Photofunctionalization enhances bone-implant contact, dynamics of interfacial osteogenesis, marginal bone seal, and removal torque value of implants: a dog jawbone study

Beyond microroughness: novel approaches to navigate osteoblast activity on implant surfaces

Considering the biological activity of osteoblasts is crucial when devising new approaches to enhance the osseointegration of implant surfaces, as their behavior profoundly influences clinical outcomes. An established inverse correlation exists between osteoblast proliferation and their functional differentiation, which constrains the rapid generation of a significant amount of bone. Examining the surface morphology of implants reveals that roughened titanium surfaces facilitate rapid but thin bone formation, whereas smooth, machined surfaces promote greater volumes of bone formation albeit at a slower pace. Consequently, osteoblasts differentiate faster on roughened surfaces but at the expense of proliferation speed. Moreover, the attachment and initial spreading behavior of osteoblasts are notably compromised on microrough surfaces. This review delves into our current understanding and recent advances in nanonodular texturing, meso-scale texturing, and UV photofunctionalization as potential strategies to address the "biological dilemma" of osteoblast kinetics, aiming to improve the quality and quantity of osseointegration. We discuss how these topographical and physicochemical strategies effectively mitigate and even overcome the dichotomy of osteoblast behavior and the biological challenges posed by microrough surfaces. Indeed, surfaces modified with these strategies exhibit enhanced recruitment, attachment, spread, and proliferation of osteoblasts compared to smooth surfaces, while maintaining or amplifying the inherent advantage of cell differentiation. These technology platforms suggest promising avenues for the development of future implants.

Nanofeatured surfaces in dental implants: contemporary insights and impending challenges

Dental implant therapy, established as standard-of-care nearly three decades ago with the advent of microrough titanium surfaces, revolutionized clinical outcomes through enhanced osseointegration. However, despite this pivotal advancement, challenges persist, including prolonged healing times, restricted clinical indications, plateauing success rates, and a notable incidence of peri-implantitis. This review explores the biological merits and constraints of microrough surfaces and evaluates the current landscape of nanofeatured dental implant surfaces, aiming to illuminate strategies for addressing existing impediments in implant therapy. Currently available nanofeatured dental implants incorporated nano-structures onto their predecessor microrough surfaces. While nanofeature integration into microrough surfaces demonstrates potential for enhancing early-stage osseointegration, it falls short of surpassing its predecessors in terms of osseointegration capacity. This discrepancy may be attributed, in part, to the inherent "dichotomy kinetics" of osteoblasts, wherein increased surface roughness by nanofeatures enhances osteoblast differentiation but concomitantly impedes cell attachment and proliferation. We also showcase a controllable, hybrid micro-nano titanium model surface and contrast it with commercially-available nanofeatured surfaces. Unlike the commercial nanofeatured surfaces, the controllable micro-nano hybrid surface exhibits superior potential for enhancing both cell differentiation and proliferation. Hence, present nanofeatured dental implants represent an evolutionary step from conventional microrough implants, yet they presently lack transformative capacity to surmount existing limitations. Further research and development endeavors are imperative to devise optimized surfaces rooted in fundamental science, thereby propelling technological progress in the field.

Optimizing implant osseointegration, soft tissue responses, and bacterial inhibition: A comprehensive narrative review on the multifaceted approach of the UV photofunctionalization of titanium

Titanium implants have revolutionized restorative and reconstructive therapy, yet achieving optimal osseointegration and ensuring long-term implant success remain persistent challenges. In this review, we explore a cutting-edge approach to enhancing implant properties: ultraviolet (UV) photofunctionalization. By harnessing UV energy, photofunctionalization rejuvenates aging implants, leveraging and often surpassing the intrinsic potential of titanium materials. The primary aim of this narrative review is to offer an updated perspective on the advancements made in the field, providing a comprehensive overview of recent findings and exploring the relationship between UV-induced physicochemical alterations and cellular responses. There is now compelling evidence of significant transformations in titanium surface chemistry induced by photofunctionalization, transitioning from hydrocarbon-rich to carbon pellicle-free surfaces, generating superhydrophilic surfaces, and modulating the electrostatic properties. These changes are closely associated with improved cellular attachment, spreading, proliferation, differentiation, and, ultimately, osseointegration. Additionally, we discuss clinical studies demonstrating the efficacy of UV photofunctionalization in accelerating and enhancing the osseointegration of dental implants. Furthermore, we delve into recent advancements, including the development of one-minute vacuum UV (VUV) photofunctionalization, which addresses the limitations of conventional UV methods as well as the newly discovered functions of photofunctionalization in modulating soft tissue and bacterial interfaces. By elucidating the intricate relationship between surface science and biology, this body of research lays the groundwork for innovative strategies aimed at enhancing the clinical performance of titanium implants, marking a new era in implantology.

