Biofilm formation on dental implants with different surface micro-topography: An in vitro study

Photocatalytic and antibacterial activity properties of Ti surface treated by femtosecond laser-a prospective solution to peri-implant disease

Laser texturing seems to be a promising technique for reducing bacterial adhesion on titanium implant surfaces. This work aims to demonstrate the possibility of obtaining a functionally orientated surface of titanium implant elements with a specific architecture with specific bacteriological and photocatalytic properties. Femtosecond laser-generated surface structures, such as laser-induced periodic surface structures (LIPSS, wrinkles), grooves, and spikes on titanium, have been characterised by XRD, Raman spectroscopy, and scanning electron microscopy (SEM). The photocatalytic activity of the titanium surfaces produced was tested based on the degradation effect of methylene blue (MB). The correlation between the photocatalytic activity of TiO2 coatings and their morphology and structure has been analysed. Features related to the size, shape, and distribution of the roughness patterns were found to influence the adhesion of the bacterial strain on different surfaces. On the laser-structurised surface, the adhesion of Escherichia coli bacteria were reduced by 80% compared to an untreated reference surface.

A Comprehensive Review of the Contemporary Methods for Enhancing Osseointegration and the Antimicrobial Properties of Titanium Dental Implants

Titanium dental implants with various restorative options are popular for replacing missing teeth due to their comfortable fit, excellent stability, natural appearance, and impressive track record in clinical settings. However, challenges such as potential issues with osseointegration, peri-implant bone loss, and peri-implantitis might lead to implant failure, causing concern for patients and dental staff. Surface modification has the potential to significantly enhance the success rate of titanium implants and meet the needs of clinical applications. This involves the application of various physical, chemical, and bioactive coatings, as well as adjustments to implant surface topography, offering significant potential for enhancing implant outcomes in terms of osseointegration and antimicrobial properties. Many surface modification methods have been employed to improve titanium implants, showcasing the diversity of approaches in this field including sandblasting, acid etching, plasma spraying, plasma immersion ion implantation, physical vapor deposition, electrophoretic deposition, electrochemical deposition, anodization, microarc oxidation, laser treatments, sol-gel method, layer-by-layer self-assembly technology, and the adsorption of biomolecules. This article provides a comprehensive overview of the surface modification methods for titanium implants to address issues with insufficient osseointegration and implant-related infections. It encompasses the physical, chemical, and biological aspects of these methods to provide researchers and dental professionals with a robust resource to aid them in their study and practical use of dental implant materials, ensuring they are thoroughly knowledgeable and well-prepared for their endeavors.

The influence of two distinct surface modification techniques on the clinical efficacy of titanium implants: A systematic review and meta-analysis

PURPOSE

To compare the effectiveness of anodized and sandblasted large-grit acid-etched surface modification implants in clinical applications.

METHODS

This systematic review has been registered at PROSPERO (CRD42023423656). A systematic search was performed using seven databases. The meta-analysis was performed using the RevMan 5.4 program and Stata 17.0 software. An analysis of the risk of bias in the included studies was conducted using the Cochrane Handbook for Systematic Reviews of Interventions and the Newcastle-Ottawa scale.

RESULTS

A comprehensive analysis of 16 studies, which collectively encompassed a total of 2768 implants, was finished. Following a five years follow-up, the meta-analysis showed that the cumulative survival rate of implants was lower in the anodized group compared to the sandblasted large-grit acid-etched group (RR, 3.47; 95 % confidence interval [CI], 1.23 to 9.81; P = 0.02). Furthermore, the anodized group and the sandblasted large-grit acid-etched group had similar marginal bone loss over the one to three years follow-up period. However, it was observed that the marginal bone loss increased at the five years follow-up period in the anodized group in comparison to the sandblasted large-grit acid-etched group (SMD, 2.98; 95 % CI, 0.91 to 5.06; P = 0.005). In terms of biological complications, plaque index, bleeding on probing, and probing pocket depth, we found no statistically significant differences between the anodized and sandblasted large-grit acid-etched group.

CONCLUSIONS

The sandblasted large-grit acid-etched group exhibited higher implants cumulative survival rate and less marginal bone loss compared to the anodized group. Moreover, both groups demonstrated similar incidences of biological complications, plaque index, bleeding on probing, and probing pocket depth, suggesting overall equivalence in these aspects.

Zirconia Dental Implant Designs and Surface Modifications: A Narrative Review

Titanium currently has a well-established position as the gold standard for manufacturing dental implants; however, it is not free of flaws. Mentions of possible soft-tissue discoloration, corrosion, and possible allergic reactions have led to the development of zirconia dental implants. Various techniques for the surface modification of titanium have been applied to increase titanium implants' ability to osseointegrate. Similarly, to achieve the best possible results, zirconia dental implants have also had their surface modified to promote proper healing and satisfactory long-term results. Despite zirconium oxide being a ceramic material, not simply a metal, there have been mentions of it being susceptible to corrosion too. In this article, we aim to review the literature available on zirconia implants, the available techniques for the surface modification of zirconia, and the effects of these techniques on zirconia's biological properties. Zirconia's biocompatibility and ability to osseointegrate appears unquestionably good. Despite some of its mechanical properties being, factually, inferior to those of titanium, the benefits seem to outweigh the drawbacks. Zirconia implants show very good success rates in clinical research. This is partially due to available methods of surface treatment, including nanotopography alterations, which allow for improved wettability, bone-to-implant contact, and osteointegration in general.

Antimicrobial Potential of Strontium-Functionalized Titanium Against Bacteria Associated With Peri-Implantitis

OBJECTIVES

To explore the antimicrobial potential of strontium (Sr)-functionalized wafers against multiple bacteria associated with per-implant infections, in both mono- and multispecies biofilms.

MATERIALS AND METHODS

The bactericidal and bacteriostatic effect of silicon wafers functionalized with a strontium titanium oxygen coating (Sr-Ti-O) or covered only with Ti (controls) against several bacteria, either grown as a mono-species or multispecies biofilms, was assessed using a bacterial viability assay and a plate counting method. Mono-species biofilms were assessed after 2 and 24 h, while the antimicrobial effect on multispecies biofilms was assessed at Days 1, 3, and 6. The impact of Sr functionalization on the total percentage of Porphyromonas gingivalis in the multispecies biofilm, using qPCR, and gingipain activity was also assessed.

