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Titanium and Titanium Based Materials in Biomedical Applications

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A special issue of Materials (ISSN 1996-1944). This special issue belongs to the section "Biomaterials".

Deadline for manuscript submissions: closed (20 November 2021) | Viewed by 39918

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Prof. Dr. Jae Sung Kwon

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Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea
Interests: biomaterials; dental materials; biocompatibility; standard; medical devices; plasma
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Special Issue Information

Dear colleagues,

Titanium and titanium alloys have been used in the field of biomedical application for a long period of time. It is one of the most commonly used metal-based biomaterials in many parts of medical applications, utilizing the characteristics of biocompatible and bioactive titanium surface. Today, dental implants and most orthopedic implants are made of titanium for this reason, while other favorable characteristics such as hardness and high level of mechanical strength will be other contributing factors for the choice of selections. Other uses of titanium include the use of titanium-based alloy, where titanium–aluminum–vanadium alloy (Ti–6Al–4V) has been widely used in many biomedical applications, allowing somewhat improved chemical and physical properties, while nickel–titanium alloy has been commonly used as shape–memory metal in orthodontics. Moreover, the recent progress in additive manufacturing, so called 3D-printing technology, has widened the use of titanium and titanium alloys in the field of biomedical application, where processes such as selective laser sintering using titanium or titanium alloy powders allowed the formation of patient-specific devices. Comprehensive knowledge of the biological, chemical, physical, and mechanical proprieties of titanium and titanium alloys, in relation to biomedical applications, requires a multidisciplinary approach. Hence, the aim of this Special Issue would be a participation of worldwide researchers from various backgrounds and encourage interactions to provide insights on titanium and titanium-based materials in biomedical applications. We aim to publish innovative results on several aspects of the titanium and titanium based materials used in the biomedical field. For this purpose, original research articles, review articles, and significant preliminary communications are invited, with particular interest in articles describing current research trends and future perspectives in titanium and titanium-based materials in biomedical applications.

Potential topics include but are not limited to:

Titanium and titanium-based biomaterials
Titanium surface modification for biomedical application
Titanium and titanium-based materials for orthopedic application
Titanium and titanium-based materials for dental implant
Titanium and titanium-based materials for orthodontic application
Titanium-based nanomaterials

Prof. Dr. Jae-Sung Kwon
Guest Editor

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Published Papers (13 papers)

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Research

14 pages, 8191 KiB

Open AccessFeature PaperArticle

In Vitro Characterization of In Situ Alloyed Ti6Al4V(ELI)-3 at.% Cu Obtained by Laser Powder Bed Fusion

by Anna Martín Vilardell, Pavel Krakhmalev, Ina Yadroitsava, Igor Yadroitsev and Natalia Garcia-Giralt

Materials 2021, 14(23), 7260; https://doi.org/10.3390/ma14237260 - 27 Nov 2021

Cited by 4 | Viewed by 1827

Abstract

The intensive cytotoxicity of pure copper is effectively kills bacteria, but it can compromise cellular behavior, so a rational balance must be found for Cu-loaded implants. In the present study, the individual and combined effect of surface composition and roughness on osteoblast cell behavior of in situ alloyed Ti6Al4V(ELI)-3 at.% Cu obtained by laser powder bed fusion was studied. Surface composition was studied using scanning electron microscopy, energy dispersive spectroscopy, and X-ray diffraction. Surface roughness measurements were carried out using confocal microscopy. In vitro osteoblast performance was evaluated by means of cell morphology observation of cell viability, proliferation, and mineralization. In vitro studies were performed at 1, 7, and 14 days of cell culture, except for cell mineralization at 28 days, on grounded and as-built (rough) samples with and without 3 at.% Cu. The addition of 3 at.% Cu did not show cell cytotoxicity but inhibited cell proliferation. Cell mineralization tends to be higher for samples with 3 at.% Cu content. Surface roughness inhibited cell proliferation too, but showed enhanced cell mineralization capacity and therefore, higher osteoblast performance, especially when as-built samples contained 3 at.% Cu. Cell proliferation was only observed on ground samples without Cu but showed the lowest cell mineralization. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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22 pages, 4613 KiB