Advanced Antimicrobial and Anti-Infective Strategies to Manage Peri-Implant Infection: A Narrative Review

Despite reductions in bacterial infection and enhanced success rate, the widespread use of systemic antibiotic prophylaxis in implant dentistry is controversial. This use has contributed to the growing problem of antimicrobial resistance, along with creating significant health and economic burdens. The basic mechanisms that cause implant infection can be targeted by new prevention and treatment methods which can also lead to the reduction of systemic antibiotic exposure and its associated adverse effects. This review aims to summarize advanced biomaterial strategies applied to implant components based on anti-pathogenic mechanisms and immune balance mechanisms. It emphasizes that modifying the dental implant surface and regulating the early immune response are promising strategies, which may further prevent or slow the development of peri-implant infection, and subsequent failure.

Vacuum Ultraviolet (VUV) Light Photofunctionalization to Induce Human Oral Fibroblast Transmigration on Zirconia

Soft tissue adhesion and sealing around dental and maxillofacial implants, related prosthetic components, and crowns are a clinical imperative to prevent adverse outcomes of periodontitis and periimplantitis. Zirconia is often used to fabricate implant components and crowns. Here, we hypothesized that UV treatment of zirconia would induce unique behaviors in fibroblasts that favor the establishment of a soft tissue seal. Human oral fibroblasts were cultured on zirconia specimens to confluency before placing a second zirconia specimen (either untreated or treated with one minute of 172 nm vacuum UV (VUV) light) next to the first specimen separated by a gap of 150 µm. After seven days of culture, fibroblasts only transmigrated onto VUV-treated zirconia, forming a 2.36 mm volume zone and 5.30 mm leading edge. Cells migrating on VUV-treated zirconia were enlarged, with robust formation of multidirectional cytoplastic projections, even on day seven. Fibroblasts were also cultured on horizontally placed and 45° and 60° tilted zirconia specimens, with the latter configurations compromising initial attachment and proliferation. However, VUV treatment of zirconia mitigated the negative impact of tilting, with higher tilt angles increasing the difference in cellular behavior between control and VUV-treated specimens. Fibroblast size, perimeter, and diameter on day seven were greater than on day one exclusively on VUV-treated zirconia. VUV treatment reduced surface elemental carbon and induced superhydrophilicity, confirming the removal of the hydrocarbon pellicle. Similar effects of VUV treatment were observed on glazed zirconia specimens with silica surfaces. One-minute VUV photofunctionalization of zirconia and silica therefore promotes human oral fibroblast attachment and proliferation, especially under challenging culture conditions, and induces specimen-to-specimen transmigration and sustainable photofunctionalization for at least seven days.

Gas Plasma Treatment Improves Titanium Dental Implant Osseointegration-A Preclinical In Vivo Experimental Study

Recent technological advancements led to the development of various plasma-based technologies for post-packaging modifications. The purpose of the present preclinical in vivo study was to assess the safety and efficacy of a novel chairside nonthermal gas plasma treatment for enhancing osseointegration of titanium implants. Six male mixed foxhounds underwent extraction of mandibular premolars and first molars, and the sockets healed for 42 days. Canine mandibles were randomized to receive either plasma-treated (test) or non-plasma-treated (control) dental implants. A total of 36 implants were placed in six animals, and they were sacrificed at 2 weeks (two animals), 4 weeks (two animals), and 6 weeks (two animals) after the implant surgery. When the radiographic analysis was performed, the changes in bone level were not statistically significant between the two groups at 2 weeks and 4 weeks. The difference became significant at 6 weeks (p = 0.016), indicating more bone loss from baseline to 6 weeks for the control group. The bone-to-implant contact (BIC) appeared to be higher for the test groups at all time points, and the BIC was significantly higher for the test group at 4 weeks (p = 0.046). In conclusion, this study underscored the potential of nonthermal plasma treatment in enhancing implant osseointegration.

Evaluation of UV photofunctionalization effect on ultrastructural properties of SLA titanium disks: An in vitro study

Background

The success rate of dental implants diminishes over time; the lack of osseointegration and infection are the major causes of most implant failures. One of the effective methods to improve the surface properties is to irradiate ultraviolet (UV) light. This study investigated the effect of UV photofunctionalization on the ultrasuperficial properties of sandblasted, large-grit, acid-etched (SLA) titanium discs.

Methods

In this in vitro study, 24 sandblasted and acid-etched titanium discs, with a lifespan of more than four weeks, were categorized into three groups (n=8): control, ultraviolet C (UVC), and ultraviolet B (UVB). Then, they were exposed to a UV light source for 48 hours at a 1-cm distance. In addition to measuring the contact angle between the liquid and the disc surface in each of the three groups, the atomic concentrations of carbon, oxygen, and nitrogen atoms were measured at three different sites on each disc. One-way ANOVA and post hoc Tukey tests were used to analyze data.

Results

The mean concentration of carbon atoms significantly differed in the control, UVC, and UVB groups (P<0.001). The mean concentrations of nitrogen atoms differed significantly between the three groups (P<0.001). However, the mean concentrations of oxygen atoms were not significantly different between the three groups. In examining the contact angle, wettability was higher in the UVC group than in the UVB group and higher in the UBV group than in the control group.

Conclusion

Photofunctionalization with UV light significantly decreased carbon and nitrogen concentrations on the surface of titanium implants, indicating that the implant's superficial hydrocarbons were eliminated. It was observed that UVC photofunctionalization was more effective than UVB photofunctionalization in reducing superficial contamination and improving wettability.

