Design of dental implants at materials level: An overview

Graphene oxide/ε-poly-L-lysine self-assembled functionalized coatings improve the biocompatibility and antibacterial properties of titanium implants

The construction of an antibacterial biological coating on titanium surface plays an important role in the long-term stability of oral implant restoration. Graphene oxide (GO) has been widely studied because of its excellent antibacterial properties and osteogenic activity. However, striking a balance between its biological toxicity and antibacterial properties remains a significant challenge with GO. ε-poly-L-lysine (PLL) has broad-spectrum antibacterial activity and ultra-high safety performance. Using Layer-by-layer self-assembly technology (LBL), different layers of PLL/GO coatings and GO self-assembly coatings were assembled on the surface of titanium sheet. The materials were characterized using scanning electron microscope (SEM), Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS) and contact angle test. The antibacterial properties of Porphyromonas gingivalis (P.g.) were analyzed through SEM, coated plate experiment, and inhibition zone experiment. CCK-8 was used to determine the cytotoxicity of the material to MC3T3 cells, and zebrafish larvae and embryos were used to determine the developmental toxicity and inflammatory effects of the material. The results show that the combined assembly of 20 layers of GO and PLL exhibits good antibacterial properties and no biological toxicity, suggesting a potential application for a titanium-based implant modification scheme.

Influence of the Method of Calculating the Effective Atomic Number on the Estimate of Fluorescence Yield for Metal Alloys of Biomedical Interest

ABSTRACT

This study evaluates the influence of the method used to calculate the effective atomic number (Z eff ) on the estimate of secondary radiation yielded under kilovoltage x-ray beams by metal alloys with a wide range of biomedical applications. Two methods for calculating Z eff (referred to here as M 1 and M 2 ) are considered, and six metallic alloys are investigated: Ti-6Al-4 V, Co-Cr-Mo, Ni-Cr-Ti, Ni-Cr, Co-Cr-Mo-W, and Ag 3 Sn-Hg (amalgam). The results indicate significant differences in the estimates of fluorescence yield depending on the method used to estimate Z eff for each metallic alloy. Both the choice of the calculation method for Z eff and the energy ranges of the incident radiation are essential factors affecting the behavior of alloys in terms of fluorescence production. Our results may guide the selection of the best material for a biomedical application. The metallic alloys simulated here show equivalences and discrepancies that depend on the method used to estimate Z eff and the energy range of the incident photons. This finding allows for the creation of combinations of alloys and methods for calculating Z eff and the photon energy to maximize safety and minimize cost.

An epidemiological qualitative/quantitative SWOT-AHP analysis in order to highlight the positive or critical aspects of dental implants: A pilot study

OBJECTIVES

In recent years, dental implants are increasing in popularity due to their high success rate, demonstrated functionality, and aesthetic treatment results. Scientific research is very active in proposing improvements in the quality and survival of implants, taking into consideration various aspects. The objective of this study was to provide a holistic epidemiologic view of the state of dental implants, using a systematic approach based on a multimethod SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis and AHP (analytical hierarchical process) qualitative-quantitative analysis to identify the characteristics that can determine their success or failure.

MATERIALS AND METHODS

The study used the hybrid method of SWOT-AHP.

RESULTS

Analysis of the results showed that among strengths, the skill of the dentist was considered the most important factor, followed by the success of dental implants in the old people; among weaknesses, bruxism and chronic diseases were highlighted; for opportunities, biomechanical behavior, in terms of good mechanical strength and good tribological resistance to chemical and physical agents in the oral cavity, were considered the most important factors; finally, among threats, medical liability and biomechanical problems had equal weight.

CONCLUSIONS

This study applied a multimethod SWOT-AHP approach to bring out favorable or critical evidence on the topic of dental implants. In accordance with the result of the strategic vector identified in the Twisting zone Adjustment type section, showed that implant surgery is a widespread technique but always needs improvement to increase the likelihood of success and reduce the complications that can lead to implant failure.