Open AccessArticle

Mechanical Properties and Residual Stress Measurements of Grade IV Titanium and Ti-6Al-4V and Ti-13Nb-13Zr Titanium Alloys after Laser Treatment

by Magdalena Jażdżewska, Dominika Beata Kwidzińska, Wiktor Seyda, Dariusz Fydrych and Andrzej Zieliński

Materials 2021, 14(21), 6316; https://doi.org/10.3390/ma14216316 - 22 Oct 2021

Cited by 15 | Viewed by 3529

Abstract

Nowadays, surface engineering focuses on research into materials for medical applications. Titanium and its alloys are prominent, especially Ti-6Al-4V and Ti-13Nb-13Zr. Samples made of pure grade IV titanium and the titanium alloys Ti-6Al-4V and Ti-13Nb-13Zr were modified via laser treatment with laser beam frequency f = 25 Hz and laser beam power P = 1000 W during a laser pulse with duration t = 1 ms. Subsequently, to analyze the properties of the obtained surface layers, the following tests were performed: scanning electron microscopy, chemical and phase composition analysis, wetting angle tests and roughness tests. The assessment of the impact of the laser modification on the internal stresses of the investigated materials was carried out by comparing the values of the stresses of the laser-modified samples to those of the reference samples. The obtained results showed increased values of tensile stresses after laser modification: the highest value was found for the Ti-6Al-4V alloy at 6.7434 GPa and the lowest for pure grade IV titanium at 3.742 GPa. After laser and heat treatment, a reduction in the stress was observed, together with a significant increase in the hardness of the tested materials, with the highest value for Ti-6Al-4V alloy at 27.723 GPa. This can provide better abrasion resistance and lower long-term toxicity, both of which are desirable when using Ti-6Al-4V and Ti-13Nb-13Zr alloys for implant materials. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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17 pages, 3296 KiB

Open AccessArticle

The Open Cell Form of 3D-Printed Titanium Improves Osteconductive Properties and Adhesion Behavior of Dental Pulp Stem Cells

by Marialucia Gallorini, Susi Zara, Alessia Ricci, Francesco Guido Mangano, Amelia Cataldi and Carlo Mangano

Materials 2021, 14(18), 5308; https://doi.org/10.3390/ma14185308 - 15 Sep 2021

Cited by 11 | Viewed by 2763

Abstract

Titanium specimens have been proven to be safe and effective biomaterials in terms of their osseo-integration. To improve the bioactivity and develop customized implants titanium, the surface can be modified with selective laser melting (SLM). Moreover, the design of macro-porous structures has become popular for reaching a durable bone fixation. 3D-printed titanium (Titanium A, B, and C), were cleaned using an organic acid treatment or with electrochemical polishing, and were characterized in terms of their surface morphology using scanning electron microscopy. Next, Dental Pulp Stem Cells (DPSCs) were cultured on titanium in order to analyze their biocompatibility, cell adhesion, and osteoconductive properties. All tested specimens were biocompatible, due to the time-dependent increase of DPSC proliferation paralleled by the decrease of LDH released. Furthermore, data highlighted that the open cell form with interconnected pores of titanium A, resembling the inner structure of the native bone, allows cells to better adhere inside the specimen, being proteins related to cell adherence highly expressed. Likewise, titanium A displays more suitable osteoconductive properties, being the profile of osteogenic markers improved compared to titanium B and C. The present work has demonstrated that the inner design and post-production treatments on titanium surfaces have a dynamic influence on DPSC behavior toward adhesion and osteogenic commitment. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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19 pages, 4980 KiB

Open AccessArticle

Improvement of Osseointegration by Ultraviolet and/or Simvastatin Treatment on Titanium Implants with or without Bone Graft Materials

by Ji Hoon Jun, Kyung Chul Oh, Kyu-Hyung Park, Narae Jung, Jiayi Li and Hong Seok Moon