A Novel High-Energy Vacuum Ultraviolet Light Photofunctionalization Approach for Decomposing Organic Molecules around Titanium

Titanium undergoes biological aging, represented by increased hydrophobicity and surface accumulation of organic molecules over time, which compromises the osseointegration of dental and orthopedic implants. Here, we evaluated the efficacy of a novel UV light source, 172 nm wavelength vacuum UV (VUV), in decomposing organic molecules around titanium. Methylene blue solution used as a model organic molecule placed in a quartz ampoule with and without titanium specimens was treated with four different UV light sources: (i) ultraviolet C (UVC), (ii) high-energy UVC (HUVC), (iii) proprietary UV (PUV), and (iv) VUV. After one minute of treatment, VUV decomposed over 90% of methylene blue, while there was 3-, 3-, and 8-fold more methylene blue after the HUVC, PUV, and UVC treatments, respectively. In dose-dependency experiments, maximal methylene blue decomposition occurred after one minute of VUV treatment and after 20-30 min of UVC treatment. Rapid and effective VUV-mediated organic decomposition was not influenced by the surface topography of titanium or its alloy and even occurred in the absence of titanium, indicating only a minimal photocatalytic contribution of titanium dioxide to organic decomposition. VUV-mediated but not other light source-mediated methylene blue decomposition was proportional to its concentration. Plastic tubes significantly reduced methylene blue decomposition for all light sources. These results suggest that VUV, in synergy with quartz ampoules, mediates rapid and effective organic decomposition compared with other UV sources. This proof-of-concept study paves the way for rapid and effective VUV-powered photofunctionalization of titanium to overcome biological aging.

Decomposing Organic Molecules on Titanium with Vacuum Ultraviolet Light for Effective and Rapid Photofunctionalization

Ultraviolet (UV) photofunctionalization counteracts the biological aging of titanium to increase the bioactivity and osseointegration of titanium implants. However, UV photofunctionalization currently requires long treatment times of between 12 min and 48 h, precluding routine clinical use. Here, we tested the ability of a novel, xenon excimer lamp emitting 172 nm vacuum UV (VUV) to decompose organic molecules coated on titanium as a surrogate of photofunctionalization. Methylene blue as a model organic molecule was coated on grade 4 commercially pure titanium and treated with four UV light sources: (i) ultraviolet C (UVC), (ii) high-energy UVC (HUVC), (iii) proprietary UV (PUV), and (iv) VUV. After one minute of treatment, VUV decomposed 57% of methylene blue compared with 2%, 36%, and 42% for UVC, HUVC, and PUV, respectively. UV dose-dependency testing revealed maximal methylene blue decomposition with VUV within one minute. Equivalent decomposition was observed on grade 5 titanium alloy specimens, and placing titanium specimens in quartz ampoules did not compromise efficacy. Methylene blue was decomposed even on polymethyl methacrylate acrylic specimens at 20-25% lower efficiency than on titanium specimens, indicating a relatively small contribution of titanium dioxide-mediated photocatalytic decomposition to the total decomposition. Load-testing revealed that VUV maintained high efficacy of methylene blue decomposition regardless of the coating density, whereas other UV light sources showed low efficacy with thin coatings and plateauing efficacy with thicker coatings. This study provides foundational data on rapid and efficient VUV-mediated organic decomposition on titanium. In synergy with quartz ampoules used as containers, VUV has the potential to overcome current technical challenges hampering the clinical application of UV photofunctionalization.

Ultraviolet Light Treatment of Titanium Microfiber Scaffolds Enhances Osteoblast Recruitment and Osteoconductivity in a Vertical Bone Augmentation Model: 3D UV Photofunctionalization

Vertical bone augmentation to create host bone prior to implant placement is one of the most challenging regenerative procedures. The objective of this study is to evaluate the capacity of a UV-photofunctionalized titanium microfiber scaffold to recruit osteoblasts, generate intra-scaffold bone, and integrate with host bone in a vertical augmentation model with unidirectional, limited blood supply. Scaffolds were fabricated by molding and sintering grade 1 commercially pure titanium microfibers (20 μm diameter) and treated with UVC light (200-280 nm wavelength) emitted from a low-pressure mercury lamp for 20 min immediately before experiments. The scaffolds had an even and dense fiber network with 87% porosity and 20-50 mm inter-fiber distance. Surface carbon reduced from 30% on untreated scaffold to 10% after UV treatment, which corresponded to hydro-repellent to superhydrophilic conversion. Vertical infiltration testing revealed that UV-treated scaffolds absorbed 4-, 14-, and 15-times more blood, water, and glycerol than untreated scaffolds, respectively. In vitro, four-times more osteoblasts attached to UV-treated scaffolds than untreated scaffolds three hours after seeding. On day 2, there were 70% more osteoblasts on UV-treated scaffolds. Fluorescent microscopy visualized confluent osteoblasts on UV-treated microfibers two days after seeding but sparse and separated cells on untreated microfibers. Alkaline phosphatase activity and osteocalcin gene expression were significantly greater in osteoblasts grown on UV-treated microfiber scaffolds. In an in vivo model of vertical augmentation on rat femoral cortical bone, the interfacial strength between innate cortical bone and UV-treated microfiber scaffold after two weeks of healing was double that observed between bone and untreated scaffold. Morphological and chemical analysis confirmed seamless integration of the innate cortical and regenerated bone within microfiber networks for UV-treated scaffolds. These results indicate synergy between titanium microfiber scaffolds and UV photofunctionalization to provide a novel and effective strategy for vertical bone augmentation.

