Search Results (43)

Background: Degenerative joint diseases are a major cause of disability and drive the increasing demand for joint arthroplasty. Long-term prosthesis success depends on rapid and stable bone–implant integration, which is influenced by the osteo-inductive and osteo-conductive properties of implant materials. Chromium–cobalt (CrCo) and titanium (Ti) alloys are widely used in reconstructive orthopedics, but direct comparative data on their biological performance, particularly for trabecular titanium (T-Ti), remain limited. This study aimed to directly compare the biocompatibility and osteogenic potential of CrCo and T-Ti using human mesenchymal stromal cells (MSCs). Methods: Human MSCs were characterized by immunophenotyping and cultured on CrCo and T-Ti scaffolds under control and osteogenic conditions for up to 28 days. Cell adhesion and morphology were assessed by scanning electron microscopy. Proliferation and viability were quantified, and osteogenic differentiation was evaluated using alkaline phosphatase activity, calcium deposition assays, and gene expression profiling of osteogenic markers. Results: Both materials supported MSC adhesion and proliferation, confirming cytocompatibility. Under control conditions, T-Ti significantly increased alkaline phosphatase activity and osteogenic gene expression. Under osteogenic stimulation, T-Ti accelerated differentiation and mineralized matrix deposition. CrCo exhibited limited stimulation of the osteogenic-supportive microenvironment and delayed differentiation responses. Conclusions: Trabecular titanium, in terms of morphology and topology, provides a biologically active scaffold that both induces and conducts osteogenic differentiation of human MSCs, whereas CrCo acts primarily as a mechanically optimized but biologically passive material. These findings support the use of trabecular titanium at bone-contact interfaces in joint prostheses to enhance osteointegration and potentially improve long-term implant stability. Full article

Background/Objectives: The preliminary experience with new dual-mobility system for small Japanese patients was introduced in this paper. Methods: Twenty-nine hips which underwent primary THA were retrospectively reviewed. All cups were inserted via Hardinge lateral approach. The ability to perform formal Japanese sitting in a kneeling position (Seiza in Japanese) and bowing while sitting (Zarei in Japanese) was evaluated. The mean follow-up was 6 months. Results: The mean age at surgery was 70 years, mean height was 156 cm, mean weight was 58 kg, and mean body mass index was 23.6. The acetabular cups utilized were a hemispherical hydroxy-apatite coated cup (25 hips) and a hemispherical trabecular titanium cup (4 hips), with diameters of 46 mm in 5, 48 mm in 15, 50 mm in 3, 52 mm in 1, 54 mm in 3, 56 mm in 1, and 62 mm in 1; mean diameter was 49.4 mm. No postoperative dislocations including intraprosthetic dislocation or metal allergy were observed. The mean Harris hip score improved significantly from 39 points preoperatively to 89 points postoperatively (p < 0.05). Radiographic evaluation demonstrated bone ingrowth stability in all cases according to Engh’s criteria and no aseptic loosening of the implants. Mean hip flexion increased from 75° preoperatively to 90° postoperatively (p < 0.05). The ability to perform Seiza increased from 8 patients preoperatively to 23 patients postoperatively (p < 0.05). The ability to perform Zarei (deep bowing) increased from 7 patients preoperatively to 20 patients postoperatively (p < 0.05). Conclusions: This novel dual-mobility system designed for smaller Japanese patients offers three distinct advantages: (1) availability of 42, 44, 46 and 48–66 mm outer diameter cups, (2) 1 mm deeper center of rotation, providing increased jumping distance compared to other designs, and (3) improved assembly instrumentation (cement-gun-type bearing press). Early clinical results suggest that this newly developed dual-mobility THA system is well-suited to the lifestyle and anatomical characteristics of Japanese patients. Full article

