Novel bioactive tetracycline-containing electrospun polymer fibers as a potential antibacterial dental implant coating

Biomaterials science and surface engineering strategies for dental peri-implantitis management

Peri-implantitis is a bacterial infection that causes soft tissue inflammatory lesions and alveolar bone resorption, ultimately resulting in implant failure. Dental implants for clinical use barely have antibacterial properties, and bacterial colonization and biofilm formation on the dental implants are major causes of peri-implantitis. Treatment strategies such as mechanical debridement and antibiotic therapy have been used to remove dental plaque. However, it is particularly important to prevent the occurrence of peri-implantitis rather than treatment. Therefore, the current research spot has focused on improving the antibacterial properties of dental implants, such as the construction of specific micro-nano surface texture, the introduction of diverse functional coatings, or the application of materials with intrinsic antibacterial properties. The aforementioned antibacterial surfaces can be incorporated with bioactive molecules, metallic nanoparticles, or other functional components to further enhance the osteogenic properties and accelerate the healing process. In this review, we summarize the recent developments in biomaterial science and the modification strategies applied to dental implants to inhibit biofilm formation and facilitate bone-implant integration. Furthermore, we summarized the obstacles existing in the process of laboratory research to reach the clinic products, and propose corresponding directions for future developments and research perspectives, so that to provide insights into the rational design and construction of dental implants with the aim to balance antibacterial efficacy, biological safety, and osteogenic property.

PLA and PBAT-Based Electrospun Fibers Functionalized with Antibacterial Bio-Based Polymers

Antimicrobial fibers based on biodegradable polymers, poly(lactic acid) (PLA), and poly(butylene adipate-co-terephthalate) (PBAT) are prepared by electrospinning. For this purpose, a biodegradable/bio-based polyitaconate containing azoles groups (PTTI) is incorporated at 10 wt.% into the electrospinning formulations. The resulting fibers functionalized with azole moieties are uniform and free of beads. Then, the accessible azole groups are subjected to N-alkylation, treatment that provides cationic azolium groups with antibacterial activity at the surface of fibers. The positive charge density, roughness, and wettability of the cationic fibers are evaluated and compared with flat films. It is confirmed that these parameters exert an important effect on the antimicrobial properties, as well as the length of the alkylating agent and the hydrophobicity of the matrix. The quaternized PLA/PTTI fibers exhibit the highest efficiency against the tested bacteria, yielding a 4-Log reduction against S. aureus and 1.7-Log against MRSA. Then, biocompatibility and bioactivity of the fibers are evaluated in terms of adhesion, morphology and viability of fibroblasts. The results show no cytotoxic effect of the samples, however, a cytostatic effect is appreciated, which is ascribed to the strong electrostatic interactions between the positive charge at the fiber surface and the negative charge of the cell membranes.

Design of Cefotaxime Sodium-Loaded Polydopamine Coatings with Controlled Surface Roughness for Titanium Implants

The success rate of dental implants is limited by peri-implant infection and insufficient osseointegration. Therefore, reducing the occurrence of peri-implantitis and promoting osseointegration are in demand. A roughened surface has commonly been applied to improve the osseointegration of implants, but it will accelerate the attachment of bacteria. We have developed novel antibiotic-decorated titanium (Ti) surfaces by the immobilization of dopamine and cefotaxime sodium (CS) simultaneously. Moreover, the surface roughness of the polydopamine (PDA)/CS coating was controlled by the changes in polymerization times as determined by atomic force microscopy. Then, all antibiotic-grafted Ti surfaces could effectively prevent the adhesion and proliferation of both Escherichia coli and Streptococcus mutans in comparison to the pristine control. For the culture and osteogenic differentiation of human umbilical mesenchymal stem cells (hUMSCs) on the substrate surface, PDA/CS coating with polymerization times less than 30 min showed acceptable biocompatibility, but the upregulation of marker genes and proteins was detected when the polymerization time was more than 30 min. Moreover, the best calcium deposition results were found in the 30 min PDA/CS group with or without the addition of osteogenic factors. Therefore, our PDA/CS coating with a polymerization time of 30 min holds great potential to design dental implants with dual bacteriostatic and osteogenic properties.

Advanced biomaterials for periodontal tissue regeneration

The periodontium is a suitable target for regenerative intervention, since it does not functionally restore itself after disease. Importantly, the limited regeneration capacity of the periodontium could be improved with the development of novel biomaterials and therapeutic strategies. Of note, the regenerative potential of the periodontium depends not only on its tissue-specific architecture and function, but also on its ability to reconstruct distinct tissues and tissue interfaces, suggesting that the advancement of tissue engineering approaches can ultimately offer new perspectives to promote the organized reconstruction of soft and hard periodontal tissues. Here, we discuss material-based, biologically active cues, and the application of innovative biofabrication technologies to regenerate the multiple tissues that comprise the periodontium.

