Advancing dental implants: Bioactive and therapeutic modifications of zirconia

Advances in zirconia-based dental materials: Properties, classification, applications, and future prospects

OBJECTIVES

Zirconia (ZrO2) ceramics are widely used in dental restorations due to their superior mechanical properties, durability, and ever-improving translucency. This review aims to explore the properties, classification, applications, and recent advancements of zirconia-based dental materials, highlighting their potential to revolutionize dental restoration techniques.

STUDY SELECTION, DATA AND SOURCES

The most recent literature available in scientific databases (PubMed and Web of Science) reporting advances of zirconia-based materials within the dental field is thoroughly examined and summarized, covering the major keywords "dental zirconia, classification, aesthetic, LTD, applications, manufacturing, surface treatments".

CONCLUSIONS

An exhaustive overview of the properties, classifications, and applications of dental zirconia was presented, alongside an exploration of future prospects and potential advances. This review highlighted the importance of addressing challenges such as low-temperature degradation resistance and optimizing the balance between mechanical strength and translucency. Also, innovative approaches to improve the performances of zirconia as dental material was discussed.

CLINICAL SIGNIFICANCE

This review provides a better understanding of zirconia-based dental biomaterials for dentists, helping them to make better choice when choosing a specific material to fabricate the restorations or to place the implant. Moreover, new generations of zirconia are still expected to make progress on key issues such as the long-term applications in dental materials while maintaining both damage resistance and aesthetic appeal, defining the directions for future research.

Biodegradable Zn-2Cu-0.5Zr alloy promotes the bone repair of senile osteoporotic fractures via the immune-modulation of macrophages

Delayed bone-healing of senile osteoporotic fractures remains a clinical challenge due to the alterations caused by aging in bone and immune systems. The novel biomaterials that address the deficiencies in both skeletal cells and immune systems are required to effectively treat the bone injuries of older patients. Zinc (Zn) has shown promise as a biodegradable material for use in orthopedic implants. To address the bone-healing deficiencies in elderly patients with bone injuries, we developed a biodegradable Zn-based alloy (Zn-2Cu-0.5Zr) with enhanced mechanical properties, including a yield strength of 198.7 MPa and ultimate tensile strength of 217.6 MPa, surpassing those of pure Zn and Zn-2Cu alloys. Cytotoxicity tests conducted on bone marrow mesenchymal stem cells (BMSCs) and MC3T3-E1 cells demonstrated that the extracts from Zn-2Cu-0.5Zr alloy exhibited no observable cytotoxic effects. Furthermore, the extracts of Zn-2Cu-0.5Zr alloy exhibited significant anti-inflammatory effects through regulation of inflammation-related cytokine production and modulation of macrophage polarization. The improved immune-osteo microenvironment subsequently contributed to osteogenic differentiation of BMSCs. The potential therapeutic application of Zn-2Cu-0.5Zr in senile osteoporotic fracture was tested using a rat model of age-related osteoporosis. The Zn-2Cu-0.5Zr alloy met the requirements for load-bearing applications and accelerated the healing process in a tibial fracture in aged rats. The imaging and histological analyses showed that it could accelerate the bone-repair process and promote the fracture healing in senile osteoporotic rats. These findings suggest that the novel Zn-2Cu-0.5Zr alloy holds potential for influencing the immunomodulatory function of macrophages and facilitating bone repair in elderly individuals with osteoporosis.

Effect of bioceramic powder abrasion on different implant surfaces

PURPOSE

Bioceramic coatings have been shown to promote bone repair, which aids in the early integration of implants. This study aimed to evaluate the influence of air abrasion with a bioceramic abrasive on the surface characteristics of different implant materials and surfaces. The dissolution of the applied treatment from the surfaces over 3 weeks was also assessed.

MATERIALS AND METHODS

Discs of three alloys used for dental implants were studied and compared: two types of commercially pure titanium (CpTi)/ (CpTi SLActive) and titanium-zirconia (TiZr). The tested surfaces were: CpTi control (CpC), sandblasted (SB), sandblasted and acid-etched (SBE), and CpTi SLActive®, (TiZr) Roxolid®. Three discs from each group underwent air abrasion with apatite bioceramic powders, 95% hydroxyapatite (HA)/5% calcium oxide (CaO), and 90% hydroxyapatite (HA)/10% calcium oxide (CaO). The treated discs were surface characterized by optical profilometry to obtain surface roughness, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS) to compare element weight percentages of titanium, calcium, and phosphate. Dissolution was assessed using inductively coupled plasma optic emission spectrometry (ICP-OES).

