1
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Sahrmann P, Tarsch J, Schmidlin PR. Comparison of clinical parameters of peri-implantitis and parameters related to tissue macrophage sensitization on TiO 2. Clin Oral Investig 2024; 28:499. [PMID: 39182209 PMCID: PMC11345321 DOI: 10.1007/s00784-024-05880-3] [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: 01/18/2024] [Accepted: 08/06/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE Dental implants show impressive survival and like rates, but peri-implantitis is a frequent inflammatory disease which affects the implant-surrounding tissues. While biofilms on the implant surface is considered its etiologic reason, several risk factors determine the pace of progression of peri-implant bone loss. Some risk factors are generally accepted while others are still unconfirmed and a matter of ongoing discussion. Among the latter, tissue macrophage sensitization on TiO2 has gained scientific interest in recent years. The aim of the present case-control study was to test for potential associations between clinically manifest peri-implantitis and MS related parameters. MATERIALS AND METHODS In patients with implants affected by peri-implantitis in the test group and healthy implants in the control group clinical parameters (peri-implant pocket depths (PPD) and bleeding on probing (BOP) were measured. Samples of aMMP-8 were taken from the entrance of the peri-implant sulcus and bacterial samples were collected from the sulcus. Blood samples were obtained from the basilic vein to assess MA-related laboratory parameters. Potential correlations between clinical and laboratory parameters were tested by multiple regression (p < 0.05). RESULTS No statistically significant correlations were found between clinical or bacteriological findings and laboratory parameters were found. CONCLUSIONS Based on the findings of this study elevated MA-related laboratory parameters do not appear to be linked to peri-implantitis. CLINICAL RELEVANCE Sensitization on TiO2 is not associated with clinical symptoms of peri-implantitis.
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Affiliation(s)
- Philipp Sahrmann
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, Basel, Switzerland.
| | | | - Patrick R Schmidlin
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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2
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Domingo MG, Kurtz M, Maglione G, Martin M, Brites F, Tasat DR, Olmedo DG. Chronic exposure to TiO 2 micro- and nano particles: A biochemical and histopathological experimental study. J Biomed Mater Res B Appl Biomater 2024; 112:e35443. [PMID: 38968028 DOI: 10.1002/jbm.b.35443] [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: 04/17/2023] [Revised: 04/08/2024] [Accepted: 06/09/2024] [Indexed: 07/07/2024]
Abstract
The aim of this work was to analyze the effects of long-term exposure to titanium dioxide (TiO2) micro- (MPs) and nanoparticles (NPs) (six and 12 months) on the biochemical and histopathological response of target organs using a murine model. Male Wistar rats were intraperitoneally injected with a suspension of TiO2 NPs (5 nm; TiO2-NP5 group) or MPs (45 μm; TiO2-NP5 group); the control group was injected with saline solution. Six and 12 months post-injection, titanium (Ti) concentration in plasma and target organs was determined spectrometrically (ICP-MS). Blood smears and organ tissue samples were evaluated by light microscopy. Liver and kidney function was evaluated using serum biochemical parameters. Oxidative metabolism was assessed 6 months post-injection (determination of superoxide anion by nitroblue tetrazolium (NBT) test, superoxide dismutase (SOD) and catalase (CAT), lipid peroxidation, and paraoxonase 1). Titanium (Ti) concentration in target organs and plasma was significantly higher in the TiO2-exposed groups than in the control group. Histological evaluation showed the presence of titanium-based particles in the target organs, which displayed no structural alterations, and in blood monocytes. Oxidative metabolism analysis showed that TiO2 NPs were more reactive over time than MPs (p < .05) and mobilization of antioxidant enzymes and membrane damage varied among the studied organs. Clearance of TiO2 micro and nanoparticles differed among the target organs, and lung clearance was more rapid than clearance from the lungs and kidneys (p < .05). Conversely, Ti concentration in plasma increased with time (p < .05). In conclusion, neither serum biochemical parameters nor oxidative metabolism markers appear to be useful as biomarkers of tissue damage in response to TiO2 micro- and nanoparticle deposits at chronic time points.
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Affiliation(s)
- Mariela Gisele Domingo
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Anatomía Patológica, Buenos Aires, Argentina
- Becario de Investigación de la Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Melisa Kurtz
- CONICET, Buenos Aires, Argentina
- Instituto de Tecnologías Emergentes y Ciencias Aplicadas (ITECA), Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín-CONICET, Buenos Aires, Argentina
| | - Guillermo Maglione
- Instituto de Tecnologías Emergentes y Ciencias Aplicadas (ITECA), Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín-CONICET, Buenos Aires, Argentina
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Histología y Embriología, Buenos Aires, Argentina
| | | | - Fernando Brites
- CONICET, Buenos Aires, Argentina
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Laboratorio de Lípidos y Lipoproteínas, Buenos Aires, Argentina
| | - Deborah Ruth Tasat
- Instituto de Tecnologías Emergentes y Ciencias Aplicadas (ITECA), Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín-CONICET, Buenos Aires, Argentina
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Histología y Embriología, Buenos Aires, Argentina
| | - Daniel Gustavo Olmedo
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Anatomía Patológica, Buenos Aires, Argentina
- CONICET, Buenos Aires, Argentina
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3
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Morsy MS, Hassan AAHAA, Alshawkani HA, Mattoo KA, Mathur A, Fiorillo L. Effect of Repeated Moist Heat Sterilization on Titanium Implant-Abutment Interface-An In Vitro Study. Eur J Dent 2024; 18:860-868. [PMID: 38198814 PMCID: PMC11290932 DOI: 10.1055/s-0043-1776314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES Sterilization eliminates microbial viability by decreasing the biological load, but likewise have the ability to deteriorate the mechanical properties of an implant material. This study intended to evaluate the effect of repeated moist heat sterilization on implant-abutment interface using two different implant systems. MATERIALS AND METHODS Forty screw-retained titanium implant-abutment combinations (fixture 3.5 ×10 mm, abutment 2 mm diameter), twenty each from Genesis (Aktiv Implant Systems, United States) and Bredent (SKY, Germany), were divided into four different groups (n = 10) and placed in a computer-aided diagnostic model. The abutments from each group were exposed to first and second autoclave cycle (121°C for 30 minutes), connected back to the fixture and analyzed under scanning electron microscope for marginal gap and surface roughness. RESULTS Genesis group showed higher marginal gaps on both sides (buccal/mesial [2.8 ± 0.47]; lingual/distal [2.8 ± 0.33]), while Bredent implant-abutment system (IAS) did not show any changes in marginal gaps after autoclaving. Differences within and between the group were found to be statistically significant. Surface roughness for Genesis (243.7 ± 70.30) and Bredent groups (528.9 ± 213.19) was highest at second autoclave, with Bredent implant-abutment showing higher values for surface roughness than Genesis IAS. CONCLUSION Marginal vertical gap increased with autoclaving for Genesis IAS, while Bredent implant abutments were more stable. Surface roughness increases with autoclaving for both Genesis and Bredent group of IAS.
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Affiliation(s)
- Mohamed S.M. Morsy
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, KSA
| | | | - Hamed A. Alshawkani
- Department of Restorative Dental Science, College of Dentistry, Jazan University, Jazan, KSA
| | - Khurshid A. Mattoo
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, KSA
| | - Ankita Mathur
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy
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4
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De Stefano M, Singh K, Raina A, Mohan S, Ul Haq MI, Ruggiero A. Tribocorrosion of 3D printed dental implants: An overview. J Taibah Univ Med Sci 2024; 19:644-663. [PMID: 38807965 PMCID: PMC11131088 DOI: 10.1016/j.jtumed.2024.05.004] [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: 11/27/2023] [Revised: 03/30/2024] [Accepted: 05/03/2024] [Indexed: 05/30/2024] Open
Abstract
With the advancements in dental science and the growing need for improved dental health, it has become imperative to develop new implant materials which possess better geometrical, mechanical, and physical properties. The oral environment is a corrosive environment and the relative motion between the teeth also makes the environment more hostile. Therefore, the combined corrosion and tribology commonly known as tribocorrosion of implants needs to be studied. The complex shapes of the dental implants and the high-performance requirements of these implants make manufacturing difficult by conventional manufacturing processes. With the advent of additive manufacturing or 3D-printing, the development of implants has become easy. However, the various requirements such as surface roughness, mechanical strength, and corrosion resistance further make the manufacturing of implants difficult. The current paper reviews the various studies related to3D-printed implants. Also, the paper tries to highlight the role of 3D-Printing can play in the area of dental implants. Further studies both experimental and numerical are needed to devise optimized conditions for 3D-printing implants to develop implants with improved mechanical, corrosion, and biological properties.
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Affiliation(s)
- Marco De Stefano
- Department of Industrial Engineering, University of Salerno, Fisciano, Italy
| | - Khushneet Singh
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, Katra, Jammu and Kashmir, India
| | - Ankush Raina
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, Katra, Jammu and Kashmir, India
| | - Sanjay Mohan
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, Katra, Jammu and Kashmir, India
| | - Mir Irfan Ul Haq
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, Katra, Jammu and Kashmir, India
| | - Alessandro Ruggiero
- Department of Industrial Engineering, University of Salerno, Fisciano, Italy
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Safaei M, Mohammadi H, Beddu S, Mozaffari HR, Rezaei R, Sharifi R, Moradpoor H, Fallahnia N, Ebadi M, Md Jamil MS, Md Zain AR, Yusop MR. Surface Topography Steer Soft Tissue Response and Antibacterial Function at the Transmucosal Region of Titanium Implant. Int J Nanomedicine 2024; 19:4835-4856. [PMID: 38828200 PMCID: PMC11141758 DOI: 10.2147/ijn.s461549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/10/2024] [Indexed: 06/05/2024] Open
Abstract
Metallic dental implants have been extensively used in clinical practice due to their superior mechanical properties, biocompatibility, and aesthetic outcomes. However, their integration with the surrounding soft tissue at the mucosal region remains challenging and can cause implant failure due to the peri-implant immune microenvironment. The soft tissue integration of dental implants can be ameliorated through different surface modifications. This review discussed and summarized the current knowledge of topography-mediated immune response and topography-mediated antibacterial activity in Ti dental implants which enhance soft tissue integration and their clinical performance. For example, nanopillar-like topographies such as spinules, and spikes showed effective antibacterial activity in human salivary biofilm which was due to the lethal stretching of bacterial membrane between the nanopillars. The key findings of this review were (I) cross-talk between surface nanotopography and soft tissue integration in which the surface nanotopography can guide the perpendicular orientation of collagen fibers into connective tissue which leads to the stability of soft tissue, (II) nanotubular array could shift the macrophage phenotype from pro-inflammatory (M1) to anti-inflammatory (M2) and manipulate the balance of osteogenesis/osteoclasia, and (III) surface nanotopography can provide specific sites for the loading of antibacterial agents and metallic nanoparticles of clinical interest functionalizing the implant surface. Silver-containing nanotubular topography significantly decreased the formation of fibrous encapsulation in per-implant soft tissue and showed synergistic antifungal and antibacterial properties. Although the Ti implants with surface nanotopography have shown promising in targeting soft tissue healing in vitro and in vivo through their immunomodulatory and antibacterial properties, however, long-term in vivo studies need to be conducted particularly in osteoporotic, and diabetic patients to ensure their desired performance with immunomodulatory and antibacterial properties. The optimization of product development is another challenging issue for its clinical translation, as the dental implant with surface nanotopography must endure implantation and operation inside the dental microenvironment. Finally, the sustainable release of metallic nanoparticles could be challenging to reduce cytotoxicity while augmenting the therapeutic effects.
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Affiliation(s)
- Mohsen Safaei
- Division of Dental Biomaterials, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Advanced Dental Sciences and Technology Research Center, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Mohammadi
- Biomaterials Research Group, School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal, Penang, 14300, Malaysia
- Institute of Energy Infrastructure (IEI), Universiti Tenaga Nasional, Jalan IKRAM UNITEN, Kajang, Selangor, 43000, Malaysia
| | - Salmia Beddu
- Institute of Energy Infrastructure (IEI), Universiti Tenaga Nasional, Jalan IKRAM UNITEN, Kajang, Selangor, 43000, Malaysia
| | - Hamid Reza Mozaffari
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Razieh Rezaei
- Advanced Dental Sciences and Technology Research Center, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roohollah Sharifi
- Department of Endodontics, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hedaiat Moradpoor
- Department of Prosthodontics, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nima Fallahnia
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mona Ebadi
- Department of Chemical Sciences, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, 43600, Malaysia
| | - Mohd Suzeren Md Jamil
- Department of Chemical Sciences, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, 43600, Malaysia
| | - Ahmad Rifqi Md Zain
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia (UKM), Bangi, Selangor, 43600, Malaysia
| | - Muhammad Rahimi Yusop
- Department of Chemical Sciences, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, UKM Bangi, Selangor, 43600, Malaysia
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6
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Vierling L, Liu CC, Wiedemeier D, Gubler A, Schmidlin PR. Assessing the Impact of Various Decontamination Instruments on Titanium and Zirconia Dental Implants: An In Vitro Study. Dent J (Basel) 2024; 12:136. [PMID: 38786534 PMCID: PMC11119916 DOI: 10.3390/dj12050136] [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: 03/18/2024] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
This study investigates the impact of various instrumentation techniques on material removal and surface changes in titanium (Ti)- and zirconia (Zr) implant discs. Ti- and Zr discs were subjected to standardized experiments using various instruments including airflow, ultrasound, carbide, and diamond burs. Instrumentation was performed for 60 s with continuous automatic motion. Abrasion and changes in surface roughness were assessed using profilometry, while scanning electron microscopy was used to examine morphological changes and particle size. Carbide burs predominantly caused abrasion on Ti discs, while diamond burs caused more abrasion on Zr discs. The Ti discs were more susceptible to surface changes. However, among the materials tested, machined Zr discs treated with diamond burs produced the largest particle. In certain cases, a statistical significance (p < 0.05) was observed between the groups, while in others, there was no considerable difference among the means (p > 0.05). These results highlighted the statistical significance of our findings. These results found diverse alterations in surface characteristics of Ti- and Zr discs due to different instruments, with carbide and diamond burs causing notable effects. The findings highlight the need for a careful balance between promoting healing and minimizing harm during implantoplasty.
