Hydrophilic modification of sandblasted and acid-etched implants improves stability during early healing: a human double-blind randomized controlled trial

Atomic Layer Deposition of Zirconia on Titanium Implants Improves Osseointegration in Rabbit Bones

Purpose

Atomic layer deposition (ALD) is a method that can deposit zirconia uniformly on an atomic basis. The effect of deposited zirconia on titanium implants using ALD was evaluated in vivo.

Methods

Machined titanium implants (MTIs) were used as the Control. MTIs treated by sandblasting with large grit and acid etching (SA) and MTIs deposited with zirconia using ALD are referred to as Groups S and Z, respectively. Twelve implants were prepared for each group. Six rabbits were used as experimental animals. To evaluate the osteogenesis and osteocyte aspects around the implants, radiological and histological analyses were performed. The bone-to-implant contact (BIC) ratio was measured and statistically analyzed to evaluate the osseointegration capabilities.

Results

In the micro-CT analysis, more radiopaque bone tissues were observed around the implants in Groups S and Z. Histological observation found that Groups S and Z had more and denser mature bone tissues around the implants in the cortical bone area. Many new and mature bone tissues were also observed in the medullary cavity area. For the BIC ratio, Groups S and Z were significantly higher than the Control in the cortical bone area (P < 0.017), but there was no significant difference between Groups S and Z.

Conclusion

MTIs deposited with zirconia using ALD (Group Z) radiologically and histologically showed more mature bone formation and activated osteocytes compared with MTIs (Control). Group Z also had a significantly higher BIC ratio than the Control. Within the limitations of this study, depositing zirconia on the surface of MTIs using ALD can improve osseointegration in vivo.

Nano-scaled surfaces and sustainable-antibiotic-release from polymeric coating for application on intra-osseous implants and trans-mucosal abutments

Multifunctional surfaces may display the potential to accelerate and promote the healing process around dental implants. However, the initial cellular biocompatibility, molecular activity, and the release of functionalized molecules from these novel surfaces require extensive investigation for clinical use. Aiming to develop and compare innovative surfaces for application in dental implants, the present study utilized titanium disks, which were treated and divided into four groups: machined (Macro); acid-etched (Micro); anodized-hydrophilic surface (TNTs); and anodized surface coated with a rifampicin-loaded polymeric layer (poly(lactide-co-glycolide), PLGA) (TNTsRIMP). The samples were characterized regarding their physicochemical properties and the cumulative release of rifampicin (RIMP), investigated at different pH values. Additionally, differentiated osteoblasts from mesenchymal cells were used for cell viability and qRT-PCR analysis. Antibacterial properties of each surface treatment were investigated against Staphylococcus epidermidis. TNTsRIMP demonstrated controlled drug release for up to 7 days in neutral pH environments. Osteogenic cell cultures indicated that all the evaluated surfaces showed biocompatibility. The TNTs group revealed up-regulated values for bone-related gene quantification in 7 days, followed by the TNTsRIMP group. Furthermore, the antibiotic-functionalized surface revealed effectiveness to inhibit S. epidermidis and stimulate promising conditions for osteogenic cell behavior. Characteristics such as nanomorphology and hydrophilicity were determinants for the up-regulated quantification of osteogenic biomarkers related to early bone maturation, encouraging application in intra-osseous implant surfaces; in addition, antibiotic-functionalized surfaces demonstrated significant higher antibacterial properties compared to the other groups. Our findings suggest that polymeric-antibiotic-loaded coating might be applied for the prevention of early infections, favoring its application in multifunctional surfaces for intra- and/or trans-mucosal components of dental implants, while, hydrophilic nanotextured surfaces promoted optimistic properties to stimulate early bone-related cell responses, favoring its application in bone-anchored surfaces.

Surface Coatings of Dental Implants: A Review

Replacement of missing teeth is possible using biocompatible devices such as endosseous implants. This study aims to analyze and recognize the best characteristics of different implant surfaces that ensure good peri-implant tissue healing and thus clinical success over time. The present review was performed on the recent literature concerning endosseous implants made of titanium, a material most frequently used because of its mechanical, physical, and chemical characteristics. Thanks to its low bioactivity, titanium exhibits slow osseointegration. Implant surfaces are treated so that cells do not reject the surface as a foreign material and accept it as fully biocompatible. Analysis of different types of implant surface coatings was performed in order to identify ideal surfaces that improve osseointegration, epithelial attachment to the implant site, and overall peri-implant health. This study shows that the implant surface, with different adhesion, proliferation, and spreading capabilities of osteoblastic and epithelial cells, influences the cells involved in anchorage. Implant surfaces must have antibacterial capabilities to prevent peri-implant disease. Research still needs to improve implant material to minimize clinical failure.

