Vincent Offermanns

Accelerated bone ingrowth by local delivery of strontium from surface functionalized titanium implants

Studies have indicated systemic treatment with strontium (Sr) as a potential route to increase bone quality and formation around osseointegrating implants. However, adverse effects are linked to such treatment. In this study we present a surface modification method designed for sustained local release of Sr from implants. The four groups used were prepared by a magnetron co-sputtering process and selected on the basis of Sr release data. The composition, morphology and mechanical stability of the coatings were analyzed and the Sr release profiles were investigated in vitro by washout experiments. Mesenchymal stem cells were cultured on the different coatings to evaluate potential cytotoxic effects and the effect on cellular proliferation. No indication of toxicity was found. A rodent study demonstrated a significant increase in direct bone-to-implant contact and peri-implant bone volume, for several of the groups, four weeks after implantation when compared to a Grade 4 titanium reference group. Median values of bone-to-implant contact and new bone formation was found to be 19% and 53%, respectively, for the best group compared to 0% for both parameters with respect to the Grade 4 titanium reference. The results indicate that this method may have applications within the orthopedic and dental industry.

Enhanced osseointegration of endosseous implants by predictable sustained release properties of strontium

UNLABELLED Studies have shown that strontium (Sr) incorporated into surfaces may enhance osseointegration. Thus, we suggested that a sustained Sr release from implant surfaces could improve bone healing. This study verifies and further investigates the effect of a novel Ti-Sr-O functionalized implant surface prepared from a magnetron co-sputtering platform with a continuous release of Sr. MATERIALS AND METHODS Four experimental Ti-Sr-O groups, which differed from each other in Sr contents and pre-wash procedures, were tested. Implants were prepared with a Ti-Sr-O coating by means of magnetron co-sputtering and compared to Grade 4 titanium. Composition, morphology and mechanical stability were analyzed; Sr-release data were gained from in vitro washout experiments. In vivo investigations were carried out in a rat model and analyzed histologically regarding bone-to-implant contact and new bone formation 30 days after implantation. RESULTS Structural differences were detected between the two basis Ti-Sr-O coatings with 6.7 at.% and 8.9 at.% Sr, respectively. Different release profiles were observed with 8.9 at.% Sr coating exhibiting the highest long-term release of Sr. Median values of new bone formation and bone-to-implant contact was found to be 60.1% and 91.6%, respectively, for the best group compared to 16.6% and 70.6% for the Grade 4 titanium reference. The increase in new bone formation was found to correlate with the amount of Sr released in vitro. CONCLUSION The results show that sputtered Ti-Sr-O coatings with sustained release of Sr may improve osseointegration, and could thus have impact on practical applications for medical implants.

Effect of strontium surface-functionalized implants on early and late osseointegration: A histological, spectrometric and tomographic evaluation

Numerous in vivo, in vitro and clinical studies report on beneficial effects of strontium with respect to increased bone growth. Based on this knowledge the aim of this study was to evaluate early and late osseointegration stages of functionalized titanium implants showing sustained release of strontium (Sr) and further investigate its potential systemic effect. Strontium functionalized (Ti-Sr-O) and Grade 4 (Control) titanium implants were inserted in the femoral condyle of New Zealand White rabbits. The Ti-Sr-O coating was characterized using Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray Spectrometry (EDX) for structure, coating thickness and chemical composition. Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-AES) was used to evaluate released strontium in vitro while Atomic Absorption Spectrometry (AAS) was utilized to monitor serum levels of strontium and calcium. Additionally, histological and tomographic analysis of bone-to-implant contact (BIC%) and bone formation (BF%) was performed, following implantation periods of two or twelve weeks, respectively. Median values for BIC% for Ti-Sr-O revealed significant differences within the two- and twelve-week observation periods, while exceeding BF% was discovered especially after twelve weeks when performing the histological evaluation. The results from the micro-computed tomography (µ-CT) showed no significant differences, when comparing the experimental groups. AAS measurements did not indicate a systemic effect by the local strontium release. Within the limitations of the study, it was shown that a Ti-Sr-O coating with sustained release characteristics of strontium, accelerates bone apposition and represents a potential potent surface modification for endosseous medical implant devices. STATEMENT OF SIGNIFICANCE This study presents first data with respect to early and late in vivo response on a strontium functionalized titanium surface comprising a nanotopography manufactured by a magnetron sputtering process. We investigated different osseointegration stages of screw-shaped implants with dental implant geometries in a rabbit femur model observing beneficial effects of the functionalized surface on bone-to-implant contact and bone formation caused by tailored release of the bone anabolic strontium. Histomorphometrical data revealed that a functionalized titanium surface with controlled liberation of strontium accelerates osseointegration while spectrometry measurements did not indicate a potential systemic effect of this osteoinductive agent and could thus have impact on modifications of medical implant devices.