RESULTS

Bioceramic powders were deposited on all tested surfaces leading to changes in surface characteristics. The only statistically significant differences between the material groups for surface roughness were found with 95% HA/5% CaO powder in the Sp and Rp parameters (p = 0.03 and 0.04, respectively). There were no significant differences in the Ca and P wt% between all groups and powders 95% HA/5% CaO and 90% HA/10% CaO (p = 0.14, 0.18, and p = 0.15, 0.12, respectively). A non-uniform dispersion of the treatment on the surface layer was visible on all treated surfaces. The bioceramic powder continued to dissolute from the tested surfaces for 3 weeks.

CONCLUSION

Bioceramic abrasion modifies implant surface characteristics, although the change in surface characteristics resulting from such treatment was not influenced by the implant material or surface treatment. Air abrasion with hydroxyapatite and calcium oxide bioceramics leaves powder deposits on the treated implant surfaces that could potentially influence the healing of implants affected by peri-implantitis.

Mussel byssus-inspired dual-functionalization of zirconia dental implants for improved bone integration

Zirconia faces challenges in dental implant applications due to its inherent biological inertness, which compromises osseointegration, a critical factor for the long-term success of implants that rely heavily on specific cell adhesion and enhanced osteogenic activity. Here, we fabricated a dual-functional coating that incorporates strontium ions, aimed at enhancing osteogenic activity, along with an integrin-targeting sequence to improve cell adhesion by mussel byssus-inspired surface chemistry. The results indicated that although the integrin-targeting sequence at the interface solely enhances osteoblast adhesion without directly increasing osteogenic activity, its synergistic interaction with the continuously released strontium ions from the coating, as compared to the release of strontium ions alone, significantly enhances the overall osteogenic effect. More importantly, compared to traditional polydopamine surface chemistry, the coating surface is enriched with amino groups capable of undergoing various chemical reactions and exhibits enhanced stability and aesthetic appeal. Therefore, the synergistic interplay between strontium and the functionally customizable surface offers considerable potential to improve the success of zirconia implantation.

Revolutionizing endodontics: Advancements in nickel-titanium instrument surfaces

Nickel-titanium (NiTi) instruments have become the backbone of endodontics due to their exceptional properties, superelasticity, and shape memory. However, challenges such as unexpected breakage, poor cutting efficiency, and corrosion have prompted researchers to explore innovative surface modifications to enhance their performance. This comprehensive review discusses the latest advancements in NiTi metallurgy and their impact on rotary NiTi file systems. Various surface treatment techniques, including ion implantation, cryogenic treatment (CT), thermal nitridation, electropolishing, and physical or chemical vapor deposition, have been investigated to minimize defects, boost surface hardness, and improve cyclic fatigue resistance. Ion implantation has shown promise by increasing wear resistance and cutting efficiency through nitrogen ion incorporation. Thermal nitridation has successfully formed titanium nitride (TiN) coatings, resulting in improved corrosion resistance and cutting efficiency. CT has demonstrated increased cutting efficiency and overall strength by creating a martensite transformation and finer carbide particles. Electropolishing has yielded mixed results, providing smoother surfaces but varying impacts on fatigue resistance. Physical or chemical vapor deposition has proven effective in forming TiN coatings, enhancing hardness and wear resistance. Furthermore, the concept of surface functionalization with silver ions for antibacterial properties has been explored. These advancements present an exciting future for endodontic procedures, offering the potential for enhanced NiTi instruments with improved performance, durability, and patient outcomes.

Titanium particles in peri-implantitis: distribution, pathogenesis and prospects

Peri-implantitis is one of the most important biological complications in the field of oral implantology. Identifying the causative factors of peri-implant inflammation and osteolysis is crucial for the disease's prevention and treatment. The underlying risk factors and detailed pathogenesis of peri-implantitis remain to be elucidated. Titanium-based implants as the most widely used implant inevitably release titanium particles into the surrounding tissue. Notably, the concentration of titanium particles increases significantly at peri-implantitis sites, suggesting titanium particles as a potential risk factor for the condition. Previous studies have indicated that titanium particles can induce peripheral osteolysis and foster the development of aseptic osteoarthritis in orthopedic joint replacement. However, it remains unconfirmed whether this phenomenon also triggers inflammation and bone resorption in peri-implant tissues. This review summarizes the distribution of titanium particles around the implant, the potential roles in peri-implantitis and the prevalent prevention strategies, which expects to provide new directions for the study of the pathogenesis and treatment of peri-implantitis.

