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Su G, Zhang Y, Jin C, Zhang Q, Lu J, Liu Z, Wang Q, Zhang X, Ma J. 3D printed zirconia used as dental materials: a critical review. J Biol Eng 2023; 17:78. [PMID: 38129905 PMCID: PMC10740276 DOI: 10.1186/s13036-023-00396-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
In view of its high mechanical performance, outstanding aesthetic qualities, and biological stability, zirconia has been widely used in the fields of dentistry. Due to its potential to produce suitable advanced configurations and structures for a number of medical applications, especially personalized created devices, ceramic additive manufacturing (AM) has been attracting a great deal of attention in recent years. AM zirconia hews out infinite possibilities that are otherwise barely possible with traditional processes thanks to its freedom and efficiency. In the review, AM zirconia's physical and adhesive characteristics, accuracy, biocompatibility, as well as their clinical applications have been reviewed. Here, we highlight the accuracy and biocompatibility of 3D printed zirconia. Also, current obstacles and a forecast of AM zirconia for its development and improvement have been covered. In summary, this review offers a description of the basic characteristics of AM zirconia materials intended for oral medicine. Furthermore, it provides a generally novel and fundamental basis for the utilization of 3D printed zirconia in dentistry.
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Affiliation(s)
- Guanyu Su
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China
| | - Yushi Zhang
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China
| | - Chunyu Jin
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China
| | - Qiyue Zhang
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China
| | - Jiarui Lu
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China
| | - Zengqian Liu
- Shi-Changxu Innovation Center for Advanced Materials, Institute of Metal Research, Chinese Academy of Sciences, Shenyang, 110016, China
- School of Materials Science and Engineering, University of Science and Technology of China, Hefei, 230026, China
| | - Qiang Wang
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China
| | - Xue Zhang
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China.
| | - Jia Ma
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China.
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Thu MK, Kang YS, Kwak JM, Jo YH, Han JS, Yeo ISL. Comparison between bone-implant interfaces of microtopographically modified zirconia and titanium implants. Sci Rep 2023; 13:11142. [PMID: 37429939 DOI: 10.1038/s41598-023-38432-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/07/2023] [Indexed: 07/12/2023] Open
Abstract
The aim of this study was to investigate the surface characteristics and evaluate the bone-implant interfaces of injection molded zirconia implants with or without surface treatment and compare them with those of conventional titanium implants. Four different zirconia and titanium implant groups (n = 14 for each group) were prepared: injection-molded zirconia implants without surface treatment (IM ZrO2); injection-molded zirconia implants with surface treatment via sandblasting (IM ZrO2-S); turned titanium implants (Ti-turned); and titanium implants with surface treatments via sandblasting with large-grit particles and acid-etching (Ti-SLA). Scanning electron microscopy, confocal laser scanning microscopy, and energy dispersive spectroscopy were used to assess the surface characteristics of the implant specimens. Eight rabbits were used, and four implants from each group were placed into the tibiae of each rabbit. Bone-to-implant contact (BIC) and bone area (BA) were measured to evaluate the bone response after 10-day and 28-day healing periods. One-way analysis of variance with Tukey's pairwise comparison was used to find any significant differences. The significance level was set at α = 0.05. Surface physical analysis showed that Ti-SLA had the highest surface roughness, followed by IM ZrO2-S, IM ZrO2, and Ti-turned. There were no statistically significant differences (p > 0.05) in BIC and BA among the different groups according to the histomorphometric analysis. This study suggests that injection-molded zirconia implants are reliable and predictable alternatives to titanium implants for future clinical applications.
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Affiliation(s)
- Myint Kyaw Thu
- Department of Prosthodontics, School of Dentistry and Dental Research Institute, Seoul National University, 101, Daehak-ro, Jongro-gu, Seoul, 03080, Korea
| | - Young Suk Kang
- 618th Medical Company (Dental Area Support)/Dental Health Activity-Korea, Camp Humphreys, APO, AP, 96297, USA
| | - Jeong Min Kwak
- Department of Prosthodontics, School of Dentistry and Dental Research Institute, Seoul National University, 101, Daehak-ro, Jongro-gu, Seoul, 03080, Korea
| | - Ye-Hyeon Jo
- Dental Research Institute, Seoul National University, Seoul, 03080, Korea
| | - Jung-Suk Han
- Department of Prosthodontics, School of Dentistry and Dental Research Institute, Seoul National University, 101, Daehak-ro, Jongro-gu, Seoul, 03080, Korea
| | - In-Sung Luke Yeo
- Department of Prosthodontics, School of Dentistry and Dental Research Institute, Seoul National University, 101, Daehak-ro, Jongro-gu, Seoul, 03080, Korea.
