Pre-Treatment of Titanium Alloy with Platelet-Rich Plasma Enhances Human Osteoblast Responses

이지혜,남진우,남광우,김희중,유정준 한국조직공학과 재생의학회 2016 조직공학과 재생의학 Vol.13 No.4

Osseointegration, the histological direct bone-to-implant contact, is the ultimate goal of implant healing and the first prerequisite for long-term success of endosseous implants. It is well-known that metal implants with rough surfaces achieve better osseointegration than those with smooth surfaces in vivo. The implantation of metal materials into bone is always accompanied by bleeding. The implant surface is initially coated with blood and these initial events could determine subsequent osseointegration. However, there is little concordance between in vitro results and in vivo findings regarding the effect of surface roughness on osseointegration. Here, we show that the osteoblast response to metal surfaces pre-treated with platelets and plasma proteins elucidates the superior osseointegration of rough surfaced implants in vivo. We found that osteoblast attachment, proliferation, and osteoblastic differentiation were significantly higher on a rough titanium surface pre-treated with platelet-rich plasma (PRP) than on the same surface without pretreatment. Furthermore, we found that the three-dimensional fibrillar network formed on the rough surface of the titanium by PRP pre-treatment might enhance osteoblast responses. Our results demonstrate why osseointegration is found to be most active on metal implants with a rough surface in vivo. We anticipate that our assay would be a useful tool for mimicking the in vivo model of osseointegration. Because cellular responses to the titanium implant that are pre-treated with platelet and plasma proteins on their surfaces after the biomimetic process in vitro, may be more similar to the events that occur in vivo.

Osseointegration을 이용한 절단된 수지 재건의 임상치험례

방사익,박양수,문구현 충북대학교 의과대학 충북대학교 의학연구소 1998 忠北醫大學術誌 Vol.8 No.2

연구목적 : 절단된 무지의 재건시 족지 유리전이술,무지형성술등이 시행되어왔으나 이는 숙련된 기술을 요하고 공여부의 희생이 문제되어왔다. 보다 기술적으로 용이하고 간편하며 쉽게 적용할 수 있는 수술법을 찾고자 골통합술을 무지결손환자에게 시도하였다. 재료 및 방법 : 수지절간 관절부위의 외상성 무지절단환자에서 골통합 티타늄 고정기을 이용하여 무지보형물을 무지근위지골에 접합시키려 2단계 수술을 시행하였다. 1단계로 장골 해면 질골이식과 같이 고정기를 근위지골 원위단 골수강래에 삽입시켰다. 고정기가 주변골과 통합이 되는 3개월째에 고정기를 노출시키고 그 위에 접합체를 고정시키는 수술을 실시하였다. 2주후 무지보형물을 접합체를 이용 고정기에 고정시킬수 있었다. 결과 : 술후 12개월간 추적관찰한 결과 고정기의 골통합이 유지되었고, 피부괴사 등의 합병증은 발생하지 않았으며 어느정도의 식별촉각을 보였다. 결론 : 절단된 수지의 재건에 있어서 골통합을 이용한 보형물법이 선택적 경우에 효과적인 대안이 될 수 있겠다 Purpose : Reconstruction of amputated finger is challenging field. Free toe-to-finger transfer, pollicization are well-known useful methods but require skillful techies, sacrifice of donor digit. To find and evaluate more readily appliable method, we tried to reconstruct amputated finger using osseointegration. Materials and Methods : A case with traumatic amputation of the thumb at the interphalangeal joint level underwent two stage reconstruction aimed at fixation of a thumb prosthesis to the first proximal phalangeal bone via an osseointegrated titanium fixture. The first stage included insertion of the fixture into the medullary cavity of the first proximal phalanx in combination with transplantation of cancellous bone from the iliac crest. After 3 months. when the fixture was firmly integrated into the bone, a skin-penetrating abutment was placed on top of the fixture, the surrounding skin being thinned to the thickness of a split-thickness skin graft to minimize relative mobility. A thumb prosthesis could then be firmly attached to this fixture. Results : At follow-up examination at 12 months postoperatively, good osseointegration of the implant persisted. There was no skin problems. Some extent of tactile discrimination was achieved in the prosthesis hypothetically based on transfer of tactile stimuli to endosteal nerves in the bone via the titanium fixture. Conclusion : Amputated finger can be successfully reconstructed using osseointegrated implant without sacrifice of donor toe or finger.

