Search Results (467)

The management of severely comminuted acetabular posterior wall fractures in young, active patients presents a significant surgical challenge. When anatomical open reduction and internal fixation (ORIF) is not feasible, primary total hip arthroplasty (THA) is often considered but is a suboptimal solution due to concerns over long-term implant survivorship and the inevitability of revision surgery. This single-patient technical note presents a novel joint-preserving technique for managing unreconstructible acetabular posterior wall fractures using with cement-augmented screw fixation via the Kocher–Langenbeck approach. A 28-year-old male sustained a left posterior hip dislocation with a comminuted acetabular posterior wall fracture involving >30% of the articular surface, alongside a tibial shaft fracture, following a high-energy motorcycle collision. Intraoperative assessment confirmed the posterior wall was unreconstructible, with six non-viable osteochondral fragments. A joint-preserving salvage procedure was performed. After debridement, a stable metallic framework was created using three screws anchored in the posterior column. Polymethylmethacrylate (PMMA) bone cement was then applied over this framework in its doughy phase, meticulously contoured to reconstruct the articular surface. The hip was reduced, and the tibia was fixed with an intramedullary nail. The patient was mobilized with weight-bearing as tolerated on postoperative day 3. At the 21-month follow-up, the patient reported no pain during daily activities and only mild discomfort during deep squatting. Radiographic and CT evaluations demonstrated a stable hip joint, concentric reduction, well-maintained joint space, and no evidence of implant loosening or osteolysis. Level of Evidence: V (Technical Note/single-patient Case report). For unreconstructible, comminuted fractures of the non-weight-bearing portion of the acetabular posterior wall in young patients, cement-augmented screw fixation offers a viable joint-preserving alternative to primary THA. This technique provides immediate stability, facilitates early mobilization, and preserves bone stock. While long-term outcomes require further study, this case demonstrates excellent functional and radiographic results at 21 months, presenting a promising new option for managing these complex injuries. Full article

Titanium and its alloys are the most widely used metallic materials for bone contact implants. However, despite advances in implant technology, these alloys are still susceptible to post-operative clinical complications such as inflammation, which is often joined by infections and biofilm formation. A number of coatings were studied to overcome the drawbacks of these complications, but the controlled release of bioactive molecules over the first few days and the adhesion of the coating to the substrate remain recognized challenges. Carbon dots and the antibacterial potential of chiral carbon dots (CCDs) were recently reported, and their chirality was identified as a major contribution to the bactericidal effect. This study aimed to achieve a stimuli-responsive medium-term controlled release for up to one month. Two types of chiral carbon dots (CCDs) with distinct functional groups were incorporated into a stable and adherent biodegradable polymer coating, i.e., poly(lactic-co-glycolic acid) (PLGA). To enhance the coating adhesion, the titanium alloy surfaces were pre-treated and activated. The wettability, morphology, and surface composition of the coatings were characterized by contact angle, profilometry, SEM, and XPS, respectively. Coating degradation, adhesion, and CCDs release were studied at physiological pH (7.4) and at an acidic pH characteristic of an inflammatory site (pH 3.0) for up to one month. Their biological performances and blood compatibility were assessed as well. Degradation studies conducted over 28 days revealed a slow mass loss of approximately 10%, with maximum release rates for CCDs-OH and CCDs-NH₂ of 67% and 45% at pH 7.4, respectively. At pH 3.0 an inverse trend was observed with 49% and 59% maximum release after 28 days. Furthermore, the coatings did not exhibit any cytotoxic and hemolytic effects. These findings demonstrate the potential of this approach to providing titanium implants with pH-sensitive controlled release of bioactive CCDs lasting up to one month, which could address key challenges in implant-associated complications. Full article

