Antibacterial effect of copper-bearing titanium alloy (Ti-Cu) against Streptococcus mutans and Porphyromonas gingivalis

Research Interest in Copper Materials for Caries Management: A Bibliometric Analysis

This study examined research interest in copper materials for caries management. We conducted an exhaustive literature search of English publications on copper materials for caries management. We removed duplicate publications and screened the titles and abstracts to identify relevant publications. Then, we analyzed the bibliometric data of the publications using the Bibliometrix and VOSviewer programs. This study included 75 laboratory studies, six clinical trials, and 17 reviews. Most of the original research studied copper or copper oxide nanoparticles (45/81, 56%). The materials could be doped into topical agents, restorative fillers, dental adhesives, dental implants, and orthodontic appliances. Since the first paper was published in 1980, publication counts gradually increased and surged in 2019. Among publications on copper materials for caries management, the publication counts and citations from 2019 to 2024 accounted for 65% (64/98) and 74% (1677/2255) over the last 45 years. Cocitation analysis revealed that the two main keywords were nanoparticles and antibacterial activity, and their burst strengths (period) were 3.84 (2021-2024) and 2.21 (2020-2021). The topics of the top two publications with the highest citation burst strength (period) are the antimicrobial effect of copper oxide nanoparticles (3.14, 2021-2022) and the dental application of copper nanoparticles (2.84, 2022-2024). In conclusion, this study revealed a growing interest in copper materials for caries management.

Gallic acid exerts antibiofilm activity by inhibiting methicillin-resistant Staphylococcus aureus adhesion

Methicillin-resistant Staphylococcus aureus (MRSA) is a serious threat to patients with nosocomial infections, and infection is strongly associated with biofilm formation. Gallic acid (GA) is a natural bioactive compound found in traditional Chinese medicines that exerts potent antimicrobial activity. However, the anti-MRSA biofilm efficacy of GA remained to be determined. This study investigated the antimicrobial activities of GA against MRSA and the mechanisms involved. The results revealed the significant antibacterial and antibiofilm activities of GA. The minimal inhibitory concentration of GA against MRSA was 32 μg/mL and a growth curve assay confirmed the significant inhibitory effect of GA on planktonic MRSA. Crystal violet and XTT assays showed that 8 µg/mL GA effectively inhibited the formation of new biofilms and disrupted existing biofilms by reducing both biofilm biomass and metabolic activities. Alkaline phosphatase and β-galactosidase leakage assays and live/dead staining provided evidence that GA disrupted the integrity of bacterial cell walls and membranes within the biofilm. Scanning electron microscopy observations showed that GA significantly inhibited bacterial adhesion and aggregation, affecting the overall structure of the biofilm. Bacterial adhesion, polysaccharide intercellular adhesion (PIA) production and real-time quantitative PCR assay confirmed that GA inhibited bacterial adhesion, PIA synthesis, and the expression of icaAD and sarA. These results suggested that GA inhibited biofilm formation by inhibiting the expression of sarA, then downregulating the expression of icaA and icaD, thereby reducing the synthesis of PIA to attenuate the adhesion capacity of MRSA. GA is therefore a promising candidate for development as a pharmaceutical agent for the prevention and treatment of bacterial infections caused by MRSA.

Physico-Chemical Properties of Copper-Doped Hydroxyapatite Coatings Obtained by Vacuum Deposition Technique

The hydroxyapatite and copper-doped hydroxyapatite coatings (Ca10-xCux(PO4)6(OH)2; xCu = 0, 0.03; HAp and 3CuHAp) were obtained by the vacuum deposition technique. Then, both coatings were analyzed by the X-ray diffraction (XRD), scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FTIR) and water contact angle techniques. Information regarding the in vitro antibacterial activity and biological evaluation were obtained. The XRD studies confirmed that the obtained thin films consist of a single phase associated with hydroxyapatite (HAp). The obtained 2D and 3D SEM images did not show cracks or other types of surface defects. The FTIR studies' results proved the presence of vibrational bands characteristic of the hydroxyapatite structure in the studied coating. Moreover, information regarding the HAp and 3CuHAp surface wettability was obtained by water contact angle measurements. The biocompatibility of the HAp and 3CuHAp coatings was evaluated using the HeLa and MG63 cell lines. The cytotoxicity evaluation of the coatings was performed by assessing the cell viability through the MTT assay after incubation with the HAp and 3CuHAp coatings for 24, 48, and 72 h. The results proved that the 3CuHAp coatings exhibited good biocompatible activity for all the tested intervals. The ability of Pseudomonas aeruginosa 27853 ATCC (P. aeruginosa) cells to adhere to and develop on the surface of the HAp and 3CuHAp coatings was investigated using AFM studies. The AFM studies revealed that the 3CuHAp coatings inhibited the formation of P. aeruginosa biofilms. The AFM data indicated that P. aeruginosa's attachment and development on the 3CuHAp coatings were significantly inhibited within the first 24 h. Both the 2D and 3D topographies showed a rapid decrease in attached bacterial cells over time, with a significant reduction observed after 72 h of exposure. Our studies suggest that 3CuHAp coatings could be suitable candidates for biomedical uses such as the development of new antimicrobial agents.

Design and Fabrication of Broad-Spectrum Antimicrobial Porous Metallo-Polymeric Microsphere for Water Disinfection

An expedient and efficient approach is used to synthesize a new class of metallo-polymeric microspheres (MPMs) as antimicrobials to succumb the wide range of bacteria from water. Three types of MPMs, that is, poly[Silver (I)-methacrylate-co-methylmethacrylate] (pAgMA), poly[Copper (II)-methacrylate-co-methyl methacrylate] (pCuMA), and poly[Nickel (II)-methacrylate-co-methylmethacrylate] (pNiMA), are prepared via radical suspension polymerization technique in 3D shape with porous texture. The structural and morphological characterization of the prepared microspheres are examined by analytical techniques. The antimicrobial potentialities of prepared MPMs are investigated at the laboratory scale study, revealing that the MPMs exhibit strong antibacterial activity (≈99.9% killing) against Gram-negative and Gram-positive bacteria [Enterobacter hormaechei (EH), Bacillus megatarium (BM), and Bacillus bataviensis (BB)]. The MacConkey agar medium test reveals that MPMs have substantial biocidal efficacy against broad-spectrum Gram-negative bacteria present in tap water. The MPMs exhibit significant antimicrobial efficacy via contact killing owe to the presence of integrated biocidal metal moiety, which represents that the MPMs are safe for water disinfection.

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

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

Silver-deposited titanium as a prophylactic 'nano coat' for peri-implantitis

Dental implant failures caused by bacterial infections are a significant concern for dental implantologists. We modified the titanium surface by depositing silver (Ti-Ag) using direct current (DC) sputtering and confirmed the formation of a 'nano coat' by X-ray photoelectron spectroscopy (XPS), surface profilometry and energy dispersive spectroscopy (EDS). Scanning electron microscopy (SEM) and atomic force microscopy (AFM) revealed the deposition of a uniform nano Ag thin film. A gradual increase in thickness was observed, and the film thickness (530 nm) at 5 min deposition time (Ti-Ag5) resulted in a reduction of the water contact angle (WCA, 15%) and an increase in surface energy (SFE, 22%) in comparison to the uncoated Ti surface. Using inductively coupled plasma-atomic emission spectroscopy (ICP-AES), the slow, steady release of Ag from the coating was observed over 21 days. The Ti-Ag5 surface exhibited excellent antibacterial activity against Streptococcus oralis, Streptococcus sanguinis, Aggregatibacter actinomycetemcomitans, and Porphyromonas gingivalis, which belonged to the yellow, purple, and red complexes, representing specific periodontal pathogens. Furthermore, we observed excellent cytocompatibility of Ag-deposited Ti towards MG-63 osteoblasts with no inhibitory effect on their proliferative potential. Quantitation of alkaline phosphatase (ALP) activity, mineralization efficiency, and osteogenesis-related gene expression of MG-63 cells over 21 days was suggestive of rapid osseointegration. Overall, the 'nano coat' of Ag on Ti is indeed a prophylactic against peri-implantitis, ensuring increased implant success.

