@phdthesis{Meininger2022,
  author    = {Meininger, Markus},
  title     = {Calcium hydroxide as antibacterial implant coating},
  doi       = {10.25972/OPUS-26112},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-261122},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2022},
  abstract  = {In modern medicine hip and knee joint replacement are common surgical procedures. However, about 11 \% of hip implants and about 7 \% of knee implants need re-operations. The comparison of implant registers revealed two major indications for re-operations: aseptic loosening and implant infections, that both severely impact the patients' health and are an economic burden for the health care system. To address these problems, a calcium hydroxide coating on titanium was investigated in this thesis. Calcium hydroxide is a well-known antibacterial agent and used with success in dentistry. The coatings were applied with electrochemically assisted deposition, a versatile tool that combines easiness of process with the ability to coat complex geometries homogeneously. The pH-gradient during coating was investigated and showed the surface confinement of the coating process. Surface pre-treatment altered the surface morphology and chemistry of the titanium substrates and was shown to affect the morphology of the calcium hydroxide coatings. The influence of the coating parameters stirring speed and current pulsing were examined in various configurations and combinations and could also affect the surface morphology. A change in surface morphology results in a changed adhesion and behavior of cells and bacteria. Thus, the parameters surface pre-treatment, stirring speed and current pulsing presented a toolset for tailoring cellular response and antibacterial properties. Microbiological tests with S. aureus and S. epidermidis were performed to test the time-dependent antibacterial activity of the calcium hydroxide coatings. A reduction of both strains could be achieved for 13 h, which makes calcium hydroxide a promising antibacterial coating. To give insight into biofilm growth, a protocol for biofilm staining was investigated on titanium disks with S. aureus and S. epidermidis. Biofilm growth could be detected after 5 days of bacterial incubation, which was much earlier than the 3 weeks that are currently assumed in medical treatment. Thus, it should be considered to treat infections as if a biofilm were present from day 5 on. The ephemeral antibacterial properties of calcium hydroxide were further enhanced and prolonged with the addition of silver and copper ions. Both ionic modifications significantly enhanced the bactericidal potential. The copper modification showed higher antibacterial effects than the silver modification and had a higher cytocompatibility which was comparable to the pure calcium hydroxide coating. Thus, copper ions are an auspicious option to enhance the antibacterial properties. Calcium hydroxide coatings presented in this thesis have promising antibacterial properties and can easily be applied to complex geometries, thus they are a step in fighting aseptic loosening and implant infections.},
  subject      = {Calciumhydroxid},
  language  = {en}
}
@article{WolfBrandstetterBeutnerHessetal.2020,
  author    = {Wolf-Brandstetter, C and Beutner, R and Hess, R and Bierbaum, S and Wagner, K and Scharnweber, D and Gbureck, U and Moseke, C},
  title     = {Multifunctional calcium phosphate based coatings on titanium implants with integrated trace elements},
  series = {Biomedical Materials},
  volume    = {15},
  journal   = {Biomedical Materials},
  number    = {2},
  doi       = {10.1088/1748-605X/ab5d7b},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-254085},
  year      = {2020},
  abstract  = {For decades, the main focus of titanium implants developed to restore bone functionality was on improved osseointegration. Additional antimicrobial properties have now become desirable, due to the risk that rising antibiotic resistance poses for implant-associated infections. To this end, the trace elements of copper and zinc were integrated into calcium phosphate based coatings by electrochemically assisted deposition. In addition to their antimicrobial activity, zinc is reported to attract bone progenitor cells through chemotaxis and thus increase osteogenic differentiation, and copper to stimulate angiogenesis. Quantities of up to 68.9 ± 0.1 μg cm\(^{-2}\) of copper and 56.6 ± 0.4 μg cm\(^{-2}\) of zinc were deposited; co-deposition of both ions did not influence the amount of zinc but slightly increased the amount of copper in the coatings. The release of deposited copper and zinc species was negligible in serum-free simulated body fluid. In protein-containing solutions, a burst release of up to 10 μg ml\(^{-1}\) was observed for copper, while zinc was released continuously for up to 14 days. The presence of zinc was beneficial for adhesion and growth of human mesenchymal stromal cells in a concentration-dependent manner, but cytotoxic effects were already visible for coatings with an intermediate copper content. However, co-deposited zinc could somewhat alleviate the adverse effects of copper. Antimicrobial tests with E. coli revealed a decrease in adherent bacteria on brushite without copper or zinc of 60\%, but if the coating contained both ions there was almost no bacterial adhesion after 12 h. Coatings with high zinc content and intermediate copper content had the overall best multifunctional properties.},
  language  = {en}
}