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Huang CL, Huang KT, Lee TM. The biological responses of osteoblasts on titanium: Effect of oxygen level and surface roughness. J Formos Med Assoc 2023:S0929-6646(23)00009-8. [PMID: 36732135 DOI: 10.1016/j.jfma.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND/PURPOSE Due to the general application of in vitro test, cell culture is generally selected to evaluate the cytocompatibility of devices and materials. The choice of test condition should depend on the probable site and clinical application. The oxygen content of human body could be estimated around 5%∼12%, and the oxygen level of healing bone fracture range from 0.8%∼3.8%%. However, materials for bone implant are traditionally evaluated under laboratory normoxia condition (21% O2) in vitro. The aim was to study the effect of oxygen level on osteoblast upon high stiffness titanium with different roughness. METHODS After sandblasted and acid-etched (SLA) process, we create titanium surfaces with four different roughness. The differentiation and proliferation of MC3T3-E1 osteoblast cultured on SLA-treated specimens were evaluated in designed chamber with oxygen level of 1%, 5%, 10%, 21%. RESULTS By scanning electron microscopy, all samples had sub-micro pit inside the micro-holes upon SLA-treated Ti disk surface. The decrease of oxygen level from 21% to 5% promoted osteoblast growth of SLA-treated specimens, but 1% O2 delayed cell proliferation. The surface roughness of specimens influenced osteoblast cell differentiation. The differentiation and proliferation ability of the cells upon SLA-treated specimens is proportional to oxygen level. CONCLUSION Our results demonstrated that 5% O2 will easily discriminate osteoblasts responses on different SLA-treated specimens. These results suggest that hypoxia (5% O2) environment is better model for biological evaluation of bone-related materials.
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Affiliation(s)
- Chih-Ling Huang
- Center for Fundamental Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kai-Ting Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Tzer-Min Lee
- School of Dentistry, National Cheng Kung University, Tainan, Taiwan; Institute of Oral Medicine, National Cheng Kung University, Tainan, Taiwan; Taiwan Instrument Research Institute, National Applied Research Laboratories, Hsinchu, Taiwan.
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Sala L, Zufía J, Blasi G, Carrillo-de-Albornoz A. Clinical evaluation and patient related outcomes of one- and two-piece zirconia implants at five years of loading: A case series study. J ESTHET RESTOR DENT 2022; 35:577-585. [PMID: 36583946 DOI: 10.1111/jerd.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the survival and biological and mechanical complications of one-piece and two-piece zirconia implants at five years of loading. MATERIALS AND METHODS Consecutive patients receiving zirconia implants were studied, collecting data at five years of loading on their clinical history, peri-implant health status, mechanical complications, esthetic results, and patient related outcomes. RESULTS The study included 18 patients with 29 implants. The survival rate was 86% in implant-based analysis and 78% in patient-based analysis. There were no cases of peri-implantitis, but mucositis was present in 53% of implants. A mean of 4.1 ± 0.81 mm was obtained for probing depth and 1.6 ± 0.9 mm for crestal bone loss (radiographic assessment). There were no implant fractures. Major (10%) and minor (10%) prosthesis complications were observed. The esthetic outcome was moderate to almost perfect, with a high level of patient satisfaction. No significant association was found between survival rate and the presence of mucositis around one- or two-piece implants or any other study variable. CONCLUSIONS The survival rate is low for one- and two-piece zirconia implants. Both types of implants demonstrated a low mechanical complication rate. The incidence of periimplantitis is low but mucositis is present in 50%. Patient satisfaction related to esthetics and function is moderate to high. They represent a good option for patients requiring an alternative to titanium implants. CLINICAL RELEVANCE Zirconia implants appear to be an alternative to the titanium option and may be indicated for patients requiring "metal-free" restorations.