Influence of Novel SrTiO3/MnO2 Hybrid Nanoparticles on Poly(methyl methacrylate) Thermal and Mechanical Behavior

While dental poly methyl methacrylate(PMMA) possesses distinctive qualities such as ease of fabrication, cost-effectiveness, and favorable physical and mechanical properties, these attributes alone are inadequate to impart the necessary impact strength and hardness. Consequently, pure PMMA is less suitable for dental applications. This research focused on the incorporation of Strontium titanate (SrTiO3-STO) and hybrid filler STO/Manganese oxide (MnO2) to improve impact resistance and hardness. The potential of STO in reinforcing PMMA is poorly investigated, while hybrid filler STO/MnO2 has not been presented yet. Differential scanning calorimetry is conducted in order to investigate the agglomeration influence on the PMMA glass transition temperature (Tg), as well as the leaching of residual monomer and volatile additives that could pose a threat to human health. It has been determined that agglomeration with 1 wt% loading had no influence on Tg, while the first scan revealed differences in evaporation of small molecules, in favor of composite PMMA-STO/MnO2, which showed the trapping potential of volatiles. Investigations of mechanical properties have revealed the significant influence of hybrid STO/MnO2 filler on microhardness and total absorbed impact energy, which were increased by 89.9% and 145.4%, respectively. Results presented in this study revealed the reinforcing potential of hybrid nanoparticles that could find application in other polymers as well.

State-of-the-art polyetheretherketone three-dimensional printing and multifunctional modification for dental implants

Polyetheretherketone (PEEK) is a high-performance thermoplastic polymer with an elastic modulus close to that of the jawbone. PEEK has the potential to become a new dental implant material for special patients due to its radiolucency, chemical stability, color similarity to teeth, and low allergy rate. However, the aromatic main chain and lack of surface charge and chemical functional groups make PEEK hydrophobic and biologically inert, which hinders subsequent protein adsorption and osteoblast adhesion and differentiation. This will be detrimental to the deposition and mineralization of apatite on the surface of PEEK and limit its clinical application. Researchers have explored different modification methods to effectively improve the biomechanical, antibacterial, immunomodulatory, angiogenic, antioxidative, osteogenic and anti-osteoclastogenic, and soft tissue adhesion properties. This review comprehensively summarizes the latest research progress in material property advantages, three-dimensional printing synthesis, and functional modification of PEEK in the fields of implant dentistry and provides solutions for existing difficulties. We confirm the broad prospects of PEEK as a dental implant material to promote the clinical conversion of PEEK-based dental implants.

Novel carbon nanozymes with enhanced phosphatase-like catalytic activity for antimicrobial applications

In this work, Sulfur and Nitrogen co-doped carbon nanoparticles (SN-CNPs) were synthesized by hydrothermal method using dried beet powder as the carbon source. TEM and AFM images indicated that these SN-CNPs form a round-shape ball with an approximate diameter of 50 nm. The presence of Sulfur and Nitrogen in these carbon-based nanoparticles was confirmed by FTIR and XPS analyses. These SN-CNPs were found to have strong phosphatase-like enzymatic activity. The enzymatic behavior of SN-CNPs follows the Michaelis-Menten mechanism with greater v_max and much lower K_m values compared to alkaline phosphatase. Their antimicrobial properties were tested on E. coli and L. lactis, with MIC values of 63 μg mL^-1 and 250 μg mL^-1, respectively. SEM and AFM images of fixed and live E. coli cells revealed that SN-CNPs strongly interacted with the outer membranes of bacterial cells, significantly increasing the cell surface roughness. The chemical interaction between SN-CNPs and phospholipid modeled using quantum mechanical calculations further support our hypothesis that the phosphatase and antimicrobial properties of SN-CNPs are due to the thiol group on the SN-CNPs, which is a mimic of the cysteine-based protein phosphatase. The present work is the first to report carbon-based nanoparticles with strong phosphatase activity and propose a phosphatase natured antimicrobial mechanism. This novel class of carbon nanozymes has the potential to be used for effective catalytic and antibacterial applications.

