Biofunctionalization of microgroove titanium surfaces with an antimicrobial peptide to enhance their bactericidal activity and cytocompatibility

A review on antimicrobial strategies in mitigating biofilm-associated infections on medical implants

Biomedical implants are crucial in providing support and functionality to patients with missing or defective body parts. However, implants carry an inherent risk of bacterial infections that are biofilm-associated and lead to significant complications. These infections often result in implant failure, requiring replacement by surgical restoration. Given these complications, it is crucial to study the biofilm formation mechanism on various biomedical implants that will help prevent implant failures. Therefore, this comprehensive review explores various types of implants (e.g., dental implant, orthopedic implant, tracheal stent, breast implant, central venous catheter, cochlear implant, urinary catheter, intraocular lens, and heart valve) and medical devices (hemodialyzer and pacemaker) in use. In addition, the mechanism of biofilm formation on those implants, and their pathogenesis were discussed. Furthermore, this article critically reviews various approaches in combating implant-associated infections, with a special emphasis on novel non-antibiotic alternatives to mitigate biofilm infections.

Nano-topography and functionalization with the synthetic peptoid GN2-Npm9 as a strategy for antibacterial and biocompatible titanium implants

In recent years, antimicrobial peptides (AMPs) have attracted great interest in scientific research, especially for biomedical applications such as drug delivery and orthopedic applications. Since they are readily degradable in the physiological environment, scientific research has recently been trying to make AMPs more stable. Peptoids are synthetic N-substituted glycine oligomers that mimic the structure of peptides. They have a structure that does not allow proteolytic degradation, which makes them more stable while maintaining microbial activity. This structure also brings many advantages to the molecule, such as greater diversity and specificity, making it more suitable for biological applications. For the first time, a synthesized peptoid (GN2-Npm9) was used to functionalize a nanometric chemically pre-treated (CT) titanium surface for bone-contact implant applications. A preliminary characterization of the functionalized surfaces was performed using the contact angle measurements and zeta potential titration curves. These preliminary analyses confirmed the presence of the peptoid and its adsorption on CT. The functionalized surface had a hydrophilic behaviour (contact angle = 30°) but the hydrophobic tryptophan-like residues were also exposed. An electrostatic interaction between the lysine residue of GN2-Npm9 and the surface allowed a chemisorption mechanism. The biological characterization of the CT_GN2-Nmp9 surfaces demonstrated the ability to prevent surface colonization and biofilm formation by the pathogens Escherichia coli and Staphylococcus epidermidis thus showing a broad-range activity. The cytocompatibility was confirmed by human mesenchymal stem cells. Finally, a bacteria-cells co-culture model was applied to demonstrate the selective bioactivity of the CT_GN2-Nmp9 surface that was able to preserve colonizing cells adhered to the device surface from bacterial infection.

GL13K-modified titanium regulates osteogenic differentiation via the NF-κB pathway

The osteoimmune response plays a crucial regulatory role in the osseointegration of dental implants. Previous studies found the antimicrobial peptide coating (GL13K) could activate the immunomodulatory potential of macrophages (Raw 264.7) and promote osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). To further investigate the mechanism of interaction between immunomodulation and differentiation, a co-culture model of the representative cells (Raw 264.7 and BMSCs) was constructed to mimic the immune microenvironment. In this system, GL13K coating of titanium implant effectively inhibited the polarization of the inflammatory M1 type and promoted the polarization of the anti-inflammatory M2 type. Furthermore, the inhibited NF-κB signaling pathway and Mip-2 gene expression were found and validated by bioinformatics analysis and virus-induced gene silencing, which significantly affected the tissue repair process. It can be concluded that the GL13K coating had the potential to establish a localized immune microenvironment conducive to osteogenic differentiation through cellular interactions. Subsequent investigations would be dedicated to a thorough examination of the osseointegration effects of GL13K coating.

Conjugation of antimicrobial peptides to enhance therapeutic efficacy

The growing prevalence of antimicrobial resistance (AMR) has brought with it a continual increase in the numbers of deaths from multidrug-resistant (MDR) infections. Since the current arsenal of antibiotics has become increasingly ineffective, there exists an urgent need for discovery and development of novel antimicrobials. Antimicrobial peptides (AMPs) are considered to be a promising class of molecules due to their broad-spectrum activities and low resistance rates compared with other types of antibiotics. Since AMPs also often play major roles in elevating the host immune response, the molecules may also be called "host defense peptides." Despite the great promise of AMPs, the majority remain unsuitable for clinical use due to issues of structural instability, degradation by proteases, and/or toxicity to host cells. Moreover, AMP activities in vivo can be influenced by many factors, such as interaction with blood and serum biomolecules, physiological salt concentrations or different pH values. To overcome these limitations, structural modifications can be made to the AMP. Among several modifications, physical and chemical conjugation of AMP to other biomolecules is widely considered an effective strategy. In this review, we discuss structural modification strategies related to conjugation of AMPs and their possible effects on mode of action. The conjugation of fatty acids, glycans, antibiotics, photosensitizers, polymers, nucleic acids, nanoparticles, and immobilization to biomaterials are highlighted.

Prolonged release of an antimicrobial peptide GL13K-loaded thermosensitive hydrogel on a titanium surface improves its antibacterial and anti-inflammatory properties

The application of titanium in the orthopedic and dental fields is associated with bacterial infection and chronic inflammation, especially in the early stages after its implantation. In the present study, we investigated the antibacterial and anti-inflammatory activities of a titanium surface that was immobilized in a thermosensitive PLGA-PEG-PLGA hydrogel containing the antimicrobial peptide GL13K. The FTIR results confirmed the successful loading of GL13K. The degradation of the hydrogel and release of GL13K persisted for two weeks. The modified titanium surface exhibited a significant inhibitory effect on Porphyromonas gingivalis in contact with its surface, as well as an inhibitory effect on P.g in the surrounding environment by releasing GL13K antimicrobial peptides. The modified titanium surfaces were biocompatible with RAW264.7. Furthermore, the expression of pro-inflammatory cytokines IL-1β, TNF-α and iNOS was down-regulated, whereas anti-inflammatory cytokines Arg-1, IL-10 and VEGF-A were up-regulated on the modified titanium surfaces on days 3 and 5. This effect was attributed to the polarization of macrophages from the M1 to M2 phenotype, which was confirmed by the detection of macrophage M1/M2 biomarkers via immunofluorescence staining and flow cytometry. Thus, the thermosensitive PLGA-PEG-PLGA hydrogel release system carrying the antimicrobial peptide GL13K on a titanium surface exhibited antibacterial and anti-inflammatory properties and promoted macrophage polarization from the M1 to M2 phenotype, which may help create a favourable niche for bone formation under infective condition.

