment for porous titanium, which removed sodium from the complexly shaped porous structure more effectively than conventional hot water treatment. Three types of surface treatments were applied: (a) alkali and heat treatment, (b) alkali, hot water, and heat treatment (conventional treatment), and (c) alkali, dilute HCl, hot water, and heat treatment (Na-free treatment). The osteoinductivity of the materials implanted in the back muscles of adult beagle dogs was examined at three, six, and twelve months. Na-free porous bioactive titanium exhibited the highest osteoinductivity, and bone formation was observed within three months. This study showed that sodium removal has a significant positive effect on the osteoinductivity of the porous bioactive titanium implant.

Osteoinductive porous titanium implants: Effect of sodium removal by dilute HCl treatment

In a previous study, we observed that chemically and thermally treated plasma-sprayed porous titanium possesses intrinsic osteoinductivity and that bone formation occurs after 12 months in the muscles of beagle dogs. The aim of this study was to optimize the surface treatment and to accelerate the osteoinductivity. Previous studies have reported that sodium removal converts the sodium titanate layer on the surface of an alkali-treated titanium plate into a more bioactive titania layer. In this study, we developed a dilute hydrochloric acid (HCl) treatment for porous titanium, which removed sodium from the complexly shaped porous structure more effectively than conventional hot water treatment. Three types of surface treatments were applied: (a) alkali and heat treatment (AH treatment); (b) alkali, hot water, and heat treatment (Water–AH treatment); and (c) alkali, dilute HCl, hot water, and heat treatment (HCl–AH treatment). The osteoinductivity of the materials implanted in the back muscles of adult beagle dogs was examined at 3, 6, and 12 months. The HCl–AH-treated porous bioactive titanium implant had the highest osteoinductivity, with induction of a large amount of bone formation within 3 months. The dilute HCl treatment was considered to give both chemical (titania formation and sodium removal) and topographic (etching) effects on the titanium surface, although we cannot determine which is the predominant factor. Nevertheless, adding the dilute HCl treatment to the conventional chemical and thermal treatments is a promising candidate for advanced surface treatment of porous titanium implants.

2753 粉末シート積層法によるチタン製多孔質人工歯根の作製(S39-1 新機能多孔質材料の創製と評価(1),S39 新機能多孔質材料の創製と評価)

The present study aims to develop a dental implant with interconnected pores that enable tissue regeneration. The implant can be fabricated by a combined technology of rapid prototyping with spark plasma sintering (SPS) using titanium sheet made of a pure powder. This paper reports the evaluation of basic properties of the laminated titanium sheet that has been sintered by the SPS method, followed by the investigation of a technology for controlling internal cell structures. The use of NaCl powder in the SPS process plays an essential role in the retention of pores as well as outer shape of the implant.

Influence of biomaterial structure and hardness on its osseo-integration: histomorphometric evaluation of porous nitinol and titanium implants

The aim of this research was to evaluate and compare the bone integration and apposition capacities of two metallic intervertebral fusion implants, porous nitinol (PNT: porous Nickel Titanium Naval Ordonance Laboratory) and titanium intervertebral cage, in the sheep lumbar spine. Sixteen sheep received two implants each at L2–L3 and L4–L5 lumbar levels so as to subject both the implants to the same mechanical loads. The sheep were then sacrificed at 3, 6 and 12 months post-implantation periods. Lumbar segments were then harvested. A qualitative (macroscopic and microscopic observation) and quantitative (histomorphometric) analysis of bone integration and apposition was carried out on histological slides. The results indicated that the PNT obtained the better bone integration and apposition compared to titanium cage. The osseo-integration of each implant seemed to be influenced by its structure and its hardness. However, the biocompatibility of two implants seemed comparable.

Biological Factors Involved in the Osseointegration of Oral Titanium Implants With Different Surfaces: A Pilot Study in Minipigs

The stability of titanium implants is determined by the rigid load-bearing connections that are formed by the bone, a process that involves a complex network of cells, pro- and anti-inflammatory mediators, and growth factors. The osseointegration processes at the interfaces of machined and porous implants were studied using molecular and histological techniques. Two machined and two porous titanium implants were inserted into the tibiae of four minipigs. The animals were sacrificed at 15, 30, 60, and 90 days post-implantation. The levels of bone morphogenetic protein (BMP)-4, transforming growth factor (TGF)-beta1, and tumor necrosis factor (TNF)-alpha were quantified in the peri-implant osseous samples. The levels of interleukin (IL)-1beta, IL-6, IL-10, and TNF-alpha in the serum were also assessed. Histomorphological analysis showed evidence of bone ossification around the porous implant at 60 days. Surrounding the machined implants, highly sclerotic fibrous pads started the healing response at 90 days, and the levels of TGF-beta1 and BMP-4 began to increase at 60 days, at which time bone ossification around the porous implants was already evident. TNF-alpha was not present in the bone next to the implants. The serum levels of cytokines IL-1beta, IL-6, and IL-10 were not increased. The serum level of TNF-alpha increased during the healing process. We observed that the levels of BMP-4 and TGF-beta1, which play essential roles in the osteogenesis process, increased earlier around the porous implants than around the machined implants. Similarly, the ossification process was initiated earlier at the surfaces of the porous implants than at the surfaces of the machined implants.

TREATMENT OF SPONDYLOLISTHESIS WITH A DEVICE FOR EXTERNAL TRANSPEDICULAR SPINAL FIXATION

Objectives. To analyze issues of surgical treatment of complicated spondylolisthesis in the lumbar spine. Materials and Methods. Forty-five patients at the age of 14 to 62 years were operated on with a device for external transpedicular fixation. All patients underwent clinical, radiological and physiologic examinations. To characterize the degree of spondylolisthesis the Meyerding classification was used. Grade I and II dislocations were treated by laminectomy of a displaced vertebra, excision of scars and mobilization of a dural sack, discectomy at a pathologic level involving both end plates of the adjacent vertebral bodies, impacting of 2 autografts (of the bone excised during laminectomy) into a disc space, and placement of a device for external transpedicular fixation. For Grade III and IV the second stage was performed after instrumentation and maximum possible reduction of dislocation. The procedure included anterior fusion of displaced and adjacent vertebrae in the achieved position either with autografts of the illiac crest or with porous nickel titanium implants through trans- or extraperitoneal approach. Results. Achieved results of application of the device for external transpedicular fixation in patients with spondylolisthesis enable to consider clinically justified a partial or total reduction of a displaced vertebra followed by neurologic status monitoring and radiological control during the post-operative period. Use of porous nickel titanium implant accelerates the formation of a bony block and decreases the time of surgery, as there is no need for autograft preparation.