RESULTS

Sr-functionalized wafers, compared to controls, were associated with statistically significant less viable cells in both mono- and multispecies tests. The number of colony forming units (CFUs) within the biofilm was significantly less in Sr-functionalized wafers, compared to control wafers, for Staphylococcus aureus at all time points of evaluation and for Escherichia coli at Day 1. Gingipain activity was less in Sr-functionalized wafers, compared to control wafers, and the qPCR showed that P. gingivalis remained below detection levels at Sr-functionalized wafers, while it consisted of 15% of the total biofilm on control wafers at Day 6.

CONCLUSION

Sr functionalization displayed promising antimicrobial potential, possessing bactericidal and bacteriostatic ability against bacteria associated with peri-implantitis grown either as mono-species or mixed in a multispecies consortium with several common oral microorganisms.

Bactericidal Effect of Different Photochemical-Based Therapy Options on Implant Surfaces-An In Vitro Study

Objectives: Photochemical systems are frequently recommended as an adjuvant treatment option in peri-implantitis therapy. The aim of the present study was to evaluate the efficacy of these treatment options, as well as a novel curcumin-based option, in a biofilm model on implants. Methods: Eighty dental implants were inoculated with an artificial biofilm of periodontal pathogens and placed in peri-implant pocket models. The following groups were analyzed: I, photodynamic therapy (PDT); II, PDT dye; III, curcumin/DMSO + laser; IV, curcumin/DMSO only; V, dimethyl sulfoxide (DMSO) only; VI, photothermal therapy (PTT); VII, PTT dye; VIII, control. After treatment, remaining bacterial loads were assessed microbiologically using quantitative real-time polymerase chain reaction analysis. Results: The PDT, PTT, and DMSO treatment methods were associated with statistically significant (p < 0.05) improvements in germ reduction in comparison with the other methods and the untreated control group. The mean percentage reductions were as follows: I (PDT) 93.9%, II (PDT dye) 62.9%, III (curcumin/DMSO + laser) 74.8%, IV (curcumin/DMSO only) 67.9%, V (DMSO) 89.4%, VI (PTT) 86.8%, and VII (PTT dye) 66.3%. Conclusions: The commercially available PDT and PTT adjuvant treatment systems were associated with the largest statistically significant reduction in periopathogenic bacteria on implant surfaces. However, activation with laser light at a suitable wavelength is necessary to achieve the bactericidal effects. The use of curcumin as a photosensitizer for 445 nm laser irradiation did not lead to any improvement in antibacterial efficacy in comparison with rinsing with DMSO solution alone.

Biomaterials science and surface engineering strategies for dental peri-implantitis management

Peri-implantitis is a bacterial infection that causes soft tissue inflammatory lesions and alveolar bone resorption, ultimately resulting in implant failure. Dental implants for clinical use barely have antibacterial properties, and bacterial colonization and biofilm formation on the dental implants are major causes of peri-implantitis. Treatment strategies such as mechanical debridement and antibiotic therapy have been used to remove dental plaque. However, it is particularly important to prevent the occurrence of peri-implantitis rather than treatment. Therefore, the current research spot has focused on improving the antibacterial properties of dental implants, such as the construction of specific micro-nano surface texture, the introduction of diverse functional coatings, or the application of materials with intrinsic antibacterial properties. The aforementioned antibacterial surfaces can be incorporated with bioactive molecules, metallic nanoparticles, or other functional components to further enhance the osteogenic properties and accelerate the healing process. In this review, we summarize the recent developments in biomaterial science and the modification strategies applied to dental implants to inhibit biofilm formation and facilitate bone-implant integration. Furthermore, we summarized the obstacles existing in the process of laboratory research to reach the clinic products, and propose corresponding directions for future developments and research perspectives, so that to provide insights into the rational design and construction of dental implants with the aim to balance antibacterial efficacy, biological safety, and osteogenic property.

The biofilm removal effect and osteogenic potential on the titanium surface by electrolytic cleaning: An in vitro comparison of electrolytic parameters and five techniques

OBJECTIVES

To determine the optimal current and time of electrolytic cleaning (EC), compare its biofilm removal effect with generic treatments and evaluate the influence of EC to surface characteristics and osteogenic potential of SLA titanium (Ti) discs.

MATERIALS AND METHODS

The six-species biofilm-covered Ti discs were placed as cathodes in physiologic saline and subjected to various current and time treatments. The residual biofilms were evaluated to determine the optimal parameters. The contaminated Ti discs were randomized and treated by rotating Ti brush; ultrasonic-scaling with metal tips; ultrasonic-scaling with PEEK tips; air-polishing and EC. The residual biofilms were compared using a lipopolysaccharide kit (LPS), scanning electron microscope (SEM), confocal laser scanning microscopy and colony-forming unit counting. Non-contaminated Ti discs were treated and characterized. The bone marrow mesenchymal stem cells (BMSCs) were cultured on treated non-contaminated Ti discs. The adhesion, proliferation, alkaline phosphatase (ALP) activity and osteocalcin level of BMSCs were assessed.

RESULTS

The parameters at 0.6A5min were considered optimal. For LPS and SEM, EC promoted a significantly greater biofilm removal than the other groups. There were no changes in the Ti discs' colour, topography, roughness and chemical elements after EC, and the electrolysis-treated Ti discs obtained a super-hydrophilic surface. EC positively impacted the proliferation and ALP activity of BMSCs, surpassing the efficacy of alternative treatments.

CONCLUSIONS

EC achieves a near-complete eradication of contaminants on the SLA surface, causes no surface damage with improved hydrophilicity, and promotes the early osteogenic response of BMSCs, which makes it a promising treatment for peri-implantitis.

Efficacy of Biofilm Removal on the Dental Implant Surface by Sodium Bicarbonate and Erythritol Powder Airflow System

OBJECTIVE

 Peri-implantitis is a common complication in implant therapy and it is one of the main contributing factors to implant failure. This can be prevented by regular maintenance with mechanical debridement. One of the recent mechanical debridement methods is air abrasion therapy using different abrasive powders. This study aimed to evaluate the two common abrasive powders of different sizes (sodium bicarbonate and erythritol) for their biofilm cleaning efficacy on dental implant surfaces.