Built-up sodium alginate/chlorhexidine multilayer coating on dental implants with initiating anti-infection and cyto-compatibility sequentially for soft-tissue sealing

Soft-tissue sealing at transmucosal sites is very important for preventing the invasion of pathogens and maintaining the long-term stability and function of dental implants. However, the colonization of oral pathogens on the implant surface and surrounding soft tissues can disturb the early establishment of soft-tissue sealing and even induce peri-implant infection. The purpose of this study was to construct two antibacterial coatings with 5 or 10 sodium alginate/chlorhexidine bilayers on titanium surfaces using layer-by-layer self-assembly technology to promote soft-tissue sealing. The corresponding chemical composition, surface topography, wettability and release behaviour were investigated to prove that the resultant coating of sodium alginate and chlorhexidine was coated on the porous titanium surface. In-vitro and in-vivo antibacterial results showed that both prepared coatings inhibited or killed the bacteria on their surfaces and the surrounding areas to prevent plaque biofilm formation, especially the coating with 10 bilayers. Although both coatings inhibited the initial adhesion of fibroblasts, the cytocompatibility gradually improved with coating degradation. More importantly, both coatings achieved cell adhesion and proliferation in an in-vitro bacterial environment and effectively alleviated bacteria-induced subcutaneous inflammation in-vivo. Therefore, this study demonstrated that the multilayered coating could prevent implant-related infections in the initial stage of implant surgery and then improve soft-tissue integration with implant devices.

Biomaterial engineering surface to control polymicrobial dental implant-related infections: focusing on disease modulating factors and coatings development

INTRODUCTION

Peri-implantitis is the leading cause of dental implant loss and is initiated by a polymicrobial dysbiotic biofilm formation on the implant surface. The destruction of peri-implant tissue by the host immune response and the low effectiveness of surgical or non-surgical treatments highlight the need for new strategies to prevent, modulate and/or eliminate biofilm formation on the implant surface. Currently, several surface modifications have been proposed using biomolecules, ions, antimicrobial agents, and topography alterations.

AREAS COVERED

Initially, this review provides an overview of the etiopathogenesis and host- and material-dependent modulating factors of peri-implant disease. In addition, a critical discussion about the antimicrobial surface modification mechanisms and techniques employed to modify the titanium implant material is provided. Finally, we also considered the future perspectives on the development of antimicrobial surfaces to narrow the bridge between idea and product and favor the clinical application possibility.

EXPERT OPINION

Antimicrobial surface modifications have demonstrated effective results; however, there is no consensus about the best modification strategy and in-depth information on the safety and longevity of the antimicrobial effect. Modified surfaces display recurring challenges such as short-term effectiveness, the burst release of drugs, cytotoxicity, and lack of reusability. Stimulus-responsive surfaces seem to be a promising strategy for a controlled and precise antimicrobial effect, and future research should focus on this technology and study it from models that better mimic clinical conditions.

Peptides in Dentistry: A Scoping Review

Currently, it remains unclear which specific peptides could be appropriate for applications in different fields of dentistry. The aim of this scoping review was to scan the contemporary scientific papers related to the types, uses and applications of peptides in dentistry at the moment. Literature database searches were performed in the following databases: PubMed/MEDLINE, Scopus, Web of Science, Embase, and Scielo. A total of 133 articles involving the use of peptides in dentistry-related applications were included. The studies involved experimental designs in animals, microorganisms, or cells; clinical trials were also identified within this review. Most of the applications of peptides included caries management, implant osseointegration, guided tissue regeneration, vital pulp therapy, antimicrobial activity, enamel remineralization, periodontal therapy, the surface modification of tooth implants, and the modification of other restorative materials such as dental adhesives and denture base resins. The in vitro and in vivo studies included in this review suggested that peptides may have beneficial effects for treating early carious lesions, promoting cell adhesion, enhancing the adhesion strength of dental implants, and in tissue engineering as healthy promotors of the periodontium and antimicrobial agents. The lack of clinical trials should be highlighted, leaving a wide space available for the investigation of peptides in dentistry.

The Potential of Surface-Immobilized Antimicrobial Peptides for the Enhancement of Orthopaedic Medical Devices: A Review

Due to the well-known phenomenon of antibiotic resistance, there is a constant need for antibiotics with novel mechanisms and different targets respect to those currently in use. In this regard, the antimicrobial peptides (AMPs) seem very promising by virtue of their bactericidal action, based on membrane permeabilization of susceptible microbes. Thanks to this feature, AMPs have a broad activity spectrum, including antibiotic-resistant strains, and microbial biofilms. Additionally, several AMPs display properties that can help tissue regeneration. A possible interesting field of application for AMPs is the development of antimicrobial coatings for implantable medical devices (e.g., orthopaedic prostheses) to prevent device-related infection. In this review, we will take note of the state of the art of AMP-based coatings for orthopaedic prostheses. We will review the most recent studies by focusing on covalently linked AMPs to titanium, their antimicrobial efficacy and plausible mode of action, and cytocompatibility. We will try to extrapolate some general rules for structure-activity (orientation, density) relationships, in order to identify the most suitable physical and chemical features of peptide candidates, and to optimize the coupling strategies to obtain antimicrobial surfaces with improved biological performance.

How Porphyromonas gingivalis Navigate the Map: The Effect of Surface Topography on the Adhesion of Porphyromonas gingivalis on Biomaterials

The main purpose of this study is to develop an understanding of how Porphyromonas gingivalis responds to subperiosteal implant surface topography. A literature review was drawn from various electronic databases from 2000 to 2021. The two main keywords used were "Porphyromonas gingivalis" and "Surface Topography". We excluded all reviews and or meta-analysis articles, articles not published in English, and articles with no surface characterization process or average surface roughness (Ra) value. A total of 26 selected publications were then included in this study. All research included showed the effect of topography on Porphyromonas gingivalis to various degrees. It was found that topography features such as size and shape affected Porphyromonas gingivalis adhesion to subperiosteal implant materials. In general, a smaller Ra value reduces Porphyromonas gingivalis regardless of the type of materials, with a threshold of 0.3 µm for titanium.

Antimicrobial peptide GL13K immobilized onto SLA-treated titanium by silanization: antibacterial effect against methicillin-resistant Staphylococcus aureus (MRSA)

Infection is the main reason for implant failure, and the incidence of drug-resistant bacterial infection has increased in recent years. Further, methicillin-resistant Staphylococcus aureus (MRSA)-related implant infection has become a serious worldwide threat. New strategies, other than antibiotics, to tackle drug-resistance, are of high clinical significance. Antimicrobial peptides show clear superiority over conventional antibiotics in inhibiting drug-resistant bacteria. In the present study, we combined the antimicrobial peptide, GL13K, with sandblasting and acid-etching (SLA)-treated titanium using a silane coupling agent. Field emission scanning electron microscopy images showed the morphology of the coating. Attenuated total reflectance Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy results confirmed loading of GL13K, and the hydrophilicity of the SLA-GL13K coating was evaluated by water contact angle analysis. The releasing study of samples showed that the coating has a sustained releasing profile. SLA-GL13K coating exhibited strong contact- and release-killing abilities against MRSA, E. coli, and S. aureus. Meanwhile, Cell Counting Kit 8 analysis and examination of cell morphology demonstrated that the SLA-GL13K coating had good cytocompatibility at antibacterial concentrations. Overall, all these results suggest that SLA-GL13K coating can be successfully fabricated using silanization, and is a promising candidate for controlling MRSA-induced implant-related infection.