Bone regenerating effect of surface-functionalized titanium implants with sustained-release characteristics of strontium in ovariectomized rats

Since strontium (Sr) is known for its anabolic and anticatabolic effect on bone, research has been focused on its potential impact on osseointegration. The objective of this study was to investigate the performance of nanotopographic implants with a Sr-functionalized titanium (Ti) coating (Ti–Sr–O) with respect to osseointegration in osteoporotic bone. The trial was designed to examine the effect of sustained-release characteristics of Sr in poor-quality bone. Three Ti–Sr–O groups, which differed from each other in coating thickness, Sr contents, and Sr release, were examined. These were prepared by a magnetron sputtering process and compared to uncoated grade 4 Ti. Composition, morphology, and mechanical stability of the coatings were analyzed, and Sr release data were gained from in vitro washout experiments. In vivo investigation was carried out in an osteoporotic rat model and analyzed histologically, 6 weeks and 12 weeks after implantation. Median values of bone-to-implant contact and new bone formation after 6 weeks were found to be 84.7% and 54.9% (best performing Sr group) as compared to 65.2% and 23.8% (grade 4 Ti reference), respectively. The 12-week observation period revealed 84.3% and 56.5% (best performing Sr group) and 81.3% and 39.4% (grade 4 Ti reference), respectively, for the same measurements. The increase in new bone formation was found to correlate with the amount of Sr released in vitro. The results indicate that sputtered nanostructured Ti–Sr–O coatings showed sustained release of Sr and accelerate osseointegration even in poor-quality bone, and thus, may have impact on practical applications for medical implants.

Osteoneogenesis due to periosteal elevation with degradable and nondegradable devices in Göttingen Minipigs

INTRODUCTION Periosteal distraction or elevation has been known as an experimental method to induce new bone formation. Although it uses the principles of distraction osteogenesis no further osteotomy is necessary. The purpose of this study was to test devices of different materials and to evaluate the point of origin of the new bone formation. MATERIAL & METHODS On each calvaria of twelve male adult Göttingen Minipigs three devices were implanted. The materials used were degradable PDLLA (poly-DL-lactide), PGA (polyglycolic acid) and nondegradable Ti (titanium). After a consolidation time of 2, 4 and 6 weeks days a total of 36 specimens were harvested. To identify the total amount of newly created bone, micro-CT and histological analysis were performed. RESULTS All degradable devices collapsed to a certain extent within the observation time but osteoneogenesis took place in all materials after a consolidation time of 2, 4 and 6 weeks after implantation above and under the devices. No statistical significant differences between the materials were found. However, most bone formation took place in the space under the periosteum and above the devices (p < 0.001). CONCLUSION Periosteal elevation can produce new bone formation with degradable devices, which derives from the periosteum and the underlying bone. In this interaction the periosteum seems to contain the larger share.