A study on mechanical and tribological properties of eco-friendly synthesized ZrO2-doped borosilicate glasses

The research article aims to investigate the mechanical and tribological characteristics of bioactive glass specimens comprising 31B2O3-20SiO2-24.5Na2O-(24.5-x) CaO and xZrO2 (mol%). This glass system was partially derived from bio-waste, with varying concentrations of Zirconia (ZrO2) represented x (x = 0, 1, 3, and 5). The specimens were fabricated using the traditional melt-quench method. Mechanical studies like hardness and compressive strength were measured using Vickers hardness tester and universal tensile machine respectively, while a pin-on-disk tribometer was used to analyze the tribological characteristics. All the specimens were soaked in SBF for a week to assess in-vitro bioactivity. The research findings indicate that Zirconia inclusion resulted in a significant reduction in the intensity of hydroxyapatite peaks of FTIR and XRD spectra, suggesting a decrease in bioactivity. However, it concurrently resulted in increased glass hardness, with the highest value (∼7.55 GPa) observed in the BSG-5 glass sample. Similarly, compressive strength results demonstrated maximum strength in BSG-5 glass specimen, with a value of approximately ∼132 MPa. Moreover, the tribological properties of the glass system were enhanced, evident from the reduced coefficient of friction and specific wear rate. Notably, the BSG-5 glass specimen exhibited the least wear coefficient of 0.018 mm3/N-m at a track radius of 40 mm and a load of 15N. These findings were further supported by SEM images of the worn-out ZrO2-Doped Borosilicate Glass surface. Overall, the results suggest that the addition of Zirconia to borosilicate glass holds promise for improving its mechanical and tribological characteristics. However, this enhancement comes at the expense of its bioactivity. Consequently, the modified glass system presents a cost effective viable option for various applications, particularly in load-bearing and dental applications.

Profiling to Probing: Atomic force microscopy to characterize nano-engineered implants

Surface modification of implants in the nanoscale or implant nano-engineering has been recognized as a strategy for augmenting implant bioactivity and achieving long-term implant success. Characterizing and optimizing implant characteristics is crucial to achieving desirable effects post-implantation. Modified implant enables tailored, guided and accelerated tissue integration; however, our understanding is limited to multicellular (bulk) interactions. Finding the nanoscale forces experienced by a single cell on nano-engineered implants will aid in predicting implants' bioactivity and engineering the next generation of bioactive implants. Atomic force microscope (AFM) is a unique tool that enables surface characterization and understanding of the interactions between implant surface and biological tissues. The characterization of surface topography using AFM to gauge nano-engineered implants' characteristics (topographical, mechanical, chemical, electrical and magnetic) and bioactivity (adhesion of cells) is presented. A special focus of the review is to discuss the use of single-cell force spectroscopy (SCFS) employing AFM to investigate the minute forces involved with the adhesion of a single cell (resident tissue cell or bacterium) to the surface of nano-engineered implants. Finally, the research gaps and future perspectives relating to AFM-characterized current and emerging nano-engineered implants are discussed towards achieving desirable bioactivity performances. This review highlights the use of advanced AFM-based characterization of nano-engineered implant surfaces via profiling (investigating implant topography) or probing (using a single cell as a probe to study precise adhesive forces with the implant surface). STATEMENT OF SIGNIFICANCE: Nano-engineering is emerging as a surface modification platform for implants to augment their bioactivity and achieve favourable treatment outcomes. In this extensive review, we closely examine the use of Atomic Force Microscopy (AFM) to characterize the properties of nano-engineered implant surfaces (topography, mechanical, chemical, electrical and magnetic). Next, we discuss Single-Cell Force Spectroscopy (SCFS) via AFM towards precise force quantification encompassing a single cell's interaction with the implant surface. This interdisciplinary review will appeal to researchers from the broader scientific community interested in implants and cell adhesion to implants and provide an improved understanding of the surface characterization of nano-engineered implants.