Antimicrobial and Antibiofilm Coating of Dental Implants—Past and New Perspectives

Regarded as one of the best solutions to replace missing teeth in the oral cavity, dental implants have been the focus of plenty of studies and research in the past few years. Antimicrobial coatings are a promising solution to control and prevent bacterial infections that compromise the success of dental implants. In the last few years, new materials that prevent biofilm adhesion to the surface of titanium implants have been reported, ranging from improved methods to already established coating surfaces. The purpose of this review is to present the developed antimicrobial and antibiofilm coatings that may have the potential to reduce bacterial infections and improve the success rate of titanium dental implants. All referred coating surfaces showed high antimicrobial properties with effectiveness in biofilm control, while maintaining implant biocompatibility. We expect that by combining the use of oligonucleotide probes as a covering material with novel peri-implant adjuvant therapies, we will be able to avoid the downsides of other covering materials (such as antibiotic resistance), prevent bacterial infections, and raise the success rate of dental implants. The existing knowledge on the optimal coating material for dental implants is limited, and further research is needed before more definitive conclusions can be drawn.

Facilitating GL13K Peptide Grafting on Polyetheretherketone via 1-Ethyl-3-(3-dimethylaminopropyl)carbodiimide: Surface Properties and Antibacterial Activity

In the present work, the antimicrobial peptide (AMP) of GL13K was successfully coated onto a polyetheretherketone (PEEK) substrate to investigate its antibacterial activities against Staphylococcus aureus (S. aureus) bacteria. To improve the coating efficiency, 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) was mixed with a GL13K solution and coated on the PEEK surface for comparison. Both energy-dispersive X-ray spectroscopy (EDX) and X-ray photoelectron spectroscopy (XPS) data confirmed 30% greater peptide coating on PEEK/GL13K-EDC than PEEK without EDC treatment. The GL13K graft levels are depicted in the micrograms per square centimeter range. The PEEK/GL13K-EDC sample showed a smoother and lower roughness (Rq of 0.530 µm) than the PEEK/GL13K (0.634 µm) and PEEK (0.697 µm) samples. The surface of the PEEK/GL13K-EDC was more hydrophilic (with a water contact angle of 24°) than the PEEK/GL13K (40°) and pure PEEK (89°) samples. The pure PEEK disc did not exhibit any inhibition zone against S. aureus. After peptide coating, the samples demonstrated significant zones of inhibition: 28 mm and 25 mm for the PEEK/GL13K-EDC and PEEK/GL13K samples, respectively. The bacteria-challenged PEEK sample showed numerous bacteria clusters, whereas PEEK/GL13K contained a little bacteria and PEEK/GL13K-EDC had no bacterial attachment. The results confirm that the GL13K peptide coating was able to induce antibacterial and biofilm-inhibitory effects. To the best of our knowledge, this is the first report of successful GL13K peptide grafting on a PEEK substrate via EDC coupling. The present work illustrates a facile and promising coating technique for a polymeric surface to provide bactericidal activity and biofilm resistance to medical implantable devices.

Martins MC, Costa F. Antimicrobial Peptides in the Battle against Orthopedic Implant-Related Infections: A Review

Prevention of orthopedic implant-related infections is a major medical challenge, particularly due to the involvement of biofilm-encased and multidrug-resistant bacteria. Current therapies, based on antibiotic administration, have proven to be insufficient, and infection prevalence may rise due to the dissemination of antibiotic resistance. Antimicrobial peptides (AMPs) have attracted attention as promising substitutes of conventional antibiotics, owing to their broad-spectrum of activity, high efficacy at very low concentrations, and, importantly, low propensity for inducing resistance. The aim of this review is to offer an updated perspective of the development of AMPs-based preventive strategies for orthopedic and dental implant-related infections. In this regard, two major research strategies are herein addressed, namely (i) AMP-releasing systems from titanium-modified surfaces and from bone cements or beads; and (ii) AMP immobilization strategies used to graft AMPs onto titanium or other model surfaces with potential translation as coatings. In overview, releasing strategies have evolved to guarantee higher loadings, prolonged and targeted delivery periods upon infection. In addition, avant-garde self-assembling strategies or polymer brushes allowed higher immobilized peptide surface densities, overcoming bioavailability issues. Future research efforts should focus on the regulatory demands for pre-clinical and clinical validation towards clinical translation.

The integration of pore size and porosity distribution on Ti-6A1-4V scaffolds by 3D printing in the modulation of osteo-differentation

PURPOSE

In this study, pore size and porosity distribution of porous Ti-6Al-4V scaffolds (pTi) were controlled by 3D printing. The effects of pore size distribution at a constant porosity, or porosity distribution at a constant pore size pertaining to functions of adhesion, proliferation, and differentiation of the mouse embryonic osteoblast precursor (MC3T3-E1) cells were researched separately.

METHODS

3D printing was used to design five groups of pTi, designated as PS₃₀₀/HP, PS₃₀₀/LP, PS₅₀₀/HP, PS₅₀₀/LP, and PS₈₀₀/HP based on pore size and porosity distribution. MC3T3-E1 cells were cultured on pTi, and non-porous Ti-6Al-4V samples (npTi) were prepared as control. The pTi was characterized with the scanning electron microscopy (SEM). MC3T3-E1 cells were stained via AlamarBlue assay and viability and proliferation analyzed. The mRNA levels of alkaline phosphatase (ALP), osteocalcin (OCN), collagentype-1 (Col-1), and runt-related transcription factor 2 (Runx2) in MC3T3-E1 cells were analyzed by real-time PCR analysis.

RESULTS

The average pore size and porosity of pTi were recorded as (301 ± 9 μm, 58.8 ± 1.8%), (300 ± 9 μm, 43.4 ± 1.3%), (501 ± 11 μm, 58.3 ± 1.2%), (499 ± 12 μm, 42.7 ± 1.1%), and (804 ± 10 μm, 58.9 ± 1.3%), respectively. SEM images confirmed active attachment of cells and oriented with the direction of metal rod after pTi/MC3T3-E1 co-culture for 3 and 7 days. In addition, MC3T3-E1 cells grown on the PS₈₀₀/HP displayed significantly higher proliferation compared with each group after 3 days incubation (p < 0.05). Moreover, cells showed some degree of proliferation in all groups, with the highest value recorded for PS₈₀₀/HP after culture for 7 days (p < 0.05). The gene expression pattern of ALP, OCN, Col-1, and Runx2 confirmed that these were down-regulated when pore size increased or porosity decreased of pTi (p < 0.05).

