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Park G, Matsuura T, Komatsu K, Ogawa T. Optimizing implant osseointegration, soft tissue responses, and bacterial inhibition: A comprehensive narrative review on the multifaceted approach of the UV photofunctionalization of titanium. J Prosthodont Res 2024:JPR_D_24_00086. [PMID: 38853001 DOI: 10.2186/jpr.jpr_d_24_00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Titanium implants have revolutionized restorative and reconstructive therapy, yet achieving optimal osseointegration and ensuring long-term implant success remain persistent challenges. In this review, we explore a cutting-edge approach to enhancing implant properties: ultraviolet (UV) photofunctionalization. By harnessing UV energy, photofunctionalization rejuvenates aging implants, leveraging and often surpassing the intrinsic potential of titanium materials. The primary aim of this narrative review is to offer an updated perspective on the advancements made in the field, providing a comprehensive overview of recent findings and exploring the relationship between UV-induced physicochemical alterations and cellular responses. There is now compelling evidence of significant transformations in titanium surface chemistry induced by photofunctionalization, transitioning from hydrocarbon-rich to carbon pellicle-free surfaces, generating superhydrophilic surfaces, and modulating the electrostatic properties. These changes are closely associated with improved cellular attachment, spreading, proliferation, differentiation, and, ultimately, osseointegration. Additionally, we discuss clinical studies demonstrating the efficacy of UV photofunctionalization in accelerating and enhancing the osseointegration of dental implants. Furthermore, we delve into recent advancements, including the development of one-minute vacuum UV (VUV) photofunctionalization, which addresses the limitations of conventional UV methods as well as the newly discovered functions of photofunctionalization in modulating soft tissue and bacterial interfaces. By elucidating the intricate relationship between surface science and biology, this body of research lays the groundwork for innovative strategies aimed at enhancing the clinical performance of titanium implants, marking a new era in implantology.
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Affiliation(s)
- Gunwoo Park
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, USA
| | - Takanori Matsuura
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, USA
| | - Keiji Komatsu
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, USA
| | - Takahiro Ogawa
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, USA
- Division of Regenerative and Reconstructive Sciences, UCLA School of Dentistry, Los Angeles, USA
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Burioni R, Silvestrini L, D’Orto B, Tetè G, Nagni M, Polizzi E, Gherlone EF. Could Dental Material Reuse Play a Significant Role in Preservation of Raw Materials, Water, Energy, and Costs? Microbiological Analysis of New versus Reused Healing Abutments: An In Vitro Study. Bioengineering (Basel) 2024; 11:387. [PMID: 38671808 PMCID: PMC11048622 DOI: 10.3390/bioengineering11040387] [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: 03/21/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
AIM The objective of this in vitro study was to compare reused and sterilized versus new healing abutments to assess whether a decontamination and sterilization process performed on resued healing abutments was sufficient to remove residual proteins. The two groups were comparable with respect to patient safety. MATERIALS AND METHODS During the period from September 2022 to October 2023, healing abutment screws were selected and divided into two groups according to whether they were new or previously used in patients. The samples were subjected to a decontamination and sterilization protocol, and results from sample sterility evaluation and assessment of surface protein levels were recorded. RESULTS The obtained results revealed a significant difference in the OD562 nm values between new and reused healing abutment samples. The assay demonstrates how treated healing abutments were still contaminated by residual proteins. CONCLUSION Within the limitations of the present study, although from an infectious point of view sterilization results in the total eradication of pathogens, surface proteins remain on reused healing abutments.
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Affiliation(s)
- Roberto Burioni
- Department of Microbiology and Virology, University “Vita-Salute” San Raffaele, 20132 Milan, Italy; (R.B.); (L.S.)
| | - Lucia Silvestrini
- Department of Microbiology and Virology, University “Vita-Salute” San Raffaele, 20132 Milan, Italy; (R.B.); (L.S.)
| | - Bianca D’Orto
- Department of Dentistry, Dental School, IRCCS San Raffaele Hospital, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (B.D.); (G.T.); (M.N.)
| | - Giulia Tetè
- Department of Dentistry, Dental School, IRCCS San Raffaele Hospital, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (B.D.); (G.T.); (M.N.)
| | - Matteo Nagni
- Department of Dentistry, Dental School, IRCCS San Raffaele Hospital, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (B.D.); (G.T.); (M.N.)
| | - Elisabetta Polizzi
- Chair Center for Oral Hygiene and Prevention, Department of Dentistry, Dental School, IRCCS San Raffaele Hospital, “Vita-Salute” San Raffaele University, 20132 Milan, Italy
| | - Enrico Felice Gherlone
- Dental School, IRCCS San Raffaele Hospital, “Vita-Salute” University, 20132 Milan, Italy;
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Areid N, Abushahba F, Riivari S, Närhi T. Effect of TiO 2 Abutment Coatings on Peri-Implant Soft Tissue Behavior: A Systematic Review of In Vivo Studies. Int J Dent 2024; 2024:9079673. [PMID: 38533472 PMCID: PMC10965279 DOI: 10.1155/2024/9079673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/21/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
Establishing a proper soft tissue adhesion around the implant abutment is essential to prevent microbial invasion, inhibit epithelial downgrowth, and obtain an optimal healing process. This systematic review aims to evaluate the real potential of TiO2 coating on the behavior of peri-implant soft tissue health and maintenance. A specific aim was to evaluate clinically and histologically the effect of TiO2 abutment coating on epithelial and connective tissue attachment. Electronic database searches were conducted from 1990 to 2023 in MEDLINE/PubMed and the Web of Science databases. In total, 15 out of 485 publications were included. Eight studies involved humans, and seven were animal studies. Exposure time ranges from 2 days to 5 years. The peri-implant soft tissue evaluations included clinical assessment (plaque index (PI), peri-implant probing pocket depth (PPD), and bleeding on probing (BoP)), histological as well as histomorphometric analysis. The Office of Health Assessment and Translation (OHAT) Risk of Bias Rating Tool for Human and Animal Studies was used to evaluate the overall quality of the studies included in the review. The results showed some variation but remained within acceptable limits. Within the limitations of this systematic review, the present findings suggest that TiO2 coatings seem to influence soft tissue healing. TiO2-coated abutments with a roughness value between 0.2 and 0.5 μm enhance soft tissue health. Sol-gel-derived TiO2 coatings induced better soft tissue attachment than noncoated machined abutment surfaces. The anodized titanium abutments demonstrate comparable clinical and histological outcomes to conventional machined abutments. However, there was variation among the included studies concerning TiO2 coating characteristics and the measured outcomes used to evaluate the soft tissue response, and therefore, quantitative analysis was not feasible. Long-term in vivo studies with standardized soft tissue analysis and coating surface parameters are necessary before a definitive conclusion can be drawn. OSF Registration No.: 10.17605/OSF.IO/E5RQV.
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Affiliation(s)
- Nagat Areid
- Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Turku, Turku FI-20520, Finland
| | - Faleh Abushahba
- Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Turku, Turku FI-20520, Finland
- Department of Biomaterials Science and Turku Clinical Biomaterial Center-TCBC, Institute of Dentistry, University of Turku, Turku FI-20520, Finland
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Libyan International Medical University (LIMU), Benghazi 339P+62Q, Libya
| | - Sini Riivari
- Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Turku, Turku FI-20520, Finland
| | - Timo Närhi
- Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Turku, Turku FI-20520, Finland
- Wellbeing Services County of South-West Finland, Turku FI-20521, Finland
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Canullo L, Donato A, Savadori P, Radovanovic S, Iacono R, Rakic M. Effect of argon plasma abutment activation on soft tissue healing: RCT with histological assessment. Clin Implant Dent Relat Res 2024; 26:226-236. [PMID: 37853303 DOI: 10.1111/cid.13286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To assess the peri-implant soft tissue profiles between argon plasma treatment (PT) and non-treated (NPT) healing abutments by comparing clinical and histological parameters 2 months following abutment placement. MATERIALS AND METHODS Thirty participants were randomly assigned to argon-plasma treatment abutments group (PT) or non-treated abutments (NPT) group. Two months after healing abutment placement, soft peri-implant tissues and abutment were harvested, and histological and clinical parameters including plaque index, bleeding on probing, and keratinized mucosa diameter (KM) were assessed. Specialized stainings (hematoxylin-eosin and picrocirious red) coupled with immunohistochemistry (vimentin, collagen, and CK10) were performed to assess soft tissue inflammation and healing, and the collagen content keratinization. In addition to standard statistical methods, machine learning algorithms were applied for advanced soft tissue profiling between the test and control groups. RESULTS PT group showed lower plaque accumulation and inflammation grade (6.71% vs. 13.25%, respectively; p-value 0.02), and more advanced connective tissue healing and integration compared to NPT (31.77% vs. 23.3%, respectively; p = 0.009). In the control group, more expressed keratinization was found compared to the PT group, showing significantly higher CK10 (>47.5%). No differences in KM were found between the groups. SIGNIFICANCE PT seems to be a promising protocol for guided peri-implant soft tissue morphogenesis reducing plaque accumulation and inflammation, and stimulating collagen and soft tissue but without effects on epithelial tissues and keratinization.