Effectiveness of photofunctionalized titanium alloy on osseointegration in rats with type 2 diabetes

Background

Ultraviolet (UV) light-mediated photofunctionalization improves the osseointegration of pure titanium and titanium alloy (Ti6Al4V). However, little is known about the effect of UV irradiation on Ti6Al4V, used frequently in orthopedic surgery, in diabetic patients. We examined the effect of UV irradiation on Ti6Al4V in rats with type 2 diabetes.

Methods

Cylinder Ti6Al4V implants were used. Half the animals were Sprague Dawley rats (the control group), and the other half were Spontaneously Diabetic Torii fatty rats (the diabetes mellitus model). For radiological analysis, bone density was observed and calculated using 3D microcomputed tomography. Histological analysis was performed to calculate the bone–implant contact (BIC) ratio. We used Pearson correlation to analyze the correlation between average blood glucose level and BIC ratio, and between average blood glucose level and bone volume (BV) ratio.

Results

In the UV light-treated group, the BIC ratios of the normal and diabetic rats increased significantly compared with those in the untreated group at 2 weeks; at 4 weeks, the BIC ratio of the diabetic rats increased significantly, but there was no significant increase in the control animals. In both the control and diabetic groups, there was no significant difference in the BV ratios between the UV-treated and untreated implants at 2 or 4 weeks. The average blood glucose level in the 4-week group negatively correlated with the BIC and BV ratios. The average blood glucose level in the UV-treated group negatively correlated with the BIC ratio.

Conclusion

Photofunctionalization of Ti6Al4V implants may promote osseointegration in the early stages in rats with type 2 diabetes.

Clinical Applications of Photofunctionalization on Dental Implant Surfaces: A Narrative Review

Dental implant therapy is a common clinical procedure for the restoration of missing teeth. Many methods have been used to promote osseointegration for successful implant therapy, including photofunctionalization (PhF), which is defined as the modification of titanium surfaces after ultraviolet treatment. It includes the alteration of the physicochemical properties and the enhancement of biological capabilities, which can alter the surface wettability and eliminate hydrocarbons from the implant surface by a biological aging process. PhF can also enhance cellular migration, attachment, and proliferation, thereby promoting osseointegration and coronal soft tissue seal. However, PhF did not overcome the dental implant challenge of oral cancer cases. It is necessary to have more clinical trials focused on complex implant cases and non-dental fields in the future.

A Novel Cell Delivery System Exploiting Synergy between Fresh Titanium and Fibronectin

Delivering and retaining cells in areas of interest is an ongoing challenge in tissue engineering. Here we introduce a novel approach to fabricate osteoblast-loaded titanium suitable for cell delivery for bone integration, regeneration, and engineering. We hypothesized that titanium age influences the efficiency of protein adsorption and cell loading onto titanium surfaces. Fresh (newly machined) and 1-month-old (aged) commercial grade 4 titanium disks were prepared. Fresh titanium surfaces were hydrophilic, whereas aged surfaces were hydrophobic. Twice the amount of type 1 collagen and fibronectin adsorbed to fresh titanium surfaces than aged titanium surfaces after a short incubation period of three hours, and 2.5-times more fibronectin than collagen adsorbed regardless of titanium age. Rat bone marrow-derived osteoblasts were incubated on protein-adsorbed titanium surfaces for three hours, and osteoblast loading was most efficient on fresh titanium adsorbed with fibronectin. The number of osteoblasts loaded using this synergy between fresh titanium and fibronectin was nine times greater than that on aged titanium with no protein adsorption. The loaded cells were confirmed to be firmly attached and functional. The number of loaded cells was strongly correlated with the amount of protein adsorbed regardless of the protein type, with fibronectin simply more efficiently adsorbed on titanium surfaces than collagen. The role of surface hydrophilicity of fresh titanium surfaces in increasing protein adsorption or cell loading was unclear. The hydrophilicity of protein-adsorbed titanium increased with the amount of protein but was not the primary determinant of cell loading. In conclusion, the osteoblast loading efficiency was dependent on the age of the titanium and the amount of protein adsorption. In addition, the efficiency of protein adsorption was specific to the protein, with fibronectin being much more efficient than collagen. This is a novel strategy to effectively deliver osteoblasts ex vivo and in vivo using titanium as a vehicle.