CONCLUSION

The pTi facilitated the adhesion and differentiation of osteoblast when pore size decreased or porosity increased. The scaffold model resembles physical modification with porous structures, which has potential application in the surface modifications of Ti implant.

Regulation of an Antimicrobial Peptide GL13K-Modified Titanium Surface on Osteogenesis, Osteoclastogenesis, and Angiogenesis Base on Osteoimmunology

Creating a pro-regenerative immune microenvironment around implant biomaterial surfaces is significant to osseointegration. Immune cells, especially macrophages that participate in the osseointegration, including osteogenesis, osteoclastogenesis, and angiogenesis, should be considered when testing biomaterials. In this study, we immobilized an antimicrobial peptide GL13K with immunomodulatory properties onto a titanium surface via silanization. The modified surfaces show good biocompatibility with bone mesenchymal stromal cells (BMSCs), human umbilical vein endothelial cells (HUVECs), and RAW264.7. By co-culturing BMSCs with RAW264.7, we found that the GL13K-coated titanium surfaces could promote late-stage osteogenesis as demonstrated by the upregulated expression of recombinant collagen type I alpha 1 (COL-1α1) and more extracellular matrix mineralization, while the early phase remained unchanged. The surfaces inhibited the osteoclastogenic differentiation of RAW264.7 cells by restraining nuclear factor-activated T cells, cytoplasmic 1 (NFATc1), the main factor of the receptor activator of nuclear factor-κ B, and the receptor activator of the nuclear factor-κ B ligand signaling pathway, from entering the nucleus and further reduced the expression of the activating osteoclastogenic tartrate-resistant acid phosphatase gene. Moreover, the GL13K-coated titanium surface demonstrated significant promotion of angiogenesis differentiation of HUVECs as indicated by the upregulated expression of essential angiogenesis function genes, including hypoxia-inducible factor-1α, endothelial nitric oxide synthase, kinase insert domain receptor, and vascular endothelial growth factor A (HIF-1α, eNOS, KDR, and VEGF-A). Taken together, these results demonstrated that the GL13K coating had properties of osteogenesis, angiogenesis, and anti-osteoclastogenesis via its immunomodulatory potential.

The prospects of antimicrobial coated medical implants

The implants are increasingly being a part of modern medicine in various surgical procedures for functional or cosmetic purposes. The progressive use of implants is associated with increased infectious complications and prevention of such infections always remains precedence in the clinical settings. The preventive approaches include the systemic administration of antimicrobial agents before and after the surgical procedures as well as the local application of antibiotics. The relevant literature and existing clinical practices have highlighted the role of antimicrobial coating approaches in the prevention of implants associated infections, although the applications of these strategies are not yet standardized, and the clinical efficacy is not much clear. The adequate data from the randomized control trials is challenging because of the unavailability of a large sample size although it is compulsory in this context to assess the clinical efficacy of preemptive practices. This review compares the efficacy of preventive approaches and the prospects of antimicrobial-coated implants in preventing implant-related infections.

Additive manufacturing of Ti6Al4V alloy via electron beam melting for the development of implants for the biomedical industry

Additive Manufacturing (AM) or rapid prototyping technologies are presented as one of the best options to produce customized prostheses and implants with high-level requirements in terms of complex geometries, mechanical properties, and short production times. The AM method that has been more investigated to obtain metallic implants for medical and biomedical use is Electron Beam Melting (EBM), which is based on the powder bed fusion technique. One of the most common metals employed to manufacture medical implants is titanium. Although discovered in 1790, titanium and its alloys only started to be used as engineering materials for biomedical prostheses after the 1950s. In the biomedical field, these materials have been mainly employed to facilitate bone adhesion and fixation, as well as for joint replacement surgeries, thanks to their good chemical, mechanical, and biocompatibility properties. Therefore, this study aims to collect relevant and up-to-date information from an exhaustive literature review on EBM and its applications in the medical and biomedical fields. This AM method has become increasingly popular in the manufacturing sector due to its great versatility and geometry control.

Surface engineering of biomaterials in orthopedic and dental implants: Strategies to improve osteointegration, bacteriostatic and bactericidal activities

BACKGROUND

The success of biomedical implants in orthopedic and dental applications is usually limited due to insufficient bone-implant integration, and implant-related infections. Biointerfaces are critical in regulating their interactions and the desirable performance of biomaterials in biological environment. Surface engineering has been widely studied to realize better control of the interface interaction to further enhance the desired behavior of biomaterials.

PURPOSE AND SCOPE

This review aims to investigate surface coating strategies in hard tissue applications to address insufficient osteointegration and implant-related infection problems.

SUMMARY

We first focused on surface coatings to enhance the osteointegration and biocompatibility of implants by emphasizing calcium phosphate-related, nanoscale TiO₂ -related, bioactive tantalum-based and biomolecules incorporated coatings. Different coating strategies such as plasma spraying, biomimetic deposition, electrochemical anodization and LENS are discussed. We then discussed techniques to construct anti-adhesive and bactericidal surface while emphasizing multifunctional surface coating techniques that combine potential osteointegration and antibacterial activities. The effects of nanotopography via TiO₂ coatings on antibacterial performance are interesting and included. A smart bacteria-responsive titanium dioxide nanotubes coating is also attractive and elaborated.

CONCLUSION

Developing multifunctional surface coatings combining osteogenesis and antimicrobial activity is the current trend. Surface engineering methods are usually combined to obtain hierarchical multiscale surface structures with better biofunctionalization outcomes.

Characteristics and therapeutic applications of antimicrobial peptides

The demand for novel antimicrobial compounds is rapidly growing due to the phenomenon of antibiotic resistance in bacteria. In response, numerous alternative approaches are being taken including use of polymers, metals, combinatorial approaches, and antimicrobial peptides (AMPs). AMPs are a naturally occurring part of the immune system of all higher organisms and display remarkable broad-spectrum activity and high selectivity for bacterial cells over host cells. However, despite good activity and safety profiles, AMPs have struggled to find success in the clinic. In this review, we outline the fundamental properties of AMPs that make them effective antimicrobials and extend this into three main approaches being used to help AMPs become viable clinical options. These three approaches are the incorporation of non-natural amino acids into the AMP sequence to impart better pharmacological properties, the incorporation of AMPs in hydrogels, and the chemical modification of surfaces with AMPs for device applications. These approaches are being developed to enhance the biocompatibility, stability, and/or bioavailability of AMPs as clinical options.