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Affiliation(s)
- Luigi Canullo
- Department of Surgical Sciences (DISC), University of Genoa, Genova, Italy
- Department of Periodontology, University of Bern, Bern, Switzerland
| | | | - Paolo Savadori
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Maxillo-Facial Surgery and Dental Unit, Milan, Italy
| | - Sandro Radovanovic
- Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - Roberta Iacono
- Department of Oral and Maxillo-facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Mia Rakic
- Facultad de Odontologia, Etiology and Therapy of Periodontal Diseases (ETEP) Research Group, Universidad Complutense de Madrid, Madrid, Spain
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Marin E, Lanzutti A. Biomedical Applications of Titanium Alloys: A Comprehensive Review. MATERIALS (BASEL, SWITZERLAND) 2023; 17:114. [PMID: 38203968 PMCID: PMC10780041 DOI: 10.3390/ma17010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
Titanium alloys have emerged as the most successful metallic material to ever be applied in the field of biomedical engineering. This comprehensive review covers the history of titanium in medicine, the properties of titanium and its alloys, the production technologies used to produce biomedical implants, and the most common uses for titanium and its alloys, ranging from orthopedic implants to dental prosthetics and cardiovascular devices. At the core of this success lies the combination of machinability, mechanical strength, biocompatibility, and corrosion resistance. This unique combination of useful traits has positioned titanium alloys as an indispensable material for biomedical engineering applications, enabling safer, more durable, and more efficient treatments for patients affected by various kinds of pathologies. This review takes an in-depth journey into the inherent properties that define titanium alloys and which of them are advantageous for biomedical use. It explores their production techniques and the fabrication methodologies that are utilized to machine them into their final shape. The biomedical applications of titanium alloys are then categorized and described in detail, focusing on which specific advantages titanium alloys are present when compared to other materials. This review not only captures the current state of the art, but also explores the future possibilities and limitations of titanium alloys applied in the biomedical field.
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Affiliation(s)
- Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Kyoto 606-8585, Japan
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100 Udine, Italy
- Biomedical Research Center, Kyoto Institute of Technology, Sakyo-ku, Kyoto 606-8585, Japan
| | - Alex Lanzutti
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100 Udine, Italy
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Pesce P, Del Fabbro M, Menini M, De Giovanni E, Annunziata M, Khijmatgar S, Canullo L. Effects of abutment materials on peri-implant soft tissue health and stability: A network meta-analysis. J Prosthodont Res 2023; 67:506-517. [PMID: 37081626 DOI: 10.2186/jpr.jpr_d_22_00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
PURPOSE This systematic review aimed to evaluate the effect of the abutment material on peri-implant soft tissue health and stability. STUDY SELECTION An electronic and hand search was conducted until February 2022. Only prospective randomized trials (RCTs) and controlled clinical trials (CCTs) comparing titanium abutments with abutments made of different materials, with a follow-up of at least 6 months, were selected by two independent reviewers. Data on marginal bone loss (MBL) and peri-implant tissue indexes, i.e., plaque index (PI), bleeding on probing (BOP), probing depth (PD), and recession (REC), were collected. The risk of bias for RCTs and non-RCTs was evaluated according to the tool reported in the Cochrane Handbook for Systematic Reviews of Interventions and the ROBINS-I tool, respectively. Both pairwise and network meta-analyses (NMA) were performed. RESULTS We included 18 relevant studies from 1,437 identified studies. Overall, 612 patients were treated, and 848 abutments were inserted. Five studies presented a low risk of bias. Pairwise meta-analysis showed that, as compared to titanium, zirconia abutments presented a significantly reduced MBL (0.20 mm, 95% Confidence Interval CI [0.14-0.26], P < 0.00001). No significant differences were found for the other outcomes. In the NMA, zirconia abutments demonstrated an 83.3% probability of achieving the highest rank in PI, an 87.0% in BOP, and a 65.0% in PD outcome, suggesting that zirconia abutments generally performed better than titanium and alumina abutments. CONCLUSIONS Within the limits of the present study, zirconia abutments seem a viable alternative to titanium ones.
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Affiliation(s)
- Paolo Pesce
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, L. Rosanna Benzi, Genoa, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Menini
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, L. Rosanna Benzi, Genoa, Italy
| | - Emanuele De Giovanni
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, L. Rosanna Benzi, Genoa, Italy
| | - Marco Annunziata
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Luigi Canullo
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, L. Rosanna Benzi, Genoa, Italy
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Cascos R, Celemín-Viñuela A, Mory-Rubiños N, Gómez-Polo C, Ortega R, Agustín-Panadero R, Gómez-Polo M. Influence of the Use of Transepithelial Abutments vs. Titanium Base Abutments on Microgap Formation at the Dental Implant-Abutment Interface: An In Vitro Study. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6532. [PMID: 37834669 PMCID: PMC10573618 DOI: 10.3390/ma16196532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
This in vitro study aimed to assess the presence of microgaps at the implant-abutment interface in monolithic zirconia partial implant-supported fixed prostheses on transepithelial abutments versus Ti-base abutments. METHODS Sixty conical connection dental implants were divided into two groups (n = 30). The control group consisted of three-unit bridge monolithic zirconia connected to two implants by a transepithelial abutment. The test group consisted of monolithic zirconia three-unit restoration connected to two implants directly by a titanium base (Ti-base) abutment. The sample was subjected to thermocycling (10,000 cycles at 5 °C to 55 °C, dwelling time 50 s) and chewing simulation (300,000 cycles, under 200 N at frequencies of 2 Hz, at a 30° angle). The microgap was evaluated at six points (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, and distolingual) of each implant-abutment interface by using a scanning electron microscope (SEM). The data were analyzed using the Mann-Whitney U tests (p > 0.05). RESULTS The SEM analysis showed a smaller microgap at the implant-abutment interface in the control group (0.270 μm) than in the test group (3.902 μm). Statistically significant differences were observed between both groups (p < 0.05). CONCLUSIONS The use or not of transepithelial abutments affects the microgap size. The transepithelial abutments group presented lower microgap values at the interface with the implant than the Ti-base group in monolithic zirconia partial implant-supported fixed prostheses. However, both groups had microgap values within the clinically acceptable range.
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Affiliation(s)
- Rocío Cascos
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (A.C.-V.); (N.M.-R.); (M.G.-P.)
- Department of Nursing and Estomatology, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Department of Prosthetic Dentistry, School of Dentistry, European University of Madrid, 28670 Madrid, Spain;
| | - Alicia Celemín-Viñuela
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (A.C.-V.); (N.M.-R.); (M.G.-P.)
| | - Nataly Mory-Rubiños
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (A.C.-V.); (N.M.-R.); (M.G.-P.)
| | - Cristina Gómez-Polo
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain;
| | - Rocío Ortega
- Department of Prosthetic Dentistry, School of Dentistry, European University of Madrid, 28670 Madrid, Spain;
| | - Rubén Agustín-Panadero
- Prosthodontic and Occlusion Unit, Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, 46010 Valencia, Spain;
| | - Miguel Gómez-Polo
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (A.C.-V.); (N.M.-R.); (M.G.-P.)
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Pera F, Pesce P, Menini M, Fanelli F, Kim BC, Zhurakivska K, Mayer Y, Isola G, Cianciotta G, Crupi A, Ambrogio G, Scotti N, Carossa M. Immediate loading full-arch rehabilitation using transmucosal tissue-level implants with different variables associated: a one-year observational study. Minerva Dent Oral Sci 2023; 72:230-238. [PMID: 37194244 DOI: 10.23736/s2724-6329.23.04782-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND The aim of the present observational study was to investigate the application of transmucosal tissue-level implants in immediate loading full-arch rehabilitation with different variables associated. METHODS Patients needing a full-arch implant rehabilitation were recruited and rehabilitated with four transmucosal tissue level implants. Data related to implants' diameters and lengths, jaw distributions, and presence of angulated abutments were collected. The following outcomes were evaluated: survival rate, marginal bone loss (MBL), Plaque Index (PI), bleeding on probing (BoP), probing depth (PD). Descriptive statistical analysis was reported and univariate linear regression models were built to assess a significant correlation between MBL and the different implant related factors. RESULTS Twenty patients were rehabilitated for a total implant number of 80; 11 rehabilitations were performed on the maxilla, while 9 were performed on the mandible; 48 implants presented a 3.8 mm diameter and 32 implants presented a 4.25 mm diameter. Implants length varied between 10 to 15 mm; 40 tilted implants were connected to angulated abutment, while 40 straight implants were connected directly to the prostheses (no abutments). At the one year follow-up visit no implants failed resulting in an implant survival rate of 100%. The overall MBL was 1.19±0.30 mm. No statistically significant difference (P>0.05) was highlighted among any of the subgroups analyzed. CONCLUSIONS Despite different variables associated, tissue level implants seem to represent a valid option when applied in immediate loading full-arch rehabilitation. Further research and longer observational periods are encouraged to confirm the result.