Antimicrobial effects of nanocurcumin gel on reducing the microbial count of gingival fluids of implant‒abutment interface: A clinical study

Background. This clinical study aimed to prepare and evaluate the effect of antimicrobial nanocurcumin gel on reducing the microbial counts of gingival fluids of the implant‒abutment interface in patients referred to the Tabriz Faculty of Dentistry for the placement of two dental implants. Methods. Fifteen patients applying for at least two dental implants were included in the study. During the uncovering session, nanocurcumin gel was placed in one implant, and no substance was placed in another (the control group). Then, in three sessions, implantation sessions (10 days after the repair abutment closure session), prosthesis delivery (15 days after the implantation session), and one month after prosthesis delivery, the patients' gingival fluid was sampled and cultured to determine bacterial counts in the gingival fluid by colony-forming units (CFU/mL). T-test was used for statistical analysis of data, and statistical significance was set at P<0.05. Results. This study showed that nanocurcumin gel significantly reduced the CFU/mL of gingival fluid in all three sampling stages compared to the control group. Conclusion. According to the results of this study, the application of antimicrobial nanocurcumin gel inside the implant fixture could reduce the microbial counts of gingival fluids.

A Bibliometric Analysis of Electrospun Nanofibers for Dentistry

Electrospun nanofibers have been widely used in dentistry due to their excellent properties, such as high surface area and high porosity, this bibliometric study aimed to review the application fields, research status, and development trends of electrospun nanofibers in different fields of dentistry in recent years. All of the data were obtained from the Web of Science from 2004 to 2021. Origin, Microsoft Excel, VOSviewer, and Carrot² were used to process, analyze, and evaluate the publication year, countries/region, affiliations, authors, citations, keywords, and journal data. After being refined by the year of publication, document types and research fields, a total of 378 publications were included in this study, and an increasing number of publications was evident. Through linear regression calculations, it is predicted that the number of published articles in 2022 will be 66. The most published journal about electrospun dental materials is Materials Science & Engineering C-Materials for Biological Applications, among the six core journals identified, the percent of journals with Journal Citation Reports (JCR) Q1 was 60%. A total of 17.60% of the publications originated from China, and the most productive institution was the University of Sheffield. Among all the 1949 authors, the most productive author was Marco C. Bottino. Most electrospun dental nanofibers are used in periodontal regeneration, and Polycaprolactone (PCL) is the most frequently used material in all studies. With the global upsurge in research on electrospun dental materials, bone regeneration, tissue regeneration, and cell differentiation and proliferation will still be the research hotspots of electrospun dental materials in recent years. Extensive collaboration and citations among authors, institutions and countries will also reach a new level.

Electrospun Nanofibers Revisited: An Update on the Emerging Applications in Nanomedicine

Electrospinning (ES) has become a straightforward and customizable drug delivery technique for fabricating drug-loaded nanofibers (NFs) using various biodegradable and non-biodegradable polymers. One of NF's pros is to provide a controlled drug release through managing the NF structure by changing the spinneret type and nature of the used polymer. Electrospun NFs are employed as implants in several applications including, cancer therapy, microbial infections, and regenerative medicine. These implants facilitate a unique local delivery of chemotherapy because of their high loading capability, wide surface area, and cost-effectiveness. Multi-drug combination, magnetic, thermal, and gene therapies are promising strategies for improving chemotherapeutic efficiency. In addition, implants are recognized as an effective antimicrobial drug delivery system overriding drawbacks of traditional antibiotic administration routes such as their bioavailability and dosage levels. Recently, a sophisticated strategy has emerged for wound healing by producing biomimetic nanofibrous materials with clinically relevant properties and desirable loading capability with regenerative agents. Electrospun NFs have proposed unique solutions, including pelvic organ prolapse treatment, viable alternatives to surgical operations, and dental tissue regeneration. Conventional ES setups include difficult-assembled mega-sized equipment producing bulky matrices with inadequate stability and storage. Lately, there has become an increasing need for portable ES devices using completely available off-shelf materials to yield highly-efficient NFs for dressing wounds and rapid hemostasis. This review covers recent updates on electrospun NFs in nanomedicine applications. ES of biopolymers and drugs is discussed regarding their current scope and future outlook.