MATERIALS AND METHODS

 In an in vitro setting, a total of 33 implants were divided into three groups: Group 1 (n =11) = no treatment; group 2 (n = 11) = air abrasion therapy treated group using a sodium bicarbonate powder (AIRFLOW Powder Classic Comfort, EMS Electro Medical Systems, Nyon, Switzerland); and group 3 (n = 11) = air abrasion therapy treated group using an erythritol powder (AIRFLOW Powder Plus, EMS Electro Medical Systems, Nyon, Switzerland). The implants in each group were subjected to biofilm formation, and group 2 and group 3 were treated with air abrasion therapy of two different powders having different sizes with the same settings. The particle sizes were sodium bicarbonate (40 µm) and erythritol (14µm). The surface characteristics of the dental implants in three groups were studied from a digital camera and under the scanning electron microscope at different magnifications. The comparison of biofilm-removal efficacy between the three groups was performed by using a one-way analysis of variance with post-hoc Dunnett's T3 test. A p-value less than 0.05 was chosen to indicate statistical significance.

RESULTS

 There were no statistical differences (p > 0.05) between the two powder-treated groups for the biofilm cleaning efficacy. However, both groups showed significantly better biofilm-cleaning efficacy than the control group (p < 0.05).

CONCLUSION

 This suggests that both powders are effective in removing biofilm from the implant surface under ideal conditions. However, there was no clear distinction between the cleaning potential of the two powders, as both performed in a similar manner.

Nanotopography and oral bacterial adhesion on titanium surfaces: in vitro and in vivo studies

The present study aimed to evaluate the influence of titanium surface nanotopography on the initial bacterial adhesion process by in vivo and in vitro study models. Titanium disks were produced and characterized according to their surface topography: machined (Ti-M), microtopography (Ti-Micro), and nanotopography (Ti-Nano). For the in vivo study, 18 subjects wore oral acrylic splints containing 2 disks from each group for 24 h (n = 36). After this period, the disks were removed from the splints and evaluated by microbial culture method, scanning electron microscopy (SEM), and qPCR for quantification of Streptococcus oralis, Actinomyces naeslundii, Fusobacterium nucleatum, as well as total bacteria. For the in vitro study, adhesion tests were performed with the species S. oralis and A. naeslundii for 24 h. Data were compared by ANOVA, with Tukey's post-test. Regarding the in vivo study, both the total aerobic and total anaerobic bacteria counts were similar among groups (p > 0.05). In qPCR, there was no difference among groups of bacteria adhered to the disks (p > 0.05), except for A. naeslundii, which was found in lower proportions in the Ti-Nano group (p < 0.05). In the SEM analysis, the groups had a similar bacterial distribution, with a predominance of cocci and few bacilli. In the in vitro study, there was no difference in the adhesion profile for S. oralis and A. naeslundii after 24 h of biofilm formation (p > 0.05). Thus, we conclude that micro- and nanotopography do not affect bacterial adhesion, considering an initial period of biofilm formation.

Influence of a D-enantiomeric peptide on the anticorrosion ability of titanium with different surface roughness against Streptococcus mutans biofilms

OBJECTIVE

To investigate the effectiveness of a d-enantiomeric antibiofilm peptide (DJK-5) on the anticorrosion ability of titanium (Ti) with different surface roughness against Streptococcus mutans biofilms.

METHODS

Commercially pure Ti disks with machined (MA, smooth) or sandblasted + acid-etched (SLA, rough) surfaces were prepared and characterized. All disks were divided into three groups: a positive control (PC) group with S. mutans, a DJK-5-treated group, and a negative control (NC) group without S. mutans. Biofilm formation and corrosion on Ti surfaces were determined by confocal laser scanning microscopy and scanning electron microscopy after 2 and 6 days, and the electrochemical properties were evaluated.

RESULTS

Ten μg/mL of DJK-5 killed 83.3 % and 87.4 % of biofilms on SLA and MA Ti surfaces, respectively after 2 days, and 72.9 % and 77.7 % after 6 days, with more bacteria surviving on SLA surfaces with higher roughness (p < 0.05). DJK-5 treatment induced less surface defects with tiny pit corrosion than PC. DJK-5 treatment when compared to PC, led to electrochemical properties more reflecting NC surfaces, including significantly less negative corrosion potential, lower corrosion current, and higher passive film resistance (p < 0.05). SLA surfaces exhibited higher current density and lower resistance than MA surfaces (p < 0.05).

CONCLUSION

DJK-5 effectively enhanced the corrosion resistance of Ti with different surface roughness while killing S. mutans biofilms, and smooth surfaces were more susceptible to peptide treatment.

CLINICAL SIGNIFICANCE

The antibiofilm peptide is promising for promoting the anticorrosion ability of Ti against biofilms, thereby preventing biofilm-related infections.

Overview of strategies to improve the antibacterial property of dental implants

The increasing number of peri-implant diseases and the unsatisfactory results of conventional treatment are causing great concern to patients and medical staff. The effective removal of plaque which is one of the key causes of peri-implant disease from the surface of implants has become one of the main problems to be solved urgently in the field of peri-implant disease prevention and treatment. In recent years, with the advancement of materials science and pharmacology, a lot of research has been conducted to enhance the implant antimicrobial properties, including the addition of antimicrobial coatings on the implant surface, the adjustment of implant surface topography, and the development of new implant materials, and significant progress has been made in various aspects. Antimicrobial materials have shown promising applications in the prevention of peri-implant diseases, but meanwhile, there are some shortcomings, which leads to the lack of clinical widespread use of antimicrobial materials. This paper summarizes the research on antimicrobial materials applied to implants in recent years and presents an outlook on the future development.

Trans-mucosal platforms for dental implants: Strategies to induce muco-integration and shield peri-implant diseases

OBJECTIVES

Trans-mucosal platforms connecting the bone-anchored implants to the prosthetic teeth are essential for the success of oral rehabilitation in implant dentistry. This region promotes a challenging environment for the successfulness of dental components due to the transitional characteristics between soft and hard tissues, the presence of bacteria, and mechanical forces. This review explored the most current approaches to modify trans-mucosal components in terms of macro-design and surface properties.

METHODS

This critical review article revised intensely the literature until July 2023 to demonstrate, discuss, and summarize the current knowledge about marketable and innovative trans-mucosal components for dental implants.

RESULTS

A large number of dental implant brands have promoted the development of several implant-abutment designs in the clinical market. The progress of abutment designs shows an optimistic reduction of bacteria colonization underlying the implant-abutment gap, although, not completely inhibited. Fundamental and preclinical studies have demonstrated promising outcomes for altered-surface properties targeting antibacterial properties and soft tissue sealing. Nanotopographies, biomimetic coatings, and antibiotic-release properties have been shown to be able to modulate, align, orient soft tissue cells, and induce a reduction in biofilm formation, suggesting superior abilities compared to the current trans-mucosal platforms available on the market.

