Rapid prototyping and rapid manufacturing in medicine and dentistry

The fundamentals and latest developments of Rapid Prototyping (RP) and Rapid Manufacturing (RM) technologies and the application of most common biomaterials such as titanium and titanium alloy (Ti6Al4V) are discussed in this paper. The issues while fabricating pre-surgical models, scaffolds for cell growth and tissue engineering and concerning fabrication of medical implants and dental prostheses are addressed. Major resources related to RP/RM technology, biocompatible materials and RP/RM applications in medicine and dentistry are reviewed. A large number of papers published in leading journals are searched.

Besides the titanium and titanium alloys which were established as bio-compatible materials over five decades ago, other biocompatible materials such as cobalt-chromium and PEEK have also been increasingly used in medical implants and dental prosthesis fabrication. For over a decade RP technologies such as Selective Laser Sintering (SLS) and Selective Laser Melting (SLM) along with the Fused Depositing Modelling (FDM) are predominantly employed in the fabrication of implants, prostheses and scaffolds. Recently Electron Beam Melting (EBM) has been successfully employed for fabrication of medical implants and dental prostheses with complex features. In dentistry crown restoration, the use of thin copings of Ti6Al4V made by the EBM process is an emerging trend. This review is based upon the findings published in highly cited papers during the last two decades. However the major breakthrough in the field of RP/RM for medical implants and dental prostheses took place in the last decade. The fabrication of medical implants and prostheses and biological models have three distinct characteristics: low volume, complex shapes and they are highly customised. These characteristics make them suitable to be made by RM technologies even on a commercial scale. Finally, current status and methodology and their limitations as well as future directions are discussed.     

Bone response to a titanium aluminium nitride coating on metallic implants

The design, surface characteristics and strength of metallic implants are dependant on their intended use and clinical application. Surface modifications of materials may enable reduction of the time taken for osseointegration and improve the biological response of bio-mechanically favourable metals and alloys. The influence of a titanium aluminium nitride (TAN) coating on the response of bone to commercially pure titanium and austenitic 18/8 stainless steel wire is reported. TAN coated and plain rods of stainless steel and commercially pure titanium were implanted into the mid-shaft of the femur of Wistar rats. The femurs were harvested at four weeks and processed for scanning electron and light microscopy. All implants exhibited a favourable response in bone with no evidence of fibrous encapsulation. There was no significant difference in the amount of new bone formed around the different rods (osseoconduction), however, there was a greater degree of shrinkage separation of bone from the coated rods than from the plain rods (p = 0.017 stainless steel and p = 0.0085 titanium). TAN coating may result in reduced osseointegration between bone and implant.     

Designation and development of biomedical Ti alloys with finer biomechanical compatibility in long-term surgical implants

Developing the new titanium alloys with excellent biomechanical compatibility has been an important research direction of surgical implants materials. Present paper summarizes the international researches and developments of biomedical titanium alloys. Aiming at increasing the biomechanical compatibility, it also introduces the exploration and improvement of alloy designing, mechanical processing, microstructure and phase transformation, and finally outlines the directions for scientific research on the biomedical titanium alloys in the future.     

Titanium: The implant material of today

The use of metals for the replacement of structural components of the human body has been with us for some considerable time. The metals originally used were stainless steels which have gradually been replaced by cobalt-chromium alloys. Although titanium has been used since the late forties, it is only relatively recently that it has gained widespread interest. Titanium and its alloys are being used more and more in preference to the cobalt-chromium alloys and has broadened the field of applications. The features which make titanium such an interesting material are its excellent corrosion resistance in the biological environment, combined with an exception degree of biocompatibility which it shares with only a handful of other materials. In this review the background to the clinical use of titanium is discussed with particular attention to the biological aspects of the material. While there are now many clinical uses for titanium and its alloys their main areas of application are in the field of dentistry and orthopaedics and these are described in some detail.     

