Suitability of differently designed matrix-based implant surface coatings: An animal study on bone formation

The minipig intraoral dental implant model: A systematic review and meta-analysis

OBJECTIVES

The objective of this report was to provide a review of the minipig intraoral dental implant model including a meta-analysis to estimate osseointegration and crestal bone remodeling.

METHODS

A systematic review including PubMed and EMBASE databases through June 2021 was conducted. Two independent examiners screened titles/abstracts and selected full-text articles. Studies evaluating titanium dental implant osseointegration in native alveolar bone were included. A quality assessment of reporting was performed. Random-effects meta-analyses and meta-regressions were produced for bone-implant contact (BIC), first BIC, and crestal bone level.

RESULTS

125 out of 249 full-text articles were reviewed, 55 original studies were included. Quality of reporting was generally low, omissions included animal characteristics, examiner masking/calibration, and sample size calculation. The typical minipig model protocol included surgical extraction of the mandibular premolars and first molar, 12±4 wks post-extraction healing, placement of three narrow regular length dental implants per jaw quadrant, submerged implant healing and 8 wks of osseointegration. Approximately 90% of studies reported undecalcified incandescent light microscopy histometrics. Overall, mean BIC was 59.88% (95%CI: 57.43-62.33). BIC increased significantly over time (p<0.001): 40.93 (95%CI: 34.95-46.90) at 2 wks, 58.37% (95%CI: 54.38-62.36) at 4 wks, and 66.33% (95%CI: 63.45-69.21) beyond 4 wks. Variability among studies was mainly explained by differences in observation interval post-extraction and post-implant placement, and implant surface. Heterogeneity was high for all studies (I2 > 90%, p<0.001).

CONCLUSIONS

The minipig intraoral dental implant model appears to effectively demonstrate osseointegration and alveolar bone remodeling similar to that observed in humans and canine models.

A systematic review and meta-analysis on the influence of biological implant surface coatings on periimplant bone formation

This systematic review and meta-analysis evaluated the influence of biological implant surface coatings on periimplant bone formation in comparison to an uncoated titanium reference surface in experimental large animal models. The analysis was structured according to the PRISMA criteriae. Of the1077 studies, 30 studies met the inclusion criteriae. Nineteen studies examined the bone implant contact (BIC) and were included in the meta-analysis. Overall, the mean increase in BIC for the test surfaces compared to the reference surfaces was 3.7 percentage points (pp) (95% CI -3.9-11.2, p = 0.339). Analyzing the increase in BIC for specific coated surfaces in comparison to uncoated reference surfaces, inorganic surface coatings showed a significant mean increase in BIC of 14.7 pp (95% CI 10.6-18.9, p < 0.01), extracellular matrix (ECM) surface coatings showed an increase of 10.0 pp (95% CI 4.4-15.6, p < 0.001), and peptide coatings showed a statistical trend with 7.1 pp BIC increase (95% CI -0.8-15.0, p = 0.08). In this review, no statistically significant difference could be found for growth factor surface coatings (observed difference -3.3 pp, 95% CI -16.5-9.9, p = 0.6). All analyses are exploratory in nature. The results show a statistically significant effect of inorganic and ECM coatings on periimplant bone formation. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2898-2910, 2016.

Surface chemistry and effects on bone regeneration of a novel biomimetic synthetic bone filler

The paper presents results of physico-chemical and biological investigations of a surface-engineered synthetic bone filler. Surface analysis confirms that the ceramic phosphate granules present a collagen nanolayer to the surrounding environment. Cell cultures tests show that, in agreement with literature reports, surface-immobilized collagen molecular cues can stimulate progression along the osteogenic pathway of undifferentiated human mesenchymal cells. Finally, in vivo test in a rabbit model of critical bone defects shows statistically significant increase of bone volume and mineral apposition rate between the biomimetic bone filler and collagen-free control. All together, obtained data confirm that biomolecular surface engineering can upgrade the properties of implant device, by promoting more specific and targeted implant-host cells interactions.

