Yasuhiro Tanimoto

A review of improved fixation methods for dental implants. Part I: Surface optimization for rapid osseointegration

PURPOSE Titanium is a primary metallic biomaterial used in load-bearing orthopedic or dental implants because of its favorable mechanical properties and osseointegration capability. This article reviews the current status of surface optimization techniques for titanium implants, whether such concepts are in the form of sufficiently evidence-based, and highlights the related experimental tools. STUDY SELECTION A strong emphasis was placed on the enhanced biological responses to titanium implants by modifying the surface finishing process. On this basis, a clear partition of surface chemistry and topography was critical. RESULTS The intrinsic host tissue response to titanium implants is facilitated by the chemistry or topography of a passive oxide film, although the extent to which the surface characteristics enable rapid osseointegration is still uncertain. CONCLUSION Besides the fundamental requirements, such as the promotion of osteogenic differentiation, the titanium implant surface should accelerate wound-healing phenomena prior to bone ingrowth toward the surface. Moreover, because initial bacterial attachment to the implant surface is unavoidable, infection control by surface modification is also an important determinant in reducing surgical failure. A desirable surface-biological relationship often needs to be characterized at the nanoscale by means of advanced technologies.

Regeneration of the femoral epicondyle on calcium-binding silk scaffolds developed using transgenic silk fibroin produced by transgenic silkworm.

Genetically modified silk fibroin containing a poly-glutamic acid site, [(AGSGAG)4E8AS]4, for mineralization was produced as fibers by transgenic silkworms through systematic transformation of the silkworms. The Ca binding activity and mineralization of the transgenic silk fibroin were examined in vitro, showing that this transgenic silk fibroin had relatively high Ca binding activity compared with native silk fibroin. Porous silk scaffolds were prepared with the transgenic and native silk fibroins. Healing of femoral epicondyle defects in rabbit femurs treated with the scaffolds was examined by observing changes in images of the defects using micro-computed tomography. Earlier mineralization and bone formation were observed with scaffolds of transgenic silk fibroin compared with those of native silk fibroin. Thus, this study shows the feasibility of using genetically modified silk fibroin from transgenic silkworms as a mineralization-accelerating material for bone repair.

Silk fibroin-based scaffolds for bone regeneration.

Porous scaffolds were prepared using regenerated Bombyx mori silk fibroin dissolved in water or hexafluoroisopropanol (HFIP). The effects of these two preparations on the formation and growth of new bone on implantation into the rabbit femoral epicondyle was examined. The aqueous-based fibroin (A-F) scaffold exhibited significantly greater osteoconductivity as judged by bone volume, bone mineral content, and bone mineral density at the implant site than the HFIP-based fibroin (HFIP-F) scaffold. Micro-CT analyses showed that the morphology of the newly formed bone differed significantly in the two types of silk fibroin scaffold. After 4 weeks of implantation, new trabecular bone was seen inside the pores of the A-F scaffold implant while the HFIP-F scaffold only contained necrotic cells. No trabecular bone was seen within the pores of the latter scaffolds, although the pores of these did contain giant cells and granulation tissue.

Evaluation of adhesive properties of three resilient denture liners by the modified peel test method.

The characteristics of adhesive properties between a denture base and resilient denture liner were investigated by a modified peel test with an L-shaped metal attachment. Three commercially resilient denture lining materials, namely GC Reline Soft (S), GC Reline Extra Soft (ES), and GC Reline Ultra Soft (US), were evaluated. Acrylic resin (GC Acron) was used as denture base material. Peel specimens consisting of the denture base acrylic resin and resilient denture liner were tested after storage for 1 and 30 days in distilled water at 37 degrees C. The modified peel test method gave load-displacement curves and work of adhesion (W(A)) values of the denture base material and resilient denture liner. The W(A) of specimens after 1 day of storage ranged from 1.71 to 2.55 N mm(-1) and increased in the order from US to S to ES. On the other hand, the W(A) of specimens after 30 day of storage ranged from 1.44 to 2.47 N mm(-1) and increased in the order from US to ES to S. US had significantly lower W(A) after 1 and 30 days of storage than did S and ES (P<0.05). Comparison of the W(A) between 1 and 30 days, reveals large differences for ES and US, but not for S. This could be explained by the difference in failure modes. Within the limitations of this investigation, it was concluded the modified peel test is effective for evaluating the adhesion between denture base material and a resilient denture liner.

Preparation, mechanical, and in vitro properties of glass fiber‐reinforced polycarbonate composites for orthodontic application

Generally, orthodontic treatment uses metallic wires made from stainless steel, cobalt-chromium-nickel alloy, β-titanium alloy, and nickel-titanium (Ni-Ti) alloy. However, these wires are not esthetically pleasing and may induce allergic or toxic reactions. To correct these issues, in the present study we developed glass-fiber-reinforced plastic (GFRP) orthodontic wires made from polycarbonate and E-glass fiber by using pultrusion. After fabricating these GFRP round wires with a diameter of 0.45 mm (0.018 inch), we examined their mechanical and in vitro properties. To investigate how the glass-fiber diameter affected their physical properties, we prepared GFRP wires of varying diameters (7 and 13 µm). Both the GFRP with 13-µm fibers (GFRP-13) and GFRP with 7 µm fibers (GFRP-7) were more transparent than the metallic orthodontic wires. Flexural strengths of GFRP-13 and GFRP-7 were 690.3 ± 99.2 and 938.1 ± 95.0 MPa, respectively; flexural moduli of GFRP-13 and GFRP-7 were 25.4 ± 4.9 and 34.7 ± 7.7 GPa, respectively. These flexural properties of the GFRP wires were nearly equivalent to those of available Ni-Ti wires. GFRP-7 had better flexural properties than GFRP-13, indicating that the flexural properties of GFRP increase with decreasing fiber diameter. Using thermocycling, we found no significant change in the flexural properties of the GFRPs after 600 or 1,200 cycles. Using a cytotoxicity detection kit, we found that the glass fiber and polycarbonate components comprising the GFRP were not cytotoxic within the limitations of this study. We expect this metal-free GFRP wire composed of polycarbonate and glass fiber to be useful as an esthetically pleasing alternative to current metallic orthodontic wire.