Ultraviolet Treatment of Titanium to Enhance Adhesion and Retention of Oral Mucosa Connective Tissue and Fibroblasts

Peri-implantitis is an unsolved but critical problem with dental implants. It is postulated that creating a seal of gingival soft tissue around the implant neck is key to preventing peri-implantitis. The objective of this study was to determine the effect of UV surface treatment of titanium disks on the adhesion strength and retention time of oral connective tissues as well as on the adherence of mucosal fibroblasts. Titanium disks with a smooth machined surface were prepared and treated with UV light for 15 min. Keratinized mucosal tissue sections (3 × 3 mm) from rat palates were incubated for 24 h on the titanium disks. The adhered tissue sections were then mechanically detached by agitating the culture dishes. The tissue sections remained adherent for significantly longer (15.5 h) on the UV-treated disks than on the untreated control disks (7.5 h). A total of 94% of the tissue sections were adherent for 5 h or longer on the UV-treated disks, whereas only 50% of the sections remained on the control disks for 5 h. The adhesion strength of the tissue sections to the titanium disks, as measured by tensile testing, was six times greater after UV treatment. In the culture studies, mucosal fibroblasts extracted from rat palates were attached to titanium disks by incubating for 24, 48, or 96 h. The number of attached cells was consistently 15–30% greater on the UV-treated disks than on the control disks. The cells were then subjected to mechanical or chemical (trypsinization) detachment. After mechanical detachment, the residual cell rates on the UV-treated surfaces after 24 and 48 h of incubation were 35% and 25% higher, respectively, than those on the control surfaces. The remaining rate after chemical detachment was 74% on the control surface and 88% on the UV-treated surface for the cells cultured for 48 h. These trends were also confirmed in mouse embryonic fibroblasts, with an intense expression of vinculin, a focal adhesion protein, on the UV-treated disks even after detachment. The UV-treated titanium was superhydrophilic, whereas the control titanium was hydrophobic. X-ray photoelectron spectroscopy (XPS) chemical analysis revealed that the amount of carbon at the surface was significantly reduced after UV treatment, while the amount of TiOH molecules was increased. These ex vivo and in vitro results indicate that the UV treatment of titanium increases the adhesion and retention of oral mucosa connective tissue as a result of increased resistance of constituent fibroblasts against exogenous detachment, both mechanically and chemically, as well as UV-induced physicochemical changes of the titanium surface.

Osteoblast Attachment Compromised by High and Low Temperature of Titanium and Its Restoration by UV Photofunctionalization

Titanium implants undergo temperature fluctuations during manufacturing, transport, and storage. However, it is unknown how this affects their bioactivity. Herein, we explored how storage (six months, dark conditions) and temperature fluctuations (5-50 °C) affected the bioactivity of titanium implants. Stored and fresh acid-etched titanium disks were exposed to different temperatures for 30 min under wet or dry conditions, and their hydrophilicity/hydrophobicity and bioactivity (using osteoblasts derived from rat bone marrow) were evaluated. Ultraviolet (UV) treatment was evaluated as a method of restoring the bioactivity. The fresh samples were superhydrophilic after holding at 5 or 25 °C under wet or dry conditions, and hydrophilic after holding at 50 °C. In contrast, all the stored samples were hydrophobic. For both fresh and stored samples, exposure to 5 or 50 °C reduced osteoblast attachment compared to holding at 25 °C under both wet and dry conditions. Regression analysis indicated that holding at 31 °C would maximize cell attachment (p < 0.05). After UV treatment, cell attachment was the same or better than that before temperature fluctuations. Overall, titanium surfaces may have lower bioactivity when the temperature fluctuates by ≥20 °C (particularly toward lower temperatures), independent of the hydrophilicity/hydrophobicity. UV treatment was effective in restoring the temperature-compromised bioactivity.

Effects of photofunctionalization on early osseointegration of titanium dental implants in the maxillary posterior region: a randomized double-blinded clinical trial

Background

This study aimed to investigate the effects of ultraviolet (UV) photofunctionalization on the stability of implants during the early phase in the posterior region of the maxilla. The study was a randomized double-blinded clinical trial. Half of the participants received conventional commercial implants while the other half received UV-irradiated implants. The surgical sites were classified into three bone quality groups (II, III, IV) based on the grayscale value measured on cone-beam computed tomography. The values obtained from resonance frequency analysis were recorded immediately after implant placement and at 4 weeks and at 4 months postoperatively. The marginal bone level of the implants was evaluated using periapical radiographs at 4 weeks, 4 months, and 1 year postoperatively.

Results

Fifty-seven implants placed in 34 participants were analyzed in this study. In group III, significant differences were observed in terms of the differences of resonance frequency analysis values at 4 weeks (p = 0.004) and 4 months (p = 0.017) postoperatively. In group II, the UV-treated group showed significantly lesser bone loss at 4 weeks post-operatively (p = 0.037).

Conclusions

Within the limitation of the present study, we concluded that UV surface treatment on implants may increase the initial stability in the region of the maxilla with poor bone quality.