Latest Trends in Surface Modification for Dental Implantology: Innovative Developments and Analytical Applications

An increase in the world population and its life expectancy, as well as the ongoing concern about our physical appearance, have elevated the relevance of dental implantology in recent decades. Engineering strategies to improve the survival rate of dental implants have been widely investigated, focusing on implant material composition, geometry (usually guided to reduce stiffness), and interface surrounding tissues. Although efforts to develop different implant surface modifications are being applied in commercial dental prostheses today, the inclusion of surface coatings has gained special interest, as they can be tailored to efficiently enhance osseointegration, as well as to reduce bacterial-related infection, minimizing peri-implantitis appearance and its associated risks. The use of biomaterials to replace teeth has highlighted the need for the development of reliable analytical methods to assess the therapeutic benefits of implants. This literature review considers the state-of-the-art strategies for surface modification or coating and analytical methodologies for increasing the survival rate for teeth restoration.

Nature-Derived and Synthetic Additives to poly(ɛ-Caprolactone) Nanofibrous Systems for Biomedicine; an Updated Overview

As a low cost, biocompatible, and bioresorbable synthetic polymer, poly (ɛ-caprolactone) (PCL) is widely used for different biomedical applications including drug delivery, wound dressing, and tissue engineering. An extensive range of in vitro and in vivo tests has proven the favourable applicability of PCL in biomedicine, bringing about the FDA approval for a plethora of PCL made medical or drug delivery systems. This popular polymer, widely researched since the 1970s, can be readily processed through various techniques such as 3D printing and electrospinning to create biomimetic and customized medical products. However, low mechanical strength, insufficient number of cellular recognition sites, poor bioactivity, and hydrophobicity are main shortcomings of PCL limiting its broader use for biomedical applications. To maintain and benefit from the high potential of PCL, yet addressing its physicochemical and biological challenges, blending with nature-derived (bio)polymers and incorporation of nanofillers have been extensively investigated. Here, we discuss novel additives that have been meant for enhancement of PCL nanofiber properties and thus for further extension of the PCL nanofiber application domain. The most recent researches (since 2017) have been covered and an updated overview about hybrid PCL nanofibers is presented with focus on those including nature-derived additives, e.g., polysaccharides and proteins, and synthetic additives, e.g., inorganic and carbon nanomaterials.

Personalized and Defect-Specific Antibiotic-Laden Scaffolds for Periodontal Infection Ablation

Periodontitis compromises the integrity and function of tooth-supporting structures. Although therapeutic approaches have been offered, predictable regeneration of periodontal tissues remains intangible, particularly in anatomically complex defects. In this work, personalized and defect-specific antibiotic-laden polymeric scaffolds containing metronidazole (MET), tetracycline (TCH), or their combination (MET/TCH) were created via electrospinning. An initial screening of the synthesized fibers comprising chemo-morphological analyses, cytocompatibility assessment, and antimicrobial validation against periodontopathogens was accomplished to determine the cell-friendly and anti-infective nature of the scaffolds. According to the cytocompatibility and antimicrobial data, the 1:3 MET/TCH formulation was used to obtain three-dimensional defect-specific scaffolds to treat periodontally compromised three-wall osseous defects in rats. Inflammatory cell response and new bone formation were assessed by histology. Micro-computerized tomography was performed to assess bone loss in the furcation area at 2 and 6 weeks post implantation. Chemo-morphological and cell compatibility analyses confirmed the synthesis of cytocompatible antibiotic-laden fibers with antimicrobial action. Importantly, the 1:3 MET/TCH defect-specific scaffolds led to increased new bone formation, lower bone loss, and reduced inflammatory response when compared to antibiotic-free scaffolds. Altogether, our results suggest that the fabrication of defect-specific antibiotic-laden scaffolds holds great potential toward the development of personalized (i.e., patient-specific medication) scaffolds to ablate infection while affording regenerative properties.

Innovations in Craniofacial Bone and Periodontal Tissue Engineering - From Electrospinning to Converged Biofabrication

From a materials perspective, the pillars for the development of clinically translatable scaffold-based strategies for craniomaxillofacial (CMF) bone and periodontal regeneration have included electrospinning and 3D printing (biofabrication) technologies. Here, we offer a detailed analysis of the latest innovations in 3D (bio)printing strategies for CMF bone and periodontal regeneration and provide future directions envisioning the development of advanced 3D architectures for successful clinical translation. First, the principles of electrospinning applied to the generation of biodegradable scaffolds are discussed. Next, we present on extrusion-based 3D printing technologies with a focus on creating scaffolds with improved regenerative capacity. In addition, we offer a critical appraisal on 3D (bio)printing and multitechnology convergence to enable the reconstruction of CMF bones and periodontal tissues. As a future outlook, we highlight future directions associated with the utilization of complementary biomaterials and (bio)fabrication technologies for effective translation of personalized and functional scaffolds into the clinics.

