Balancing the antibacterial and osteogenic effects of double-layer TiO2 nanotubes loaded with silver nanoparticles for the osseointegration of implants

Programmed surface platform orchestrates anti-bacterial ability and time-sequential bone healing for implant-associated infection

Implant-associated infection (IAI) has become an intractable challenge in clinic. The healing of IAI is a complex physiological process involving a series of spatiotemporal connected events. However, existing titanium-based implants in clinic suffer from poor antibacterial effect and single function. Herein, a versatile surface platform based on the presentation of sequential function is developed. Fabrication of titania nanotubes and poly-γ-glutamic acid (γ-PGA) achieves the efficient incorporation of silver ions (Ag+) and the pH-sensitive release in response to acidic bone infection microenvironment. The optimized PGA/Ag platform exhibits satisfactory biocompatibility and converts macrophages from pro-inflammatory M1 to pro-healing M2 phenotype during the subsequent healing stage, which creates a beneficial osteoimmune microenvironment and promotes angio/osteogenesis. Furthermore, the PGA/Ag platform mediates osteoblast/osteoclast coupling through inhibiting CCL3/CCR1 signaling. These biological effects synergistically improve osseointegration under bacterial infection in vivo, matching the healing process of IAI. Overall, the novel integrated PGA/Ag surface platform proposed in this study fulfills function cascades under pathological state and shows great potential in IAI therapy.

Advances in Regenerative and Reconstructive Medicine in the Prevention and Treatment of Bone Infections

Reconstructive and regenerative medicine are critical disciplines dedicated to restoring tissues and organs affected by injury, disease, or congenital anomalies. These fields rely on biomaterials like synthetic polymers, metals, ceramics, and biological tissues to create substitutes that integrate seamlessly with the body. Personalized implants and prosthetics, designed using advanced imaging and computer-assisted techniques, ensure optimal functionality and fit. Regenerative medicine focuses on stimulating natural healing mechanisms through cellular therapies and biomaterial scaffolds, enhancing tissue regeneration. In bone repair, addressing defects requires advanced solutions such as bone grafts, essential in medical and dental practices worldwide. Bovine bone scaffolds offer advantages over autogenous grafts, reducing surgical risks and costs. Incorporating antimicrobial properties into bone substitutes, particularly with metals like zinc, copper, and silver, shows promise in preventing infections associated with graft procedures. Silver nanoparticles exhibit robust antimicrobial efficacy, while zinc nanoparticles aid in infection prevention and support bone healing; 3D printing technology facilitates the production of customized implants and scaffolds, revolutionizing treatment approaches across medical disciplines. In this review, we discuss the primary biomaterials and their association with antimicrobial agents.

Multifunctional Prosthesis Surface: Modification of Titanium with Cinnamaldehyde-Loaded Hierarchical Titanium Dioxide Nanotubes

Orthopedic prostheses are the ultimate therapeutic solution for various end-stage orthopedic conditions. However, aseptic loosening and pyogenic infections remain as primary complications associated with these devices. In this study, a hierarchical titanium dioxide (TiO2) nanotube drug delivery system loaded with cinnamaldehyde for the surface modification of titanium implants, is constructed. These specially designed dual-layer TiO2 nanotubes enhance material reactivity and provide an extensive drug-loading platform within a short time. The introduction of cinnamaldehyde enhances the bone integration performance of the scaffold (simultaneously promoting bone formation and inhibiting bone resorption), anti-inflammatory capacity, and antibacterial properties. In vitro experiments have demonstrated that this system promoted osteogenesis by upregulating both Wnt/β-catenin and MAPK signaling pathways. Furthermore, it inhibits osteoclast formation, suppresses macrophage-mediated inflammatory responses, and impedes the proliferation of Staphylococcus aureus and Escherichia coli. In vivo experiments shows that this material enhances bone integration in a rat model of femoral defects. In addition, it effectively enhances the antibacterial and anti-inflammatory properties in a subcutaneous implant in a rat model. This study provides a straightforward and highly effective surface modification strategy for orthopedic Ti implants.