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Affiliation(s)
- Francesco Pera
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Pesce
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Maria Menini
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Francesco Fanelli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Byung-Chan Kim
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Yaniv Mayer
- School of Graduate Dentistry, Health Care Campus Rambam, Haifa, Israel
| | - Gaetano Isola
- School of Dentistry, Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy
| | - Giulia Cianciotta
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Armando Crupi
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giulia Ambrogio
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Nicola Scotti
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Massimo Carossa
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy -
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Wang C, Wang X, Lu R, Cao X, Yuan D, Chen S. Influence of surface nanotopography and wettability on early phases of peri-implant soft tissue healing: an in-vivo study in dogs. BMC Oral Health 2023; 23:651. [PMID: 37684664 PMCID: PMC10492342 DOI: 10.1186/s12903-023-03347-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND It is well established that nanotopography and wettability of implant surfaces contribute to osseointegration and long-term implant success. However, the effects of a hydrogenated surface with nanotubular and superhydrophilic properties on peri-implant soft tissue remain unclear. This study was designed to study the impact of a modified abutment surface on early soft tissue integration compared with a machined surface. METHODS Thirty-six implants were placed at the bone level in the bilateral mandible of six beagles, followed by healing abutments belonging to the standard machined Ti-6Al-4V alloy abutments (TC4-M), anodized abutments with nanotubes (TC4-Nano), and hydrogenated abutments (TC4-H/Nano) groups, which were randomly screwed to the implants. After two and four weeks of wound healing, the animals were euthanized for histological evaluation. RESULTS A superhydrophilic nanotubular surface developed on the hydrogenated abutment. Histological and histometric analyses revealed similar peri-implant soft tissue healing and dimensions for the three types of abutments at two and four weeks. Connective tissue (CT) length was longer around TC4-H/Nano abutments compared with standard abutments; however, the differences were not statistically significant. Moreover, collagen fibers in the TC4-H/Nano group extended and were attached perpendicularly to the superhydrophilic surface. CONCLUSIONS Our results revealed that the soft tissue interface adjacent to the hydrogenated abutment is comparable to that of the machined abutment. A tendency of increased CT length and perpendicular collagen fibers was observed around the modified abutment. This study suggests that nanotubular/superhydrophilic surfaces could be a promising modification to enhance soft tissue sealing. However, comprehensive studies should be conducted to evaluate the peri-implant soft tissue around the modified abutment immunohistochemically, histopathologically, and clinically.
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Affiliation(s)
- Caiyun Wang
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Xin Wang
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Ran Lu
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Xu Cao
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Dingxiang Yuan
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Su Chen
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China.
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Pesce P, Del Fabbro M, Modenese L, Sandron S, Francetti L, Isola G, Canullo L, Menini M. Influence of implant diameter on implant survival rate and clinical outcomes in the posterior area: a systematic review and meta-analysis. BMC Oral Health 2023; 23:235. [PMID: 37085829 PMCID: PMC10122303 DOI: 10.1186/s12903-023-02962-8] [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: 10/01/2022] [Accepted: 04/11/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE The aim of the present systematic review was to test the hypothesis that the diameter of implants inserted in the posterior area affects implant survival rate, prosthetic survival rate and peri-implant parameters (bleeding on probing (BoP), marginal bone loss (MBL), pocket probing depth (PPD)). MATERIALS AND METHODS An electronic search of studies published until December 2021 was done on three databases (Pubmed, Scopus, Cochrane) independently by two authors. Clinical trials comparing implant survival rate, BoP, MBL and PPD among narrow diameter implants (NDI: ≥ 3.0 mm to < 3.75 mm) and regular diameter implants (RDI ≥ 3.75 mm to < 5 mm) were included. Data were independently extracted by two reviewers. Risk of bias was evaluated according to the Cochrane risk-of-bias tool for randomized studies and to the Joanna Briggs Institute Critical Appraisal tools for non-randomized ones. A pair-wise meta-analysis was conducted on the included studies. RESULTS Seven articles were included out of the 4291 identified from the digital research. Overall, a total of 939 implants were inserted (319 NDI, 620 RDI). Only one study was judged at serious risk of bias. No statistically significant difference was found in implant survival rate (risk ratio 1.01 (95% CI [0.98 to 1.04], P = 0.67)) while the difference was significant for BoP (mean difference 2.89 (95% CI [0.30 to 5.48] mm, P = 0.03)) with higher values for NDI. Higher MBL was identified among regular diameter implants (mean difference -0.15 mm (95% CI [-0.32 to 0.01 mm], P = 0.07). No statistically significant differences were identified for prosthetic survival and PPD. CONCLUSIONS No differences were found in implant survival rate between narrow and regular implants. A higher BoP was identified among narrow implants, but there was no higher bone loss. It is not possible to draw definitive conclusions about the use of narrow-diameter implants in the posterior region.
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Affiliation(s)
- Paolo Pesce
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Modenese
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- IRCCS Orthopedic Institute Galeazzi, Dental Clinic, Milan, Italy
| | - Stefano Sandron
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132, Genoa, Italy
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- IRCCS Orthopedic Institute Galeazzi, Dental Clinic, Milan, Italy
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical SpecialtiesSchool of Dentistry, University of Catania Via S, Sofia 78, Pad. 2 Piano -1 Stanza 53, 95124, Catania, Italy
| | - Luigi Canullo
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132, Genoa, Italy
| | - Maria Menini
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132, Genoa, Italy
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11
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Wen Y, Dong H, Lin J, Zhuang X, Xian R, Li P, Li S. Response of Human Gingival Fibroblasts and Porphyromonas gingivalis to UVC-Activated Titanium Surfaces. J Funct Biomater 2023; 14:jfb14030137. [PMID: 36976061 PMCID: PMC10051447 DOI: 10.3390/jfb14030137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
Ultraviolet (UV) photofunctionalization has been demonstrated to synergistically improve the osteoblast response and reduce biofilm formation on titanium (Ti) surfaces. However, it remains obscure how photofunctionalization affects soft tissue integration and microbial adhesion on the transmucosal part of a dental implant. This study aimed to investigate the effect of UVC (100–280 nm) pretreatment on the response of human gingival fibroblasts (HGFs) and Porphyromonas gingivalis (P. g.) to Ti-based implant surfaces. The smooth and anodized nano-engineered Ti-based surfaces were triggered by UVC irradiation, respectively. The results showed that both smooth and nano-surfaces acquired super hydrophilicity without structural alteration after UVC photofunctionalization. UVC-activated smooth surfaces enhanced the adhesion and proliferation of HGFs compared to the untreated smooth ones. Regarding the anodized nano-engineered surfaces, UVC pretreatment weakened the fibroblast attachment but had no adverse effects on proliferation and the related gene expression. Additionally, both Ti-based surfaces could effectively inhibit P. g. adhesion after UVC irradiation. Therefore, the UVC photofunctionalization could be more potentially favorable to synergistically improve the fibroblast response and inhibit P. g. adhesion on the smooth Ti-based surfaces.
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Affiliation(s)
- Yin Wen
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, China
| | - Hao Dong
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, China
| | - Jiating Lin
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, China
| | - Xianxian Zhuang
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, China
| | - Ruoting Xian
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, China
| | - Ping Li
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, China
- Correspondence: (P.L.); (S.L.)
| | - Shaobing Li
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, China
- First Clinical Medical College, Xinjiang Medical University, Urumqi 830011, China
- The First People’s Hospital of Kashgar Region, Kashgar 844000, China
- Correspondence: (P.L.); (S.L.)
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12
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Hamilton A, Putra A, Nakapaksin P, Kamolroongwarakul P, Gallucci GO. Implant prosthodontic design as a predisposing or precipitating factor for peri-implant disease: A review. Clin Implant Dent Relat Res 2023. [PMID: 36691784 DOI: 10.1111/cid.13183] [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: 10/24/2022] [Revised: 12/20/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023]
Abstract
Over the past decade, emerging evidence indicates a strong relationship between prosthetic design and peri-implant tissue health. The objective of this narrative review was to evaluate the evidence for the corresponding implant prosthodontic design factors on the risk to peri-implant tissue health. One of the most important factors to achieve an acceptable implant restorative design is the ideal implant position. Malpositioned implants often result in a restorative emergence profile at the implant-abutment junction that can restrict the access for patients to perform adequate oral hygiene. Inadequate cleansability and poor oral hygiene has been reported as a precipitating factors to induce the peri-implant mucositis and peri-implantitis and are influenced by restorative contours. The implant-abutment connection, restorative material selection and restoration design are also reported in the literature as having the potential to influence peri-implant sort tissue health.
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Affiliation(s)
- Adam Hamilton
- Division of Oral Restorative and Rehabilitative Sciences, University of Western Australia, Perth, Western Australia, Australia.,Division of Regenerative and Implant Sciences, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Armand Putra
- Private Practice, Perth, Western Australia, Australia.,Department of Graduate Prosthodontic, University of Washington, Seattle, Washington, USA
| | - Pranai Nakapaksin
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Pongrapee Kamolroongwarakul
- Dental Center, Private Hospital, Bangkok, Thailand.,Department of Graduate Prosthodontic, Mahidol University, Bangkok, Thailand
| | - German O Gallucci
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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13
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Canullo L, Rakic M, Corvino E, Burton M, Krumbeck JA, Chittoor Prem A, Ravidà A, Ignjatović N, Sculean A, Menini M, Pesce P. Effect of argon plasma pre-treatment of healing abutments on peri-implant microbiome and soft tissue integration: a proof-of-concept randomized study. BMC Oral Health 2023; 23:27. [PMID: 36650477 PMCID: PMC9843976 DOI: 10.1186/s12903-023-02729-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Biofilm-free implant surface is ultimate prerequisite for successful soft and bone tissue integration. Objective of the study was to estimate the effects of argon plasma healing abutment pre-treatment (PT) on peri-implant soft-tissue phenotype (PiSP), inflammation, plaque accumulation and the microbiome (PiM) between non-treated (NPT) and treated (PT) abutments following 3-months healing period. The hypothesis was that cell-conductive and antimicrobial properties of PT would yield optimal conditions for soft tissue integration. MATERIAL AND METHODS Two months following second-phase surgery, microbiological and clinical parameters were assessed around thirty-six healing abutments with two types of microtopography, smooth surface (MACHINED) and ultrathin threaded microsurface (ROUGH). A two level randomization schema was used to achieve equal distribution and abutments were randomly divided into rough and machined groups, and then divided into PT and NPT groups. PiM was assessed using next-generation DNA sequencing. RESULTS PiM bacterial composition was highly diverse already two months post-implantation, consisting of key-stone pathogens, early and late colonizers, while the mycobiome was less diverse. PT was associated with lower plaque accumulation and inflammation without significant impact on PiSP, while in NPT clinical parameters were increased and associated with periopathogens. NPT mostly harbored late colonizers, while PT exerted higher abundance of early colonizers suggesting less advanced plaque formation. Interaction analysis in PT demonstrated S. mitis co-occurrence with pro-healthy Rothia dentocariosa and co-exclusion with Parvimonas micra, Porphyromonas endodontalis and Prevotella oris. PiSP parameters were generally similar between the groups, but significant association between PiM and keratinized mucosa width was observed in both groups, with remarkably more expressed diversity in NPT compared to PT. PT resulted in significantly lower BOP and PI around rough and machined abutments, respectively, without specific effect on PiM and PiSP. CONCLUSIONS PT contributed to significantly the less advanced biofilm accumulation and inflammation without specific effects on PiSP.
