Effect of Nanofeatured Topography on Ceria-Stabilized Zirconia/Alumina Nanocomposite on Osteogenesis and Osseointegration

Purpose: The objective of this study was to evaluate the osteogenic and osseointegration capability of the Ce-tetragonal zirconia polycrystal (TZP)-based nanostructured zirconia/alumina composite (Ce-TZP/Al2O3) that was treated with hydrofluoric acid (HF). Materials and Methods: Osteogenic MC3T3-E1 cells were cultured on acid-etched titanium (AETi) disks and Ce-TZP/Al2O3 disks without HF treatment (Zr[0%]), with 4% HF treatment (Zr[4%]), or with 55% HF treatment (Zr[55%]) for 24 hours, and biologic responses were compared among four conditions in vitro. Miniature implants of AETi and Zr(55%) were surgically placed in the femora of rats. Osseointegration was evaluated by a biomechanical push-in test after 2 and 4 weeks of healing. Results: The surface of Zr(55%) rendered nanofeatured topography with a greater surface area and roughness, and extensive geographical undercut as ceria-zirconia crystal disappeared from the superficial layer and was similar to the surface morphology of biomineralized matrices. Culture studies showed that the attachment, proliferation, spread, and functional phenotypes of osteogenic cells, such as alkaline phosphatase activity and bone-related gene expression, were remarkably increased on the Zr(55%) surface. The strength of osseointegration measured using the biomechanical push-in test in a rat model was stronger for Zr(55%) implants than for AETi implants by 1.6 fold. Conclusion: The nanostructured Ce-TZP/ Al2O3 surface substantially enhanced the osteogenic response in vitro and the osseointegration capability in vivo, which suggest its potential clinical application as a novel implant material. Keywords: bone-implant integration, Ce-TZP/Al2O3, surface topography, zirconia implant