A review of improved fixation methods for dental implants. Part II: Biomechanical integrity at bone–implant interface

PURPOSE The purpose of this article is to review the mechanical requirements of the tissue-implant interface and analyze related theories. STUDY SELECTION The osseointegration capacity of titanium implants has been investigated over the past 50 years. We considered the ultimate goal of osseointegration to which form a desirable interfacial layer and a bone matrix with adequate biomechanical properties. RESULTS Occasionally, the interface comprises porous titanium and bone ingrowth that enables a functionally graded Youngs modulus, thereby allowing reduction of stress shielding. However, the optimal biomechanical connection at the interface has not yet been fully clarified. There have been publications supporting several universal mechanical testing technologies in terms of bone-titanium bonding ability, although the separation of newly formed bone quality is unlikely. CONCLUSIONS The understanding of complex mechanical bone behavior and size-dependent properties ranging from a nano- to a macroscopic level are essential in the biomechanical optimization of implants. The requirements of regenerated tissue at the interface include high strength, fracture toughness related to ductility, and time-dependent energy dissipation and/or elastic-plastic stress distribution. Moreover, a strong relationship between strain signals and peri-implant tissue turnover could be expected, so that ideal implant biomechanics may enable longevity via adaptive bone remodeling.

Effect of plasma-irradiated silk fibroin in bone regeneration.

We have recently identified plasma-irradiated silk fibroin (P-AF) as a key regulator of bone matrix properties and composition. Bone matrix properties were tested in 48 femur critical size defects (3.25 mm in diameter) with the expression of osteoblast specific genes at 1 and 2 weeks after surgery. The scaffolds were characterized by various states of techniques; the scanning electronic microcopy revealed the large sized pores in the aqueous-based silk fibroin (A-F) scaffold and showed no alteration into the architecture by the addition of plasma irradiation. The contact angle measurements confirmed the introduction of plasma helped to change the hydrophobic nature into hydrophilic. The histological analyses confirmed the presence of silk fibroin in scaffolds and newly formed bone around the scaffolds. Immunohistochemical examination revealed the increased expression pattern in a set of osteoblast specific genes (TGF-β, TGF-β type III receptor, Runx2, type I collagen and osteocalcin). These data were the first to show that the properties of bone matrix are regulated, specifically through Runx2 pathway in P-AF group. Thus, an employment of P-AF increases several compositional properties of bone, including increased bone matrix, mineral concentration, cortical thickness, and trabecular bone volume.

Antioxidant and osteogenic properties of anodically oxidized titanium.

Cells adhering onto implant surfaces are subjected to oxidative stress during wound healing processes. Although titanium and its alloys are among the most frequently used biomaterials in orthopedic and dental implants, titanium surfaces do not have antioxidant properties, and cells grown on these surfaces can show permanent oxidative stress. The present study assessed the antioxidant property and osteogenic properties of titanium samples with or without oxidation treatments. A thick rutile TiO₂ film was observed on thermally oxidized titanium surfaces, while amorphous anatase TiO₂ formed on anodically oxidized titanium surfaces prepared by discharging in 1 M Na₂HPO₄. A resistance to the depletion of reduced glutathione in adherent osteoblasts, which correlates with antioxidant behavior, occurred on anodically oxidized titanium. Enhanced osteogenic gene expressions and nano-biomechanical properties of mineralized tissue were achieved on anodically oxidized titanium, in comparison with thermally oxidized or untreated titanium. Thus, anodic oxidation by discharging in electrolyte is expected to be a useful surface modification for titanium implants.

Mini-Implants in the Anchorage Armamentarium: New Paradigms in the Orthodontics

Paradigms have started to shift in the orthodontic world since the introduction of mini-implants in the anchorage armamentarium. Various forms of skeletal anchorage, including miniscrews and miniplates, have been reported in the literature. Recently, great emphasis has been placed on the miniscrew type of temporary anchorage device (TAD). These devices are small, are implanted with a relatively simple surgical procedure, and increase the potential for better orthodontic results. Therefore, miniscrews not only free orthodontists from anchorage-demanding cases, but they also enable clinicians to have good control over tooth movement in 3 dimensions. The miniplate type also produces significant improvements in treatment outcomes and has widened the spectrum of orthodontics. The purpose of this paper is to update clinicians on the current concepts and versatile uses and clinical applications of skeletal anchorage in orthodontics.

Static and dynamic moduli of posterior dental resin composites under compressive loading.

Dental resin composites are commonly used as restorative materials for dental treatment. To comprehend the static and dynamic moduli of dental resin composites, we investigated the mechanical behaviors of resin composites under static and dynamic loading conditions. Four commercially available resin composites for posterior restorations were evaluated. The percentages, by weight, of inorganic fillers of resin composites were examined by the ashing technique. The static compressive tests were undertaken with a constant loading speed of 1.0 mm/min using a computer-controlled INSTRON testing machine. The dynamic properties of composites were determined using the split Hopkinson pressure bar (SHPB) technique. When inorganic filler content was increased, a remarkable increase in the static modulus and dynamic modulus were observed. Furthermore, there was a strong relationship between the static modulus and dynamic modulus (r(2) = 0.947). The SHPB technique clearly demonstrated the dynamic properties of composites, and was a useful technique for determining the mechanical behavior of composites under dynamic compressive loading.