Laser surface texturing of zirconia-based ceramics for dental applications: A review

Laser surface texturing is widely explored for modifying the surface topography of various materials and thereby tuning their optical, tribological, biological, and other surface properties. In dentistry, improved osseointegration has been observed with laser textured titanium dental implants in clinical trials. Due to several limitations of titanium materials, dental implants made of zirconia-based ceramics are now considered as one of the best alternatives. Laser surface texturing of zirconia dental implants is therefore attracting increasing attention. However, due to the brittle nature of zirconia, as well as the metastable tetragonal ZrO₂ phase, laser texturing in the case of zirconia is more challenging than in the case of titanium. Understanding these challenges requires different fields of expertise, including laser engineering, materials science, and dentistry. Even though much progress was made within each field of expertise, a comprehensive analysis of all the related factors is still missing. This review paper provides thus an overview of the common challenges and current status on the use of lasers for surface texturing of zirconia-based ceramics for dental applications, including texturing of zirconia implants for improving osseointegration, texturing of zirconia abutments for reducing peri-implant inflammation, and texturing of zirconia restorations for improving restoration retention by bonding.

Photo and Plasma Activation of Dental Implant Titanium Surfaces. A Systematic Review with Meta-Analysis of Pre-Clinical Studies

Background: Ultraviolet (UV) and non-thermal plasma functionalization are surface treatment modalities that seem able to improve osseointegration. The aim of this systematic review and meta-analysis is to assess the effect of the two methods and possible differences. Materials and Methods: The systematic research of pre-clinical animal studies was conducted up to May 2020 in the databases PubMed/Medline, Scopus and the Cochrane Lybrary. A meta-analysis was performed by using the DerSimonian–Laird estimator in random-effects models. Results: Through the digital search, 518 articles were identified; after duplicate removal and screening process 10 papers were included. Four studies evaluating UV treatment in rabbits were included in the meta-analysis. The qualitative evaluation of the included studies showed that both UV photofunctionalization and non-thermal plasma argon functionalization of titanium implant surfaces might be effective in vivo to improve the osseointegration. The meta-analysis on four studies evaluating UV treatment in rabbits showed that bone to implant contact values (expressed as standardized mean differences and raw mean differences) were significantly increased in the bio-activated groups when follow-up times were relatively homogeneous, although a high heterogeneity (I² > 75%) was found in all models. Conclusions: The present systematic review and meta-analysis on pre-clinical studies demonstrated that chair-side treatment of implants with UV or non-thermal plasma appear to be effective for improving osseointegration. This systematic review supports further clinical trials on this topic.

Photofunctionalization as a suitable approach to improve the osseointegration of implants in animal models-A systematic review and meta-analysis

OBJECTIVES

To determine whether photofunctionalization influences dental implant osseointegration.

MATERIAL AND METHODS

Data on osseointegration rates were extracted from 8 databases, based on bone-to-implant contact (BIC) and pushout tests. Internal validity was accessed through the SYRCLE risk of bias tool for animal experimental studies. Meta-analyses were performed for investigation of the influence of photofunctionalization on implant osseointegration, with a random effect and a confidence interval of 95%. The certainty of evidence was accessed through the GRADE approach.

RESULTS

Thirty-four records were identified, and 10 were included in the meta-analysis. Photofunctionalized implants showed higher mean values for BIC in rabbits (MD 6.92 [1.01, 12.82], p = .02), dogs (MD 23.70 [10.23, 37.16], p = .001), rats (MD 20.93 [12.91, 28.95], p < .0001), and in the pooled BIC analyses (MD 14.23 [7.80, 20.66], p < .0001) compared to those in control implants in the overall assay. Conversely, at late healing periods, the pooled BIC meta-analyses showed no statistically significant differences (p > .05) for photofunctionalized and control implants at 12 weeks of follow-up. For pushout analysis, photofunctionalized implants presented greater bone strength integration (MD 19.92 [13.88, 25.96], p < .0001) compared to that of control implants. The heterogeneity between studies ranged from "not important" to "moderate" for rabbits I²  = 24%, dogs I²  = 0%, rats I²  = 0%, and pooled BIC (I²  = 49%), while considerable heterogeneity was observed for pushouts (I²  = 90%).

CONCLUSION

Photofunctionalization improves osseointegration in the initial healing period of implants, as summarized from available data from rabbit, dog, and rat in vivo models.

Effects of Ultraviolet Photoactivation on Osseointegration of Commercial Pure Titanium Dental Implant After 8 Weeks in a Rabbit Model

This study investigated whether a 6-Watt ultraviolet C-lamp was capable of producing photofunctionalization on commercial implants during a medium observation term of 8 weeks. A total of 20 implants were inserted in 5 New Zealand rabbits, with each animal receiving 2 implants per tibia (one photofunctionalized and one untreated), according to a previously established randomization sequence. All implants were inserted by a single surgeon following the manufacturer's instructions. Histological analysis was performed by an evaluator who was blinded to the treatment condition. After 8 weeks of healing, the 2 groups showed no statistically significant differences in terms of bone-to-implant contact. Compared to control implants, the photofunctionalized implants showed improved wettability and more homogenous results. Within the limits of the present study, the use of this 6-W ultraviolet C-lamp, for an irradiation time of 15 minutes at a distance of 15 cm, did not improve the percentages of bone-to-implant contact in rabbits at an osseointegration time of 8 weeks.