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Affiliation(s)
- Louisa Vierling
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (L.V.); (C.C.L.); (A.G.)
| | - Chun Ching Liu
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (L.V.); (C.C.L.); (A.G.)
| | - Daniel Wiedemeier
- Statistics Group, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland;
| | - Andrea Gubler
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (L.V.); (C.C.L.); (A.G.)
| | - Patrick R. Schmidlin
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (L.V.); (C.C.L.); (A.G.)
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7
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Atchuta A, Reddy A, Bhadauriya S, Beeravolu M, Vasudevan S. Characterization of Titanium Corrosion and Its Association With Peri-Implantitis Using Energy Dispersive X-ray Spectroscopy: A Case Report. Cureus 2024; 16:e60533. [PMID: 38887364 PMCID: PMC11181099 DOI: 10.7759/cureus.60533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
Dental implant corrosion is now being recognized as a contributing factor in the onset and advancement of peri-implantitis, posing significant challenges to both the durability of implants and the well-being of patients. The dissemination of titanium microparticles due to corrosion raises concerns about plausible toxicity and biological effects, especially for patients with long-standing implant prostheses. This case report focuses on the release of titanium particles in the peri-implant mucosa due to corrosion and its association with peri-implantitis. It emphasizes the critical need for strategies to minimize corrosion and alleviate its detrimental effects in order to optimize patient outcomes in the field of implant dentistry. Additionally, there is a call for research into the increasing biochemical effects of these microparticles on oral soft tissues surrounding metallic implants to enhance the longevity and clinical outcomes of implants.
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Affiliation(s)
- Abhinav Atchuta
- Periodontology, Army College of Dental Sciences, Secunderabad, IND
| | - Ajay Reddy
- Periodontology, Army College of Dental Sciences, Secunderabad, IND
| | | | - Mounika Beeravolu
- Periodontology, Kamineni Institute of Dental Sciences, Nalgonda, IND
| | - Sanjay Vasudevan
- Periodontology, Army College of Dental Sciences, Secunderabad, IND
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8
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Zhao X, Zhang X, Zhou Z, Meng F, Liu R, Zhang M, Hao Y, Xie Q, Sun X, Zhang B, Wang X. Atomic layer deposited TiO 2 nanofilm on titanium implant for reduced the release of particles. Front Bioeng Biotechnol 2024; 12:1346404. [PMID: 38737539 PMCID: PMC11082355 DOI: 10.3389/fbioe.2024.1346404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Objective: Titanium implants are widely used in surgeries for their biocompatibility and mechanical properties. However, excessive titanium particle release can cause implant failure. This study explores Atomic Layer Deposition (ALD) to coat commercially pure titanium (Cp-Ti) with TiO2, aiming to improve its frictional and corrosion resistance while reducing particle release. By comparing TiO2 films with varying ALD cycle numbers, we assess surface properties, particle release, friction, and corrosion performance, providing insights into mitigating particle release from implants. Methods: Cp-Ti surfaces were prepared and coated with TiO2 films of 100, 300, and 500 ALD cycles. Surface characterization involved SEM, EDX, and XRD. Friction was tested using SEM, nanoindentation, and ICP-MS. Corrosion resistance was evaluated through immersion tests and electrochemical analysis. Cytotoxicity was assessed using BMSCs. Results: Surface characterization revealed smoother surfaces with increased ALD cycles, confirming successful TiO2 deposition. Friction testing showed reduced friction coefficients with higher ALD cycles, supported by nanoindentation results. Corrosion resistance improved with increasing ALD cycles, as evidenced by electrochemical tests and reduced titanium release. Cytotoxicity studies showed no significant cytotoxic effects. Conclusion: ALD-coated TiO2 films significantly enhance frictional and corrosion resistance of titanium implants while reducing particle release. The study underscores the importance of ALD cycle numbers in optimizing film performance, offering insights for designing implants with improved properties.
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Affiliation(s)
- Xiangyu Zhao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Xiaoxuan Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Zilan Zhou
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Fanchun Meng
- State Key Laboratory of Coal Conversion, Institute of Coal Chemistry, Chinese Academy of Sciences, Taiyuan, China
| | - Ruilin Liu
- State Key Laboratory of Coal Conversion, Institute of Coal Chemistry, Chinese Academy of Sciences, Taiyuan, China
| | - Mengyuan Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Yujia Hao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Qingpeng Xie
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Xiaojun Sun
- Department of Stomatology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Bin Zhang
- State Key Laboratory of Coal Conversion, Institute of Coal Chemistry, Chinese Academy of Sciences, Taiyuan, China
| | - Xing Wang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
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9
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Liang W, Zhou C, Bai J, Zhang H, Long H, Jiang B, Dai H, Wang J, Zhang H, Zhao J. Current developments and future perspectives of nanotechnology in orthopedic implants: an updated review. Front Bioeng Biotechnol 2024; 12:1342340. [PMID: 38567086 PMCID: PMC10986186 DOI: 10.3389/fbioe.2024.1342340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Orthopedic implants are the most commonly used fracture fixation devices for facilitating the growth and development of incipient bone and treating bone diseases and defects. However, most orthopedic implants suffer from various drawbacks and complications, including bacterial adhesion, poor cell proliferation, and limited resistance to corrosion. One of the major drawbacks of currently available orthopedic implants is their inadequate osseointegration at the tissue-implant interface. This leads to loosening as a result of immunological rejection, wear debris formation, low mechanical fixation, and implant-related infections. Nanotechnology holds the promise to offer a wide range of innovative technologies for use in translational orthopedic research. Nanomaterials have great potential for use in orthopedic applications due to their exceptional tribological qualities, high resistance to wear and tear, ability to maintain drug release, capacity for osseointegration, and capability to regenerate tissue. Furthermore, nanostructured materials possess the ability to mimic the features and hierarchical structure of native bones. They facilitate cell proliferation, decrease the rate of infection, and prevent biofilm formation, among other diverse functions. The emergence of nanostructured polymers, metals, ceramics, and carbon materials has enabled novel approaches in orthopaedic research. This review provides a concise overview of nanotechnology-based biomaterials utilized in orthopedics, encompassing metallic and nonmetallic nanomaterials. A further overview is provided regarding the biomedical applications of nanotechnology-based biomaterials, including their application in orthopedics for drug delivery systems and bone tissue engineering to facilitate scaffold preparation, surface modification of implantable materials to improve their osteointegration properties, and treatment of musculoskeletal infections. Hence, this review article offers a contemporary overview of the current applications of nanotechnology in orthopedic implants and bone tissue engineering, as well as its prospective future applications.
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Affiliation(s)
- Wenqing Liang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Chao Zhou
- Department of Orthopedics, Zhoushan Guanghua Hospital, Zhoushan, China
| | - Juqin Bai
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Hongwei Zhang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Hengguo Long
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Bo Jiang
- Rehabilitation Department, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Haidong Dai
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Jiangwei Wang
- Medical Research Center, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Hengjian Zhang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Jiayi Zhao
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
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10
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Lin X, Yang Y, Huang Y, Li E, Zhuang X, Zhang Z, Xu R, Yu X, Deng F. Mettl3‑mediated m 6A RNA methylation regulates osteolysis induced by titanium particles. Mol Med Rep 2024; 29:36. [PMID: 38214327 PMCID: PMC10823336 DOI: 10.3892/mmr.2024.13160] [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] [Received: 08/11/2023] [Accepted: 11/24/2023] [Indexed: 01/13/2024] Open
Abstract
Peri‑prosthetic osteolysis (PPO) induced by wear particles is considered the primary cause of titanium prosthesis failure and revision surgery. The specific molecular mechanisms involve titanium particles inducing multiple intracellular pathways, which impact disease prevention and the targeted therapy of PPO. Notably, N6‑methyladenosine (m6A) serves critical roles in epigenetic regulation, particularly in bone metabolism and inflammatory responses. Thus, the present study aimed to determine the role of RNA methylation in titanium particle‑induced osteolysis. Results of reverse transcription‑quantitative PCR (RT‑qPCR), western blotting, ELISA and RNA dot blot assays revealed that titanium particles induced osteogenic inhibition and proinflammatory responses, accompanied by the reduced expression of methyltransferase‑like (Mettl) 3, a key component of m6A methyltransferase. Specific lentiviruses vectors were employed for Mettl3 knockdown and overexpression experiments. RT‑qPCR, western blotting and ELISA revealed that the knockdown of Mettl3 induced osteogenic inhibition and proinflammatory responses comparable with that induced by titanium particle, while Mettl3 overexpression attenuated titanium particle‑induced cellular reactions. Methylated RNA immunoprecipitation‑qPCR results revealed that titanium particles mediated the methylation of two inhibitory molecules, namely Smad7 and SMAD specific E3 ubiquitin protein ligase 1, via Mettl3 in bone morphogenetic protein signaling, leading to osteogenic inhibition. Furthermore, titanium particles induced activation of the nucleotide binding oligomerization domain 1 signaling pathway through methylation regulation, and the subsequent activation of the MAPK and NF‑κB pathways. Collectively, the results of the present study indicated that titanium particles utilized Mettl3 as an upstream regulatory molecule to induce osteogenic inhibition and inflammatory responses. Thus, the present study may provide novel insights into potential therapeutic targets for aseptic loosening in titanium prostheses.
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Affiliation(s)
- Xiaoxuan Lin
- Department of Oral Implantology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, P.R. China
| | - Yang Yang
- Department of Oral Implantology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, P.R. China
| | - Yaohong Huang
- Department of Oral Implantology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, P.R. China
| | - E Li
- Department of Stomatology, Zhuhai Center for Maternal and Child Healthcare, Zhuhai Women and Children's Hospital, Zhuhai, Guangdong 519000, P.R. China
| | - Xiumei Zhuang
- Department of Stomatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510000, P.R. China
| | - Zhengchuan Zhang
- Department of Oral Implantology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, P.R. China
| | - Ruogu Xu
- Department of Oral Implantology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, P.R. China
| | - Xiaolin Yu
- Department of Oral Implantology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, P.R. China
| | - Feilong Deng
- Department of Oral Implantology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, P.R. China
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11
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Huang C, Chiang SYV, Gawkrodger DJ. The contribution of metal allergy to the failure of metal alloy implants, with special reference to titanium: Current knowledge and controversies. Contact Dermatitis 2024; 90:201-210. [PMID: 38148670 DOI: 10.1111/cod.14481] [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] [Received: 09/25/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Abstract
After almost three-quarters of a century during which contact dermatologists have often struggled to comprehend the relationship between metal allergy and failure of metal-alloy containing implant, it is possible to say that a relationship does exist, particularly for cobalt and chromium, but also for nickel. There is still debate as to whether allergy develops as a consequent of failure but thenceforth contributes to it, or whether sensitisation starts first and induces failure secondarily-opinion probably favours the first. Metal-on-polypropylene articulations were associated with few metal allergic problems but now are less favoured by orthopaedists due to plastic wear products causing osteolysis and pseudotumour formation through local inflammation. New metal alloys are regularly being introduced such that interested dermatologists need to stay on top of the situation. The jury is still out as to whether the recent favouring of titanium-containing alloys will confirm them to be more inert allergenically. Case reports do show some clinical reactions to titanium-containing implants and patch test series have inferred sometimes quite a high background rate of allergy, but interpretation must be tempered by the awareness that titanium salts on patch testing have a tendency to cause irritant reactions. Blood monitoring of metal ion values is now recommended in certain situations after joint replacement and increasing levels may be an indication that allergy with joint failure can develop, in which case patch testing is indicated, and suggested series are available. Predictive patch testing, whilst generally not recommended in the past, has been introduced into some protocols often by non-dermatologists, such that it is now needed for temporo-mandibular joint and Nuss bar insertion, and it can be anticipated that this may become more commonplace in the future. One of the major current deficits for patch testers is standardised guidance on which preparation or preparations to use for suspected titanium allergy. One suggestion is 0.5% titanium sulphate in petrolatum, though experience in at least one centre suggests the use of a battery of titanium salts might be desirable.
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Affiliation(s)
- Chenghao Huang
- Calderdale Royal Hospital, Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK
| | - Shu Yu Vanessa Chiang
- Calderdale Royal Hospital, Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK
| | - David J Gawkrodger
- Department of Dermatology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
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12
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Ng E, Tay JRH, Mattheos N, Bostanci N, Belibasakis GN, Seneviratne CJ. A Mapping Review of the Pathogenesis of Peri-Implantitis: The Biofilm-Mediated Inflammation and Bone Dysregulation (BIND) Hypothesis. Cells 2024; 13:315. [PMID: 38391928 PMCID: PMC10886485 DOI: 10.3390/cells13040315] [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] [Received: 12/07/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
This mapping review highlights the need for a new paradigm in the understanding of peri-implantitis pathogenesis. The biofilm-mediated inflammation and bone dysregulation (BIND) hypothesis is proposed, focusing on the relationship between biofilm, inflammation, and bone biology. The close interactions between immune and bone cells are discussed, with multiple stable states likely existing between clinically observable definitions of peri-implant health and peri-implantitis. The framework presented aims to explain the transition from health to disease as a staged and incremental process, where multiple factors contribute to distinct steps towards a tipping point where disease is manifested clinically. These steps might be reached in different ways in different patients and may constitute highly individualised paths. Notably, factors affecting the underlying biology are identified in the pathogenesis of peri-implantitis, highlighting that disruptions to the host-microbe homeostasis at the implant-mucosa interface may not be the sole factor. An improved understanding of disease pathogenesis will allow for intervention on multiple levels and a personalised treatment approach. Further research areas are identified, such as the use of novel biomarkers to detect changes in macrophage polarisation and activation status, and bone turnover.
