Chronic alcohol abuse and endosseous implants: Linkage of in vitro osteoblast dysfunction to titanium osseointegration rate

Patient-reported outcome measures following surgeries in implant dentistry and associated factors: a cross-sectional study

OBJECTIVES

We aimed to evaluate the patient-reported outcome measures (PROMs) of dental implant surgeries and analyse the associated indicators.

DESIGN

A cross-sectional study design was used.

SETTING

Department of Oral Implantology, Hospital of Stomatology, Wuhan University (May 2020-April 2021).

PARTICIPANTS

Participants with missing teeth in need of implant-supported rehabilitation.

INTERVENTIONS

Dental implant placement and/or bone augmentation procedures.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was discomfort on postoperative day 1, measured using a numerical rating scale (NRS). Secondary outcomes included pain and anxiety during surgery; discomfort on postoperative days 3, 7 and 14; and post-surgical complications.

RESULTS

A total of 366 participants were included, of which 288 (78.7%) and 328 (89.7%) reported no to mild pain and anxiety (NRS 0-3) during surgery, respectively. The proportion of patients reporting discomfort decreased from postoperative day 1 (57.7%) to day 3 (36.1%) and day 7 (17.5%). The most frequent postoperative adverse events were pain and swelling. Patient-related factors (age, sex, smoking, alcohol consumption, history of periodontitis, and pain and anxiety during surgery) and surgery-related factors (type and extent of surgical procedure) were analysed. The factors associated with the severity of discomfort after surgery included alcohol consumption, pain perception during surgery, bone augmentation procedures and age (p<0.05). Similarly, the factors associated with the duration of discomfort included alcohol consumption, pain perception during surgery and age (p<0.05).

CONCLUSIONS

PROMs related to dental implant surgeries can be predicted using certain risk indicators. Alcohol consumption, pain during surgery and age were associated with discomfort following dental implant surgery.

Outlining cell interaction and inflammatory cytokines on UV-photofunctionalized mixed-phase TiO2 thin film

Photofunctionalization mediated by ultraviolet (UV) light seems to be a promising approach to improve the physico-chemical characteristics and the biological response of titanium (Ti) dental implants. Seeing that photofunctionalization is able to remove carbon from the surface, besides to promote reactions on the titanium dioxide (TiO₂) layer, coating the Ti with a stable TiO₂ film could potentialize the UV effect. Thus, here we determined the impact of UV-photofunctionalized mixed-phase (anatase and rutile) TiO₂ films on the physico-chemical properties of Ti substrate and cell biology. Mixed-phase TiO₂ films were grown by radiofrequency magnetron sputtering on commercially pure titanium (cpTi) discs, and samples were divided as follow: cpTi (negative control), TiO₂ (positive control), cpTi UV, TiO₂ UV (experimental). Photofunctionalization was performed using UVA (360 nm - 40 W) and UVC (250 nm - 40 W) lamps for 48 h. Surfaces were analyzed in terms of morphology, topography, chemical composition, crystalline phase, wettability and surface free energy. Pre-osteoblastic cells (MC3T3E1) were used to assess cell morphology and adhesion, metabolism, mineralization potential and cytokine secretion (IFN-γ, TNF-α, IL-4, IL-6 and IL-17). TiO₂-coated surfaces exhibited granular surface morphology and greater roughness. Photofunctionalization increased wettability (p < 0.05) and surface free energy (p < 0.001) on both surface conditions. TiO₂-treated groups featured normal cell morphology and spreading, and greater cellular metabolic activity at 2 and 4 days (p < 0.05), whereas UV-photofunctionalized surfaces enhanced cell metabolism, cell adhered area, and calcium deposition (day 14) (p < 0.05). In general, assessed proteins were found slightly affected by either UV or TiO₂ treatments. Altogether, our findings suggest that UV-photofunctionalized TiO₂ surface has the potential to improve pre-osteoblastic cell differentiation and the ability of cells to form mineral nodules by modifying Ti physico-chemical properties towards a more stable context. UV-modified surfaces modulate the secretion of key inflammatory markers.