Recent Advances in the Development of Antimicrobial and Antifouling Biocompatible Materials for Dental Applications

The risk of secondary bacterial infections resulting from dental procedures has driven the design of antimicrobial and antifouling dental materials to curb pathogenic microbial growth, biofilm formation and subsequent oral and dental diseases. Studies have investigated approaches based primarily on contact-killing or release-killing materials. These materials are designed for addition into dental resins, adhesives and fillings or as immobilized coatings on tooth surfaces, titanium implants and dental prosthetics. This review discusses the recent developments in the different classes of biomaterials for antimicrobial and antifouling dental applications: polymeric drug-releasing materials, polymeric and metallic nanoparticles, polymeric biocides and antimicrobial peptides. With modifications to improve cytotoxicity and mechanical properties, contact-killing and anti-adhesion materials show potential for incorporation into dental materials for long-term clinical use as opposed to short-lived antimicrobial release-based coatings. However, extended durations of biocompatibility testing, and adjustment of essential biomaterial features to enhance material longevity in the oral cavity require further investigations to confirm suitability and safety of these materials in the clinical setting. The continuous exposure of dental restorative and regenerative materials to pathogenic microbes necessitates the implementation of antimicrobial and antifouling materials to either replace antibiotics or improve its rational use, especially in the day and age of the ever-increasing problem of antimicrobial resistance.

Effect of the Addition of Alginate and/or Tetracycline on Brushite Cement Properties

Calcium phosphate cements have the advantage that they can be prepared as a paste that sets in a few minutes and can be easily adapted to the shape of the bone defect, which facilitates its clinical application. In this research, six formulations of brushite (dicalcium phosphate dihydrated) cement were obtained and the effect of the addition of sodium alginate was analyzed, such as its capacity as a tetracycline release system. The samples that contain sodium alginate set in 4 or 5 min and showed a high percentage of injectability (93%). The cements exhibit compression resistance values between 1.6 and 2.6 MPa. The drug was released in a range between 12.6 and 13.2% after 7 days. The antimicrobial activity of all the cements containing antibiotics was proven. All samples reached values of cell viability above 70 percent. We also observed that the addition of the sodium alginate and tetracycline improved the cell viability.

Effectiveness of Antibacterial Surfaces in Osseointegration of Titanium Dental Implants: A Systematic Review

Titanium (Ti) dental implant failure as a result of infection has been established at 40%, being regarded as one of the most habitual and untreatable problems. Current research is focused on the design of new surfaces that can generate long-lasting, infection-free osseointegration. The purpose of our study was to assess studies on Ti implants coated with different antibacterial surfaces, assessing their osseointegration. The PubMed, Web of Science and Scopus databases were electronically searched for in vivo studies up to December 2020, selecting six studies that met the inclusion criteria. The quality of the selected studies was assessed using the ARRIVE (Animal Research: Reporting of In Vivo Experiments) criteria and Systematic Review Center for Laboratory animal Experimentation's (SYRCLE's) risk of bias tool. Although all the included studies, proved greater osseointegration capacity of the different antibacterial surfaces studied, the methodological quality and experimental models used in some of them make it difficult to draw predictable conclusions. Because of the foregoing, we recommend caution when interpreting the results obtained.

Implant functionalization with mesoporous silica: A promising antibacterial strategy, but does such an implant osseointegrate?

Objectives

New strategies for implant surface functionalization in the prevention of peri‐implantitis while not compromising osseointegration are currently explored. The aim of this in vivo study was to assess the osseointegration of a titanium‐silica composite implant, previously shown to enable controlled release of therapeutic concentrations of chlorhexidine, in the Göttingen mini‐pig oral model.

Material and Methods

Three implant groups were designed: macroporous titanium implants (Ti‐Porous); macroporous titanium implants infiltrated with mesoporous silica (Ti‐Porous + SiO₂); and conventional titanium implants (Ti‐control). Mandibular last premolar and first molar teeth were extracted bilaterally and implants were installed. After 1 month healing, the bone in contact with the implant and the bone regeneration in the peri‐implant gap was evaluated histomorphometrically.

Results

Bone‐to‐implant contact and peri‐implant bone volume for Ti‐Porous versus Ti‐Porous + SiO₂ implants did not differ significantly, but were significantly higher in the Ti‐Control group compared with Ti‐Porous + SiO₂ implants. Functionalization of titanium implants via infiltration of a SiO₂ phase into the titanium macropores does not seem to inhibit implant osseointegration. Yet, the importance of the implant macro‐design, in particular the screw thread design in a marginal gap implant surgery set‐up, was emphasized by the outstanding results of the Ti‐Control implant.

