Functionality-packed additively manufactured porous titanium implants

Hengel, I.A.J. van; Gelderman, F.S.A.; Athanasiadis, S.; Minneboo, Michelle; Weinans, Harrie; Fluit, Ad C.; Eerden, Bram C.J. van der; Fratila‐Apachitei, Lidy E.; Apachitei, I.; Zadpoor, Amir A.

doi:10.1016/j.mtbio.2020.100060

Cited by 29 publications

(50 citation statements)

References 82 publications

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“…Another way to enhance the cytocompatibility of PEO-biofunctionalized implants is by combining two or more antibacterial metals (i.e., Ag, Cu, and Zn), as synergic effects between various such agents are reported to exist [ 19 , 20 ] and could be used to reduce the concentration of Ag [ 126 , 198 ]. In addition, combining these elements with other osteogenic elements, such as Sr [ 50 ] may enhance their antibacterial and biocompatible properties. Finally, the combination of multiple antibacterial elements significantly reduces the risk of the development of bacterial resistance, thereby ensuring that the prolonged use of these elements will remain possible [ 199 ].…”

Section: Discussionmentioning

confidence: 99%

“…A decade of PEO biofunctionalization of titanium implants with Ag, Cu, and Zn confirmed the great potential of this method as an effective, fast, and scalable process. At the moment, however, the research on antibacterial PEO-biofunctionalized titanium implants is still far away from clinical application, as the research was primarily conducted in vitro with few studies also exploring ex vivo models [ 20 , 50 ]. Furthermore, PEO was shown to enhance the osteogenic capacity of titanium implants in vivo [ 38 , 39 , 203 ], including surfaces bearing Zn [ 204 ].…”

Section: Discussionmentioning

confidence: 99%

“…While all studies that performed XRD analysis identified the TiO 2 phases, not all studies analyzed the other phases formed by the elements incorporated from the electrolyte. Since many PEO electrolytes contain both Ca and P, 19% of the studies observed hydroxyapatite [ 31 , 35 , 50 , 55 , 56 , 57 , 58 , 64 , 65 ] and 28% contain other Ca/P phases including α-TCP [ 35 , 52 , 53 ], β-TCP [ 52 , 53 ], TiP 2 O 7 [ 70 ], CaTiO 3 [ 31 , 55 , 56 , 57 , 58 , 65 ], Ca 2 P 2 O 7 [ 35 , 52 ], and Ca 3 (PO 4 ) 2 [ 31 , 71 ]. In addition, phases with Cu, Cu 2 O, and CuO [ 76 , 78 ], as well as ZnO [ 78 , 79 , 87 ] were observed.…”

Section: Synthesis and Characterization Of Peo Biofunctionalized Smentioning

confidence: 99%

“…Given that Ag, Cu, and Zn form an alternative to antibiotics, it is important to analyze the results on antibiotic resistant bacteria, such as MRSA, which are involved in up to 32% of fracture-related infections [ 140 , 141 ]. MRSA was investigated in 9 studies and found to be strongly inhibited by Ag [ 15 , 31 , 32 , 50 , 65 ], Ag and Cu [ 19 ], Ag and Zn [ 20 ], Cu and Zn [ 88 ] bearing surfaces, while one study that included Zn surfaces did not observe any inhibition [ 86 ]. Thukkaram et al observed that the antibacterial effect of Ag containing surfaces against MRSA was lower compared to S. aureus and E. coli , although with increasing doses of Ag, all bacterial species were targeted equally [ 65 ].…”

Section: Antibacterial Propertiesmentioning

confidence: 99%

“…In addition to in vitro assays, ex vivo models were explored, in which infected implants biofunctionalized with Ag and Cu, Zn, or Sr are inserted into a murine femur [ 19 , 20 , 31 , 50 ]. Subsequently, the number of CFU present are quantified (e.g., after 24 h).…”

Section: Antibacterial Propertiesmentioning

confidence: 99%

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Antibacterial Titanium Implants Biofunctionalized by Plasma Electrolytic Oxidation with Silver, Zinc, and Copper: A Systematic Review