Materials 2021, 14(13), 3707; https://doi.org/10.3390/ma14133707 - 2 Jul 2021

Cited by 9 | Viewed by 2430 | Correction

Abstract

We evaluated and compared ultraviolet (UV) treatment and simvastatin (SIM) immersion effects on the osseointegration of sandblasted, large-grit, acid-etched (SLA) titanium dental implants at two different time points in rabbit tibias, with or without xenogenic bone graft materials. The surface alteration on simvastatin treatment titanium discs was analyzed using an infrared spectrometer. Implants were categorized into four groups according to the surface treatment type. Twelve rabbits received two implants per tibia. A tibial defect model was created using a trephine bur, with implants in contact with the bone surface and bovine bone graft materials for gap filling. The rabbits were sacrificed after 2 or 4 weeks. UV treatment or SIM immersion increased the bone-to-implant contact (BIC) on nongrafted sides, and both increased the BIC and bone area (BA) on grafted sides. The application of both treatments did not result in higher BIC or BA than a single treatment. At two different time points, BIC in the nongrafted sides did not differ significantly among the UV and/or SIM treated groups, whereas BA differed significantly. UV or SIM treatment of SLA titanium implants accelerates osseointegration in tibias with or without xenogenic bone graft materials. The combination of both treatments did not show synergy. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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10 pages, 1564 KiB

Open AccessArticle

Osseointegration of Plasma Jet Treated Titanium Implant Surface in an Animal Model

by Min-Ho Jang, Young-Bum Park, Jae-Sung Kwon, Yeun-Ju Kim and Jae-Hoon Lee

Materials 2021, 14(8), 1942; https://doi.org/10.3390/ma14081942 - 13 Apr 2021

Cited by 3 | Viewed by 1854

Abstract

Osseointegration of titanium implant is important for the success of both dental and medical implants. Previous studies have attempted to improve osseointegration by considering the use of plasma jet technology, where information with animal models and parameters related to osseointegration is still lacking. Therefore, this study investigated the effects of non-thermal atmospheric pressure plasma jet (NTAPPJ) treatment on titanium implants in terms of osseointegration in mongrel dogs. A total of 41 implants; 21 NTAPPJ treated and 20 control, were placed in the maxilla and mandible of six mongrel dogs for either 4 or 8 weeks. The bone volume (BV) and bone-to-implant contact (BIC) ratio were determined by region of interest (ROI). Statistical analysis was performed with the Wilcoxon rank-sum test. The NTAPPJ group at 4 weeks showed higher numbers in both BV and BIC (p < 0.05) compared to the control group. However, at 8 weeks there were less significant differences between the control or experimental group as the control group had caught up with the experimental group. Hence, NTAPPJ may be an effective treatment for the initial healing period which is critical to ensure reliable long-term predictability. The BV and BIC have been clinically proven to accelerate in the initial stages with the use of NTAPPJ to aid in the healing and initial stability of implants. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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19 pages, 22120 KiB

Open AccessArticle

In Vivo Study for Clinical Application of Dental Stem Cell Therapy Incorporated with Dental Titanium Implants

by Hyunmin Choi, Kyu-Hyung Park, Narae Jung, June-Sung Shim, Hong-Seok Moon, Hyung-Jun Kim, Seung-Han Oh, Yoon Young Kim, Seung-Yup Ku and Young-Bum Park

Materials 2021, 14(2), 381; https://doi.org/10.3390/ma14020381 - 14 Jan 2021

Cited by 3 | Viewed by 2610

Abstract

The aim of this study was to investigate the behavior of dental-derived human mesenchymal stem cells (d-hMSCs) in response to differently surface-treated implants and to evaluate the effect of d-hMSCs on local osteogenesis around an implant in vivo. d-hMSCs derived from alveolar bone were established and cultured on machined, sandblasted and acid-etched (SLA)-treated titanium discs with and without osteogenic induction medium. Their morphological and osteogenic potential was assessed by scanning electron microscopy (SEM) and real-time polymerase chain reaction (RT-PCR) via mixing of 5 × 10⁶ of d-hMSCs with 1 mL of Metrigel and 20 μL of gel-cell mixture, which was dispensed into the defect followed by the placement of customized mini-implants (machined, SLA-treated implants) in New Zealand white rabbits. Following healing periods of 2 weeks and 12 weeks, the obtained samples in each group were analyzed radiographically, histomorphometrically and immunohistochemically. The quantitative change in osteogenic differentiation of d-hMSCs was identified according to the type of surface treatment. Radiographic analysis revealed that an increase in new bone formation was statistically significant in the d-hMSCs group. Histomorphometric analysis was in accordance with radiographic analysis, showing the significantly increased new bone formation in the d-hMSCs group regardless of time of sacrifice. Human nuclei A was identified near the area where d-hMSCs were implanted but the level of expression was found to be decreased as time passed. Within the limitations of the present study, in this animal model, the transplantation of d-hMSCs enhanced the new bone formation around an implant and the survival and function of the stem cells was experimentally proven up to 12 weeks post-sacrifice. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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10 pages, 1172 KiB