A comparative study of zirconium and titanium implants in rat: osseointegration and bone material quality

Permanent metal implants are widely used in human medical treatments and orthopedics, for example as hip joint replacements. They are commonly made of titanium alloys and beyond the optimization of this established material, it is also essential to explore alternative implant materials in view of improved osseointegration. The aim of our study was to characterize the implant performance of zirconium in comparison to titanium implants. Zirconium implants have been characterized in a previous study concerning material properties and surface characteristics in vitro, such as oxide layer thickness and surface roughness. In the present study, we compare bone material quality around zirconium and titanium implants in terms of osseointegration and therefore characterized bone material properties in a rat model using a multi-method approach. We used light and electron microscopy, micro Raman spectroscopy, micro X-ray fluorescence and X-ray scattering techniques to investigate the osseointegration in terms of compositional and structural properties of the newly formed bone. Regarding the mineralization level, the mineral composition, and the alignment and order of the mineral particles, our results show that the maturity of the newly formed bone after 8 weeks of implantation is already very high. In conclusion, the bone material quality obtained for zirconium implants is at least as good as for titanium. It seems that the zirconium implants can be a good candidate for using as permanent metal prosthesis for orthopedic treatments.     

Corrosion of bio implants

Chemical stability, mechanical behaviour and biocompatibility in body fluids and tissues are the basic requirements for successful application of implant materials in bone fractures and replacements. Corrosion is one of the major processes affecting the life and service of orthopaedic devices made of metals and alloys used as implants in the body. Among the metals and alloys known, stainless steels (SS), Co-Cr alloys and titanium and its alloys are the most widely used for the making of biodevices for extended life in human body. Incidences of failure of stainless steel implant devices reveal the occurrence of significant localised corroding viz., pitting and crevice corrosion. Titanium forms a stable TiO₂ film which can release titanium particles under wear into the body environment. To reduce corrosion and achieve better biocompatibility, bulk alloying of stainless steels with titanium and nitrogen, surface alloying by ion implantation of stainless steels and titanium and its alloys, and surface modification of stainless steel with bioceramic coatings are considered potential methods for improving the performance of orthopaedic devices. This review discusses these issues in depth and examines emerging directions.     

Structure of the interface between rabbit cortical bone and implants of gold, zirconium and titanium

The role of surface properties (chemical and structural) for the interaction between biomaterials and tissue is not yet understood. In the present study, implants made of titanium, zirconium (transition metals with surface oxides) and gold (metallic surface) were inserted into the rabbit tibia. Light microscopic (LM) morphometry showed that after 1 and 6 mo the gold implants had less amount of bone within the threads and a lower degree of bone-implant contact than the titanium and zirconium implants, which did not differ from each other. These quantitative differences were supported by LM and ultrastructural observations of the interface. The ultrastructural observations in addition demonstrated that the layer of non-collagenous amorphous material located between the implant and the calcified bone was appreciably thicker around zirconium than around titanium implants. The factors potentially responsible for the observed morphological differences in the bone around the different material surfaces are discussed.     

Distribution of cells in soft tissue and fluid space around hollow and solid implants in the rat

The development of the tissue surrounding an implanted material is anticipated to be regulated by the biological factors in the interface as well as the physicochemical properties of the implant material. In the present study light microscopic morphometry and transmission electron microscopy were used to evaluate the distribution of cells adjacent to the implant surface of different implant designs (hollow and solid implants) and materials (titanium and polytetrafluoroethylene). An increased number of leukocytes, predominantly PMN, was retrieved from the exudate inside hollow implants 1 and 9 days after surgery. In contrast, the increased cellularity in the soft tissue around the hollow implants was mainly due to an increased number of monocytes/macrophages and fibroblasts. The presence of a fluid space around both hollow and solid implants was revealed by the use of an electropolishing technique and ground sections. In the fluid space around solid titanium the concentration of leukocytes and the proportion of PMN decreased between 1 and 7 days. After 1 day the majority of leukocytes were freely suspended in the fluid and were rarely directly apposed to the implant surface. A majority of the monocytes/macrophages present in the fluid space after 7 days were attached to the fibrin matrix at the border between the fluid space and the reorganized tissue. Our studies demonstrate that hollow implants promote the influx and a persistence of PMN in the interior of the implant in comparison with the tissue surrounding the hollow and solid implants. Furthermore, during the first week after implantation inflammatory cells are not preferentially distributed directly on the titanium implant surface.     

医用镁金属材料的研究进展

镁及其合金具有优良的综合力学性能、与人体良好的生物相容性能以及生物可降解吸收等特点,有望成为一类新型医用植入材料.综述了镁金属作为医用植入材料的研究发展现状,分析了其应用上的优势与不足,对医用镁金属的表面改性技术进行了简单的论述,并对其作为医用植入材料的发展前景进行了展望.     

