1
|
Jin S, Yu Y, Zhang T, Xie D, Zheng Y, Wang C, Liu Y, Xia D. Surface modification strategies to reinforce the soft tissue seal at transmucosal region of dental implants. Bioact Mater 2024; 42:404-432. [PMID: 39308548 PMCID: PMC11415887 DOI: 10.1016/j.bioactmat.2024.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 08/29/2024] [Accepted: 08/29/2024] [Indexed: 09/25/2024] Open
Abstract
Soft tissue seal around the transmucosal region of dental implants is crucial for shielding oral bacterial invasion and guaranteeing the long-term functioning of implants. Compared with the robust periodontal tissue barrier around a natural tooth, the peri-implant mucosa presents a lower bonding efficiency to the transmucosal region of dental implants, due to physiological structural differences. As such, the weaker soft tissue seal around the transmucosal region can be easily broken by oral pathogens, which may stimulate serious inflammatory responses and lead to the development of peri-implant mucositis. Without timely treatment, the curable peri-implant mucositis would evolve into irreversible peri-implantitis, finally causing the failure of implantation. Herein, this review has summarized current surface modification strategies for the transmucosal region of dental implants with improved soft tissue bonding capacities (e.g., improving surface wettability, fabricating micro/nano topographies, altering the surface chemical composition and constructing bioactive coatings). Furthermore, the surfaces with advanced soft tissue bonding abilities can be incorporated with antibacterial properties to prevent infections, and/or with immunomodulatory designs to facilitate the establishment of soft tissue seal. Finally, we proposed future research orientations for developing multifunctional surfaces, thus establishing a firm soft tissue seal at the transmucosal region and achieving the long-term predictability of dental implants.
Collapse
Affiliation(s)
- Siqi Jin
- Department of Dental Materials, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, 100081, China
| | - Yameng Yu
- Department of Dental Materials, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, 100081, China
| | - Ting Zhang
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China
| | - Daping Xie
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau SAR, 999078, China
| | - Yufeng Zheng
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China
- International Research Organization for Advanced Science and Technology (IROAST), Kumamoto University, 2-39-2 Kumamoto, 860-8555, Japan
| | - Chunming Wang
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau SAR, 999078, China
| | - Yunsong Liu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Dandan Xia
- Department of Dental Materials, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, 100081, China
| |
Collapse
|
2
|
Shahdad S, Rawlinson S, Razaghi N, Patankar A, Patel M, Roccuzzo M, Gill T. Osseointegration of Anodized vs. Sandblasted Implant Surfaces in a Guided Bone Regeneration Acute Dehiscence-Type Defect: An In Vivo Experimental Mandibular Minipig Model. Clin Oral Implants Res 2024. [PMID: 39387129 DOI: 10.1111/clr.14369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/20/2024] [Accepted: 09/21/2024] [Indexed: 10/12/2024]
Abstract
OBJECTIVES This controlled preclinical study analyzed the effect of implant surface characteristics on osseointegration and crestal bone formation in a grafted dehiscence defect minipig model. MATERIAL AND METHODS A standardized 3 mm × 3 mm acute-type buccal dehiscence minipig model grafted with deproteinized bovine bone mineral and covered with a porcine collagen membrane after 2 and 8 weeks of healing was utilized. Crestal bone formation was analyzed histologically and histomorphometrically to compare three implant groups: (1) a novel, commercially available, gradient anodized (NGA) implant, to two custom-made geometric replicas of implant "1," (2) a superhydrophilic micro-rough large-grit sandblasted and acid-etched surface, and (3) a relatively hydrophobic micro-rough large-grit sandblasted and acid-etched surface. RESULTS At 2 and 8 weeks, there was no difference between the amount and height of newly formed bone (NBH, new bone height; BATA, bone area to total area) for any of the groups (p > 0.05). First bone-to-implant contact (fBIC) and vertical bone creep (VBC) at 2 and 8 weeks were significantly increased for Groups 2 and 3 compared to Group 1 (p < 0.05). At 8 weeks, osseointegration in the dehiscence (dehiscence bone-implant-contact; dBIC) was significantly higher for Groups 2 and 3 compared to Group 1 (p < 0.05). CONCLUSIONS The amount of newly formed bone (BATA) and NBH was not influenced by surface type. However, moderately rough surfaces demonstrated significantly superior levels of osseointegration (dBIC) and coronal bone apposition (fBIC) in the dehiscence defect compared to the NGA surface at 2 and 8 weeks. TRIAL REGISTRATION For this type of study, clinical trial registration is not required. This study was conducted at the Biomedical Department of Lund University (Lund, Sweden) and approved by the local Ethics Committee of the University (M-192-14).