Open AccessArticle

Efficacy of a Nickel-Titanium Ultrasonic Instrument for Biofilm Removal in a Simulated Complex Root Canal

by Young-Ryul Oh, Hye-Min Ku, Dohyun Kim, Su-Jung Shin and Il-Young Jung

Materials 2020, 13(21), 4914; https://doi.org/10.3390/ma13214914 - 31 Oct 2020

Cited by 6 | Viewed by 1962

Abstract

This study evaluated the effectiveness of NiTi ultrasonic tips for Enterococcus faecalis (E. faecalis) biofilm removal in simulated complex root canals. Sixty root canal models consisting of a 30-degree curved main canal and two lateral canals were constructed from polydimethylsiloxane and incubated with E. faecalis. Irrigants in root canals were activated using a manual syringe (SI), a stainless steel (SS) instrument, a nickel-titanium (Ni-Ti) ultrasonic instrument, or a sonic instrument (EA). Instruments of SI, SS, and NiTi-9 groups were placed 9 mm from the apex, whereas those in NiTi-2 and EA groups were placed 2 mm from the apex. The efficacy of each method was determined as the ratio of fluorescence concentration before and after activation. In the apical curved canal, the highest efficacy was found in the NiTi-2 group (99.40%), followed by SI (84.25%), EA (80.38%), SS (76.93%), and NiTi-9 (67.29%) groups. In lateral canals 1 and 2, the efficacy was the highest in the NiTi-2 group and the lowest in the SI group. The NiTi ultrasonic instrument could effectively remove biofilms in the curved canal and lateral canals. This instrument should be introduced close to the working length. An up-and-down motion of the activation instrument is recommended. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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12 pages, 2915 KiB

Open AccessArticle

Primary Stability of Orthodontic Titanium Miniscrews due to Cortical Bone Density and Re-Insertion

by Gi-Tae Kim, Jie Jin, Utkarsh Mangal, Kee-Joon Lee, Kwang-Mahn Kim, Sung-Hwan Choi and Jae-Sung Kwon

Materials 2020, 13(19), 4433; https://doi.org/10.3390/ma13194433 - 5 Oct 2020

Cited by 8 | Viewed by 2684

Abstract

The increasing demand for orthodontic treatment over recent years has led to a growing need for the retrieval and reuse of titanium-based miniscrews to reduce the cost of treatment, especially in patients with early treatment failure due to insufficient primary stability. This in vitro study aimed to evaluate differences in the primary stability between initially inserted and re-inserted miniscrews within different cortical bone densities. Artificial bone was used to simulate cortical bone of different densities, namely 20, 30, 40, and 50 pound per cubic foot (pcf), where primary stability was evaluated based on maximum insertion torque (MIT), maximum removal torque (MRT), horizontal resistance, and micromotion. Scanning electron microscopy was used to evaluate morphological changes in the retrieved miniscrews. The MIT, MRT, horizontal resistance, and micromotion was better in samples with higher cortical bone density, thereby indicating better primary stability (P < 0.05). Furthermore, a significant reduction of MIT, MRT, and horizontal resistance was observed during re-insertion compared with the initial insertion, especially in the higher density cortical bone groups. However, there was no significant change in micromotion. While higher cortical bone density led to better primary stability, it also caused more abrasion to the miniscrews, thereby decreasing the primary stability during re-insertion. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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15 pages, 5151 KiB