Additively manufactured Ti-Ta-Cu alloys for the next-generation load-bearing implants

Bacterial colonization of orthopedic implants is one of the leading causes of failure and clinical complexities for load-bearing metallic implants. Topical or systemic administration of antibiotics may not offer the most efficient defense against colonization, especially in the case of secondary infection, leading to surgical removal of implants and in some cases even limbs. In this study, laser powder bed fusion was implemented to fabricate Ti3Al2V alloy by a 1:1 weight mixture of CpTi and Ti6Al4V powders. Ti-Tantalum (Ta)-Copper (Cu) alloys were further analyzed by the addition of Ta and Cu into the Ti3Al2V custom alloy. The biological, mechanical, and tribo-biocorrosion properties of Ti3Al2V alloy were evaluated. A 10 wt.% Ta (10Ta) and 3 wt.% Cu (3Cu) were added to the Ti3Al2V alloy to enhance biocompatibility and impart inherent bacterial resistance. Additively manufactured implants were investigated for resistance against Pseudomonas aeruginosa and Staphylococcus aureus strains of bacteria for up to 48 h. A 3 wt.% Cu addition to Ti3Al2V displayed improved antibacterial efficacy, i.e. 78%-86% with respect to CpTi. Mechanical properties for Ti3Al2V-10Ta-3Cu alloy were evaluated, demonstrating excellent fatigue resistance, exceptional shear strength, and improved tribological and tribo-biocorrosion characteristics when compared to Ti6Al4V. In vivo studies using a rat distal femur model revealed improved early-stage osseointegration for alloys with 10 wt.% Ta addition compared to CpTi and Ti6Al4V. The 3 wt.% Cu-added compositions displayed biocompatibility and no adverse inflammatory response in vivo. Our results establish the Ti3Al2V-10Ta-3Cu alloy's synergistic effect on improving both in vivo biocompatibility and microbial resistance for the next generation of load-bearing metallic implants.

Additively Manufactured SiO2 and Cu-Added Ti Implants for Synergistic Enhancement of Bone Formation and Antibacterial Efficacy

Commercially pure titanium (CpTi), a bioinert metal, is used as an implant material at low load-bearing sites and as a porous coating on Ti6Al4V at high load-bearing sites. There is an unmet need for metallic biomaterials to improve osseointegration and inherent antimicrobial resistance. In this study, we have added 1 wt % SiO2 and 3 wt % Cu to the CpTi matrix and processed via metal additive manufacturing (AM). Si4+ ions promote angiogenesis and osteogenesis. CpTi-SiO2 composition exhibited 4.5 times higher bone formation at the bone-implant interface over CpTi in an in vivo study with a rat distal femur model. In vitro bacterial studies with Gram-positive Staphylococcus aureus bacterium revealed 85% antibacterial efficacy by CpTi-SiO2-3Cu than CpTi. CpTi-SiO2-3Cu did not show any inflammatory markers in vivo, indicating the absence of cytotoxicity, but displayed delayed osseointegration compared to CpTi-SiO2. CpTi-SiO2-3Cu displayed 3-fold higher mineralized bone formation than CpTi. Our results emphasize the synergistic effect of SiO2 and Cu addition in CpTi, promoting enhanced early stage osseointegration and inherent antibacterial efficacy, contributing toward implant longevity and stability in vivo.

Copper Materials for Caries Management: A Scoping Review

This study comprehensively reviewed the types, properties and potential applications of copper materials for caries management. Two researchers independently searched English publications using PubMed, Scopus and Web of Science. They screened the titles and abstracts of publications presenting original studies for review. They included 34 publications on copper materials, which were categorized as copper and copper alloy materials (13/34, 38%), copper salt materials (13/34, 38%) and copper oxide materials (8/34, 24%). All reported copper materials inhibited the growth of cariogenic bacteria such as Streptococcus mutans and Candida albicans. The materials could be doped into topical agents, restorative fillers, dental adhesives, drinking water, dental implants, orthodontic appliances, mouthwash and sugar. Most publications (29/34, 83%) were laboratory studies, five (5/34, 14%) were animal studies and only one paper (1/34, 3%) was clinical research. In conclusion, copper and copper alloy materials, copper salt materials and copper oxide materials have an antimicrobial property that inhibits cariogenic bacteria and Candida albicans. These copper materials may be incorporated into dental materials and even drinking water and sugar for caries prevention. Most publications are laboratory studies. Further clinical studies are essential to validate the effectiveness of copper materials in caries prevention.

Enhanced osteogenesis and bactericidal performance with additively manufactured MgO and Cu-added CpTi for load-bearing implants

Titanium, being the ultimate choice of metallic material for implant applications, its bio-inertness causes delayed bone-tissue integration at the implant site and prevents expedited healing for the patient. This can cause a severe issue for patients with immunocompromised bone health. Infections at the implant site are another concern; titanium does not offer inherent antimicrobial properties. Current strategies addressing the issues above include using cemented implants as a coating on Ti6Al4V bulk material for orthopedic applications. Roadblock arises with coating failure due to weak interfacial bond at the Ti-cement interface, resulting in revision surgeries. We have added osteogenic MgO and antibacterial Cu to CpTi and processed them using metal additive manufacturing (AM) to address these issues. Mg, an essential trace element in the body, has been proven to enhance osseointegration in vivo. Cu has been popular for its bactericidal capabilities. With 1 wt.% of MgO addition in the CpTi matrix, we have observed a four-fold increase in the mineralized bone formation at the bone-implant interface in vivo. The presence of 3 wt.% of Cu showed no cytotoxicity markers, and adding Cu to CpTi-MgO chemical makeup showed similar in vivo performance to CpTi-MgO. In vitro bacterial studies with gram-positive Staphylococcus aureus bacteria showed 81% bacterial efficiency displayed by CpTi-MgO-Cu at the end of 72 h of culture. Our findings highlight the synergistic benefits of CpTi-MgO-Cu, which exhibit superior early-stage osseointegration and antimicrobial capabilities.

Active nanoceramic compound dipped in biopolymers to create composite coating for metallic implant surface

Biofunctionalization of an implant using functional ceramics with exceptional electrical characterization, such as BaTiO3 and SrTiO3, has gained considerable attention in creating a composite coating with bio-polymer to activate metal implant surfaces for bone tissue engineering applications and, at the same time, resist bacterial infection. A Ti-Zr alloy sample was created by powder technology, and then a coating was applied using the electrospinning technique. Individually, nanopowders of ceramic compounds such as nBaTiO3 and nSrTiO3 were added to a blend of polycaprolactone and chitosan to create composite solutions that could be converted into a nanofibrous coating layer using the electrospinning technique. The samples were analyzed for their morphology, chemical composition, surface roughness, dielectric constant, and wettability. The techniques employed were SEM, EDS, FTIR, an LCR meter, and a contact angle goniometer. The samples' cytocompatibility was assessed by examining the cell viability, ALP activity, proliferation, and attachment of MC3T3-E1 osteoblast cells on both coated and uncoated sample surfaces.The bacterial resistance assays were conducted against Staphylococcus aureus and Streptococcus mutans. The findings demonstrate a notable enhancement in the biocompatibility of the coated specimens following a week of cellular cultivation. The composite coating containing piezoelectric BaTiO3 has a dielectric constant Ɛr (16) close to dry human bone at 100HZ frequency. Cell proliferation increases dramatically with time in coated samples, and the improvement approaches 125.16% for (BA1) and 111.38% for (SR1) as compared to uncoated Ti-25Zr sample. Cell viability percentage for the coated samples is compared with bare Ti-25Zr, which has an 80.52 ± 1.97% crucial increase, while (BA1) has 181.63 ± 17.87 and (SR1) 170.09 ± 18.12%. No zone of inhibition was detected in the bacterial resistance test for the uncoated sample, while the samples with composite coating show an adequate and comparable inhibitory zone. The composite nano-fiber has a strong biocompatibility, and the coating process is simple and economical, holding potential for use in orthodontic and orthopedic bone regeneration applications.