Collapse
Affiliation(s)
- Shakeel Shahdad
- Barts and the London School of Medicine and Dentistry, Institute of Dentistry, Queen Mary University of London, London, UK
- Department of Restorative Dentistry, The Royal London Dental Hospital, Barts Health NHS Trust, London, UK
| | - Simon Rawlinson
- Barts and the London School of Medicine and Dentistry, Institute of Dentistry, Queen Mary University of London, London, UK
| | - Nahal Razaghi
- Department of Restorative Dentistry, The Royal London Dental Hospital, Barts Health NHS Trust, London, UK
| | - Anuya Patankar
- Department of Restorative Dentistry, The Royal London Dental Hospital, Barts Health NHS Trust, London, UK
| | - Mital Patel
- Department of Restorative Dentistry, The Royal London Dental Hospital, Barts Health NHS Trust, London, UK
| | - Mario Roccuzzo
- Private Practice, Torino, Italy
- Department of Maxillo-Facial Surgery, University of Torino, Torino, Italy
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas Gill
- Barts and the London School of Medicine and Dentistry, Institute of Dentistry, Queen Mary University of London, London, UK
- Department of Restorative Dentistry, The Royal London Dental Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
3
|
Shrivas S, Samaur H, Yadav V, Boda SK. Soft and Hard Tissue Integration around Percutaneous Bone-Anchored Titanium Prostheses: Toward Achieving Holistic Biointegration. ACS Biomater Sci Eng 2024; 10:1966-1987. [PMID: 38530973 DOI: 10.1021/acsbiomaterials.3c01555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
A holistic biointegration of percutaneous bone-anchored metallic prostheses with both hard and soft tissues dictates their longevity in the human body. While titanium (Ti) has nearly solved osseointegration, soft tissue integration of percutaneous metallic prostheses is a perennial problem. Unlike the firm soft tissue sealing in biological percutaneous structures (fingernails and teeth), foreign body response of the skin to titanium (Ti) leads to inflammation, epidermal downgrowth and inferior peri-implant soft tissue sealing. This review discusses various implant surface treatments/texturing and coatings for osseointegration, soft tissue integration, and against bacterial attachment. While surface microroughness by SLA (sandblasting with large grit and acid etched) and porous calcium phosphate (CaP) coatings improve Ti osseointegration, smooth and textured titania nanopores, nanotubes, microgrooves, and biomolecular coatings encourage soft tissue attachment. However, the inferior peri-implant soft tissue sealing compared to natural teeth can lead to peri-implantitis. Toward this end, the application of smart multifunctional bioadhesives with strong adhesion to soft tissues, mechanical resilience, durability, antibacterial, and immunomodulatory properties for soft tissue attachment to metallic prostheses is proposed.
Collapse
Affiliation(s)
- Sangeeta Shrivas
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore 453552, India
| | - Harshita Samaur
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore 453552, India
| | - Vinod Yadav
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore 453552, India
| | - Sunil Kumar Boda
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore 453552, India
| |
Collapse
|
4
|
Musskopf ML, Finger Stadler A, Fiorini T, Ramos UD, de Sousa Rabelo M, de Castro Pinto RN, Susin C. Performance of a new implant system and drilling protocol-A minipig intraoral dental implant model study. Clin Oral Implants Res 2024; 35:40-51. [PMID: 37855174 DOI: 10.1111/clr.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/06/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023]
Abstract
AIM A new implant system encompassing implants with a tri-oval cross-sectional design and a simplified site preparation protocol at low speed and no irrigation has been developed. The objective of this study was to assess the safety and efficacy of the new implant system using the minipig intraoral dental implant model. METHODS Eight Yucatan minipigs were included. Twelve weeks after extractions, four implants per animal were randomly placed and allowed to heal transmucosal for 13 weeks: two Ø3.5 × 10 mm implants with a back-tapered collar and circular cross-section (control) and two Ø3.5 × 11 mm implants with tri-oval collar and cross-section (test). MicroCT and histological analysis was performed. RESULTS Thirty-two implants were placed; one implant for the control group was lost. Histologically, BIC was higher in the test compared with the control group (74.1% vs. 60.9%, p < .001). At the platform level, inflammation was statistically significantly higher albeit mild in the test compared with the control group. No other significant differences were observed between groups. MicroCT analysis showed that bone-to-implant-contact (BIC) and trabecular thickness were statistically significantly higher for the test than the control group. Test group had significantly higher first BIC distance than controls on lingual sites. CONCLUSIONS The present study results support the safety and efficacy of the new dental implant system and simplified site preparation protocol; human studies should be carried out to confirm these findings.