Influence of Chronic Alcohol Use on Osteoblastic Differentiation of Bone Marrow Cells, Bone Properties, and Hepatic and Renal Morphology of Rats

Chronic alcohol exposure can affect the osteoblastic activity and the proliferation and differentiation of cells due to its toxic effect, which can affect negatively bone repair and bone microarchitecture. The aim of this study was to evaluate the effects of chronic use of 20% alcohol on rats regarding osteoblastic differentiation, extrinsic and intrinsic properties of the tibia, and hepatic and renal morphology. Wistar rats were divided into three groups (n = 9) in accordance with a 24-week diet. After euthanasia, kidneys, liver, and tibias were removed for analysis and femurs mesenchymal cells were collected. The results showed that chronic use of 20% alcohol influenced neither the alkaline phosphatase production nor total protein (p > 0.05) in rats, with similar formation of nodules in all groups (p > 0.05). However, significant changes in the liver and kidneys and adverse effects on the mechanical properties of the tibia were observed. According to the results, it can be concluded that the chronic use of alcohol for 24 weeks had no negative influence on the activity and differentiation of osteoblasts, but the mechanical properties of the tibia were impaired and the organs responsible for metabolism and excretion were also affected due to the consumption of alcohol.

The Effect of Opioids, Alcohol, and Nonsteroidal Anti-inflammatory Drugs on Fracture Union

The estimated rate of fracture nonunion is between 5% and 10%, adding significant cost to the health care system. The cause of fracture nonunion is multifactorial, including the severity of the injury, patient factors resulting in aberrancies in the biology of fracture, and the side effects of pain control modalities. Minimizing surgeon-controlled factors causing nonunion is important to reduce the cost of health care and improve patient outcomes. Opioids, alcohol, and nonsteroidal anti-inflammatory drugs have been implicated as risk factors for fracture nonunion. Current literature was reviewed to examine the effects of opioids, alcohol, and nonsteroidal anti-inflammatory drugs on fracture union.

Extended Periods of Alcohol Intake Negatively Affects Osseointegration in Rats

The negative effects of chronic and excessive consumption of alcohol on bone metabolism are reported in the literature. Alcoholism causes a reduction in bone quality and delays fracture repair, among other deleterious effects. However, its effect on osseointegration in dental implants is not fully established. The aim of this research was to investigate the influence of prolonged and excessive consumption of alcohol on osseointegration in rats. Thirty-five female rats, 3 months of age, were divided into five groups according to alcohol consumption period: control (no alcohol), and 3, 4, 5, and 6 months of alcohol consumption. All animals received solid food ad libitum. At 8 months of age, all animals received a dental implant in the right femur, and euthanasia was performed 1 month after the implant placement (final n = 27). Quantification of the percentage of bone-implant direct contact was performed by histomorphometry. Serum levels of calcium and phosphate were also measured. The groups that consumed alcohol for longer periods presented decreased percentages of bone-implant direct contact. The difference was higher in implants apical region. Alcohol consumption did not affect serum calcium levels but raised the level of serum phosphate. Alcohol consumption increased caloric intake but also increased weight loss. It was concluded that chronic and excessive consumption of alcohol can impair osseointegration in rats.

Harmful lifestyles on orthopedic implantation surgery: a descriptive review on alcohol and tobacco use

Alcohol abuse and smoking habits have adverse effects on bone health and are a risk factor for osteoporosis, fractures and impaired fracture repair. Osteointegration processes around implanted biomaterials involve a coordinated cascade of complex events that are very similar to those occurring during fracture repair and require a suitable microenvironment and the coordinated action of cells and signal molecules. Therefore, diseases and harmful lifestyles that impair the normal bone healing process can reduce the success of implant surgery and may negatively influence the osteointegration of prostheses and implant devices for fracture fixation such as screws, nails and plates. Understanding the effects of harmful lifestyles on bone implant osteointegration is important for successful implant therapy, orthopedic reconstructive surgery and tissue-engineered-based therapies. However, the mechanisms by which smoking and alcoholism affect bone metabolism, bone mass and the balance of bone resorption and formation, also in the presence of an orthopedic implant, are not completely understood and remain inadequately elucidated. This review aims to analyze in vitro and in vivo studies regarding orthopedic implant integration in the presence of tobacco smoking and alcohol consumption with a focus on pathophysiology and local or systemic mechanisms of action on bone.