Understanding the influence of alloying elements on the print quality of powder bed fusion-based metal additive manufacturing: Ta and Cu addition to Ti alloy

Alloy design coupled with metal additive manufacturing (AM) opens many opportunities for materials innovation. Investigating the effect of printing parameters for alloy design is essential to achieve good part quality. Among different factors, laser absorptivity, heat diffusivity, and in situ intermetallic phase formations are critical. In this study, the first step employed was a reduction in Al and V contents in Ti6Al4V to design Ti3Al2V alloy, and further 10 wt.% tantalum (Ta) and 3 wt.% copper (Cu) were added to Ti3Al2V. A synergistic effect of Ta and Cu addition in Ti3Al2V negated their effect with higher porosities in Ti3Al2V-Ta-Cu. Ti3Al2V-Ta composition was more sensitive to the laser power, whereas Ti3Al2V-Ta-Cu to the overall energy density. Understanding the effect of energy density on these alloys' microstructural evolution and mechanical properties highlights the need for process-property optimization during alloy design using AM.

Influence of blackberry leaf extract on the copper corrosion behaviour in 0.5 M NaCl

The research presented in this paper is focused on blackberry leaf extract (BLE) as a environmentally friendly corrosion inhibitor for copper in 0.5 M NaCl. The caffeic acid, quercetin-3-O-glucoside and kaempferol-3-O-glucoside were identified in BLE by using high-performance liquid chromatography (HPLC-DAD). The BLE functional groups were identified (ATR-FTIR). The electrochemical methods (potentiodynamic polarization, electrochemical frequency modulation and electrochemical impedance spectroscopy) show that BLE acts as a mixed type of inhibitor (max. IE is 97.19 %). The corrosion process is controlled by diffusion (BLE lower than 15 g/L) and charge transfer (15 g/L BLE).

Advances in Research on Titanium and Titanium Alloys with Antibacterial Functionality for Medical Use—A Review

Materials based on titanium and its alloys are widely used in the medical and dental fields because of their excellent physical properties such as hardness, ductility and elastic modulus, etc. However, because commonly used titanium alloy internal plants do not have antibacterial properties, when these implants are implanted into the human body, there is a certain risk of infection. Such infections are extremely painful for the patient and problematic for the attending physician. In the past, infections of implants were usually treated with systemic antibiotics in combination with thorough debridement or implant replacement. However, these are passive treatments and typically cause huge physical and economic burdens on the patient. Therefore, attempts towards the development of implants with antibacterial functionality have been increasing, with the combination of titanium alloys with antibiotics, antibacterialmetals, and antibacterial peptides being the main research direction. Therefore, this paper will discuss the latest research progress in the preparation of titanium alloys with antibacterial strategies such as combining antibiotics or antimicrobial peptides, adding antimicrobial metals, and the antibacterial properties and biocompatibility of proposed systems are summarised and discussed herein. This review should serve as a reference for further research on antibacterial titanium alloy implants.

The progress in titanium alloys used as biomedical implants: From the view of reactive oxygen species

Titanium and Titanium alloys are widely used as biomedical implants in oral and maxillofacial surgery, due to superior mechanical properties and biocompatibility. In specific clinical populations such as the elderly, diabetics and patients with metabolic diseases, the failure rate of medical metal implants is increased significantly, putting them at increased risk of revision surgery. Many studies show that the content of reactive oxygen species (ROS) in the microenvironment of bone tissue surrounding implant materials is increased in patients undergoing revision surgery. In addition, the size and shape of materials, the morphology, wettability, mechanical properties, and other properties play significant roles in the production of ROS. The accumulated ROS break the original balance of oxidation and anti-oxidation, resulting in host oxidative stress. It may accelerate implant degradation mainly by activating inflammatory cells. Peri-implantitis usually leads to a loss of bone mass around the implant, which tends to affect the long-term stability and longevity of implant. Therefore, a great deal of research is urgently needed to focus on developing antibacterial technologies. The addition of active elements to biomedical titanium and titanium alloys greatly reduce the risk of postoperative infection in patients. Besides, innovative technologies are developing new biomaterials surfaces conferring anti-infective properties that rely on the production of ROS. It can be considered that ROS may act as a messenger substance for the communication between the host and the implanted material, which run through the entire wound repair process and play a role that cannot be ignored. It is necessary to understand the interaction between oxidative stress and materials, the effects of oxidative stress products on osseointegration and implant life as well as ROS-induced bactericidal activity. This helps to facilitate the development of a new generation of well-biocompatible implant materials with ROS responsiveness, and ultimately prolong the lifespan of implants.

Antibacterial Ti-Cu implants: A critical review on mechanisms of action

Titanium (Ti) has been widely used for manufacturing of bone implants because of its mechanical properties, biological compatibility, and favorable corrosion resistance in biological environments. However, Ti implants are prone to infection (peri-implantitis) by bacteria which in extreme cases necessitate painful and costly revision surgeries. An emerging, viable solution for this problem is to use copper (Cu) as an antibacterial agent in the alloying system of Ti. The addition of copper provides excellent antibacterial activities, but the underpinning mechanisms are still obscure. This review sheds light on such mechanisms and reviews how incorporation of Cu can render Ti-Cu implants with antibacterial activity. The review first discusses the fundamentals of interactions between bacteria and implanted surfaces followed by an overview of the most common engineering strategies utilized to endow an implant with antibacterial activity. The underlying mechanisms for antibacterial activity of Ti-Cu implants are then discussed in detail. Special attention is paid to contact killing mechanisms because the misinterpretation of this mechanism is the root of discrepancies in the literature.

Preventing Peri-implantitis: The Quest for a Next Generation of Titanium Dental Implants

Titanium and its alloys are frequently the biomaterial of choice for dental implant applications. Although titanium dental implants have been utilized for decades, there are yet unresolved issues pertaining to implant failure. Dental implant failure can arise either through wear and fatigue of the implant itself or peri-implant disease and subsequent host inflammation. In the present report, we provide a comprehensive review of titanium and its alloys in the context of dental implant material, and how surface properties influence the rate of bacterial colonization and peri-implant disease. Details are provided on the various periodontal pathogens implicated in peri-implantitis, their adhesive behavior, and how this relationship is governed by the implant surface properties. Issues of osteointegration and immunomodulation are also discussed in relation to titanium dental implants. Some impediments in the commercial translation for a novel titanium-based dental implant from "bench to bedside" are discussed. Numerous in vitro studies on novel materials, processing techniques, and methodologies performed on dental implants have been highlighted. The present report review that comprehensively compares the in vitro, in vivo, and clinical studies of titanium and its alloys for dental implants.