Background/Objective: Clinical statistics show that bacterial infection is a major driver of implant failure. To enhance antibacterial performance, some metallic elements, such as silver (Ag), zinc (Zn), and copper (Cu), are commonly used to modify the titanium surface. Despite the promising antibacterial performance of Ag, concerns persist regarding dose-dependent cytotoxicity, systemic accumulation, and potential effects on local bone metabolism. This review aimed to investigate the effects of incorporating or coating titanium (Ti) implant surfaces with Ag on bone formation around implants. Methods: A search was undertaken using three main databases (PubMed, Web of Science, and Scopus). The search was limited to studies published within the last 20 years that involved animal experiments using endosseous implants coated with or incorporating Ag. Meta-analyses were performed for bone-to-implant contact (BIC), bone formation (BA), and bone volume (BV/TV) around the implant in control and test groups. The compared groups were subjected to similar implant surface treatments aside from the presence of silver in the test group. Results: Sixteen studies met the inclusion criteria in this study and were included. The analysis of BIC values revealed a statistically significant overall effect in favor of silver-coated implants (Z = 2.01, p = 0.04), along with 95% confidence intervals (CIs). The BA analysis found no significant difference between silver-coated and control implants (Z = 1.09, p = 0.28). The BV/TV analysis also showed no statistically significant overall difference (Z = 0.35, p = 0.73). Conclusions: In animal models, silver-coated Ti implants improve bone–implant contact without altering peri-implant bone volume metrics. Full article

In recent years, apatite-based materials have garnered significant interest, particularly for applications in tissue engineering. Apatite is most commonly employed as a coating for metallic implants, as a component in composite materials, and as scaffolds for bone and dental tissue regeneration. Among its various forms, hydroxyapatite (HAP) is the most widely used, owing to its natural occurrence in human and animal hard tissues. An emerging area of research involves the use of fluoride-substituted apatite, particularly fluorapatite (FAP), which can serve as a direct fluoride source at the implant site, potentially offering several biological and therapeutic advantages. However, substituting HAP with FAP may lead to unforeseen changes in material behavior due to the differing physicochemical properties of these two calcium phosphate phases. This study investigates the effects of replacing hydroxyapatite with fluorapatite in ceramic–polymer composite materials incorporating β-1,3-glucan as a bioactive polymeric binder. The β-1,3-glucan polysaccharide was selected for its proven biocompatibility, biodegradability, and ability to form stable hydrogels that promote cellular interactions. Nitrogen adsorption analysis revealed that FAP/glucan composites had a significantly lower specific surface area (0.5 m²/g) and total pore volume (0.002 cm³/g) compared to HAP/glucan composites (14.15 m²/g and 0.03 cm³/g, respectively), indicating enhanced ceramic–polymer interactions in fluoride-containing systems. Optical profilometry measurements showed statistically significant differences in profile parameters (e.g., Rp: 134 μm for HAP/glucan vs. 352 μm for FAP/glucan), although average roughness (Ra) remained similar (34.1 vs. 27.6 μm, respectively). Microscopic evaluation showed that FAP/glucan composites had smaller particle sizes (1 μm) than their HAP counterparts (2 μm), despite larger primary crystal sizes in FAP, as confirmed by TEM. XRD analysis indicated structural differences between the apatites, with FAP exhibiting a reduced unit cell volume (524.6 ų) compared to HAP (528.2 ų), due to substitution of hydroxyl groups with fluoride ions. Spectroscopic analyses (FTIR, Raman, ³¹P NMR) confirmed chemical shifts associated with fluorine incorporation and revealed distinct ceramic–polymer interfacial behaviors, including an upfield shift of PO₄³⁻ bands (964 cm⁻¹ in FAP vs. 961 cm⁻¹ in HAP) and OH vibration shifts (3537 cm⁻¹ in FAP vs. 3573 cm⁻¹ in HAP). The glucan polymer showed different hydrogen bonding patterns when combined with FAP versus HAP, as evidenced by shifts in polymer-specific bands at 888 cm⁻¹ and 1157 cm⁻¹, demonstrating that fluoride substitution significantly influences ceramic–polymer interactions in these bioactive composite systems. Full article