Effects of alcohol and nicotine on the mechanical resistance of bone and bone neoformation around hydroxyapatite implants

The consumption of alcohol or nicotine is harmful to the integrity of bone tissue, hindering or even impeding the fixation and maintenance of bone implants. The aim of the present work was to evaluate the effects of ethanol and nicotine, when consumed alone and simultaneously, on both bone mechanical resistance and bone neoformation around hydroxyapatite implants. Twenty rats were divided into four groups: control (CT), alcohol (A), nicotine (N) and nicotine + alcohol (N + A). After 4 weeks of alcohol and/or nicotine consumption, dense (HAD) and porous (HAP) bodies were respectively implanted in a surgically produced bone defect in the right and left tibiae. After the surgeries, the animals continued to consume alcohol and/or nicotine. After ninety days, the animals were sacrificed and the tibiae and femurs were isolated for histological processing and mechanical assays. All the animals presented newly formed bone tissue close to the HAD and HAP ceramic bodies. The animals of the N + A group presented a smaller volume of neoformed bone. Group A animals presented smaller bone volume around the implants in relation to the animals from group N. Bone resistance to mechanical loads was smallest in animals from the N + A group, followed (in order) by the A and N groups. Thus, it can be concluded that nicotine or alcohol consumption produced negative effects on bone mechanical resistance and on the osteogenesis around the HAD and HAP implants. In addition, the simultaneous consumption of the two substances intensified their harmful effects.

Effect of melatonin on proliferation of neonatal cord blood mononuclear cells

BACKGROUND

Pineal melatonin (MLT) is a neuroendocrine hormone that possesses a wide variety of biological effects. MLT regulation of the immune system has been studied in recent years. But very little is known about MLT interaction with neonatal cord blood mononuclear cells (CBMCs) and the lymphocyte immune system in neonates. This study was designed to investigate the proliferative effects of MLT on CBMCs and peripheral blood mononuclear cells (PBMCs).

METHODS

Cord blood samples were collected from 10 normal full-term infants at the Guangzhou Maternal and Infant Hospital, China. Ten samples of adult peripheral blood were also collected from healthy volunteers. (3)H-thymidine ((3)H-TdR) incorporation was used to analyze the influence of MLT on proliferation of CBMCs. The effects of MLT on proliferation of CBMCs and PBMCs were compared.

RESULTS

(3)H-TdR incorporation increased in a dose-dependent manner with varying MLT concentrations (50 pg/ml-50 ng/ml), but peaked at 5 ng/ml. After incubation with MLT (5 ng/ml), interleukin-2 (IL-2, 50 ng/ml), MLT+phytohemagglutinin (PHA, 5 microg/ml), and MLT+IL-2, respectively in CBMCs media, (3)H-TdR incorporation rates were 114 327+/-52 863, 16 087+/-9006, 118 360+/-59 207, and 17 682+/-7391. Compared to the control cell suspension (14 133+/-8688), (3)H-TdR incorporation rates of the MLT and MLT+PHA groups were significantly increased (t=5.9143, P<0.001; t=5.5078, P<0.001). (3)H-TdR incorporation was not different between the IL-2 and MLT+IL-2 groups (t=0.4983, P>0.05; t=0.9839, P>0.05). PHA treatment (110 397+/- 48 663) presented no difference in (3)H-TdR incorporation compared to the MLT or MLT+PHA groups (t=0.1730, P>0.05; t=0.3286, P>0.05). (3)H-TdR incorporation was significantly greater in CBMCs than in PBMCs cultures after addition of various stimulators to the culture media.

CONCLUSIONS

MLT promoted proliferation of PBMCs and also enhanced proliferation of CBMCs. The proliferative effects of MLT were greater on CBMCs than on PBMCs.