Low-density cancellous bone results in reduced trabecular support and may increase crestal cortical strain around implants. Osseodensification (OD) compacts trabecular bone and may create a peri-osteotomy densified zone, but its strain-level effects in osteoporotic-like bone are unclear. This study evaluated whether an OD-inspired peri-implant densified trabecular zone reduces crestal cortical strain compared with conventional drilling (CD) in an osteoporotic-like model. A three-dimensional finite element model of a mandibular posterior segment with a 2.0-mm cortical shell and D4 cancellous core was constructed with a 4.3 × 11.4-mm titanium implant and a cemented monolithic zirconia crown. CD used a 4.0-mm osteotomy in D4 bone. The OD model used the same osteotomy plus a concentric peri-implant densified shell with radial density gradation from D1 to D3. The implant–bone interface was defined as bonded. Static 100 N axial and 45° oblique loads were applied. Outcomes were ε_eq, ε_max, and ε_min, summarized as mean top-10 nodal values. OD reduced crestal cortical strains under both loads. Under axial loading, ε_eq, ε_max, and |ε_min| decreased by 17.7%, 19.0%, and 24.1%, respectively. Under oblique loading, the corresponding reductions were 9.8%, 8.0%, and 8.9%. Oblique loading produced higher cortical strains than axial loading in both models. OD-inspired peri-implant densification reduced crestal cortical strain in this osteoporotic-like model, whereas oblique loading remained the main driver of elevated strain. These findings support occlusal/prosthetic strategies that minimize oblique forces and warrant experimental and clinical validation. Full article

Titanium-based alloys are widely used in dental implantology; however, the mechanical limitations of commercially pure titanium (cpTi) and unresolved concerns regarding stress shielding remain. This study evaluated the structure–property–function relationship of a novel β-type titanium-niobium-zirconium (Ti-Nb-Zr; TNZ) alloy for dental implant applications. Laboratory testing assessed the elemental composition, tensile properties, and fatigue resistance of the cpTi, compared with modified Grade 4 cpTi (MG4T). In parallel, a randomized, single-blind, controlled clinical trial was conducted over 12 months to compare the clinical performance of TNZ and MG4T implants under functional loading. A total of 80 participants (mean age: 54.2 years; 43 females, 37 males) were enrolled, with 77 completing the 12-month follow-up (TNZ: n = 38; MG4T: n = 39). Clinical outcomes included implant success and survival, peri-implant soft tissue parameters, marginal bone levels, fractal dimension (FD) analysis of trabecular bone, and adverse events. TNZ implants demonstrated superior fatigue resistance without an increase in the elastic modulus relative to MG4T. Clinically, both groups achieved 100% implant success and survival, with no implant-related adverse events. FD analysis revealed time-dependent bone remodeling without evidence of pathological adaptation. These findings support the functional viability of TNZ as a mechanically robust, biocompatible implant material. Further long-term, multicenter trials are warranted to confirm sustained clinical benefits and broader applicability. Full article

Introduction: Acromegaly is a chronic endocrine disorder caused by excessive secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Acromegaly leads to a wide range of systemic alterations, including metabolic disturbances, abnormalities in bone microarchitecture, soft tissue overgrowth, and morphological changes in the maxilla and mandible. All these factors may significantly complicate the planning and success of implant therapy. Study Aim: This narrative review aimed to critically analyze the impact of acromegaly on bone healing and osseointegration, with particular emphasis on the stability of implant biomaterials, and to assess whether the disease constitutes a contraindication to implant prosthetic treatment. Methods: A narrative literature review was conducted using the PubMed, Scopus, and Web of Science databases, covering publications from 2000 to August 2025. Manual screening of reference lists from key articles was also performed. Peer-reviewed publications in English, including experimental and preclinical studies, case reports, biomaterials research, and conceptual reviews, were included based on their relevance to acromegaly, bone metabolism, stomatognathic alterations, and implant therapy outcomes. No formal inclusion or exclusion criteria were applied, and methodological quality was not formally assessed, reflecting the exploratory and conceptual nature of this review. Results: Patients with acromegaly exhibit persistent structural bone deficits, such as reduced trabecular number, irregular trabecular distribution, and increased cortical porosity, despite normal or even elevated bone mineral density. In parallel, profound changes in soft tissues and dentition are observed, including macroglossia, diastemas, gingival overgrowth, and mandibular prognathism, which further complicate prosthetic rehabilitation. Animal studies suggest that GH and IGF-1 may support early osseointegration, although the long-term effects of their excess remain inconclusive. Clinical data, although limited, indicate that implant placement in patients with acromegaly is feasible when treatment is meticulously planned and carried out within an interdisciplinary setting. Standard biomaterials, such as titanium and its alloys, may undergo degradation under conditions of chronic inflammation and oxidative stress, underscoring the need for innovative solutions integrating bioactive and immunomodulatory materials, as well as patient-specific implants manufactured using 3D printing technologies. Conclusions: Acromegaly should not be regarded as an absolute contraindication to implant therapy; however, the current evidence is limited. Implant placement requires individualized planning, endocrine control, and interdisciplinary coordination. Further clinical and preclinical studies are needed to establish reliable treatment protocols for this population. Full article