Strain-induced deformations and phase evolutions are two hidden factors that may influence cytocompatibility of Gum Metal alloys during processing for relevant implant applications. In the present research, changes in cell viability of a new Gum Metal Ti-Nb-Zr alloy in its cold-rolled state and after heat treatments (at 700, 850, and 900 °C) were investigated by a comprehensive study of microstructural phases and their role in deformation mechanisms as well as mechanical properties. In its cold-rolled state, the alloy showed a lamellar microstructure along with stress-induced α″ martensite and ω phases, as confirmed by optical microscopy (OM) and X-ray diffractometry (XRD) analysis. The instability in the β phase led to a strain-induced martensitic (SIM) transformation from β to α′/α″ phases, causing lower viability of MG-63 cells compared with commercially pure titanium. MG-63 cell viability was significantly higher (p < 0.0001) in the alloy heat-treated at 900 °C compared with those heat-treated at 700 and 850 °C. This can be directly attributed to the increased portion of the stable and dominant β phase. The stabilized β phase greatly improved the alloy’s cellular response by reducing harmful phase interactions and maintaining mechanical compatibility with bone (admissible strain of 1.3%). Importantly, heat treatment at high temperatures (between 850 and 900 °C) effectively converted the stress-induced α″ and ω phases back into a stable β phase matrix as the dominant phase. Full article

Metallic nanoparticles (MNPs) have emerged as leading candidates in biomedical applications owing to their unique physicochemical properties and dual functionality, combining potent bactericidal and osteoinductive effects. These bioactivities are intricately governed by structural parameters such as size, shape, crystallinity, and chemical composition, which collectively dictate their interactions with biological systems. These interactions affect key mechanisms including oxidative stress induction, membrane disruption, and modulation of cellular signaling pathways. Despite considerable progress, a comprehensive understanding of the structure property–activity-specific structural relationship in MNPs remains incomplete, hindering the rational design of optimized nanomaterials. This review critically examines recent advances in elucidating the bactericidal and osteoinductive mechanisms of MNPs, with a particular focus on the role of structural determinants. Furthermore, current challenges and future directions for tailoring nanoparticle architecture to enhance clinical performance are discussed. To address this, we conducted a systematic review of the literature published between 2005 and 2024 using Web and Web of Science direct and Scopus databases. Our analysis is structured around a structure →mechanism→outcome perspective, linking nanoparticle features to biological responses. Key insights include the following: (i) nanoparticles below ~20 nm generally enhance bacterial efficiency through enhanced membrane disruption; (ii) surface hydroxyl density above critical thresholds promotes osteogenic signaling; and (iii) safe concentration windows remain narrow, highlighting the importance of dose optimization. We conclude by discussing the translational challenges and future directions for tailoring nanoparticle architectures to advance clinical applications. Full article

Nanobiocomposites are a class of biomaterials that include at least one phase with constituents in the nanometer range. Nanobiocomposites, a new class of materials formed by combining natural and inorganic materials (metals, ceramics, polymers, and graphene) at the nanoscale dimension, are expected to revolutionize tissue engineering and bone implant applications because of their enhanced corrosion resistance, mechanical properties, biocompatibility, and antimicrobial activity. Titanium-based nanocomposites are gaining attention in biomedical applications due to their exceptional biocompatibility, corrosion resistance, and mechanical properties. These composites typically consist of a titanium or titanium alloy matrix that is embedded with nanoscale bioactive phases, such as hydroxyapatite, bioactive glass, polymers, or carbon-based nanomaterials. Common methods for synthesizing Ti-based nanobiocomposites and their parts, including bottom-up and top-down approaches, are presented and discussed. The synthesis conditions and appropriate functionalization influence the final properties of nanobiomaterials. By modifying the surface roughness at the nanoscale level, composite implants can be enhanced to improve tissue integration, leading to increased cell adhesion and protein adsorption. The objective of this review is to illustrate the most recent research on the synthesis and properties of Ti-based biocomposites and their scaffolds. Full article