The Effect of Ultraviolet Photofunctionalization on a Titanium Dental Implant with Machined Surface: An In Vitro and In Vivo Study

Ultraviolet (UV) photofunctionalization has been suggested as an effective method to enhance the osseointegration of titanium surface. In this study, machined surface treated with UV light (M + UV) was compared to sandblasted, large-grit, acid-etched (SLA) surface through in vitro and in vivo studies. Groups of titanium specimens were defined as machined (M), SLA, and M + UV for the disc type, and M + UV and SLA for the implant. The discs and implants were assessed using scanning electron microscopy, confocal laser scanning microscopy, electron spectroscopy for chemical analysis, and the contact angle. Additionally, we evaluated the cell attachment, proliferation assay, and real-time polymerase chain reaction for the MC3T3-E1 cells. In a rabbit tibia model, the implants were examined to evaluate the bone-to-implant contact ratio and the bone area. In the M + UV group, we observed the lower amount of carbon, a 0°-degree contact angle, and enhanced osteogenic cell activities (p < 0.05). The histomorphometric analysis showed that a higher bone-to-implant contact ratio was found in the M + UV implant at 10 days (p < 0.05). In conclusion, the UV photofunctionalization of a Ti dental implant with M surface attained earlier osseointegration than SLA.

Ultraviolet Functionalization Improved Bone Integration on Titanium Surfaces by Fluorescent Analysis in Rabbit Calvarium

This study evaluated the effect of ultraviolet functionalization (UV) on bone integration ability in rabbit model, using epifluorescence microscopy. Each of 12 rabbits (n = 6) received randomly four titanium domes prepared with or without ultraviolet for 48 hours (UVC, λ = 250 ± 20 nm; Philips, Tokyo, Japan): (1) turned surface (T), (2) turned surface with UV (T-UV), (3) sandblasted (120 μm aluminum oxide) and etched by 18% hydrochloric acid and 49% sulphuric acid at 60°C for 30 min (SLA) and (4) SLA surface with UV (SLA-UV). Fluorochrome bone labels were marked by oxytetracycline at 25 mg/kg on 13th days and 14th days and calcein at 5 mg/kg on 3th days and 4th days before euthanization. The study samples were sacrified at 2 weeks and 4 weeks. The undecalcified specimens were prepared. The newly formed total bone of cross-sectional area (TB, %), the mineralized trabecular bone of cross-sectional area (MB, %), and the new bone and dome contact (BDC, %) were measured and analyzed by fluorescence microscope and Image Pro Express 6.0. The data of MB and TB showed new bone regeneration was increased in all groups, but no signs of difference were found. However, the means BDC of UV treatment on turned surface at 4 weeks, the UV treated on SLA surface at 2 weeks and 4 weeks were statistically significantly higher than the control group (P &lt; .05). Within the limitations of the study, it can be concluded that ultraviolet functionalization on the titanium surface could enhance the new bone tissues and titanium surface integration.

Effect of ultraviolet photofunctionalization of dental titanium implants on osseointegration

OBJECTIVE

The aim of the current study was to evaluate the effect of ultraviolet (UV) photofunctionalization of dental titanium implants with exposure to the oral cavity on osseointegration in an animal model.

METHODS

Forty-eight titanium implants (Camlog^® Conelog^® 4.3 mmx9.0 mm) were placed epicrestally into the edentulous jaws of three minipigs and implant stability was assessed by measuring the implant stability quotient (ISQ). Prior to implantation half of the implants were photofunctionalized with intense UV-light. After three months, the implants were exposed and ISQ was measured again. After six months of implant exposure, the minipigs were sacrificed and the harvested specimens were analyzed using histomorphometric, light, and fluorescence microscopy.

MAIN RESULTS

Forty-two of 48 implants osseointegrated. The overall mean bone-implant contact area (BIC) was (64±22)%. No significant differences were found in BIC or ISQ value (multivariate analysis of variance (MANOVA), P>0.05) between implants with and without exposure to UV photofunctionalization.

CONCLUSIONS

No significant effects were observed on osseointegration of dental titanium implants nine months after exposure of UV photofunctionalization.

Photofunctionalised Ti6Al4V implants enhance early phase osseointegration

Objectives

Ultraviolet (UV) light-mediated photofunctionalisation is known to improve osseointegration of pure titanium (Ti). However, histological examination of titanium alloy (Ti6Al4V), which is frequently applied in orthopaedic and dental surgery, has not yet been performed. This study examined the osseointegration of photofunctionalised Ti6Al4V implants.

Methods

Ti and Ti6Al4V implants were treated with UV light, and the chemical composition and contact angle on the surfaces were evaluated to confirm photofunctionalisation. The implants were inserted into femurs in rats, and the rats were killed two or four weeks after the surgery. For histomorphometric analysis, both the bone–implant contact (BIC) ratio and the bone volume (BV) ratio were calculated from histological analysis and microcomputed tomography data.

Results

The amount of carbon and the contact angle on both implants were significantly reduced after UV irradiation. The BIC ratios for both UV light-treated implants significantly increased at two weeks, but there was no significant difference at four weeks. There was no significant difference in the BV ratios between the UV light-treated and control implants at two or four weeks.