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Affiliation(s)
- Ethan Ng
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore;
| | - John Rong Hao Tay
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore;
| | - Nikos Mattheos
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok 10330, Thailand;
- Division of Oral Health and Periodontology, Department of Dental Medicine, Karolinska Institute, 14152 Stockholm, Sweden; (N.B.); (G.N.B.)
| | - Nagihan Bostanci
- Division of Oral Health and Periodontology, Department of Dental Medicine, Karolinska Institute, 14152 Stockholm, Sweden; (N.B.); (G.N.B.)
| | - Georgios N. Belibasakis
- Division of Oral Health and Periodontology, Department of Dental Medicine, Karolinska Institute, 14152 Stockholm, Sweden; (N.B.); (G.N.B.)
| | - Chaminda Jayampath Seneviratne
- School of Dentistry, The University of Queensland, Brisbane, QLD 4006, Australia
- School of Dentistry, Center for Oral-Facial Regeneration, Rehabilitation and Reconstruction (COR3), The University of Queensland, Brisbane, QLD 4072, Australia
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore 168938, Singapore
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13
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Berglundh T, Mombelli A, Schwarz F, Derks J. Etiology, pathogenesis and treatment of peri-implantitis: A European perspective. Periodontol 2000 2024. [PMID: 38305506 DOI: 10.1111/prd.12549] [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: 10/03/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024]
Abstract
Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants. It is characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Over the last 30 years, peri-implantitis has become a major disease burden in dentistry. An understanding of the diagnosis, etiology and pathogenesis, epidemiology, and treatment of peri-implantitis must be a central component in undergraduate and postgraduate training programs in dentistry. In view of the strong role of European research in periodontology and implant dentistry, the focus of this review was to address peri-implantitis from a European perspective. One component of the work was to summarize new and reliable data on patients with dental implants to underpin the relevance of peri-implantitis from a population perspective. The nature of the peri-implantitis lesion was evaluated through results presented in preclinical models and evaluations of human biopsy material together with an appraisal of the microbiological characteristics. An overview of strategies and outcomes presented in clinical studies on nonsurgical and surgical treatment of peri-implantitis is discussed with a particular focus on end points of therapy and recommendations presented in the S3 level Clinical Practice Guideline for the prevention and treatment of peri-implant diseases.
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Affiliation(s)
- Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrea Mombelli
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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14
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Insua A, Galindo-Moreno P, Miron RJ, Wang HL, Monje A. Emerging factors affecting peri-implant bone metabolism. Periodontol 2000 2024; 94:27-78. [PMID: 37904311 DOI: 10.1111/prd.12532] [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] [Received: 05/03/2023] [Revised: 08/05/2023] [Accepted: 09/10/2023] [Indexed: 11/01/2023]
Abstract
Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis.
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Affiliation(s)
- Angel Insua
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Pablo Galindo-Moreno
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Oral Surgery and Implant Dentistry, University of Granada, Granada, Spain
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, University of Bern, Bern, Switzerland
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
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15
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Baima G, Romano F, Roato I, Mosca Balma A, Pedraza R, Faga MG, Amoroso F, Orrico C, Genova T, Aimetti M, Mussano F. Efficacy of a Solution Containing 33% Trichloroacetic Acid and Hydrogen Peroxide in Decontaminating Machined vs. Sand-Blasted Acid-Etched Titanium Surfaces. J Funct Biomater 2024; 15:21. [PMID: 38248688 PMCID: PMC10816840 DOI: 10.3390/jfb15010021] [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: 11/07/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
This in vitro study assessed the efficacy of a solution containing 33% trichloroacetic acid (CCl3COOH; TCA) and hydrogen peroxide (H2O2) in decontaminating machined (MAC) and sand-blasted acid-etched (SBAE) titanium surfaces. A total of 80 titanium disks were prepared (40 MAC and 40 SBAE). Streptococcus sanguinis and Enterococcus faecalis strains were incubated on 36 samples, while the remaining 44 were kept as controls. Roughness analysis and scanning electron microscopy were used to evaluate the surface features before and after TCAH2O2 treatment. The viability of human adipose-derived mesenchymal stem cells (ASCs) after TCAH2O2 decontamination was assessed with a chemiluminescent assay along with cell morphology through fluorescent staining. TCAH2O2 preserved the surface topography of MAC and SBAE specimens. It also effectively eradicated bacteria on both types of specimens without altering the surface roughness (p > 0.05). Also, no significant differences in protein adsorption between the pristine and TCAH2O2-treated surfaces were found (p = 0.71 and p = 0.94). While ASC proliferation remained unchanged on MAC surfaces, a decrease was observed on the decontaminated SBAE specimens at 24 and 48 h (p < 0.05), with no difference at 72 h (p > 0.05). Cell morphology showed no significant changes after 72 h on both surface types even after decontamination. This study suggests TCAH2O2 as a promising decontamination agent for titanium surfaces, with potential implications for peri-implant health and treatment outcomes.
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Affiliation(s)
- Giacomo Baima
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
- DIMEAS, Politecnico di Torino, 10129 Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
| | - Ilaria Roato
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
| | - Alessandro Mosca Balma
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
| | - Riccardo Pedraza
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
- DIMEAS, Politecnico di Torino, 10129 Turin, Italy
- Institute of Sciences and Technologies for Sustainable Energy and Mobility, National Council of Research, 10135 Turin, Italy;
| | - Maria Giulia Faga
- Institute of Sciences and Technologies for Sustainable Energy and Mobility, National Council of Research, 10135 Turin, Italy;
| | - Federico Amoroso
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
- DIMEAS, Politecnico di Torino, 10129 Turin, Italy
| | - Clarissa Orrico
- Fondazione Ricerca Molinette—Onlus, A.O.U. Città della Salute e della Scienza, 10126 Turin, Italy;
| | | | - Mario Aimetti
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
| | - Federico Mussano
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (F.R.); (I.R.); (A.M.B.); (R.P.); (F.A.); (M.A.); (F.M.)
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16
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Altay B, Çoban E. Dental Implant Corrosion Products May Accumulate in the Human Body. J Oral Maxillofac Surg 2024; 82:56-64. [PMID: 37898154 DOI: 10.1016/j.joms.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Corrosion products resulting from the degradation of the dental implant surface due to biological fluids and infection may accumulate in the body and lead to clinical consequences. PURPOSE The primary aim of this study is to measure the accumulation of dental implant corrosion products in the human body and the secondary aim is to estimate the association between corrosion products and fatigue. STUDY DESIGN, SETTING, SAMPLE This study was designed as a prospective cross-sectional and was conducted with patients presenting at to the Department of Oral and Maxillofacial Surgery. The study included patients with Grade IV dental implants made of pure titanium (Ti) at the bone level and Grade V abutments composed of Ti, aluminum (Al), and vanadium (V). Individuals possessing different metallic implants and those prone to metal exposure were not included in the study. Blood and hair samples were procured from each participant and subsequently analyzed. PREDICTOR VARIABLES The predictor variable is implant exposure, and it was divided into 3 groups; Group I, patients with healthy dental implants; Group II, patients with peri-implantitis; Control Group, individuals without dental implants. MAIN OUTCOME VARIABLES The primary outcome variables are Al, Ti, V levels in blood and hair samples and the secondary outcome variable is the fatigue questionnaire score. COVARIATES Age and gender, along with the dental implant number and duration of exposure within the study groups, are utilized as covariates. ANALYSES Groups were compared using the Kruskal-Wallis and Mann-Whitney U-tests. Spearman's correlation coefficient determined relationships between groups, signifying significance with P values <.05. RESULTS The sample consisted of 30 patients aged 18 to 68, with 53% being female and 47% male. The differences among the 3 groups in the median values of blood Ti, V; hair Al, Ti, V; and fatigue questionnaire scores were not statistically significant (P > .05). However, the median blood Al value was statistically higher in Group II (P < .05). CONCLUSIONS AND RELEVANCE While the presence of healthy dental implants may not affect the accumulation of Al, Ti, and V within the body, patients with peri-implantitis exhibited elevated blood Al levels, possibly due to infection influencing the corrosion process.
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Affiliation(s)
- Berkan Altay
- Assistant Professor, Department Head, Department of Oral and Maxillofacial Surgery, Kırıkkale University, Kırıkkale, Turkey.
| | - Elif Çoban
- Resarch Assistant, Department of Oral and Maxillofacial Surgery, Kütahya Health Sciences University, Kütahya, Turkey
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17
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Chen L, Tong Z, Luo H, Qu Y, Gu X, Si M. Titanium particles in peri-implantitis: distribution, pathogenesis and prospects. Int J Oral Sci 2023; 15:49. [PMID: 37996420 PMCID: PMC10667540 DOI: 10.1038/s41368-023-00256-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
Peri-implantitis is one of the most important biological complications in the field of oral implantology. Identifying the causative factors of peri-implant inflammation and osteolysis is crucial for the disease's prevention and treatment. The underlying risk factors and detailed pathogenesis of peri-implantitis remain to be elucidated. Titanium-based implants as the most widely used implant inevitably release titanium particles into the surrounding tissue. Notably, the concentration of titanium particles increases significantly at peri-implantitis sites, suggesting titanium particles as a potential risk factor for the condition. Previous studies have indicated that titanium particles can induce peripheral osteolysis and foster the development of aseptic osteoarthritis in orthopedic joint replacement. However, it remains unconfirmed whether this phenomenon also triggers inflammation and bone resorption in peri-implant tissues. This review summarizes the distribution of titanium particles around the implant, the potential roles in peri-implantitis and the prevalent prevention strategies, which expects to provide new directions for the study of the pathogenesis and treatment of peri-implantitis.
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Affiliation(s)
- Long Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
- Department of Stomatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zian Tong
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Hongke Luo
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Yuan Qu
- Zhejiang University-University of Edinburgh Institute, International Campus, Zhejiang University, Haining, China
| | - Xinhua Gu
- Department of Stomatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Misi Si
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
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18
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Kowalski J, Rylska D, Januszewicz B, Konieczny B, Cichomski M, Matinlinna JP, Radwanski M, Sokolowski J, Lukomska-Szymanska M. Corrosion Resistance of Titanium Dental Implant Abutments: Comparative Analysis and Surface Characterization. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6624. [PMID: 37895605 PMCID: PMC10608008 DOI: 10.3390/ma16206624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Metals subjected to the oral environment are prone to corrosion over time and this can be harmful. Metallic restoration components such as dental subgingival implant abutments are exposed to pH changes and different ions while in contact with saliva. The aim of the study was to evaluate the corrosion resistance of titanium dental implant abutments and to compare and contrast the surface characteristics of these alloys before and after corrosion. The corrosion examination (Ecorr, jcorr, OCP, polarization curve) of two implant abutments (TiDesign EV, Astra Tech, Dentsply, York, PA, USA; Individual Titanium Abutment, Apollo Implants Components, Pabianice, Poland) was performed in 0.9% NaCl and 5% HCl. Moreover, specimens were investigated using SEM-EDS before and after the corrosion test. The value of jcorr in NaCl was higher for Astra (34.2 × 10-8 ± 2.5 × 10-8 A/cm2) than for Apollo (8.8 × 10-8 ± 2.5 × 10-8 A/cm2). Whereas, in HCl, the opposite relationship was observed (Astra 2.9 × 10-4 ± 0.8 × 10-4 A/cm2 and Apollo 62.7 × 10-4 ± 9.3 × 10-4 A/cm2). An average reactive anodic current density in NaCl for Astra amounted up to ~0.2 × 10-5-1.5 × 10-5 A/cm2, while for Apollo-up to ~3.3-9.7 × 10-7 A/cm2. The composition of both alloys after corrosion in NaCl demonstrated some changes: a decrease in the Ti, and Al and an increase in oxygen content. Hence, both alloys after corrosion in HCl demonstrated some minor changes in the elemental composition. Based on the results it can be concluded that: 1. Astra and Apollo abutments revealed good corrosion resistance and a passivation layer on the surface. 2. Apollo abutments exhibited better corrosion resistance in a neutral environment, suggesting that Astra abutments were found to be more resistant to corrosion in an acidic medium.