Surface engineering and architectural design represent key frontiers in total ankle arthroplasty (TAA) implant development. This narrative review examines biointegration strategies, focusing on porous structures, surface modification techniques, and emerging smart technologies. Optimal porous architectures with 300–600 µm pore sizes facilitate bone ingrowth and osseointegration, while functionally graded structures address regional biomechanical demands. Surface modification encompasses bioactive treatments (such as calcium phosphate coatings), topographical modifications (including micro/nanotexturing), antimicrobial approaches (utilizing metallic ions or antibiotic incorporation), and wear-resistant technologies (such as diamond-like carbon coatings). Multifunctional approaches combine strategies to simultaneously address infection prevention, enhance osseointegration, and improve wear resistance. Emerging technologies include biodegradable scaffolds, biomimetic surface nanotechnology, and intelligent sensor-based monitoring systems. While many innovations remain in the research stage, they demonstrate the potential to establish TAA as a comprehensive alternative to arthrodesis. Successful implant design requires integrated surface engineering tailored to the ankle joint’s demanding biomechanical and biological environment Full article

Aseptic loosening (AL) represents the leading cause of long-term failure in total joint arthroplasty, often necessitating revision surgery. This review explores the complex mechanisms underlying AL, which involve a multifaceted interaction between the implanted biomaterials and the host immune response. We outline the key inflammatory mechanisms triggered by wear debris from polyethylene, polymethylmethacrylate, metal, and ceramic materials. We also examine emerging biomarkers for early detection and differentiation between stable and loosened implants, including proinflammatory cytokines, bone metabolism markers, extracellular matrix degradation products, microRNAs, and genetic polymorphisms. Lastly, we discuss current and future strategies for prevention and treatment, ranging from surgical optimization and biomaterial selection to pharmacological interventions. A comprehensive understanding of these mechanisms may help reduce the incidence of AL and improve long-term outcomes in arthroplasty patients. Full article

Poly(L-lactic acid) (PLLA) and iron (Fe) are popular bioresorbable material candidates for biomedical implants. However, PLLA coronary stents are relatively too thick compared to metallic stents when providing the same mechanical strength, while iron degrades too slowly. Recent studies show that PLLA coatings can enhance iron’s corrosion rate, and iron has strong mechanical strength, making PLLA–Fe composites ideal for bioresorbable implants. Although PLLA coatings on iron samples have been studied, research on embedding iron wires in relatively thick PLLA matrices is limited. Moreover, no studies have yet explored 3D-printed metal wire-reinforced PLLA monofilaments for biomedical applications. To address these research gaps and investigate the in vitro degradation profile of PLLA/Fe wire monofilaments for bioresorbable stents, this study first developed a novel polymer filament–metal wire coextrusion 3D printer for printing PLLA/Fe wire monofilaments. In vitro degradation tests were then conducted on both PLLA/Fe and neat PLLA monofilaments at 50 °C. Thereafter, characterizations, including mass loss, pH, surface appearance and morphology, tensile tests, gel permeation chromatography (GPC), and differential scanning calorimetry (DSC), were performed. Results indicated that the overall degradation rate of PLLA/Fe monofilaments was higher than that of PLLA counterparts, while the degradation rate of PLLA matrix was not affected by the embedded iron wire according to molecular weight analysis. Notably, the Young’s modulus and stiffness of PLLA monofilaments were significantly improved by the iron wires during the early stages of degradation, but the reinforcement in tensile strength was negative after immersion due to the poor embedding quality of the iron wires in the PLLA monofilaments. With future improvement of the embedding quality of iron wire, the 3D-printed PLLA/Fe wire composites can have great potential in the development of biomedical devices using the novel 3D printing method, including most types of stents and bone scaffolds. Full article