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Affiliation(s)
- Luigi Canullo
- grid.5734.50000 0001 0726 5157Department of Periodontology, University of Bern, Bern, Switzerland ,grid.5606.50000 0001 2151 3065Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Mia Rakic
- grid.4795.f0000 0001 2157 7667ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Emilio Corvino
- grid.8404.80000 0004 1757 2304University of Florence, Florence, Italy
| | - Maria Burton
- Zymo Research Corporation, 17062 Murphy Ave, Irvine, CA 92614 USA
| | - Janina A. Krumbeck
- Zymo Research Corporation, 17062 Murphy Ave, Irvine, CA 92614 USA ,Pangea Laboratory, 14762 Bentley Cir., Tustin, CA 92780 USA
| | | | | | - Nenad Ignjatović
- grid.419857.60000 0001 2221 9722Institute of Technical Science of the Serbian Academy of Sciences and Arts, 11000 Belgrade, Serbia
| | - Anton Sculean
- grid.5734.50000 0001 0726 5157Department of Periodontology, University of Bern, Bern, Switzerland
| | - Maria Menini
- grid.5606.50000 0001 2151 3065Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Paolo Pesce
- grid.5606.50000 0001 2151 3065Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
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14
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Pera F, Menini M, Alovisi M, Crupi A, Ambrogio G, Asero S, Marchetti C, Canepa C, Merlini L, Pesce P, Carossa M. Can Abutment with Novel Superlattice CrN/NbN Coatings Influence Peri-Implant Tissue Health and Implant Survival Rate Compared to Machined Abutment? 6-Month Results from a Multi-Center Split-Mouth Randomized Control Trial. MATERIALS (BASEL, SWITZERLAND) 2022; 16:ma16010246. [PMID: 36614586 PMCID: PMC9821948 DOI: 10.3390/ma16010246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/12/2022] [Accepted: 12/23/2022] [Indexed: 05/12/2023]
Abstract
Background: The aim of the present multi-center split-mouth randomized control trial was to investigate the effect on peri-implant tissue of abutment with chromium nitride/ niobium nitride (CrN/NbN) coatings (superlattice) compared to traditional machined surface. Methods: Two adjacent posterior implants were inserted in 20 patients. A machined abutment was randomly screwed on either the mesial or distal implant, while a superlattice abutment was screwed on the other one. Implant survival rate, peri-implant probing depth (PPD), plaque index (PI), and bleeding index (BI) were collected 6 months after surgery, while marginal bone loss (MBL) was evaluated at T0 and T6.; Results: Implant survival rate was 97.7%. A total MBL of 0.77 ± 0.50 mm was recorded for superlattice abutments, while a mean MBL of 0.79 ± 0.40 mm was recorded for the abutment with machined surface. A mean PPD of 1.3 ± 0.23 mm was recorded for the superlattice Group, and a mean PPD of 1.31 ± 0.3 was recorded for the machined surface Group. PI was of 0.55 ± 0.51 for superlattice Group and 0.57 ± 0.50 for machined Group, while BI was of 0.47 ± 0.49 for superlattice Group and of 0.46 ± 0.40 for the machined one. No statistically significant difference was highlighted between the two Groups (p > 0.05). Conclusions: After a 6-month observational period, no statistically significant differences were highlighted between superlattice abutment and traditional machined abutment. Further in vitro studies as well as clinical research with longer follow-ups are required to better investigate the surface properties of the novel abutments’ superlattice coating and its effect on the oral tissues.
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Affiliation(s)
- Francesco Pera
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, 10126 Turin, Italy
| | - Maria Menini
- Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Mario Alovisi
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, 10126 Turin, Italy
| | - Armando Crupi
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, 10126 Turin, Italy
| | - Giulia Ambrogio
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, 10126 Turin, Italy
| | - Sofia Asero
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, 10126 Turin, Italy
| | - Carlotta Marchetti
- Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Camilla Canepa
- Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Laura Merlini
- Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Paolo Pesce
- Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Massimo Carossa
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, 10126 Turin, Italy
- Correspondence:
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15
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Fischer NG, Aparicio C. Junctional epithelium and hemidesmosomes: Tape and rivets for solving the "percutaneous device dilemma" in dental and other permanent implants. Bioact Mater 2022; 18:178-198. [PMID: 35387164 PMCID: PMC8961425 DOI: 10.1016/j.bioactmat.2022.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/14/2022] [Accepted: 03/12/2022] [Indexed: 02/06/2023] Open
Abstract
The percutaneous device dilemma describes etiological factors, centered around the disrupted epithelial tissue surrounding non-remodelable devices, that contribute to rampant percutaneous device infection. Natural percutaneous organs, in particular their extracellular matrix mediating the "device"/epithelium interface, serve as exquisite examples to inspire longer lasting long-term percutaneous device design. For example, the tooth's imperviousness to infection is mediated by the epithelium directly surrounding it, the junctional epithelium (JE). The hallmark feature of JE is formation of hemidesmosomes, cell/matrix adhesive structures that attach surrounding oral gingiva to the tooth's enamel through a basement membrane. Here, the authors survey the multifaceted functions of the JE, emphasizing the role of the matrix, with a particular focus on hemidesmosomes and their five main components. The authors highlight the known (and unknown) effects dental implant - as a model percutaneous device - placement has on JE regeneration and synthesize this information for application to other percutaneous devices. The authors conclude with a summary of bioengineering strategies aimed at solving the percutaneous device dilemma and invigorating greater collaboration between clinicians, bioengineers, and matrix biologists.
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Affiliation(s)
- Nicholas G. Fischer
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, MN, 55455, USA
| | - Conrado Aparicio
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, MN, 55455, USA
- Division of Basic Research, Faculty of Odontology, UIC Barcelona – Universitat Internacional de Catalunya, C/. Josep Trueta s/n, 08195, Sant Cugat del Valles, Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), C/. Baldiri Reixac 10-12, 08028, Barcelona, Spain
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16
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Clinical Outcomes of Dental Implants with Two Different Internal Connection Configurations—A RCT. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4040046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The aim of the present study was to highlight clinical and radiographical differences among implants sharing the same macro-geometry but with two different prosthodontic connections. Methods: Patients requiring at least 2 implants in the posterior area of the jaw were randomly divided into two groups (Conical (CS) and Internal Hexagonal (IH) connection). At implant surgery (T0), insertion torque, implant stability quotient (ISQ values recorded by resonance frequency analysis, RFA), and soft tissue thickness (STH) were assessed. A 1-abutment/1-time protocol was applied, and the prosthesis was realized following a fully digital workflow. At the 36-month follow-up periapical x-rays were taken. In order to statistically analyse differences among the two groups and the different variables, paired T-test was used. Linear regression analysis was conducted to analyze how marginal bone loss (MBL) was affected by other independent variables. A neural network created to predict the success (good or not good) of the implant itself was implemented. Results: 30 out of 33 patients (14 males, 16 females, mean age: 68.94 ± 13.01 years) (32 CS and 32 IH) were analyzed. No implants failed. Marginal bone loss at the 3-year time-point was 0.33 ± 0.34 mm and 0.43 ± 0.37 mm respectively for CS and IH with a significant difference between the two groups (p = 0.004). The presence of keratinized gingiva (p = 0.034) significantly influenced MBL. Conclusions: Both the implant connections investigated presented optimal clinical outcomes with minimal marginal bone loss; however, CS implants and implants with the presence of a greater width of keratinized tissue presented significantly lower MBL.