A chlorogenic acid-chitosan complex bifunctional coating for improving osteogenesis differentiation and bactericidal properties of zirconia implants

Poor osteogenesis caused by limited bioactivity and peri-implantitis caused by bacterial colonization are the main challenges affecting the use of zirconia-based materials in dental implants. Accordingly, the development of a surface treatment method with an antibacterial effect and that promotes osteogenesis without damage to cells is crucial for yttrium-stabilized tetragonal zirconia (Y-TZP) implants. Herein, we have developed a functional surface modification strategy whereby a poly (ethylene imine)/hyaluronic acid /chitosan-chlorogenic acid (PEI/HA/CGA-CS) conjugate is deposited on a zirconia surface by the layer-by-layer (LBL) technique, enhancing its osteogenic differentiation and antibacterial activities. The results showed that the PEI/HA/CGA-CS coating improved the wettability of the zirconia surface and maintained stable release of CGA. The PEI/HA/CGA-CS functional coating was found to promote early cell adhesion, proliferation, differentiation, and calcification. The results of bacterial adhesion and activity tests showed that the coating effectively inhibits the proliferation and activity of Porphyromonas gingivalis (P. gingivalis) and Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) without impairing the biological activity of osteoblasts. In addition, we found that the PEI/HA/CGA-CS coating enhances the osteogenesis of MC3T3-E1 cells by promoting the protein expression of Nephronectin (NPNT) and activating the Wnt/β-catenin signaling pathway. The above results are of profound significance for the practical application of zirconia-based implants. DATA AVAILABILITY: Data will be made available on request.

The integration of peri-implant soft tissues around zirconia abutments: Challenges and strategies

Stable soft tissue integration around the implant abutment attenuates pathogen penetration, protects underlying bone tissue, prevents peri-implantitis and is essential in maintaining long-term implant stability. The desire for "metal free" and "aesthetic restoration" has favored zirconia over titanium abutments, especially for implant restorations in the anterior region and for patients with thin gingival biotype. Soft tissue attachment to the zirconia abutment surface remains a challenge. A comprehensive review of advances in zirconia surface treatment (micro-design) and structural design (macro-design) affecting soft tissue attachment is presented and strategies and research directions are discussed. Soft tissue models for abutment research are described. Guidelines for development of zirconia abutment surfaces that promote soft tissue integration and evidence-based references to inform clinical choice of abutment structure and postoperative maintenance are presented.

Effects of Surface Treatment Method Forming New Nano/Micro Hierarchical Structures on Attachment and Proliferation of Osteoblast-like Cells

Titanium (Ti) and Ti-based alloys are commonly used in dental implants, and surface modifications of dental implants are important for achieving osseointegration (i.e., direct connection between the implant surface and bone). This study investigated the effect of an eco-friendly etching solution-a hydrogen peroxide-sodium bicarbonate mixture-on the surface properties and contact angles of osteoblast adhesion and proliferation on Ti surfaces. Disk-shaped Ti specimens were prepared using different surface treatments (machining, sandblasting, and sandblasting/acid-etching), and they were immersed in the etching solution and ultrasonically cleaned. Surface characterization was performed using scanning electron microscopy, digital microscopy, contact angle analysis, and X-ray photoelectron spectroscopy. MG-63 osteoblasts were cultured on the specimens, and their adhesion to the specimen surface and proliferation were examined using staining and the MTT assay, respectively. Additional etching with the etching solution caused the formation of nano/micro hierarchical structures, increased surface roughness, and enhanced hydrophilicity. Osteoblast adhesion and proliferation were found to improve on the modified surfaces. The eco-friendly etching method has the potential to enhance the biological properties of Ti implant surfaces and thereby improve dental implant performance.

Fit and forget: The future of dental implant therapy via nanotechnology

Unlike orthopedic implants, dental implants require the orchestration of both osseointegration at the bone-implant interface and soft-tissue integration at the transmucosal region in a complex oral micro-environment with ubiquitous pathogenic bacteria. This represents a very challenging environment for early acceptance and long-term survival of dental implants, especially in compromised patient conditions, including aged, smoking and diabetic patients. Enabling advanced local therapy from the surface of titanium-based dental implants via novel nano-engineering strategies is emerging. This includes anodized nano-engineered implants eluting growth factors, antibiotics, therapeutic nanoparticles and biopolymers to achieve maximum localized therapeutic action. An important criterion is balancing bioactivity enhancement and therapy (like bactericidal efficacy) without causing cytotoxicity. Critical research gaps still need to be addressed to enable the clinical translation of these therapeutic dental implants. This review informs the latest developments, challenges and future directions in this domain to enable the successful fabrication of clinically-translatable therapeutic dental implants that would allow for long-term success, even in compromised patient conditions.