표면변화에 따른 티타늄합금에의 골유착

원중희,서중배 충북대학교 의과대학 충북대학교 의학연구소 1996 忠北醫大學術誌 Vol.6 No.2

미세공표면을 갖는 순수 티타늄 fiber-metal로 둘러싸인 막대봉(porous coated)과 거친표면처리한 티타늄봉(rough-blasted)을 토끼의 원위대퇴골 골수강내에 삽입하여 시간경과에 따른 골유착의 유무 및 정도를 관찰하였다. 총 30마리의 토끼가 사용되었고, 15마리에는 Porous coated 삽입물을 삽입하였으며 15마리에는 rough-blasted 삽입물을 삽입하였다. 토끼는 각각 3마리씩 1, 2, 4, 6, 12 주에 희생되어 삽입물의 정중위부를 절편하여 조직학적으로 검사하였다. 전체삽입물주위에 골이 직접 닿은 부위의 비율을 측정한 결과 rough-blasted 티타늄봉과 porous-coated 티타늄봉 주위에 상당한정도의 골유착이 있었으며 전체군의 평균을 볼 때 rough-blasted 군은 36.5%, porous-coated군은 19.2% 에서 골유착이 있었다. 삽입물주위의 골형성 및 골유착은 삽입후 1주부터 관찰할 수 있었고, 4주 이후에는 골유착면적의 커다란 증가가 보이지 않았다. 임상적 의의 : 인공관절치환시 골시멘트를 사용하지 않는 경우 삽입물의 견고한 고정을 위해 삽입물 표면을 미세공처리하는 것이 필수적이며 보편적인 것으로 알려져 있다. 또한 보다 신속하고 확실한 고정을 위해 hydroxyapatite의 표면처리도 주장되고 있다. 하지만 유럽지역에서 시작된 비미세공처리한 티타늄합금의 인공관절 사용은 10년 이상 사용되고, 우수한 임상적, 방사선학적 결과를 보여주고 있다. 토끼에서 보이는 rough-blasted 티타늄봉에의 골유착이 미세골표면을 갖는 삽입물보다 우수하거나 비슷한 소견을 보여준 이 연구는 임상적, 방사선학적 우수성의 배경을 갖고있는 rough-blasted 티타늄합금의 인공관절 삽입물 사용의 이론적 근거를 보다 확실하게 하고 있다. 미세공표면 처리나 hydroxyapatite의 사용은 처리과정의 복잡성과 경제적인 비용, 또한 내재적인 단점이 많다. 따라서 특별한 적응증이 있는 경우가 아니라면 인공 관절치환술에서 rough-blasted 표면을 갖는 티타늄합금의 사용이 좋을 것으로 생각된다 The Purpose of this study was to see the host-bone response to pure titanium fiber-metal surrounding titanium alloy core and rough-blasted titanium alloy(Ti-6Al-4V) implants placed in the medullary cavity of distal femur of rabbit. Each rod was implnated into medullary cavity of tight distal femur through the knee. A total of thirty New Zealand rabbits were used. Fifteen were for fiber-metal rods and another fifteen were for rough blasted rods. The rabbits were killed at one, two, four, six, and twelve weeks after operation and studied histologically and histomorphometrically. Percentage implant perimeter surface length in contact with new bone were measured. Histomorphometry revealed excellent, comparable osseointegration onto rough-blasted titanium compared with fiber-metal titanium rod. When whole group means were compared, it was found that 36.5 percent of perimeter of the rough blasted implants was covered with bone compared with 19.2 percent of the perimeter of the fiber-metal coated implants. Peripheral bone formation and osseointegration was evident at one week, and quantitative plateau was reached at four weeks. Clinical relevance : Implantation with or without bone cement huts been a controversy among orthopaedic surgeons. Biological fixation was an alternative method introduced into the alrhroplasty field, but prerequisite was porous coated material or hydroxyapatite coated surface. However many Europian scientist suggested that a porous-coated surface is not necessary for osseointegration. Our study proved that nonporous-coated rough blasted titanium surface was enough for osseointegration not inferior to fiber-metal titanium surface. We have radiographic and clinical evidence that hip prostheses with rough-blasted titanium surface show osseointegration. The cost of manufacturing porous-coated prosthesis is high and the adverse effects of it are many. The use of rough-blasted surface may help to improve the functional outcome of total joint replacements and reduce the cost of arthroplasty.