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Affiliation(s)
- Leticia Sala
- Department of Periodontology, School of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Juan Zufía
- Private Practice in Madrid, Madrid, Spain
| | - Gonzalo Blasi
- Department of Periodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland, USA.,Department of Periodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ana Carrillo-de-Albornoz
- Department of Periodontology, School of Dentistry, Complutense University of Madrid, Madrid, Spain
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Preparation and Characterization of a Polyetherketoneketone/Hydroxyapatite Hybrid for Dental Applications. J Funct Biomater 2022; 13:jfb13040220. [PMID: 36412861 PMCID: PMC9680429 DOI: 10.3390/jfb13040220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Here, we developed a new synthetic method for the production of a new class of polymeric inorganic hybrid biomaterial that has potential for dental implant applications and, in general, other orthopedic applications owing to its excellent mechanical properties and biomechanical compatibility. The new hybrid biomaterial is a composite consisting of polyetherketoneketone (PEKK) and hydroxyapatite (HA). This hybrid material boasts several unique features, including its high HA loading (up to 50 wt%), which is close to that of natural human bone; the homogeneous HA distribution in the PEKK matrix without phase separation; and the fact that the addition of HA has no effect on the molecular weight of PEKK. Nanoindentation analysis was used to investigate the mechanical properties of the composite, and its nano/microstructure variations were investigated through a structural model developed here. Through nanoindentation technology, the newly developed PEKK/HA hybrid biomaterial has an indentation modulus of 12.1 ± 2.5 GPa and a hardness of 0.42 ± 0.09 GPa, which are comparable with those of human bone. Overall, the new PEKK/HA biomaterial exhibits excellent biomechanical compatibility and shows great promise for application to dental and orthopedic devices.
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Blanc-Sylvestre N, Bouchard P, Chaussain C, Bardet C. Pre-Clinical Models in Implant Dentistry: Past, Present, Future. Biomedicines 2021; 9:1538. [PMID: 34829765 PMCID: PMC8615291 DOI: 10.3390/biomedicines9111538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022] Open
Abstract
Biomedical research seeks to generate experimental results for translation to clinical settings. In order to improve the transition from bench to bedside, researchers must draw justifiable conclusions based on data from an appropriate model. Animal testing, as a prerequisite to human clinical exposure, is performed in a range of species, from laboratory mice to larger animals (such as dogs or non-human primates). Minipigs appear to be the animal of choice for studying bone surgery around intraoral dental implants. Dog models, well-known in the field of dental implant research, tend now to be used for studies conducted under compromised oral conditions (biofilm). Regarding small animal models, research studies mostly use rodents, with interest in rabbit models declining. Mouse models remain a reference for genetic studies. On the other hand, over the last decade, scientific advances and government guidelines have led to the replacement, reduction, and refinement of the use of all animal models in dental implant research. In new development strategies, some in vivo experiments are being progressively replaced by in vitro or biomaterial approaches. In this review, we summarize the key information on the animal models currently available for dental implant research and highlight (i) the pros and cons of each type, (ii) new levels of decisional procedures regarding study objectives, and (iii) the outlook for animal research, discussing possible non-animal options.
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Affiliation(s)
- Nicolas Blanc-Sylvestre
- Université de Paris, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), 92120 Montrouge, France; (N.B.-S.); (P.B.); (C.C.)
- AP-HP, Department of Periodontology, Rothschild Hospital, European Postgraduate in Periodontology and Implantology, Université de Paris, 75012 Paris, France
| | - Philippe Bouchard
- Université de Paris, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), 92120 Montrouge, France; (N.B.-S.); (P.B.); (C.C.)
- AP-HP, Department of Periodontology, Rothschild Hospital, European Postgraduate in Periodontology and Implantology, Université de Paris, 75012 Paris, France
| | - Catherine Chaussain
- Université de Paris, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), 92120 Montrouge, France; (N.B.-S.); (P.B.); (C.C.)
- AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Dental Medicine Department, Bretonneau Hospital, GHN-Université de Paris, 75018 Paris, France
| | - Claire Bardet
- Université de Paris, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), 92120 Montrouge, France; (N.B.-S.); (P.B.); (C.C.)