Osseointegration of short titan implants: A pilot study in pigs

Reduced vertical bone level in the implantation area is often considered one of the limiting factors before implant insertion. Inserting implants of reduced length might be useful in order to avoid vertical bone augmentation prior to implantation. To the present day, no official guidelines exist as to the optimal length for these implants. It is nevertheless well known that the stability of an implant depends primarily on its osseointegration, which could otherwise be influenced by modifying implant surface texture. The aim of our study was to evaluate osseointegration in correlation with implant length and surface texture. Three different variations of titan implants (n=5) were compared: two types, each with an acid-etched and ceramic blasted surface, were inserted in the upper jaw of adult female minipigs at different lengths (tioLogic ST Shorty, 5mm length; tioLogic ST, 9mm length) and were compared to a control group (tioLogic ST, 9mm length, ceramic blasted surface). Eight weeks after unloaded healing, bone tissue specimens containing the implants were processed, stained with Masson-Goldner-trichrome and analyzed histologically. Regardless of implant length and surface texture, new bone formation with no signs of inflammation could be detected in the area of the threads. Implants with a modified surface showed no statistically significant difference in bone-implant-contact (BIC) (tioLogic ST Shorty, 56.5%; tioLogic(©)ST; 77.2%), but a statistically significant difference could be found, when the 9mm implants were compared to the control group (BIC 48.9%). Surface modification could positively influence osseointegration as well as contribute to overcoming the adverse effects of length reduction.

Functionalization of biomaterial surfaces using artificial extracellular matrices

Construction of biomaterials with the ability to guide cell function is a topic of high interest in biomaterial development. One approach is using components native to the ECM of the target tissue to generate in vitro a microenvironment that can also elicit specific responses in cells and tissues—an artificial ECM (aECM). The focus is on collagen as the basic material, which can be modified using a number of different glycoproteins, proteoglycans and glycosaminoglycans. Preparation, immobilization and the biochemical characteristics of such aECM are discussed, as well as the in vitro and in vivo response of cells and tissues, illustrating the potential of such matrices to direct cell fate.

Poly(L-lactide-co-glycolide) scaffolds coated with collagen and glycosaminoglycans: impact on proliferation and osteogenic differentiation of human mesenchymal stem cells

In this study, we analyzed poly(L-lactide-co-glycolide) (PLGA) scaffolds modified with artificial extracellular matrices (aECM) consisting of collagen type I, chondroitin sulphate, and sulphated hyaluronan (sHya). We investigated the effect of these aECM coatings on proliferation and osteogenic differentiation of human mesenchymal stem cells (hMSC) in vitro. We found that scaffolds were homogeneously coated, and cross-linking of aECM did not significantly influence the amount of collagen immobilized. Cell proliferation was significantly increased on cross-linked surfaces in expansion medium (EM), but was retarded on cross-linked and non-cross-linked collagen/sHya coatings. The alkaline phosphatase activity was increased on sHya-containing coatings in EM even without the presence of differentiation supplements, but was six to ten times higher in differentiation medium (DM) and comparable for cross-linked and non-cross-linked collagen/sHya. The highest amount of calcium phosphate mineral was deposited on day 28 on cross-linked collagen/sHya. Therefore, coatings of PLGA scaffolds with collagen/sHya promoted the osteogenic differentiation of hMSCs in vitro and might be an interesting candidate for the modification of PLGA for bone reconstruction in vivo.

A novel cyclic RGD-containing peptide polymer improves serum-free adhesion of adipose tissue-derived mesenchymal stem cells to bone implant surfaces

Seeding of bone implants with mesenchymal stem cells (MSCs) may promote osseointegration and bone regeneration. However, implant material surfaces, such as titanium or bovine bone mineral, fail to support rapid and efficient attachment of MSCs, especially under serum-free conditions that may be desirable when human applications or tightly controlled experiments are envisioned. Here we demonstrate that a branched poly[Lys(Ser(i)-DL-Ala(m))] polymer functionalized with cyclic arginyl-glycyl-aspartate, when immobilized by simple adsorption to tissue culture plastic, surgical titanium alloy (Ti6Al4V), or Bio-Oss(®) bovine bone substitute, significantly accelerates serum-free adhesion and enhances seeding efficiency of human adipose tissue-derived MSCs. Moreover, when exposed to serum-containing osteogenic medium, MSCs survived and differentiated on the peptide-coated scaffolds. In summary, the presented novel polypeptide conjugate can be conveniently used for coating various surfaces, and may find applications whenever quick and efficient seeding of MSCs is required to various scaffolds in the absence of serum.

The pig as an experimental model for clinical craniofacial research

The pig represents a useful, large experimental model for biomedical research. Recently, it has been used in different areas of biomedical research. The aim of this study was to review the basic anatomical structures of the head region in the pig in relation to their use in current research. Attention was focused on the areas that are frequently affected by pathological processes in humans: the oral cavity with teeth, salivary gland, orbit, nasal cavity and paranasal sinuses, maxilla, mandible and temporomandibular joint. Not all of the structures have an equal morphology in the pig and human, and these morphological dissimilarities must be taken into account before choosing the pig as an experimental model for regenerative medicine.