Ag2 O-TiO2 -NTs enhance osteogenic activity in vitro by modulating TNF-α/β-catenin signaling in bone marrow-derived mesenchymal stem cells

The toxic effects of nanoparticles-silver oxide (Ag2 O) limited its use. However, loading Ag2 O nanoparticles into titanium dioxide (TiO2 ) nanotubes (Ag2 O-TiO2 -NTs) has more efficient biological activity and safety. The aim of this study was to observe the effect of Ag2 O-TiO2 -NTs on osteogenic differentiation of bone marrow-derived mesenchymal stem cells (BMSCs) and its mechanism. The enzyme activity of lactate dehydrogenase (LDH) and the expression of RUNX family transcription factor 2 (Runx2), OPN, OCN in BMSCs were detected by quantitative real time polymerase chain reaction. At 14 days of induction, the mineralization ability and alkaline phosphatase (ALP) activity of cells in each group were observed by Alizarin Red S staining and ALP staining. In addition, the protein levels of tumor necrosis factor-α (TNF-α) and β-catenin in BMSCs of each group were observed by western blot. After 14 days of the induction, the mineralization ability and ALP activity of BMSCs in the Ag2 O-TiO2 -NTs group were significantly enhanced compared with those in the Ag2 O and TiO2 groups. Western blot analysis showed that the BMSCs in the Ag2 O-TiO2 -NTs group exhibited much lower protein level of TNF-α and higher protein level of β-catenin than those in the Ag2 O and TiO2 groups.Ag2 O-TiO2 -NTs enhance the osteogenic activity of BMSCs by modulating TNF-α/β-catenin signaling.

Construction of antibacterial bone implants and their application in bone regeneration

Bacterial infection represents a prevalent challenge during the bone repair process, often resulting in implant failure. However, the extensive use of antibiotics has limited local antibacterial effects at the infection site and is prone to side effects. In order to address the issue of bacterial infection during the transplantation of bone implants, four types of bone scaffold implants with long-term antimicrobial functionality have been constructed, including direct contact antimicrobial scaffold, dissolution-penetration antimicrobial scaffold, photocatalytic antimicrobial scaffold, and multimodal synergistic antimicrobial scaffold. The direct contact antimicrobial scaffold involves the physical penetration or disruption of bacterial cell membranes by the scaffold surface or hindrance of bacterial adhesion through surface charge, microstructure, and other factors. The dissolution-penetration antimicrobial scaffold releases antimicrobial substances from the scaffold's interior through degradation and other means to achieve local antimicrobial effects. The photocatalytic antimicrobial scaffold utilizes the absorption of light to generate reactive oxygen species (ROS) with enhanced chemical reactivity for antimicrobial activity. ROS can cause damage to bacterial cell membranes, deoxyribonucleic acid (DNA), proteins, and other components. The multimodal synergistic antimicrobial scaffold involves the combined use of multiple antimicrobial methods to achieve synergistic effects and effectively overcome the limitations of individual antimicrobial approaches. Additionally, the biocompatibility issues of the antimicrobial bone scaffold are also discussed, including in vitro cell adhesion, proliferation, and osteogenic differentiation, as well as in vivo bone repair and vascularization. Finally, the challenges and prospects of antimicrobial bone implants are summarized. The development of antimicrobial bone implants can provide effective solutions to bacterial infection issues in bone defect repair in the foreseeable future.

The impact of immediate versus delayed mini-screw placement on alveolar bone preservation and bone density following tooth extraction: evidence from a canine model

The aim of this study was to evaluate the impact of mini-screw placement on the alveolar ridge using a split-mouth design. Twelve beagles underwent bilateral extraction of their lateral teeth. In the immediate group, a mini-screw was unilaterally placed approximately 3-4 mm below the alveolar crest of the extraction site on the experimental side. The delayed group received mini-screws six weeks after tooth extraction. On average, the dogs were sacrificed after 11 weeks, and the maxillary bones were excised and scanned using cone-beam computed tomography (CBCT). Histopathological examinations were conducted to assess inflammation and bone formation scores. The results showed that in the immediate group, bone height was significantly greater on the intervention side compared to the control side (p < 0.05), whereas there was no significant difference in the delayed group. In both groups, there was a significant increase in bone density around the mini-screws compared to the control sides (p < 0.05). Mini-screw insertion led to a significant enhancement of bone growth in both groups (p < 0.05), with no notable differences between the two groups. The mini-screws did not have any impact on bone inflammation or width. Overall, both immediate and delayed mini-screw placement in the extraction socket positively influenced bone dimensions, density, and histological properties. However, immediate insertion was more effective than delayed placement in preserving vertical bone height, despite delayed insertion resulting in higher bone density.

