The Role of Oral Cavity Biofilm on Metallic Biomaterial Surface Destruction-Corrosion and Friction Aspects

Microbial corrosion of metallic biomaterials in the oral environment

A wide variety of microorganisms have been closely linked to metal corrosion in the form of adherent surface biofilms. Biofilms allow the development and maintenance of locally corrosive environments and/or permit direct corrosion including pitting corrosion. The presence of numerous genetically distinct microorganisms in the oral environment poses a threat to the integrity and durability of the surface of metallic prostheses and implants used in routine dentistry. However, the association between oral microorganisms and specific corrosion mechanisms is not clear. It is of practical importance to understand how microbial corrosion occurs and the associated risks to metallic materials in the oral environment. This knowledge is also important for researchers and clinicians who are increasingly concerned about the biological activity of the released corrosion products. Accordingly, the main goal was to comprehensively review the current literature regarding oral microbiologically influenced corrosion (MIC) including characteristics of biofilms and of the oral environment, MIC mechanisms, corrosion behavior in the presence of oral microorganisms and potentially mitigating technologies. Findings included that oral MIC has been ascribed mostly to aggressive metabolites secreted during microbial metabolism (metabolite-mediated MIC). However, from a thermodynamic point of view, extracellular electron transfer mechanisms (EET-MIC) through pili or electron transfer compounds cannot be ruled out. Various MIC mitigating methods have been demonstrated to be effective in short term, but long term evaluations are necessary before clinical applications can be considered. Currently most in-vitro studies fail to simulate the complexity of intraoral physiological conditions which may either reduce or exacerbate corrosion risk, which must be addressed in future studies. STATEMENT OF SIGNIFICANCE: A thorough analysis on literature regarding oral MIC (microbiologically influenced corrosion) of biomedical metallic materials has been carried out, including characteristics of oral environment, MIC mechanisms, corrosion behaviors in the presence of typical oral microorganisms and potential mitigating methods (materials design and surface design). There is currently a lack of mechanistic understanding of oral MIC which is very important not only to corrosion researchers but also to dentists and clinicians. This paper discusses the significance of biofilms from a biocorrosion perspective and summarizes several aspects of MIC mechanisms which could be caused by oral microorganisms. Oral MIC has been closely associated with not only the materials research but also the dental/clinical research fields in this work.

Accelerated corrosion of 316L stainless steel in a simulated oral environment via extracellular electron transfer and acid metabolites of subgingival microbiota

316L stainless steel (SS) is widely applied as microimplant anchorage (MIA) due to its excellent mechanical properties. However, the risk that the oral microorganisms can corrode 316L SS is fully neglected. Microbiologically influenced corrosion (MIC) of 316L SS is essential to the health and safety of all patients because the accelerated corrosion caused by the oral microbiota can trigger the release of Cr and Ni ions. This study investigated the corrosion behavior and mechanism of subgingival microbiota on 316L SS by 16S rRNA and metagenome sequencing, electrochemical measurements, and surface characterization techniques. Multispecies biofilms were formed by the oral subgingival microbiota in the simulated oral anaerobic environment on 316L SS surfaces, significantly accelerating the corrosion in the form of pitting. The microbiota samples collected from the subjects differed in biofilm compositions, corrosion behaviors, and mechanisms. The oral subgingival microbiota contributed to the accelerated corrosion of 316L SS via acidic metabolites and extracellular electron transfer. Our findings provide a new insight into the underlying mechanisms of oral microbial corrosion and guide the design of oral microbial corrosion-resistant materials.

N-acyl homoserine lactone signaling modulates bacterial community associated with human dental plaque

N-acyl homoserine lactones (AHLs) are small diffusible signaling molecules that mediate a cell density-dependent bacterial communication system known as quorum sensing (QS). AHL-mediated QS regulates gene expression to control many critical bacterial behaviors including biofilm formation, pathogenicity, and antimicrobial resistance. Dental plaque is a complex multispecies oral biofilm formed by successive colonization of the tooth surface by groups of commensal, symbiotic, and pathogenic bacteria, which can contribute to tooth decay and periodontal diseases. While the existence and roles of AHL-mediated QS in oral microbiota have been debated, recent evidence indicates that AHLs play significant roles in oral biofilm development and community dysbiosis. The underlying mechanisms, however, remain poorly characterized. To better understand the importance of AHL signaling in dental plaque formation, we manipulated AHL signaling by adding AHL lactonases or exogenous AHL signaling molecules. We find that AHLs can be detected in dental plaque grown under 5% CO2 conditions, but not when grown under anaerobic conditions, and yet anaerobic cultures are still responsive to AHLs. QS signal disruption using lactonases leads to changes in microbial population structures in both planktonic and biofilm states, changes that are dependent on the substrate preference of the used lactonase but mainly result in the increase in the abundance of commensal and pioneer colonizer species. Remarkably, the opposite manipulation, that is the addition of exogenous AHLs increases the abundance of late colonizer bacterial species. Hence, this work highlights the importance of AHL-mediated QS in dental plaque communities, its potential different roles in anaerobic and aerobic parts of dental plaque, and underscores the potential of QS interference in the control of periodontal diseases.