医用钛合金及其表面改性

目前钛合金被广泛应用于医学领域，如矫形用种植体。简要综述了新型医用钛合金的开发以及钛合金表面改性提高其表面生物活性和耐磨性能的研究进展。     

Processing and mechanical properties of autogenous titanium implant materials

Pure titanium and some of its alloys are currently considered as the most attractive metallic materials for biomedical applications due to their excellent mechanical properties, corrosion resistance, and biocompatibility. It has been demonstrated that titanium and titanium alloys are well accepted by human tissues as compared to other metals such as SUS316L stainless steel and Co–Cr–Mo type alloy. In the present study, highly porous titanium foams with porosities 80% are produced by using a novel powder metallurgical process, which includes the adding of the selected spacers into the starting powders. The optimal process parameters are investigated. The porous titanium foams are characterized by using optical microscopy and scanning electron microscopy. The distribution of the pore size is measured by quantitative image analyses. The mechanical properties are investigated by compressive tests. This open-cellular titanium foams, with the pore size of 200–500 m are expected to be a very promising biomaterial candidates for bone implants because its porous structure permits the ingrowths of new-bone tissues and the transport of body fluids.     

Auftraglöten zum Verschleißschutz von Titanwerkstoffen

Wear Protection of Titanium using Surface Brazing Titanium and titanium alloys possess high specific strengths up to a temperature of about 600 °C in addition to an extraordinary corrosion resistance [1]. The low wear resistance constitutes a crucial impediment for a much broader use. Titanium materials are especially susceptible to friction fatigue and erosion. Coating techniques have to be developed in order to counteract this technical constraint. Surface brazing presents a promising approach. Hard metals mixed with brazing filler metals on a silver and titanium basis were brazed in a vacuum furnace and subsequently characterized. Wear resistance was quantified and optimized using ball on disc measurements.     

Oxidative stress and antioxidant responses of liver and kidney tissue after implantation of titanium or titanium oxide coated plate in rat tibiae

Coating with titanium oxides is a promising method to improve the blood compatibility of materials to be used for medical implants. However, biodegradation of the coating can result in microparticles that subsequently cause oxidative stress. Therefore, the present study was carried out to throw some light on the mechanisms affecting the reaction of tissue surroundings Ti implants either in the form of titanium oxide or not in tibiae of rats. The serum collected twice from animals during the period of study and rats were sacrificed after two months of implantation. The complete blood picture, total proteins content and the activities of some serum enzymes were determined as liver biomarker. Kidney function was examined by measuring the levels of serum creatinine and uric acid. The level of lipid peroxidation and the activities of superoxide dismutase, catalase and glutathione S-transferase as well as glutathione content in liver and kidney tissue were evaluated. It has been indicated that the lipid peroxidation is one of the molecular mechanisms involved in Ti-plate induced cytotoxicity however; the TiO(2)-plate did not. The biodegradation of Ti-plate was very slow that could explain why the all enzymatic and non-enzymatic antioxidant not affected by implantation of Ti-plate. The total antioxidant level in serum was better in rats had TiO(2)/Ti-plate than those animals that had Ti-plate. The coating of titanium implants with titanium oxide leads to attaining of reduced the oxidative state in the cells, which enhance the healing process in comparison with the uncoated implants.     

Degradable biomaterials based on magnesium corrosion

Biodegradable metals are breaking the current paradigm in biomaterial science to develop only corrosion resistant metals. In particular, metals which consist of trace elements existing in the human body are promising candidates for temporary implant materials. These implants would be temporarily needed to provide mechanical support during the healing process of the injured or pathological tissue. Magnesium and its alloys have been investigated recently by many authors as a suitable biodegradable biomaterial. In this investigative review we would like to summarize the latest achievements and comment on the selection and use, test methods and the approaches to develop and produce magnesium alloys that are intended to perform clinically with an appropriate host response.     