Conclusions

Next‐generation implants made of macroporous Ti infiltrated with mesoporous SiO₂ do not seem to compromise the osseointegration process. Such implant functionalization may be promising for the prevention and treatment of peri‐implantitis given the evidenced potential of mesoporous SiO₂ for controlled drug release.

Surface Modified Techniques and Emerging Functional Coating of Dental Implants

Dental implants are widely used in the field of oral restoration, but there are still problems leading to implant failures in clinical application, such as failed osseointegration, marginal bone resorption, and peri-implantitis, which restrict the success rate of dental implants and patient satisfaction. Poor osseointegration and bacterial infection are the most essential reasons resulting in implant failure. To improve the clinical outcomes of implants, many scholars devoted to modifying the surface of implants, especially to preparing different physical and chemical modifications to improve the osseointegration between alveolar bone and implant surface. Besides, the bioactive-coatings to promote the adhesion and colonization of ossteointegration-related proteins and cells also aim to improve the osseointegration. Meanwhile, improving the anti-bacterial performance of the implant surface can obstruct the adhesion and activity of bacteria, avoiding the occurrence of inflammation related to implants. Therefore, this review comprehensively investigates and summarizes the modifying or coating methods of implant surfaces, and analyzes the ossteointegration ability and anti-bacterial characteristics of emerging functional coatings in published references.

The role of nanohydroxyapatite on the morphological, physical, and biological properties of chitosan nanofibers

OBJECTIVES

This study aimed to evaluate the effects of nanohydroxyapatite (nHAp) particles on the morphological, chemical, physical, and biological properties of chitosan electrospun nanofibers.

MATERIALS AND METHODS

nHAp particles with a 1.67 Ca/P ratio were synthesized via the aqueous precipitation method, incorporated into chitosan polymer solution (0.5 wt%), and electrospun into nHAp-loaded fibers (ChHa fibers). Neat chitosan fibers (nHAp-free, Ch fibers) were used as the control. The electrospun fiber mats were characterized using morphological, topographical, chemical, thermal, and a range of biological (antibacterial, antibiofilm, cell viability, and alkaline phosphatase [ALP] activity) analyses. Data were analyzed using ANOVA and Tukey's test (α = 0.05).

RESULTS

ChHa fibers demonstrated a bead-like morphology, with thinner (331 ± 110 nm) and smoother (Ra = 2.9 ± 0.3 μm) distribution as compared to the control fibers. Despite showing similar cell viability and ALP activity to Ch fibers, the ChHa fibers demonstrated greater antibacterial potential against most tested bacteria (except for P. intermedia), and higher antibiofilm activity against P. gingivalis biofilm.

CONCLUSIONS

The incorporation of nHAp particles did not jeopardize the overall morphology, topography, physical, and biological characteristics of the chitosan nanofibers.

CLINICAL RELEVANCE

The combination of nHAp particles with chitosan can be used to engineer bioactive, electrospun composite nanofibers with potential applications in regenerative dentistry.

pH-Responsive Resveratrol-Loaded Electrospun Membranes for the Prevention of Implant-Associated Infections

To date, the implant-associated infections represent a worldwide challenge for the recently reported bacterial drug resistance that can lead to the inefficacy or low efficacy of conventional antibiotic therapies. Plant polyphenolic compounds, including resveratrol (RSV), are increasingly gaining consensus as valid and effective alternatives to antibiotics limiting antibiotic resistance. In this study, electrospun polylactic acid (PLA) membranes loaded with different concentrations of RSV are synthesized and characterized in their chemical, morphological, and release features. The obtained data show that the RSV release rate from the PLA-membranes is remarkably higher in acidic conditions than at neutral pH. In addition, a change in pH from neutral to slightly acidic triggers a significant increase in the RSV release. This behavior indicates that the PLA-RSV membranes can act as drug reservoir when the environmental pH is neutral, starting to release the bioactive molecules when the pH decreases, as in presence of oral bacterial infection. Indeed, our results demonstrate that PLA-RSV2 displays a significant antibacterial and antibiofilm activity against two bacterial strains, Pseudomonas aeruginosa PAO1, and Streptococcus mutans, responsible for both acute and chronic infections in humans, thus representing a promising solution for the prevention of the implant-associated infections.