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Sun L, Hong G. Surface Modifications for Zirconia Dental Implants: A Review. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.733242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Zirconia-based bioceramic is a potential material for dental implants developed and introduced in dentistry 30 years ago. However, some limitations still exist for zirconia implants caused by several factors, such as manufacturing difficulties, low-temperature degradation (LTD), long-term stability, and clinical experience. Several studies validated that some subtle changes on the zirconia surface might significantly impact its mechanical properties and osseointegration. Thus, attention was paid to the effect of surface modification of zirconia implants. This review generally summarizes the surface modifications of zirconia implants to date classified as physical treatment, chemical treatment, and surface coating, aiming to give an overall perspective based on the current situation. In conclusion, surface modification is an effective and essential method for zirconia implant application. However, before clinical use, we need more knowledge about these modification methods.
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Kim JC, Yeo ISL. Bone Response to Conventional Titanium Implants and New Zirconia Implants Produced by Additive Manufacturing. MATERIALS 2021; 14:ma14164405. [PMID: 34442927 PMCID: PMC8401228 DOI: 10.3390/ma14164405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 12/18/2022]
Abstract
The aim of the present study was to evaluate the in vivo bone response to an additively manufactured zirconia surface compared to osseointegration into titanium (Ti) surfaces. Scanning electron microscopy, confocal laser scanning microscopy, and electron spectroscopy for chemical analysis were performed to assess the surface characteristics of implant specimens. For the in vivo evaluation, eight Ti implants and eight 3D-printed zirconia implants were used. The surface of four Ti implants was sandblasted, large-grit, and acid-etched (Ti-SLA group), while those of the other four Ti implants were left untreated (Ti-turned group). The zirconia implants had no further surface modification. Implants were placed into the tibiae of four rabbits; two received the Ti-SLA and zirconia implants and the other two received Ti-turned and zirconia implants. The experimental animals were sacrificed after four weeks of surgery, and the undecalcified microscopic slides were prepared. The bone–implant interface was analyzed by histomorphometry to evaluate the bone response. The degree of surface roughness showed that Ti-SLA was the highest, followed by zirconia and Ti-turned surfaces. The 3D-printed zirconia surface showed similar bone-to-implant contact to the Ti-turned surface, and Ti-SLA had the most bone-to-implant contact. The additively manufactured zirconia implant surface is biocompatible with respect to osseointegration compared to the commercially pure Ti surface.
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Affiliation(s)
- Jin-Cheol Kim
- Department of Prosthodontics, Seoul National University School of Dentistry, Seoul 03080, Korea;
| | - In-Sung Luke Yeo
- Department of Prosthodontics, School of Dentistry and Dental Research Institute, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-2072-2661; Fax: +82-2-2072-3860
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Lorusso F, Noumbissi S, Francesco I, Rapone B, Khater AGA, Scarano A. Scientific Trends in Clinical Research on Zirconia Dental Implants: A Bibliometric Review. MATERIALS 2020; 13:ma13235534. [PMID: 33291827 PMCID: PMC7730252 DOI: 10.3390/ma13235534] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022]
Abstract
Background: The clinical use of zirconia implants has been shown to increase steadily due to their biological, aesthetic, and physical properties; therefore, this bibliometric study aimed to review the clinical research and co-authors in the field of zirconia dental implant rehabilitation. Methods: We searched Scopus and Web of Science databases using a comprehensive search strategy to 5 October 2020, and independently paired reviewers who screened studies, and collected data with inclusion criteria restricted to clinical research only (either prospective or retrospective). Data on article title, co-authors, number of citations received, journal details, publication year, country and institution involved, funding, study design, marginal bone loss, survival rate, failure, follow-up, and the author’s bibliometric data were collected and evaluated. Results: A total of 29 clinical studies were published between 2008 and 2020 as 41.4% were prospective cohort studies and 48.3% originated from Germany. Most of the included studies had been published in Clinical Oral Implant Research (n = 12), and the most productive institution was the Medical Center of University of Freiburg. The author with the largest number of clinical studies on zirconia implants was Kohal R.J. (n = 10), followed by Spies B.C. (n = 8). Conclusions: This study revealed that zirconia implants have been more prominent in the last ten years, which is a valuable option for oral rehabilitation with marginal bone loss and survival rate comparable to titanium dental implants.
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Affiliation(s)
- Felice Lorusso
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.L.); (S.N.)