SIGNIFICANCE

Future clinical implant-abutments show the possibility to reduce peri-implant diseases and fortify soft tissue interaction with the implant-substrate, defending the implant system from bacteria invasion. However, the absence of technologies translated to commercial stages reveals the need for findings to "bridge the gap" between scientific evidences published and applied science in the industry.

Comparison of In Vitro Biofilm Formation on Titanium and Zirconia Implants

Background

Peri-implant diseases are emerging issues in contemporary implant dentistry. As biofilms play a critical role in peri-implant diseases, the characteristic of resisting bacterial adhesion would be ideal for dental implants. The aims of the study were to compare titanium (Ti) and zirconia (Zr) implants regarding the amount of biofilm formation at different time frames and assess the distribution of biofilm on different aspects of dental implants.

Methods

Biofilm was developed on Ti and Zr dental implants with a peri-implant-related multispecies model with Streptococcus oralis, Actinomyces naeslundii, Veillonella dispar, and Porphyromonas gingivalis, for 3 and 14 days. Quantitative assessment was performed with the measurement of total bacterial viability (colony forming units, CFU/mg). Scanning electron microscopy (SEM) was used to evaluate biofilm formation on different aspects of the implants.

Results

Three-day-old biofilm on Ti implants was significantly higher than that on Zr implants (p < 0.001). The Ti and Zr groups were not significantly different for 14-day-old biofilm. SEM images demonstrated that 3-day-old biofilm on Zr implants was sparse while biofilm growth was more pronounced for 3-day-old biofilm on Ti implants and 14-day-old biofilm groups. It appeared that less biofilm formed on the valley compared to the thread top for 3-day-old biofilm on Zr implants. Differences between the valley and the thread top became indistinguishable with the development of mature biofilm.

Conclusion

While early formed biofilms show greater accumulation on Ti implants compared to Zr implants, older biofilms between the two groups are comparable. The distribution of biofilms was not uniform on different areas of implant threads during early biofilm development.

Impact of salivary contamination during implant placement with different surface characteristics in native and augmented bone: An in vivo study in sheep calvaria model

OBJECTIVES

The aim of this study was to evaluate whether salivary contamination during placement of implants with different surface characteristics affects osseointegration in native and in augmented bone areas.

MATERIALS AND METHODS

Forty eight implants with machined surface (MS) and 48 implants with moderately rough surface (RS) were tested in the calvaria of 12 sheep. At the first surgery, 64 bony critical defects were randomly created and were subsequently augmented with two materials (autogenous or bovine bone). After 5 weeks of graft healing, 8 implants were placed per sheep, in native bone and in the centre of the augmented defects. Forty eight implants were soaked with saliva before placement (contaminated group [CG]), while 48 implants were not (non-contaminated group [NCG]). Five weeks after implant placement, bone-to-implant contact (BIC) and bone material area fraction occupancy (BMAFO) were calculated histomorphometrically.

RESULTS

Saliva contamination showed a significant negative effect (p = .000) on BIC, especially in augmented areas. RS showed significant positive effect on BIC, compared to MS (p = .000), while there were no significant differences for different bone conditions (p = .103). For BMAFO, the contamination showed a significantly negative affect (p = .000), while there were no significant differences for surface characteristics (p = .322) and for bone condition (p = .538).

CONCLUSION

Saliva contamination during dental implant placement has a negative effect on osseointegration in augmented areas. Moderately rough surface has a possible advantage in the aspect of initial bone to implant contact. However, it seems to be advisable to avoid saliva contamination especially for implants placed in augmented bone areas.

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

The improvement of Ag nanoparticles (AgNPs), in particular, loaded titania nanotubes, includes not only the antibacterial effect but also balancing the side effects from the antibacterial effect and osteogenesis properties, which can lead to an increased success rate of implants. Herein, based on the various needs of the graft to inhibit bacteria at different stages in vivo, we used a special osteogenic honeycomb-like "large tube over small tube" double-layered nanotube structure and created ultra-small-sized silver nanoparticles uniformly loaded on the surface and the interior of double-layer nanotubes by an optimized sputter coating method to ensure the time-dependent controllable release of antibacterial Ag ions from grafts and achieve the balance of the antibacterial effect and osteogenesis properties. The release of Ag⁺ from DNT-Ag8 was determined by inductively coupled plasma spectrometry. The release rate of Ag was slow; it was 30% on the first day and plateaued by the 19th day. Porphyromonas gingivalis adhesion and live bacteria were less abundant on the surface of DNT-Ag8, reaching an antibacterial efficiency of 55.6% in vitro. DNT-Ag8 shows a significantly higher antibacterial effect in a rat model infected with Staphylococcus aureus. An in vitro study demonstrated that DNT-Ag8 had no adverse effects on the adhesion, viability, proliferation, ALP staining, or activity assays of rat BMSCs. In contrast, it increased the expression of osteogenic genes. In vivo, DNT-Ag8 promoted bone-implant osseointegration in a beagle mandibular tooth loss model. This study demonstrated that the uniform loading of small-diameter silver nanoparticles using a honeycomb bilayer nanotube template structure is a promising method for modifying titanium surfaces to improve both bacteriostasis and osseointegration.

The Antimicrobial Activity of Curcumin and Xanthohumol on Bacterial Biofilms Developed over Dental Implant Surfaces

In search for natural products with antimicrobial properties for use in the prevention and treatment of peri-implantitis, the purpose of this investigation was to evaluate the antimicrobial activity of curcumin and xanthohumol, using an in vitro multi-species dynamic biofilm model including Streptococcus oralis, Actinomyces naeslundii, Veillonella parvula, Fusobacterium nucleatum, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. The antimicrobial activities of curcumin (5 mM) and xanthohumol (100 μM) extracts, and the respective controls, were evaluated with 72-h biofilms formed over dental implants by their submersion for 60 seconds. The evaluation was assessed by quantitative polymerase chain reaction (qPCR), confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). For the data analysis, comparisons were tested applying ANOVA tests with post-hoc Bonferroni corrections to evaluate the antimicrobial activity of both extracts. With qPCR, statistically significant reductions in bacterial counts were observed for curcumin and xanthohumol, when compared to the negative control. The results with CLSM and SEM were consistent with those reported with qPCR. It was concluded that both curcumin and xanthohumol have demonstrated antimicrobial activity against the six bacterial species included in the dynamic in vitro biofilm model used.