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17
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Halim FC, Pesce P, De Angelis N, Benedicenti S, Menini M. Comparison of the Clinical Outcomes of Titanium and Zirconia Implant Abutments: A Systematic Review of Systematic Reviews. J Clin Med 2022; 11:jcm11175052. [PMID: 36078982 PMCID: PMC9456707 DOI: 10.3390/jcm11175052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 01/07/2023] Open
Abstract
Background: Dental implants are widely used and in order to answer to esthetic demands, zirconia has been introduced as an abutment material as an alternative to titanium. Several studies have been published on this topic, but the results have been often inconsistent. The objective of the present study is to systematically analyze the existing literature comparing clinical outcomes of titanium and zirconia implant abutments. The study was designed as a systematic review of systematic reviews. Methods: This systematic review is in accordance with the Transparent Reporting of Systematic Reviews and Meta-analyses. A MEDLINE/PubMed, Cochrane Database of Systematic Reviews and SCOPUS literature search was performed up to and including June 2021. Data were extracted independently by two reviewers and tAMSTAR2 was used to assess the quality of the systematic reviews. Results: The electronic search identified 1146 papers, and 175 duplicates were removed. After manual screening, 954 studies were excluded and the final analysis was conducted on 11 papers. Both mechanical and esthetic outcomes and biological complications were analyzed. Conclusions: It can be concluded that titanium abutments have a better mechanical resistance than zirconia ones. Plaque accumulation is reported to be slightly higher on titanium but without any significant inflammatory process. The esthetic outcomes seem to be more related to the thickness (>3 mm) of the soft tissues than to the abutment material.
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Affiliation(s)
| | - Paolo Pesce
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Nicola De Angelis
- Division of Restorative Dentistry and Endodontics, Department of Surgical Sciences (DISC), University of Genoa, 16126 Genoa, Italy
- Dental Department, University Tunku Abdul Raman, Sungai Buloh 47000, Malaysia
- Dental Department, University Trisakti, Jakarta 11440, Indonesia
- Correspondence:
| | - Stefano Benedicenti
- Division of Restorative Dentistry and Endodontics, Department of Surgical Sciences (DISC), University of Genoa, 16126 Genoa, Italy
| | - Maria Menini
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
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18
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Campos MRD, Oliveira TTD, Botelho AL, Reis ACD. Mechanical, Chemical, and Biological Properties of 3D-Printed Abutments: A Systematic Review. JOURNAL OF ADVANCED ORAL RESEARCH 2022. [DOI: 10.1177/23202068221099772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: A systematic review of the methods of 3D printing and the materials used so far for the manufacture of abutments was performed to evaluate whether their clinical use is indicated through the mechanical, chemical, and biological analyses carried out. Materials and Methods: An electronic search conducted by three independent reviewers was carried out in the PubMed, Web of Science, Cochrane Library, Science Direct, and Lilac databases. The inclusion criterion was researching articles in English that contained as subject the manufacturing of abutments through 3D printing/additive manufacturing. Any meta-analyses, reviews, book chapters, abstracts, letters, conferences papers, and studies without abutments printed were excluded. Results: We found 780 references, which after applying the exclusion criteria resulted in the final inclusion of seven articles for review. The studies had a high heterogeneity, showing different materials and methodologies to manufacture abutments, which makes a comparison between them difficult, and for this reason it was not possible to carry out a meta-analysis with the data found. Conclusions: Even with the limitations found in the present research, it is possible to conclude that printed abutments have adequate mechanical, chemical, and biological properties that can indicate their clinical use. 3D printing presents high accuracy and speed and can produce customized abutments according to each case.
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Affiliation(s)
- Murilo Rodrigues de Campos
- Department of Dental Materials and Prosthodontics, Ribeirão Preto Dental School, Ribeirão Preto, SP, Brazil
| | | | - André Luís Botelho
- Department of Dental Materials and Prosthodontics, Ribeirão Preto Dental School, Ribeirão Preto, SP, Brazil
| | - Andréa Cândido dos Reis
- Department of Dental Materials and Prosthodontics, Ribeirão Preto Dental School, Ribeirão Preto, SP, Brazil
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19
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Cao X, Wu K, Wang C, Guo Y, Lu R, Wang X, Chen S. Graphene Oxide Loaded on TiO 2-Nanotube-Modified Ti Regulates the Behavior of Human Gingival Fibroblasts. Int J Mol Sci 2022; 23:ijms23158723. [PMID: 35955856 PMCID: PMC9368857 DOI: 10.3390/ijms23158723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022] Open
Abstract
Surface topography, protein adsorption, and the loading of coating materials can affect soft tissue sealing. Graphene oxide (GO) is a promising candidate for improving material surface functionalization to facilitate soft tissue integration between cells and biomaterials. In this study, TiO2 nanotubes (TNTs) were prepared by the anodization of Ti, and TNT-graphene oxide composites (TNT-GO) were prepared by subsequent electroplating. The aim of this study was to investigate the effect of TNTs and TNT-GO surface modifications on the behavior of human gingival fibroblasts (HGFs). Commercially pure Ti and TNTs were used as the control group, and the TNT-GO surface was used as the experimental group. Scanning electron microscopy, X-ray photoelectron spectroscopy, and X-ray diffraction were used to perform sample characterization. Cell adhesion, cell proliferation, cell immunofluorescence staining, a wound-healing assay, real-time reverse-transcriptase polymerase chain reaction (RT-PCR), and Western blotting showed that the proliferation, adhesion, migration, and adhesion-related relative gene expression of HGFs on TNT-GO were significantly enhanced compared to the control groups, which may be mediated by the activation of integrin β1 and the MAPK-Erk1/2 pathway. Our findings suggest that the biological reactivity of HGFs can be enhanced by the TNT-GO surface, thereby improving the soft tissue sealing ability.
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Affiliation(s)
| | | | | | | | | | | | - Su Chen
- Correspondence: ; Tel.: +86-010-5709-9270
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20
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Mühl A, Szabó P, Krafcsik O, Aigner Z, Kopniczky J, Ákos Nagy, Marada G, Turzó K. Comparison of surface aspects of turned and anodized titanium dental implant, or abutment material for an optimal soft tissue integration. Heliyon 2022; 8:e10263. [PMID: 36042714 PMCID: PMC9420512 DOI: 10.1016/j.heliyon.2022.e10263] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/06/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Soft tissue integration of dental implants lags behind natural biological integration of teeth mainly because of non-optimal surface features. Peri-implant infections resulting in loss of supporting bone jeopardize the success of implants. Our aim was to compare an anodized surface design with a turned one for a more optimal surface. Methods Morphological and chemical structures of turned and anodized Ti surfaces (grade 5: Ti6Al4V) discs were examined by scanning electron microscopy (SEM-EDS), energy dispersive X-ray spectroscopy (EDS), and atomic force microscopy (AFM). The hydrophilic or hydrophobic features of the surfaces were determined by dynamic contact angle measurement. Results SEM and AFM revealed significant differences in the morphology and roughness (Ra) of the samples. Anodized discs presented a granular structure, while turned ones had circular grooves. The roughness was significantly higher for the anodized samples compared to the turned ones. XPS and EDS confirmed typical elements for both Ti6Al4V samples. Due to anodization, the amount of Ti (IV) had increased and Ti (III) had decreased in the thicker oxide layer. Anodized samples resulted in a more hydrophilic surface than the turned ones. Significance The results suggest that the tested anodized samples present optimal surface characteristics to be used as abutment material for an optimal soft tissue integration. Optimization of soft tissue barrier is a crucial factor in long-term dental implant success and peri-implant health. The applied anodization is an easy-to-use process to change the color of titanium to a more favorable yellow. Changes in surface morphology and hydrophilic features were favorable for soft tissue attachment. Anodized samples presented optimal surface composition to be used as abutment material of dental implants.
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Affiliation(s)
- Attila Mühl
- Private Dental Office, H-7300 Pécsi út 1., Komló, Hungary
| | - Péter Szabó
- Szentágothai Research Center, Environmental Analytical and Geoanalytical Research Group, Ifjúság útja 20., H-7624, Pécs, Hungary
| | - Olga Krafcsik
- Department of Atomic Physics, Budapest University of Technology and Economics, Budafoki út 8., H-1111, Budapest, Hungary
| | - Zoltán Aigner
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Zrínyi u. 9., H-6720, Szeged, Hungary
| | - Judit Kopniczky
- Department of Optics and Quantum Electronics, University of Szeged, Dóm tér 9., H-6720, Szeged, Hungary
| | - Ákos Nagy
- Dental School, Medical Faculty, University of Pécs, Dischka Gy. u. 5., H-7621, Pécs, Hungary
| | - Gyula Marada
- Dental School, Medical Faculty, University of Pécs, Dischka Gy. u. 5., H-7621, Pécs, Hungary
| | - Kinga Turzó
- Dental School, Medical Faculty, University of Pécs, Dischka Gy. u. 5., H-7621, Pécs, Hungary
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Dib-Zaitum I, Guadilla-González Y, Flores-Fraile J, Dib-Zakkour J, Benito-Garzón L, Montero J. Effect Morphology and Surface Treatment of the Abutments of Dental Implants on the Dimension and Health of Peri-Implant Biological Space. MATERIALS 2022; 15:ma15134422. [PMID: 35806548 PMCID: PMC9267537 DOI: 10.3390/ma15134422] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 12/10/2022]
Abstract
Statement of the problem: The gingival configuration around implant abutments is of paramount importance for preserving the underlying marginal bone, and hence for the long-term success of dental implants. Objective: The objective was to study, clinically and histologically, the effects of the change in the morphology of abutments connected to the endosseous implant, and of their surface treatment. In particular, the objective was to ascertain the effect of changing the shape of the transepithelial pillar and the treatment of its surface on the dimensions, quality and health of the components of the peri-implant biological space, such as the dimensions of the epithelial and connective tissues of the biological space, the concentration of inflammatory cells and the density of collagen fibers. Methods: A clinical trial of 10 patients with a totally edentulous maxilla, who had four implants (IPX4010_GALIMPLANT®, Sarria, Spain) inserted in the area of the first and second molars on both sides with computer-guided implant surgery, was conducted with the final purpose of assessing the quality of the peri-implant soft tissue attachment around the transepithelial abutments which were employed (aesthetic machined (RM), aesthetic anodized (RA), slim machined (SM) and slim anodized (SA)). At 8 weeks and following the collection of the samples (removal of the implant-abutment assembly with its surrounding hard and soft tissue) and their processing for subsequent histological and histomorphometric analysis in order to study the dimensions, quality and health of the peri-implant soft tissue area, the variables previously mentioned were determined according to the aims of the study. By using appropriate diameter trephine in order to obtain a useful fringe of soft tissue around the transepithelial pillars, ANOVA and chi-square tests were performed. Results: The SPSS statistical analysis ANOVA results revealed that the machined slim abutments have a better performance considering the variables analyzed with epithelial and connective attachment heights of 1.52 mm and 2.3 mm, respectively, and that connective density (density of collagen fibers) was high at 85.7% of the sample size affected by the design for the slim abutments and 92.9% of the high-density sample size affected by the surface treatment for the machined surface. Conclusions: All variables studied, despite the small sample size, showed the superiority of the slim machined abutment among the four groups.