In Situ Surface-Directed Assembly of 2D Metal Nanoplatelets for Drug-Free Treatment of Antibiotic-Resistant Bacteria

The development of antibiotic resistance among bacterial strains is a major global public health concern. To address this, drug-free antibacterial approaches are needed. Copper surfaces have long been known for their antibacterial properties. In this work, a one-step surface modification technique is used to assemble 2D copper chloride nanoplatelets directly onto copper surfaces such as copper tape, transmission electron microscopy (TEM) grids, electrodes, and granules. The nanoplatelets are formed using copper ions from the copper surfaces, enabling their direct assembly onto these surfaces in a one-step process that does not require separate nanoparticle synthesis. The synthesis of the nanoplatelets is confirmed with TEM, scanning electron microscopy, energy dispersive spectroscopy (EDS), X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FT-IR). Antibacterial properties of the Cu nanoplatelets are demonstrated in multidrug-resistant (MDR) Escherichia coli, MDR Acinetobacter baumannii, MDR Staphylococcus aureus, E. coli, and Streptococcus mutans. Nanoplatelets lead to a marked improvement in antibacterial properties compared to the copper surfaces alone, affecting bacterial cell morphology, preventing bacterial cell division, reducing their viability, damaging bacterial DNA, and altering protein expression. This work presents a robust method to directly assemble copper nanoplatelets onto any copper surface to imbue it with improved antibacterial properties.

Recent Advances in Copper and Copper-Derived Materials for Antimicrobial Resistance and Infection Control

Antibacterial properties of copper have been known for ages. With the rise of antimicrobial resistance (AMR), hospital-acquired infections, and the current SARS-CoV-2 pandemic, copper and copper-derived materials are being widely researched for healthcare ranging from therapeutics to advanced wound dressing to medical devices. We cover current research that highlights the potential uses of metallic and ionic copper, copper alloys, copper nanostructures, and copper composites as antibacterial, antifungal, and antiviral agents, including those against the SARS-CoV-2 virus. The applications of copper-enabled engineered materials in medical devices, wound dressings, personal protective equipment, and self-cleaning surfaces are discussed. We emphasize the potential of copper and copper-derived materials in combating AMR and efficiently reducing infections in clinical settings.

Copper-containing nanoparticles: Mechanism of antimicrobial effect and application in dentistry-a narrative review

Copper has been used as an antimicrobial agent long time ago. Nowadays, copper-containing nanoparticles (NPs) with antimicrobial properties have been widely used in all aspects of our daily life. Copper-containing NPs may also be incorporated or coated on the surface of dental materials to inhibit oral pathogenic microorganisms. This review aims to detail copper-containing NPs' antimicrobial mechanism, cytotoxic effect and their application in dentistry.

Enhanced Corrosion Resistance and Biological Properties of Ultrafine-Grained Ti15Zr5Cu Alloy

Titanium alloys are widely used in the biomedical field. To ensure their strength meets requirements in clinics, medical titanium alloys are generally alloyed with toxic Al and/or V elements, hence ensuring their long-term biological safety after implantation is a challenge. In our previous research, we developed an ultrafine-grained Ti15Zr5Cu alloy without toxic elements while its mechanical properties were at the same level with the most widely used Ti6Al4V alloy. In order to promote the clinical application of the ultrafine-grained Ti15Zr5Cu alloy, herein we have systematically studied the hot deformation behaviors of the material as well as evaluated its corrosion resistance and biological properties. Results showed that when the as-quenched Ti15Zr5Cu alloy deformed at 0.05 ≤ ε˙ ≤ 1, 730 °C ≤ T ≤ 750 °C, it not only possessed good workability but also can be converted into an equiaxed ultrafine-grained microstructure. Moreover, the material also exhibited better corrosion resistance, antibacterial properties and biocompatibility than the Ti15Zr alloy and the commercial pure Ti. The results of the present study help lay a foundation for the development of a new generation of medical titanium alloys.

Microstructure and Properties in Simulated Seawater of Copper-Doped Micro-arc Coatings on TC4 Alloy

Micro-arc oxidation (MAO) ceramic coatings were prepared on TC4 titanium alloys by adding CuSO4 to a (NaPO3)6 base solution. The microstructures of the MAO coatings were characterized by scanning electron microscopy (SEM), energy dispersive (EDS), and X-ray photoelectron spectroscopy (XPS). The corrosion resistance and wear resistance of these coatings were evaluated via hydrochloric acid immersion of weight deficit and friction tests. Those results indicated the presence of Cu in the MAO coating in the form of CuO and Cu2O. Incorporation of CuSO4 results in a thickness and roughness increase in the coating. The coating has a lower coefficient of friction (0.2) upon the addition of 4 g/L of CuSO4. The antibacterial properties of the MAO coatings were maximized at 6 g/L of CuSO4. However, the corrosion resistance of the copper-doped MAO coating did not exceed the undoped coating. This study shows that the addition of CuSO4 to the electrolyte successfully prepared copper-containing micro-arc oxidation coatings, which improved the wear resistance and antibacterial properties of the coating.

Human Gingival Fibroblast Adhesion and Proliferation on Hydroxyapatite-Coated Zirconia Abutment Surfaces

Applying antibacterial coatings to dental implant materials seems reasonable but can have negative influences on desired cell adhesion and healing. In this study, zirconia abutment specimens interacting with gingival tissue were used. The aim was to compare the influence of machined or coated zirconia surfaces on the adhesion and proliferation of human gingival fibroblasts (HGF-1). Surface modifications were performed using atmospheric plasma coating with hydroxyapatite, zinc, and copper. Zirconia specimens were divided into four groups: hydroxyapatite, hydroxyapatite with zinc oxide (ZnO), hydroxyapatite with copper (Cu), and an untreated machined surface. After the characterization of the surface conditions, the morphology of adhered HGF-1 was determined by fluorescence staining and subjected to statistical evaluation. The visual analysis of cell morphology by SEM showed flat, polygonal, and largely adherent fibroblast cells in the untreated group, while round to partially flat cells were recorded in the groups with hydroxyapatite, hydroxyapatite + ZnO, and hydroxyapatite + Cu. The cell membranes in the hydroxyapatite + ZnO and hydroxyapatite + Cu groups appeared porous. The results show that HGF-1 adhere and proliferate well on machined zirconia, while plasma coating with hydroxyapatite or hydroxyapatite mixtures does not lead to increased adhesion or proliferation.

Study of the Osteoimmunomodulatory Properties of Curcumin-Modified Copper-Bearing Titanium

Peri-implantitis can lead to implant failure. In this study, curcumin (CUR) was modified onto the copper-bearing titanium alloy (Cu-Ti) with the assistance of polydopamine (PDA) in order to study the bone immune response and subsequent osteogenesis. FE-SEM, XPS and water contact angle were utilized to characterize the coating surface. Bone marrow mesenchymal stem cells (BMSCs) and macrophages were cultured separately and together onto the CUR modified Cu-Ti. Cell activity, expression of relative genes and proteins, cell migration ability, and fluorescence staining of cells were performed. CUR modification slightly increased the activation of M1-type and M2-type cells under physiological conditions. In the inflammation state, CUR inhibited the overexpression of M1 macrophages and induced M2-type differentiation. In addition, the modification itself could provoke the expression of osteoblastic-related genes of BMSCs, while promoting the osteogenic differentiation of BMSCs through the activation of macrophages in both physiological and inflammatory states. The BMSCs migration was increased, the expression of osteogenic-related genes and proteins was up-regulated, and alkaline phosphatase activity (ALP) was increased. Thus, the modification of CUR can promote the osteointegration effect of Cu-Ti by bone immunomodulation and may, in addition, improve the success rate of implants.