Conclusions

This study suggests that photofunctionalisation of Ti6Al4V implants, similar to that of Ti implants, may promotes osseointegration in early but not in the late phase of osseointegration.

Cite this article: R. Yamauchi, T. Itabashi, K. Wada, T. Tanaka, G. Kumagai, Y. Ishibashi. Photofunctionalised Ti6Al4V implants enhance early phase osseointegration. Bone Joint Res 2017;6:331–336. DOI: 10.1302/2046-3758.65.BJR-2016-0221.R1.

Photofunctionalization of Dental Implants

After dental implants are manufactured there can be a loss of biological activity that may be reactivated by exposure to ultraviolet (UV) radiation, that is, photofunctionalization. The titanium surface is energy conditioned by UV radiation. This imparts a slight positive surface energy and hydrophilicity to the titanium dental implant surface. This conditioning renews biological activity lost after a shelf life of as little as 2 weeks. The UV radiation has chemical and biological effects on the osseous-implant interface. Photofunctionization for as little as 15 minutes accelerates healing and increases bone to implant contact. The most effective time exposure and UV wave length are in need of identification to produce a surface most conducive for osseointegration.

Effect of Photofunctionalization on Ti6Al4V Screw Stability Placed in Segmental Bone Defects in Rat Femurs

PURPOSE

Ultraviolet-mediated photofunctionalization is a new technology to improve bone and titanium integration. We hypothesized that photofunctionalization would enhance the stability of titanium screws used for segmental bone defects.

MATERIALS AND METHODS

Disks were prepared of a titanium alloy (Ti6Al4V) for an in vitro study to evaluate the attachment, proliferation, and differentiation of osteoblasts. Commercially available Ti6Al4V screws were used in vivo. Segmental bone defects were created in rat femurs as an immediate loading reconstruction model. The defects were reconstructed with commercially available titanium plates and Ti6Al4V screws, with or without photofunctionalization. The screw survival rates and mechanical stability were evaluated at 2 and 4 weeks, and the bone formation around the screws was analyzed.

RESULTS

Osteoblasts showed greater attachment, proliferation, and differentiation on the photofunctionalized Ti6Al4V disks. Photofunctionalized screws had significantly greater survival rates and mechanical stability at 2 and 4 weeks. The bone formation around the photofunctionalized screws was significantly greater than that around the untreated screws at 4 weeks.

CONCLUSIONS

The results of the present study have demonstrated the efficacy of photofunctionalization on enhancing the survival and stability of Ti6Al4V screws under a loaded condition in the reconstruction of segmental defects. This was associated with increased bioactivity and bone formation around the photofunctionalized Ti6Al4V material.

Effect of UV-photofunctionalization on oral bacterial attachment and biofilm formation to titanium implant material

Bacterial biofilm infections remain prevalent reasons for implant failure. Dental implant placement occurs in the oral environment, which harbors a plethora of biofilm-forming bacteria. Due to its trans-mucosal placement, part of the implant structure is exposed to oral cavity and there is no effective measure to prevent bacterial attachment to implant materials. Here, we demonstrated that UV treatment of titanium immediately prior to use (photofunctionalization) affects the ability of human polymicrobial oral biofilm communities to colonize in the presence of salivary and blood components. UV-treatment of machined titanium transformed the surface from hydrophobic to superhydrophilic. UV-treated surfaces exhibited a significant reduction in bacterial attachment as well as subsequent biofilm formation compared to untreated ones, even though overall bacterial viability was not affected. The function of reducing bacterial colonization was maintained on UV-treated titanium that had been stored in a liquid environment before use. Denaturing gradient gel-electrophoresis (DGGE) and DNA sequencing analyses revealed that while bacterial community profiles appeared different between UV-treated and untreated titanium in the initial attachment phase, this difference vanished as biofilm formation progressed. Our findings confirm that UV-photofunctionalization of titanium has a strong potential to improve outcome of implant placement by creating and maintaining antimicrobial surfaces.

Assessment of Atmospheric Pressure Plasma Treatment for Implant Osseointegration

This study assessed the osseointegrative effects of atmospheric pressure plasma (APP) surface treatment for implants in a canine model. Control surfaces were untreated textured titanium (Ti) and calcium phosphate (CaP). Experimental surfaces were their 80-second air-based APP-treated counterparts. Physicochemical characterization was performed to assess topography, surface energy, and chemical composition. One implant from each control and experimental group (four in total) was placed in one radius of each of the seven male beagles for three weeks, and one implant from each group was placed in the contralateral radius for six weeks. After sacrifice, bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) were assessed. X-ray photoelectron spectroscopy showed decreased surface levels of carbon and increased Ti and oxygen, and calcium and oxygen, posttreatment for Ti and CaP surfaces, respectively. There was a significant (P < 0.001) increase in BIC for APP-treated textured Ti surfaces at six weeks but not at three weeks or for CaP surfaces. There were no significant (P = 0.57) differences for BAFO between treated and untreated surfaces for either material at either time point. This suggests that air-based APP surface treatment may improve osseointegration of textured Ti surfaces but not CaP surfaces. Studies optimizing APP parameters and applications are warranted.