Total ankle arthroplasty (TAA) has evolved significantly through advances in alloy selection and manufacturing technologies. This narrative review examines the metallurgical foundations of contemporary TAA implants, analyzing primary alloy systems and their mechanical properties. Cobalt-chromium alloys provide superior mechanical strength and durability but present metal ion release concerns, while titanium alloys (Ti6Al4V) optimize biocompatibility with elastic modulus values (101–113 GPa) closer to bone, despite tribological limitations. Novel β-titanium formulations (Ti-35Nb-7Zr-5Ta, Ti10Mo6Zr4Sn3Nb) eliminate toxic aluminum and vanadium components while achieving lower elastic modulus values (50–85 GPa) that better match cortical bone properties. Manufacturing has transitioned from traditional methods (investment casting, forging, CNC machining) toward additive manufacturing technologies. Selective laser melting and electron beam melting enable patient-specific geometries, controlled porosity, and optimized microstructures, though challenges remain with residual stresses, surface finish requirements, and post-processing needs. Emerging biodegradable materials, composite structures, and hybrid implant designs represent promising future directions for addressing current material limitations. This review provides evidence-based insights for alloy selection and manufacturing approaches, emphasizing the critical role of materials engineering in TAA implant performance and clinical outcomes. Full article

Objectives: Ameloblastoma is a locally aggressive odontogenic tumor of the jaws characterized by a high recurrence rate. This work aims to present our clinical experience in managing patient oral rehabilitation following an extensive mandibular ameloblastoma, with a specific focus on mandibular reconstruction using a fibula free flap, followed by dental implant placement and prosthetic rehabilitation in a female patient. Additionally, we provide a comprehensive review of the current evidence on surgical management, reconstruction techniques, and long-term outcomes in ameloblastoma treatment. Methods: A 44-year-old female patient presented with a painless swelling in the left mandible. Orthopantomography (OPG) and computed tomography (CT) demonstrated a well-defined radiolucent lesion extending from the canine to the second premolar. An incisional biopsy was performed, and histopathological examination confirmed the diagnosis of mandibular ameloblastoma. The patient underwent segmental resection of the left mandibular body, followed by immediate reconstruction using a vascularized fibular free flap. Eighteen months postoperatively, four dental implants were placed. One implant failed during the osseointegration phase and was removed. Due to residual hard and soft tissue deficiency, prosthetic rehabilitation was achieved with a metal-reinforced resin overdenture, restoring both function and aesthetics. Results: At the three-year follow-up, clinical and radiographic examinations revealed no evidence of tumor recurrence. The patient remained asymptomatic, reporting neither pain nor functional discomfort. Prosthetic rehabilitation with the metal-reinforced resin overdenture was successfully completed, achieving satisfactory masticatory function and aesthetics. Conclusions: The use of the fibula free flap for mandibular reconstruction after ameloblastoma resection provides excellent flexibility, enabling effective bone integration of dental implants. Full article

Polyetheretherketone (PEEK) is a semi-crystalline thermoplastic polymer which, due to its very high mechanical properties and high chemical resistance, has found application in the automotive, aerospace, chemical, food and medical (biomedical engineering) industries. Owing to the use of additive technologies, particularly the Fused Filament Fabrication (FFF) method, this material is the most widely used plastic to produce skull reconstruction implants, parts of dental implants and orthopedic implants, including spinal, knee and hip implants. PEEK enables the creation of personalized implants, which not only have greater elasticity compared to implants made of metal alloys but also resemble the physical properties of the cortical layer of human bone in terms of their mechanical properties. Therefore, the aim of this article is to characterize polyether ether ketone as an alternative material used in the manufacturing of implants in orthopedics and dentistry. Full article