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Affiliation(s)
- Jakub Kowalski
- Department of General Dentistry, Medical University of Lodz, 92-213 Lodz, Poland
| | - Dorota Rylska
- Institute of Materials Science and Engineering, Lodz University of Technology, 1/15 Stefanowskiego St., 90-924 Lodz, Poland; (D.R.); (B.J.)
| | - Bartłomiej Januszewicz
- Institute of Materials Science and Engineering, Lodz University of Technology, 1/15 Stefanowskiego St., 90-924 Lodz, Poland; (D.R.); (B.J.)
| | - Bartlomiej Konieczny
- University Laboratory of Materials Research, Medical University of Lodz, 251 Pomorska St., 92-213 Lodz, Poland;
| | - Michal Cichomski
- Department of Material Technology and Chemistry, Faculty of Chemistry, University of Lodz, 163 Pomorska St., 90-236 Lodz, Poland;
| | - Jukka P. Matinlinna
- Biomaterials Science, Division of Dentistry, The University of Manchester, Manchester M13 9PL, UK;
| | - Mateusz Radwanski
- Department of Endodontics, Medical University of Lodz, 92-213 Lodz, Poland;
| | - Jerzy Sokolowski
- Department of General Dentistry, Medical University of Lodz, 92-213 Lodz, Poland
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19
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Rossi N, Hadad H, Bejar-Chapa M, Peretti GM, Randolph MA, Redmond RW, Guastaldi FPS. Bone Marrow Stem Cells with Tissue-Engineered Scaffolds for Large Bone Segmental Defects: A Systematic Review. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:457-472. [PMID: 36905366 DOI: 10.1089/ten.teb.2022.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Critical-sized bone defects (CSBDs) represent a significant clinical challenge, stimulating researchers to seek new methods for successful bone reconstruction. The aim of this systematic review is to assess whether bone marrow stem cells (BMSCs) combined with tissue-engineered scaffolds have demonstrated improved bone regeneration in the treatment of CSBD in large preclinical animal models. A search of electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) focused on in vivo large animal studies identified 10 articles according to the following inclusion criteria: (1) in vivo large animal models with segmental bone defects; (2) treatment with tissue-engineered scaffolds combined with BMSCs; (3) the presence of a control group; and (4) a minimum of a histological analysis outcome. Animal research: reporting of in Vivo Experiments guidelines were used for quality assessment, and Systematic Review Center for Laboratory animal Experimentation's risk of bias tool was used to define internal validity. The results demonstrated that tissue-engineered scaffolds, either from autografts or allografts, when combined with BMSCs provide improved bone mineralization and bone formation, including a critical role in the remodeling phase of bone healing. BMSC-seeded scaffolds showed improved biomechanical properties and microarchitecture properties of the regenerated bone when compared with untreated and scaffold-alone groups. This review highlights the efficacy of tissue engineering strategies for the repair of extensive bone defects in preclinical large-animal models. In particular, the use of mesenchymal stem cells, combined with bioscaffolds, seems to be a successful method in comparison to cell-free scaffolds.
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Affiliation(s)
- Nicolò Rossi
- Wellman Center for Photomedicine and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Henrique Hadad
- Skeletal Biology Research Center, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Maria Bejar-Chapa
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Giuseppe M Peretti
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Mark A Randolph
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Redmond
- Wellman Center for Photomedicine and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fernando P S Guastaldi
- Skeletal Biology Research Center, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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20
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Daubert D, Lee E, Botto A, Eftekhar M, Palaiologou A, Kotsakis GA. Assessment of titanium release following non-surgical peri-implantitis treatment: A randomized clinical trial. J Periodontol 2023; 94:1122-1132. [PMID: 37070363 PMCID: PMC10524263 DOI: 10.1002/jper.22-0716] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Peri-implantitis is a frequent finding. Initial treatment involves non-surgical debridement of the implant surface. Recent studies have found a correlation between titanium (Ti) particle release and peri-implantitis, yet there is a dearth of information regarding the effect of various non-surgical instrumentation on particle release or peri-implantitis resolution. METHODS Patients with peri-implantitis were recruited for a randomized, blinded, parallel-group clinical trial. The implants were randomized to treatment composed of Ti curettes ("Mech" group) or implant-specific treatment composed of rotary polymer microbrushes ("Imp" group). Ti release in submucosal peri-implant plaque pre- and 8 weeks posttreatment was assessed as the primary outcome. Peri-implant probing depth, bleeding on probing, and suppuration on probing were evaluated and compared between groups. RESULTS Thirty-four participants completed treatment; 18 were randomized to the Mech group and 16 to the Imp group. The groups were comparable for Ti levels and probing depths at baseline. A trend was noted for 10-fold greater Ti dissolution in the Mech group posttreatment compared to the Imp group (p = 0.069). The Imp group had a significant reduction in probing depth posttreatment (p = 0.006), while the Mech group reduction was not significant. CONCLUSION Peri-implantitis treated non-surgically with implant-specific instruments (Imp group) had a significantly greater decrease in probing depth versus the Mech treatment group. This improvement was linked with a trend for less Ti release to the peri-implant plaque by the non-abrasive treatment.
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Affiliation(s)
- Diane Daubert
- Department of Periodontics, University of Washington, Seattle, Washington, USA
| | - Eddie Lee
- Department of Periodontics, University of Washington, Seattle, Washington, USA
| | - Antonella Botto
- Department of Periodontics, UT Health San Antonio, San Antonio, Texas, USA
| | - Mojdeh Eftekhar
- Department of Periodontics, University of Washington, Seattle, Washington, USA
| | | | - Georgios A Kotsakis
- Department of Periodontics, UT Health San Antonio, San Antonio, Texas, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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21
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Roehling S, Gahlert M, Bacevic M, Woelfler H, Laleman I. Clinical and radiographic outcomes of zirconia dental implants-A systematic review and meta-analysis. Clin Oral Implants Res 2023; 34 Suppl 26:112-124. [PMID: 37750521 DOI: 10.1111/clr.14133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES For the present review, the following focused question was addressed: In patients with root-analog dental implants, what is the effect of implants made of other materials than titanium (alloy) on implant survival, marginal bone loss (MBL), and technical and biological complications after at least 5 years. MATERIALS AND METHODS An electronic (Medline, Embase, Web of Science) search was performed to identify observational clinical studies published from January 2000 investigating a minimum of 20 commercially available zirconia implants with a mean follow-up of at least 60 months. Primary outcome was implant survival, secondary outcomes included peri-implant MBL, probing depths (PDs), and technical and biological complications. Meta-analyses were performed to evaluate implant survival, MBL, and PD. RESULTS From 5129 titles, 580 abstracts were selected, and 111 full-text articles were screened. Finally, 4 prospective and 2 retrospective observational clinical cohort studies were included for data extraction. Meta-analyses estimated after 5 years of loading mean values of 97.2% (95% CI 94.7-99.1) for survival (277 implants, 221 patients), 1.1 mm (95% CI: 0.9-1.3) for MBL (229 implants, 173 patients), and 3.0 mm (95% CI 2.5-3.4) for PDs (231 implants, 175 patients). CONCLUSIONS After 5 years, commercially available zirconia implants showed reliable clinical performance based on survival rates, MBL, and PD values. However, more well-designed prospective clinical studies and randomized clinical trials investigating titanium and zirconia implants are needed to confirm the presently evaluated promising outcomes.
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Affiliation(s)
- S Roehling
- Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Clinic for Oral and Cranio-Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
- Private Dental Clinic PD Dr. Gahlert & PD Dr. Roehling, Munich, Germany
| | - M Gahlert
- Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Private Dental Clinic PD Dr. Gahlert & PD Dr. Roehling, Munich, Germany
- Sigmund Freud Private University, Vienna, Austria
| | - M Bacevic
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
- Centre for Oral Clinical Research, Institute of Dentistry, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | | | - I Laleman
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
- Dental Biomaterials Research Unit (d-BRU), Faculty of Medicine, University of Liège, Liège, Belgium
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22
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Dong S, Zhao T, Wu W, Zhang Z, Wu J, Cai K, Li G, Lv J, Zhou H, Tang C. Sandblasted/Acid-Etched Titanium Surface Modified with Calcium Phytate Enhances Bone Regeneration in a High-Glucose Microenvironment by Regulating Reactive Oxygen Species and Cell Senescence. ACS Biomater Sci Eng 2023; 9:4720-4734. [PMID: 37491189 DOI: 10.1021/acsbiomaterials.3c00385] [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: 07/27/2023]
Abstract
Hyperglycemia in patients with diabetes affect osteoblast function, leading to abnormal bone metabolism and implant failure. Adequate bone volume surrounding an implant is essential for osseointegration, which can be improved by implant surface modifications. In this study, titanium surfaces were hydrothermally treated with a mixture of phytic acid (PA) and calcium hydroxide to produce a calcium-decorated surface. The control group comprised pure titanium with a sandblasted/acid-etched (SLA) surface. The elemental composition, hydrophilicity, surface roughness, and morphology of the titanium surfaces were examined. Evaluation of in vitro osteogenic differentiation ability in a high-glucose environment using alkaline phosphatase (ALP) staining, ALP activity assays, Alizarin Red S staining, quantitative reverse transcription-polymerase chain reaction (qRT-PCR), and immunofluorescence staining revealed that Ca-PA-modified SLA titanium surfaces can promote osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs). Evaluation of oxidative stress and aging using reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD), and β-galactosidase staining revealed that Ca-PA-modified SLA titanium surfaces can reduce ROS production and ameliorate oxidative stress damage in hBMSCs. In vivo assessment of osteogenesis in a diabetic rat model revealed that Ca-PA coating promotes peri-implant osseointegration. Ca-PA-modified SLA titanium surface is a candidate for improving implant osseointegration in patients with diabetes.
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Affiliation(s)
- Shuo Dong
- Department of Dental Implantology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210000, China
| | - Tong Zhao
- Department of Dental Implantology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210000, China
| | - Wei Wu
- Department of Dental Implantology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210000, China
| | - Zhewei Zhang
- Department of Dental Implantology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210000, China
| | - Jin Wu
- Department of Dental Implantology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210000, China
| | - Kunzhan Cai
- Department of Dental Implantology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210000, China
| | - Guoqing Li
- Department of Dental Implantology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210000, China
| | - Jiaxin Lv
- Department of Dental Implantology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210000, China
| | - Heyang Zhou
- Department of Dental Implantology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210000, China
| | - Chunbo Tang
- Department of Dental Implantology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210000, China
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23
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Cionca N, Meyer J, Michalet S, Varesio E, Hashim D. Quantification of titanium and zirconium elements in oral mucosa around healthy dental implants: a case-control pilot study. Clin Oral Investig 2023; 27:4715-4726. [PMID: 37270723 PMCID: PMC10415439 DOI: 10.1007/s00784-023-05099-8] [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: 05/18/2022] [Accepted: 05/29/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Metallic particles are detected in different sites of the oral cavity, mainly in patients with peri-implantitis lesions. The aim of this pilot study was to analyze the levels of titanium and zirconium elements in the oral mucosa around healthy implants and to investigate the impact of titanium exogenous contamination on the measurements. MATERIALS AND METHODS Forty-one participants were included in this three-phase study. Two groups of subjects were defined according to presence of titanium or zirconia implants (n: 20) or without any implants nor metallic restorations (n:21). Thirteen patients (n: 5 with zirconia implant; n: 3 with titanium implants; n: 5 control group) took part to the first part designed to optimize and validate the method of detecting titanium (Ti) and zirconium (Zr) elements in the oral mucosa and gingival tissues by the Inductively Coupled Plasma Mass Spectrometry (ICPMS). The second phase compared the levels of Ti and Zr concentrations in patients with implants (n: 12) and without implants (n: 6) who were controlled for their intake of titanium dioxide (TiO2). The last step included ten control subjects without any metallic devices to measure the concentration of Ti and Zr before and after having candies containing TiO2. RESULTS In the first phase, concentrations of Ti and Zr were below the limit of detection (LOD) in most cases, 0.18 μg/L and 0.07 μg/L respectively. In the titanium group, two out of three subjects displayed concentrations above the LOD, 0.21 μg/L and 0.66 μg/L. Zr element was only found in patients with zirconia implants. After controlling the intake of TiO2, all concentrations of Ti and Zr were below the limit of quantification (LOQ). Moreover, in patients with no implants, the Ti concentration in gingiva cells was superior for 75% of the samples after having a TiO2 diet. CONCLUSIONS Zirconium was only found in patients with zirconia implants, whereas titanium was detected in all groups even in subjects with no titanium implants. Zirconium and titanium elements were not detected in patients who were controlled for their intake of food and their use of toothpaste irrespective of the presence of implants or not. For 70% of the patients, the titanium detection was directly influenced by the intake of TiO2 contained candies. CLINICAL RELEVANCE When analyzing titanium particles, it is necessary to pay attention to the risk of contamination bias brought by external products. When this parameter was controlled, no titanium particles were detected around clinically healthy implants.
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Affiliation(s)
- Norbert Cionca
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Julien Meyer
- Mass Spectrometry Core Facility (MZ 2.0), Faculty of Sciences, University of Geneva, Geneva, Switzerland
| | - Sophie Michalet
- Mass Spectrometry Core Facility (MZ 2.0), Faculty of Sciences, University of Geneva, Geneva, Switzerland
| | - Emmanuel Varesio
- Mass Spectrometry Core Facility (MZ 2.0), Faculty of Sciences, University of Geneva, Geneva, Switzerland
| | - Dena Hashim
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Kheder W, Bouzid A, Venkatachalam T, Talaat IM, Elemam NM, Raju TK, Sheela S, Jayakumar MN, Maghazachi AA, Samsudin AR, Hamoudi R. Titanium Particles Modulate Lymphocyte and Macrophage Polarization in Peri-Implant Gingival Tissues. Int J Mol Sci 2023; 24:11644. [PMID: 37511404 PMCID: PMC10381089 DOI: 10.3390/ijms241411644] [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: 06/18/2023] [Revised: 07/06/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
Titanium dental implants are one of the modalities to replace missing teeth. The release of titanium particles from the implant's surface may modulate the immune cells, resulting in implant failure. However, little is known about the immune microenvironment that plays a role in peri-implant inflammation as a consequence of titanium particles. In this study, the peri-implant gingival tissues were collected from patients with failed implants, successful implants and no implants, and then a whole transcriptome analysis was performed. The gene set enrichment analysis confirmed that macrophage M1/M2 polarization and lymphocyte proliferation were differentially expressed between the study groups. The functional clustering and pathway analysis of the differentially expressed genes between the failed implants and successful implants versus no implants revealed that the immune response pathways were the most common in both comparisons, implying the critical role of infiltrating immune cells in the peri-implant tissues. The H&E and IHC staining confirmed the presence of titanium particles and immune cells in the tissue samples, with an increase in the infiltration of lymphocytes and macrophages in the failed implant samples. The in vitro validation showed a significant increase in the level of IL-1β, IL-8 and IL-18 expression by macrophages. Our findings showed evidence that titanium particles modulate lymphocyte and macrophage polarization in peri-implant gingival tissues, which can help in the understanding of the imbalance in osteoblast-osteoclast activity and failure of dental implant osseointegration.