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20910, USA
| | - Sammy Noumbissi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.L.); (S.N.)
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20910, USA
| | - Inchingolo Francesco
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70121 Bari, Italy;
| | - Biagio Rapone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, 70121 Bari, Italy;
| | - Ahmad G. A. Khater
- Faculty of Oral and Dental Medicine, Ahram Canadian University, 6th of October City, 8655 Giza, Egypt;
| | - Antonio Scarano
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.L.); (S.N.)
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20910, USA
- Correspondence: ; Tel.: +39-0871-355-4084; Fax: +39-0871-355-4099
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Affiliation(s)
- Takao HANAWA
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University
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11
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Siddiqui DA, Sridhar S, Wang F, Jacob JJ, Rodrigues DC. Can Oral Bacteria and Mechanical Fatigue Degrade Zirconia Dental Implants in Vitro? ACS Biomater Sci Eng 2019; 5:2821-2833. [DOI: 10.1021/acsbiomaterials.9b00223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Danyal A. Siddiqui
- Department of Bioengineering, The University of Texas at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Sathyanarayanan Sridhar
- Department of Bioengineering, The University of Texas at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Frederick Wang
- Department of Bioengineering, The University of Texas at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Joel J. Jacob
- Department of Biological Sciences, The University of Texas at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
| | - Danieli C. Rodrigues
- Department of Bioengineering, The University of Texas at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, United States
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Roehling S, Schlegel KA, Woelfler H, Gahlert M. Zirconia compared to titanium dental implants in preclinical studies—A systematic review and meta‐analysis. Clin Oral Implants Res 2019; 30:365-395. [DOI: 10.1111/clr.13425] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Stefan Roehling
- Clinic for Oral and Cranio‐Maxillofacial Surgery Hightech Research Center University Hospital Basel University of Basel Basel Switzerland
- Clinic for Oral and Cranio‐Maxillofacial Surgery Kantonsspital Aarau Aarau Switzerland
- Unit for Oral & Maxillofacial Surgery Medical Healthcare Center Lörrach Lörrach Germany
| | - Karl A. Schlegel
- Private Clinic for Oral and Maxillofacial Surgery Prof. Schlegel Munich Germany
- Maxillofacial Surgery Department University Hospital Erlangen University of Erlangen Erlangen Germany
| | | | - Michael Gahlert
- Clinic for Oral and Cranio‐Maxillofacial Surgery Hightech Research Center University Hospital Basel University of Basel Basel Switzerland
- Dental Clinic for Oral Surgery and Implant Dentistry Prof. Gahlert Munich Germany
- Department for Oral Surgery Faculty of Medicine Sigmund Freud University Vienna Vienna Austria
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Schünemann FH, Galárraga-Vinueza ME, Magini R, Fredel M, Silva F, Souza JCM, Zhang Y, Henriques B. Zirconia surface modifications for implant dentistry. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 98:1294-1305. [PMID: 30813009 DOI: 10.1016/j.msec.2019.01.062] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Zirconia has emerged as a versatile dental material due to its excellent aesthetic outcomes such as color and opacity, unique mechanical properties that can mimic the appearance of natural teeth and decrease peri-implant inflammatory reactions. OBJECTIVE The aim of this review was to critically explore the state of art of zirconia surface treatment to enhance the biological and osseointegration behavior of zirconia in implant dentistry. MATERIALS AND METHODS An electronic search in PubMed database was carried out until May 2018 using the following combination of key words and MeSH terms without time periods: "zirconia surface treatment" or "zirconia surface modification" or "zirconia coating" and "osseointegration" or "biological properties" or "bioactivity" or "functionally graded properties". RESULTS Previous studies have reported the influence of zirconia-based implant surface on the adhesion, proliferation, and differentiation of osteoblast and fibroblasts at the implant to bone interface during the osseointegration process. A large number of physicochemical methods have been used to change the implant surfaces and therefore to improve the early and late bone-to-implant integration, namely: acid etching, gritblasting, laser treatment, UV light, CVD, and PVD. The development of coatings composed of silica, magnesium, graphene, dopamine, and bioactive molecules has been assessed although the development of a functionally graded material for implants has shown encouraging mechanical and biological behavior. CONCLUSION Modified zirconia surfaces clearly demonstrate faster osseointegration than that on untreated surfaces. However, there is no consensus regarding the surface treatment and consequent morphological aspects of the surfaces to enhance osseointegration.