One-Piece Zirconia Oral Implants for the Support of Three-Unit Fixed Dental Prostheses: Three-Year Results from a Prospective Case Series

The objective was to investigate the clinical and radiological outcome of one-piece zirconia oral implants to support three-unit fixed dental prostheses (FDP) after three years in function. Twenty-seven patients were treated with a total of 54 implants in a one-stage surgery and immediate provisionalization. Standardized radiographs were taken at implant placement, after one year and after three years, to evaluate peri-implant bone loss. Soft-tissue parameters were also assessed. Linear mixed regression models as well as Wilcoxon Signed Rank tests were used for analyzing differences between groups and time points (p < 0.05). At the three-year evaluation, one implant was lost, resulting in a cumulative survival rate of 98.1%. The mean marginal bone loss amounted to 2.16 mm. An implant success grade I of 52% (bone loss of ≤2 mm) and success grade II of 61% (bone loss of ≤3 mm) were achieved. None of the evaluated baseline parameters affected bone loss. The survival rate of the zirconia implants was comparable to market-available titanium implants. However, an increased marginal bone loss was observed with a high peri-implantitis incidence and a resulting low implant success rate.

How Porphyromonas gingivalis Navigate the Map: The Effect of Surface Topography on the Adhesion of Porphyromonas gingivalis on Biomaterials

The main purpose of this study is to develop an understanding of how Porphyromonas gingivalis responds to subperiosteal implant surface topography. A literature review was drawn from various electronic databases from 2000 to 2021. The two main keywords used were "Porphyromonas gingivalis" and "Surface Topography". We excluded all reviews and or meta-analysis articles, articles not published in English, and articles with no surface characterization process or average surface roughness (Ra) value. A total of 26 selected publications were then included in this study. All research included showed the effect of topography on Porphyromonas gingivalis to various degrees. It was found that topography features such as size and shape affected Porphyromonas gingivalis adhesion to subperiosteal implant materials. In general, a smaller Ra value reduces Porphyromonas gingivalis regardless of the type of materials, with a threshold of 0.3 µm for titanium.

Novel Titanium Nanospike Structure Using Low-Energy Helium Ion Bombardment for the Transgingival Part of a Dental Implant

AIM(S)

The aim of the study was to fabricate a nanospike surface on a titanium alloy surface using a newly established method of low-energy helium ion bombardment. Various methods to achieve nanospike formation on titanium have been introduced recently, and their antibacterial properties have been mainly investigated with respect to Escherichia coli and Staphylococcus aureus. Oral pathogens such as Porphyromonas gingivalis play an important role in the development of peri-implantitis. For that reason, the antibacterial properties of the novel, nanostructured titanium surface against P. gingivalis were assessed, and a possible effect on the viability of gingival fibroblasts was evaluated.

MATERIALS AND METHODS

Helium sputtering was employed for developing titanium surfaces with nanospikes of 500 nm (ND) in height; commercially available smooth-machined (MD) and sandblasted and acid-etched titanium disks (SLA) were used as controls. Surface structure characterization was performed through scanning electron microscopy (SEM) and atomic force microscopy (AFM). Following incubation with P. gingivalis, antibacterial properties were determined via conventional culturing and SEM. Additionally, the viability of human gingival fibroblasts (HGFs) was tested through MTT assay, and cell morphology was assessed through SEM.

RESULTS

SEM images confirmed the successful establishment of a nanospike surface with required heights, albeit with heterogeneity. AFM images of the 500 nm nanospike surface revealed that the roughness is dominated by large-scale hills and valleys. For frame sizes of 5 × 5 μm and smaller, the average roughness is dominated by the height of the titanium spikes. ND successfully induces dysmorphisms within P. gingivalis cultures following the incubation period, while conventional culturing reveals a 17% and 20% reduction for ND compared to MD and SLA, respectively. Moreover, the nanospike surfaces did not affect the viability of human growth fibroblasts despite their sharp surface.

CONCLUSION(S)

This study successfully developed a novel titanium-nanospike-based structuration technique for titanium surfaces. In addition, the nanospikes did not hinder gingival fibroblast viability. Enhanced antimicrobial effects for such a novel nanospike-based resurfacing technique can be achieved through further optimizations for nanospike spacing and height parameters.

Physicochemical Properties of Dentine Subjected to Microabrasive Blasting and Its Influence on Bonding to Self-Adhesive Prosthetic Cement in Shear Bond Strength Test: An In Vitro Study

The aim of this in vitro study was to assess the influence of microabrasive blasting on the physicochemical properties of dentine and shear bond strength (SBS) of self-adhesive resin cement (Maxcem Elite, Kerr, Orange, CA, USA) bonded to the dentine surface. Ninety cylindrical specimens with exposed dentine of human teeth were prepared and divided into three randomized, parallel sample sets A, B, and C. Groups B and C were subjected to abrasive blasting using a micro-sandblasting device (Microetcher IIa, Danville Materials, Carlsbad, CA, USA) with two gradations of Al₂O₃ abrasives (Group B, abrasion with a gradation of 50 μm; group C, abrasion with a gradation of 27 μm). SEM imaging, profilometry, chemical composition analysis, contact angle measurements, surface free energy, and SBS tests were performed. The resulting data were statistically analyzed using the Statistica software (ver. 13.3, Tibco Software Inc., Palo Alto, CA, USA). Microabrasive blasting caused changes in surface topography, structural features, and the connection strength between the dentin surface and self-adhesive prosthetic cement. Air microabrasion through the multifactorial positive reorganization of the treated surface of dentine is recommended as a pretreatment method in fixed prosthodontics adhesive cementation protocols.