Collapse
Affiliation(s)
- Marta Liliana Musskopf
- Laboratory for Applied Periodontal & Craniofacial Research, Division of Comprehensive Oral Health - Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amanda Finger Stadler
- Laboratory for Applied Periodontal & Craniofacial Research, Division of Comprehensive Oral Health - Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tiago Fiorini
- Department of Conservative Dentistry - Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Cristiano Susin
- Laboratory for Applied Periodontal & Craniofacial Research, Division of Comprehensive Oral Health - Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
5
|
Foletti JM, Remy F, Chevenement L, Sterba M, Tavitian P, Badih L, Kenck-Veran O. Effect of LED photobiomodulation on dental implant osseointegration: An in vivo study. J Dent Res Dent Clin Dent Prospects 2023; 17:28-34. [PMID: 37650019 PMCID: PMC10462914 DOI: 10.34172/joddd.2023.36954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/25/2023] [Indexed: 09/01/2023] Open
Abstract
Background Photobiomodulation (PBM) may be prescribed after dental surgery to accelerate tissue healing and improve implant stability. The objective of this study is to evaluate the efficiency of LED-PBM on the dental implant osseointegration. Methods A total of 48 implants (KontactTM) were inserted in 8 Yucatan minipigs (6 implants per minipig) divided into 2 groups (test and control). The test group received LED-PBM with a total energy of 124.2 J/cm2 delivered over 4 sessions (at day0, day+8, day+15 and day+28) lasting 12 minutes each. At day+28, all animals were sacrificed, and their mandibles removed to perform histologic and histomorphometric analysis. Implant osseointegration was evaluated using the computation of bone/implant contact (BIC) index and bone surface/total surface (BS/ TS) ratio. The groups were compared using Student's unpaired t test. Results BIC index and BS/TS ratio were significantly higher within the test group as compared to the control group (P<0.01). Histologic observations on bone tissues demonstrated that LED-PBM may improve and accelerate dental implant osseointegration: 25% of dental implants analyzed within the test group were completely osseointegrated, versus 12.5% within the control group. Conclusion This experimental study indicates that LED-PBM contributes to enhancing implant treatment outcomes.
Collapse
Affiliation(s)
- Jean-Marc Foletti
- Department of Oral and maxillofacial Surgery, APHM, Conception University Hospital, Marseille, France
- Aix-Marseille Univ, Gustave Eiffel Univ, LBA, Marseille, France
| | - Floriane Remy
- Aix-Marseille Univ, Gustave Eiffel Univ, LBA, Marseille, France
| | - Luc Chevenement
- Aix-Marseille Univ, Gustave Eiffel Univ, LBA, Marseille, France
| | | | - Patrick Tavitian
- Department of Dentistry, APHM, la Timone University Hospital, Marseille, France
| | | | | |
Collapse
|
6
|
Musskopf ML, Finger Stadler A, Wikesjö UME, Susin C. The minipig intraoral dental implant model: A systematic review and meta-analysis. PLoS One 2022; 17:e0264475. [PMID: 35226690 PMCID: PMC8884544 DOI: 10.1371/journal.pone.0264475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/10/2022] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVES The objective of this report was to provide a review of the minipig intraoral dental implant model including a meta-analysis to estimate osseointegration and crestal bone remodeling. METHODS A systematic review including PubMed and EMBASE databases through June 2021 was conducted. Two independent examiners screened titles/abstracts and selected full-text articles. Studies evaluating titanium dental implant osseointegration in native alveolar bone were included. A quality assessment of reporting was performed. Random-effects meta-analyses and meta-regressions were produced for bone-implant contact (BIC), first BIC, and crestal bone level. RESULTS 125 out of 249 full-text articles were reviewed, 55 original studies were included. Quality of reporting was generally low, omissions included animal characteristics, examiner masking/calibration, and sample size calculation. The typical minipig model protocol included surgical extraction of the mandibular premolars and first molar, 12±4 wks post-extraction healing, placement of three narrow regular length dental