One-step in situ deposition of phytic acid-metal coordination complexes for combined Porphyromonas gingivalis infection prevention and osteogenic induction

Postoperative infection and poor osteogenesis will cause the failure of dental implant surgery. Thus, the antibacterial and osteogenic activities are the core requirements for the surface modification of dental implants. Inspired by the strong chelating ability of naturally occurring phytic acid (PA), an in situ deposition method on the surface of titanium implants was developed based on the metal-phosphate coordination networks. Biologically relevant metal cations (i.e. ferric ions and divalent copper ions) were selected as metal constituents for the construction of organic-inorganic coordination network films. The stability of PA-metal coordination bonds is rationally explained by the chemical nature of transition metal elements. This PA-metal coordination complex coating exhibited an excellent antibacterial activity against Porphyromonas gingivalis, reducing the bacterial implant colonization by > 3.92 log₁₀. The abundant phosphate groups greatly increased the surface hydrophilicity, promoted the early adhesion of proteins, improved the proliferation of bone marrow mesenchymal stem cells, and finally achieved an enhanced osteogenic activity. In addition, the phosphate groups of PA also facilitated the deposition of hydroxyapatite by providing reaction sites to chelate with calcium ions. These findings evaluate the anti-bacterial and osteogenic potentials of PA-metal coordination complexes, and clarify the feasibility for surface modification of dental implants.

Mechanisms of Hierarchical Topographies Tuning Bacteria and Cell Biological Responses to the Surfaces of Pure Titanium and Cu-Bearing Titanium Alloy

The competition between cells integration and bacterial colonization determines the fate of implantations. To reveal the effects of clinical implant topographies on osteoblast differentiation and bacterial biofilm formation, a series of micron/submicron/nano-hierarchical structures were created at pure titanium surfaces (Ti-I, Ti-II, Ti-III). It was found that the hierarchical structures promoted MC3T3-E1 cell differentiation through contact guidance and Ti-II processed the best osteogenic ability. Undesirably, hierarchical surfaces further accelerated the biofilm formation due to submicron structures with low interaction. To reduce the risk of bacterial infections, hierarchical structures were prepared on the antibacterial Cu-bearing titanium alloy surfaces (TiCu-I, TiCu-II, TiCu-III). Hierarchical topographies not only endowed TiCu surfaces with antibacterial trapping characteristics due to CuO doped in the outermost oxides layer but also shifted the corrosion behavior of TiCu alloy into activation-passivation, increasing the Cu-ion release rate and further promoting the osteogenic differentiation. TiCu-III possessed excellent antibacterial trapping ability and optimal osteogenic action. Finally, in the osteomyelitis-modeled mice, hierarchical topographies aggravated the bacterial infection around Ti implants, which entirely lost the osseointegration, while all of the TiCu surfaces significantly inhibited the infection and accelerated the formation of new bone tunnels around the implants. In vivo studies successfully confirmed the tuning mechanism of hierarchical topographies on the biological responses of bacteria and cells to the Ti and TiCu alloys, which would pave the way to develop novel biofunctionalized metal implants.

Corrosion Resistance of Selective Laser Melted Ti6Al4V3Cu Alloy Produced Using Pre-Alloyed and Mixed Powder

Metallic elemental powder mixture and pre-alloyed metallic powder are both frequently used powder feedstock in the additive manufacturing process. However, little research has been conducted to compare the corrosion behavior of selective laser melting (SLM) alloys, fabricated by pre-alloyed metallic powder and mixed metallic powder. Hence, it is important to investigate the corrosion behavior of SLMed alloys, as well as the corresponding cast ingot, with the aim to better understand the feasibility of designing new materials. In this work, the SLM-produced Ti6Al4V3Cu alloys were manufactured using a metallic elemental powder mixture and pre-alloyed metallic powder, respectively. The corrosion behavior of the different Ti6Al4V3Cu alloys was investigated in following electrochemical tests and ion release measurements. The results showed that the Ti6Al4V3Cu alloy prepared by pre-alloyed metallic powder showed better corrosion resistance than that produced from mixed metallic powder. Moreover, the SLM-produced Ti6Al4V3Cu alloys performed significantly better in corrosion resistance than the cast Ti6Al4V3Cu. The results are expected to achieve a better understanding of the feasibility of designing new materials using mixed powders, contributing to reducing development costs and cycles.

Recent Advances in Copper-Doped Titanium Implants

Titanium (Ti) and its alloys have been extensively used as implant materials in clinical practice due to their high corrosion resistance, light weight and excellent biocompatibility. However, the insufficient intrinsic osteogenic capacity of Ti and its alloys impedes bone repair and regeneration, and implant-related infection or inflammation remains the leading cause of implant failure. Bacterial infections or inflammatory diseases constitute severe threats to human health. The physicochemical properties of the material are critical to the success of clinical procedures, and the doping of Cu into Ti implants has been confirmed to be capable of enhancing the bone repair/regeneration, angiogenesis and antibacterial capability. This review outlines the recent advances in the design and preparation of Cu-doped Ti and Ti alloy implants, with a special focus on various methods, including plasma immersion implantation, magnetron sputtering, galvanic deposition, microarc oxidation and sol-gel synthesis. More importantly, the antibacterial and mechanical properties as well as the corrosion resistance and biocompatibility of Cu-doped Ti implants from different methods are systematically reviewed, and their prospects and limitations are also discussed.

Application of Copper Nanoparticles in Dentistry

Nanoparticles based on metal and metallic oxides have become a novel trend for dental applications. Metal nanoparticles are commonly used in dentistry for their exclusive shape-dependent properties, including their variable nano-sizes and forms, unique distribution, and large surface-area-to-volume ratio. These properties enhance the bio-physio-chemical functionalization, antimicrobial activity, and biocompatibility of the nanoparticles. Copper is an earth-abundant inexpensive metal, and its nanoparticle synthesis is cost effective. Copper nanoparticles readily intermix and bind with other metals, ceramics, and polymers, and they exhibit physiochemical stability in the compounds. Hence, copper nanoparticles are among the commonly used metal nanoparticles in dentistry. Copper nanoparticles have been used to enhance the physical and chemical properties of various dental materials, such as dental amalgam, restorative cements, adhesives, resins, endodontic-irrigation solutions, obturation materials, dental implants, and orthodontic archwires and brackets. The objective of this review is to provide an overview of copper nanoparticles and their applications in dentistry.

Promoting osteointegration effect of Cu alloyed titanium (TiCu) in ovariectomized rats

Osteoporosis is a common skeletal disease making patients be prone to the osteoporotic fracture. However, the clinical implants made of titanium and its alloys with a poor osseointegration need a long time for healing and easily to loosening. Thus, a new class of Cu-alloyed titanium (TiCu) alloys with excellent mechanical properties and bio-functionalization has been developed. In this study, the osteoporosis modeled rats were used to study the osteointegration effect and underlying mechanism of TiCu. The results showed that after implantation for 4 weeks, TiCu alloy could promote the reconstruction of vascular network around the implant by up-regulating vascular endothelial growth factor expression. After 8 weeks, it could further promote the proliferation and differentiation of osteoblasts, mineralization and deposition of collagens, and then significantly increasing bone mineral density around the implant. In conclusion, TiCu alloy would enhance the fixation stability, accelerate the osteointegration, and thus reduce the risk of aseptic loosening during the long-term implantation in the osteoporosis environment. This study was the first to report the role and mechanism of a Cu-alloyed metal in promoting osteointegration in osteoporosis environment, which provides a new attractive support for the improvement of future clinical applications of Cu-alloyed antibacterial titanium alloys.

