Search Results (401)

Background: Transforaminal lumbar interbody fusion (TLIF) with static cages is a frequently performed procedure. Larger series focusing on the use of expandable TLIF spacers are less common. Methods: This retrospective, single-center observational cohort study reviewed consecutive patients treated by TLIF using expandable titanium interbody implants (ALTERA™, Globus Medical Inc., Audubon, PA, USA) for degenerative pathologies from L2-S1 between 11/2018 and 09/2023. Surgical parameters, adverse events, radiological outcomes (fusion rate, segmental lordosis, spinopelvic parameters), and clinical outcomes were analyzed through a mean postoperative follow-up of 12 months. Results: This study identified 270 patients (mean age 65 years, 50.4% female) who underwent TLIF with expandable interbody spacers at 324 levels. Clinical outcomes were good or excellent in 74.1% of patients at 3 months and 71.8% at 12 months. Radiographic fusion was achieved in 73.1% of assessable segments at 12 months. Segmental lordosis increased significantly from 17.8° preoperatively to 20.0° at 12 months (p < 0.001). Adverse event (AE) rates were acceptable across all timepoints, with no device failures or device-associated complications observed. Conclusions: This study demonstrates that TLIF with expandable titanium interbody implants was safe, associated with high fusion rates, and enabled significant restoration of segmental lordosis that was maintained during follow-up. Full article

This study evaluated the effects of low-dose recombinant human bone morphogenetic protein-2 (rhBMP-2) coating in combination with vacuum plasma treatment on titanium implants, aiming to enhance osseointegration and bone regeneration while minimizing the adverse effects associated with high-dose rhBMP-2. In vitro analyses demonstrated that plasma treatment increased surface energy, promoting cell adhesion and proliferation. Additionally, it facilitated sustained rhBMP-2 release by enhancing protein binding to the implant surface. In vivo experiments using the four-beagle mandibular defect model were conducted with the following four groups: un-treated implants, rhBMP-2–coated implants, plasma-treated implants, and implants treated with both rhBMP-2 and plasma. Micro-computed tomography (micro-CT) and medical CT analyses revealed a significantly greater volume of newly formed bone in the combined treatment group (p < 0.05). Histological evaluation further confirmed superior outcomes in the combined group, showing significantly higher bone-to-implant contact (BIC), new bone area (NBA), and inter-thread bone density (ITBD) compared to the other groups (p < 0.05). These findings indicate that vacuum plasma treatment enhances the biological efficacy of low-dose rhBMP-2, representing a promising strategy to improve implant integration in compromised conditions. Further studies are warranted to determine the optimal clinical dosage. Full article

Healthcare-associated infection, mainly through medical device-associated infection, remains a critical issue in hospital care. Bacterial adhesion, proliferation, and biofilm formation on the device surface have been considered the foremost cause of medical device-associated infection. Different means have been explored to reduce microbial attachment and proliferation, including forming a bactericidal or microbial adhesion-resistant surface layer. Fear of limited bactericidal capability if the dead microbes remained adhered to the surface has withheld the widespread use of a bactericidal surface in medical devices if it was intended for long-term use. By contrast, constructing a microbial adhesion-resistant or antifouling surface, such as a surface with zwitterionic functionality, would be more feasible for devices intended to be used for the long term. Nevertheless, a sophisticated multi-step chemical reaction process would be needed. Instead, a simple immersion method that utilized a novel mussel-inspired catechol compound with zwitterionic sulfobetaine functionality, ZDS, was explored in this investigation for the surface modification of substrates with distinctively different surface characteristics, including titanium and polyvinyl chloride. Dopamine, NaIO₄ oxidants, and chemicals that could affect ionic interactions (NaCl and polyethyleneimine) were added to the ZDS-containing immersion solution to compare their effects on modifying titanium and PVC substrates. Furthermore, a layer-by-layer immersion method, in which the substrate was first immersed in the no-ZDS-added dopamine-containing solution, followed by the ZDS-containing solution, was also attempted on the PVC substrate. By properly selecting the immersion solution formulation and additional NaIO₄ oxidation modification, the antibacterial capability of ZDS-modified substrates can be optimized without causing cytotoxicity. The maximum antibacterial percentages against S. aureus were 84.2% and 81.7% for the modified titanium and PVC substrate, respectively, and both modified surfaces did not show any cytotoxicity. Full article