Antimicrobial and Antibiofilm Coating of Dental Implants—Past and New Perspectives

Regarded as one of the best solutions to replace missing teeth in the oral cavity, dental implants have been the focus of plenty of studies and research in the past few years. Antimicrobial coatings are a promising solution to control and prevent bacterial infections that compromise the success of dental implants. In the last few years, new materials that prevent biofilm adhesion to the surface of titanium implants have been reported, ranging from improved methods to already established coating surfaces. The purpose of this review is to present the developed antimicrobial and antibiofilm coatings that may have the potential to reduce bacterial infections and improve the success rate of titanium dental implants. All referred coating surfaces showed high antimicrobial properties with effectiveness in biofilm control, while maintaining implant biocompatibility. We expect that by combining the use of oligonucleotide probes as a covering material with novel peri-implant adjuvant therapies, we will be able to avoid the downsides of other covering materials (such as antibiotic resistance), prevent bacterial infections, and raise the success rate of dental implants. The existing knowledge on the optimal coating material for dental implants is limited, and further research is needed before more definitive conclusions can be drawn.

A Bacteria and Cell Repellent Zwitterionic Polymer Coating on Titanium Base Substrates towards Smart Implant Devices

Biofouling and biofilm formation on implant surfaces are serious issues that more than often lead to inflammatory reactions and the necessity of lengthy post-operation treatments or the removal of the implant, thus entailing a protracted healing process. This issue may be tackled with a biocompatible polymeric coating that at the same time prevents biofouling. In this work, oxygen plasma-activated silanized titanium substrates are coated with poly(sulfobetaine methacrylate), a zwitterionic antibiofouling polymer, using photopolymerization. The characterization of polymer films includes FT-IR, AFM, and adhesion strength measurements, where adhesion strength is analyzed using a cylindrical flat punch indenter and water contact angle (WCA) measurements. Both cytotoxicity analysis with primary human fibroblasts and fluorescence microscopy with fibroblasts and plaque bacteria are also performed is this work, with each procedure including seeding on coated and control surfaces. The film morphology obtained by the AFM shows a fine structure akin to nanoropes. The coatings can resist ultrasonic and sterilization treatments. The adhesion strength properties substantially increase when the films are soaked in 0.51 M of NaCl prior to testing when compared to deionized water. The coatings are superhydrophilic with a WCA of 10° that increases to 15° after dry aging. The viability of fibroblasts in the presence of coated substrates is comparable to that of bare titanium. When in direct contact with fibroblasts or bacteria, marginal adhesion for both species occurs on coating imperfections. Because photopolymerization can easily be adapted to surface patterning, smart devices that promote both osseointegration (in non-coated areas) and prevent cell overgrowth and biofilm formation (in coated areas) demonstrate practical potential.

The Impact of Dental Implant Surface Modifications on Osseointegration and Biofilm Formation

Implant surface design has evolved to meet oral rehabilitation challenges in both healthy and compromised bone. For example, to conquer the most common dental implant-related complications, peri-implantitis, and subsequent implant loss, implant surfaces have been modified to introduce desired properties to a dental implant and thus increase the implant success rate and expand their indications. Until now, a diversity of implant surface modifications, including different physical, chemical, and biological techniques, have been applied to a broad range of materials, such as titanium, zirconia, and polyether ether ketone, to achieve these goals. Ideal modifications enhance the interaction between the implant's surface and its surrounding bone which will facilitate osseointegration while minimizing the bacterial colonization to reduce the risk of biofilm formation. This review article aims to comprehensively discuss currently available implant surface modifications commonly used in implantology in terms of their impact on osseointegration and biofilm formation, which is critical for clinicians to choose the most suitable materials to improve the success and survival of implantation.

Effects of toothbrush abrasion on surface and antibacterial properties of hydroxyapatite-tryptophan complex with gray titania

Photocatalysts have attracted attention in the medical field for their antibacterial effects. However, typical photocatalysts are activated by ultraviolet rays, which may have adverse effects. Therefore, we focused on a new photocatalyst that is activated by visible light, hydroxyapatite (HAp), and amino acid complex with gray titania, and evaluated its antibacterial effects against Porphyromonas gingivalis and effect by toothbrushing. The test sample was a titanium alloy substrate, and four surface treatments were applied: (1) substrate only, (2) substrate with HAp complex, (3) substrate with HAp complex with gray titania, and (4) HAp-tryptophan complex with gray titania (TR). These surface treatments were evaluated with or without toothbrushing (8 total groups). Surface roughness (Sa), fluorescent X-ray analysis (XRF), and scanning electron microscopy (SEM) were used to evaluate surface properties. To investigate antibacterial effects, each sample was seeded with P. gingivalis, irradiated with red light, and total viable bacterial count was determined. For Sa measurement, TR showed no significant difference after toothbrushing. However, in XRF and SEM observation, TR exhibited peeling of the applied coating after toothbrushing. In the antibacterial test, TR showed a decrease in P. gingivalis under no toothbrushing condition. Conversely, with toothbrushing, the TR coating appeared to peel. However, no significant difference in P. gingivalis count was observed among all groups. HAp-tryptophan complex with gray titania coating showed an antibacterial effect against P. gingivalis when irradiated with visible light. However, toothbrushing can result in coat peeling and consequently reduce the antibacterial effect.

Peri-implantitis is not periodontitis: Scientific discoveries shed light on microbiome-biomaterial interactions that may determine disease phenotype

Peri-implantitis is an immune-mediated biological complication that is attributed to bacterial biofilms on the implant surface. As both periodontitis and peri-implantitis have similar inflammatory phenotypes when assessed cross-sectionally, treatment protocols for peri-implantitis were modeled according to those used for periodontitis. However, lack of efficacy of antimicrobial treatments targeting periodontal pathogens coupled with recent discoveries from open-ended microbial investigation studies create a heightened need to revisit the pathogenesis of peri-implantitis compared with that of periodontitis. The tale of biofilm formation on intraoral solid surfaces begins with pellicle formation, which supports initial bacterial adhesion. The differences between implant- and tooth-bound biofilms appear as early as bacterial adhesion commences. The electrostatic forces and ionic bonding that drive initial bacterial adhesion are fundamentally different in the presence of titanium dioxide or other implant alloys vs mineralized organic hydroxyapatite, respectively. Moreover, the interaction between metal surfaces and the oral environment leads to the release of implant degradation products into the peri-implant sulcus, which exposes the microbiota to increased environmental stress and may alter immune responses to bacteria. Clinically, biofilms found in peri-implantitis are resistant to beta-lactam antibiotics, which are effective against periodontal communities even as monotherapies and demonstrate a composition different from that of biofilms found in periodontitis; these facts strongly suggest that a new model of peri-implant infection is required.