Anti-infection mechanism of a novel dental implant made of titanium-copper (TiCu) alloy and its mechanism associated with oral microbiology

This work was focused on study of anti-infection ability and its underlying mechanism of a novel dental implant made of titanium-copper (TiCu) alloy. In general, most studies on antibacterial implants have used a single pathogen to test their anti-infection ability using infectious animal models. However, dental implant-associated infections are polymicrobial diseases. We innovatively combine the classic ligature model in dogs with sucrose-rich diets to induce oral infections via the canine native oral bacteria. The anti-infection ability, biocompatibility and underlying mechanism of TiCu implant were systematically investigated in comparison with pure Ti implant via general inspection, hematology, imageology (micro-CT), microbiology (16S rDNA and metagenome), histology, and Cu ion detections. Compared with Ti implant, TiCu implant demonstrated remarkable anti-infection potentials with excellent biocompatibility. Additionally, the underlying anti-infection mechanism of TiCu implant was considered to involve maintaining the oral microbiota homeostasis. It was found that the carbohydrates in the plaques formed on the surface of TiCu implant were metabolized through the tricarboxylic acid cycle (TCA) cycles, which prevented the formation of an acidic microenvironment and inhibited the accumulation of acidogens and pathogens, thereby maintaining the microflora balance between aerobic and anaerobic bacteria.

Inhibition efficiency of 304-Cu stainless steel against oral bacterial biofilm

PURPOSE

This study aims to evaluate the antibacterial properties of 304 Cu-bearing stainless steel (SS) with different Cu contents (0, 2.5, 4.5 wt.%) against oral biofilms of Streptococcus mutans (S. mutans), Streptococcus sanguinis (S. sanguinis), and their mixture.

METHODS

Bacterial biofilms on the surface of 304-Cu SS were characterized by plate counting, 4', 6-diamidino-2-phenylindole (DAPI) staining with aid of sanning electron microscopy (SEM) and 2, 3-bis (2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide inner salt (XTT). In addition, the inhibition zone method was also employed to evaluate the antibacterial properties of 304-Cu SS. Cell Counting Kit-8 (CCK-8) and flow cytometry were used to assess the cytotoxicity and apoptosis rate of 304-Cu SS, respectively.

RESULTS

304-4.5Cu SS could effectively inhibit the attachment, formation, activity, and metabolism of bacterial biofilm, possessing the best antibacterial properties exceeding 99.9% of antibacterial rate against S. mutans, S. sanguinis, and their mixture. The diameters of inhibition zones to S. mutans and S. sanguinis on the surface of 304-4.5Cu SS were 21.7 and 14.7 mm, respectively. The results of cell experiments in vitro showed that both 304-2.5Cu SS and 304-4.5Cu SS had no evident cytotoxicity with an identical grade 1. The apoptosis rate exhibited a gradually increased tendency with increase of the Cu content in 304 SS.

CONCLUSIONS

304-4.5Cu SS without cytotoxic effect on NIH3T3 cells has obvious antibacterial activity against S. mutans, S. sanguinis and their mixture.

CLINICAL SIGNIFICANCE

The Cu-bearing stainless steel provides a new solution to be used as oral orthodontic devices for inhibiting oral microflora imbalance and enamel demineralization.

Advances in Copper-Based Biomaterials With Antibacterial and Osteogenic Properties for Bone Tissue Engineering

Treating bone defects coupled with pathogen infections poses a formidable challenge to clinical medicine. Thus, there is an urgent need to develop orthopedic implants that provide excellent antibacterial and osteogenic properties. Of the various types, copper-based biomaterials capable of both regenerating bone and fighting infections are an effective therapeutic strategy for bone tissue engineering and therefore have attracted significant research interest. This review examines the advantages of copper-based biomaterials for biological functions and introduces these materials’ antibacterial mechanisms. We summarize current knowledge about the application of copper-based biomaterials with antimicrobial and osteogenic properties in the prevention and treatment of bone infection and discuss their potential uses in the field of orthopedics. By examining both broad and in-depth research, this review functions as a practical guide to developing copper-based biomaterials and offers directions for possible future work.

A novel Ti-Au alloy with strong antibacterial properties and excellent biocompatibility for biomedical application

In order to avoid the toxic and side effects on human body of long-term dissolution of metal ions from antibacterial titanium alloys, Au element with non-toxicity and non-side effect was selected as the alloying element to prepare a new Ti-Au alloy with strong antibacterial property. We produced Ti-Au(S) sintered alloy by powder metallurgy and Ti-Au ingot alloy by ingot metallurgy, and investigated the influence of the secondary phase on the relative antimicrobial properties and antibacterial mechanism in this work. The results indicated that the aged Ti-Au(T6) alloy and Ti-Au(S) sintered alloy exhibited strong antibacterial rate against S. aureus due to the formation of Ti₃Au phases. In vitro cell culture (MC3T3 cells) experiments showed that Ti-Au alloys had good cytocompatibility and osteogenic properties. The following viewpoints of antibacterial mechanism are that the Ti₃Au destroyed the ROS homeostasis of bacteria, causing oxidative stress in bacterial cells and preventing from the biofilms formation.

Antibacterial mechanism of Cu-bearing 430 ferritic stainless steel

Copper (Cu)-bearing stainless steel has testified its effectiveness to reduce the risk of bacterial infections. However, its antibacterial mechanism is still controversial. Therefore, three 430 ferritic stainless steels with different Cu contents are selected to conduct deeper research by the way of bacterial inactivation from two aspects of material and biology. Hereinto, electrochemical and antibacterial results show that the increase in Cu content simultaneously improves the corrosion resistance and antibacterial property of 430 stainless steel. In addition, it is found that Escherichia coli (E. coli) on the surface 430 Cu-bearing stainless steel by the dry method of inoculation possesses a rapid inactivation ability. X-ray photoelectron spectroscopy (XPS) aids with ion chelation experiments prove that Cu (I) plays a more crucial role in the contact-killing efficiency than Cu (II), resulting from more production of reactive oxygen species (ROS).

Construction of multi-layered Zn-modified TiO2 coating by ultrasound-auxiliary micro-arc oxidation: Microstructure and biological property

Surfaces with desirable cytocompatibility and bactericidal ability are favoured for orthopaedic implants to stimulate osteogenic activity and to prevent implant-associated infection. In this work, we creatively introduce ultrasonic vibration (UV) to micro-arc oxidation (MAO) process and explore its influence on the microstructure, corrosion property and biological responses of Zn-modified TiO₂ coating. With the introduction of UV, a uniform surface layer with homogeneously-distributed clusters could be produced as the outer layer, which possesses a fusion band with the underlying TiO₂. The microstructural modification associated with UV results in the enhanced corrosion resistance, increased adhesive strength and improved biological performances of the resultant coating relative to that with the absence of UV. Hence, the ultrasonic auxiliary micro-arc oxidation (UMAO) is regarded as a promising surface modification method to produce Ti-based orthopaedic implants of high quality.

In Vitro Characterization of In Situ Alloyed Ti6Al4V(ELI)-3 at.% Cu Obtained by Laser Powder Bed Fusion

The intensive cytotoxicity of pure copper is effectively kills bacteria, but it can compromise cellular behavior, so a rational balance must be found for Cu-loaded implants. In the present study, the individual and combined effect of surface composition and roughness on osteoblast cell behavior of in situ alloyed Ti6Al4V(ELI)-3 at.% Cu obtained by laser powder bed fusion was studied. Surface composition was studied using scanning electron microscopy, energy dispersive spectroscopy, and X-ray diffraction. Surface roughness measurements were carried out using confocal microscopy. In vitro osteoblast performance was evaluated by means of cell morphology observation of cell viability, proliferation, and mineralization. In vitro studies were performed at 1, 7, and 14 days of cell culture, except for cell mineralization at 28 days, on grounded and as-built (rough) samples with and without 3 at.% Cu. The addition of 3 at.% Cu did not show cell cytotoxicity but inhibited cell proliferation. Cell mineralization tends to be higher for samples with 3 at.% Cu content. Surface roughness inhibited cell proliferation too, but showed enhanced cell mineralization capacity and therefore, higher osteoblast performance, especially when as-built samples contained 3 at.% Cu. Cell proliferation was only observed on ground samples without Cu but showed the lowest cell mineralization.

