The biological cause of peri-implantitis formation is that a variety of bacteria attach to the implant surface to form a bacterial biofilm, leading to peri-implant infection and developing inflammation. PTA has been shown to have highly effective antimicrobial properties and can reduce the inflammatory response. Good osseointegration is fundamental to the success of dental implants and, during the surface modification of the implants, cannot damage the biological activity of the material itself. In this study, we investigated the photothermal properties, photothermal antibacterial capability, as well as the biological activity of nano-TiO2 coatings on the surface of titanium alloys.
A series of experiments on material characterization indicated the formation of an oxide layer on the sample surface and the nano-TiO2 coating was successfully prepared on the sample surface using the hydrothermal method. The water contact angle in the Ti6Al4V@TiO2 group was less than the Ti6Al4V group, indicating that the formation of nano-TiO2 improved the hydrophilic nature of the material, potentially related to the larger surface area of the nanostructure. Most current views suggest that the surface of highly hydrophilic materials can promote the adhesion of fibronectin thus promoting the adhesion of osteoblasts [20].
To assess the in vitro photothermal conversion ability of the nano-TiO2 coating, we irradiated the samples in PBS with 808 nm NIR light and measured their temperature every minute. The critical temperature of the implant during surgery was 47°C [21]; therefore, we adjusted the irradiation power of the NIR light to ensure that the stable temperature did not exceed 47°C and determined that the optimal NIR optical power was 0.8 W/cm2. The temperature of the sample increased with illumination time, eventually reaching a plateau. The final temperature of the Ti6Al4V group was stable at approximately 40.4°C, and the final temperature of the Ti6Al4V@TiO2 group was stable at approximately 46.9°C. The nano-TiO2 coating had a good photothermal conversion effect because of its inherent optical properties and its nanostructure [22]. At the same time, the photothermal stability experiment shows that nano TiO2 coating has excellent photothermal stability, can withstand repeated illumination and play an antibacterial effect, which is particularly important for clinical use.
Due to the complex microbial environment in the mouth, preventing infection after implantation is particularly important. In this study, we selected representative gram-positive and gram-negative bacteria: S. aureus and E. coli. Using Ti6Al4V as a control, the antimicrobial ability of each group was assessed using viable plate count experiments. The three groups produced significant antimicrobial effects on both bacteria; among them, the antibacterial effects of the Ti6Al4V + NIR group against S. aureus and E. coli were approximately 55.83% and 63.84%, respectively. This potentially occurred because Ti6Al4V also has partial photothermal antibacterial ability under irradiation with NIR light, as described above, and the temperature could reach 40.4°C after 15 min of irradiation. However, the resistance of bacteria to sudden increases in temperature was much weaker than that to direct heating. At this time, the bacterial cell membrane ruptured, causing changes in permeability and the degeneration of the bacterial proteins, which eventually led to the death of the bacteria [23]. The antibacterial rates of the Ti6Al4V@TiO2 group against S. aureus and E. coli were approximately 39.70% and 43.78%, respectively, which could be attributed to the inherent antimicrobial properties of the nanosurface [24]. Bhardwaj and Webster [25] reported that a nanoscale TiO2 coating could affect the adsorption of proteins by changing the surface free energy to achieve bacteriostatic effects. Jenkins et al. [26] showed that nanostructures could destroy the bacterial cell membrane by stretching and piercing the bacterial cell membrane, thus killing bacteria. The Ti6Al4V@TiO2 + NIR group had the strongest antibacterial ability, and the antibacterial rates reached 90.11% and 90.60% for S. aureus and E. coli, respectively. Thus, due to the excellent photothermal properties of the nano-TiO2 coating and its physical antibacterial properties, Ti6Al4V@TiO2 could eliminate most of the bacteria within 15 min under 0.8 W/cm2 NIR light irradiation. A comparison of S. aureus and E. coli revealed that the antibacterial effect of each group against S. aureus was weaker than that against E. aureus, probably because S. aureus is a gram-positive bacterium with thicker bacterial cell walls, whereas E. coli has a thin cell wall; thus, relative to S. aureus, E. coli is more sensitive to temperature changes and the surface of the nanostructures [27]. The results of the live/dead bacterial staining correspond to the results of the viable plate count experiment, providing further confirmation.
The CCK-method was used to assess whether Ti6Al4V@TiO2 caused damage to cells after NIR irradiation. The results suggest that after light exposure early osteoblast adhesion is partially affected, but there is quick recovery from these effects. This likely occurred because the photothermal effect of NIR light irradiation at 0.8 W/cm2 had some effect on the cell adhesion ability, but this effect could be eliminated in the short term. On the one hand, Ti6Al4V@TiO2 has smaller water contact angles, with better hydrophilic properties, and the improved hydrophilicity could promote cell adhesion to the surface of the material [28]. On the other hand, the nano-TiO2 coating changed the roughness of the material surface for more favourable cell adhesion. Studies have shown that when the surface roughness of an implant is close to that of bone tissue, the implant can strongly promote the adhesion of osteoblasts [29, 30]. At 1, 3 and 7 d, the proliferative capacity of Ti6Al4V@TiO2 surface cells was not affected by NIR illumination; instead, they were significantly better than the control cells. This was caused by the hydrophilic surface of Ti6Al4V@TiO2 and the rough surface at the nanoscale. High hydrophilicity and rough surfaces could promote the proliferation of osteoblasts [31].
The adhesive morphology of cells on the material surface is one of the important factors for the success of material implantation. The SEM results revealed that the number and spread of surface cells in the Ti6Al4V@TiO2 + NIR group were greater than those in the Ti6Al4V group; thus, the promotion of the adhesion capacity of MC3T3-E1 osteoblasts by the nano-TiO2 coating was sufficient to eliminate the photothermal effect produced by the NIR irradiation of the nano-TiO2 coating on early cell adhesion. Studies have shown that cells on nanostructured TiO2 surfaces have abundant filopodia anchored to the material surface, thereby promoting cell adhesion. The mechanism involves mainly the cell alignment of the cytoskeleton and the formation of focal adhesions [32–34].
These results of actin staining were consistent those from the cell adhesion capacity assessed by the CCK-8 assay. The nano-TiO2 coating could promote cell extension and thus adhesion; these results further indicated that the side effects of NIR light irradiation on cell behaviour were negligible. Nanostructures have been shown to promote cytoskeletal extension by promoting the expression of integrins and focal adhesion spot formation, thus promoting cell adhesion [35].