Background/Objectives: Full-arch implant-supported prostheses have become a widely accepted solution for edentulous patients, yet long-term biological and mechanical complications remain a clinical concern. Methods: This retrospective study included 70 fully edentulous patients (362 implants) rehabilitated with either fixed or removable implant-supported prostheses. Data were collected on demographics, medical status, type and location of prostheses, implant type, abutments, method of fixation, and complications. Statistical analysis included Fisher’s exact test, the Mann–Whitney U test, and chi-squared tests, with a significance level set at p < 0.05. Results: Mechanical complications occurred in 41.4% of patients (29 out of 70), with framework fractures reported in eight cases (27.6%), ceramic chipping in six cases (20.7%), and resin discoloration in four cases (13.8%). The prostheses were fabricated using monolithic zirconia, metal–ceramic crowns, zirconia on titanium bars, and hybrid resin/PMMA on cobalt–chromium frameworks. Gingival inflammation was also noted in 41.4% of cases (n = 29), predominantly in posterior implant regions. Younger patients and those without systemic diseases showed a significantly higher incidence of mechanical complications. Conclusions: Two years post-treatment, mechanical and biological complications appear to be independent phenomena, not significantly associated with most prosthetic variables. Patient-specific factors, particularly age and general health status, may have greater predictive value than prosthetic design. Limitations of the study include its retrospective design and the lack of radiographic data to assess peri-implant bone changes. Full article

Polyetheretherketone (PEEK) is a high-performance thermoplastic polymer widely recognized for its distinct mechanical strength, chemical resistance, and biocompatibility. These characteristics make it suitable for a wide range of applications, particularly in medical, aerospace, chemical, and electronics fields. Conventional processing techniques, such as 3D printing, molding, and extrusion, are widely employed for PEEK fabrication. This review critically examines recent advancements in PEEK research, with an emphasis on additive manufacturing techniques that are expanding its applications in the medical field. We provide an in-depth analysis of PEEK’s intrinsic properties, diverse processing methods, and current challenges that hinder its wider adoption. In addition to evaluating PEEK’s performance, this review compares it with alternative biomaterials—such as titanium and ultra-high molecular weight polyethylene (UHMWPE)—to explore its advantages and limitations in biomedical applications. Furthermore, this review discusses cost considerations, regulatory constraints, long-term clinical performance challenges, and failure modes that are essential for validating and ensuring the reliability of PEEK in clinical use. By synthesizing the recent literature, particularly from the last decade, this review highlights the significant potential of PEEK and underscores ongoing research efforts aimed at overcoming its limitations, paving the way for its broader implementation in advanced technological applications. Full article

Stainless steel (SS) is one of the materials most commonly utilized for fabrication of medical implants and its properties are often improved by deposition of protective coatings. This study investigates certain physico-chemical and biological properties of SS substrate coated with multilayer thin film consisting of titanium nitride and silver layers (TiN-Ag film). TiN-Ag films were deposited on the surface of AISI 316 SS substrate by a combination of cathodic arc evaporation and DC magnetron sputtering. SS substrate was analyzed by TEM, while deposited coatings were analyzed by SEM, EDS and wettability measurements. Also, mitochondrial activity assay, and osteogenic and chondrogenic differentiation were performed on dental pulp stem cells (DPSCs). SEM and EDS revealed excellent adhesion between coatings’ layers, with the top layer predominantly composed of Ag, which is responsible for antibacterial properties. TiN-Ag film exhibited moderately hydrophilic behaviour which is desirable for orthopedic implant applications. Biological assays revealed significantly higher mitochondrial activity and enhanced osteogenic and chondrogenic differentiation of DPSC on TiN-Ag films compared to TiN films. The newly designed TiN-Ag coatings showed a great potential for the surface modification of SS implants, and further detailed investigations will explore their suitability for application in clinical practice. Full article