Effects of Cold Atmospheric Plasma Pre-Treatment of Titanium on the Biological Activity of Primary Human Gingival Fibroblasts

Cold atmospheric plasma treatment (CAP) enables the contactless modification of titanium. This study aimed to investigate the attachment of primary human gingival fibroblasts on titanium. Machined and microstructured titanium discs were exposed to cold atmospheric plasma, followed by the application of primary human gingival fibroblasts onto the disc. The fibroblast cultures were analyzed by fluorescence, scanning electron microscopy and cell-biological tests. The treated titanium displayed a more homogeneous and denser fibroblast coverage, while its biological behavior was not altered. This study demonstrated for the first time the beneficial effect of CAP treatment on the initial attachment of primary human gingival fibroblasts on titanium. The results support the application of CAP in the context of pre-implantation conditioning, as well as of peri-implant disease treatment.

Comparison of the Biological Behavior and Topographical Surface Assessment of a Minimally Invasive Dental Implant and a Standard Implant: An In Vitro Study

The current study aimed to assess the topographical and physical properties of a minimally invasive implant (MagiCore®: MC®, InnosBioSurg, IBS) and to evaluate its biological behavior compared to a gold standard implant (NobelParallel™: NB™, Nobel Biocare™). After surface characterization, the biological behavior assessment was conducted regarding human gingival fibroblasts (hGF) and osteoblast-like cells (MG63). Roughness values for NBTM were Ra = 1.28 µm and for MC® they were Ra = 2.02 µm. Alamar BlueTM assay LIVE/DEADTM staining results indicated equivalent biological development regarding both cell types for the two implants. Significant enhancement was found for hGF ALP activity in the presence of the two tested implants in a time-dependent manner from day 7 to day 14 (** p < 0.01). Alizarin red staining demonstrated significant calcium deposition enhancement when cells were interfaced with the NB™ compared to the MC® implant (** p < 0.05). Moreover, SEM and confocal imaging revealed good cell adhesion with a denser cellular layer on the MC® than the NB™ surface. The MC® cytocompatibility was ranked as equivalent to the gold standard implant despite the surface properties differences. These findings provide new insights about the minimally invasive implant’s biological behavior and its potential clinical implication in different implantology situations.

Dental Implants: Enhancing Biological Response Through Surface Modifications

Surface characteristics are an important factor for long-term clinical success of dental implants. Alterations of implant surface characteristics accelerate or improve osseointegration by interacting with the physiology of bone healing. Dental implant surfaces have been traditionally modified at the microlevel. Recently, researchers have actively investigated nano-modifications in dental implants. This review explores implant surface modifications that enhance biological response at the interface between a bone and the implant.

The Promotion of Mechanical Properties by Bone Ingrowth in Additive-Manufactured Titanium Scaffolds

Although the initial mechanical properties of additive-manufactured (AM) metal scaffolds have been thoroughly studied and have become a cornerstone in the design of porous orthopaedic implants, the potential promotion of the mechanical properties of the scaffolds by bone ingrowth has barely been studied. In this study, the promotion of bone ingrowth on the mechanical properties of AM titanium alloy scaffolds was investigated through in vivo experiments and numerical simulation. On one hand, the osseointegration characteristics of scaffolds with architectures of body-centred cubic (BCC) and diamond were compared through animal experiments in which the mechanical properties of both scaffolds were not enhanced by the four-week implantation. On the other hand, the influences of the type and morphology of bone tissue in the BCC scaffolds on its mechanical properties were investigated by the finite element model of osseointegrated scaffolds, which was calibrated by the results of biomechanical testing. Significant promotion of the mechanical properties of AM metal scaffolds was only found when cortical bone filled the pores in the scaffolds. This paper provides a numerical prediction method to investigate the effect of bone ingrowth on the mechanical properties of AM porous implants, which might be valuable for the design of porous implants.

The applications of polysaccharides in dentistry

Polysaccharides are natural polymers widely present in animals, plants, and several microorganisms. Polysaccharides have remarkable properties, including easy extractions, degradability, and renewability, and have no apparent toxicity, making them ideal for biomedical applications. Moreover, polysaccharides are suitable for repairing oral tissue defects and treating oral diseases due to their excellent biocompatibility, biosafety, anti-inflammatory, and antibacterial properties. The oral cavity is a relatively complex environment vulnerable to numerous conditions, including soft tissue diseases, hard tissue disorders, and as well as soft and hard tissue diseases, all of which are complex to treat. In this article, we reviewed different structures of natural polysaccharides with high commercial values and their applications in treating various oral disease, such as drug delivery, tissue regeneration, material modification, and tissue repair.