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Affiliation(s)
- Ibrahim Dib-Zaitum
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain; (I.D.-Z.); (Y.G.-G.); (J.D.-Z.); (J.M.)
| | - Yasmina Guadilla-González
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain; (I.D.-Z.); (Y.G.-G.); (J.D.-Z.); (J.M.)
| | - Javier Flores-Fraile
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain; (I.D.-Z.); (Y.G.-G.); (J.D.-Z.); (J.M.)
- Correspondence:
| | - Juan Dib-Zakkour
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain; (I.D.-Z.); (Y.G.-G.); (J.D.-Z.); (J.M.)
| | - Lorena Benito-Garzón
- Department of Human Anatomy and Histology, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain;
| | - Javier Montero
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain; (I.D.-Z.); (Y.G.-G.); (J.D.-Z.); (J.M.)
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Roth LA, Bastos MF, Melo MA, Barão VAR, Costa RC, Giro G, Souza JGS, Grzech-Leśniak K, Shibli JA. The Potential Role of a Surface-Modified Additive-Manufactured Healing Abutment on the Expression of Integrins α2, β1, αv, and β6 in the Peri-Implant Mucosa: A Preliminary Human Study. Life (Basel) 2022; 12:life12070937. [PMID: 35888027 PMCID: PMC9316083 DOI: 10.3390/life12070937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
The stability of peri-implant soft tissues is essential for long-term success. Integrins play a vital role in biological processes through developing and maintaining cell interactions; however, few studies have evaluated the effects of modifications to abutment surfaces on cell adhesion across integrin expression. Therefore, this pilot study assessed the influence of different surface topographies of titanium healing abutments prepared by additive manufacturing (AM) on the gene expression levels of the integrin subunits α2, β1, αv, and β6 in the human peri-implant mucosa. Thirteen healthy adults were included. Depending on the number of required implants, the subjects were distributed in different groups as a function of healing abutment topography: group 1 (fully rough surface); group 2 (upper machined + lower rough); group 3 (rough upper surface + lower machined); group 4 (fully machined). A total of 40 samples (n = 10/group) of the peri-implant mucosa around the abutments were collected 30 days after implant placement, and subsequently, the gene expression levels were evaluated using real-time PCR. The levels of gene expression of β1-subunit integrin were upregulated for individuals receiving fully rough surface abutments compared with the other surface topographies (p < 0.05). However, the healing abutment topography did not affect the gene expression levels of the α2, αv, and β6 integrin subunits in the human peri-implant mucosa (p > 0.05). This preliminary study suggested that controlled modifications of the surface topography of titanium healing abutments produced by AM may influence the quality of the peri-implant mucosa in the early stages of the soft tissue healing process.
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Affiliation(s)
- Leandro Amadeu Roth
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (L.A.R.); (M.A.M.); (G.G.); (J.G.S.S.); or (J.A.S.)
| | - Marta Ferreira Bastos
- Postgraduate Program in Aging Sciences, Universidade São Judas Tadeu, Rua. Taquari, 546, São Paulo 03166-000, SP, Brazil;
| | - Marcelo A. Melo
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (L.A.R.); (M.A.M.); (G.G.); (J.G.S.S.); or (J.A.S.)
| | - Valentim A. R. Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba 13414-903, SP, Brazil; (V.A.R.B.); (R.C.C.)
| | - Raphael C. Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba 13414-903, SP, Brazil; (V.A.R.B.); (R.C.C.)
| | - Gabriela Giro
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (L.A.R.); (M.A.M.); (G.G.); (J.G.S.S.); or (J.A.S.)
| | - João Gabriel Silva Souza
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (L.A.R.); (M.A.M.); (G.G.); (J.G.S.S.); or (J.A.S.)
- Dental Science School (Faculdade de Ciências Odontológicas—FCO), Av. Waldomiro Marcondes Oliveira, 20-Ibituruna, Montes Claros 39401-303, MG, Brazil
| | - Kinga Grzech-Leśniak
- Department of Oral Surgery, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA
- Correspondence:
| | - Jamil Awad Shibli
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (L.A.R.); (M.A.M.); (G.G.); (J.G.S.S.); or (J.A.S.)
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Gianfreda F, Bollero P, Muzzi M, Di Giulio A, Nicolai E, Canullo L. The Effects of Ultrasonic Scaling and Air-Abrasive Powders on the Decontamination of 9 Implant-Abutment Surfaces: Scanning Electron Analysis and In Vitro Study. Dent J (Basel) 2022; 10:dj10030036. [PMID: 35323237 PMCID: PMC8947291 DOI: 10.3390/dj10030036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 12/20/2022] Open
Abstract
(1) Background: The aim of this study is to understand from a microscopic point of view whether bicarbonate air-abrasive powders associated with ultrasonic instruments can decontaminate nine different surfaces used for the abutment/implant junction. Fibroblast growth was carried out on decontaminated surface in order to understand if there are significative differences in terms of biocompatibility. (2) Methods: After taking samples of patient plaque, nine different surfaces were contaminated and analyzed by SEM, then their wettability was evaluated. Fibroblasts were cultured on the decontaminated surfaces to understand their ability to establish a connective tissue seal after decontamination. The results were analyzed from a statistical point of view to hypothesize a mathematical model capable of explaining the properties of the surfaces. (3) Results: A negative correlation between roughness and contamination has been demonstrated, whereas a weak correlation was observed between wettability and decontamination capacity. All surfaces were topographically damaged after the decontamination treatment. Grade 5 titanium surfaces appear tougher, whereas anodized surfaces tend to lose the anodizing layer. (4) Conclusions: further studies will be needed to fully understand how these decontaminated surfaces affect the adhesion, proliferation and differentiation of fibroblasts and osteoblasts.
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Affiliation(s)
- Francesco Gianfreda
- Department of Industrial Engineering, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Patrizio Bollero
- Department of System Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Maurizio Muzzi
- Department of Science, University Roma Tre, Viale G. Marconi, 446, 00146 Rome, Italy; (M.M.); (A.D.G.)
| | - Andrea Di Giulio
- Department of Science, University Roma Tre, Viale G. Marconi, 446, 00146 Rome, Italy; (M.M.); (A.D.G.)
| | - Eleonora Nicolai
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy;
| | - Luigi Canullo
- Independent Researcher, 00198 Rome, Italy
- Correspondence:
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Rathe F, Junker R, Gröger S, Meyle J, Schlee M. Inflammatory effects of individualized abutments bonded onto titanium base on peri-implant tissue health: A randomized controlled clinical trial. Clin Implant Dent Relat Res 2021; 23:874-882. [PMID: 34668304 DOI: 10.1111/cid.13050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/29/2021] [Accepted: 09/28/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND In implant prosthodontics, computer-assisted design and computer-assisted manufacturing (CAD/CAM) zirconia abutments bonded onto titanium bases are frequently used in prosthetic dentistry. Unpolymerized monomer of the bonding material or the adhesive gap itself may have a negative effect on peri-implant tissue health. However, evidence addressing this problem is not available. PURPOSE The aim of the current trial was to study inflammatory effects of individualized abutments bonded onto titanium bases. MATERIAL AND METHOD A total of 24 patients with one test abutment and one control abutment each participated in this prospective, double-blind, randomized controlled clinical trial. Thereby, test abutments were CAD/CAM titanium abutments bonded onto titanium abutments (Ti-Base). As control abutments individualized, one-piece CAD/CAM titanium abutments were used. At abutment installation as well as 6 and 12 months thereafter bone level changes, clinical parameters as well as Il-1β levels were assessed. RESULTS Neither for bone level or clinical parameters nor for Il-1β levels, significant differences between test and control abutments could be found. However, in both groups Il-1β levels were significantly elevated at both the 6 and 12 months follow-up compared to baseline. CONCLUSION Within the limits of this RCT, it can be concluded that effects on the inflammatory state of peri-implant tissues do not differ between individualized abutments bonded onto Ti-Bases and individualized one-piece abutments.