Open AccessArticle

Visible Light-Enhanced Antibacterial and Osteogenic Functionality of Au and Pt Nanoparticles Deposited on TiO₂ Nanotubes

by Kyoung-Suk Moon, Eun-Joo Choi, Ji-Myung Bae, Young-Bum Park and Seunghan Oh

Materials 2020, 13(17), 3721; https://doi.org/10.3390/ma13173721 - 23 Aug 2020

Cited by 19 | Viewed by 3214

Abstract

This study aimed at evaluating the visible light mediated antimicrobial and osteogenic applications of noble metal, such as gold (Au) and platinum (Pt) coated titania (TiO₂) nanotubes (NTs). In this study, the Au and Pt nanoparticles (NPs) were deposited on anodized 100 nm TiO₂ NTs by ion plasma sputtering. The Au and Pt NPs were mainly deposited on the top surface layer of TiO₂ NTs and showed light absorbance peaks around the 470 and 600 nm visible light region used in this study, as seen from the surface characterization. From the results of antibacterial activity test, Au and Pt NPs that were deposited on TiO₂ NTs showed excellent antibacterial activity under 470 nm visible light irradiation due to the plasmonic photocatalysis based on the localized surface plasmon resonance effect of the Au and Pt NPs. In addition, alkaline phosphate activity test and quantitative real-time PCR assay of osteogenic related genes resulted that these NPs promoted the osteogenic functionality of human mesenchymal stem cells (hMSCs) under 600 nm visible light irradiation, because of the synergic effect of the photothermal scattering of noble metal nanoparticles and visible light low-level laser therapy (LLLT). Therefore, the combination of noble metal coated TiO₂ NTs and visible light irradiation would be expected to perform permanent antibacterial activity without the need of an antibacterial agent besides promoting osteogenic functionality. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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16 pages, 4718 KiB

Open AccessArticle

Laser Ablated Periodic Nanostructures on Titanium and Steel Implants Influence Adhesion and Osteogenic Differentiation of Mesenchymal Stem Cells

by Kai Oliver Böker, Frederick Kleinwort, Jan-Hendrick Klein-Wiele, Peter Simon, Katharina Jäckle, Shahed Taheri, Wolfgang Lehmann and Arndt F. Schilling

Materials 2020, 13(16), 3526; https://doi.org/10.3390/ma13163526 - 10 Aug 2020

Cited by 14 | Viewed by 2749

Abstract

Metal implants used in trauma surgeries are sometimes difficult to remove after the completion of the healing process due to the strong integration with the bone tissue. Periodic surface micro- and nanostructures can directly influence cell adhesion and differentiation on metallic implant materials. However, the fabrication of such structures with classical lithographic methods is too slow and cost-intensive to be of practical relevance. Therefore, we used laser beam interference ablation structuring to systematically generate periodic nanostructures on titanium and steel plates. The newly developed laser process uses a special grating interferometer in combination with an industrial laser scanner and ultrashort pulse laser source, allowing for fast, precise, and cost-effective modification of metal surfaces in a single step process. A total of 30 different periodic topologies reaching from linear over crossed to complex crossed nanostructures with varying depths were generated on steel and titanium plates and tested in bone cell culture. Reduced cell adhesion was found for four different structure types, while cell morphology was influenced by two different structures. Furthermore, we observed impaired osteogenic differentiation for three structures, indicating reduced bone formation around the implant. This efficient way of surface structuring in combination with new insights about its influence on bone cells could lead to newly designed implant surfaces for trauma surgeries with reduced adhesion, resulting in faster removal times, reduced operation times, and reduced complication rates. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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12 pages, 3470 KiB

Open AccessArticle

Influence of Orthodontic Anchor Screw Anchorage Method on the Stability of Artificial Bone: An In Vitro Study

by Seen-Young Kang, Ji-Min Yu, Hyoung-Sik Kim, Jun-Seok Lee, Chan-Mi Yeon, Ki-Sook Park, Sung-Hwan Choi and Seung-Youl Lee