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Affiliation(s)
- Fernanda H Schünemann
- School of Dentistry (DODT), Post-Graduate Program in Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900 Florianópolis, SC, Brazil
| | - María E Galárraga-Vinueza
- School of Dentistry (DODT), Post-Graduate Program in Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900 Florianópolis, SC, Brazil
| | - Ricardo Magini
- School of Dentistry (DODT), Post-Graduate Program in Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900 Florianópolis, SC, Brazil
| | - Márcio Fredel
- Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900, Florianópolis, SC, Brazil
| | - Filipe Silva
- CMEMS-UMinho, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal
| | - Júlio C M Souza
- CMEMS-UMinho, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal; Department of Dental Sciences, University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra, Portugal
| | - Yu Zhang
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, NYU, New York, NY 10010, USA
| | - Bruno Henriques
- Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900, Florianópolis, SC, Brazil; CMEMS-UMinho, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal.
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Current status of zirconia implants in dentistry: preclinical tests. J Prosthodont Res 2018; 63:1-14. [PMID: 30205949 DOI: 10.1016/j.jpor.2018.07.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 07/18/2018] [Accepted: 07/26/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE This systematic review aimed to provide an overview of zirconia implants as well as regarding the outcome of the implant-restorative complex in preclinical studies. STUDY SELECTION An electronic search of the literature prior to July 2017 was performed to identify all articles related to preclinical research on zirconia implants. The search was conducted using MEDLINE (National Library of Medicine) and PubMed without restrictions concerning the date of publication. The search terminology included: zirconia implant, osseointegration, bone-to-implant contact, soft tissue, histology, histomorphometry, surface modification, surface roughness, surface characteristics, and restoration (connecting multiple keywords with AND, OR). RESULTS Fifty-seven studies were finally selected from an initial yield of 654 titles, and the data were extracted. The identified preclinical studies focused on several aspects related to zirconia implants, namely biocompatibility, mechanical properties, implant design, osseointegration capacity, soft tissue response, and restorative options. Due to heterogeneity of the studies, a meta-analysis was not possible. The most frequently used zirconia material for the fabrication of implants is yttria-stabilized tetragonal zirconia polycrystal. The resistance-to-fracture for zirconia implants ranged between 516-2044N. The mostly investigated parameter was osseointegration, which is compared to that of titanium. A lack of evidence was found with other parameters. CONCLUSIONS Due to its good biocompatibility as well as favorable physical and mechanical properties, zirconia implants are a potential alternative to titanium implants. However, knowledge regarding the implant-restorative complex and related aspects is still immature to recommend its application for daily practice.
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Rezaei NM, Hasegawa M, Ishijima M, Nakhaei K, Okubo T, Taniyama T, Ghassemi A, Tahsili T, Park W, Hirota M, Ogawa T. Biological and osseointegration capabilities of hierarchically (meso-/micro-/nano-scale) roughened zirconia. Int J Nanomedicine 2018; 13:3381-3395. [PMID: 29922058 PMCID: PMC5997135 DOI: 10.2147/ijn.s159955] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Zirconia is a potential alternative to titanium for dental and orthopedic implants. Here we report the biological and bone integration capabilities of a new zirconia surface with distinct morphology at the meso-, micro-, and nano-scales. METHODS Machine-smooth and roughened zirconia disks were prepared from yttria-stabilized tetragonal zirconia polycrystal (Y-TZP), with rough zirconia created by solid-state laser sculpting. Morphology of the surfaces was analyzed by three-dimensional imaging and profiling. Rat femur-derived bone marrow cells were cultured on zirconia disks. Zirconia implants were placed in rat femurs and the strength of osseointegration was evaluated by biomechanical push-in test. RESULTS The rough zirconia surface was characterized by meso-scale (50 µm wide, 6-8 µm deep) grooves, micro-scale (1-10 µm wide, 0.1-3 µm deep) valleys, and nano-scale (10-400 nm wide, 10-300 nm high) nodules, whereas the machined surface was flat and uniform. The average roughness (Ra) of rough zirconia was five times greater than that of machined zirconia. The expression of bone-related genes such as collagen I, osteopontin, osteocalcin, and BMP-2 was 7-25 times upregulated in osteoblasts on rough zirconia at the early stage of culture. The number of attached cells and rate of proliferation were similar between machined and rough zirconia. The strength of osseointegration for rough zirconia was twice that of machined zirconia at weeks two and four of healing, with evidence of mineralized tissue persisting around rough zirconia implants as visualized by electron microscopy and elemental analysis. CONCLUSION This unique meso-/micro-/nano-scale rough zirconia showed a remarkable increase in osseointegration compared to machine-smooth zirconia associated with accelerated differentiation of osteoblasts. Cell attachment and proliferation were not compromised on rough zirconia unlike on rough titanium. This is the first report introducing a rough zirconia surface with distinct hierarchical morphology and providing an effective strategy to improve and develop zirconia implants.