Environmental, Microbiological, and Immunological Features of Bacterial Biofilms Associated with Implanted Medical Devices

The spread of biofilms on medical implants represents one of the principal triggers of persistent and chronic infections in clinical settings, and it has been the subject of many studies in the past few years, with most of them focused on prosthetic joint infections. We review here recent works on biofilm formation and microbial colonization on a large variety of indwelling devices, ranging from heart valves and pacemakers to urological and breast implants and from biliary stents and endoscopic tubes to contact lenses and neurosurgical implants. We focus on bacterial abundance and distribution across different devices and body sites and on the role of environmental features, such as the presence of fluid flow and properties of the implant surface, as well as on the interplay between bacterial colonization and the response of the human immune system.

Comparison of the osseointegration of implants placed in areas grafted with HA/TCP and native bone

This study evaluated the osseointegration of implants in areas grafted with biphasic ceramic based on hydroxyapatite/β-tricalcium phosphate (HA/TCP) and in native bone (NB). Twenty-eight rats were randomly assigned into two groups of 14 animals each: HA/TCP group: implants installed in areas grafted with HA/TCP and NB group: implants installed in areas of native bone. Bone defects were made in both tibiae of the rats belonging to the HA/TCP group and then filled with this bone substitute. After 60 days, the rats were submitted to surgical procedures for implant placement in grafted areas in both tibiae in the HA/TCP group while the implants were installed directly in native bone in the NB group. The animals were euthanized 15 and 45 days, respectively, after the implant placement. Biomechanical (removal torque), microtomographic (volume of mineralized tissues around the implants), and histomorphometric (Bone-Implant contact-%BIC and bone area between the implant threads-%BBT) analyzes were conducted to assess the osseointegration process. The HA/TCP group showed lower values of removal torque, volume of mineralized tissue around the implants, lower %BIC, and %BBT compared to the NB group in both experimental periods. Osseointegration of implants placed in grafted areas with HA/TCP was lower compared to the osseointegration observed in native bone areas.

Success Factors of Additive Manufactured Root Analogue Implants

Dental implantation is an effective method for the treatment of loose teeth, but the threaded dental implants used in the clinic cannot match with the tooth extraction socket. A root analogue implant (RAI) has the congruence shape, which reduces the damage to bone and soft tissue. Additive manufacturing (AM) technologies have the advantages of high precision, flexibility, and easy operation, becoming the main manufacturing method of RAI in basic research. The purpose of this systematic review is to summarize AM technologies used for RAI manufacturing as well as the factors affecting successful implantation. First, it introduces the AM technologies according to different operating principles and summarizes the advantages and disadvantages of each method. Then the influences of materials, structure design, surface characteristics, implant site, and positioning are discussed, providing reference for designers and dentists. Finally, it addresses the gap between basic research and clinical application for additive manufactured RAIs and discusses the current challenges and future research directions for this field.

Titanium Implants and Local Drug Delivery Systems Become Mutual Promoters in Orthopedic Clinics

Titanium implants have always been regarded as one of the gold standard treatments for orthopedic applications, but they still face challenges such as pain, bacterial infections, insufficient osseointegration, immune rejection, and difficulty in personalizing treatment in the clinic. These challenges may lead to the patients having to undergo a painful second operation, along with increased economic burden, but the use of drugs is actively solving these problems. The use of systemic drug delivery systems through oral, intravenous, and intramuscular injection of various drugs with different pharmacological properties has effectively reduced the levels of inflammation, lowered the risk of endophytic bacterial infection, and regulated the progress of bone tumor cells, processing and regulating the balance of bone metabolism around the titanium implants. However, due to the limitations of systemic drug delivery systems-such as pharmacokinetics, and the characteristics of bone tissue in the event of different forms of trauma or disease-sometimes the expected effect cannot be achieved. Meanwhile, titanium implants loaded with drugs for local administration have gradually attracted the attention of many researchers. This article reviews the latest developments in local drug delivery systems in recent years, detailing how various types of drugs cooperate with titanium implants to enhance antibacterial, antitumor, and osseointegration effects. Additionally, we summarize the improved technology of titanium implants for drug loading and the control of drug release, along with molecular mechanisms of bone regeneration and vascularization. Finally, we lay out some future prospects in this field.