Nanofibers as drug-delivery systems for infection control in dentistry

INTRODUCTION

Due to the complexity of different oral infections, new anti-infective nanotechnological approaches have been emerging for dentistry in recent years. These strategies may contribute to antimicrobial molecules delivery, tissue regeneration, and oral health maintenance by acting in a more specific site and not being cytotoxic. In this context, nanofibers appear as versatile structures and might act both in the release of antimicrobial molecules and as a scaffold for new tissue formation.

AREAS COVERED

This review addresses the application of different nanofibers as new strategies for the delivery of antimicrobial molecules for dentistry. Here, we present the main polymers used to construct nanofibers, methods of production and mainly their antimicrobial activity against microorganisms commonly responsible for the usual dental infections. These biomaterials may be associated to restorative materials, prostheses, and mucoadhesive structures. Besides, nanofibers can be used for endodontic or periodontal therapy, or even on implant surfaces.

EXPERT OPINION

A wide variety of studies report the potential application of anti-infective nanofibers in the oral cavity. Although there are still several barriers between in vitro and in vivo studies, these new formulations appear as promising new therapies for dentistry.

Biofunctionalization of Textile Materials. 2. Antimicrobial Modification of Poly(lactide) (PLA) Nonwoven Fabricsby Fosfomycin

This research is focused on obtaining antimicrobial hybrid materials consisting of poly(lactide) nonwoven fabrics and using phosphoro-organic compound—fosfomycin—as a coating and modifying agent. Polylactide (PLA) presents biodegradable polymer with multifunctional application, widely engaged in medical related areas. Fosfomycin as functionalized phosphonates presents antibiotic properties expressed by broad spectrum of antimicrobial properties. The analysis of these biofunctionalized nonwoven fabrics processed by the melt-blown technique, included: scanning electron microscopy (SEM), UV/VIS transmittance, FTIR spectrometry, air permeability. The functionalized nonwovens were tested on microbial activity tests against colonies of gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli) bacteria.

Design of dental implants at materials level: An overview

Due to the excellent restoration of masticatory function, satisfaction on aesthetics and other superiorities, dental implants represent an effective method to resolve tooth losing and damaging. Current dental implant systems still have problems waiting to be addressed, and problems are centralized on the materials of implant bodies. This review aims to summarize major developments in the field of dental implant materials, starting with an overview on structures, procedures of dental implants and challenges of implant materials. Next, implant materials are examined in three categories, that is, metals, ceramics, and polymers, their mechanical properties, biocompatibility, and bioactivity are summarized. And as an important aspect, strategies of surface modification are also reviewed, along with some finite element analysis to guiding the research direction of implant materials. Finally, the conclusive remarks are outlined to provide an outlook on the future research directions and prospects of dental implants.

Emerging Applications of Drug Delivery Systems in Oral Infectious Diseases Prevention and Treatment

The oral cavity is a unique complex ecosystem colonized with huge numbers of microorganism species. Oral cavities are closely associated with oral health and sequentially with systemic health. Many factors might cause the shift of composition of oral microbiota, thus leading to the dysbiosis of oral micro-environment and oral infectious diseases. Local therapies and dental hygiene procedures are the main kinds of treatment. Currently, oral drug delivery systems (DDS) have drawn great attention, and are considered as important adjuvant therapy for oral infectious diseases. DDS are devices that could transport and release the therapeutic drugs or bioactive agents to a certain site and a certain rate in vivo. They could significantly increase the therapeutic effect and reduce the side effect compared with traditional medicine. In the review, emerging recent applications of DDS in the treatment for oral infectious diseases have been summarized, including dental caries, periodontitis, peri-implantitis and oral candidiasis. Furthermore, oral stimuli-responsive DDS, also known as "smart" DDS, have been reported recently, which could react to oral environment and provide more accurate drug delivery or release. In this article, oral smart DDS have also been reviewed. The limits have been discussed, and the research potential demonstrates good prospects.

Rapid Release Polymeric Fibers for Inhibition of Porphyromonas gingivalis Adherence to Streptococcus gordonii