Comparison between bone-implant interfaces of microtopographically modified zirconia and titanium implants

The aim of this study was to investigate the surface characteristics and evaluate the bone-implant interfaces of injection molded zirconia implants with or without surface treatment and compare them with those of conventional titanium implants. Four different zirconia and titanium implant groups (n = 14 for each group) were prepared: injection-molded zirconia implants without surface treatment (IM ZrO₂); injection-molded zirconia implants with surface treatment via sandblasting (IM ZrO₂-S); turned titanium implants (Ti-turned); and titanium implants with surface treatments via sandblasting with large-grit particles and acid-etching (Ti-SLA). Scanning electron microscopy, confocal laser scanning microscopy, and energy dispersive spectroscopy were used to assess the surface characteristics of the implant specimens. Eight rabbits were used, and four implants from each group were placed into the tibiae of each rabbit. Bone-to-implant contact (BIC) and bone area (BA) were measured to evaluate the bone response after 10-day and 28-day healing periods. One-way analysis of variance with Tukey's pairwise comparison was used to find any significant differences. The significance level was set at α = 0.05. Surface physical analysis showed that Ti-SLA had the highest surface roughness, followed by IM ZrO₂-S, IM ZrO₂, and Ti-turned. There were no statistically significant differences (p > 0.05) in BIC and BA among the different groups according to the histomorphometric analysis. This study suggests that injection-molded zirconia implants are reliable and predictable alternatives to titanium implants for future clinical applications.

Advancing Nitinol: From heat treatment to surface functionalization for nickel–titanium (NiTi) instruments in endodontics

Nickel-titanium (NiTi) alloy has been extensively researched in endodontics, particularly in cleaning and shaping the root canal system. Research advances have primarily focused on the design, shape, and geometry of the NiTi files as well as metallurgy and mechanical properties. So far, extensive investigations have been made surrounding surface and thermomechanical treatments, however, limited work has been done in the realm of surface functionalization to augment its performance in endodontics. This review summarizes the unique characteristics, current use, and latest developments in thermomechanically treated NiTi endodontic files. It discusses recent improvements in nano-engineering and the possibility of customizing the NiTi file surface for added functionalization. Whilst clinical translation of this technology has yet to be fully realized, future research direction will lie in the use of nanotechnology.

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Nitinol (Nickel Titanium alloy) is widely used to clean/shape root canal system in endodontics.

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To enhance its performance, various thermo-mechanical and nano-engineering modifications have been performed.

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This comprehensive review summarizes the latest advances and future trends relating to functionalized NiTi endodontic files.

Craniofacial therapy: advanced local therapies from nano-engineered titanium implants to treat craniofacial conditions

Nano-engineering-based tissue regeneration and local therapeutic delivery strategies show significant potential to reduce the health and economic burden associated with craniofacial defects, including traumas and tumours. Critical to the success of such nano-engineered non-resorbable craniofacial implants include load-bearing functioning and survival in complex local trauma conditions. Further, race to invade between multiple cells and pathogens is an important criterion that dictates the fate of the implant. In this pioneering review, we compare the therapeutic efficacy of nano-engineered titanium-based craniofacial implants towards maximised local therapy addressing bone formation/resorption, soft-tissue integration, bacterial infection and cancers/tumours. We present the various strategies to engineer titanium-based craniofacial implants in the macro-, micro- and nano-scales, using topographical, chemical, electrochemical, biological and therapeutic modifications. A particular focus is electrochemically anodised titanium implants with controlled nanotopographies that enable tailored and enhanced bioactivity and local therapeutic release. Next, we review the clinical translation challenges associated with such implants. This review will inform the readers of the latest developments and challenges related to therapeutic nano-engineered craniofacial implants.

Temperature-Responsive, Femtosecond Laser-Ablated Ceramic Surfaces with Switchable Wettability for On-Demand Droplet Transfer

Reversible wettability transition has drawn substantial interest because of its importance for widespread applications, but facile realization of such transition on ceramic surfaces, which is promising for achieving on-demand droplet manipulation under harsh conditions, remains rare. Herein, superhydrophobic zirconia ceramic surfaces that can reversibly and repeatedly transit between superhydrophobicity and superhydrophilicity after alternate heating treatments have been fabricated using a femtosecond laser. The underlying mechanisms of the complex wettability transitions on the laser-ablated zirconia surfaces are elucidated. Hydrophilic polished zirconia surfaces immediately become superhydrophilic after laser ablation, which is mainly attributed to the amplification effect of the laser-induced micro/nanostructures and has no obvious relationship with oxygen vacancies. The obtained superhydrophilic surfaces are transformed into superhydrophobic surfaces because of rapid adsorption of airborne organic compounds driven mainly by physical interaction under heating conditions. With the alternate removal and re-adsorption of organic compounds, reversible and repeatable wettability transition between superhydrophobicity and superhydrophilicity happens on the zirconia surfaces. The laser-induced micro/nanostructures also contribute to the wettability transitions. Furthermore, utilizing the superhydrophobic zirconia surfaces with switchable wettability, on-demand transfer of strong acid droplet in air and oil droplet under strong acid solution has been achieved. This work will inspire the environmentally friendly fabrication of switchable superhydrophobic ceramic surfaces and their multifunctional applications under harsh conditions.