Toughening of Bioceramic Composites for Bone Regeneration

Bioceramics are widely considered as elective materials for the regeneration of bone tissue, due to their compositional mimicry with bone inorganic components. However, they are intrinsically brittle, which limits their capability to sustain multiple biomechanical loads, especially in the case of load-bearing bone districts. In the last decades, intense research has been dedicated to combining processes to enhance both the strength and toughness of bioceramics, leading to bioceramic composite scaffolds. This review summarizes the recent approaches to this purpose, particularly those addressed to limiting the propagation of cracks to prevent the sudden mechanical failure of bioceramic composites.

Innovative Coatings of Metallic Alloys Used as Bioactive Surfaces in Implantology: A Review

Metallic implants are widely used in the field of implantology, but there are still problems leading to implant failures due to weak osseointegration, low mechanical strength for the implant, inadequate antibacterial properties, and low patient satisfaction. Implant failure can be caused by bacterial infections and poor osteointegration. To improve the implant functionalization, many researchers focus on surface modifications to prepare the proper physical and chemical conditions able to increase biocompatibility and osteointegration between implant and bone. Improving the antibacterial performance is also a key factor to avoid the inflammation in the human body. This paper is a brief review for the types of coatings used to increase osseointegration and biocompatibility for the successful use of metal alloys in the field of implantology.

Texture analysis of cone beam computed tomography images reveals dental implant stability

The aim of this study was to characterize the alveolar bone of edentulous maxillary sites using texture analysis (TA) of cone beam computed tomography (CBCT) images and to correlate the results to the insertion torque, thus verifying whether TA is a predictive tool of final implant treatment. This study was conducted on patients who had received single implants in the maxilla (46 implants) 1year earlier and whose torque values were properly recorded. Three cross-sections of the sites were selected on CBCT scans. Two regions of interest (ROIs) corresponding to the implant bone site and peri-implant bone were also outlined, according to virtual planning. The CBCT scans were exported to MaZda software, where the two ROIs were delimited following the previously demarcated contours. Values for the co-occurrence matrix were calculated for TA. With regard to the insertion torque value, there was a direct correlation with the contrast of the peri-implant bone (P<0.001) and an inverse correlation with the entropy of the implant bone site (P=0.006). A greater contrast indicates a greater torque value for insertion of the implants, and there is a possible association with a lower entropy value of the implant-bone interface.

Scaffold-based developmental tissue engineering strategies for ectodermal organ regeneration

Tissue engineering (TE) is a multidisciplinary research field aiming at the regeneration, restoration, or replacement of damaged tissues and organs. Classical TE approaches combine scaffolds, cells and soluble factors to fabricate constructs mimicking the native tissue to be regenerated. However, to date, limited success in clinical translations has been achieved by classical TE approaches, because of the lack of satisfactory biomorphological and biofunctional features of the obtained constructs. Developmental TE has emerged as a novel TE paradigm to obtain tissues and organs with correct biomorphology and biofunctionality by mimicking the morphogenetic processes leading to the tissue/organ generation in the embryo. Ectodermal appendages, for instance, develop in vivo by sequential interactions between epithelium and mesenchyme, in a process known as secondary induction. A fine artificial replication of these complex interactions can potentially lead to the fabrication of the tissues/organs to be regenerated. Successful developmental TE applications have been reported, in vitro and in vivo, for ectodermal appendages such as teeth, hair follicles and glands. Developmental TE strategies require an accurate selection of cell sources, scaffolds and cell culture configurations to allow for the correct replication of the in vivo morphogenetic cues. Herein, we describe and discuss the emergence of this TE paradigm by reviewing the achievements obtained so far in developmental TE 3D scaffolds for teeth, hair follicles, and salivary and lacrimal glands, with particular focus on the selection of biomaterials and cell culture configurations.