Surface Properties of Ti65Zr Alloy Modified with TiZr Oxide and Hydroxyapatite

Titanium-zirconium dioxide nanostructures loaded by hydroxyapatite were produced on the surface of Ti65Zr alloy. The alloy was treated by anodization with the subsequent immersion in calcium glycerophosphate (CG) solutions. The resulting surfaces present TiO2-ZrO2 nanotubular (TiZr-NT) structures enriched with hydroxyapatite (HAP). The nanotube texture is expected to enhance the surface's corrosion resistance and promote integration with bone tissue in dental implants. The TiZr-NT structure had a diameter of 73 ± 2.2 nm and a length of 10.1 ± 0.5 μm. The most favorable result for the growth of HAP in Hanks' balanced salt solution (Hanks' BSS) was obtained at a CG concentration of 0.5 g/L. Samples soaked in CG at a concentration of 0.5 g/L demonstrated in a decrease of the contact angles to 25.2°; after 3 days of exposure to Hanks' BSS, the contact angles further reduced to 18.5°. The corrosion studies also showed that the TiZr-NT structure soaked in the CG = 0.5 g/L solution exhibited the best corrosion stability.

Hydrogels for Mucosal Drug Delivery

Mucosal tissues are often a desirable site of drug action to treat disease and engage the immune system. However, systemically administered drugs suffer from limited bioavailability in mucosal tissues where technologies to enable direct, local delivery to these sites would prove useful. In this Spotlight on Applications article, we discuss hydrogels as an attractive means for local delivery of therapeutics to address a range of conditions affecting the eye, nose, oral cavity, gastrointestinal, urinary bladder, and vaginal tracts. Considering the barriers to effective mucosal delivery, we provide an overview of the key parameters in the use of hydrogels for these applications. Finally, we highlight recent work demonstrating their use for inflammatory and infectious diseases affecting these tissues.

Inhibitory Activity of Essential Oils of Mentha spicata and Eucalyptus globulus on Biofilms of Streptococcus mutans in an In Vitro Model

The aim of this study was to evaluate the inhibitory activity of the commercially available essential oils of Mentha spicata (spearmint) and Eucalyptus globulus (eucalyptus) on Streptococcus mutans ATCC 25175 biofilms in vitro, emulating dental plaque conditions. The composition of the essential oils (EOs) was determined using gas chromatography coupled with mass spectrometry (GC-MS), with the main metabolites being Carvone (57.93%) and Limonene (12.91%) for Mentha spicata and 1,8-Cineole (Eucalyptol) (65.83%) for Eucalyptus globulus. The inhibitory activity was evaluated using the methods of agar-well diffusion and colorimetric microdilution. The inhibition halos were 18.3 ± 0.47 mm and 27.0 ± 0.82 mm, and the MICs were 1.8484 mg/mL and 1.9168 mg/mL for the EOs of Mentha spicata and Eucalyptus globulus, respectively. The activity against the biofilms was evaluated on a substrate of bovine enamel pieces using a basal mucin medium (BMM) in anaerobic conditions with daily sucrose exposition cycles in order to emulate oral cavity conditions. The EOs were applied in a concentration of 0.5% in a sterile saline vehicle with 1% polysorbate 20. After 72 h of cultivation, a significant reduction was observed (p < 0.001%) on the biofilm biomass, which was evaluated by its turbidity in suspension and using a count of the recoverable organisms with regards to the control. The effects of the Eos were not significantly distinct from each other. The EOs showed antimicrobial activity against both the Streptococcus mutans planktonic and biofilm cultures. Thus, EOs may have great potential for the development of pharmaceutical and sanitary products for oral health.

Prevalence of white spot lesions and gingival index during orthodontic treatment in an academic setting

INTRODUCTION

The objective of this study was to determine the prevalence of white spot lesions (WSL) in orthodontic patients in an academic setting. Specific aims include using a novel combination to measure plaque accumulation (PA) and detect the association between WSL and PA and the associations between multiple independent variables.

METHODS

Cross-sectional data were collected on 111 patients. To enhance standardization, a combination of plaque-disclosing agents and standardized intraoral photographs was used to analyze plaque index (PI) and WSL for all teeth except molars. Factors including time in fixed appliances (FA), number of teeth, location of the lesions, and demographic information were reported. A multiple linear regression model was used to detect associations between the PI and WSL and the independent variables (P <0.05).

RESULTS

Approximately 79.3% of participants had at least one WSL, with a mean of 4 affected teeth per patient. A significant association was found between time in FA and the more severe PI reporting (P <0.001). There was no significant association between WSL and PI or the other variables. WSL was greater in the maxilla than in the mandible. PI was greater on the left than on the right side. Interexaminer reliability was assessed for PI and WSL (κ = 0.93 and 0.92).