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Affiliation(s)
- Waad Kheder
- College of Dental Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Amal Bouzid
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Thenmozhi Venkatachalam
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Iman M Talaat
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Noha Mousaad Elemam
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Tom Kalathil Raju
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Soumya Sheela
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Manju Nidagodu Jayakumar
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Azzam A Maghazachi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Abdul Rani Samsudin
- College of Dental Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Rifat Hamoudi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
- Division of Surgery and Interventional Science, University College London, London NW3 2PS, UK
- ASPIRE Precision Medicine Research Institute Abu Dhabi, University of Sharjah, Sharjah 27272, United Arab Emirates
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25
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Poli PP, Manfredini M, Oliva N, Bettini S, Damiani G, Goldoni R, Strambini L, Casati S, Del Fabbro M, Tartaglia GM. Detection and sensing of oral xenobiotics in edentulous patients rehabilitated with titanium dental implants: Insights from a scoping review. J Prosthet Dent 2023:S0022-3913(23)00342-6. [PMID: 37423787 DOI: 10.1016/j.prosdent.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 07/11/2023]
Abstract
STATEMENT OF PROBLEM Titanium has been considered the standard element in implant manufacturing. Recent studies have evaluated the role of titanium as a biological modulator of oral health. However, evidence regarding the association between the release of metal particles and peri-implantitis is lacking. PURPOSE The purpose of this scoping review was to evaluate the literature regarding the release of metal particles in peri-implant tissues correlated with the methods of detection and the local and systemic implications. MATERIAL AND METHODS The study was performed in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and was registered with the National Institute for Health Research PROSPERO (Submission No. 275576; ID: CRD42021275576). A systematic search was conducted in the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE via PubMed, Scopus, and Web of Science bibliographic databases, complemented by a manual evaluation. Only in vivo human studies written in the English language and published between January 2000 and June 2022 were included. RESULTS In total, 10 studies were included according to eligibility criteria. Different tissues and analytic techniques were reported: the characterization technique most used was inductively coupled plasma mass spectrometry. All 10 studies analyzed the release of metal particles in patients with dental implants, continuously detecting titanium. None of the studies reported a significant association between metal particles and biological effects. CONCLUSIONS Titanium is still considered the material of choice in implant dentistry, despite the detection of metal particles in peri-implant tissues. Further studies are necessary to evaluate the association between analytes and local health or inflammatory status.
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Affiliation(s)
- Pier Paolo Poli
- Research Fellow, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Research Fellow, Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mattia Manfredini
- PhD Student, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; PhD Student, Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Nadim Oliva
- Resident, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Sofia Bettini
- Resident, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Resident, Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Damiani
- Assistant Professor, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Assistant Professor, Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy; Assistant Professor, Division of Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Riccardo Goldoni
- PhD Student, Department of Electronics, Information and Bioengineering (DEIB), Politecnico Di Milano, Milan, Italy; PhD Student, National Research Council, Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Lucanos Strambini
- Research Fellow, National Research Council, Department of Electronics, Computer and Telecommunication Engineering (CNR-IEIIT), Milan, Italy
| | - Sara Casati
- Research Fellow, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Massimo Del Fabbro
- Associate Professor, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Associate Professor, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca M Tartaglia
- Associate Professor, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Associate Professor, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
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26
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Olander J, Barkarmo S, Hammarström Johansson P, Wennerberg A, Stenport VF. Inflammatory Gene Profile and Particle Presence in Peri-Implant Mucosa: a Pilot Study on 9 Patients. J Oral Maxillofac Res 2023; 14:e2. [PMID: 37969950 PMCID: PMC10645473 DOI: 10.5037/jomr.2023.14302] [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: 08/22/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
Objectives The purpose of this pilot study is to compare gene expression in mucosa around dental implants with zirconia abutment to titanium and investigate presence of particles in mucosa samples and on implant heads. Material and Methods Ten patients with a single implant supported prosthesis connected to zirconia or titanium abutments were invited at the five-year control. A clinical examination and a survey on experience of function and appearance were conducted. A mucosa biopsy taken in close vicinity to the implant were analysed by real-time polymerase chain reaction (qPCR) and presence of particles in a scanning electron microscope/energy-dispersive X-ray spectroscope (SEM/EDX). Cytological smear samples were collected and analysed through inductively coupled plasma mass spectrometry (ICP-MS) to investigate presence of particles on implant heads. Results In total, 9 patients participated in the study, five with titanium abutments and four with zirconia abutments. All patients were satisfied with function and aesthetics. Titanium and iron particles were detected in mucosa biopsies. The ICP - MS analysis demonstrated presence of zirconia and titanium. Several proinflammatory genes were upregulated in the zirconia abutment group. Conclusions Around zirconia abutments a slight increase in proinflammatory response and amount of wear particles was seen as compared to titanium. Wear particles of titanium were present in all soft tissue samples, however zirconia particles only in the samples from implants heads/mucosa with zirconia abutments.
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Affiliation(s)
- Julia Olander
- Department of Prosthodontics and Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, GothenburgSweden.
| | - Sargon Barkarmo
- Department of Prosthodontics and Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, GothenburgSweden.
| | - Petra Hammarström Johansson
- Department of Prosthodontics and Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, GothenburgSweden.
| | - Ann Wennerberg
- Department of Prosthodontics and Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, GothenburgSweden.
| | - Victoria Franke Stenport
- Department of Prosthodontics and Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, GothenburgSweden.
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27
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Conforte JJ, Sousa CA, da Silva ACR, Ribeiro AV, Duque C, Assunção WG. Effect of Enterococcus faecalis Biofilm on Corrosion Kinetics in Titanium Grade 4 Alloys with Different Surface Treatments. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4532. [PMID: 37444846 DOI: 10.3390/ma16134532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
E. faecalis has been associated with bacteremia, sepsis, and bacterial endocarditis and peri-implantitis. This microorganism can remain in the alveolus even after extraction of the root remnant. This study aimed to evaluate the corrosion on different surfaces of commercially pure titanium (Ti) grade 4 (Ticp-G4) as a function of the bacterial biofilm effect of Enterococcus faecalis. A total of 57 discs were randomly divided according to their surface finish (n = 19). For microbiological analysis (n = 9), the discs were placed in 12-well plates containing E. faecalis culture and incubated at 37 °C for 7 days. The results show that for the intergroup analysis, considering the "electrolyte" factor, there was a difference between the groups. There was greater biofilm formation for the D.A.Zir group, with greater electrochemical exchange for Biofilm, and the presence of biofilm favored greater electrochemical exchange with the medium.
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Affiliation(s)
- Jadison Junio Conforte
- Department of Dental Materials and Prosthodontic, Araçatuba School of Dentistry, São Paulo State University (UNESP), Sao Paulo 16015-050, Brazil
| | - Cecília Alves Sousa
- Department of Dental Materials and Prosthodontic, Araçatuba School of Dentistry, São Paulo State University (UNESP), Sao Paulo 16015-050, Brazil
| | - Ana Claudia Rodrigues da Silva
- Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University (UNESP), Sao Paulo 16015-050, Brazil
| | | | - Cristiane Duque
- Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University (UNESP), Sao Paulo 16015-050, Brazil
| | - Wirley Gonçalves Assunção
- Department of Dental Materials and Prosthodontic, Araçatuba School of Dentistry, São Paulo State University (UNESP), Sao Paulo 16015-050, Brazil
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28
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Robles D, Brizuela A, Fernández-Domínguez M, Gil J. Corrosion Resistance and Titanium Ion Release of Hybrid Dental Implants. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16103650. [PMID: 37241275 DOI: 10.3390/ma16103650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
One of the strategies for the fight against peri-implantitis is the fabrication of titanium dental implants with the part close to the neck without roughness. It is well known that roughness favors osseointegration but hinders the formation of biofilm. Implants with this type of structure are called hybrid dental implants, which sacrifice better coronal osseointegration for a smooth surface that hinders bacterial colonization. In this contribution, we have studied the corrosion resistance and the release of titanium ions to the medium of smooth (L), hybrid (H), and rough (R) dental implants. All implants were identical in design. Roughness was determined with an optical interferometer and residual stresses were determined for each surface by X-ray diffraction using the Bragg-Bentano technique. Corrosion studies were carried out with a Voltalab PGZ301 potentiostat, using Hank's solution as an electrolyte at a temperature of 37 °C. Open-circuit potentials (Eocp), corrosion potential (Ecorr), and current density (icorr) were determined. Implant surfaces were observed by JEOL 5410 scanning electron microscopy. Finally, for each of the different dental implants, the release of ions into Hank's solution at 37 °C at 1, 7, 14, and 30 days of immersion was determined by ICP-MS. The results, as expected, show a higher roughness of R with respect to L and compressive residual stresses of -201.2 MPa and -20.2 MPa, respectively. These differences in residual stresses create a potential difference in the H implant corresponding to Eocp of -186.4 mV higher than for the L and R of -200.9 and -192.2 mV, respectively. The corrosion potentials and current intensity are also higher for the H implants (-223 mV and 0.069 μA/mm2) with respect to the L (-280 mV and 0.014 μA/mm2 and R (-273 mV and 0.019 μA/mm2). Scanning electron microscopy revealed pitting in the interface zone of the H implants and no pitting in the L and R dental implants. The titanium ion release values to the medium are higher in the R implants due to their higher specific surface area compared to the H and L implants. The maximum values obtained are low, not exceeding 6 ppb in 30 days.
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Affiliation(s)
- Daniel Robles
- Department of Translational Medicine CEU, San Pablo University, Urbanización Montepríncipe, Alcorcón, 28925 Madrid, Spain
- Facultad de Odontología, Universidad Europea Miguel de Cervantes, C/del Padre Julio Chevalier 2, 47012 Valladolid, Spain
| | - Aritza Brizuela
- Facultad de Odontología, Universidad Europea Miguel de Cervantes, C/del Padre Julio Chevalier 2, 47012 Valladolid, Spain
| | - Manuel Fernández-Domínguez
- Department of Oral and Maxillofacial Surgery, Hospital Monteprincipe, University CEU San Pablo, Av. de Montepríncipe s/n, Alcorcón, 28668 Madrid, Spain
| | - Javier Gil
- Bioengineering Institute of Technology, Facultad de Medicina y Ciencias de la Salud, Universidad Internacional de Catalunya, Josep Trueta s/n, Sant Cugat del Vallés, 08195 Barcelona, Spain
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Aung LM, Lin JCY, Salamanca E, Wu YF, Pan YH, Teng NC, Huang HM, Sun YS, Chang WJ. Functionalization of zirconia ceramic with fibronectin proteins enhanced bioactivity and osteogenic response of osteoblast-like cells. Front Bioeng Biotechnol 2023; 11:1159639. [PMID: 37180046 PMCID: PMC10167021 DOI: 10.3389/fbioe.2023.1159639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023] Open
Abstract
Introduction: To overcome the genuine bioinert properties of zirconia ceramic, functionalization of the surface with the bioactive protein fibronectin was conducted. Methods: Glow discharge plasma (GDP)-Argon was first used to clean the zirconia surface. Then allylamine was treated at three different powers of 50 W, 75 W, and 85 W and immersed into 2 different fibronectin concentrations (5 µg/ml and 10 µg/ml). Results and Discussion: After surface treatment, irregularly folded protein-like substances were attached on the fibronectin coated disks, and a granular pattern was observed for allylamine grafted samples. Infrared spectroscopy detected C-O, N-O, N-H, C-H, and O-H functional groups for fibronectin treated samples. Surface roughness rose and hydrophilicity improved after the surface modification, with MTT assay showing the highest level of cell viability for the A50F10 group. Cell differentiation markers also showed that fibronectin grafted disks with A50F10 and A85F10 were the most active, which in turn encouraged late-stage mineralization activity on 21d. Up-regulation of osteogenic related mRNA expression from 1d to 10d can be observed in RT-qPCR data for ALP, OC, DLX5, SP7, OPG and RANK biomarkers. These physical and biological properties clearly indicate that an allylamine and fibronectin composite grafted surface significantly stimulated the bioactivity of osteoblast-like cells, and can be utilized for future dental implant applications.