Active agents targeting key bacterial interactions that initiate biofilm formation in the oral cavity, may alter periodontitis progression; however, to date, specifically-targeted prophylactic and treatment strategies have been limited. Previously we developed a peptide, BAR (SspB Adherence Region), that inhibits oral P. gingivalis/S. gordonii biofilm formation in vitro and in vivo, and BAR nanoparticles that increase BAR effectiveness via multivalency and prolonged delivery. However, limited BAR loading and nanoparticle retention in the oral cavity can result in inadequate release and efficaciousness. Given this, an effective delivery platform that can release concentrations of BAR suitable for twice-daily applications, may offer an alternative that enhances loading, ease of administration, and retention in the oral cavity. With this in mind, the study objectives were to develop and characterize a rapid-release platform, composed of polymeric electrospun fibers (EFs) that encapsulate BAR, and to evaluate fiber safety and functionality against P. gingivalis/S. gordonii biofilms in vitro. Poly(lactic-co-glycolic acid) (PLGA), poly(L-lactic acid) (PLLA), and polycaprolactone (PCL) were electrospun alone or blended with polyethylene oxide (PEO), to provide high BAR loading and rapid-release. The most promising formulation, 10:90 PLGA:PEO EFs, provided 95% BAR release after 4 h, dose-dependent inhibition of biofilm formation (IC50 = 1.3 μM), disruption of established dual-species biofilms (IC50 = 2 μM), and maintained high cell viability. These results suggest that BAR-incorporated EFs may provide a safe and specifically-targeted rapid-release platform to inhibit and disrupt dual-species biofilms, that we envision may be applied twice-daily to exert prophylactic effect in the oral cavity.

Electrospun Bioresorbable Membrane Eluting Chlorhexidine for Dental Implants

To prevent the uncontrolled development of a pathogenic biofilm around a dental implant, an antimicrobial drug-release electrospun membrane, set up between the implant and the gingival tissue, was developed by taking several technical, industrial and regulatory specifications into account. The membrane formulation is made of a blend of poly(l-lactic–co–gycolic acid) (PLGA, 85:15) and poly(l-lactic acide–co–ɛ-caprolactone) (PLC, 70:30) copolymers with chlorhexidine diacetate (CHX) complexed with β-cyclodextrin (CD). The amount of residual solvent, the mechanical properties and the drug release kinetics were tuned by the copolymers’ ratio, between 30% and 100% of PLC, and a CHX loading up to 20% w/w. The membranes were sterilized by γ-irradiation without significant property changes. The fiber′s diameter was between 600 nm and 3 µm, depending on the membrane composition and the electrospinning parameters. CHX was released in vitro over 10 days and the bacterial inhibitory concentration, 80 µg·mL⁻¹, was reached within eight days. The optimal membrane, PGLA/PLC/CHX-CD (60%/40%/4%), exhibited a breaking strain of 50%, allowing its safe handling. This membrane and a membrane without CHX-CD were implanted subcutaneous in a rat model. The cell penetration remained low. The next step will be to increase the porosity of the membrane to improve the dynamic cell penetration and tissue remodeling.

Achievements in the Topographic Design of Commercial Titanium Dental Implants: Towards Anti-Peri-Implantitis Surfaces

Titanium and its alloys constitute the gold standard materials for oral implantology in which their performance is mainly conditioned by their osseointegration capacity in the host's bone. We aim to provide an overview of the advances in surface modification of commercial dental implants analyzing and comparing the osseointegration capacity and the clinical outcome exhibited by different surfaces. Besides, the development of peri-implantitis constitutes one of the most common causes of implant loss due to bacteria colonization. Thus, a synergic response from industry and materials scientists is needed to provide reliable technical and commercial solutions to this issue. The second part of the review focuses on an update of the recent findings toward the development of new materials with osteogenic and antibacterial capacity that are most likely to be marketed, and their correlation with implant geometry, biomechanical behavior, biomaterials features, and clinical outcomes.

Polycaprolactone nanofibers loaded oxytetracycline hydrochloride and zinc oxide for treatment of periodontal disease

Periodontal diseases (PD) are mixed bacterial infections caused by microorganisms that colonize the tooth surface, leading to destructions at tooth-supporting tissues. Several local delivery systems, as nanofibers, have been developed for the treatment of PD. The purpose of the present study was developing polycaprolactone (PCL) nanofibers incorporating two antibacterial agents, OTC and ZnO, for use in the treatment of PD. Nanofibers were produced by electrospinning method: PCL loaded with ZnO (PCL-Z), PCL loaded with OTC (PCL-OTC), PCL loaded with OTC and ZnO (PCL-OTCz) and pristine PCL (PCL-P). The nanofibers were characterized physicochemically using different techniques. In addition, in vitro study of the OTC release from the nanofibers was performed. The PCL-OCT showed sustained release of the drug up to 10 h, releasing 100% of OTC. However, the PCL-OTCz nanofiber showed a slow release of OTC up to 120 h (5th day) with 54% of drug retention. The cytotoxicity assay showed that PCL-OTC nanofiber was slightly cytotoxic after 48 h and the other nanofibers were non-cytotoxic. The antibacterial activity of the nanofibers was evaluated by qualitative and quantitative analysis and against mixed bacterial culture, composed of four Gram-negative anaerobic bacteria involved in periodontal diseases. The disk diffusion method showed that the PCL-OTC displayed higher inhibition zone than PCL-OTCz (p < 0.001). The quantitative analysis, evaluated by broth culture, showed that the PCL-OTC and PCL-OTCz exhibited excellent activity against a mixed bacterial culture with growth inhibition of 98.0% and 97.5%, respectively. Based on these results, the PCL-OTCz nanofibers developed have great potential as a drug delivery system for the PD treatment.

