Review on Surface Treatment for Implant Infection via Gentamicin and Antibiotic Releasing Coatings

Process Development of a Generative Method for Partial and Controlled Integration of Active Substances into Open-Porous Matrix Structures

A special generative manufacturing (AM) process was developed for the partial integration of active ingredients into open-porous matrix structures. A mixture of a silver-containing solution as an antibacterial material with an alginate hydrogel as a carrier system was produced as the active ingredient. The AM process developed was used to introduce the active ingredient solution into an open-porous niobium containing a β-titanium matrix structure, thus creating a reproducible active ingredient delivery system. The matrix structure had already been produced in a separate AM process by means of selective laser melting (SLM). The main advantage of this process is the ability to control porosity with high precision. To determine optimal surface conditions for the integration of active ingredients into the matrix structure, different surface conditions of the titanium substrate were tested for their impact on wetting behaviour of a silver-containing hydrogel solution. The solution-substrate contact angle was measured and evaluated to determine the most favourable surface condition. To develop the generative manufacturing process, an FDM printer underwent modifications that permitted partial application of the drug solution to the structure in accordance with the bioprinting principle. The modified process enabled flexible control and programming of both the position and volume of the applied drug. Furthermore, the process was able to fill up to 95% of the titanium matrix body pore volume used. The customised application of drug carriers onto implants as a drug delivery system can be achieved via the developed process, providing an alternative to established methods like dip coating that lack this capability.

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.

Prolonged Antibacterial Activity in Tannic Acid-Iron Complexed Chitosan Films for Medical Device Applications

Healthcare-associated infections (HAIs) represent a global burden, leading to significant mortality and generating financial costs. One important cause of HAIs is the microbiological contamination of implantable medical devices. In this context, a novel antimicrobial drug-eluting system, based on chitosan and loaded with gentamicin, a broad-spectrum antibiotic, was developed. The effects of the addition of tannic acid and different FeSO₄ concentrations on the loaded antibiotic release were evaluated. The properties of the films were assessed in terms of thickness, swelling, mass loss and wettability. The films' surface composition was characterized by X-ray photoelectron spectroscopy and Fourier-transform infrared spectroscopy. The antibiotic release in phosphate buffer saline was quantified by high-performance liquid chromatography-mass spectrometry, and the antibacterial activity was evaluated. Hemolysis and cytotoxicity were also assessed. The results showed that the addition of tannic acid and iron decreased the swelling degree and degradation due to strong interactions between the different components, thus impacting gentamicin release for up to 35 days. In conclusion, this study presents a novel strategy to produce low-cost and biocompatible antimicrobial drug-eluting systems with sustained and prolonged antibacterial activity over more than a month.

Antimicrobial Natural Hydrogels in Biomedicine: Properties, Applications, and Challenges-A Concise Review

Natural hydrogels are widely used as biomedical materials in many areas, including drug delivery, tissue scaffolds, and particularly wound dressings, where they can act as an antimicrobial factor lowering the risk of microbial infections, which are serious health problems, especially with respect to wound healing. In this review article, a number of promising strategies in the development of hydrogels with biocidal properties, particularly those originating from natural polymers, are briefly summarized and concisely discussed. Common strategies to design and fabricate hydrogels with intrinsic or stimuli-triggered antibacterial activity are exemplified, and the mechanisms lying behind these properties are also discussed. Finally, practical antibacterial applications are also considered while discussing the current challenges and perspectives.

Recent Advancements in Metallic Drug-Eluting Implants

Over the past decade, metallic drug-eluting implants have gained significance in orthopedic and dental applications for controlled drug release, specifically for preventing infection associated with implants. Recent studies showed that metallic implants loaded with drugs were substituted for conventional bare metal implants to achieve sustained and controlled drug release, resulting in a desired local therapeutic concentration. A number of secondary features can be provided by the incorporated active molecules, including the promotion of osteoconduction and angiogenesis, the inhibition of bacterial invasion, and the modulation of host body reaction. This paper reviews recent trends in the development of the metallic drug-eluting implants with various drug delivery systems in the past three years. There are various types of drug-eluting implants that have been developed to meet this purpose, depending on the drug or agents that have been loaded on them. These include anti-inflammatory drugs, antibiotics agents, growth factors, and anti-resorptive drugs.

Metabolic Conditions and Peri-Implantitis

Dental implants to replace lost teeth are a common dentistry practice nowadays. Titanium dental implants display a high success rate and improved safety profile. Nevertheless, there is an increasing peri-implantitis (PI), an inflammatory disease associated with polymicrobial infection that adversely affects the hard and soft tissues around the implant. The present review highlights the contribution of different metabolic conditions to PI. The considerations of both local and systemic metabolic conditions are crucial for planning successful dental implant procedures and during the treatment course of PI. Un- or undertreated PI can lead to permanent jaw bone suffering and dental implant losses. The common mediators of PI are inflammation and oxidative stress, which are also the key mediators of most systemic metabolic disorders. Chronic periodontitis, low-grade tissue inflammation, and increased oxidative stress raise the incidence of PI and the underlying systemic metabolic conditions, such as obesity, diabetes mellitus, or harmful lifestyle factors (cigarette smoking, etc.). Using dental biomaterials with antimicrobial effects could partly solve the problem of pathogenic microbial contamination and local inflammation. With local dentistry considering factors, including oral microbiota and implant quality control, the inclusion of the underlying systemic metabolic conditions into the pre-procedure planning and during the treatment course should improve the chances of successful outcomes.