Implants with hydrophilic surfaces equalize the osseointegration of implants in normo- and hyperglycaemic rats

The purpose of this study was to evaluate the effect of a surface modified by blasting and acid attack and maintained in an isotonic solution compared to a machined surface on osseointegration in normo- and hyperglycaemic animals. Sixty-four animals were allocated into 4 groups with 16 animals each, and they were subdivided into two experimental periods (15 and 45 days), with 8 animals in each group. The groups were divided according to the type of implant that was installed in the animals' tibia and the animals' systemic condition: CM - Machined implants placed in Healthy animals; CH - Hydrophilic implants placed in Healthy animals, HM - Machined implants placed in animals with hyperglycaemia; HH- Hydrophilic implants installed in animals with hyperglycaemia. The following analyses were performed: biomechanical (removal torque), microtomographic (evaluation of the bone volume around the implants- BV/TV), and histomorphometric (evaluation of bone-implant contact BIC% and of the bone formation area between the threads BBT%). It was found that the implants with hydrophilic surfaces presented higher removal torques and quantities of BV/TV% and higher BIC% and BBT% values in normo- and hyperglycaemic animals. The results of this study indicated that the hydrophilic surface accelerates the osseointegration process (~ 15% BIC/BBT at 15-day period), especially in animals with hyperglycaemia. The hydrophilic surface equaled the osseointegration between normo- and hyperglycaemic animals, reversing the negative potential of hyperglycaemia on the osseointegration process.

Minimization of Adverse Effects Associated with Dental Alloys

Metal alloys are one of the most popular materials used in current dental practice. In the oral cavity, metal structures are exposed to various mechanical and chemical factors. Consequently, metal ions are released into the oral fluid, which may negatively affect the surrounding tissues and even internal organs. Adverse effects associated with metallic oral appliances may have various local and systemic manifestations, such as mouth burning, potentially malignant oral lesions, and local or systemic hypersensitivity. However, clear diagnostic criteria and treatment guidelines for adverse effects associated with dental alloys have not been developed yet. The present comprehensive literature review aims (1) to summarize the current information related to possible side effects of metallic oral appliances; (2) to analyze the risk factors aggravating the negative effects of dental alloys; and (3) to develop recommendations for diagnosis, management, and prevention of pathological conditions associated with metallic oral appliances.

Superhydrophilic Nanotextured Surfaces for Dental Implants: Influence of Early Saliva Contamination and Wet Storage

Hydrophilic and nanotextured surfaces for dental implants have been reported as relevant properties for early osseointegration. However, these surface characteristics are quite sensitive to oral interactions. Therefore, this pilot study aimed to investigate the superficial alterations caused on hydrophilic nanotubular surfaces after early human saliva interaction. Titanium disks were treated using an anodization protocol followed by reactive plasma application in order to achieve nanotopography and hydrophilicity, additionally; surfaces were stored in normal atmospheric oxygen or wet conditioning. Following, samples were interacted with saliva for 10 min and analyzed regarding physical–chemical properties and cellular viability. Saliva interaction did not show any significant influence on morphological characteristics, roughness measurements and chemical composition; however, hydrophilicity was statistically altered compromising this feature when the samples were stored in common air. Cellular viability tested with pre-osteoblasts cell line (MC3T3-E1) reduced significantly at 48 h on the samples without wet storage after saliva contamination. The applied wet-storage methodology appears to be effective in maintaining properties such as hydrophilicity during saliva interaction. In conclusion, saliva contamination might impair important properties of hydrophilic nanotubular surfaces when not stored in wet conditions, suggesting the need of saliva-controlled sites for oral application of hydrophilic surfaces and/or the use of modified-package methods associated with their wet storage.

A chair-side plasma treatment system for rapidly enhancing the surface hydrophilicity of titanium dental implants in clinical operations

PURPOSE

In order to promote osseointegration and shorten the healing time after dental implant operations, this study was conducted to develop a chair-side plasma treatment system in which Ti implants were used as a coaxial internal electrode to rapidly enhance their surface hydrophilicity.

METHODS

Surface hydrophilicity was evaluated by measurement of the water contact angle and the defined wetting time. Changes in temperature and chemical composition were analyzed using infrared thermal imaging and X-ray photoelectron spectroscopy (XPS), respectively. The biocompatibility of the treated implants was examined in an animal experiment.