Antimicrobial additives for poly(lactic acid) materials and their applications: current state and perspectives

Poly(lactic acid)-based antimicrobial materials received considerable attention as promising systems to control microbial growth. The remarkable physicochemical properties of PLA such as renewability, biodegradability, and US Food and Drug Administration (FDA) approval for clinical use open up interesting perspectives for application in food packaging and biomedical materials. Nowadays, there is an increasing consumer demands for fresh, high-quality, and natural foods packaged with environmentally friendly materials that prolong the shelf life. The incorporation of antimicrobial agents into PLA-based polymers is likely to lead to the next generation of packaging materials. The development of antimicrobial PLA materials as a delivery system or coating for biomedical devices is also advantageous in order to reduce possible dose-dependent side effects and limit the phenomena of antibiotic resistance. This mini-review summarizes the most recent advances made in antimicrobial PLA-based polymers including their preparation, biocidal action, and applications. It also highlights the potential of PLA systems as efficient stabilizers-carriers of various kinds of antimicrobial additives including essential oils and other natural compounds, active particles and nanoparticles, and conventional and synthetic molecules.

Polymeric materials and films in dentistry: An overview

The use of polymeric materials (PMs) and polymeric films (PMFs) has increased in medicine and dentistry. This increasing interest is attributed to not only the excellent surfaces of PMs and PMFs but also their desired mechanical and biological properties, low production cost, and ease in processing, allowing them to be tailored for a wide range of applications. Specifically, PMs and PMFs are used in dentistry for their antimicrobial, drug delivery properties; in preventive, restorative and regenerative therapies; and for corrosion and friction reduction. PMFs such as acrylic acid copolymers are used as a dental adhesive; polylactic acids are used for dental pulp and dentin regeneration, and bioactive polymers are used as advanced drug delivery systems. The objective of this article was to review the literatures on the latest advancements in the use of PMs and PMFs in medicine and dentistry. Published literature (1990–2017) on PMs and PMFs for use in medicine and dentistry was reviewed using MEDLINE/PubMed and ScienceDirect resources. Furthermore, this review also explores the diversity of latest PMs and PMFs that have been utilized in dental applications, and analyzes the benefits and limitations of PMs and PMFs. Most of the PMs and PMFs have shown to improve the biomechanical properties of dental materials, but in future, more clinical studies are needed to create better treatment guidelines for patients.

Trends in polymeric electrospun fibers and their use as oral biomaterials

Electrospinning is one of the techniques to produce structured polymeric fibers in the micro or nano scale and to generate novel materials for biomedical proposes. Electrospinning versatility provides fibers that could support different surgical and rehabilitation treatments. However, its diversity in equipment assembly, polymeric materials, and functional molecules to be incorporated in fibers result in profusion of recent biomaterials that are not fully explored, even though the recognized relevance of the technique. The present article describes the main electrospun polymeric materials used in oral applications, and the main aspects and parameters of the technique. Natural and synthetic polymers, blends, and composites were identified from the available literature and recent developments. Main applications of electrospun fibers were focused on drug delivery systems, tissue regeneration, and material reinforcement or modification, although studies require further investigation in order to enable direct use in human. Current and potential usages as biomaterials for oral applications must motivate the development in the use of electrospinning as an efficient method to produce highly innovative biomaterials, over the next few years. Impact statement Nanotechnology is a challenge for many researchers that look for obtaining different materials behaviors by modifying characteristics at a very low scale. Thus, the production of nanostructured materials represents a very important field in bioengineering, in which the electrospinning technique appears as a suitable alternative. This review discusses and provides further explanation on this versatile technique to produce novel polymeric biomaterials for oral applications. The use of electrospun fibers is incipient in oral areas, mainly because of the unfamiliarity with the technique. Provided disclosure, possibilities and state of the art are aimed at supporting interested researchers to better choose proper materials, understand, and design new experiments. This work seeks to encourage many other researchers-Dentists, Biologists, Engineers, Pharmacists-to develop innovative materials from different polymers. We highlight synthetic and natural polymers as trends in treatments to motivate an advance in the worldwide discussion and exploration of this interdisciplinary field.