Role of New Hydrophilic Surfaces on Early Success Rate and Implant Stability: 1-Year Post-loading Results of a Multicenter, Split-Mouth, Randomized Controlled Trial

Nano-Based Approaches in Surface Modifications of Dental Implants: A Literature Review

Rehabilitation of fully or partially edentulous patients with dental implants represents one of the most frequently used surgical procedures. The work of Branemark, who observed that a piece of titanium embedded in rabbit bone became firmly attached and difficult to remove, introduced the concept of osseointegration and revolutionized modern dentistry. Since then, an ever-growing need for improved implant materials towards enhanced material-tissue integration has emerged. There is a strong belief that nanoscale materials will produce a superior generation of implants with high efficiency, low cost, and high volume. The aim of this review is to explore the contribution of nanomaterials in implantology. A variety of nanomaterials have been proposed as potential candidates for implant surface customization. They can have inherent antibacterial properties, provide enhanced conditions for osseointegration, or act as reservoirs for biomolecules and drugs. Titania nanotubes alone or in combination with biological agents or drugs are used for enhanced tissue integration in dental implants. Regarding immunomodulation and in order to avoid implant rejection, titania nanotubes, graphene, and biopolymers have successfully been utilized, sometimes loaded with anti-inflammatory agents and extracellular vesicles. Peri-implantitis prevention can be achieved through the inherent antibacterial properties of metal nanoparticles and chitosan or hybrid coatings bearing antibiotic substances. For improved corrosion resistance various materials have been explored. However, even though these modifications have shown promising results, future research is necessary to assess their clinical behavior in humans and proceed to widespread commercialization.

Prognosis of Implants with Implant-Supported Fixed Dental Prostheses in the Elderly Population: A Retrospective Study with a 5- to 10-Year Follow-Up

This retrospective study aimed to investigate the survival rate of implants from 5 to 10 years after the placement of implant-supported fixed dental prostheses (ISFDPs) and the management of implant loss in the elderly population. Elderly patients (≥65 years old) who had been treated with ISFDPs and followed up with for at least 5 years between October 2009 and March 2020 were enrolled. Patient profiles and implant-related data were extracted. The survival rate of implants up to 5 years as well as the 10-year cumulative survival rate were evaluated. The management of implant loss and prosthetic interventions were also investigated. In total, 195 patients (mean age: 70.1 ± 4.5 years old) and 687 implants (287 ISFDPs) were assessed. The 5-year survival rate was 99.0% and the 10-year cumulative survival rate was 98.1%. Seven of the eleven implants lost were lost due to peri-implantitis. Only three implants in two patients were placed after the loss of the implants; most were restored using non-invasive procedures. Two patients underwent a conversion from ISFDPs to removable prostheses. This study showed that high survival rates were observed in an elderly population with ISFDPs and that non-invasive procedures were often applied after the loss of an implant.

Clinical and Radiographic Evaluation of a Novel Triangular Implant Neck Design: A Case Series

The objective of this study was to evaluate the clinical and radiographic behavior of a novel triangular neck implant configuration in partially edentulous patients. Sixteen patients with a mean age of 58.3 years, were rehabilitated with 25 implants inserted in the healed sites of the maxilla and mandible; implant diameter was Ø3.3 and 3.9 mm. Clinical and radiographic measurements were first performed at prosthesis delivery that served as baseline; they were further evaluated after a mean period of 15.6 months. The interproximal peri-implant bone levels were the primary outcome; the mesial and distal data were recorded and a mean value was calculated. Secondary outcomes included peri-implant probing depth (PPD) and bleeding on probing (BoP). The paired t-test was used to compare the radiographic and clinical outcomes between baseline and follow-up. The mean bone levels at the mesial and distal aspects at baseline were 0.45 (0.47) and 0.57 (0.69), respectively; at follow-up they were 0.59 (0.42) and 0.78 (0.59), respectively. The differences were not statistically significant. Similarly, no significant differences were found for the clinical parameters. Within the limitations of the present study, it could be concluded that this new triangular neck bone level implant macro-design was used successfully to treat partially edentulous patients. Larger controlled clinical studies are warranted to confirm the present radiographic and clinical findings.