Over the past two decades, titanium dioxide nanotubes (TiO₂ NTs) have gained considerable attention as multifunctional materials in sensing technologies. Their large surface area, adjustable morphology, chemical stability, and photoactivity have positioned them as promising candidates for diverse sensor applications. This review presents a broad overview of the development of TiO₂ NTs in sensing technologies for medical diagnostics over the last two decades. It further explores strategies for enhancing their sensing capabilities through structural modifications and hybridization with nanomaterials. Despite notable advancements, challenges such as device scalability, long-term operational stability, and fabrication reproducibility remain. This review outlines the evolution of TiO₂ NT-based sensors for medical diagnostics, highlighting both foundational progress and emerging trends, while providing insights into future directions for their practical implementation across scientific and industrial domains. Full article

The purpose of this study was to estimate the peak stresses in a laser powder bed fusion (LPBF) additive-manufactured (AM) osteosynthesis plate during physiological loading and establish if the mechanical properties of LPBF titanium alloy were suitable for this use case. Finite element models of subject-specific osteosynthesis plates for a cohort of 28 patients were created and used to calculate the peak maximum principal stresses during physiological loading, which was estimated to be 166 MPa twelve weeks post-operatively. All specimens were LPBF additively manufactured in Ti-6Al-4V alloy. ISO compliant tests were performed for tensile and fatigue, respectively. Fatigue testing was performed for specimens that had been heat-treated only and those that had been heat-treated and polished. The Upper Yield Stress was 1012.5 ± 19.2 MPa. The fatigue limit was 227 MPa for heat-treated only specimens and increased to 286 MPa for heat-treated and polished specimens. The finite element predicted stresses were below the experimentally established limits of yield and fatigue. The tensile and fatigue properties of heat-treated LPBF Ti-6Al-4V are therefore sufficient to meet the mechanical requirements of osteosynthesis plates. Polishing is recommended to improve fatigue resistance. Full article

Objective: In recent years, a significant increase in the incidence of both total hip arthroplasty and acetabular revision surgery has been observed. A substantial proportion of patients requiring these revision procedures present with major bone deficits and extensive osteolysis. In light of these challenges, this study aims to provide a comprehensive comparison between two commonly utilized methods: trabecular titanium shell implants and Burch–Schneider acetabular reinforcement cages. Methods: Participants of both sexes were included through a retrospective review of medical records. The sole inclusion criterion was that the patient had undergone revision hip arthroplasty using either Burch–Schneider acetabular reinforcement cages or Regenerex trabecular titanium shell within the past 18 years. No exclusion criteria were applied concerning patient age, laterality, ethnicity, or post-operative status. Each patient was evaluated based on nine predictive factors, including the Paprosky classification, duration of surgery, perioperative blood loss, number of bone grafts and screws used, as well as pre- and post-operative Harris Hip Score (HHS) and Visual Analogue Scale (VAS). Results: A total of 220 patients were included in the analysis, with 75% (n = 165) comprising the group treated with trabecular titanium implants and 25% (n = 55) treated with Burch–Schneider cages. The use of Regenerex trabecular titanium was associated with a 32.40% (n = 23.13 mL) reduction in bone graft tissue required and a 13.7% (n = 0.59) increase in the number of screws needed. Additionally, the trabecular titanium group experienced a 15.93% (n = 179.64 mL) reduction in perioperative blood loss compared to the Burch–Schneider cage group. The other parameters analyzed in the study did not demonstrate statistical significance. Conclusions: The use of a trabecular titanium acetabular shell may be an effective option, particularly in patients with severe acetabular deficits, as it provides favorable clinical and radiological outcomes. Additionally, it reduces the number of bone grafts required and allows for faster and more immediate partial weight-bearing on the operated limb. Full article