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Affiliation(s)
- Lwin Moe Aung
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jerry Chin-Yi Lin
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, United States
| | - Eisner Salamanca
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Fan Wu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hwan Pan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
- School of Dentistry, College of Medicine, China Medical University, Taichung, Taiwan
| | - Nai-Chia Teng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Haw-Ming Huang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Sui Sun
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Jen Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Dental Department, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Stolzer C, Müller M, Gosau M, Henningsen A, Fuest S, Aavani F, Smeets R. Do Titanium Dioxide Particles Stimulate Macrophages to Release Proinflammatory Cytokines and Increase the Risk for Peri-implantitis? J Oral Maxillofac Surg 2023; 81:308-317. [PMID: 36442535 DOI: 10.1016/j.joms.2022.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/09/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Titanium dioxide (TiO2) particles detached from titanium dental implants by tribocorrosion can be phagocytosed by macrophages, releasing various proinflammatory cytokines at the implant sites that may trigger peri-implantitis. The study objective was to measure the association between peri-implantitis and the presence of non-allergy-related proinflammatory cytokines associated with TiO2 particles. METHODS The investigators implemented a retrospective cross-sectional study and enrolled a sample of 60 subjects from a dental practice. Subjects were excluded if the plaque index was grade 3 (Silness and Löe). The predictor variable was a positive or negative TiO2 stimulation test, an in vitro macrophage proinflammatory response test. The outcome variable was peri-implantitis status defined as present or absent. Three groups were considered: control group with 20 patients without dental implants (group 1), 2 groups of patients with titanium dental implants, one without peri-implantitis (group 2), and the other with peri-implantitis (group 3) (n = 20 each). For patients with implants, depth of the gingival pockets of the implants were measured, and existing bleeding and suppuration were determined to assess peri-implantitis. Radiographs were taken if one or more factors applied to confirm the diagnosis of peri-implantitis. Further covariates were age, sex, duration of implant wear, and number of implants which were analyzed descriptively. Inferential analyses were undertaken using χ2 test, Kruskal-Wallis-, Wilcoxon-two-sample tests, and logistic regressions. RESULTS The sample was composed of 35 female and 25 male patients with a mean age of 54.2 years (standard deviation = 14.76). The overall TiO2 stimulation test positivity frequency was 28.3% and were 30.0%, 5.0%, and 50.0% in the control, implants without peri-implantitis, and implants with peri-implantitis groups. No statistically significant differences could be seen in the frequencies of the TiO2 stimulation test results between control group and combined groups 2 and 3 (P-value = .84). The risk for positive TiO2 patients with a titanium implant of developing peri-implantitis was statistically significant and higher compared to negative TiO2 patients (odds ratio, 19.0 with 95% confidence interval [2.12,170.38]; P-value< .01). CONCLUSIONS The data in this study showed a statistically significant relationship between a positive TiO2 stimulation test and peri-implantitis. Further studies with larger numbers of subjects are recommended to confirm this result.
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Affiliation(s)
- Carolin Stolzer
- Consultant, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Martin Gosau
- Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anders Henningsen
- Assistant Professor, Consultant, Division of Regenerative Orofacial Medicine, Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Fuest
- Research Assistant, Division of Regenerative Orofacial Medicine, Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Farzaneh Aavani
- Research Assistant, Division of Regenerative Orofacial Medicine, Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Smeets
- Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kohal RJ, Burkhardt F, Chevalier J, Patzelt SBM, Butz F. One-Piece Zirconia Oral Implants for Single Tooth Replacement: Five-Year Results from a Prospective Cohort Study. J Funct Biomater 2023; 14:jfb14020116. [PMID: 36826915 PMCID: PMC9964460 DOI: 10.3390/jfb14020116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
The intention of this 5-year prospective cohort investigation was to clinically and radiographically investigate the outcomes of a one-piece zirconia implant system for single tooth replacement. Sixty-five patients received a total of 66 single-tooth implants. All implants immediately received temporary restorations and were finally restored with all-ceramic crowns. Follow-ups were performed at the prosthetic delivery, after 1, 3, and 5 years. Peri-implant and dental soft-tissue parameters were evaluated and patient-reported outcomes recorded. To monitor peri-implant bone remodelling, standardised radiographs were taken at the implant insertion and at the 1-, 3-, and 5-year follow-ups. In the course of 5 years, 14 implants were lost, resulting in a cumulative implant survival rate of 78.2%. The mean marginal bone loss from the implant insertion to the 5-year follow-up amounted to 1.12 mm. Probing depth, clinical attachment level, bleeding, and plaque index increased over time. In 91.5% of the implants, the papilla index showed levels of 1 or 2, respectively. At the end of the study, the patient satisfaction was higher compared to the pre-treatment measurements. Due to the low survival rate after five years and the noticeably high frequency of advanced bone loss observed in this study, the implant has not met the launch criteria, as it would have not been recommended for routine clinical use.
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Affiliation(s)
- Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Felix Burkhardt
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Jerome Chevalier
- INSA-Lyon, MATEIS Laboratory, University of Lyon, UMR CNRS 5510, 20 Avenue Albert Einstein, CEDEX, 69621 Villeurbanne, France
| | - Sebastian Berthold Maximilian Patzelt
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Private Dental Clinic, Am Dorfplatz 3, 78658 Zimmern ob Rottweil, Germany
| | - Frank Butz
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Private Dental Clinic, Belchenstrasse 6a, 79189 Bad Krozingen, Germany
- Correspondence:
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Ozkan A, Çakır DA, Tezel H, Sanajou S, Yirun A, Baydar T, Erkekoglu P. Dental Implants and Implant Coatings: A Focus on Their Toxicity and Safety. J Environ Pathol Toxicol Oncol 2023; 42:31-48. [PMID: 36749088 DOI: 10.1615/jenvironpatholtoxicoloncol.2022043467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Dental implants are medical devices that are surgically inserted into the patient's jawbone by an orthodontist to act as roots of missing teeth. After the implantation, the maxilla or mandible integrates with the surface of the dental implant. This process, called "osseointegration," is an important period to ensure the long-term use of dental implants and prevent implant failures. Metal implants are the most used implant materials. However, they have disadvantages such as corrosion, metal ion release from metal implant surfaces and associated toxicity. To avoid these adverse effects and improve osseointegration, alternative dental implant materials such as ceramics, polymers, composites, and novel surface modification technologies have been developed. The safety of these materials are also of concern for toxicologists. This review will give general information about dental implant materials, osseointegration and successful implantation process. Moreover, we will focus on the new surface coatings materials for of dental implants and their toxicity and safety concerns will be discussed.
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Affiliation(s)
- Atakan Ozkan
- TOBB University of Economics and Technology, Faculty of Engineering, Department of Biomedical Engineering, Ankara, Turkey
| | - Deniz Arca Çakır
- Hacettepe University Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara, Turkey; Hacettepe University Vaccine Institute, Department of Vaccinology, Ankara, Turkey
| | - Hülya Tezel
- Hacettepe University Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara, Turkey
| | - Sonia Sanajou
- Hacettepe University Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara, Turkey
| | - Anil Yirun
- Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Sıhhiye 06100, Ankara, Turkey; Çukurova University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Adana, Turkey
| | - Terken Baydar
- Hacettepe University Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara, Turkey
| | - Pinar Erkekoglu
- Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Sıhhiye 06100, Ankara, Turkey; Hacettepe University Vaccine Institute, Department of Vaccinology, Ankara, Turkey
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Enhanced Corrosion Resistance and Local Therapy from Nano-Engineered Titanium Dental Implants. Pharmaceutics 2023; 15:pharmaceutics15020315. [PMID: 36839638 PMCID: PMC9963924 DOI: 10.3390/pharmaceutics15020315] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Titanium is the ideal material for fabricating dental implants with favorable biocompatibility and biomechanics. However, the chemical corrosions arising from interaction with the surrounding tissues and fluids in oral cavity can challenge the integrity of Ti implants and leach Ti ions/nanoparticles, thereby causing cytotoxicity. Various nanoscale surface modifications have been performed to augment the chemical and electrochemical stability of Ti-based dental implants, and this review discusses and details these advances. For instance, depositing nanowires/nanoparticles via alkali-heat treatment and plasma spraying results in the fabrication of a nanostructured layer to reduce chemical corrosion. Further, refining the grain size to nanoscale could enhance Ti implants' mechanical and chemical stability by alleviating the internal strain and establishing a uniform TiO2 layer. More recently, electrochemical anodization (EA) has emerged as a promising method to fabricate controlled TiO2 nanostructures on Ti dental implants. These anodized implants enhance Ti implants' corrosion resistance and bioactivity. A particular focus of this review is to highlight critical advances in anodized Ti implants with nanotubes/nanopores for local drug delivery of potent therapeutics to augment osseo- and soft-tissue integration. This review aims to improve the understanding of novel nano-engineered Ti dental implant modifications, focusing on anodized nanostructures to fabricate the next generation of therapeutic and corrosion-resistant dental implants. The review explores the latest developments, clinical translation challenges, and future directions to assist in developing the next generation of dental implants that will survive long-term in the complex corrosive oral microenvironment.
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Bešlić I, Vučić M, Buljan M. The mystery of "4M": metallosis mimicking melanoma metastasis. Int J Dermatol 2023; 62:e1-e2. [PMID: 35949008 DOI: 10.1111/ijd.16383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/29/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Iva Bešlić
- Department of Dermatology and Venereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Majda Vučić
- Department of Pathology "Ljudevit Jurak", Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Marija Buljan
- Department of Dermatology and Venereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Toledano-Serrabona J, Camps-Font O, de Moraes DP, Corte-Rodríguez M, Montes-Bayón M, Valmaseda-Castellón E, Gay-Escoda C, Sánchez-Garcés MÁ. Ion release and local effects of titanium metal particles from dental implants: An experimental study in rats. J Periodontol 2023; 94:119-129. [PMID: 35678251 PMCID: PMC10087269 DOI: 10.1002/jper.22-0091] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the accumulation of ions in blood and organs caused by titanium (Ti) metal particles in a mandibular defect in rats, together with a description of the local reaction of oral tissues to this Ti alloy debris. METHODS Twenty Sprague-Dawley rats were randomly distributed into three groups: an experimental group with a mandibular bone defect filled with metallic debris obtained by implantoplasty; a positive control group; and a negative control group. Thirty days after surgery, the rats were euthanized and perilesional tissue surrounding the mandibular defect was removed, together with the lungs, spleen, liver, and brain. Two blood samples were collected: immediately before surgery and before euthanasia. The perilesional tissue was histologically analyzed using hematoxylin-eosin staining, and Ti, aluminum, and vanadium ion concentrations in blood and organs were measured by TQ-ICP-MS. Descriptive and bivariate analyses of the data were performed. RESULTS All rats with implanted metal debris showed metal particles and a bone fracture callus on the osseous defect. The metal particles were surrounded by a foreign body reaction characterized by the presence of histiocytes and multinucleated giant cells (MNGCs). The experimental group had a significant higher concentration of Ti ions in all studied organs except lung tissue (p < 0.05). In addition, there were more V ions in the brain in the experimental group (p = 0.008). CONCLUSIONS Although further studies are required to confirm the clinical relevance of these results, Ti metal particles in the jaw might increase the concentration of metal ions in vital organs and induce a foreign body reaction.
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Affiliation(s)
- Jorge Toledano-Serrabona
- Department of Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Octavi Camps-Font
- Department of Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Diogo Pompéu de Moraes
- Department of Physical and Analytical Chemistry, Faculty of Chemistry, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Institute of Chemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mario Corte-Rodríguez
- Department of Physical and Analytical Chemistry, Faculty of Chemistry, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - María Montes-Bayón
- Department of Physical and Analytical Chemistry, Faculty of Chemistry, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Eduard Valmaseda-Castellón
- Department of Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Cosme Gay-Escoda
- Department of Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - M Ángeles Sánchez-Garcés
- Department of Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
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Muacevic A, Adler JR, Eguia A. On Peri-Implant Bone Loss Theories: Trying To Piece Together the Jigsaw. Cureus 2023; 15:e33237. [PMID: 36733558 PMCID: PMC9890078 DOI: 10.7759/cureus.33237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
This review aims to explore the plausibility of new theories on the etiopathogenesis of marginal bone loss (MBL) and peri-implantitis (PI) and to discuss possible underlying pathogenic mechanisms. The former concept of osteointegration of dental implants can now be conceptualized as a foreign body response histologically characterized by a bony demarcation in combination with chronic inflammation. Different risk factors can provoke additional inflammation and, therefore, pro-inflammatory cytokine release in soft tissues and bone, leading to an overpass of the threshold of peri-implant bone defensive and regenerative capacity. Progressive bone loss observed in MBL and PI is ultimately due to a localized imbalance in the receptor activator of nuclear factor kappaB ligand (RANKL)/Receptor activator of nuclear factor κ B (RANK)/osteoprotegerin (OPG) pathway in favor of increased catabolic activity. The genetic background and the severity and duration of the risk factors could explain differences between individuals in the threshold needed to reach an imbalanced scenario. MBL and PI pathogenesis could be better explained by the "inflammation-immunological balance" theory rather than a solely "infectious disease" conception. The link between the effect of biofilm and other risk factors leading to an imbalanced foreign body response lies in osteoclast differentiation and activation pathways (over)stimulation.
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Yang J, Liu C, Sun H, Liu Y, Liu Z, Zhang D, Zhao G, Wang Q, Yang D. The progress in titanium alloys used as biomedical implants: From the view of reactive oxygen species. Front Bioeng Biotechnol 2022; 10:1092916. [PMID: 36601391 PMCID: PMC9806234 DOI: 10.3389/fbioe.2022.1092916] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Titanium and Titanium alloys are widely used as biomedical implants in oral and maxillofacial surgery, due to superior mechanical properties and biocompatibility. In specific clinical populations such as the elderly, diabetics and patients with metabolic diseases, the failure rate of medical metal implants is increased significantly, putting them at increased risk of revision surgery. Many studies show that the content of reactive oxygen species (ROS) in the microenvironment of bone tissue surrounding implant materials is increased in patients undergoing revision surgery. In addition, the size and shape of materials, the morphology, wettability, mechanical properties, and other properties play significant roles in the production of ROS. The accumulated ROS break the original balance of oxidation and anti-oxidation, resulting in host oxidative stress. It may accelerate implant degradation mainly by activating inflammatory cells. Peri-implantitis usually leads to a loss of bone mass around the implant, which tends to affect the long-term stability and longevity of implant. Therefore, a great deal of research is urgently needed to focus on developing antibacterial technologies. The addition of active elements to biomedical titanium and titanium alloys greatly reduce the risk of postoperative infection in patients. Besides, innovative technologies are developing new biomaterials surfaces conferring anti-infective properties that rely on the production of ROS. It can be considered that ROS may act as a messenger substance for the communication between the host and the implanted material, which run through the entire wound repair process and play a role that cannot be ignored. It is necessary to understand the interaction between oxidative stress and materials, the effects of oxidative stress products on osseointegration and implant life as well as ROS-induced bactericidal activity. This helps to facilitate the development of a new generation of well-biocompatible implant materials with ROS responsiveness, and ultimately prolong the lifespan of implants.