The impact of different low-pressure plasma types on the physical, chemical and biological surface properties of PEEK

OBJECTIVE

Plasma treatment can be used as surface treatment of PEEK (poly-ether-ether-ketone) to increase the bonding strength between veneering composite and dental prosthetic frameworks of PEEK or enhance biocompatibility of PEEK implants. These improvements are probably based on chemical changes of the PEEK surface. However, the aim of the study was to evaluate the impact of different low-pressure plasma treatments on surface properties of PEEK, such as roughness, hydrophilicity, micro-hardness, crystallinity and biological activity of PEEK.

METHODS

Due to different plasma treatments, 143 disc-shaped specimens of pure implantable PEEK were divided into 4 groups: PEEK (no plasma treatment, n = 29), H-PEEK (hydrogen plasma treatment, n = 38), O-PEEK (oxygen plasma treatment, n = 38), H/O-PEEK (hydrogen/oxygen plasma treatment with a gas mix ratio of 2:1, n = 38). Subsequently, surface roughness, surface contact angle, surface crystallinity, surface micro-hardness and human osteoblast cell coverage area of each group were examined.

RESULTS

The hydrophilicity, crystallinity and micro-hardness of the plasma-treated groups increased significantly compared to the untreated group, whereas significant differences in the results of the micro-hardness tests could be shown between all groups up to a test force of 0.02N. Cell density was significantly higher on treated vs. untreated PEEK surfaces. Oxygen and H/O plasma treatments revealed to be most effective, whereas H/O plasma worked ten times faster to achieve the same effects.

SIGNIFICANCE

The hydrogen-oxygen, 2/1-mixed plasma treatment combines the effect of hydrogen and oxygen plasma which strongly improve the surface properties of PEEK implant material, such as hydrophilicity, crystallinity, surface micro-hardness and HOB cell adhesion.

Role of the Hippo-YAP/NF-κB signaling pathway crosstalk in regulating biological behaviors of macrophages under titanium ion exposure

The presence of metal ions, such as titanium (Ti) ions, is toxic to adjacent tissues of implants. Indeed, Ti ions may induce an inflammatory response through the NF-κB pathway, thus causing damage to soft and hard tissues. The involvement of Yes-associated protein (YAP), a key factor of the Hippo pathway, in an immuno-inflammatory response has been confirmed, whereas its role in Ti ion-mediated inflammation has not been elucidated. Therefore, this study aimed to investigate the role of signal crosstalk between the Hippo/YAP and NF-κB signaling pathways in the pro-inflammatory effect of Ti ions on macrophages. In our work, RAW264.7 cells were cocultured with Ti ions. The migration capacity of macrophages under Ti ion exposure was measured by transwell assay. Western blot analysis was used to detect the expressions of related proteins. Polymerase chain reaction was used to evaluate the expression of pro-inflammatory cytokines. The nucleus translocation of YAP and P65 was visualized and analyzed via immunofluorescence staining. The results showed that the migration of macrophages was promoted under Ti ion exposure. Ten parts per million Ti ions induced nuclear expression of YAP and activated the NF-κB pathway, which finally upregulated the expression of pro-inflammatory cytokines in macrophages. Moreover, the inhibition of the NF-κB pathway rescued the reduction of YAP expression under Ti ion exposure. Most importantly, the overexpression of YAP exacerbated the inflammatory response mediated by Ti ions through the NF-κB pathway. In summary, this study explored the mechanism of Hippo-YAP/NF-κB pathway crosstalk involved in the regulation of macrophage behaviors under Ti ion exposure.

Errors in Implant Positioning Due to Lack of Planning: A Clinical Case Report of New Prosthetic Materials and Solutions

The achievement of the optimal implant position is a critical consideration in implant surgery, as it can facilitate the ideal prosthesis design and allow adequate oral hygiene maintenance. The switch from bone-driven to prosthetic-driven implant placement, through a comprehensive diagnosis and adequate treatment plan, is a prerequisite for long-term successful implant-based therapy. The aim of the present case report is to describe a step-by-step prosthetic retreatment of a patient with primary treatment failure due to incorrect dental implant placement. Although dental implants achieve high survival rates, the success of implant prosthetic therapy significantly relies on an appropriate implant position. Malpositioned implants can cause damage to vital structures, like nerves or vessels. Moreover, improper implant positioning can result in esthetic, biological, and technical complications and can, in extreme situations, render the desired prosthetic rehabilitation impossible to achieve.