Background and Objectives: The goal of this study was to introduce a novel device, the iMPACT implant planer, designed to machine (create a complete smooth surface) contaminated implant surfaces intraorally, promoting peri-implant tissue healing and possible re-osseointegration, and the new Quadrant protocol, evaluating them in vitro and clinically. The null hypothesis was that there would be no improvement in the clinical parameters for the implants with peri-implantitis (PI) treated with the new protocol and tool. Materials and Methods: The Quadrant protocol was used in conjunction with the iMPACT tool, which primarily functions to remove biofilm and microbial contaminants from the exposed implant surface, while simultaneously preparing the surface through standardized implantoplasty, thereby enhancing the potential for re-osseointegration. An in vitro analysis was developed, and three medium/long-term cases were presented, detailing the procedures and outcomes. Results: The in vitro assessment showed smooth surfaces after treatment. Different areas presented minimal particles (<1 μm) on the implant surface, with a high content of titanium (Ti) and tungsten (W). In case 1, severe and advanced peri-implantitis around implants #46 and #47 was found. A combination of resective (Quadrant + iMPACT) and regenerative surgery was used for treatment, along with a buccal single flap (BSF). Significant clinical and radiographic improvements were observed at 14 and 43 months postoperatively, including vertical bone gain with re-osseointegration and stable probing depths (PDs). In the second case, a severe PI and prosthesis instability were observed. Resective (Quadrant + iMPACT) and regenerative procedures were applied. At 3 and 12 months postoperatively, clinical and radiographic evaluations demonstrated significant improvements with re-osseointegration, including PDs reduced to 0–1 mm and a vertical bone gain of approximately 6.5 mm. In case 3, mandibular implants from 42 to 47 exhibited inflammation, suppuration, and moderate-to-severe bone loss. Just resective surgery (Quadrant + iMPACT), without grafting, was performed. At 6- and 12-month follow-ups, clinical and radiographic assessments showed the resolution of inflammation, stable bone levels, and healthy peri-implant gingiva. Conclusions: Favorable outcomes were achieved using the iMPACT and Quadrant protocols in the three clinical cases, resulting in re-osseointegration when combined with regenerative procedures. The favorable medium/long-term outcomes achieved, despite the patient’s complex medical history and, at times, inconsistent oral hygiene, underscore the potential efficacy of such interventions. Full article

Medical titanium alloy Ti-6Al-4V (TC4) is widely used as a surgical implant material in biomedical fields owing to its superior biocompatibility, corrosion resistance, and mechanical performance, particularly for osseous integration applications. However, long-term contact of medical titanium-based implants with human soft tissues may induce infection and inflammation. To address these limitations, a drug-loading gel was designed to be synthesized on a TC4 surface to improve biointegration. Considering the critical regulatory roles of temperature and pH in physiological environments, this study synthesized a dual-responsive hydrogel using the temperature-sensitive monomers 2-(2-methoxyethoxy)ethyl methacrylate (MEO₂MA) and oligoethylene glycol methacrylate (OEGMA) and the pH-sensitive monomer diethylaminoethyl methacrylate (DEAEMA), employing stereocomplexed polylactic acid as a physical crosslinker and N,N′-methylenebisacrylamide (MBA) as a chemical crosslinker. A polydopamine-based initiator was synthesized via dopamine functionalization with 2-bromoisobutyryl bromide (BIBB). The amphiphilic co-network hydrogel was grafted onto a modified TC4 surface through atom transfer radical polymerization (ATRP). Integration of the drug-loading gel and TC4 gives the implant an “active therapeutic” function by localized drug release. The results demonstrated that the energy storage modulus of the double-crosslinked gel matched that of human soft tissues. The gels exhibited efficient drug release. Full article

Osseointegration is the direct contact between living bone and a dental implant, with supporting evidence confirming the direct connection between bone and titanium, found using an electron microscope. However, the fundamental mechanisms and interconnections between the bone and titanium are not clearly understood. At present, osteoimmunology explores the interaction between bone and immune cells not only in the medical field but also in dentistry. Immunology in bone cell formation has long been a research topic; however, interest in these effects has recently surged. Through subsequent studies, osteoimmune reaction occurs in response to dental implant insertion into the bone and this mechanism portrays more accurate tissue response compared to the traditional term osseointegration. Additionally, osseointegration is a foreign body defense mechanism to protect the implant when bone forms at the contact surface between the dental implant and the alveolar bone. The term “osteoimmunology” refers to the relationship between the immune system and bone tissues. Understanding osteoimmunologic concepts may enable the development of immunomodulatory strategies to improve, maintain, and ultimately restore osseointegration. In order for biocompatible materials such as dental implants to settle and be maintained in the body, it is necessary to understand the complex interrelationships of the bone immune environment, which will enable the development of biomaterials that are more favorable to osteoimmune environments. Therefore, this review presents previous insights into cellular and molecular interactions between bone and the immune system, specifies the roles of T-regulatory cells (Tregs) and macrophages, and demonstrates their potential for translational applications worldwide. Full article