A comparative in vivo study of strontium-functionalized and SLActive™ implant surfaces in early bone healing

Purpose Studies have shown that strontium-doped medical applications benefit bone metabolism leading to improved bone healing and osseointegration. Based on this knowledge, the aim of the study was to evaluate the performance of an implant surface, functionalized by a physical vapor deposition (PVD) coating (Ti-Sr-O), designed to yield predictable release of strontium. The Ti-Sr-O functionalized surface is compared to a routinely used, commercially available surface (SLActive™) with respect to bone-to-implant contact (BIC%) and new bone formation (BF%) in two defined regions of interest (ROI-I and ROI-II, respectively). Materials and methods: Ti-Sr-O functionalized, SLActive, and Grade 4 titanium implants were inserted in the femoral condyle of adult male New Zealand White rabbits. The PVD magnetron-sputtered Ti-Sr-O surface coating was characterized using scanning electron microscopy (SEM) for morphology and coating thickness. Strontium release and mechanical stability of the coating, under simulated insertion conditions, were evaluated. Furthermore, histomorphometrical BIC and BF were carried out 2 weeks after insertion. Results Histomorphometry revealed increased bone formation of Ti-Sr-O with significant differences compared to SLActive and Grade 4 titanium in both regions of interest, ROI-I and ROI-II, at 0–250 µm and 250–500 µm distance from the implant surfaces. Analogous results of bone-to-implant contact were observed for the two modified surfaces. Conclusion The results show that a nanopatterned Ti-Sr-O functionalized titanium surface, with sustained release of strontium, increases peri-implant bone volume and could potentially contribute to enhancement of bone anchorage of osseointegrated implants.

In Vitro Analysis of the Fracture Resistance of CAD/CAM Denture Base Resins

Computer-aided design and computer-aided manufacturing (CAD/CAM) denture base manufacturers claim to produce their resin pucks under high heat and pressure. Therefore, CAD/CAM dentures are assumed to have enhanced mechanical properties and, as a result, are often produced with lower denture base thicknesses than conventional, manually fabricated dentures. The aim of this study was to investigate if commercially available CAD/CAM denture base resins have more favourable mechanical properties than conventionally processed denture base resins. For this purpose, a series of three-point bending tests conforming to ISO specifications were performed on a total of 80 standardised, rectangular CAD/CAM denture base resin specimens from five different manufacturers (AvaDent, Baltic Denture System, Vita VIONIC, Whole You Nexteeth, and Wieland Digital Dentures). A heat-polymerising resin and an autopolymerising resin served as the control groups. The breaking load, fracture toughness, and the elastic modulus were assessed. Additionally, the fracture surface roughness and texture were investigated. Only one CAD/CAM resin showed a significantly increased breaking load. Two CAD/CAM resins had a significantly higher fracture toughness than the control groups, and all CAD/CAM resins had higher elastic moduli than the controls. Our results indicate that CAD/CAM denture base resins do not generally have better mechanical properties than manually processed resins. Therefore, the lower minimum denture base thicknesses should be regarded with some caution.

Comparison of allogeneic and autogenous bone grafts for augmentation of alveolar ridge defects - a 12-month retrospective radiographic evaluation

Abstract Objectives The aim of this study was to compare three‐dimensional alterations following the use of autogenous versus allogeneic onlay grafts for augmentation at single tooth defects. Materials and methods Alveolar bone width at specific implant sites were assessed using sagittal and cross‐sectional CBCT images prior grafting and at three subsequent time points. Twenty‐one patients received autogenous bone blocks harvested from the retromolar region and another 21 patients received freeze‐dried cancellous allogeneic bone blocks. Results The vertical and horizontal dimensions did not significantly differ between autogenous and allogeneic bone grafts at any time point. In addition, there were no statistically significant differences in graft remodeling rates between autogenous (mean shrinkage rate after 12 months: 12.5% ± 7.8%) and allogeneic onlay grafts (mean shrinkage rate after 12 months: 14.4% ± 9.8%). Conclusions Freeze‐dried cancellous allogeneic bone blocks showed equivalent volumetric shrinkage rates as autogenous bone blocks when used for treating circumscribed bone defects classified as Type‐II to Type‐IV according to the ITI‐treatment guide categories. Therefore, it is not necessary to over‐contour the alveolar ridge when using allogeneic blocks for treating single tooth defects, but to apply the same procedure as when using autogenous blocks.