Osseodensification (OD) has emerged as a favorable osteotomy preparation technique that preserves and compacts autogenous bone along the osteotomy walls during site preparation, enhancing primary stability and implant osseointegration. While OD has demonstrated promising results in low-density trabecular bone, especially when used in conjunction with acid-etched (AE) implant surfaces, its efficacy in high-density cortical bone remains unclear—particularly in the context of varying implant surface characteristics. In this study, Grade V titanium alloy implants (Ti-6Al-4V, 4 mm × 10 mm) with deep threads, designated bone chambers and either as-machined (Mach) or AE surfaces were placed in 3.8 mm diameter osteotomies in the submandibular region of 16 adult sheep using either OD or conventional (Reg) drilling protocols. Insertion torque values (N·cm) were measured at the time of implant placement to evaluate primary stability. Mandibles were harvested at 3-, 6-, 12-, or 24-weeks post-implantation (n = 4 sheep/time point), and histologic sections were analyzed to quantify bone-to-implant contact (BIC) and bone area fractional occupancy (BAFO). Qualitative histological analysis confirmed successful osseointegration among all groups at each of the healing time points. No statistically significant differences were observed between OD and conventional drilling techniques in insertion torque (p > 0.628), BIC (p > 0.135), or BAFO (p > 0.060) values, regardless of implant surface type or healing interval. The findings indicate that neither drilling technique nor implant surface treatment significantly influences osseointegration in high density cortical bone. Furthermore, as the osteotomy was not considerably undersized, the use of OD instrumentation showed no signs of necrosis, inflammation, microfractures, or impaired osseointegration in dense cortical bone. Both OD and Reg techniques appear to be suitable for implant placement in dense bone, allowing flexibility based on surgeon preference and clinical circumstances. Full article

This study aims to evaluate the biomechanical behavior of titanium and carbon fiber-reinforced polyetheretherketone (CF-PEEK) dental implants under varying bone densities and loading conditions using finite element analysis (FEA). A single-tooth mandibular molar implant system was modeled, comprising titanium or CF-PEEK abutment and fixture, and surrounding bone structures with four configurations: (I) fully cortical bone, (II) 2 mm cortical layer with trabecular bone, (III) 1 mm cortical with high-density trabecular bone, and (IV) 1 mm cortical with low-density trabecular bone. Vertical and oblique static loads of 100 N were applied to simulate masticatory forces. FEA results revealed that titanium implants exhibited higher von Mises stress values in the implant and abutment under oblique loading, exceeding 400 MPa, while CF-PEEK components showed reduced stress but significantly higher strain levels. Cortical and trabecular bone surrounding CF-PEEK implants received more uniform stress distribution, potentially minimizing stress shielding effects. However, fatigue life analyses indicated that CF-PEEK abutment and screw components were more susceptible to mechanical failure under oblique loads, particularly in low-density bone models. In conclusion, CF-PEEK implants offer a more physiological load transfer to bone and reduced stress shielding compared to titanium. However, their structural reliability under complex loading, especially in low-quality bone conditions, requires careful consideration. These findings support the potential use of CF-PEEK in select clinical scenarios but highlight the need for further material and design optimization. Full article