Chitosan/hydroxyapatite composite coatings on porous Ti6Al4V titanium implants: in vitro and in vivo studies

Zhang, Ting,Zhang, Xinwei,Mao, Mengyun,Li, Jiayi,Wei, Ting,Sun, Huiqiang Korean Academy of Periodontology 2020 Journal of Periodontal & Implant Science Vol.50 No.6

Purpose: Titanium implants are widely used in the treatment of dentition defects; however, due to problems such as osseointegration failure, peri-implant bone resorption, and periimplant inflammation, their application is subject to certain restrictions. The surface modification of titanium implants can improve the implant success rate and meet the needs of clinical applications. The goal of this study was to evaluate the effect of the use of porous titanium with a chitosan/hydroxyapatite coating on osseointegration. Methods: Titanium implants with a dense core and a porous outer structure were prepared using a computer-aided design model and selective laser sintering technology, with a fabricated chitosan/hydroxyapatite composite coating on their surfaces. In vivo and in vitro experiments were used to assess osteogenesis. Results: The quasi-elastic gradient and compressive strength of porous titanium implants were observed to decrease as the porosity increased. The in vitro experiments demonstrated that, the porous titanium implants had no biological toxicity; additionally, the porous structure was shown to be superior to dense titanium with regard to facilitating the adhesion and proliferation of osteoblast-like MC3T3-E1 cells. The in vivo experimental results also showed that the porous structure was beneficial, as bone tissue could grow into the pores, thereby exhibiting good osseointegration. Conclusions: Porous titanium with a chitosan/hydroxyapatite coating promoted MC3T3-E1 cell proliferation and differentiation, and also improved osseointegration in vitro. This study has meaningful implications for research into ways of improving the surface structures of implants and promoting implant osseointegration.

Quantitative assessment of compress-type osseointegrated prosthetic implants in human bone using electromechanical impedance spectroscopic methods

Wentao Wang,Jerome P. Lynch 대한의용생체공학회 2020 Biomedical Engineering Letters (BMEL) Vol.10 No.1

Osseointegrated (OI) prostheses are a promising alternative to traditional socket prostheses. They can enhance the qualityof life of amputees by avoiding fi t and comfort issues commonly associated with sockets. The main structural element ofthe OI prosthesis is a biocompatible metallic implant that is surgically implanted into the bone of the residual limb. Theimplant is designed to provide a conducive surface for the host bone to osseointegrate with. The osseointegration process ofthe implant is diffi cult to clinically evaluate, leading to conservative postoperative rehabilitation approaches. Elastic stresswaves generated in an OI prosthesis have been previously proposed to interrogate the implant-bone interface for quantitativeassessment of the osseointegration process. This paper provides a detailed overview of the various elastic stress wavemethods previously explored for in situ characterization of OI implants. Specifi cally, the paper explores the use of electromechanicalimpedance spectroscopy (EIS) to assess the OI process in compress-type OI prostheses. The EIS approachmeasures the electrical impedance spectrum of lead zirconate titanate elements bonded to the free end of the implant. Theresearch utilizes both numerical simulation and experimental verifi cation to establish that the electromechanical impedancespectrum is sensitive (between 400 and 460 kHz) to both the degree and location of osseointegration. A baseline-free OIindex is proposed to quantify the degree of osseointegration at the implant-bone interface and to assess the stability of theOI implant for clinical decision making.