Influence of loading and aging on the fracture strength of an injection-molded two-piece zirconia implant restored with a zirconia abutment

OBJECTIVE

To investigate the fracture strength and potential phase transformation of an injection-molded two-piece zirconia implant restored with a zirconia abutment after loading and/or aging.

METHODS

Thirty-two two-piece zirconia implants (4.0 mm diameter) restored with zirconia abutments were embedded according to ISO 14801 and divided into four groups (n = 8/group): Three groups were either exclusively hydrothermally treated (group HT; 85°C), dynamically loaded (group DL; 10⁷  cycles; 98 N), or subjected to both treatments simultaneously (group DL/HT). One group remained untreated (group 0). A sample from each group was cross-sectioned and examined by scanning electron microscopy for possible crystal phase transformation. The remaining samples were then loaded to fracture in a static loading test. A one-way ANOVA was used for statistical analyses.

RESULTS

During dynamic loading, three implants of group DL and six implants of group DL/HT fractured at a load of 98 N. The fracture strength of group DL/HT (108 ± 141 Ncm) was significantly reduced compared to the other groups (group 0: 342 ± 36 Ncm; HT: 363 ± 49 Ncm; DL: 264 ± 198 Ncm) (p < .05). Fractures from group 0 and HT occurred at both implant and abutment level, whereas implants from group DL and DL/HT fractured only at implant level. A shallow monoclinic transformation zone of approximately 2 μm was observed following hydrothermal treatment.

CONCLUSIONS

Within the limitations of this study, it can be concluded that dynamic loading and the combination of loading and aging reduced the fracture strength of the implant abutment combination. Hydrothermal treatment caused a shallow transformation zone which had no influence on the fracture strength.

Enhanced Corrosion Resistance and Local Therapy from Nano-Engineered Titanium Dental Implants

Titanium is the ideal material for fabricating dental implants with favorable biocompatibility and biomechanics. However, the chemical corrosions arising from interaction with the surrounding tissues and fluids in oral cavity can challenge the integrity of Ti implants and leach Ti ions/nanoparticles, thereby causing cytotoxicity. Various nanoscale surface modifications have been performed to augment the chemical and electrochemical stability of Ti-based dental implants, and this review discusses and details these advances. For instance, depositing nanowires/nanoparticles via alkali-heat treatment and plasma spraying results in the fabrication of a nanostructured layer to reduce chemical corrosion. Further, refining the grain size to nanoscale could enhance Ti implants' mechanical and chemical stability by alleviating the internal strain and establishing a uniform TiO₂ layer. More recently, electrochemical anodization (EA) has emerged as a promising method to fabricate controlled TiO₂ nanostructures on Ti dental implants. These anodized implants enhance Ti implants' corrosion resistance and bioactivity. A particular focus of this review is to highlight critical advances in anodized Ti implants with nanotubes/nanopores for local drug delivery of potent therapeutics to augment osseo- and soft-tissue integration. This review aims to improve the understanding of novel nano-engineered Ti dental implant modifications, focusing on anodized nanostructures to fabricate the next generation of therapeutic and corrosion-resistant dental implants. The review explores the latest developments, clinical translation challenges, and future directions to assist in developing the next generation of dental implants that will survive long-term in the complex corrosive oral microenvironment.

Influence of Clinical Decontamination Techniques on the Surface Characteristics of SLA Titanium Implant

The study aims: 1. To perform diode laser, titanium (Ti) brush, and Ti curette treatment on sandblasted and acid-etched (SLA) Ti surfaces, with/without H2O2 and CHX, 2. To investigate the influence of decontamination techniques on implant surface topography and hydrophilicity. Diode laser, Ti brush, and Ti curette treatments were performed on the Grade 4 Ti discs, with/without treatment with 3% H2O2 solution or 0.2% CHX. Surface characteristics were investigated via SEM, optical profilometry, and water contact angle meter. SEM findings revealed flat and scratched areas when treated with Ti curette and Ti brush. For diode laser, SEM showed melting in specific areas. Ra and Rt values were lower in all test groups than in the control group (p < 0.05). The adjunctive chemical treatment showed negligible effects in SEM images and surface roughness measurements compared to laser and mechanical treatment-only groups. H2O2 treatment resulted in enhanced hydrophilicity in either treatment modalities with a significant difference compared to the negative control group (p < 0.05). In all test groups, the hydrophilicity was enhanced compared to the negative control group (p < 0.05). Diode laser treatment had the least disruptive effect on the Ti surface characteristics. The use of other mechanical methods caused significant alterations in the surface roughness.