The influence of laser frequency and groove distance on cell adhesion, cell viability, and antibacterial characteristics of Ti-6Al-4V dental implants treated by modern fiber engraving laser

OBJECTIVE

Micro-nano scale surface modification of Ti-6Al-4V was investigated through the fascinated modern fiber engraving laser method. The process was performed at a high laser speed of 2000mm/s, under different laser frequencies (20-160kHz) and groove distances (0.5-50μm).

METHODS

Topographic evaluations such as Atomic Force Microscopy (AFM) and Field Emission Scanning Electron Microscopy (FE-SEM) were used to identify the quality and regularity of patterns. The proliferation of human osteoblast-like osteosarcoma cells (MG63) was analyzed by MTT assay for up to 72h. Also, the plate counting method was used to quantify the viability potential of the modified surface against Escherichia coli bacteria.

RESULTS

The cellular viability of the sample modified at the laser frequency of 20kHz and grooving distance of 50μm increased up to 35 and 10% compared to the non-treated and control samples, respectively. In the case of the surface modification at lower grooving distances range between 0.5-50μm, the maximum laser frequency (160kHz) applied leads to lower pulse's energies and less bacterial adhesion. Otherwise, at groove distances more than 50μm, the minimum laser frequency (20kHz) applied reduces the laser pulse overlaps, increases the cell adhesion and antibacterial properties.

SIGNIFICANCE

Surface modification by the fiber engraving laser process significantly enhances the cell adhesion on the surface. As a result of such roughness and cell adhesion enhancement, the surface toxicity feature diminished, and its antibacterial properties improved.

Surface functionalization of titanium substrates with Deoxyribonuclease I inhibit peri-implant bacterial infection

This study aimed to investigate the effect of Deoxyribonuclease I (DNase I) coating on initial adhesion and biofilm formation of peri-implant bacteria. Titanium (Ti), Ti-polydopamine (Ti-PDOP), Ti-PDOP-DNase I and Ti-PDOP-inactivated DNase I samples were studied. The FE-SEM, EDS and XPS were used to confirm that DNase I was coated onto Ti. The initial adhesion and biofilm formation of Aggregatibacter actinomycetemcomitans (A.a) and Fusobacterium nucleatum (F.n) were observed by CLSM. The osteogenic induction of Ti-PDOP-DNase I on MC3T3-E1 cells was investigated by ALP activity and RT-PCR. The adhesion clearance rate of viable bacteria on the surfaces of Ti-PDOP-DNase I was 91.95% for A.a, and 96.37% for F.n, and the 24 h biofilm formation of the bacteria was significantly inhibited. In addition, on DNase I coating, the mRNA level of osteogenic marker genes (alp, opn, bsp, sp7) and the activity of ALP were both up-regulated. Therefore, DNase I coating could be an alternative approach for preventing implant-related infection.

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.

Harnessing biomolecules for bioinspired dental biomaterials

Dental clinicians have relied for centuries on traditional dental materials (polymers, ceramics, metals, and composites) to restore oral health and function to patients. Clinical outcomes for many crucial dental therapies remain poor despite many decades of intense research on these materials. Recent attention has been paid to biomolecules as a chassis for engineered preventive, restorative, and regenerative approaches in dentistry. Indeed, biomolecules represent a uniquely versatile and precise tool to enable the design and development of bioinspired multifunctional dental materials to spur advancements in dentistry. In this review, we survey the range of biomolecules that have been used across dental biomaterials. Our particular focus is on the key biological activity imparted by each biomolecule toward prevention of dental and oral diseases as well as restoration of oral health. Additional emphasis is placed on the structure-function relationships between biomolecules and their biological activity, the unique challenges of each clinical condition, limitations of conventional therapies, and the advantages of each class of biomolecule for said challenge. Biomaterials for bone regeneration are not reviewed as numerous existing reviews on the topic have been recently published. We conclude our narrative review with an outlook on the future of biomolecules in dental biomaterials and potential avenues of innovation for biomaterial-based patient oral care.

The Effects of Titanium Surfaces Modified with an Antimicrobial Peptide GL13K by Silanization on Polarization, Anti-Inflammatory, and Proinflammatory Properties of Macrophages

The polarization of macrophages and its anti-inflammatory and proinflammatory properties play a significant role in host response after implant placement to determine the outcome of osseointegration and long-term survival. In the previous study, we immobilized an antimicrobial peptide, GL13K, onto titanium surfaces to provide immune regulation property. In the herein presented study, we aimed at investigating whether GL13K immobilized titanium surface could improve osteogenesis and reduce the inflammatory reaction around the biomaterials by altering macrophage response. We evaluated the cell proliferation of the different phenotypes of macrophages seeded in GL13K-coated titanium surface, which indicated an inhibition of M1 macrophages and a good cytocompatibility to M2 macrophages. Then, we measured the inflammatory and anti-inflammatory activity of the M1 and M2 macrophages seeded on the GL13K-coated titanium surfaces. The results of the enzyme-linked immunosorbent assay and quantitative reverse transcription-polymerase chain reaction showed that the group with the GL13K modified surface had a downregulation in the expression level of the tumor necrosis factor-α and interleukin-1β in M1 macrophages and an upregulation of IL-10 and transforming growth factor-β3 (TGF-β3) levels in M2 macrophages. This study demonstrated that the GL13K modified titanium surfaces can regulate macrophages' polarization and the expression of inflammatory and anti-inflammatory effects, reducing the effects of the inflammatory process, which may promote the process of bone regeneration and osseointegration.

Enhanced Human Gingival Fibroblast Response and Reduced Porphyromonas gingivalis Adhesion with Titania Nanotubes

Successful dental implants rely on stable osseointegration and soft-tissue integration. Titania nanotubes (TNTs) with a diameter of 100 nm could increase the mesenchymal stem cell response and simultaneously decrease Staphylococcus aureus adhesion. However, the interactions between the modified surface and surrounding soft tissues are still unknown. In the present study, we fully investigated the biological behavior of human gingival fibroblasts (HGFs) and the adhesion of Porphyromonas gingivalis (P. gingivalis). TNTs were synthesized on titanium (Ti) surfaces by electrochemical anodization at 10, 30, and 60 V, and the products were denoted as NT10, NT30, and NT60, respectively. NT10 (diameter: 30 nm) and NT30 (diameter: 100 nm) could enhance the HGF functions, such as cell attachment and proliferation and extracellular matrix- (ECM-) related gene expressions, with the latter showing higher enhancement. NT60 (diameter: 200 nm) clearly impaired cell adhesion and proliferation and ECM-related gene expressions. Bacterial adhesion on the TNTs decreased and reached the lowest value on NT30. Therefore, NT30 without pharmaceuticals can be used to substantially enhance the HGF response and reduce P. gingivalis adhesion to the utmost, thus demonstrating significant potential in the transgingival part of dental implants.