Relevance of Biofilm Models in Periodontal Research: From Static to Dynamic Systems

Microbial biofilm modeling has improved in sophistication and scope, although only a limited number of standardized protocols are available. This review presents an example of a biofilm model, along with its evolution and application in studying periodontal and peri-implant diseases. In 2011, the ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) research group at the University Complutense of Madrid developed an in vitro biofilm static model using representative bacteria from the subgingival microbiota, demonstrating a pattern of bacterial colonization and maturation similar to in vivo subgingival biofilms. When the model and its methodology were standardized, the ETEP research group employed the validated in vitro biofilm model for testing in different applications. The evolution of this model is described in this manuscript, from the mere observation of biofilm growth and maturation on static models on hydroxyapatite or titanium discs, to the evaluation of the impact of dental implant surface composition and micro-structure using the dynamic biofilm model. This evolution was based on reproducing the ideal microenvironmental conditions for bacterial growth within a bioreactor and reaching the target surfaces using the fluid dynamics mimicking the salivary flow. The development of this relevant biofilm model has become a powerful tool to study the essential processes that regulate the formation and maturation of these important microbial communities, as well as their behavior when exposed to different antimicrobial compounds.

Novel technique using cold atmospheric plasma coupled with air-polishing for the treatment of titanium discs grown with biofilm: An in-vitro study

OBJECTIVES

The aim of the present study was to assess the decontamination efficacy and titanium surface alterations of erythritol based air abrasion (AA) and cold atmospheric plasma (CAP) targeting a human complex biofilm.

METHODS

Saliva collected from a peri-implantitis patient was used to develop in vitro human biofilm over titanium discs with machined (group A) and moderately rough (group B) surface. The discs were treated with AA, experimental CAP or a combination of both treatments (COM). The amount of biofilm on the discs was measured by crystal violet (CV). Surface features and roughness before and after treatment were assessed by SEM and laser profilometry, respectively. The data were statistically analyzed using Kruskal Wallis followed by Dunn's multiple comparison test after being checked for normality by Shapiro-Wilk test.

RESULTS

All the discs in group A performed better to treatments compared to group B. In both groups, CV data showed significantly lower amount of biofilm after AA treatment compared to CAP (p<0.05). Cleaning efficacy revealed relevant decontamination of both the surfaces following AA and COM treatments and almost complete biofilm removal after AA application on group A (99.92%). SEM analysis demonstrated no post-treatment alterations on the discs and laser profilometry did not show statistically significant changes in S_a and S_dr values.

SIGNIFICANCE

Decontamination with AA delivering erythritol with or without CAP is highly effective in biofilm removal from different titanium surfaces. All the tested treatments, including CAP showed no noticeable alterations of the titanium discs surface features. Further in vivo studies are necessary to understand the potential of CAP technology in implant surface decontamination.

How microbes read the map: Effects of implant topography on bacterial adhesion and biofilm formation

Microbes have remarkable capabilities to attach to the surface of implanted medical devices and form biofilms that adversely impact device function and increase the risk of multidrug-resistant infections. The physicochemical properties of biomaterials have long been known to play an important role in biofilm formation. More recently, a series of discoveries in the natural world have stimulated great interest in the use of 3D surface topography to engineer antifouling materials that resist bacterial colonization. There is also increasing evidence that some medical device surface topographies, such as those designed for tissue integration, may unintentionally promote microbial attachment. Despite a number of reviews on surface topography and biofilm control, there is a missing link between how bacteria sense and respond to 3D surface topographies and the rational design of antifouling materials. Motivated by this gap, we present a review of how bacteria interact with surface topographies, and what can be learned from current laboratory studies of microbial adhesion and biofilm formation on specific topographic features and medical devices. We also address specific biocompatibility considerations and discuss how to improve the assessment of the anti-biofilm performance of topographic surfaces. We conclude that 3D surface topography, whether intended or unintended, is an important consideration in the rational design of safe medical devices. Future research on next-generation smart antifouling materials could benefit from a greater focus on translation to real-world applications.

Ultrastructural changes of smooth and rough titanium implant surfaces induced by metal and plastic periodontal probes

Objectives

To determine the ultrastructural changes of titanium surfaces of dental implants induced by the tip of periodontal probes.

Materials and methods

A total of 40 samples of smooth and rough surfaces of titanium implants were randomly assigned for the treatment with metal or plastic periodontal probes under application angles of 20° and 60°. Titanium surfaces have been evaluated with CLSM prior and following to experimental probing determining various standardized 2D and 3D roughness parameters.

Results

The average profile and surface roughness (Ra and Sa) showed no significant difference between treated and untreated samples on smooth and rough surface areas irrespective of the probe material. On smooth surfaces several amplitude roughness parameters were increased with metal probes but reached significance only for Rp (p = 0.007). Rough surface parts showed a slight but not significant reduction of roughness following to the contact with metal probes. The surface roughness remained almost unchanged on smooth and rough implant surfaces using plastic probes. The surface roughness on implant surfaces was not dependent on the application angle irrespective of the probe material.

Conclusion

Probing of titanium implants with metal probes and even less with plastic probes causes only minor changes of the surface roughness. The clinical significance of these changes remains to be elucidated.

Clinical relevance

Using plastic probes for the clinical evaluation of the peri-implant sulcus might avoid ultrastructural changes to titanium implant surfaces.

Peri-implant soft tissue status and crestal bone loss around immediately-loaded narrow-diameter implants placed in cigarette-smokers: 6-year follow-up results

BACKGROUND

It is hypothesized that in the long-term, soft tissue inflammation (reflected by increased scores of peri-implant probing-depth [PD]) and crestal bone loss (CBL) is higher in cigarette-smoker than nonsmokers with narrow diameter implants (NDIs).

PURPOSE

The aim of the present 6-years' follow-up clinical observational study was to compare the peri-implant soft tissue inflammatory parameters (plaque index [PI], gingival index [GI], and PD) and CBL around immediately-loaded NDIs placed in cigarette-smokers and nonsmokers.

MATERIALS AND METHODS

In all groups, peri-implant GI, PI and PD were measured on six sites (distolingual/palatal, mesiolingual/palatal mesiobuccal, distobuccal, midlingual/palatal, and midbuccal) per implant. The CBL was gauged on digital bitewing x-rays, which were standardized using the long cone paralleling technique. CBL was demarcated as the vertical distance from 2 mm below the implant-abutment connection to the most crestally-positioned alveolar bone.

