Hydrophilic titanium surface modulates early stages of osseointegration in osteoporosis

Abstract Objective Using a mouse osteoporotic model, this study aimed to determine the influence of hydrophilic titanium surfaces on gene expression and bone formation during the osseointegration process. Background Based on the previous evidence, it is plausible to assume that osteoporotic bone has a different potential of bone healing. Therefore, implant surface modification study that aims at enhancing bone formation to further improve short‐ and long‐term clinical outcomes in osteoporosis is necessary. Material and Methods Fifty female, 3‐month‐old mice were included in this study. Osteoporosis was induced by ovariectomy (OVX, test group) in 25 mice. The further 25 mice had ovaries exposed but not removed (SHAM, control group). Seven weeks following the ovariectomy procedures, one customized implant (0.7 × 8 mm) of each surface was placed in each femur for both groups. Implants had either a hydrophobic surface (SAE) or a hydrophilic treatment surface (SAE‐HD). Calcium (Ca) and phosphorus (P) content was measured by energy‐dispersive X‐ray spectroscopy (EDS) after 7 days. The femurs were analyzed for bone‐to‐implant contact (BIC) and bone volume fraction (BV) by nano‐computed tomography (nano‐CT) after 14 and 28 days. Same specimens were further submitted to histological analysis. Additionally, after 3 and 7 days, implants were removed and cells were collected around the implant to access gene expression profile of key osteogenic ( Runx2 , Alp , Sp7 , Bsp , Sost , Ocn ) and inflammatory genes ( IL‐1β , IL‐10 , Tnf‐α, and Nos2 ) by qRT‐PCR assay. Statistical analysis was performed by ANOVA and paired t test with significance at P < .05. Results The amount of Ca and P deposited on the surface due to the mineralization process was higher for SAE‐HD compared to SAE on the intra‐group analysis. Nano‐CT and histology revealed more BV and BIC for SAE‐HD in SHAM and OVX groups compared to SAE. Analysis in OVX group showed that most genes (ie, ALP , Runx2 ) involved in the bone morphogenetic protein (BMP) signaling were significantly activated in the hydrophilic treatment. Conclusion Both surfaces were able to modulate bone responses toward osteoblast differentiation. SAE‐HD presented a faster response in terms of bone formation and osteogenic gene expression compared to SAE. Hydrophilic surface in situations of osteoporosis seems to provide additional benefits in the early stages of osseointegration.