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Affiliation(s)
- Jun Yang
- School of Stomatology, Jiamusi University, Jiamusi, China,Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Chang Liu
- School of Stomatology, Jiamusi University, Jiamusi, China,Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Hui Sun
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Ying Liu
- The Affiliated Taian City Central Hospital of Qingdao University, Taian, China
| | - Zhaogang Liu
- The Affiliated Taian City Central Hospital of Qingdao University, Taian, China
| | - Dan Zhang
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, Shenyang, China,*Correspondence: Donghong Yang, ; Dan Zhang,
| | - Gang Zhao
- School of Stomatology, Jiamusi University, Jiamusi, China
| | - Qiang Wang
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Donghong Yang
- School of Stomatology, Jiamusi University, Jiamusi, China,*Correspondence: Donghong Yang, ; Dan Zhang,
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Salvi GE, Stähli A, Imber JC, Sculean A, Roccuzzo A. Physiopathology of peri-implant diseases. Clin Implant Dent Relat Res 2022. [PMID: 36515007 DOI: 10.1111/cid.13167] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Peri-implant health is characterized by the absence of clinical signs of soft tissue inflammation. Peri-implant diseases are initiated by the presence of bacterial biofilms and share a similar etiology as that involved in the onset of periodontal diseases. PURPOSE To summarize available evidence on the physiopathology of peri-implant diseases with emphasis on similarities and differences with periodontal diseases. MATERIALS AND METHODS Evidence on the biologic mechanisms involved in the pathogenesis of peri-implant mucositis and peri-implantitis were explored in the recent scientific literature. RESULTS Findings of studies in animals and in humans indicate that experimental peri-implant mucositis leads to a larger inflammatory connective tissue infiltrate and to a higher frequency of bleeding sites around implants compared with teeth. Tissue destruction at experimental peri-implantitis sites is more pronounced compared with that at experimental periodontitis sites. Although human periodontitis and peri-implantitis lesions share similarities with respect to etiology and clinical features, they represent distinct entities from a physiopathologic point of view. CONCLUSIONS Diagnosis of peri-implant health requires a clinical examination to confirm absence of peri-implant soft tissue inflammation. In order to make a correct diagnosis and select the appropriate therapeutic steps to manage peri-implant diseases, knowledge of their pathogenetic mechanisms is required.
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Affiliation(s)
- Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Dong J, Wang W, Zhou W, Zhang S, Li M, Li N, Pan G, Zhang X, Bai J, Zhu C. Immunomodulatory biomaterials for implant-associated infections: from conventional to advanced therapeutic strategies. Biomater Res 2022; 26:72. [PMID: 36471454 PMCID: PMC9721013 DOI: 10.1186/s40824-022-00326-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/19/2022] [Indexed: 12/11/2022] Open
Abstract
Implant-associated infection (IAI) is increasingly emerging as a serious threat with the massive application of biomaterials. Bacteria attached to the surface of implants are often difficult to remove and exhibit high resistance to bactericides. In the quest for novel antimicrobial strategies, conventional antimicrobial materials often fail to exert their function because they tend to focus on direct bactericidal activity while neglecting the modulation of immune systems. The inflammatory response induced by host immune cells was thought to be a detrimental force impeding wound healing. However, the immune system has recently received increasing attention as a vital player in the host's defense against infection. Anti-infective strategies based on the modulation of host immune defenses are emerging as a field of interest. This review explains the importance of the immune system in combating infections and describes current advanced immune-enhanced anti-infection strategies. First, the characteristics of traditional/conventional implant biomaterials and the reasons for the difficulty of bacterial clearance in IAI were reviewed. Second, the importance of immune cells in the battle against bacteria is elucidated. Then, we discuss how to design biomaterials that activate the defense function of immune cells to enhance the antimicrobial potential. Based on the key premise of restoring proper host-protective immunity, varying advanced immune-enhanced antimicrobial strategies were discussed. Finally, current issues and perspectives in this field were offered. This review will provide scientific guidance to enhance the development of advanced anti-infective biomaterials.
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Affiliation(s)
- Jiale Dong
- grid.411395.b0000 0004 1757 0085Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, 230001 Hefei, Anhui P. R. China
| | - Wenzhi Wang
- grid.411395.b0000 0004 1757 0085Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, 230001 Hefei, Anhui P. R. China
| | - Wei Zhou
- grid.411395.b0000 0004 1757 0085Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, 230001 Hefei, Anhui P. R. China
| | - Siming Zhang
- grid.411395.b0000 0004 1757 0085Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, 230001 Hefei, Anhui P. R. China
| | - Meng Li
- grid.411395.b0000 0004 1757 0085Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, 230001 Hefei, Anhui P. R. China ,grid.263761.70000 0001 0198 0694Medical College, Soochow University, 215006 Suzhou, Jiangsu P. R. China
| | - Ning Li
- grid.411395.b0000 0004 1757 0085Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, 230001 Hefei, Anhui P. R. China
| | - Guoqing Pan
- grid.440785.a0000 0001 0743 511XInstitute for Advanced Materials, School of Materials Science and Engineering, Jiangsu University, 212013 Zhenjiang, China
| | - Xianzuo Zhang
- grid.411395.b0000 0004 1757 0085Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, 230001 Hefei, Anhui P. R. China
| | - Jiaxiang Bai
- grid.263761.70000 0001 0198 0694Medical College, Soochow University, 215006 Suzhou, Jiangsu P. R. China
| | - Chen Zhu
- grid.411395.b0000 0004 1757 0085Department of Orthopedic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, 230001 Hefei, Anhui P. R. China
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Enhanced corrosion resistance in an inflammatory environment and osteogenic properties of silicalite-1 coated titanium alloy implants. Colloids Surf B Biointerfaces 2022; 220:112922. [DOI: 10.1016/j.colsurfb.2022.112922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
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AjitSankardas P, Stein SH, Tipton D, Abhyankar V, Morrow BR. Impact of Metal Particles Released during Ultrasonic Scaling of Titanium Surfaces on Human Gingival Fibroblasts. J Long Term Eff Med Implants 2022; 33:9-22. [PMID: 36382700 DOI: 10.1615/jlongtermeffmedimplants.2022043080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Metal particles found in tissues around dental implants have been proposed to play a pathogenic role in peri-implantitis. Ultrasonic scaling has been suggested as a mechanism by which these particles can be inadvertently released into surrounding tissues. Furthermore, risk factors like diabetes can result in exacerbation of this inflammatory condition. The current study aimed to analyze metal particles released from titanium surfaces during ultrasonic scaling and their impact on pro-inflammatory cytokine production by human gingival fibroblasts. METHODS Metal particles generated from ultrasonic scaling of titanium discs using two different tips (metal and poly-etheretherketone tips) were characterized using scanning electron microscopy and elemental analysis. Endotoxin levels and Human gingival fibroblast viability, in the presence commercial and ultrasonically generated particles were determined. Fibroblasts, cultured in high or low glucose growth medium, were incubated with commercial titanium particles or ultrasonically generated particles in the presence or absence of interluekin-1β. Interleukin 6 and interleukin 8 production were then quantified using Enzyme linked immunosorbent assay. RESULTS Analysis of particles after scaling of titanium discs showed significant levels of titanium particles. Commercial titanium particles and generated particles had no effect of fibroblast viability. Endotoxin levels of all particles were too low to stimulate HGF cells. IL-1β significantly stimulated IL-6 and IL-8 production. However, commercial, and generated particles generally had no significant effect on IL- 6 and IL-8 production. CONCLUSION Our study concluded that particles generated during ultrasonic scaling had no significant effect on viability of HGF cells and cytokine production.
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Affiliation(s)
- Pooja AjitSankardas
- Department of Periodontology, University of Tennessee Health Science Center, College of Dentistry, Memphis, TN 38103
| | - Sidney H Stein
- Department of Periodontology, University of Tennessee Health Science Center, College of Dentistry, Memphis, TN 38103
| | - David Tipton
- Department of Bioscience Research, University of Tennessee Health Science Center, College of Dentistry, University of Tennessee Health Science Center, College of Dentistry, Memphis, TN 38103
| | - Vrushali Abhyankar
- Department of Periodontology, University of Tennessee Health Science Center, College of Dentistry, Memphis, TN 38103
| | - Brian R Morrow
- Department of Bioscience Research, University of Tennessee Health Science Center, College of Dentistry, University of Tennessee Health Science Center, College of Dentistry, Memphis, TN 38103
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Hydrothermal Synthesis of Fluorapatite Coatings over Titanium Implants for Enhanced Osseointegration-An In Vivo Study in the Rabbit. J Funct Biomater 2022; 13:jfb13040241. [PMID: 36412882 PMCID: PMC9680447 DOI: 10.3390/jfb13040241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
This work aims at the development and characterization of fluorapatite coatings, innovatively prepared by the hydrothermal method, aiming for enhanced osseointegration of titanium implants. Fluoride-containing coatings were prepared and characterized by scanning and transmission electron microscopy, Fourier-transform infrared spectroscopy-attenuated total reflectance, and X-ray photoelectron spectroscopy. The biological response was characterized by microtomographic evaluation and histomorphometric analysis upon orthotopic implantation in a translational rabbit experimental model. Physic-chemical analysis revealed the inclusion of fluoride in the apatite lattice with fluorapatite formation, associated with the presence of citrate species. The in vivo biological assessment of coated implants revealed an enhanced bone formation process-with increased bone-to-implant contact and bone volume. The attained enhancement of the osteogenic process may be attributable to the conjoined modulatory activity of selected fluoride and citrate levels within the produced coatings. In this regard, the production of fluorapatite coatings with citrate, through the hydrothermal method, entails a promising approach for enhanced osseointegration in implant dentistry and orthopedic applications.
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Ivanovski S, Bartold PM, Huang Y. The role of foreign body response in peri-implantitis: What is the evidence? Periodontol 2000 2022; 90:176-185. [PMID: 35916872 PMCID: PMC9804527 DOI: 10.1111/prd.12456] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Historically, there has been broad consensus that osseointegration represents a homeostasis between a titanium dental implant and the surrounding bone, and that the crestal bone loss characteristic of peri-implantitis is a plaque-induced inflammatory process. However, this notion has been challenged over the past decade by proponents of a theory that considers osseointegration an inflammatory process characterized by a foreign body reaction and peri-implant bone loss as an exacerbation of this inflammatory response. A key difference in these two schools of thought is the perception of the relative importance of dental plaque in the pathogenesis of crestal bone loss around implants, with obvious implications for treatment. This review investigates the evidence for a persistent foreign body reaction at osseointegrated dental implants and its possible role in crestal bone loss characteristic of peri-implantitis. Further, the role of implant-related material release within the surrounding tissue, particularly titanium particles and corrosion by-products, in the establishment and progression in peri-implantitis is explored. While it is acknowledged that these issues require further investigation, the available evidence suggests that osseointegration is a state of homeostasis between the titanium implant and surrounding tissues, with little evidence that a persistent foreign body reaction is responsible for peri-implant bone loss after osseointegration is established. Further, there is a lack of evidence for a unidirectional causative role of corrosion by-products and titanium particles as possible non-plaque related factors in the etiology of peri-implantitis.
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Affiliation(s)
- Sašo Ivanovski
- School of DentistryThe University of QueenslandHerstonQueenslandAustralia
| | - Peter Mark Bartold
- School of DentistryUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Yu‐Sheng Huang
- School of DentistryThe University of QueenslandHerstonQueenslandAustralia
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Evaluation of the inflammatory and osteogenic response induced by titanium particles released during implantoplasty of dental implants. Sci Rep 2022; 12:15790. [PMID: 36138061 PMCID: PMC9500064 DOI: 10.1038/s41598-022-20100-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/08/2022] [Indexed: 11/09/2022] Open
Abstract
Implantoplasty is a mechanical decontamination technique that consists of removing the threads and polishing and smoothing the dental implant surface. During implantoplasty there is a large release of titanium metal particles that might provoke a proinflammatory response and reduce the viability of osteogenic cells. We analyze the inflammatory and osteogenic response induced by Ti6Al4V particles released during implantoplasty and by as-received commercially pure Ti particles. Macrophages stimulated with metal particles obtained by implantoplasty and with as-received Ti particles showed an increased proinflammatory expression of TNF-α and a decreased expression of TGF-β and CD206. Regarding cytokine release, there was an increase in IL-1β, while IL-10 decreased. The osteogenic response of Ti6Al4V extracts showed a significant decrease in Runx2 and OC expression compared to the controls and commercially pure Ti extracts. There were no relevant changes in ALP activity. Thus, implantoplasty releases metal particles that seems to induce a pro-inflammatory response and reduce the expression of osteogenic markers.