Numerical Analysis of Zirconium and Titanium Implants under the Effect of Critical Masticatory Load

Dental implants have become an alternative to replace the teeth of people suffering from edentulous and meet the physiological and morphological characteristics (recovering 95% of the chewing function). The evolution and innovation of biomaterials for dental implants have had a trajectory that dates back to prehistory, where dental pieces were replaced by ivory or seashells, to the present day, where they are replaced by metallic materials such as titanium or ceramics such as zirconium or fiberglass. The numerical evaluation focuses on comparing the stress distribution and general displacement between different dental implants and a healthy tooth when applying a force of 850 N. For the analysis, a model of the anatomical structure was developed of a healthy tooth considering three essential parts of the tooth (enamel, dentin, and pulp). The tooth biomodel was established through computed tomography. Three dental implant models were considered by changing the geometry of the abutment. A structural simulation was carried out by applying the finite element method (FEM). In addition, the material considered for the analyses was zirconium oxide (ZrO2), which was compared against titanium alloy (Ti6Al4V). The analyses were considered with linear, isotropic, and homogeneous properties. The variables included in the biomodeling were the modulus of elasticity, Poisson's ratio, density, and elastic limit. The results obtained from the study indicated a significant difference in the biomechanical behavior of the von Mises forces and the displacement between the healthy tooth and the titanium and zirconium implant models. However, the difference between the titanium implant and the zirconium implant is minimal because one is more rigid, and the other is more tenacious.

Design of single-phased magnesium alloys with typically high solubility rare earth elements for biomedical applications: Concept and proof

Rare earth elements (REEs) have been long applied in magnesium alloys, among which the mischmetal-containing WE43 alloy has already got the CE mark approval for clinical application. A considerable amount of REEs (7 wt%) is needed in that multi-phased alloy to achieve a good combination of mechanical strength and corrosion resistance. However, the high complex RE addition accompanied with multiple second phases may bring the concern of biological hazards. Single-phased Mg-RE alloys with simpler compositions were proposed to improve the overall performance, i.e., “Simpler alloy, better performance”. The single-phased microstructure can be successfully obtained with typical high-solubility REEs (Ho, Er or Lu) through traditional smelting, casting and extrusion in a wide compositional range. A good corrosion resistance with a macroscopically uniform corrosion mode was guaranteed by the homogeneously single-phased microstructure. The bimodal-grained structure with plenty of sub-grain microstructures allow us to minimize the RE addition to <1 wt%, without losing mechanical properties. The single-phased Mg-RE alloys show comparable mechanical properties to the clinically-proven Mg-based implants. They exhibited similar in-vitro and in-vivo performances (without local or systematic toxicity in SD-rats) compared to a high purity magnesium. In addition, metal elements in our single-phased alloys can be gradually excreted through the urinary system and digestive system, showing no consistent accumulation of RE in main organs, i.e., less burden on organs. The novel concept in this study focuses on the simplification of Mg-RE based alloys for biomedical purpose, and other biodegradable metals with single-phased microstructures are expected to be explored.

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A concept of developing single-phased biodegradable magnesium alloys was proposed.

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Single-phased magnesium alloys with bimodal-grained structures were obtained.

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Good strength and corrosion resistance synergy was achieved in the alloys.

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Significantly reduced rare earth addition is beneficial to the biocompatibility.

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Simpler alloy helps to lower the possible biological risks of Mg related implants.

Bioactive Surface of Zirconia Implant Prepared by Nano-Hydroxyapatite and Type I Collagen

Zirconia, with its excellent mechanical strength and esthetics, has a growing potential for applications in dentistry and orthopedics. However, in order for zirconia to have a high affinity with bone tissue, the bioactivity of the surface must be further increased. In order to increase the bioactivity of zirconia, research was conducted to make a porous support or to fill the porous structure with nano-hydroxyapatite (nHA). In this case, there is a risk that physically filled nHA could be released depending on the living environment. In this study, nHA and type I collagen were introduced to the zirconia surface by chemical covalent bonding to increase bioactivity and ensure safety in the body. The chemical reaction of the surface was confirmed by X-ray photoelectron spectroscopy (XPS), field emission scanning electron microscopy (FE-SEM) and Fourier transform infrared (FT-IR) spectroscopy. In addition, the biological activity was evaluated by examining the cytotoxicity and bone formation ability of the modified zirconia using osteoblasts. As a result, it was found that the bioactivity of the zirconia surface was greatly improved by immobilizing nHA and type I collagen.