RESULTS

A marked improvement of hydrophilicity was demonstrated by a decrease in the water contact angle of the treated implant to 0° and wetting of the whole surface within 3 s of water contact. The Ti implant hydrophilization mechanism was explained as a decrease in the degree of hydrocarbon contamination. The surface temperature of the treated implant was close to that of the human body, and good osseointegration was observed in the in vivo experiment.

CONCLUSION

The plasma treatment system developed here is a promising chair-side procedure for rapidly enhancing the surface hydrophilicity of Ti implants in clinical operations without any need to consider the degradation of hydrophilicity caused by long-term storage.

Clinical performance of narrow-diameter implants with hydrophobic and hydrophilic surfaces with mandibular implant overdentures: 1-year results of a randomized clinical trial

OBJECTIVE

To compare peri-implant clinical and radiographic parameters between hydrophilic and hydrophobic narrow dental implants in patients with mandibular implant overdentures for 1 year.

MATERIALS AND METHODS

In a randomized, double-blind, split-mouth study with a 1-year follow-up, sixteen edentulous participants received two narrow-diameter implants in the anterior mandibular region with 2 types of surfaces: hydrophobic (Neoporos surface, NS) and hydrophilic (Acqua surface, AS). During the osseointegration period and after loading with mandibular implant overdentures, the outcomes monitored were (i) peri-implant health: early healing index (EHI), visible plaque index (VPI), calculus presence (CP), peri-implant inflammation (PI), probing depth (PD), and bleeding on probing (BOP); (ii) implant stability quotient (ISQ), (iii) crestal bone loss (CBL) and bone level change (BLC); and (iv) implant success and survival rates.

RESULTS

The PD in NS implants decreased by 31.78% between 15 and 30 days, while a similar reduction (-31.28%) occurred in the 3rd month in the AS group. The ISQ also decreased significantly during the 1st month in both groups: -10.95% after 7 days in the NS group and -7.46% after 15 days in the AS group. At 12 months, statistically significant differences were not observed; however, the AS surface presented 50.6% smaller CBL and 41.3% smaller BLC values. The success and survival rates were 62.5% for AS implants and 87.5% for NS implants.

CONCLUSION

Narrow-diameter implants with hydrophilic and hydrophobic surfaces loaded with mandibular implant overdentures showed no differences in peri-implant healing, stability, and peri-implant bone remodeling in the 1st year of follow-up.

Implant stability and survival rates of a hydrophilic versus a conventional sandblasted, acid-etched implant surface: Systematic review and meta-analysis

BACKGROUND

Modifying the implant surface via enhancing the wettability (hydrophilicity) improves osseointegration, reducing the healing period. In this study, the authors aimed to evaluate the stability and survival rates of implants with a hydrophilic surface compared with those with a sandblasted, acid-etched surface.

TYPES OF STUDIES REVIEWED

The included studies (randomized controlled trials) were identified through searches of PubMed, ScienceDirect, and Cochrane Library databases without date of publication restrictions. Quality assessment was performed using the Cochrane Collaboration tool. For primary outcome, confidence intervals were set at 95%; weighted means across the studies were calculated using a fixed-effects model or risk ratios and their 95% confidence intervals for secondary outcome.

RESULTS

The authors included 5 randomized controlled trials (246 dental implants) in the systematic review, which compared a hydrophilic with conventional sandblasted, acid-etched implant surface. The implant stability (primary outcome) was measured at baseline and 3, 6, and 8 weeks, and implant survival rates were measured as a secondary outcome. Overall, compared with the control groups, no clinically significant differences in implant stability or survival rates were identified for the hydrophilic surface groups.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The results did not show any clinically significant effect of a hydrophilic surface on improving implant stability or survival rates. However, these findings must be analyzed carefully owing to the limitations of this review, such as the small samples size and some differences among the included studies.

Evaluation of osseintegration between traditional and modified hydrophilic titanium dental implants - Systematic analysis

The aim of the study was to conduct a systematic review to access the osseointegration between traditional and modified Hydrophilic Titanium Dental Implants for period of 10 years. PUBMed articles were searched from last ten years up to 15/12/2019 from which 24 studies included in this review. This systematic review compiles the data about osseintegration in hydrophilic titanium implants in human trials. It sheds light on the mechanism of integration of hydrophilic surfaces and numeric data to support the purpose of the review.