Materials 2020, 13(14), 3205; https://doi.org/10.3390/ma13143205 - 18 Jul 2020

Cited by 3 | Viewed by 2360

Abstract

This study aims to compare the torque values for various lengths of the titanium-based orthodontic anchor screw (OAS), different anchorage methods and varying artificial bone densities after predrilling. Furthermore, the effects of these parameters on bone stability are evaluated. A total of 144 OASs were prepared with a diameter of 1.6 mm and heights of 6, 8 and 10 mm. Artificial bones were selected according to their density, corresponding to Grades 50, 40 and 30. Torque values for the automatic device and manual anchorage methods exhibited a statistically significant difference for the same-sized OAS, according to the bone density of the artificial bones (p < 0.05). However, when insertion torque was at the maximum rotations, there was no significant difference in the torque values for the Grade 30 artificial bone (p > 0.05). When the torque values of both anchorage methods were statistically compared with the mean difference for each group, the results of the manual anchorage method were significantly higher than those of the automatic device anchorage method (p < 0.05). A statistically significant difference was observed in the bone stability resulting from different OAS anchorage methods and artificial bone lengths. These findings suggest that the automatic anchorage method should be used when fixing the OAS. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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16 pages, 8430 KiB

Open AccessArticle

A 3D-Printed Ultra-Low Young’s Modulus β-Ti Alloy for Biomedical Applications

by Massimo Pellizzari, Alireza Jam, Matilde Tschon, Milena Fini, Carlo Lora and Matteo Benedetti

Materials 2020, 13(12), 2792; https://doi.org/10.3390/ma13122792 - 20 Jun 2020

Cited by 34 | Viewed by 6147

Abstract

The metastable β-Ti21S alloy is evaluated as a potential candidate for biomedical parts. Near fully dense (99.75 ± 0.02%) samples are additively manufactured (that is, 3D-printed) by laser powder-bed fusion (L-PBF). In the as-built condition, the material consists of metastable β-phase only, with columnar grains oriented along the building direction. The material exhibits an extremely low Young’s modulus (52 ± 0.3 GPa), which was never reported for this type of alloy. The combination of good mechanical strength (σ_y0.2 = 709 ± 6 MPa, ultimate tensile strength (UTS) = 831 ± 3 MPa) and high total elongation during tensile test (21% ± 1.2%) in the as-built state, that is, without any heat treatment, is close to that of the wrought alloy and comparable to that of heat treated Ti grade 5. The good biocompatibility attested by cytotoxicity tests confirms its great suitability for biomedical applications. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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12 pages, 1433 KiB

Open AccessArticle

In Vitro Effects of Cyclic Dislodgement on Retentive Properties of Various Titanium-Based Dental Implant Overdentures Attachment System

by Tae-Yun Kang, Jee-Hwan Kim, Kwang-Mahn Kim and Jae-Sung Kwon

Materials 2019, 12(22), 3770; https://doi.org/10.3390/ma12223770 - 16 Nov 2019

Cited by 7 | Viewed by 3702

Abstract

The purpose of this study was to evaluate the change in the retentive forces of four different titanium-based implant attachment systems during the simulation of insert–removal cycles in an artificial oral environment. Five types of titanium-based dental implant attachment systems (Locator, Kerator, O-ring, EZ-Lock, and Magnetic) were studied (n = 10). The specimens underwent insert–removal cycles in artificial saliva, and the retentive force was measured following 0, 750, 1500, and 2250 cycles. Significant retention loss was observed in all attachment systems, except the magnetic attachments, upon completion of 2250 insertion and removal cycles, compared to the initial retentive force (p < 0.05). A comparison of the initial retentive forces revealed the highest value for Locator, followed by the Kerator, O-ring, EZ-Lock, and Magnetic attachments. Furthermore, Kerator demonstrated the highest retentive loss, followed by Locator, O-ring, EZ-Lock, and Magnetic attachments after 2250 cycles (p < 0.05). In addition, the Locator and Kerator systems revealed significant decrease in retentive forces at all measurement points (p < 0.05). The retention force according to the insert–removal cycles were significantly different according to the types of dental implant attachment systems. Full article

(This article belongs to the Special Issue Titanium and Titanium Based Materials in Biomedical Applications)

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