Influence of the Surface Chemical Composition Differences between Zirconia and Titanium with the Similar Surface Structure and Roughness on Bone Formation

The osseointegration of zirconia (ZrO2) implants is still controversial. In this study, we aimed to make clear the influence of surface chemical composition, Ti or ZrO2, to osseointegration. First, a roughened Ti surface was prepared with a combination of large-grit sandblasting and acid treatment. Then, we applied molecular precursor solution containing Zr complex onto roughened Ti surface and can deposit thin ZrO2 film onto roughened Ti surface. We can change surface chemical composition from Ti to ZrO2 without changing the surface structure and roughness of roughened Ti. The tetragonal Zr was uniformly present on the ZrO2-coated Ti surface, and the surface of the ZrO2-coated Ti showed a higher apparent zeta potential than Ti. Ti and ZrO2-coated Ti rectangular plate implant was placed into the femur bone defect. After 2 and 4 weeks of implantation, histomorphometric observation revealed that the bone-to-implant contact ratio and the bone mass values for ZrO2-coated Ti implants inserted into the femur bone defects of the rats at 2 weeks were significantly higher than those for Ti implants (p < 0.05). It revealed that ZrO2 with a similar surface structure and roughness as that of roughened Ti promoted osteogenesis equivalent to or better than that of Ti in the early bone formation stage.

Biomimetic Implant Surfaces and Their Role in Biological Integration—A Concise Review

Background: The increased use of dental implants in oral rehabilitation has been followed by the development of new biomaterials as well as improvements in the performance of biomaterials already in use. This triggers the need for appropriate analytical approaches to assess the biological and, ultimately, clinical benefits of these approaches. Aims: To address the role of physical, chemical, mechanical, and biological characteristics in order to determine the critical parameters to improve biological responses and the long-term effectiveness of dental implant surfaces. Data sources and methods: Web of Science, MEDLINE and Lilacs databases were searched for the last 30 years in English, Spanish and Portuguese idioms. Results: Chemical composition, wettability, roughness, and topography of dental implant surfaces have all been linked to biological regulation in cell interactions, osseointegration, bone tissue and peri-implant mucosa preservation. Conclusion: Techniques involving subtractive and additive methods, especially those involving laser treatment or embedding of bioactive nanoparticles, have demonstrated promising results. However, the literature is heterogeneous regarding study design and methodology, which limits comparisons between studies and the definition of the critical determinants of optimal cell response.

ZrO2/ZnO/TiO2 Nanocomposite Coatings on Stainless Steel for Improved Corrosion Resistance, Biocompatibility, and Antimicrobial Activity

The ultrathin nanocomposite coatings made of zirconium oxide (ZrO₂), zinc oxide (ZnO), and titanium oxide (TiO₂) on stainless steel (SS) were prepared by the radio frequency sputtering method, and the effects of the nanocomposite coating on corrosion protection and antibacterial activities of nanocomposite coated SS were investigated. Scanning electron microscopy was conducted to observe surface morphology of nanocomposite coatings with distinct distribution of grains with the formation on SS substrate. From the electrochemical impedance spectroscopy results, ZrO₂/ZnO/TiO₂ nanocomposite coating showed excellent corrosion protection performance at 37 °C during immersion in simulated body fluid and saliva solution for 12 and 4 weeks, respectively. The impedance of ZrO₂/ZnO/TiO₂ (40/10/50) nanocomposite coated SS exhibited values about 5 orders of magnitude higher than that of uncoated SS with polarization at the low-frequency region. Cell viability of ZrO₂/ZnO/TiO₂ nanocomposite coated SS was examined under mouse fibroblasts culture (L929), and it was observed that the nanocomposite coating improves proliferation through effective cellular attachment compared to uncoated SS. From the antimicrobial activity results, ZrO₂/ZnO/TiO₂ nanocomposite-coated SS showed killing efficiency of 81.2% and 72.4% against Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus, respectively.

Novel Nano-Engineered Biomaterials for Bone Tissue Engineering

This Special Issue of Nanomaterials explores the recent advances relating to nano-engineered strategies for biomaterials and implants in bone tissue engineering [...].

Nano-Engineering Solutions for Dental Implant Applications

This Special Issue of Nanomaterials explores the recent advances and trends with respect to nano-engineered strategies towards dental implant applications [...].