implants per jaw quadrant, submerged implant healing and 8 wks of osseointegration. Approximately 90% of studies reported undecalcified incandescent light microscopy histometrics. Overall, mean BIC was 59.88% (95%CI: 57.43-62.33). BIC increased significantly over time (p<0.001): 40.93 (95%CI: 34.95-46.90) at 2 wks, 58.37% (95%CI: 54.38-62.36) at 4 wks, and 66.33% (95%CI: 63.45-69.21) beyond 4 wks. Variability among studies was mainly explained by differences in observation interval post-extraction and post-implant placement, and implant surface. Heterogeneity was high for all studies (I2 > 90%, p<0.001). CONCLUSIONS The minipig intraoral dental implant model appears to effectively demonstrate osseointegration and alveolar bone remodeling similar to that observed in humans and canine models.
Collapse
Affiliation(s)
- Marta Liliana Musskopf
- Division of Comprehensive Oral Health–Periodontology, Laboratory for Applied Periodontal & Craniofacial Research, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Amanda Finger Stadler
- Division of Comprehensive Oral Health–Periodontology, Laboratory for Applied Periodontal & Craniofacial Research, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Ulf ME Wikesjö
- Division of Comprehensive Oral Health–Periodontology, Laboratory for Applied Periodontal & Craniofacial Research, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Cristiano Susin
- Division of Comprehensive Oral Health–Periodontology, Laboratory for Applied Periodontal & Craniofacial Research, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| |
Collapse
|
7
|
Farrag KM, Khamis MM. Effect of anodized titanium abutment collars on peri-implant soft tissue: A split-mouth clinical study. J Prosthet Dent 2021:S0022-3913(21)00518-7. [PMID: 34756606 DOI: 10.1016/j.prosdent.2021.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
STATEMENT OF PROBLEM Anodic oxidation of titanium implant abutment collars has been used to mask their unesthetic grayish color. However, the effect of anodic oxidation on the health and appearance of peri-implant soft tissues is unclear. PURPOSE The purpose of this split-mouth clinical study was to investigate the effect of anodized titanium on the health and esthetics of peri-implant soft tissues. MATERIAL AND METHODS A total of 60 osseointegrated implants placed in 30 participants were included in the present study. Each participant received 2 randomly allocated abutments, one with a pink anodized collar and the other with an unanodized one to form 2 groups: unanodized group (control group) and anodized group (experimental group). All implants were restored with lithium disilicate restorations. Evaluations of the peri-implant soft tissues were performed at the time of definitive restoration insertion (baseline) and after 3, 6, 12, and 18 months: peri-implant probing depth, soft tissue recession, modified sulcus bleeding index, modified plaque index, and modified gingival index. The esthetics of peri-implant soft tissues were evaluated by using the modified pink esthetic score. The paired t test or Wilcoxon signed-rank test was used for comparing the 2 study groups at each point of time depending on the normality of the variables (α=.05). To compare each variable at different time points within each group separately, repeated measures ANOVA or Friedman tests were used according to the normality of the variables, followed by post hoc pairwise comparisons by using the Bonferroni adjusted significance (α=.05). RESULTS Five peri-implant soft tissue indices were followed up throughout the study. No statistically significant differences were found among the mean values of the tested indices in the anodized and unanodized groups throughout the evaluation periods (P>.05). The collective mean values of the modified pink esthetic score also showed no statistically significant differences between the groups (P>.05). CONCLUSIONS Based on this split-mouth clinical study, pink anodized titanium abutment collars do not produce a clinically significant effect on the health or esthetics of peri-implant soft tissues.
Collapse
Affiliation(s)
- Khaled Mohamed Farrag
- Demonstrator of Fixed Prosthodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Moataz Khamis
- Professor and Chairman, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| |
Collapse
|