Biological response to titanium implants coated with nanocrystals calcium phosphate or type 1 collagen in a dog model

OBJECTIVE

The current study aimed to evaluate the osteogenic potential of electrosprayed organic and non-organic surface coatings in a gap-implant model over 4 and 12 weeks of implantation into the dog mandible.

MATERIAL AND METHODS

Sixteen Beagle dogs received experimental titanium implants in the mandible 3 months after removal of left premolars (P2, P3 and P4). Three types of implants were installed in each animal: non-coated implant, nano-CaP coated implant and implant with type 1 collagen coating. Both micro-CT and histomorphometry were used to evaluate peri-implant bone response after implantation periods of 4 and 12 weeks. The bone area percentage was assessed histomorphometrically in three different zones (inner: 0-300 μm; middle: 300-600 μm; and outer: 600-1000 μm) around the implant surface. Bone-bridging of the gap was also calculated for each sample.

RESULTS

Four weeks after implantation, nano-CaP and collagen-coated implants showed significantly higher bone volume (BV) in the inner zone compared with non-coated implants (P < 0.05 and P < 0.01). After 12 weeks, histomorphometric analysis showed comparable amounts of BV between all experimental groups. Also, no significant difference was found in the BV, as measured using micro-CT, between the implant groups. Absolute bone ingrowth measurements were highest for collagen-coated implants, but these differences were not significant.

CONCLUSION

The obtained data failed to provide a consistent favourable effect on bone formation of the collagen coating over 3 months of implantation. It is concluded that the source of the collagen as well as the limited osseous environment overshadowed a possible effect of the applied implant surface modifications. Similarly, the tested nano-apatite surface coating did not improve peri-implant bone ingrowth into a gap-implant model.

Biological functionalization of dental implants with collagen and glycosaminoglycans-A comparative study

Biological implant surface coatings are an emerging technology to increase bone formation. Such an approach is of special interest in anatomical regions like the maxilla. In the present study, we hypothesized that the coating of titanium implants with components of the organic extracellular matrix increases bone formation and implant stability compared to an uncoated reference. The implants were coated using collagen-I with either two different concentrations of chondroitin sulfate (CS) or two differentially sulfated hyaluronans. Implant coatings were characterized biochemically and with atomic force microscopy. Histomorphometry was used to assess bone-implant contact (BIC) and bone-volume density (BVD) after 4 and 8 weeks of submerged healing in the maxilla of 20 minipigs. Further, implant stability was measured by resonance frequency analysis (RFA). Implants containing the lower CS concentration had significantly more BIC, compared to the uncoated reference at both times of interest. No significant increase was measured from week 4 to 8. Differences in BVD and RFA were statistically not significant. A higher concentration of CS and the application of sulfated hyaluronans showed no comparable increase in BIC. This study demonstrates a positive effect of a specific collagen-glycosaminoglycan combination on early bone formation in vivo.

Effects of implant surface coatings and composition on bone integration: a systematic review

OBJECTIVE

The aim of the present review was to evaluate the bone integration efficacy of recently developed and marketed oral implants as well as experimental surface alterations.

MATERIALS AND METHODS

A PubMed search was performed for animal studies, human reports and studies presenting bone-to-implant contact percentage or data regarding mechanical testing.

RESULTS

For recently developed and marketed oral implants, 29 publications and for experimental surface alterations 51 publications fulfilled the inclusion criteria for this review.

CONCLUSIONS

As demonstrated in the available literature dealing with recently developed and marketed oral implants, surface-roughening procedures also affect the surface chemical composition of oral implants. There is sufficient proof that surface roughening induces a safe and predictable implant-to-bone response, but it is not clear whether this effect is due to the surface roughness or to the related change in the surface composition. The review of the experimental surface alterations revealed that thin calcium phosphate (CaP) coating technology can solve the problems associated with thick CaP coatings, while they still improve implant bone integration compared with non-coated titanium implants. Nevertheless, there is a lack of human studies in which the success rate of thin CaP-coated oral implants is compared with just roughened oral implants. No unequivocal evidence is available that suggests a positive effect on the implant bone integration of peptide sequences or growth factors coated on titanium oral implants. In contrast, the available literature suggests that bone morphogenetic protein-2 coatings might even impede the magnitude of implant-to-bone response.