Mg/Cu-doped TiO2 nanotube array: A novel dual-function system with self-antibacterial activity and excellent cell compatibility

Many studies were conducted to change the surface morphology and chemical composition of Ti implants for the improvement of antibacterial ability and osseointegration between medical Ti and surrounding bone tissue. In this study, we successfully prepared a novel dual-function coating on pure Ti surface, i.e. Cu and Mg-co-doped TiO₂ nanotube (TN) coating, by combining anodisation and hydrothermal treatment (HT), which could act as a delivery platform for the sustained release of Cu and Mg ions. Results showed that the amounts of Cu and Mg were about 5.43 wt%-6.55 wt% and 0.69 wt%-0.73 wt%, respectively. In addition, the surface morphology of Cu and Mg-co-doped TN (CuMTN) coatings transformed into nanoneedles after HT for 1 h. Compared with TN, CuMTN had no change in roughness and remarkable improved hydrophilicity. Antibacterial tests revealed that CuMTN had an antibacterial rate of more than 93% against Escherichia coli and Staphylococcus aureus, thereby showing excellent antibacterial properties. In addition, CuMTN could induce the formation of apatite well after being immersed in simulated body fluid, showing good biological activity. Preosteoblasts (MC3T3-E1) cultured on CuMTN-coated Ti demonstrated better proliferation and osteogenic differentiation than pristine and as-anodised specimens. To the best of our best knowledge, this study had successfully attempted to combine anodisation and HT, introduce Cu/Mg elements and functionalise Ti-based implant surfaces with enhanced hydrophilicity, osteogenesis and antimicrobial properties that can meet clinical needs for the first time.

Antibacterial metals and alloys for potential biomedical implants

Metals and alloys, including stainless steel, titanium and its alloys, cobalt alloys, and other metals and alloys have been widely used clinically as implant materials, but implant-related infection or inflammation is still one of the main causes of implantation failure. The bacterial infection or inflammation that seriously threatens human health has already become a worldwide complaint. Antibacterial metals and alloys recently have attracted wide attention for their long-term stable antibacterial ability, good mechanical properties and good biocompatibility in vitro and in vivo. In this review, common antibacterial alloying elements, antibacterial standards and testing methods were introduced. Recent developments in the design and manufacturing of antibacterial metal alloys containing various antibacterial agents were described in detail, including antibacterial stainless steel, antibacterial titanium alloy, antibacterial zinc and alloy, antibacterial magnesium and alloy, antibacterial cobalt alloy, and other antibacterial metals and alloys. Researches on the antibacterial properties, mechanical properties, corrosion resistance and biocompatibility of antibacterial metals and alloys have been summarized in detail for the first time. It is hoped that this review could help researchers understand the development of antibacterial alloys in a timely manner, thereby could promote the development of antibacterial metal alloys and the clinical application.

Recent Advances in Research on Antibacterial Metals and Alloys as Implant Materials

Implants are widely used in orthopedic surgery and are gaining attention of late. However, their use is restricted by implant-associated infections (IAI), which represent one of the most serious and dangerous complications of implant surgeries. Various strategies have been developed to prevent and treat IAI, among which the closest to clinical translation is designing metal materials with antibacterial functions by alloying methods based on existing materials, including titanium, cobalt, tantalum, and biodegradable metals. This review first discusses the complex interaction between bacteria, host cells, and materials in IAI and the mechanisms underlying the antibacterial effects of biomedical metals and alloys. Then, their applications for the prevention and treatment of IAI are highlighted. Finally, new insights into their clinical translation are provided. This review also provides suggestions for further development of antibacterial metals and alloys.

Anti-Microbial and Remineralizing Properties of Self-Adhesive Orthodontic Resin Containing Mesoporous Bioactive Glass

Self-adhesive resins (SARs) contain adhesives, which simplify the procedures of resin application, and primers, which provide sufficient bonding ability. In this study, mesoporous bioactive glass nanoparticles (MBN) were added to a SAR to easily improve the physical properties and remineralization ability. The experimental resins comprised 1%, 3%, and 5% MBN mixed in Ortho Connect Flow (GC Corp, Tokyo, Japan). As the MBN content in the SAR increased, the microhardness increased, and a statistically significant difference was observed between the cases of 1% and 5% MBN addition. Shear bond strength increased for 1% and 3% MBN samples and decreased for 5% MBN. The addition of MBN indicated a statistically significant antibacterial effect on both gram-negative and gram-positive bacteria. The anti-demineralization experiment showed that the remineralization length increased with the MBN content of the sample. Through the above results, we found that SAR containing MBN has antibacterial and remineralization effects. Thus, by adding MBN to the SAR, we investigated the possibility of orthodontic resin development, wherein the strength is enhanced and the drawbacks of the conventional SAR addressed.

Toward Bactericidal Enhancement of Additively Manufactured Titanium Implants

Implant-associated infections (IAIs) are among the most intractable and costly complications in implant surgery. They can lead to surgery failure, a high economic burden, and a decrease in patient quality of life. This manuscript is devoted to introducing current antimicrobial strategies for additively manufactured (AM) titanium (Ti) implants and fostering a better understanding in order to pave the way for potential modern high-throughput technologies. Most bactericidal strategies rely on implant structure design and surface modification. By means of rational structural design, the performance of AM Ti implants can be improved by maintaining a favorable balance between the mechanical, osteogenic, and antibacterial properties. This subject becomes even more important when working with complex geometries; therefore, it is necessary to select appropriate surface modification techniques, including both topological and chemical modification. Antibacterial active metal and antibiotic coatings are among the most commonly used chemical modifications in AM Ti implants. These surface modifications can successfully inhibit bacterial adhesion and biofilm formation, and bacterial apoptosis, leading to improved antibacterial properties. As a result of certain issues such as drug resistance and cytotoxicity, the development of novel and alternative antimicrobial strategies is urgently required. In this regard, the present review paper provides insights into the enhancement of bactericidal properties in AM Ti implants.

Advancing of titanium medical implants by surface engineering: recent progress and challenges

Introduction:Titanium (Ti) and their alloys are used as main implant materials in orthopedics and dentistry for decades having superior mechanical properties, chemical stability and biocompatibility. Their rejections due lack of biointegration and bacterial infection are concerning with considerable healthcare costs and impacts on patients. To address these limitations, conventional Ti implants need improvements where the use of surface nanoengineering approaches and the development of a new generation of implants are recognized as promising strategies.Areas covered:This review presents an overview of recent progress on the application of surface engineering methods to advance Ti implants enable to address their key limitations. Several promising surface engineering strategies are presented and critically discussed to generate advanced surface properties and nano-topographies (tubular, porous, pillars) able not only to improve their biointegration, antibacterial performances, but also to provide multiple functions such as drug delivery, therapy, sensing, communication and health monitoring underpinning the development of new generation and smart medical implants.Expert opinion:Recent advances in cell biology, materials science, nanotechnology and additive manufacturing has progressively influencing improvements of conventional Ti implants toward the development of the next generation of implants with improved performances and multifunctionality. Current research and development are in early stage, but progressing with promising results and examples of moving into in-vivo studies an translation into real applications.