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Zhou Z, Han X, Gao W, Li Y, Yu W, Yang S, Zhang J, Wang J, Shi R, Zhou Y, Zhao J. Fabrication and mechanical properties of different types of carbon fiber reinforced polyetheretherketone: A comparative study. J Mech Behav Biomed Mater 2022; 135:105472. [PMID: 36162163 DOI: 10.1016/j.jmbbm.2022.105472] [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: 08/04/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To find alternative non-metallic materials as dental implants for clinical application, different types of carbon fiber reinforced polyetheretherketone were fabricated and investigated. METHODS Continuous carbon fiber reinforced polyetheretherketone fabrics were fabricated with polyetheretherketone fibers and carbon fibers. Different kinds of carbon fiber reinforced polyetheretherketone were synthesized by setting specific experiment parameters of injection or hot press molding. Various mechanical tests were performed to determine the mechanical properties of different carbon fiber reinforced polyetheretherketone, pure polyetheretherketone and pure titanium. RESULTS Polyetheretherketone composites presented outstanding mechanical and thermal properties after incorporating carbon fiber. The bending and tensile strength of short carbon fiber reinforced polyetheretherketone were close to human bone, and the bending strength of continuous carbon fiber reinforced polyetheretherketone reached 644 MPa, even higher than that of pure titanium. CONCLUSIONS The mechanical properties of polyetheretherketone composites are more similar to bone tissue than titanium, and the stress shielding phenomenon may be inhibited. They may become promising materials as substitutions for titanium and prospective materials in bone tissue engineering.
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Affiliation(s)
- Zhe Zhou
- Hospital of Stomatology, Jilin University, Changchun, 130021, China
| | - Xiao Han
- Hospital of Stomatology, Jilin University, Changchun, 130021, China
| | - Weijia Gao
- Hospital of Stomatology, Jilin University, Changchun, 130021, China
| | - Yongli Li
- Hospital of Stomatology, Jilin University, Changchun, 130021, China
| | - Wanqi Yu
- Hospital of Stomatology, Jilin University, Changchun, 130021, China
| | - Shihui Yang
- Hospital of Stomatology, Jilin University, Changchun, 130021, China
| | - Jingjie Zhang
- Hospital of Stomatology, Jilin University, Changchun, 130021, China
| | - Junyan Wang
- Hospital of Stomatology, Jilin University, Changchun, 130021, China
| | - Ruining Shi
- Hospital of Stomatology, Jilin University, Changchun, 130021, China
| | - Yanmin Zhou
- Hospital of Stomatology, Jilin University, Changchun, 130021, China; Jilin Province Key Laboratory of Tooth Development and Bone Remodeling, Changchun, 130021, China
| | - Jinghui Zhao
- Hospital of Stomatology, Jilin University, Changchun, 130021, China; Jilin Province Key Laboratory of Tooth Development and Bone Remodeling, Changchun, 130021, China.
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Nemec M, Behm C, Maierhofer V, Gau J, Kolba A, Jonke E, Rausch-Fan X, Andrukhov O. Effect of Titanium and Zirconia Nanoparticles on Human Gingival Mesenchymal Stromal Cells. Int J Mol Sci 2022; 23:ijms231710022. [PMID: 36077419 PMCID: PMC9456558 DOI: 10.3390/ijms231710022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Nano- and microparticles are currently being discussed as potential risk factors for peri-implant disease. In the present study, we compared the responses of human gingival mesenchymal stromal cells (hG-MSCs) on titanium and zirconia nanoparticles (<100 nm) in the absence and presence of Porphyromonas gingivalis lipopolysaccharide (LPS). The primary hG-MSCs were treated with titanium and zirconia nanoparticles in concentrations up to 2.000 µg/mL for 24 h, 72 h, and 168 h. Additionally, the cells were treated with different nanoparticles (25−100 µg/mL) in the presence of P. gingivalis LPS for 24 h. The cell proliferation and viability assay and live−dead and focal adhesion stainings were performed, and the expression levels of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein (MCP)-1 were measured. The cell proliferation and viability were inhibited by the titanium (>1000 µg/mL) but not the zirconia nanoparticles, which was accompanied by enhanced apoptosis. Both types of nanoparticles (>25 µg/mL) induced the significant expression of IL-8 in gingival MSCs, and a slightly higher effect was observed for titanium nanoparticles. Both nanoparticles substantially enhanced the P. gingivalis LPS-induced IL-8 production; a higher effect was observed for zirconia nanoparticles. The production of inflammatory mediators by hG-MSCs is affected by the nanoparticles. This effect depends on the nanoparticle material and the presence of inflammatory stimuli.
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Affiliation(s)
- Michael Nemec
- Clinical Division of Orthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Christian Behm
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Vera Maierhofer
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Jonas Gau
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Anastasiya Kolba
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Erwin Jonke
- Clinical Division of Orthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Xiaohui Rausch-Fan
- Clinical Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
- Center for Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Oleh Andrukhov
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40070-2620
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Asa'ad F, Thomsen P, Kunrath MF. The Role of Titanium Particles and Ions in the Pathogenesis of Peri-Implantitis. J Bone Metab 2022; 29:145-154. [PMID: 36153850 PMCID: PMC9511127 DOI: 10.11005/jbm.2022.29.3.145] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 11/22/2022] Open
Abstract
Titanium (Ti) particles and ions have been investigated in recent years as important factors in the pathogenesis of peri-implantitis. However, their role in the pathogenesis is yet to be fully understood. A review of pertinent literature was performed in various databases to determine the current position of Ti particles and ions role in the pathogenesis of peri-implantitis. There are several in vitro, preclinical and clinical published studies that have addressed the role of Ti particles and ions in the pathogenesis of peri-implantitis. These studies explored the effect of Ti particles and ions in the pathogenesis of peri-implantitis with respect to foreign body reaction, cellular response, epigenetic mechanisms, namely DNA methylation, and the oral microbiome. Studies have shown that the release of Ti particles/ions during implant insertion, early healing stages, late healing stages, and treatments during peri-implantitis might contribute to peri-implantitis through different mechanisms, such as foreign body reaction, cellular response, DNA methylation, and shaping the oral microbiome by increasing dysbiosis. However, further studies are needed to elucidate the complex interactions between all these mechanisms and Ti particles/ions in the pathogenesis and progression of peri-implantitis.
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Affiliation(s)
- Farah Asa'ad
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Oral Biochemistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marcel F Kunrath
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dentistry, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Müller-Heupt LK, Schiegnitz E, Kaya S, Jacobi-Gresser E, Kämmerer PW, Al-Nawas B. Diagnostic tests for titanium hypersensitivity in implant dentistry: a systematic review of the literature. Int J Implant Dent 2022; 8:29. [PMID: 35819566 PMCID: PMC9276909 DOI: 10.1186/s40729-022-00428-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/30/2022] [Indexed: 01/10/2023] Open
Abstract
PURPOSE There are rising concerns about titanium hypersensitivity reaction regarding dental endosseous implants. This review aims to summarize and compare the validity and reliability of the available dermatological and laboratory diagnostic tests regarding titanium hypersensitivity. The following PICO design was used: In Patients with titanium dental implants (P) does epicutaneous testing (ECT) (I), compared to lymphocyte transformation test (LTT) or Memory Lymphocyte Immunostimulation Assay (MELISA) (C) detect hypersensitivity reactions (O)? A literature search was performed including all studies dealing with this topic. Studies regarding orthopedic implants were excluded. METHODS Three databases (MEDLINE PubMed, Cochrane Library, SciELO) were screened for suitable studies and an additional manual search was also performed. Literature regarding hypersensitivity reactions in orthopedic implants, hypersensitivity reactions regarding implants not related to dental or maxillofacial surgery, animal studies and in vitro studies were excluded. A quality assessment of all selected full-text articles was performed. Randomized, controlled trials were evaluated with the Cochrane Risk of Bias Tool I. Cohort studies were assessed according to the New Castle-Ottawa Scale and case series according to Moga et al. (Development of a quality appraisal tool for case series studies using a modified Delphi technique. 2012). RESULTS 10 studies were included in the quantitative synthesis and available for the endpoint diagnostics of intolerance reactions to titanium dental implants: 2 clinical studies, 7 cohort studies and 1 case series. The potential for bias (internal validity) for these studies was overall rated as high. CONCLUSIONS The study of the available literature regarding ECT and MELISA or LTT in patients with suspected titanium hypersensitivity showed inconsistent results in terms of reliability and validity and thus, those tests should be regarded cautiously. There is strong evidence that titanium hypersensitivity in dental implants is associated with innate immunity: unspecific pro-inflammatory responses due to particle induced hyperreactivity of macrophages or toxicological responses especially towards nanoparticles rather than activation of the adaptive immune system. Therefore, tests detecting allergies do not seem expedient and inflammatory clinical signs should be regarded as leading parameters.
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Affiliation(s)
- Lena Katharina Müller-Heupt
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - Eik Schiegnitz
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Sebahat Kaya
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | | | - Peer Wolfgang Kämmerer
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
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Fan Q, Dai H, Bai J, Xu J, Ma Q, Fei Z, Zhou X, Leong KW, Wang C. Degradation-resistant implanted biomaterials establish an immunosuppressive microenvironment that induces T cell exhaustion by recruiting myeloid cells. FUNDAMENTAL RESEARCH 2022; 2:648-658. [PMID: 38933993 PMCID: PMC11197691 DOI: 10.1016/j.fmre.2021.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/30/2021] [Accepted: 10/13/2021] [Indexed: 01/18/2023] Open
Abstract
Implanted biomaterials have transformed healthcare and the treatment of injury and disease, but their influence on the local immune landscape remains unclear. Here we discovered that degradation-resistant titanium-based implants establish an immunosuppressive microenvironment by recruiting myeloid cells, including monocytes, macrophages, neutrophils, and myeloid-lineage dendritic cells. Unlike normal tissues, the tissues nearby implants exhibit an chronic inflamed and immunosuppressive status characterised by myeloid-rich, T cell-exhaustion gene signature by single-cell RNA sequencing. Vitamin C treatment provides an effective strategy to rescue the immunosuppressive microenvironment, which can be used as a regular supplement to reduce the risk of malignant cell survival around the implants.
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Affiliation(s)
- Qin Fan
- Institute of Functional Nano & Soft Materials, Jiangsu Key Laboratory for Carbon-based Functional Materials and Devices, Soochow University, Suzhou 215123, China
| | - Huaxing Dai
- Institute of Functional Nano & Soft Materials, Jiangsu Key Laboratory for Carbon-based Functional Materials and Devices, Soochow University, Suzhou 215123, China
| | - Jinyu Bai
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Jialu Xu
- Institute of Functional Nano & Soft Materials, Jiangsu Key Laboratory for Carbon-based Functional Materials and Devices, Soochow University, Suzhou 215123, China
| | - Qingle Ma
- Institute of Functional Nano & Soft Materials, Jiangsu Key Laboratory for Carbon-based Functional Materials and Devices, Soochow University, Suzhou 215123, China
| | - Ziying Fei
- Institute of Functional Nano & Soft Materials, Jiangsu Key Laboratory for Carbon-based Functional Materials and Devices, Soochow University, Suzhou 215123, China
| | - Xiaozhong Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Kam W. Leong
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Chao Wang
- Institute of Functional Nano & Soft Materials, Jiangsu Key Laboratory for Carbon-based Functional Materials and Devices, Soochow University, Suzhou 215123, China
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Stricker A, Bergfeldt T, Fretwurst T, Addison O, Schmelzeisen R, Rothweiler R, Nelson K, Gross C. Impurities in commercial titanium dental implants - A mass and optical emission spectrometry elemental analysis. Dent Mater 2022; 38:1395-1403. [PMID: 35781168 DOI: 10.1016/j.dental.2022.06.028] [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] [Received: 02/19/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Titanium (Ti) is considered bioinert and is still regarded as the "gold standard" material for dental implants. However, even 'commercial pure' Ti will contain minor fractions of elemental impurities. Evidence demonstrating the release of Ti ions and particles from 'passive' implant surfaces is increasing and has been attributed to biocorrosion processes which may provoke immunological reactions. However, Ti observed in peri-implant tissues has been shown to be co-located with elements considered impurities in biomedical alloys. Accordingly, this study aimed to quantify the composition of impurities in commercial Ti dental implants. METHODS Fifteen commercial titanium dental implant systems were analyzed using inductively coupled plasma-mass spectrometry (ICP-MS) and optical emission spectrometry (ICP-OES). RESULTS The elemental composition of implants manufactured from commercially pure grades of Ti, Ti-6Al-4V, and the TiZr alloy (Roxolid) conformed to the respective ISO/ASTM standards or manufacturers´ data (TiZr/Roxolid). However, all implants investigated included exogenous metal contaminants including Ni, Cr, Sb, and Nb to a variable extent. Other contaminants detected in a fraction of implants included As and the radionuclides U-238 and Th-232. SIGNIFICANCE Although all Ti implant studies conformed with their standard compositions, potentially allergenic, noxious metals and even radionuclides were detected. Since there are differences in the degree of contamination between the implant systems, a certain impurity fraction seems technically avoidable. The clinical relevance of these findings must be further investigated, and an adaptation of industry standards should be discussed.
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Affiliation(s)
- Andres Stricker
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany.
| | - Thomas Bergfeldt
- Institute of Applied Materials - Applied Material Physics (IAM-AWP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany.
| | - Tobias Fretwurst
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany.
| | - Owen Addison
- Centre for Oral, Clinical & Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, Great Maze Pond, SE1 9RT London, UK.
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany.
| | - René Rothweiler
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany.
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany.
| | - Christian Gross
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg im Breisgau, Germany.
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