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      Evaluation of osseous integration of titanium orthopedic screws with novel SLA treatment in porcine model

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          Abstract

          The success of many endosseous implants in orthopaedic and dental applications depends on the surface characteristics, as they affect osseous integration. Previous investigations indicated that a novel large-grit sand-blasted and acid-etched (SLA) titanium (denoted as SLAffinity-Ti) implant had better bone integration than that of a comparably shaped implant with a plasma-sprayed titanium surface. The purpose of the present investigation was to create a SLAffinity surface on pedicle screws and trauma screws and to compare it with the surfaces of a sand-blasted-only implant and commercial implants in terms of bone integration. The cortical bone and spine of twelve minipigs were implanted with 3 and 4 implants, respectively, and the bone integration was evaluated using micro-computed tomography (micro-CT), mechanical tests (pull-out strength and stripping torque), and histological analysis (toluidine blue and hematoxylin and eosin staining) one and three months after implantation. The micro-CT images showed that the gap between the bone and implant was consistently higher in the sand-blasted-only and commercial groups compared to that in the SLAffinity group 1 and 3 months after implantation. Moreover, the bone volume of implant inserted into bone and the percentage of implant inside bone tissue were greater in the SLAffinity screws 1 and 3 months after implantation, as compared to the sand-blasted and commercial screws. In the mechanical tests, the removal torque and pull-out strength ( p < 0.05) were higher in the SLAffinity group at 1 and 3 months. The histological results were consistent with mechanical testing, showing that the SLAffinity group had the most mineralized matrix, the most bone formation around the screws, and the most bone cells in bone tissue. These findings indicate that a SLAffinity surface can effectively enhance the holding strength and integration of pedicle screws and cortical screws, promoting early healing and improving outcomes, compared to sand-blasted-only and commercial implants.

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          Most cited references37

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          Influence of surface characteristics on bone integration of titanium implants. A histomorphometric study in miniature pigs.

          D Buser, R Schenk, S. Steinemann … (1991)
          The purpose of the present study was to evaluate the influence of different surface characteristics on bone integration of titanium implants. Hollow-cylinder implants with six different surfaces were placed in the metaphyses of the tibia and femur in six miniature pigs. After 3 and 6 weeks, the implants with surrounding bone were removed and analyzed in undecalcified transverse sections. The histologic examination revealed direct bone-implant contact for all implants. However, the morphometric analyses demonstrated significant differences in the percentage of bone-implant contact, when measured in cancellous bone. Electropolished as well as the sandblasted and acid pickled (medium grit; HF/HNO3) implant surfaces had the lowest percentage of bone contact with mean values ranging between 20 and 25%. Sandblasted implants with a large grit and titanium plasma-sprayed implants demonstrated 30-40% mean bone contact. The highest extent of bone-implant interface was observed in sandblasted and acid attacked surfaces (large grit; HCl/H2SO4) with mean values of 50-60%, and hydroxylapatite (HA)-coated implants with 60-70%. However, the HA coating consistently revealed signs of resorption. It can be concluded that the extent of bone-implant interface is positively correlated with an increasing roughness of the implant surface.
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            Understanding peri-implant endosseous healing.

            Susan E. Davies (2003)
            If dental implantology is an increasingly successful treatment modality, why should we still need to understand the mechanisms of peri-implant bone healing? Are there differences in cortical and trabecular healing? What does "poor quality" bone mean? What stages of healing are most important? How do calcium phosphate-coated implants accelerate healing? What is the mechanism of bone bonding? While there are still many aspects of peri-implant healing that need to be elucidated, it is now possible to deconvolute this biological reaction cascade, both phenomenologically and experimentally, into three distinct phases that mirror the evolution of bone into an exquisite tissue capable of regeneration. The first and most important healing phase, osteoconduction, relies on the recruitment and migration of osteogenic cells to the implant surface, through the residue of the peri-implant blood clot. Among the most important aspects of osteoconduction are the knock-on effects generated at the implant surface, by the initiation of platelet activation, which result in directed osteogenic cell migration. The second healing phase, de novo bone formation, results in a mineralized interfacial matrix equivalent to that seen in the cement line in natural bone tissue. These two healing phases, osteoconduction and de novo bone formation, result in contact osteogenesis and, given an appropriate implant surface, bone bonding. The third healing phase, bone remodeling, relies on slower processes and is not considered here. This discussion paper argues that it is the very success of dental implants that is driving their increased use in ever more challenging clinical situations and that many of the most important steps in the peri-implant healing cascade are profoundly influenced by implant surface microtopography. By understanding what is important in peri-implant bone healing, we are now able to answer all the questions listed above.
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              Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members.