Uniform porous and functionally graded porous titanium fabricated via space holder technique with spark plasma sintering for biomedical applications

Porous materials with low stiffness and high strength are sought as implant materials to prevent stress shielding and fracture during in vivo use. This study proposes a powder metallurgy-based space holder technique to fabricate porous titanium with mechanical performance suitable for implant materials. Mixed powders of titanium and sodium chloride were sintered at low temperature using spark plasma sintering, and then the sodium chloride was dissolved in water. As a result, uniform porous titanium (UP-Ti) with a wide range of microstructures: porosity from 26% to 80% and average pore size from 75 μm to 475 μm was successfully fabricated. Also, functionally graded porous titanium (FGP-Ti) was successfully fabricated, in which porous titanium with high porosity and dense titanium were placed at the inside and surface, respectively. The stiffness of UP-Ti was comparable to that of natural bones, but its strength was lower than that of natural bones, which would be insufficient for use as an implant. In contrast, the mechanical performance of FGP-Ti was improved, compared with UP-Ti with the porosity comparable to the average porosity of FGP-Ti: its strength was higher than that of natural bones and its stiffness was comparable to that of natural bones. These results imply that porous titanium, especially functionally graded porous titanium, is a candidate metal for implants used to replace heavily loaded natural bone.     

Ion implantation of titanium based biomaterials

Titanium and its alloys are widely used as implant materials. Their integration in the bone is in general very good without fibrous interface layer. However, titanium and its alloys have certain limitations. Metal ions are released from the implant alloy and have been detected in tissues close to titanium implants. The release of these elements, even in small amounts, may cause local irritation of the tissues surrounding the implant. Cell and tissue responses are affected not only by the chemical properties of the implant surface, but also by the surface topography or roughness of the implants. To overcome the problem of ion release and to improve the biological, chemical, and mechanical properties, many surface treatment techniques are used. Any surface treatment that would elicit favorable response from tissues can be applied to enhance the usefulness of the implants. In view of this, the current review describes surface modification of titanium and titanium alloys by ion beam implantation.     

关节置换植入物用材料临床应用现状及发展趋势

关节置换植入物的应用日趋增多。本文对关节置换植入物用材料的临床应用现状及发展趋势做了综述。首先介绍了关节置换植入物材料的基本要求以及国际、国内标准的相关规定。对各种植入物材料,包括不锈钢、钴基合金、纯钛和钛合金、氧化铝陶瓷、超高分子量聚乙烯和PMMA骨水泥等高分子材料以及羟基磷灰石涂层复合材料的临床应用现状等做了阐述。简要介绍了金属材料和超高分子量聚乙烯材料的发展趋势。     

Implants coated with bioactive glass by CO2-laser, an in vivo study

Due to ageing of the population, the number of revision operations is expected to increase. Thus good fixation of medical implants is crucial for successful treatment. In our previous studies, a method to coat titanium implants with bioactive glass (BAG) via CO2 laser treatment was introduced. It allows to localise the application of a bioactive coating, without heat treatment of the whole implant. In the present study, cylindrical titanium implants were used (BAG-coated, control group: NaOH-treated and grit-blasted Ti). Three implants were placed in each femoral epicondyle of six rabbits. After eight weeks the animals were sacrificed. Half of the implants were subjected to a torsional loading test. In the control groups, the failure occurred at the bone-implant interface, in the BAG group the failure occurred mainly in the reacted glass. The implants coated with BAG were integrated into host bone without a connective tissue capsule and were surrounded by significantly more bone than the control implants. The findings indicate clearly that the use of CO2 laser radiation to create BAG coatings did not inhibit the bioactive properties of the glass in terms of osteoconduction.     

Physical properties of nano-HAs/ZrO2 coating on surface of titanium materials used in dental-implants and its biological compatibility

A gradient composite coating on the surface of titanium materials, which are used in dental implants, is prepared using an electric-chemical method. The physical properties of the composite coating and its strength of combining with titanium material are studied by the scanning electron microscope, energy dispersive spectrum and X-ray diffraction analysis, etc. The results show that the nanohydroxyapatite/ZrO2 composite coating is uniformly deposited and formed on the surface of titanium materials, its strength of combining with titanium surface reaches 16.3 MPa, which is determined by the tensile test. The immersion experiment shows that a new matter of carbonate-apatite is distributed uniformly on the surface of the composite coating of nanohydroxyapatite/ZrO2. The cell experiment of cultivate exhibits that the osteoblasts MG-63 is also grown well on the surface of the composite coating. These results indicate that the nanohydroxyapatite/ZrO2 composite coating on the surface of titanium materials has a good biological activity and compatibility and could be used in the dental-implants.