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Affiliation(s)
- Naser Mohammadzadeh Rezaei
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Masakazu Hasegawa
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Manabu Ishijima
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Kourosh Nakhaei
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Takahisa Okubo
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Takashi Taniyama
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Amirreza Ghassemi
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Tania Tahsili
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Wonhee Park
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Makoto Hirota
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Takahiro Ogawa
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
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Dicationic Imidazolium-Based Ionic Liquid Coatings on Zirconia Surfaces: Physico-Chemical and Biological Characterization. J Funct Biomater 2017; 8:jfb8040050. [PMID: 29236088 PMCID: PMC5748557 DOI: 10.3390/jfb8040050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 01/07/2023] Open
Abstract
In the present work, dicationic imidazolium-based ionic liquids (ILs) were investigated as multi-functional coatings on a zirconia (ZrO2) surface to prevent biofilm formation and enhance the wear performance of zirconia while maintaining the material’s compatibility with host cells. ILs containing phenylalanine and methionine were synthesized and deposited on zirconia. Intermolecular interactions driving IL deposition on zirconia were studied using X-ray photoelectron spectroscopy (XPS). Anti-biofilm activity and cell compatibility were evaluated in vitro after one and seven days, and wear performance was tested using a pin-on-disk apparatus. ILs were observed to form strong hydrogen bonds with zirconia. IL containing phenylalanine formed a stable film on the surface after one and seven days in phosphate-buffered saline (PBS) and artificial saliva and showed excellent anti-biofilm properties against Streptococcussalivarius and Streptococcussanguinis. Compatibility with gingival fibroblasts and pre-osteoblasts was maintained, and conditions for growth and differentiation were preserved. A significantly lower coefficient of friction and wear volume loss were observed for IL-coated surfaces as compared to non-coated substrates. Overall, zirconia is an emerging alternative to titanium in dental implants systems, and this study provides additional evidence of the materials’ behavior and IL coatings as a potential surface treatment technology for improvement of its properties.
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Li Y, Li H, Zhang J, Zhao W, Shen J, Jiang D. In vitro evaluation of an yttria-stabilized zirconia reinforced nano-hydroxyapatite/polyamide 66 ternary biomaterial: biomechanics, biocompatibility and bioactivity. RSC Adv 2016. [DOI: 10.1039/c6ra24509a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The characterization of a novel ternary biomaterial composed of nano-hydroxyapatite/polyamide 66/yttria-stabilized tetragonal zirconia.
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Affiliation(s)
- Yuling Li
- Department of Orthopedics
- The First Affiliated Hospital of Chongqing Medical University
- Chongqing
- People's Republic of China
| | - Hong Li
- Research Center for Nano-Biomaterials
- Analytical and Testing Center
- Sichuan University
- Chengdu
- People's Republic of China
| | - Jing Zhang
- Department of Gastroenterology
- The Affiliated Hospital of North Sichuan Medical College
- Nanchong
- People's Republic of China
| | - Weikang Zhao
- Department of Orthopedics
- The First Affiliated Hospital of Chongqing Medical University
- Chongqing
- People's Republic of China
| | - Jieliang Shen
- Department of Orthopedics
- The First Affiliated Hospital of Chongqing Medical University
- Chongqing
- People's Republic of China
| | - Dianming Jiang
- Department of Orthopedics
- The First Affiliated Hospital of Chongqing Medical University
- Chongqing
- People's Republic of China
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