The Synergy of Topographical Micropatterning and Ta|TaCu Bilayered Thin Film on Titanium Implants Enables Dual-Functions of Enhanced Osteogenesis and Anti-Infection

Poor osteogenesis and implant-associated infection are the two leading causes of failure for dental and orthopedic implants. Surface design with enhanced osteogenesis often fails in antibacterial activity, or vice versa. Herein, a surface design strategy, which overcomes this trade-off via the synergistic effects of topographical micropatterning and a bilayered nanostructured metallic thin film is presented. A specific microgrooved pattern is fabricated on the titanium surface, followed by sequential deposition of a nanostructured copper (Cu)-containing tantalum (Ta) (TaCu) layer and a pure Ta cap layer. The microgrooved patterns coupled with the nanorough Ta cap layer shows strong contact guidance to preosteoblasts and significantly enhances the osteogenic differentiation in vitro, while the controlled local sustained release of Cu ions is responsible for high antibacterial activity. Importantly, rat calvarial defect models in vivo further confirm that the synergy of microgrooved patterns and the Ta|TaCu bilayered thin film on titanium surface could effectively promote bone regeneration. The present effective and versatile surface design strategy provides significant insight into intelligent surface engineering that can control biological response at the site of healing in dental and orthopedic implants.

Biological applications of copper-containing materials

Copper is an indispensable trace metal element in the human body, which is mainly absorbed in the stomach and small intestine and excreted into the bile. Copper is an important component and catalytic agent of many enzymes and proteins in the body, so it can influence human health through multiple mechanisms. Based on the biological functions and benefits of copper, an increasing number of researchers in the field of biomaterials have focused on developing novel copper-containing biomaterials, which exhibit unique properties in protecting the cardiovascular system, promoting bone fracture healing, and exerting antibacterial effects. Copper can also be used in promoting incisional wounds healing, killing cancer cells, Positron Emission Tomography (PET) imaging, radioimmunological tracing and radiotherapy of cancer. In the present review, the biological functions of copper in the human body are presented, along with an overview of recent progress in our understanding of the biological applications and development of copper-containing materials. Furthermore, this review also provides the prospective on the challenges of those novel biomaterials for future clinical applications.

Overview of Antibacterial Strategies of Dental Implant Materials for the Prevention of Peri-Implantitis

As dental implants have become one of the main treatment options for patients with tooth loss, the number of patients with peri-implant diseases has increased. Similar to periodontal diseases, peri-implant diseases have been associated with dental plaque formation on implants. Unconventional approaches have been reported to remove plaque from infected implants, but none of these methods can completely and permanently solve the problem of bacterial invasion. Fortunately, the constant development of antibacterial implant materials is a promising solution to this situation. In this review, the development and study of different antibacterial strategies for dental implant materials for the prevention of peri-implantitis are summarized. We hope that by highlighting the advantages and limitations of these antimicrobial strategies, we can assist in the continued development of oral implant materials.

Molecular mechanisms of osteogenesis and antibacterial activity of Cu-bearing Ti alloy in a bone defect model with infection in vivo

OBJECTIVE

The antibacterial activity of copper (Cu)-alloy biomaterials has shown a great potential in clinical application. Here, we evaluated the osteogenesis and antibacterial effects of Ti6Al4V-6.5wt%Cu alloy in an in vivo model of infected bone defects and determine their responsible proteins and pathways using proteomics.

METHODS

After bone defects were filled with Ti6Al4V and Ti6Al4V-6.5wt%Cu implants for 6 week, the tissue and bone samples around the implants were harvested for radiographic, micro-CT, histological, and bone-related gene expression analyses. An iTRAQ-based protein identification/quantification approach was used to analyze the osteogenic and antibacterial effects of Ti6Al4V-6.5wt%Cu alloy.

RESULTS

Imaging and histological results showed Ti6Al4V alloy induced a stronger inflammatory response than Ti6Al4V-6.5wt%Cu alloy; imaging results and osteogenic protein levels showed Ti6Al4V-6.5wt%Cu alloy exerted a stronger osteogenic effect. In vitro experiment, we found the Ti6Al4V-6.5wt%Cu had significant antibacterial effects and inhibited the activity of Staphylococcus aureus in the early stage. In addition, the bacterial biofilm formed in Ti6Al4V-6.5wt%Cu group was significantly lower than that in Ti6Al4V group. Proteomic screening of 4279 proteins resulted in 35 differentially expressed proteins for further examination which were mainly associated with the cellular process, metabolic process, stimulus response, and cellular component organization. In further exploration of the mechanism of osteogenic mineralization of Ti6Al4V-6.5wt%Cu alloy, we found out SDC4 and AGRN were the top two target proteins associated with osteogenic differentiation and bone mineralization.

CONCLUSION

Ti6Al4V-6.5wt%Cu alloy shows a great potential as a bone implant material due to its positive effects against bacterial infection and on bone formation.

THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE

At present, titanium alloys and other non-antibacterial metal materials are used in orthopedic internal fixation operations. Our study demonstrates that Ti6Al4V-6.5wt%Cu alloy has good antibacterial and osteogenic effects in vivo and in vitro. This means that Ti6Al4V-6.5wt%Cu alloy may become a new kind of antimicrobial metallic material as internal fixation material to continuously exert its antimicrobial effects and reduce the infection rate after clinical internal fixation.

Antibacterial and Antiviral Functional Materials: Chemistry and Biological Activity toward Tackling COVID-19-like Pandemics

The ongoing worldwide pandemic due to COVID-19 has created awareness toward ensuring best practices to avoid the spread of microorganisms. In this regard, the research on creating a surface which destroys or inhibits the adherence of microbial/viral entities has gained renewed interest. Although many research reports are available on the antibacterial materials or coatings, there is a relatively small amount of data available on the use of antiviral materials. However, with more research geared toward this area, new information is being added to the literature every day. The combination of antibacterial and antiviral chemical entities represents a potentially path-breaking intervention to mitigate the spread of disease-causing agents. In this review, we have surveyed antibacterial and antiviral materials of various classes such as small-molecule organics, synthetic and biodegradable polymers, silver, TiO2, and copper-derived chemicals. The surface protection mechanisms of the materials against the pathogen colonies are discussed in detail, which highlights the key differences that could determine the parameters that would govern the future development of advanced antibacterial and antiviral materials and surfaces.

Pentapartite fractionation of particles in oral fluids by differential centrifugation

Oral fluids (OFs) contain small extracellular vesicles (sEVs or exosomes) that carry disease-associated diagnostic molecules. However, cells generate extracellular vesicles (EVs) other than sEVs, so the EV population is quite heterogeneous. Furthermore, molecules not packaged in EVs can also serve as diagnostic markers. For these reasons, developing a complete picture of particulate matter in the oral cavity is important before focusing on specific subtypes of EVs. Here, we used differential centrifugation to fractionate human OFs from healthy volunteers and patients with oral squamous cell carcinoma into 5 fractions, and we characterized the particles, nucleic acids, and proteins in each fraction. Canonical exosome markers, including CD63, CD9, CD133, and HSP70, were found in all fractions, whereas CD81 and AQP5 were enriched in the 160K fraction, with non-negligible amounts in the 2K fraction. The 2K fraction also contained its characteristic markers that included short derivatives of EGFR and E-cadherin, as well as an autophagosome marker, LC3, and large multi-layered vesicles were observed by electronic microscopy. Most of the DNA and RNA was recovered from the 0.3K and 2K fractions, with some in the 160K fraction. These results can provide guideline information for development of purpose-designed OF-based diagnostic systems.