RESULTS

All study-participants were male. Twenty-six cigarette smokers and twenty-five nonsmokers were included. The mean age of cigarette-smokers and nonsmokers was 45.5 ± 10.3 and 47.4 ± 9.4 years, respectively. Cigarette-smokers had a smoking history of 10.6 ± 0.4 pack years. Family history of tobacco usage was more often reported by cigarette-smokers (57.7%) than nonsmokers (20%). All cigarette-smokers and nonsmokers were aware that smoking is a risk-factor of loss of implant. Three (11.5%) of cigarette-smokers reported that they have attempted to quit smoking and 76.9% of cigarette-smokers (n = 20) reported that they had no intention to quit smoking in the future. The peri-implant P-I (P < .01), PD (P < .01) and mesial (P < .01), and distal (P < .01) CBL were significantly high in cigarette-smokers compared with nonsmokers. There was no statistically significant difference in GI among the groups.

CONCLUSION

Cigarette-smoking enhances peri-implant soft tissue inflammation and increases CBL around immediately-loaded NDIs.

Biocorrosion of pure and SLA titanium surfaces in the presence of Porphyromonas gingivalis and its effects on osteoblast behavior

Objective: The study aims to investigate the biocorrosion behavior of Porphyromonas gingivalis on pure and SLA titanium surfaces and its effects on surface characteristics and osteoblast behavior. Methods: Pure and SLA titanium specimens were immersed in culture medium with P. gingivalis and incubated for 7 days. P. gingivalis colonization on the pure and SLA titanium surfaces was observed by scanning electron microscopy (SEM). The pure and SLA titanium surface characteristics were analyzed via X-ray photoelectron spectroscopy (XPS), surface roughness and surface wettability. The corrosion behaviors of pure and SLA titanium specimens were evaluated by electrochemical corrosion test. The osteoblast behavior of MC3T3-E1 cells on the pure and SLA titanium surfaces after P. gingivalis colonization was investigated by cell adhesion and western blot assays. Results: P. gingivalis colonized on the pure and SLA titanium surfaces was observed by SEM. The XPS analysis demonstrated reductions in the relative levels of titanium and oxygen and obvious reductions of dominant titanium dioxide (TiO₂) on both titanium surfaces after immersing the metal in P. gingivalis culture. In addition, their roughness and wettability were changed. Correspondingly, the electrochemical corrosion test results revealed significant decreases in the corrosion resistance and increases in the corrosion rate of the pure and SLA titanium specimens after immersion in P. gingivalis culture. The results of the in vitro study showed that the pre-corroded pure and SLA titanium surfaces by P. gingivalis exhibited lower osteocompatibility and down-regulated the adhesion, spreading and osteogenic differentiation abilities of MC3T3-E1 cells. Conclusions: P. gingivalis was able to colonize on the pure and SLA titanium surfaces and weaken their surface properties, especially a decrease in the protective TiO₂ film, which induced the biocorrosion and further negatively affected the osteoblast behavior.

The study demonstrated that P. gingivalis could colonize on pure and SLA titanium surfaces and weaken their surface properties, especially the protective TiO₂ film, which induced the biocorrosion and further negatively affected osteoblast behavior.

Antibacterial Activity and Impact of Different Antiseptics on Biofilm-Contaminated Implant Surfaces

Several antiseptic agents have been proposed for the treatment of peri-implantitis as a complementary therapeutic strategy in addition to mechanical devices. The aim of this study was to compare six different antiseptics, as well as alternative formulations of the same chemical agent, with respect to their decontamination efficacy and impact on chemical properties of the implant surface. Titanium disks with a micro-rough surface, previously contaminated with Porphyromonas gingivalis and Streptococcus mutans biofilms, were treated for 2 min with different antiseptics (liquid sodium hypochlorite 5.25%, gel sodium hypochlorite 5.25%, liquid chlorhexidine 0.2%, gel chlorhexidine 1%, gel citric acid 40%, and gel orthophosphoric acid 37%) or sterile saline solution (control) and their antibacterial activity as well as their ability to remove biofilm were assessed by viable bacterial count and scanning electron microscopy, respectively. Spectroscopic analysis was also performed on non-contaminated disks after exposure to the antiseptics, in order to detect any change in the elemental composition of the titanium surface. All the antimicrobial formulations examined were effective against P. gingivalis and S. mutans biofilms. SEM analysis revealed however that liquid sodium hypochlorite 5.25% was more effective in dissolving biofilm residues. Spectroscopic analysis detected traces of the antiseptics, probably due to insufficient rinsing of the titanium surfaces. In conclusion, since gel formulations of these antiseptic agents possessed a similar antibacterial activity to the liquid formulations, these may be proposed as alternative treatments given their properties to avoid overflows and increase contact time without significant side effects on the bone.

Effect of Novel Micro-Arc Oxidation Implant Material on Preventing Peri-Implantitis

Dental implants occasionally fail for many reasons, especially peri-implantitis. The adhesion of bacteria to the surface of titanium is the initial factor in peri-implantitis. Therefore, the aim of this study was to assess the effect of a novel micro-arc oxidation (MAO) titanium on bacteria inhibition and regulation through periodontitis, and on a healthy saliva-derived biofilm, in vitro. MAO, sandblasting and acid etching (SLA), machined titanium and plasma-sprayed hydroxyapatite (HA) were selected for further study. The metabolic activity and biomass accumulation were tested using MTT (3-(4,5-Dimethyl-thiazol-2-yl)-2,5-diphenyltetrazolium bromide) and crystal violet assay after 24 h of anaerobic incubation. The structure was determined by scanning electron microscopy (SEM) and live/dead staining. Moreover, 16S rDNA sequencing was used to assess the microbial community. The results showed that biofilms on MAO were thinner compared to HA and SLA. In the periodontitis group, the biofilm accumulation and metabolic activity reached the highest levels in the HA group (p < 0.05); MAO titanium had the smallest biofilm accumulation and higher live/dead ratio; and the relative abundance of Lactobacillus in the SLA, HA and MAO groups increased significantly compared to the machined group (p < 0.05). In the healthy group, the relative abundance of Lactobacillus in the MAO group increased significantly compared to the other three groups (p < 0.05); the amount and metabolism activity of bacteria in the MAO group was lower (p < 0.05); MAO titanium had the least biofilm accumulation and a higher live/dead ratio. In conclusion, the novel MAO titanium had the ability to combat peri-implantitis by inhibiting the biofilm and regulating the microbial ecosystem to healthier conditions.