Finite element analysis is commonly used to evaluate implant biomechanics, yet limited data exist on arch form and trabecular-surfaced implants. This study aimed to investigate the biomechanical impact of a designed trabecular surface compared with a standard implant surface in full-arch, four-implant-supported restorations, using two mandibular arch forms and four placement configurations. Finite element analyses were conducted under a 250-N oblique load applied at 30° to the posterior segment. The prosthesis was modeled as a titanium–acrylic hybrid structure. Stress distribution was evaluated in cortical and cancellous bones, implants, and prosthetic frameworks. Implants with a trabecular surface demonstrated lower stress concentrations in both bone and implant structures. The von Mises stress at the neck of the posterior implant decreased from 383.3 MPa (standard implant, hyperbolic arch, configuration 1) to 194.9 MPa (trabecular-surfaced implant, U-shaped arch, configuration 4). Similarly, the average maximum principal tensile stress in cortical bone reduced from 44.32 to 40.99 MPa with the trabecular design. Among placement strategies, Configuration 3 (all implants tilted distally) yielded the highest bone stress, whereas Configurations 2 and 4 provided more favorable load distribution. Stress concentrations were also higher in hyperbolic arches, whereas U-shaped arches exhibited a more uniform distribution. These findings emphasized the biomechanical advantage of the designed trabecular surface in reducing stress across bone and implant components, indicating that trabecular titanium may represent a more reliable and cost-effective alternative for clinical applications, potentially enhancing long-term stability. Independently, the arch form and placement strategy also significantly influenced load distribution. Despite assumptions such as isotropic, homogeneous, and linearly elastic material properties, and the use of a single oblique loading condition, this study offers valuable biomechanical insights such as the stress-reducing effect of the trabecular surface, the influence of three-dimensional arch anatomy on stress concentration sites, and the necessity of selecting implant configurations according to arch forms, which may inform future full-arch implant rehabilitations. Full article

Intraosseous hemangiomas (IH) are rare intrabony lesions that represent less than 1% of intraosseous tumors. IH are mostly seen in the axial skeleton and skull. Most commonly, the frontal bone, zygomatic, sphenoid, maxilla, ethmoid, and lacrimal bone can manifest IH. Currently, IH is classified as a developmental condition of endothelial origin. According to WHO, the five histological types of IH are cavernous, capillary, epithelioid, histiocytoid, and sclerosing. IH of the zygoma is an extremely rare condition with female predominance. A systematic review recently estimated that there were 78 cases published in the literature until 2023. The lesion is usually asymptomatic and presents with a gradually deteriorating deformity of the malar area, and the patient might be able to recall a history of trauma. Numbness due to involvement of the infraorbital nerve might also be present; however, atypical skin and bone sensations might also occur. Other symptoms include painful swelling, bone asymmetry, skin irritation, sinus pressure, paresthesia, diplopia, enophthalmos, or atypical neuralgia. A bony lesion with a trabecular pattern in a radiating formation (sunburst pattern) or a multilocal lytic lesion pattern created by the multiple cavernous spaces (honeycomb pattern) is commonly observed during radiologic evaluation. We present a rare case of IH of the zygoma in a 65-year-old generally healthy woman. A cyst-like bone tumor was revealed from the CT scan, which made preoperative biopsy of the lesion problematic. A careful radiological diagnostic differentiation of the lesion should always be conducted in such cases to outline a safe surgical plan and possible alternatives if needed. The patient underwent total tumor resection in the operating room, and the defect was reconstructed with the use of a titanium mesh and a synthetic hydroxyapatite bone graft based on a 3D surgical guide printed model. Full article

This narrative review explores the role of additive manufacturing (AM) technologies in the production of dental implants, focusing on materials and key AM methods. The study discusses several materials used in implant fabrication, including porous titanium, trabecular tantalum, zirconium dioxide, polymers, and composite materials. These materials are evaluated for their mechanical properties, biocompatibility, and suitability for AM processes. Additionally, the review examines the main AM technologies used in dental implant production, such as selective laser melting (SLM), electron beam melting (EBM), stereolithography (SLA), selective laser sintering (SLS), and direct metal laser sintering (DMLS). These technologies are compared based on their accuracy, material limitations, customization potential, and applicability in dental practice. The final section presents a data source analysis of the Web of Science and Scopus databases, based on keyword searches. The analysis evaluates the research trends using three criteria: publication category, document type, and year of publication. This provides an insight into the evolution and current trends in the field of additive manufacturing for dental implants. The findings highlight the growing importance of AM technologies in producing customized and efficient dental implants. Full article