Antibacterial Properties of Nano-Ag Coating on Healing Abutment: An In Vitro and Clinical Study

Peri-implantitis is an inflammatory disease with a relevant focus on the long-term success of dental implants and implant-supported prostheses. The present study focuses on the antibacterial effect of the silver nanoparticle and investigated the suppression of dental plaque adhesion on implant abutment and/or superstructure by micro-wave assistant nanosilver coating in vivo and in vitro. Nanosilver coating on pure titanium was prepared by microwave-assisted synthesis, and characterized by scanning electron microscopy and energy-dispersive X-ray spectroscopy. In vitro studies were conducted to analyze biocompatibility using MTS assay and fluorescence microscopy with human gingival fibroblasts to evaluate antibacterial activity. During the in vivo study, nanosilver coating was applied to the healing abutments, and the prevention of plaque accumulation on nanosilver coating was confirmed by a split-mouth randomized clinical trial. The aggregation of nano-sized particles was found on the titanium surface with an antibacterial effect. The coating had no cytotoxic effect on human gingival fibroblasts. The result of the clinical trial showed that the coating suppressed the dental plaque adhesion on the healing abutments. Nanosilver coating is a promising material with antibacterial properties and can be used for implant abutments and prostheses for preventing peri-implantitis.

Customized Therapeutic Surface Coatings for Dental Implants

Dental implants are frequently used to support fixed or removable dental prostheses to replace missing teeth. The clinical success of titanium dental implants is owed to the exceptional biocompatibility and osseointegration with the bone. Therefore, the enhanced therapeutic effectiveness of dental implants had always been preferred. Several concepts for implant coating and local drug delivery had been developed during the last decades. A drug is generally released by diffusion-controlled, solvent-controlled, and chemical controlled methods. Although a range of surface modifications and coatings (antimicrobial, bioactive, therapeutic drugs) have been explored for dental implants, it is still a long way from designing sophisticated therapeutic implant surfaces to achieve the specific needs of dental patients. The present article reviews various interdisciplinary aspects of surface coatings on dental implants from the perspectives of biomaterials, coatings, drug release, and related therapeutic effects. Additionally, the various types of implant coatings, localized drug release from coatings, and how released agents influence the bone–implant surface interface characteristics are discussed. This paper also highlights several strategies for local drug delivery and their limitations in dental implant coatings as some of these concepts are yet to be applied in clinical settings due to the specific requirements of individual patients.

Biofunctionalization of Microgroove Surfaces with Antibacterial Nanocoatings

Objectives

To investigate the physical properties of the modified microgroove (MG) and antibacterial nanocoated surfaces. In addition, the biological interactions of the modified surfaces with human gingival fibroblasts (HGFs) and the antibacterial activity of the surfaces against Porphyromonas gingivalis were studied.

Methods

The titanium nitride (TiN) and silver (Ag) coatings were deposited onto the smooth and MG surfaces using magnetron sputtering. A smooth titanium surface (Ti-S) was used as the control. The physicochemical properties including surface morphology, roughness, and hydrophilicity were characterized using scanning electron microscopy, atomic force microscopy, and an optical contact angle analyzer. The "contact guidance" morphology was assessed using confocal laser scanning microscopy. Cell proliferation was analyzed using the Cell Counting Kit-8 assay. The expression level of the main focal adhesion-related structural protein vinculin was compared using quantitative reverse transcription PCR and Western blotting. The antibacterial activity against P. gingivalis was evaluated using the LIVE/DEAD BacLight™ Bacterial Viability Kit.

Results

The Ag and TiN antibacterial nanocoatings were successfully deposited onto the smooth and MG surfaces using magnetron sputtering technology. TiN coating on a grooved surface (TiN-MG) resulted in less nanoroughness and greater surface hydrophilicity than Ag coating on a smooth surface (Ag-S), which was more hydrophobic. Cell proliferation and expression of vinculin were higher on the TiN-MG surface than on the Ag-coated surfaces. Ag-coated surfaces showed the strongest antibacterial activity, followed by TiN-coated surfaces.

Conclusion

Nano-Ag coating resulted in good antimicrobial activity; however, the biocompatibility was questionable. TiN nanocoating on an MG surface showed antibacterial properties with an optimal biocompatibility and maintained the "contact guidance" effects for HGFs.

The role of calcium phosphate surface structure in osteogenesis and the mechanisms involved

Calcium phosphate (CaP) ceramics have been widely used for bone regeneration because of their ability to induce osteogenesis. Surface properties, including chemical composition and surface structure, are known to play a crucial role in osteoconduction and osteoinduction. This review systematically analyzes the effects of surface properties, in particular the surface structure, of CaP scaffolds on cell behavior and new bone formation. We also summarize the possible signaling pathways involved in the osteogenic differentiation of bone-related cells when cultured on surfaces with various structures in vitro. The significant immune response initiated by surface structure involved in osteogenic differentiation of cells is also discussed in this review. Taken together, the new biological principle for advanced biomaterials is not only to directly stimulate osteogenic differentiation of bone-related cells but also to modulate the immune response in vivo. Although the reaction mechanism responsible for bone formation induced by CaP surface structure is not clear yet, the insights on surface structure-mediated osteogenic differentiation and osteoimmunomodulation could aid the optimization of CaP-based biomaterials for bone regeneration. STATEMENT OF SIGNIFICANCE: CaP ceramics have similar inorganic composition with natural bone, which have been widely used for bone tissue scaffolds. CaP themselves are not osteoinductive; however, osteoinductive properties could be introduced to CaP materials by surface engineering. This paper systematically summarizes the effects of surface properties, especially surface structure, of CaP scaffolds on bone formation. Additionally, increasing evidence has proved that the bone healing process is not only affected by the osteogenic differentiation of bone-related cells, but also relevant to the the cooperation of immune system. Thus, we further review the possible signaling pathways involved in the osteogenic differentiation and immune response of cells cultured on scaffold surface. These insights into surface structure-mediated osteogenic differentiation and osteoimmunomodulated-based strategy could aid the optimization of CaP-based biomaterials.