Titanium–aluminum–vanadium (Ti6Al4V) is a material chosen for spine, orthopedic, and dental implants due to its combination of desirable mechanical and biological properties. Lasers have been used to modify metal surfaces, enabling the generation of a surface on Ti6Al4V with distinct micro- and nano-scale structures. Studies indicate that topography with micro/nano features of osteoclast resorption pits causes bone marrow stromal cells (MSCs) and osteoprogenitor cells to favor differentiation into an osteoblastic phenotype. This study examined whether the biological response of human MSCs to Ti6Al4V surfaces is sensitive to laser treatment-controlled micro/nano-topography. First, 15 mm diameter Ti6Al4V discs (Spine Wave Inc., Shelton, CT, USA) were either machined (M) or additively manufactured (AM). Surface treatments included no laser treatment (NT), nanosecond laser (Ns), femtosecond laser (Fs), or nanosecond followed by femtosecond laser (Ns+Fs). Surface wettability, roughness, and surface chemistry were determined using sessile drop contact angle, laser confocal microscopy, X-ray photoelectron spectroscopy (XPS), and scanning electron microscopy (SEM). Human MSCs were cultured in growth media on tissue culture polystyrene (TCPS) or test surfaces. On day 7, the levels of osteocalcin (OCN), osteopontin (OPN), osteoprotegerin (OPG), and vascular endothelial growth factor 165 (VEGF) in the conditioned media were measured. M NT, Fs, and Ns+Fs surfaces were hydrophilic; Ns was hydrophobic. AM NT and Fs surfaces were hydrophilic; AM Ns and Ns+Fs were hydrophobic. Roughness (Sa and Sz) increased after Ns and Ns+Fs treatment for both M and AM disks. All surfaces primarily consisted of oxygen, titanium, and carbon; Fs had increased levels of aluminum for both M and AM. SEM images showed that M NT discs had a smooth surface, whereas AM surfaces appeared rough at a higher magnification. Fs surfaces had a similar morphology to their respective NT disc at low magnification, but higher magnification revealed nano-scale bumps not seen on NT surfaces. AM Fs surfaces also had regular interval ridges that were not seen on non-femto laser-ablated surfaces. Surface roughness was increased on M and AM Ns and Ns+Fs disks compared to NT and Fs disks. OCN was enhanced, and DNA was reduced on Ns and Ns+Fs, with no difference between them. OPN, OPG, and VEGF levels for laser-treated M surfaces were unchanged compared to NT, apart from an increase in OPG on Fs. MSCs grown on AM Ns and Ns+Fs surfaces had increased levels of OCN per DNA. These results indicate that MSCs cultured on AM Ns and AM Ns+Fs surfaces, which exhibited unique roughness at the microscale and nanoscale, had enhanced differentiation to an osteoblastic phenotype. The laser treatments of the surface mediated this enhancement of MSC differentiation and warrant further clinical investigation. Full article

Background/Objectives: This study aimed to assess the long-term clinical performance of full-arch fixed restorations made of fiber-reinforced composite (FRC) supported by four ultra-short implants (4.0 × 5.0 mm) in patients with edentulous, atrophic mandibles. Methods: Ten patients were treated at Sapienza University of Rome and monitored over a 10-year period. Each case involved the placement of four plateau-design implants with a pure conometric connection and a calcium phosphate-treated surface. The final prostheses were fabricated using CAD/CAM-milled Trinia^® fiber-reinforced composite frameworks. Clinical parameters included implant and prosthesis survival, marginal bone level (MBL), peri-implant probing depth (PPD), and patient-reported outcome measures (PROMs). Results: Implant and prosthesis survival reached 100% over the 10-year follow-up. MBL data showed a minor bone gain of approximately 0.11 mm per 5 years (p < 0.0001). PPD remained stable under 3 mm, with a minimal increase of 0.16 mm over the same period (p < 0.0001). PROMs reflected sustained high patient satisfaction. No technical complications, such as chipping or framework fracture, were observed. Conclusions: Rehabilitation of the edentulous mandible with ultra-short implants and metal-free FRC prostheses proved to be a minimally invasive and long-lasting treatment option. The 10-year follow-up confirmed excellent implant and prosthetic outcomes, favorable peri-implant tissue health, and strong patient satisfaction. Nonetheless, further studies with larger sample sizes are needed to confirm these encouraging results and strengthen the clinical evidence. Full article