The aim of this in vitro study is to investigate the adhesion, proliferation, and differentiation of human adipose-derived mesenchymal stem cells (hASC) on Trabecular Titanium scaffolds manufactured with different manufacturing processes (EBM and SLM). The in vitro adhesion and proliferation of hASC on titanium scaffolds with WST assays have been carried out. The comparison of the gene expression profiles of typical bone genes (Alp, Bglap, Col1a1, and Osx) through real-time PCR assays and the evaluation of extracellular matrix composition with immunofluorescence and SEM analysis have been performed. In addition, the possible osteoinductive properties of the two scaffolds have been investigated through real-time PCR and ALP assays. Data showed that Trabecular Titanium supports human adipose-derived mesenchymal stem cell colonization and induces differentiation in bone with the deposition of the abundant extracellular mineralized matrix regardless of the manufacturing process, proving that the micro- and macro-design features are the key factors responsible for the osteoinduction behavior. These features can only be achieved through tailored 3D printing process parameters. 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

Trabecular titanium implants are widely used in orthopedic surgery and are known to promote osseointegration. In this study, we investigated whether primary human osteoblast-like cells grown inside a 3D trabecular titanium scaffold undergo changes in migration capacity, transcriptomic profile, and cellular phenotype as compared to the same osteoblasts not grown inside the scaffold. Scratch tests have shown that primary human osteoblast-like cells grown inside the 3D trabecular titanium scaffold promote the migration of cells from the external environment into the scaffold. Next generation sequencing analysis demonstrated that primary human osteoblast-like cells grown inside the 3D trabecular titanium scaffold modified the expression of genes involved in cell cycle and extracellular matrix remodeling, while maintaining a normal expression of the specific osteoblast markers, such as osteocalcin and osterix, as well as a comparable mineralization capacity. These data demonstrate that primary human osteoblast-like cells grown inside the titanium scaffold in a 3D environment acquire specific features favoring osseointegration. Full article

One of the issues the modern hip implants face is that one side of the implant may detach due to stretching during its use. This leads to implant transverse compression and separation from the bone. This issue can be solved by using complex implants having one of the sides made of auxetic meta-biomaterials with negative Poisson’s ratio. On the contrary, the cross-section of such materials being stretched will increase, which results in bone growth stimulation and minimum possibility of implant detachment. The aim of this paper is to design and fabricate titanium alloy auxetic meta-biomaterials based on 3D unit cells with three types of topologies. The works involved computer simulation to determine the expected properties of the samples. The samples were fabricated by the selective laser melting method and their properties were determined. Auxetic meta-biomaterials with Poisson’s ratio values of −0.09 and −0.003 and elastic modulus values typical for a human trabecular bone were fabricated in the course of the works. Full article

Background/Objectives: As the rate of revision total hip arthroplasty (THA) has risen, there has been a drive to improve the technology in the manufacturing of the implants used. One recent advance has been 3-D printing of trabecular titanium implants to improve implant stability and osteointegration. The aim of this study was to review the clinical and radiological outcomes of these acetabular implants in revision THA. Methods: A manual search of the databases of the US National Library of medicine (PubMed/MEDLINE), Embase, and the Cochrane library was performed. The following keywords of “revision total hip arthroplasty” AND “acetabulum” AND “titanium” AND “porous” were utilised. Results: In total, 106 abstracts were identified during manual search of databases. In total, 11 studies reporting 4 different implants, with a total of 597 operated joints in 585 patients were included in this review. There were 349 (59.7%) female patients, and the mean age per study ranged from 56.0 to 78.4 years. The all-cause survival rate was 95.52% (95% CI: 92.37–97.96) at a mean follow up of 3.8 years (95% CI: 2.6–5.1). The 40 cases that required re-operation included 17 (2.8%) for infection, 14 (2.3%) instability, 2 (0.3%) for shell migration and 5 (0.8%) for aseptic loosening. The most commonly used patient reported outcome measure was the Harris Hip Score with the mean post-operative score of 86.7 (95% CI: 84.3–89.1). Conclusions: Trabecular titanium acetabular implants, when used in revision THA, resulted in excellent short- to mid-term outcomes with improved hip specific outcomes and a survivorship of 95.52% over the reported follow-up period. Future prospective studies evaluating long term outcomes are needed to make comparisons between more established solutions used in revision THA. Full article