Antibacterial Coatings for Titanium Implants: Recent Trends and Future Perspectives

Titanium and its alloys are widely used as implant materials for biomedical devices owing to their high mechanical strength, biocompatibility, and corrosion resistance. However, there is a significant rise in implant-associated infections (IAIs) leading to revision surgeries, which are more complicated than the original replacement surgery. To reduce the risk of infections, numerous antibacterial agents, e.g., bioactive compounds, metal ions, nanoparticles, antimicrobial peptides, polymers, etc., have been incorporated on the surface of the titanium implant. Various coating methods and surface modification techniques, e.g., micro-arc oxidation (MAO), layer-by-layer (LbL) assembly, plasma electrolytic oxidation (PEO), anodization, magnetron sputtering, and spin coating, are exploited in the race to create a biocompatible, antibacterial titanium implant surface that can simultaneously promote tissue integration around the implant. The nature and surface morphology of implant coatings play an important role in bacterial inhibition and drug delivery. Surface modification of titanium implants with nanostructured materials, such as titanium nanotubes, enhances bone regeneration. Antimicrobial peptides loaded with antibiotics help to achieve sustained drug release and reduce the risk of antibiotic resistance. Additive manufacturing of patient-specific porous titanium implants will have a clear future direction in the development of antimicrobial titanium implants. In this review, a brief overview of the different types of coatings that are used to prevent implant-associated infections and the applications of 3D printing in the development of antibacterial titanium implants is presented.

Advancements in antimicrobial nanoscale materials and self-assembling systems

Antimicrobial resistance is directly responsible for more deaths per year than either HIV/AIDS or malaria and is predicted to incur a cumulative societal financial burden of at least $100 trillion between 2014 and 2050. Already heralded as one of the greatest threats to human health, the onset of the coronavirus pandemic has accelerated the prevalence of antimicrobial resistant bacterial infections due to factors including increased global antibiotic/antimicrobial use. Thus an urgent need for novel therapeutics to combat what some have termed the 'silent pandemic' is evident. This review acts as a repository of research and an overview of the novel therapeutic strategies being developed to overcome antimicrobial resistance, with a focus on self-assembling systems and nanoscale materials. The fundamental mechanisms of action, as well as the key advantages and disadvantages of each system are discussed, and attention is drawn to key examples within each field. As a result, this review provides a guide to the further design and development of antimicrobial systems, and outlines the interdisciplinary techniques required to translate this fundamental research towards the clinic.

Biocompatibility of 3D-printed PLA, PEEK and PETG: Adhesion of Bone Marrow and Peritoneal Lavage Cells

Samples in the form of cylindrical plates, additively manufactured using the fused deposition modelling (or filament freeform fabrication, FDM/FFF) technology from polylactide (PLA), polyethylene terephthalate glycol (PETG) and polyetheretherketone (PEEK), were studied in series of in-vitro experiments on the adhesion of rat bone-marrow cells and rat peritoneal cells. Methods of estimation of the absolute number of cells and polymer samples’ mass change were used for the evaluation of cells adhesion, followed by the evaluation of cell-culture supernatants. The results of experiments for both types of cells demonstrated a statistically significant change in the absolute number of cells (variation from 44 to 119%) and the weight of the polymer samples (variation from 0.61 to 2.18%), depending on roughness of sample surface, controlled by a nozzle diameter of a 3D printer as well as printing layer height. It was found that more cells adhere to PLA samples with a larger nozzle diameter and layer height. For PETG samples, the results did not show a clear relationship between cell adhesion and printing parameters. For PEEK samples, on the contrary, adhesion to samples printed with a lower nozzle diameter (higher resolution) is better than to samples printed with a larger nozzle diameter (lower resolution). The difference in results for various polymers can be explained by their chemical structure.

Implant Surfaces Containing Bioglasses and Ciprofloxacin as Platforms for Bone Repair and Improved Resistance to Microbial Colonization

Coatings are an attractive and challenging selection for improving the bioperformance of metallic devices. Composite materials based on bioglass/antibiotic/polymer are herein proposed as multifunctional thin films for hard tissue implants. We deposited a thin layer of the polymeric material by matrix-assisted pulsed laser evaporation—MAPLE onto Ti substrates. A second layer consisting of bioglass + antibiotic was applied by MAPLE onto the initial thin film. The antimicrobial activity of MAPLE-deposited thin films was evaluated on Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, and Pseudomonas aeruginosa standard strains. The biocompatibility of obtained thin films was assessed on mouse osteoblast-like cells. The results of our study revealed that the laser-deposited coatings are biocompatible and resistant to microbial colonization and biofilm formation. Accordingly, they can be considered viable candidates for biomedical devices and contact surfaces that would otherwise be amenable to contact transmission.