              Stephen Esses, Alan B. Sachs, V Dreyzin (1993)
              A limited survey analysis of 617 surgical cases in which pedicle screw implants were used was undertaken to ascertain the incidence and variety of associated complications. The different implant systems used included variable spinal plating (n = 249), Edwards (n = 143), and AO fixateur interne (n = 101). The most common intraoperative problem was unrecognized screw misplacement (5.2%). Fracturing of the pedicle during screw insertion and iatrogenic cerebrospinal fluid leak occurred in 4.2% of cases. The postoperative deep infection rate was 4.2%. Transient neuropraxia occurred in 2.4% of cases, and permanent nerve root injury occurred in 2.3% of cases. Previously unreported injury to nerve roots occurred late in the postoperative course in three cases. Screw breakage occurred in 2.9% of cases. All other complications had an incidence of less than 2%. The authors conclude that pedicle screw placement may be associated with significant intraoperative and postoperative complications. This information is of value to surgeons using pedicle implant systems as well as to their patients. Repeat surgery is associated with greater numbers of complications.
              Article 0 comments Cited 112 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Tzu-Hsiang Lin: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Hsin-Tai Hu: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Hsueh-Chun Wang: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Meng-Chian Wu: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Shu-Wei Wu: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Ming-Long Yeh:
                ORCID: http://orcid.org/0000-0001-6942-060X
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                María Angeles Pérez: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 17 November 2017
                Publication date Collection: 2017
                Volume: 12
                Issue: 11
                Electronic Location Identifier: e0188364
                Affiliations
                [1 ] Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
                [2 ] Department of Technology Development, Hung Chun Bio-Science Company, Kaohsiung Science Park, Luzhu, Kaohsiung, Taiwan
                [3 ] Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
                Universidad de Zaragoza, SPAIN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ These authors also contributed equally to this work.

                Author information
                http://orcid.org/0000-0001-6942-060X
                Article
                Publisher ID: PONE-D-16-49034
                DOI: 10.1371/journal.pone.0188364
                PMC ID: 5693293
                PubMed ID: 29149204
                SO-VID: 77cc9c76-64a9-4414-b523-9dacd923056f
                Copyright © © 2017 Lin et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 12 December 2016
                Date accepted : 24 October 2017
                Page count
                Figures: 13, Tables: 1, Pages: 21
                Funding
                Funded by: National Cheng Kung University Research and Development Foundation
                Award ID: 103S023
                Award Recipient :
                ORCID: http://orcid.org/0000-0001-6942-060X
                Funded by: National Cheng Kung University Research and Development Foundation
                Award ID: 103S023
                Award Recipient :
                Funded by: National Cheng Kung University Research and Development Foundation
                Award ID: 103S023
                Award Recipient :
                Funded by: National Cheng Kung University Research and Development Foundation
                Award ID: 103S023
                Award Recipient :
                This work was supported by the Industrial Technology Develop Program (TDP) of the Ministry of Economic Affairs, R.O.C. Grant number is 102-EC-17-A-19-I1-0092. The URL is https://www.moea.gov.tw/MNS/doit/content/Content.aspx?menu_id=13394. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Tibia
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Tibia
                Subject: Biology and Life Sciences
                Subject: Developmental Biology
                Subject: Organism Development
                Subject: Organogenesis
                Subject: Bone Development
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Histology
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Histology
                Subject: Physical Sciences
                Subject: Physics
                Subject: Classical Mechanics
                Subject: Motion
                Subject: Torque
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Spine
                Subject: Vertebrae
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Spine
                Subject: Vertebrae
                Subject: Physical Sciences
                Subject: Chemistry
                Subject: Chemical Elements
                Subject: Titanium
                Subject: Biology and Life Sciences
                Subject: Cell Biology
                Subject: Cellular Types
                Subject: Animal Cells
                Subject: Connective Tissue Cells
                Subject: Osteoblasts
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Biological Tissue
                Subject: Connective Tissue
                Subject: Connective Tissue Cells
                Subject: Osteoblasts
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Biological Tissue
                Subject: Connective Tissue
                Subject: Connective Tissue Cells
                Subject: Osteoblasts
                Subject: Engineering and Technology
                Subject: Manufacturing Processes
                Subject: Surface Treatments
                Custom metadata
                Data Availability All relevant data are within the paper and its Supporting Information files.

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