Effect of Plasma Treatment on Titanium Surface on the Tissue Surrounding Implant Material

Early osseointegration is important to achieve initial stability after implant placement. We have previously reported that atmospheric-pressure plasma treatment confers superhydrophilicity to titanium. Herein, we examined the effects of titanium implant material, which was conferred superhydrophilicity by atmospheric-pressure plasma treatment, on the surrounding tissue in rat femur. Control and experimental groups included untreated screws and those irradiated with atmospheric-pressure plasma using piezobrush, respectively. The femurs of 8-week-old male Sprague-Dawley rats were used for in vivo experiments. Various data prepared from the Micro-CT analysis showed results showing that more new bone was formed in the test group than in the control group. Similar results were shown in histological analysis. Thus, titanium screw, treated with atmospheric-pressure plasma, could induce high hard tissue differentiation even at the in vivo level. This method may be useful to achieve initial stability after implant placement.

The early loading of different surface-modified implants: a randomized clinical trial

BACKGROUND

Various surface treatment options have been adopted with the aim to improve osseointegration, reducing the overall treatment time. Implant stability of early loaded implants with different modified surfaces was compared in the present study.

METHODS

Patients were selected from the Department of Oro-Maxillofacial Surgery and Stomatology at Semmelweis University. Patients randomly received SA (alumina sandblasted and acid-etched), NH (bioabsorbable apatite nanocoating) or SLA (large-grit sandblasted and acid-etched) surface implants. Outcome measures were: implant success, implant stability, and periodontal parameters. The implant stability was measured at the time of implant placement (primary stability) and six weeks after (prothesis delivery, secondary stability). Osstell and Periotest were applied to take all the measurements. The primary and secondary stability were compared in the three study groups Finally the periimplant probing depth appearing after three months of loading was checked on 6 points around to the implant-supported prostheses. Shapiro-Wilk and Mann-Whitney tests were used for the comparison between the study groups.

RESULTS

A total of 75 implants with different length and diameter were inserted into various positions. One implant failed spontaneously at the fourth week after implant placement. The survival rate was 98,7%. Comparing the primary and secondary stability values, the data were significantly improved in every groups. The difference was the highest in the NH group, however, this difference was not significant compared to the two other groups. Good periodontal parameters were experienced in all the tested implants, independently by the groups.

CONCLUSIONS

With the limitation of the present study, all the implants showed improved stability six weeks after implant placement. A trend of higher result was found for the NH group. Further studies with longer follow-up are needed to confirm this preliminary results.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN13181677; the date of registration: 04/03/2021. Retrospectively registered.

Effects of Surface Modification on Adsorption Behavior of Cell and Protein on Titanium Surface by Using Quartz Crystal Microbalance System

Primary stability and osseointegration are major challenges in dental implant treatments, where the material surface properties and wettability are critical in the early formation of hard tissue around the implant. In this study, a quartz crystal microbalance (QCM) was used to measure the nanogram level amount of protein and bone marrow cells adhered to the surfaces of titanium (Ti) surface in real time. The effects of ultraviolet (UV) and atmospheric-pressure plasma treatment to impart surface hydrophilicity to the implant surface were evaluated. The surface treatment methods resulted in a marked decrease in the surface carbon (C) content and increase in the oxygen (O) content, along with super hydrophilicity. The results of QCM measurements showed that adhesion of both adhesive proteins and bone marrow cells was enhanced after surface treatment. Although both methods produced implants with good osseointegration behavior and less reactive oxidative species, the samples treated with atmospheric pressure plasma showed the best overall performance and are recommended for clinical use. It was verified that QCM is an effective method for analyzing the initial adhesion process on dental implants.