Hengel

Tierolf

Fratila‐Apachitei

et al. 2021

IJMS

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Patients receiving orthopedic implants are at risk of implant-associated infections (IAI). A growing number of antibiotic-resistant bacteria threaten to hamper the treatment of IAI. The focus has, therefore, shifted towards the development of implants with intrinsic antibacterial activity to prevent the occurrence of infection. The use of Ag, Cu, and Zn has gained momentum as these elements display strong antibacterial behavior and target a wide spectrum of bacteria. In order to incorporate these elements into the surface of titanium-based bone implants, plasma electrolytic oxidation (PEO) has been widely investigated as a single-step process that can biofunctionalize these (highly porous) implant surfaces. Here, we present a systematic review of the studies published between 2009 until 2020 on the biomaterial properties, antibacterial behavior, and biocompatibility of titanium implants biofunctionalized by PEO using Ag, Cu, and Zn. We observed that 100% of surfaces bearing Ag (Ag-surfaces), 93% of surfaces bearing Cu (Cu-surfaces), 73% of surfaces bearing Zn (Zn-surfaces), and 100% of surfaces combining Ag, Cu, and Zn resulted in a significant (i.e., >50%) reduction of bacterial load, while 13% of Ag-surfaces, 10% of Cu-surfaces, and none of Zn or combined Ag, Cu, and Zn surfaces reported cytotoxicity against osteoblasts, stem cells, and immune cells. A majority of the studies investigated the antibacterial activity against S. aureus. Important areas for future research include the biofunctionalization of additively manufactured porous implants and surfaces combining Ag, Cu, and Zn. Furthermore, the antibacterial activity of such implants should be determined in assays focused on prevention, rather than the treatment of IAIs. These implants should be tested using appropriate in vivo bone infection models capable of assessing whether titanium implants biofunctionalized by PEO with Ag, Cu, and Zn can contribute to protect patients against IAI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Synthesis and Characterization Of Peo Biofunctionalized Smentioning

confidence: 99%

Section: Antibacterial Propertiesmentioning

confidence: 99%

Section: Antibacterial Propertiesmentioning

confidence: 99%

See 3 more Smart Citations

Antibacterial Titanium Implants Biofunctionalized by Plasma Electrolytic Oxidation with Silver, Zinc, and Copper: A Systematic Review

Hengel

Tierolf

Fratila‐Apachitei

et al. 2021

IJMS

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Inorganic Agents for Enhanced Angiogenesis of Orthopedic Biomaterials

Šalandová

Hengel

Apachitei

et al. 2021

Adv Healthcare Materials

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Aseptic loosening of a permanent prosthesis remains one of the most common reasons for bone implant failure. To improve the fixation between implant and bone tissue as well as enhance blood vessel formation, bioactive agents are incorporated into the surface of the biomaterial. This study reviews and compares five bioactive elements (copper, magnesium, silicon, strontium, and zinc) with respect to their effect on the angiogenic behavior of endothelial cells (ECs) when incorporated on the surface of biomaterials. Moreover, it provides an overview of the state-of-the-art methodologies used for the in vitro assessment of the angiogenic properties of these elements. Two databases are searched using keywords containing ECs and copper, magnesium, silicon, strontium, and zinc. After applying the defined inclusion and exclusion criteria, 59 articles are retained for the final assessment. An overview of the angiogenic properties of five bioactive elements and the methods used for assessment of their in vitro angiogenic potential is presented. The findings show that silicon and strontium can effectively enhance osseointegration through the simultaneous promotion of both angiogenesis and osteogenesis. Therefore, their integration onto the surface of biomaterials can ultimately decrease the incidence of implant failure due to aseptic loosening.

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Silver‐Containing Biomaterials for Biomedical Hard Tissue Implants

Shao

Zhang

Gong

et al. 2023

Adv Healthcare Materials

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Bacterial infection caused by biomaterials is a very serious problem in the clinical treatment of implants. The emergence of antibiotic resistance has prompted other antibacterial agents to replace traditional antibiotics. Silver is rapidly developing as an antibacterial candidate material to inhibit bone infections due to its significant advantages such as high antibacterial timeliness, high antibacterial efficiency, and less susceptibility to bacterial resistance. However, silver has strong cytotoxicity, which can cause inflammatory reactions and oxidative stress, thereby destroying tissue regeneration, making the application of silver‐containing biomaterials extremely challenging. In this paper, the application of silver in biomaterials is reviewed, focusing on the following three issues: 1) how to ensure the excellent antibacterial properties of silver, and not easy to cause bacterial resistance; 2) how to choose the appropriate method to combine silver with biomaterials; 3) how to make silver‐containing biomaterials in hard tissue implants have further research. Following a brief introduction, the discussion focuses on the application of silver‐containing biomaterials, with an emphasis on the effects of silver on the physicochemical properties, structural properties, and biological properties of biomaterials. Finally, the review concludes with the authors’ perspectives on the challenges and future directions of silver in commercialization and in‐depth research.

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Functionality-packed additively manufactured porous titanium implants

Cited by 29 publications

References 82 publications

Antibacterial Titanium Implants Biofunctionalized by Plasma Electrolytic Oxidation with Silver, Zinc, and Copper: A Systematic Review

Antibacterial Titanium Implants Biofunctionalized by Plasma Electrolytic Oxidation with Silver, Zinc, and Copper: A Systematic Review

Inorganic Agents for Enhanced Angiogenesis of Orthopedic Biomaterials

Silver‐Containing Biomaterials for Biomedical Hard Tissue Implants

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