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Affiliation(s)
- Florian Rathe
- Department of Prosthodontics and Biomaterials, DANUBE Private University, Krems an der Donau, Austria.,Private Office of Implantology and Periodontology, Forchheim, Germany
| | - Rüdiger Junker
- Department of Prosthodontics and Biomaterials, DANUBE Private University, Krems an der Donau, Austria
| | - Sabine Gröger
- Department of Periodontology, Justus Liebig-University, Gießen, Germany
| | - Jörg Meyle
- Department of Periodontology, Justus Liebig-University, Gießen, Germany
| | - Markus Schlee
- Private Office of Implantology and Periodontology, Forchheim, Germany.,Department of Maxillofacial Surgery, Johann Wolfgang von Goethe University, Frankfurt, Germany
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Abstract
Implant supported dental prostheses are increasingly used in dental practice. The aim of this narrative review is to present the influence of transmucosal surface of prosthetic abutment and implant on peri-implant tissue. The article describes causes of bone loss around the dental implant. Moreover, properties of different materials are compared and discussed. The advantages, disadvantages, and biomechanical concept of different implant-abutment connections are presented. The location of connections in relation to the bone level and the influence of microgap between the abutment and implant are described. Additionally, the implant abutments for cemented and screwed prosthetic restorations are compared. The influence of implant and abutment surface at the transmucosal level on peri-implant soft tissue is discussed. Finally, the biological aspect of abutment-implant connection is analyzed.
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Biocompatibility of Lithium Disilicate and Zirconium Oxide Ceramics with Different Surface Topographies for Dental Implant Abutments. Int J Mol Sci 2021; 22:ijms22147700. [PMID: 34299319 PMCID: PMC8306444 DOI: 10.3390/ijms22147700] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/12/2021] [Accepted: 07/17/2021] [Indexed: 01/11/2023] Open
Abstract
Gingivafibroblasts were cultured on lithium disilicate, on zirconia dioxide, and on titanium with two different surface roughnesses (0.2 µm and 0.07 µm); Proliferation (MTT), Living/Dead staining, cytotoxicity (LDH), proliferation (FGF2), and inflammation (TNFα) were analyzed after 1 day and 21 days. Furthermore, alteration in cell morphology (SEM) was analyzed. The statistical analysis was performed by a Kruskal-Wallis test. The level of significance was set at p < 0.05. There were no distinct differences in cellular behavior between the tested roughness. There were slight differences between tested materials. Cells grown on zirconia dioxide showed higher cytotoxic effects. Cells grown on lithium disilicate showed less expression of TNFα compared to those grown on zirconia dioxide or titanium. These effects persisted only during the first time span. The results indicate that the two tested high-strength ceramics and surface properties are biologically suitable for transmucosal implant components. The findings may help clinicians to choose the most appropriate biomaterial as well as the most appropriate surface treatment to use in accordance with specific clinical dental applications.
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Canullo L, Masucci L, Quaranta G, Patini R, Caponio VCA, Pesce P, Ravidà A, Penarrocha-Oltra D, Penarrocha-Diago M. Culturomic and quantitative real-time-polymerase chain reaction analyses for early contamination of abutments with different surfaces: A randomized clinical trial. Clin Implant Dent Relat Res 2021; 23:568-578. [PMID: 34196453 DOI: 10.1111/cid.13028] [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: 10/01/2020] [Revised: 05/16/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rough and/or plasma-activated abutments seem to be able to increase soft tissue adhesion and stability; however, limited evidence is available about bacterial contamination differences. PURPOSE The aim was to investigate the oral microbiota on four dental abutments with different surfaces by quantitative real-time polymerase chain reaction (qRT-PCR) and culturomic approach. METHODS Forty patients needing a single implant rehabilitation were involved in the study. Forty healing abutments, especially designed for the study, were divided into four groups according to the surface topography (1. machined [MAC], 2. machined plasma of argon treated [plasmaMAC], 3. ultrathin threaded microsurface [UTM], 4. UTM plasma of argon treated [Plasma UTM]). Random assignment was performed according to predefined randomization tables. All patients underwent surgical intervention for implant and contextual healing abutment positioning. After 2 months of healing, a sterile cotton swab was used for microbiological sampling for culturomics, while sterile paper points inserted into the sulcus were used for qRT-PCR. RESULTS At the end of the study, 36 patients completed all procedures and a total of 36 abutments (9 per group) were analyzed. qRT-PCR retrieved data for 23 bacterial species whereas culturomics revealed the presence of 74 different bacteria, most of them not routinely included into oral cavity microbiological kits of analysis or never found before in the oral microenvironment. No statistically significant differences emerged analyzing the four different surfaces (p = 0.053). On the contrary, higher total and specific bacterial counts were detected in the plasma-treated surfaces compared to the untreated ones (p = 0.021). CONCLUSIONS Abutments with different topographies and surface treatments resulted contaminated by similar oral bacterial flora. Abutments with moderately rough surface were not associated with a greater bacterial adhesion compared to machined ones. Conversely, more bacteria were found around plasma-treated abutments. Furthermore, data reported suggested to include new species not previously sought in the routine analyses of the oral bacterial microflora.
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Affiliation(s)
- Luigi Canullo
- Collaborating Professor of the Master in Oral Surgery and Implantology, University of Valencia, Valencia, Spain
| | - Luca Masucci
- Department of Microbiology and Virology, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluca Quaranta
- Department of Microbiology and Virology, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Romeo Patini
- Institute of Dentistry and Maxillofacial Surgery, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Paolo Pesce
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Andrea Ravidà
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - David Penarrocha-Oltra
- Oral Surgery Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Miguel Penarrocha-Diago
- Oral Surgery Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Canullo L, Penarrocha Oltra D, Pesce P, Zarauz C, Lattanzio R, Penarrocha Diago M, Iezzi G. Soft tissue integration of different abutment surfaces: An experimental study with histological analysis. Clin Oral Implants Res 2021; 32:928-940. [PMID: 34036644 DOI: 10.1111/clr.13782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/21/2021] [Accepted: 05/12/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate whether abutment surface and surface bio-activation have an effect on soft tissue morphogenesis. MATERIALS AND METHODS 36 patients (36 implants) were included. Abutments were randomly divided into 4 groups (n = 9): Smooth Surface-MAChined (MAC), Ultrathin Threaded Microsurface (UTM), MAC Plasma of Argon activated (Plasma-MAC), and UTM Plasma of Argon activated (Plasma-UTM). After 2 months of healing, soft tissue samples were collected and prepared for histological analysis. The margin of the peri-implant mucosa (PM), the apical extension of the barrier epithelium (aJE), and the apical location of the abutment (AM) were identified. Significances of differences among groups were tested by means of the Kruskal-Wallis test and between pairs of results by means of the Mann-Whitney test. RESULTS The mean (SD) vertical dimension of the mucosa was 2.5mm (1.0), including a connective tissue portion (CTP) of 0.8mm (0.8) in the MAC group; 3.6mm (0.2) with a CTP of 1.6mm (0.4) in the Plasma-MAC group; 3.2mm (1.0), with a CPT of 0.5mm (0.6) in the UTM; and 3.3mm (0.8), with a CPT of 0.9mm (0.7) in the Plasma-UTM group. Statistically significant differences were observed in the aJE-AM height and PM-aJE profile among the four experimental groups (p = .042 and p = .039, respectively). The Mann-Whitney test indicated differences between the Plasma-abutments and the untreated abutments both for PM-AM (p = .025) and AjE-AM (p = .021). The differences appeared more evident when the preoperative soft tissue thickness was ≤2mm. CONCLUSIONS Within its limits, the study demonstrated a favorable effect of the plasma treatment on the connective tissue portion tissues. Plasma-MAC group highlighted the best performance. This behavior appeared strictly correlated with the soft tissue thickness.
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Affiliation(s)
- Luigi Canullo
- Department of Oral Surgery and Implants, University of Valencia, Valencia, Spain
| | | | - Paolo Pesce
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Cristina Zarauz
- Department of Fixed Prosthodontics, University of Geneva, Geneva, Switzerland
| | - Rossano Lattanzio
- Department of Innovative Technologies in Medicine & Dentistry, Center for Advanced Studies and Technology (CAST), 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | | | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
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Kniha K, Heussen N, Modabber A, Hölzle F, Möhlhenrich SC. The effect of zirconia and titanium surfaces on biofilm formation and on host-derived immunological parameters. Int J Oral Maxillofac Surg 2021; 50:1361-1374. [PMID: 33618967 DOI: 10.1016/j.ijom.2021.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 01/15/2023]
Abstract
The aim of this study was to analyse the effect of zirconia and titanium surfaces on biofilm formation and host-derived parameters. Studies comparing zirconia and titanium surfaces were selected up to September 1, 2019. The outcome measures were surface roughness, contact angle, bacterial count, bacterial adherence, biofilm thickness, bacterial distribution, and specifically investigated biofilm and specific host-derived immunological parameters. Random-effects meta-analyses of in vitro and in vivo studies were conducted. A total of 39 studies were included for data extraction. In the systematic review data, 10 studies stated that zirconia accumulated less initial oral biofilm parameters, 16 investigations showed negligible inter-material differences, and only one study showed that zirconia attracted the most biofilm. However, in the meta-analysis, the bacterial coverage was found to be significantly superior for zirconia surfaces (P< 0.00001); the other outcome measures did not show any statistically significant differences between zirconia and titanium for the remaining parameters and the studies presented a substantial degree of heterogeneity. Overall, on the basis of the meta-analysis, the current data situation does not allow a clear preference for the use of zirconia or titanium.