Long-term application of silver nanoparticles in dental restoration materials: potential toxic injury to the CNS

Silver nanoparticles (AgNPs) have durable and remarkable antimicrobial effects on pathogenic microorganisms, such as bacteria and fungi, in dental plaques. As such, they are widely added to dental restoration materials, including composite resins, denture bases, adhesives, and implants, to solve the problems of denture stomatitis, peri-implant inflammation, and oral infection caused by the long-term use of these dental restoration materials. However, AgNPs can be absorbed into the blood circulatory system through the nasal/oral mucosa, lungs, gastrointestinal tract, skin, and other pathways and then distributed into the lungs, kidneys, liver, spleen, and testes, thereby causing toxic injury to these tissues and organs. It can even be transported across the blood-brain barrier (BBB) and continuously accumulate in brain tissues, causing injury and dysfunction of neurons and glial cells; consequently, neurotoxicity occurs. Other nanomaterials with antibacterial or remineralization properties are added to dental restoration materials with AgNPs. However, studies have yet to reveal the neurotoxicity caused by dental restoration materials containing AgNPs. In this review, we summarize the application of AgNPs in dental restoration materials, the mechanism of AgNPs in cytotoxicity and toxic injury to the BBB, and the related research on the accumulation of AgNPs to cause changes of neurotoxicity. We also discuss the mechanisms of neurotoxicity caused by AgNPs and the mode and rate of AgNPs released from dental restorative materials added with AgNPs to evaluate the probability of neurotoxic injury to the central nervous system (CNS), and then provide a theoretical basis for developing new composite dental restoration materials. Mechanism of neurotoxicity caused by AgNPs: AgNPs in the blood circulation enter the brain tissue after being transported across the BBB through transendothelial cell pathway and paracellular transport pathway, and continuously accumulate in brain tissue, causing damage and dysfunction of neurons and glial cells which ultimately leads to neurotoxicity. The uptake of AgNPs by neurons, astrocytes and microglia causes damage to these cells. AgNPs with non-neurotoxic level often increases the secretion of a variety of cytokines, up-regulates the expression of metallothionein in glial cells, even up-regulates autophagy and inflammation response to protect neurons from the toxic damage of AgNPs. However, the protective effect of glial cells induced by AgNPs exposure to neurotoxic levels is insufficient, which leads to neuronal damage and dysfunction and even neuronal programmed cell death, eventually cause neurotoxicity.

Assessment of Inhibition of Biofilm Formation on Non-Thermal Plasma-Treated TiO2 Nanotubes

Peri-implantitis is an inflammatory disease similar to periodontitis, caused by biofilms formed on the surface of dental implants. This inflammation can spread to bone tissues and result in bone loss. Therefore, it is essential to inhibit the formation of biofilms on the surface of dental implants. Thus, this study examined the inhibition of biofilm formation by treating TiO₂ nanotubes with heat and plasma. Commercially pure titanium specimens were anodized to form TiO₂ nanotubes. Heat treatment was performed at 400 and 600 °C, and atmospheric pressure plasma was applied using a plasma generator (PGS-200, Expantech, Suwon, Republic of Korea). Contact angles, surface roughness, surface structure, crystal structure, and chemical compositions were measured to analyze the surface properties of the specimens. The inhibition of biofilm formation was assessed using two methods. The results of this study showed that the heat treatment of TiO₂ nanotubes at 400 °C inhibited the adhesion of Streptococcus mutans (S. mutans), associated with initial biofilm formation, and that heat treatment of TiO₂ nanotubes at 600 °C inhibited the adhesion of Porphyromonas gingivalis (P. gingivalis), which causes peri-implantitis. Applying plasma to the TiO₂ nanotubes heat-treated at 600 °C inhibited the adhesion of S. mutans and P. gingivalis.