골유착 이전에 악정형력이 임프란트 주위조직에 미치는 영향

김영호,이철원 대한치과교정학회 1998 대한치과교정학회지 Vol.28 No.3

저자들은 임프란트 매식 후 골유착을 위한 초기 치유기간 이전에 악정형령이 임프란트 주위 조직에 미치는 영향을 관찰하기 위하여 가토 12마리의 양측 대퇴골에 임프란트를 식립하고 2주, 4주 그리고 6주후에 각각 300g의 악정형력을 Ni-Ti close coil spring을 이용하여 매식된 임프란트에 4주동안 가하고 관찰한 후 다음과 같은 결론을 얻었다. 1. 모든 실험군의 임프란트는 4주간의 악정항력 적용후에도 안정된 견고성을 유지하였다. 2. 2주 실험군에서 대조군에 비해 임프란트와 골조직 사이의 섬유조직 증식이 많이 관찰 되었으나 특이할만한 염증소견은 관찰되지 않았다. 3. 4주 실험군, 대조군에서는 2주 실험군, 대조군과 각각 비교하였을 때 보다 많은 양의 골재생이 관찰 되었으며 실험군과 대조군 모두에서 임프란트와 골조직 사이의 섬유조직은 관찰하기 힘들었다. 4. 6주에서는 실험군과 대조군 사이에 뚜렷한 차이가 발견되지 않았다. 이상의 결과로 보아 임프란트 주위의 골조직 재생이 충분하지 않아도 골의 양과 질이 우수해 임프란트 식립시 견고한 초기고정을 얻을 수 있다면 골유착이 완성되는 초기 치유기간 이전에도 치과교정적 고정원으로 사용가능할 것으로 사료된다. The dental implants for edentulous patients have been used for more than 20 years. After the introduction of osseointegration by Branemark, the commercially pure titanium implants were accepted by most practitioners. Recently dental implants are used for orthodontic anchorages as well as prosthetic abutment. Many researchers have reported implants as a good orthodontic anchorage through basic research and clinical evaluation. But previous researches were done after the healing time for osseointegration of inserted implants. If dental implants are to be used for prosthetic abutment the healing time for osseointegration is necessary, but orthodontic forces to implants are different from bite force regarding its amount of force, duration and direction. The authors evaluated the effect of orthopedic force to implants on bone tissue before osseointegration. 48 implants were placed at 12 rabbits. 2 implants into left side and 2 implants into right side were inserted along the long axis of femur respectively. 2 weeks (2 weeks group), 4 weeks (4 weeks group) and 6 weeks (6 week group) after implants placement, 300g force had been applied to the implants at left side femur by Ni-Ti close coil spring for 4 weeks (experimental group) and no force applied to implants at right side femur (control group). After the force application for 4weeks, rabbits were sacrificed and microscopic evaluation was done by hematoxylin-eosin stain and Masson trichrome stain. The results were followed.. 1. All implants in experimental group remained rigid after the force application for 4 weeks. 2. More fibrous tissue between bone and implants were noticed at 2 weeks experimental group than 2 weeks control group. 3. More bone remodeling was noticed at 4weeks group than 2 weeks group and it was difficult to find out fibrous tissue between bone and implants at both experimental and control group of 4 weeks group. 4. It was hard to distinguish experimental group from control group at 6 weeks group. Therefore if intial stability can be obtained on implant insertion, it can be possible to use implants as a orthodontic anchorage before the healing time for osseointegration.

유한요소해석을 통한 ITI Solid screw 임플랜트의 형상 특성이 골유착 단계에서 응력에 미치는 영향에 대한 연구

차상범,이규복,조광헌,Cha Sang-Bum,Lee Kyu-Bok,Jo Kwang-Hun 대한치과보철학회 2006 대한치과보철학회지 Vol.44 No.2

Statement of problem: Standard type of ITI solid implant model in the 6.2mm thick jaw bone was axisymmetrically modelled for finite element stress analyses. Purpose: Primary objective was to investigate the influences or the characteristic design configuration of the ITI solid implant model on the bone stress with the course of osseointegration process at the bone/implant interfaces. To simulate the characteristics of the osseointegration process, five different stages of the bone/implant interface model were implemented. As load conditions, vertical load of 50N was taken into consideration. Bone at the cervical region of implant was the areas of concern where the higher level of stress were likely to take place. Results: The results indicated that rather slightly different stress level could be obtained as a function of the osseointegration conditions. Conclusion: Under vertical load, the lower level of stress was observed at the cervical cortical bone in the initial and final stages of osseointegration. Relatively higher stress level, however, was observed during the transitional stages where the osseointegration at the cancellous bone interface were yet to fully develop.

Comparative study for osseointegration according to surface treatments of dental implants

Myung Hyun Jun,Myoung-Ju Kim,You-Song Sim,국민석 조선대학교 치의학연구원 2020 Oral Biology Research (Oral Biol Res) Vol.44 No.2

The purpose of this study was to evaluate the effect of hydroxyapatite (HA) full-coating and resorbable blast media (RBM) on the osseointegration of implants placed in the bone. Twelve rabbits were used as experimental animals and three implants were installed in each tibia. Rabbits in the control group were provided with no additional treatments to the fixture. Rabbits in experimental group I were provided with RBM treatment and rabbits in experimental group II were provided with full HA coating. The animals were sacrificed 4 weeks after implantation. The parts of the tibia containing the implant were harvested and radiographs were acquired. Specimens were prepared for histological examination and histomorphometric analysis of the bone-to-implant contact (BIC) ratio. The extent of osseointegration of the implants was different among the groups. Histomorphometrically, the full HA coating group showed the highest BIC ratio, followed by the RBM treatment and the control group. The three groups significantly differed when using the Kruskal–Wallis test and Mann–Whitney U-test. These results suggest that the full HA coating and RBM treatment to the fixture can provide significantly higher osseointegration. The full HA coating provided more osseointegration than the RBM treatment.