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Affiliation(s)
- K Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany; Private Clinic for Oral and Maxillofacial Surgery, Munich, Germany.
| | - N Heussen
- Department of Medical Statistics, University Hospital of Aachen, Aachen, Germany
| | - A Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - F Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - S C Möhlhenrich
- Department of Orthodontics, University of Witten/Herdecke, Witten, Germany
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Wang C, Wang X, Lu R, Gao S, Ling Y, Chen S. Responses of human gingival fibroblasts to superhydrophilic hydrogenated titanium dioxide nanotubes. Colloids Surf B Biointerfaces 2020; 198:111489. [PMID: 33257160 DOI: 10.1016/j.colsurfb.2020.111489] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/01/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022]
Abstract
Soft tissue integration is critical for the long-term retention of dental implants. The surface properties including topography and wettability can impact soft tissue sealing. In our work, a thermal hydrogenation technique was applied to modify anodized titanium dioxide nanotubes (TNTs). However, the effects of the hydrogenated surface on soft-tissue cells remain unclear. The aim of the present study was to investigate the bioactivities of human gingival fibroblasts (HGFs) on structured surfaces, which determine the early formation of soft tissue sealing. Three groups were examined: commercially pure titanium (Ti), anodized TNTs (air-TNTs) and hydrogenated TNTs (H2-TNTs). Scanning electron microscopy showed the nanotubular topography on the titanium surfaces after anodization. Then, hydrogenation ensured that the H2-TNTs were superhydrophilic with a contact angle of 3.5 ± 0.8°. In vitro studies such as cell adhesion assays, cell morphology, immunocytochemistry, wound healing assays, real-time PCR and enzyme-linked immunosorbent assays displayed enhanced adhesion, migration, relative gene expression levels, and extracellular matrix synthesis of the HGFs on H2-TNTs. Interestingly, focal adhesion kinase activation and integrin-mediated adhesion seemed to be induced by the H2-TNT surface. Our results revealed that a superhydrophilic nanostructure modified by anodization and hydrogenation can improve the bioactivity of HGFs and connective tissue regeneration, which will further promote and expand the application of titanium dioxide nanotubes in dental implants.
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Affiliation(s)
- Caiyun Wang
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China; Laboratory of Advanced Materials, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China
| | - Xin Wang
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Ran Lu
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Shang Gao
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Yunhan Ling
- Laboratory of Advanced Materials, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China.
| | - Su Chen
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China.
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Pesce P, Menini M, Santori G, Giovanni ED, Bagnasco F, Canullo L. Photo and Plasma Activation of Dental Implant Titanium Surfaces. A Systematic Review with Meta-Analysis of Pre-Clinical Studies. J Clin Med 2020; 9:jcm9092817. [PMID: 32878146 PMCID: PMC7565759 DOI: 10.3390/jcm9092817] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Ultraviolet (UV) and non-thermal plasma functionalization are surface treatment modalities that seem able to improve osseointegration. The aim of this systematic review and meta-analysis is to assess the effect of the two methods and possible differences. Materials and Methods: The systematic research of pre-clinical animal studies was conducted up to May 2020 in the databases PubMed/Medline, Scopus and the Cochrane Lybrary. A meta-analysis was performed by using the DerSimonian–Laird estimator in random-effects models. Results: Through the digital search, 518 articles were identified; after duplicate removal and screening process 10 papers were included. Four studies evaluating UV treatment in rabbits were included in the meta-analysis. The qualitative evaluation of the included studies showed that both UV photofunctionalization and non-thermal plasma argon functionalization of titanium implant surfaces might be effective in vivo to improve the osseointegration. The meta-analysis on four studies evaluating UV treatment in rabbits showed that bone to implant contact values (expressed as standardized mean differences and raw mean differences) were significantly increased in the bio-activated groups when follow-up times were relatively homogeneous, although a high heterogeneity (I2 > 75%) was found in all models. Conclusions: The present systematic review and meta-analysis on pre-clinical studies demonstrated that chair-side treatment of implants with UV or non-thermal plasma appear to be effective for improving osseointegration. This systematic review supports further clinical trials on this topic.
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Affiliation(s)
- Paolo Pesce
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy; (P.P.); (M.M.); (G.S.); (E.D.G.); (F.B.)
| | - Maria Menini
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy; (P.P.); (M.M.); (G.S.); (E.D.G.); (F.B.)
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy; (P.P.); (M.M.); (G.S.); (E.D.G.); (F.B.)
| | - Emanuele De Giovanni
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy; (P.P.); (M.M.); (G.S.); (E.D.G.); (F.B.)
| | - Francesco Bagnasco
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy; (P.P.); (M.M.); (G.S.); (E.D.G.); (F.B.)
| | - Luigi Canullo
- Private Practice, Via Nizza, 46, 00198 Rome, Italy
- Correspondence: ; Tel.: +39-347-6201-976
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Tanaka K, Botticelli D, Canullo L, Baba S, Xavier SP. New bone ingrowth into β-TCP/HA graft activated with argon plasma: a histomorphometric study on sinus lifting in rabbits. Int J Implant Dent 2020; 6:36. [PMID: 32789544 PMCID: PMC7423814 DOI: 10.1186/s40729-020-00236-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/02/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In a previous experimental study, new bone was found growing within granules of HA/β-TCP. In vitro and experimental studies have shown increased protein adsorption and cell adhesion graft material bioactivated with Argon plasma. The aims of the present experiment were to study new bone ingrowth into β-TCP/HA granules used as filler material for sinus lifting and the influence on the healing of the bioactivation of the graft with argon plasma. METHODS Sinus lifting was carried out in 20 rabbits using 60% HA and 40% β-TCP as filler material either bio-activated with argon plasma (plasma group) or left untreated (control group). The antrostomies were closed with collagen membranes. Biopsies representing the healing after 2 and 10 weeks were collected, and ground sections were prepared for histomorphometric analyses. Various regions of the elevated space were analyzed both around (outer bone; OB) and inside (interpenetrating bone network, IBN) the graft particles. RESULTS After 2 weeks of healing, 8.2% and 9.3% (n = 10; p = 0.635) of total new bone (OB + IBN) was found in the plasma and control groups, respectively. Small fractions of IBN were found, spreading from the periphery inward of the graft particles. After 10 weeks of healing, the total new bone was 34.0% in the plasma and 31.3% in Control groups (n = 9; p = 0.594). The respective fractions of IBN were 18.0% and 16.0%. New bone was penetrating from the peripheral regions inside the remnants of graft particles, where it was forming a network of bridges in continuity to the remnants of biomaterial through its porosities. The biomaterial decreased in proportion between 2 and 10 weeks from 52.1 to 28.3% in the plasma group, and from 52.5% to 31.9% in the control group. CONCLUSION The bio-activation with argon plasma on a synthetic graft composed of 60% HA and 40% β-TCP used as filler material for sinus lifting showed a tendency to improve bone formation; however, the difference with the control group was neither statistically significant nor clinically relevant.
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Affiliation(s)
- Kazushige Tanaka
- Department of Oral Implantology, Osaka Dental University, Osaka, Japan
- ARDEC Academy, Rimini, Italy
| | | | - Luigi Canullo
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Shunsuke Baba
- Department of Oral Implantology, Osaka Dental University, Osaka, Japan
| | - Samuel P Xavier
- Depto CTBMF e Periodontia FORP-USP-Faculty of Ribeirão Preto (SP), São Paulo, Brazil
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Canullo L, Genova T, Pesce P, Nakajima Y, Yonezawa D, Mussano F. Surface bio-functionalization using plasma of argon could alter microbiological and topographic surface analysis of dental implants? Ann Anat 2020; 230:151489. [PMID: 32165207 DOI: 10.1016/j.aanat.2020.151489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 02/07/2020] [Accepted: 02/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Plasma of argon was demonstrated to improve protein and cell adhesion on implant surface. On the other hand, increased surface energy and hydrophilicity could potentially amplify the risks of implant surface contamination during clinical phases, risks that have not yet been evaluated in Literature. The aim of the present in vitro study was to verify if Plasma treatment could alter the implant surface characteristics and its ability to remain sterile. MATERIALS AND METHODS Implants from 9 brands were collected (n=11). One implant for each company was used for SEM surface analysis. To perform the microbiological analysis, ten implants from each company were used and randomly split by allocation either in test or control group. To replicate the surgical work flow, both test and control samples were left 60s in clinical environment. Bacterial growth analysis was performed. Optical density at 600nm was measured as readout of bacterial growth and colony forming unit (CFU) after 24h was evaluated. Statistical analysis was performed by using the Wilcoxon Mann Whitney test. A p-value lower than 0.05 was considered significant. RESULTS SEM analysis revealed different categories of implant surface roughness. The optical density confirmed a readout of bacterial growth between 4 and 7 with no significant differences within groups. The number of CFU/ml for each measured sample (test and control) was lower than 102 and failed to present significant differences. CONCLUSION Surface activation using plasma of argon did not affect the degree of implant contamination, allowing to maintain a substantial sterility of the implant independently of its morphology. This may allow in the next future the use of bioactivation through plasma of argon to exploit the superhydrophilicity deriving from this biophysical process.
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Affiliation(s)
| | | | | | - Yasushi Nakajima
- ARDEC Academy, Ariminum Odontologica, Rimini, Italy; Department of Oral Implantology, Osaka Dental University, Osaka, Japan.
| | - Daichi Yonezawa
- ARDEC Academy, Ariminum Odontologica, Rimini, Italy; Department of Oral Implantology, Osaka Dental University, Osaka, Japan; Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Japan.
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