In this study, a composite substrate with adjustable dielectric properties was prepared, and its promising application in wearable medical device antennas was demonstrated. 3-Methacryloxypropyltrimethoxysilane (KH570) was used to modify titanium dioxide (TiO₂) nano-powder, and the modified powder was blended with a mixture of polydimethylsiloxane (PDMS) and polytetrafluoroethylene (PTFE) under the action of anhydrous ethanol. The resulting polymer material had the advantages of hydrophobicity, softness, low loss, and a high dielectric constant. Meanwhile, the effects of the KH570 mass fraction on the microstructure and dielectric properties of TiO₂-PTFE-PDMS composites were investigated, and the results showed that when the mass fraction was 5%, the composites exhibited better dielectric properties in the range of 2–12 GHz. Finally, an ultra-wideband antenna with an operating frequency band in the range of 2.37–11.66 GHz was prepared based on this composite substrate. The antenna demonstrated significant potential for future applications in detecting environmental thermal changes due to its special temperature-sensitive linear frequency shift characteristics, and its effect on the human body under bending conditions was studied. In addition, specific absorption rate (SAR) measurements were performed to assess the effects of antenna radiation on the human body in practical applications. Full article

Titanium dioxide (TiO₂) is one of the most widely produced nanomaterials. Many products contain nanoparticles because they have various technological, medical, and economic benefits. However, the presence of nanoparticles in the environment has a negative impact on public health. Due to the presence of TiO₂ NPs in food, food packaging, and drinking water, they can easily enter the human gastrointestinal tract (GIT), which includes environments with different pH values. These pH changes can affect the stability, dispersion, and toxicity of nanomaterials. Our experiments aimed to monitor the effect of TiO₂ NPs incubated at a pH similar to the GIT values on DNA structure. DNA damage was monitored using a DNA biosensor and a biosensing approach with electrochemical voltammetric detection. Cyclic voltammetry (CV) detected damage to DNA/GCE biosensors of up to 10%. The best way to monitor the genotoxicity of TiO₂ NPs on DNA structure was the biosensing approach, which changes in the redox indicator current response detected by differential pulse voltammetry (DPV) up to 47.6%. The highest effect of TiO₂ was observed for guanine residues at pH 8.0. The results were confirmed by UV–vis spectrophotometry and hyperchromic and bathochromic spectral shifts. Full article

Titanium (Ti) and its alloys have attracted more interest, as they are widely employed as biomaterials due to their great biocompatibility, excellent strength ratio, and lightweight. However, corrosion occurs slowly due to an electrochemical reaction once the Ti material has been placed in the human body, contributing to infection and failure of implants in medical applications. Thus, the corrosion phenomenon has caused great concern in the biomedical field. It is desirable to make the surface modification to provide better corrosion resistance. The fabrication techniques of the coatings fabricated onto Ti and/or Ti alloy surfaces have been reported, including sol–gel, annealing, plasma spraying, plasma immersion ion implantation, physical vapor deposition, chemical vapor deposition, anodization, and micro-arc oxidation. This review first describes the corrosion types, including localized corrosion (both pitting and crevice corrosion), galvanic corrosion, selective leaching, stress corrosion cracking (SCC), corrosion fatigue (CF), and fretting corrosion. In the second part, the effects of corrosion on the human body were discussed, and the primary cause for clinical failure and allergies has been identified as the excessive release of poisonous and dangerous metal ions (Co, Ni, and Ti) from corroded implants into bodily fluids. The inclusion and exclusion criteria during the selection of literature are described in the third section. In the last section, we emphasized the current research progress of Ti alloy (particularly Ti6Al4V alloy) coatings in biomaterials for medical applications involving dental, orthopedic, and cardiovascular implants for anticorrosive applications. However, there are also several problems to explore and address in future studies, such as the release of excessive metal ions, etc. This review will draw attention to both researchers and clinicians, which could help to increase the coatings fabricated onto Ti and/or Ti alloy surfaces for anticorrosive applications in biomaterials for medical applications. Full article