Ti-6Al-4V 비드코팅 임프란트 시제품의 골유착에 대한 실험적 연구

우진오,박봉욱,변준호,김승언,김규천,박봉수,김종렬,Woo, Jin-Oh,Park, Bong-Wook,Byun, June-Ho,Kim, Seung-Eon,Kim, Gyoo-Cheon,Park, Bong-Soo,Kim, Jong-Ryoul 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.1

The geometric design of an implant surface may play an important role in affecting early osseointegration. It is well known that the porous surfaced implant had much benefits for the osseointegration and the early stability of implant. However, the porous surfaced implant had weakness from the transgingival contamitants, and it resulted in alveolar bone loss. The other problem identified with porous surface implant is the loss of physical properties resulting from the bead sintering process. In this study, we developed the new bead coating implant to overcome the disadvantages of porous surfaced implant. Ti-6Al-4V beads were supplied from STARMET (USA). The beads were prepared by a plasma rotating electrode process (PREP) and had a nearly spherical shape with a diameter of 75-150 ${\mu}m$. Two types of titanium implants were supplied by KJ Meditech (Korea). One is an external hexa system (External type) and the other is an internal system with threads (Internal type). The implants were pasted with beads using polyvinylalcohol solution as a binder, and then sintered at 1250 $^{\circ}C$ for 2 hours in vacuum of $10^{-5}$ torr. The resulting porous structure was 400-500 ${\mu}m$ thick and consisted of three to four bead layers bonded to each other and the implant. The pore size was in the range of 50-150 ${\mu}m$ and the porosity was 30-40 % in volume. The aim of this study was to evaluate the osseointegration of the newly developed dental implant. The experimental implants (n=16) were inserted in the unilateral femur of 4 mongrel dogs. All animals were killed at 8 weeks after implantation, and samples were harvested for hitological examination. All bead coated porous implants were successfully osseointegrated with peripheral bone. The average bone-implant contact ratios were 84.6 % (External type) and 81.5 % (Internal type). In the modified Goldner's trichrome staining, new generated mature bones were observed at the implant interface at 8 weeks after implantation. Although, further studies are required, we could conclude that the newly developed vacuum sintered Ti-6Al-4V bead coating implant was strong enough to resist the implant insertion force, and it was easily osseointegrated with peripheral bone.

비미세공표면 티타늄합금에의 골유착

원중희 ( Choong Hee Won ),김용민 ( Yong Min Kim ),최의성 ( Eui Sung Choi ),유진선 ( Jin Seon Yoo ),지종훈 ( Jong Hun Jee ) 대한고관절학회 1996 Hip and Pelvis Vol.8 No.2

The purpose of this study was to see the host-bone response to pure titanium fiber-metal surrounding titanium alloy core and rough-blasted titanium alloy(Ti-6AI-4V) implants placed in the medullary cavity of distal femur of rabbit. Each rod was implanted into medullary cavity of right distal femur through the knee. A total of thirty New Zealand rabbits were used. Fiber-metal rods were inserted into fifteen femurs and remaining fifteen were for rough blasted rods. The rabbits were sacrificed at one, two, four, six, and twelve weeks after operation and the specimens were studied histologically. Percentage implant perimeter surface length in contact with new bone were measured. Histomorphometric study showed excellent osseointegration onto rough-blasted titanium compared to that of fiber-metal titanium rod. When whole group means were compared, it was found that 36.5 per cent of perimeter of the rough blasted implants was covered with bone compared with 19.2 per cent of the perimeter of the fiber-metal coated implants. Peripheral bone formation and osseointegration was evident at one week after implantation and quantitative plateau was reached at four weeks. This study proved that nonporous-coated rough blasted titanium surface showed evident osseointe- gration which is not inferior to fiber-metal titanium surface. We have radiographic and clinical evidence that hip prostheses with rough-blasted titanium surface show osseointegration. The manufacturing cost of porous-coated prosthesis is high and the adverse effects of it are many. The use of rough-blasted surface may help to improve the functional outcome of total joint replacements and reduce the cost of arthroplasty.