Influences of sodium tantalite submicro-particles in polyetheretherketone based composites on behaviors of rBMSCs/HGE-1 cells for dental application

Dental implanted materials require excellent mechanical properties, biocompatibility as well as integration with bone tissue and gingival tissue to achieve early loading and long-term stability. In this study, cubic shape sodium tantalite (ST) submicro-particles with the size of around 180 nm were synthesized by a hydrothermal method, and ST/polyetheretherketone (PEEK) composites (TPC) with ST content of 20 w% (TPC20) and 40 w% (TPC40) were prepared by melting blend. The results showed that the compressive strength, thermal properties, surface roughness, hydrophilicity and surface energy as well as adsorption of proteins on TPC40 were also significantly enhanced compared with TPC20 and PEEK. Moreover, the responses (adhesion and proliferation as well as differentiation) of rat bone marrow mesenchymal stem cells (rBMSCs), and responses (adhesion, and proliferation) of human gingival epithelial (HGE-1) cells to TPC40 were significantly promoted compared with TPC20 and PEEK. The results demonstrated that ST content in TPC had remarkable effects on the surface properties, which played key roles in stimulating the responses of both rBMSCs and HGE-1 cells. TPC40 with increased surface properties and excellent cytocompatibility might have great potential as an implanted material for dental application.

Antifouling and Antibacterial Properties Constructed by Quaternary Ammonium and Benzyl Ester Derived from Lysine Methacrylamide

Hemocompatibility and antibacterial property are essential for blood contact devices and medical intervention materials. In this study, positively charged quaternary ammonium (QAC) and hydrophobic benzyl group (OBzl) were introduced onto hydrophilic lysine methacrylamide (LysAAm) to obtain two monomers LysAAm-QAC and LysAAm-OBzl, respectively. The structure characterizations of LysAAm-QAC and LysAAm-OBzl were determined by proton nuclear magnetic resonance, Fourier transform infrared spectroscopy, and time-of-flight secondary ion mass spectrometry. LysAAm-QAC and LysAAm-OBzl were cografted onto a silicon wafer with different feeding ratios to construct antifouling and antibacterial properties. The results of fibrinogen adsorption and platelet adhesion proved that the modified sample with the feeding ratio of 3:7 had superior antifouling property. Furthermore, an antimicrobial test with both 2 and 24 h indicated that the modified sample with the feeding ratio of 3:7 had antibacterial ability. The antifouling property was provided by the high surface coverage of LysAAm-QAC and LysAAm-OBzl (91.49%) and the hydrophilic main structure LysAAm on LysAAm-QAC and LysAAm-OBzl (water contact angle was 43.6°). The antibacterial property was improved with the proportion of LysAAm-OBzl (43.6-58.5%) because the increasing hydrophobic OBzl enhanced the ability to insert into the membrane of bacteria and raise the bactericidal efficiency. In application, LysAAm-QAC and LysAAm-OBzl with the feeding ratio of 3:7 were grafted onto the surface of poly(styrene-b-(ethylene-co-butylene)-b-styrene), and a bifunctional surface with antifouling and antibacterial properties was fabricated, which had promising applications in blood contact devices and medical intervention materials.

Bioinspired surface modification of orthopedic implants for bone tissue engineering

Biomedical implants have been widely used in various orthopedic treatments, including total hip arthroplasty, joint arthrodesis, fracture fixation, non-union, dental repair, etc. The modern research and development of orthopedic implants have gradually shifted from traditional mechanical support to a bioactive graft in order to endow them with better osteoinduction and osteoconduction. Inspired by structural and mechanical properties of natural bone, this review provides a panorama of current biological surface modifications for facilitating the interaction between medical implants and bone tissue and gives a future outlook for fabricating the next-generation multifunctional and smart implants by systematically biomimicking the physiological processes involved in formation and functioning of bones.

Microgrooves Encourage Endothelial Cell Adhesion and Organization on Shape-Memory Polymer Surfaces

Cardiovascular stents have become the mainstay for treating coronary and other vascular diseases; however, the need for long-term anti-platelet therapies continues to drive research on novel materials and strategies to promote in situ endothelialization of these devices, which should decrease local thrombotic response. Shape-memory polymers (SMPs) have shown promise as polymer stents due to their self-deployment capabilities and vascular biocompatibility. We previously demonstrated isotropic endothelial cell adhesion on the unmodified surfaces of a family of SMPs previously developed by our group. Here, we evaluate whether endothelial cells align preferentially along microgrooved versus unpatterned surfaces of these SMPs. Results show that micropatterning SMP surfaces enhances natural surface hydrophobicity, which helps promote endothelial cell attachment and alignment along the grooves. With the addition of microgrooves to the SMP surface, this class of SMPs may provide an improved surface and material for next-generation blood-contacting devices.

Improvements on biological and antimicrobial properties of titanium modified by AgNPs-loaded chitosan-heparin polyelectrolyte multilayers

Microbial infection around dental implants is a major cause for the loss of devices, including soft tissue infection in early period, post-operation peri-implantitis, and osseointegration failure. Silver nanoparticles (AgNPs) with wide antimicrobial spectrum, strong antimicrobial effect and hypotoxicity, as well as low incidence of antibiotic resistance, are widely involved in biomedical applications. Herein, firmly anchoring AgNPs onto the surface of implants through physical-chemical reaction is likely to relieve the above issues. In this study, AgNPs were biosynthesized by a simple and "green" method with chitosan (CS) as stabilizing and reducing agents. Then, AgNPs-loaded CS-heparin polyelectrolyte multilayers (PEMs) were constructed on alkali-heat treated titanium (Ti) substrates via layer-by-layer (LbL) self-assembly technique. The successful surface modification could be confirmed by scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS), and the constructed system could provide the continuous release of Ag⁺ over 28 days till mucosa healing. In short, this work revealed that the construction of multilayer coatings containing AgNPs on Ti substrates promoted adhesion and proliferation of human gingival fibroblasts (HGFs) and also enhanced the antimicrobial properties. This manifests the LbL technique is a viable and promising method for forming continuous antimicrobial coatings, to reduce microbial infection and improve the quality of peri-implant soft tissue seal. The preparation process of AgNPs-loaded CS-heparin PEMs on Ti substrate.

Review of titanium surface modification techniques and coatings for antibacterial applications

Implanted biomaterials play a key role in the current success of orthopedic and dental procedures. Pure titanium and its alloys are the most commonly used materials for permanent implants in contact with bone. However, implant-related infections remain among the leading reasons for failure. The most critical pathogenic event in the development of infection on biomaterials is biofilm formation, which starts immediately after bacterial adhesion. In the last decade, numerous studies reported the ability of titanium surface modifications and coatings to minimize bacterial adhesion, inhibit biofilm formation and provide effective bacterial killing to protect implanted biomaterials. In the present review, the different strategies to prevent infection onto titanium surfaces are reported: surface modification and coatings by antibiotics, antimicrobial peptides, inorganic antibacterial metal elements and antibacterial polymers. STATEMENT OF SIGNIFICANCE: Implanted biomaterials play a key role in the current success of orthopedic and dental procedures. Pure titanium and its alloys are the most commonly used materials for permanent implants in contact with bone. Microbial infection is one of the main causes of implant failure. Currently, the global infection risk is 2-5% in orthopedic surgery. Numerous solutions exist to render titanium surfaces antibacterial. The LBPS team is an expert on the functionalization of titanium surfaces by using bioactive polymers to improve the biologiocal response. In this review, the different strategies to prevent infection are reported onto titanium and titanium alloy surfaces such as surface modification by antibiotics, antimicrobial peptides, inorganic antibacterial metal elements and antibacterial polymers.

Macrophage polarization, inflammatory signaling, and NF-κB activation in response to chemically modified titanium surfaces

Functionalization of titanium devices with various bioactive molecules enhances many of their properties as implants, including biocompatibility, which is typically assessed by macrophage activation and inflammation. However, functionalization requires prior introduction of reactive groups, to which bioactive agents can then be grafted. Thus, we investigated the inflammatory properties of titanium pretreated with NaOH, titanium pretreated with NaOH and then with 3-aminopropyl triethoxysilane, and titanium pretreated with dopamine. Inflammation, macrophage polarization, and activation of NF-κB signaling were assessed by real-time PCR and western blotting. The data demonstrate that silanized titanium is the least inflammatory, and promotes macrophage M2 polarization with modest engagement of the NF-κB signaling pathway. Importantly, silanization introduces a reactive amino group, providing more opportunities for further functionalization.

Dopamine self-polymerized along with hydroxyapatite onto the preactivated titanium percutaneous implants surface to promote human gingival fibroblast behavior and antimicrobial activity for biological sealing

The clinical success of dental implants requires not only the optimum osseointegration but also the integration of implant surface with soft tissues to form biological sealing. In this study, alkali-heat treatment was applied to modify the pure titanium surface constructing a unique micro-and nano-structure. Then, poly(dopamine), along and with the additional incorporation of hydroxyapatite and carboxymethyl chitosan have been successfully infiltrated into the preactivated Ti surface during dopamine self-polymerization proceeding. Here, the effects of poly(dopamine)-modified surface coating on the biological behaviors of human gingival fibroblasts (HGFs) and oral pathogens have been systematically studied, which was critical for the early peri-implant soft tissue integration. The results showed that the poly(dopamine)-modified alkali-heat-titanium surface was a superior substrate for human gingival fibroblast adhesion, spread and proliferation. Moreover, further enhancements on cytoskeleton organization, collagen secretion and fibronectin adsorption were generally observed through the additional incorporation of hydroxyapatite. The addition of carboxymethyl chitosan exerted a positive modulation effect on antibacterial activity. Overall, our study demonstrated that combined superior soft tissue integration and antibacterial activity can be achieved by using poly(dopamine)-modified titanium implant, which has great potential in the optimal design of dental implant.

Impact of surface topography and coating on osteogenesis and bacterial attachment on titanium implants

Titanium (Ti) plays a predominant role as the material of choice in orthopaedic and dental implants. Despite the majority of Ti implants having long-term success, premature failure due to unsuccessful osseointegration leading to aseptic loosening is still too common. Recently, surface topography modification and biological/non-biological coatings have been integrated into orthopaedic/dental implants in order to mimic the surrounding biological environment as well as reduce the inflammation/infection that may occur. In this review, we summarize the impact of various Ti coatings on cell behaviour both in vivo and in vitro. First, we focus on the Ti surface properties and their effects on osteogenesis and then on bacterial adhesion and viability. We conclude from the current literature that surface modification of Ti implants can be generated that offer both osteoinductive and antimicrobial properties.

Antimicrobial Peptides in Biomedical Device Manufacturing

Over the past decades the use of medical devices, such as catheters, artificial heart valves, prosthetic joints, and other implants, has grown significantly. Despite continuous improvements in device design, surgical procedures, and wound care, biomaterial-associated infections (BAI) are still a major problem in modern medicine. Conventional antibiotic treatment often fails due to the low levels of antibiotic at the site of infection. The presence of biofilms on the biomaterial and/or the multidrug-resistant phenotype of the bacteria further impair the efficacy of antibiotic treatment. Removal of the biomaterial is then the last option to control the infection. Clearly, there is a pressing need for alternative strategies to prevent and treat BAI. Synthetic antimicrobial peptides (AMPs) are considered promising candidates as they are active against a broad spectrum of (antibiotic-resistant) planktonic bacteria and biofilms. Moreover, bacteria are less likely to develop resistance to these rapidly-acting peptides. In this review we highlight the four main strategies, three of which applying AMPs, in biomedical device manufacturing to prevent BAI. The first involves modification of the physicochemical characteristics of the surface of implants. Immobilization of AMPs on surfaces of medical devices with a variety of chemical techniques is essential in the second strategy. The main disadvantage of these two strategies relates to the limited antibacterial effect in the tissue surrounding the implant. This limitation is addressed by the third strategy that releases AMPs from a coating in a controlled fashion. Lastly, AMPs can be integrated in the design and manufacturing of additively manufactured/3D-printed implants, owing to the physicochemical characteristics of the implant material and the versatile manufacturing technologies compatible with antimicrobials incorporation. These novel technologies utilizing AMPs will contribute to development of novel and safe antimicrobial medical devices, reducing complications and associated costs of device infection.

Alternating Current Electrophoretic Deposition for the Immobilization of Antimicrobial Agents on Titanium Implant Surfaces

One prominent cause of implant failure is infection; therefore, research is focusing on developing surface coatings that render the surface resistant to colonization by micro-organisms. Permanently attached coatings of antimicrobial molecules are of particular interest because of the reduced cytoxicity and lower risk of developing resistance compared to controlled release coatings. In this study, we focus on the chemical grafting of bioactive molecules on titanium. To concentrate the molecules at the metallic implant surface, we propose electrophoretic deposition (EPD) applying alternating current (AC) signals with an asymmetrical wave shape. We show that for the model molecule bovine serum albumin (BSA), as well as for the clinically relevant antifungal lipopeptide caspofungin (CASP), the deposition yield is drastically improved by superimposing a DC offset in the direction of the high-amplitude peak of the AC signal. Additionally, in order to produce immobilized CASP coatings, this experimental AC/DC-EPD method is combined with an established surface activation protocol. Principle component analysis (PCA) of time-of-flight secondary ion mass spectrometry (ToF-SIMS) data confirm the immobilization of CASP with higher yield as compared to a diffusion-controlled process, and higher purity than the clinical CASP starting suspensions. Scratch testing data indicate good coating adhesion. Importantly, the coatings remain active against the fungal pathogen C. albicans as shown by in vitro biofilm experiments. In summary, this paper delivers a proof-of-concept for the application of AC-EPD as a fast grafting tool for antimicrobial molecules without compromising their activities.

A comparative analysis of antibacterial properties and inflammatory responses for the KR-12 peptide on titanium and PEGylated titanium surfaces

Covalent KR-12 peptide immobilisation on the Ti surface with a grafted PEG spacer showed remarkable antibacterial properties and reduced macrophage inflammatory responses.