CONCLUSIONS

The prevalence of WSL for orthodontic patients treated at this institution was greater than previously reported in the literature. In addition, the severity of PI was associated with increased time in FAs. Combining the proposed method of reporting PA facilitates standardization, calibration, and documentation in an academic environment.

The Effect of Gastric Acid on the Surface Properties of Different Universal Composites: A SEM Study

The aim of this study is to compare surface roughness and microhardness changes of three monochromatic (Omnichroma, Vittra Unique, and Charisma Diamond One) and three universal shade (Neo Spectra ST, G-ænial A'CHORD, and Nova Compo C) resin composites after exposure to simulated gastric acid. A total of 144 disc-shaped specimens (24 discs of each composite resin) were prepared using plexiglass molds (R = 5 mm × h = 2 mm) for evaluation from each material. Specimens of each material were divided into two main groups for the evaluation of the microhardness and surface roughness and also two subgroups for 7- and 14-day exposures to simulated gastric acid. Initial microhardness and surface roughness measurements of all samples were measured before immersion (T1) followed by exposing the samples to simulated gastric acid for 7 days (T2) and 14 days (T3), and then, the microhardness and roughness measurements were repeated. Randomly selected specimens of each material for each of the time intervals (T1, T2, and T3) were evaluated with scanning electron microscopy (SEM). One-way ANOVA revealed that the surface roughness and hardness values of all tested composite resin restorative materials show no statistically significant difference for the initial (T1) value (p > 0.05). Regarding the 7^th day (T2) and 14^th day (T3) surface roughness and microhardness value of all composites, there are statistically significant differences between the groups (p < 0.05), while there was no statistically significant difference between the surface hardness reduction percentage between the time intervals (p > 0.05). As a result of this in vitro study, increase in surface roughness and decrease in microhardness of the tested universal composite materials when exposed to simulated gastric acid were statistically significant.

Metals Biotribology and Oral Microbiota Biocorrosion Mechanisms

During the last decades, metal-based biomaterials have been extensively explored to be used as biocompatible metals for biomedical applications, owing to their superior mechanical properties and corrosion resistance. Consequently, for long-term implanted medical devices, to assure the biomaterials' reliability, functionality, and biocompatibility, studying the various bio-tribological damage mechanisms to obtain the optimum properties is one of the most important goals. In this review, we consider the most important metal-based biomaterials such as stainless steel, alloys of titanium (Ti), cobalt-chromium (Co-Cr), and Nichel-Titatium (Ni-Ti), as well Magnesium (Mg) alloys and with Tantalum (Ta), emphasizing their characteristics, clinical applications, and deterioration over time. The influence of metal elements on biological safety, including significant effects of metal-based biomaterials in dentistry were discussed, considering the perspectives of surface, mechanical properties, corrosion behaviors, including interactions, bio-mechanisms with tissues, and oral environments. In addition, the role of the oral microbiota was explored due to its role in this erosion condition, in order to further understand the mechanism of metal-based biomaterials implanted on the microflora balance of aerobic and anaerobic bacteria in an oral environment.

Minimization of Adverse Effects Associated with Dental Alloys

Metal alloys are one of the most popular materials used in current dental practice. In the oral cavity, metal structures are exposed to various mechanical and chemical factors. Consequently, metal ions are released into the oral fluid, which may negatively affect the surrounding tissues and even internal organs. Adverse effects associated with metallic oral appliances may have various local and systemic manifestations, such as mouth burning, potentially malignant oral lesions, and local or systemic hypersensitivity. However, clear diagnostic criteria and treatment guidelines for adverse effects associated with dental alloys have not been developed yet. The present comprehensive literature review aims (1) to summarize the current information related to possible side effects of metallic oral appliances; (2) to analyze the risk factors aggravating the negative effects of dental alloys; and (3) to develop recommendations for diagnosis, management, and prevention of pathological conditions associated with metallic oral appliances.

Degradation of Polylactide and Polycaprolactone as a Result of Biofilm Formation Assessed under Experimental Conditions Simulating the Oral Cavity Environment

Polylactide (PLA) and polycaprolactone (PCL) are biodegradable and bioabsorbable thermoplastic polymers considered as promising materials for oral applications. However, any abiotic surface used, especially in areas naturally colonized by microorganisms, provides a favorable interface for microbial growth and biofilm development. In this study, we investigated the biofilm formation of C. krusei and S. mutans on the surface of PLA and PCL immersed in the artificial saliva. Using microscopic (AFM, CLSM) observations and spectrometric measurements, we assessed the mass and topography of biofilm that developed on PLA and PCL surfaces. Incubated up to 56 days in specially prepared saliva and microorganisms medium, solid polymer samples were examined for surface properties (wettability, roughness, elastic modulus of the surface layer), structure (molecular weight, crystallinity), and mechanical properties (hardness, tensile strength). It has been shown that biofilm, especially S. mutans, promotes polymer degradation. Our findings indicate the need for additional antimicrobial strategies for the effective oral applications of PLA and PCL.

Estimating Ni, Cr, Co, and Mo release from 3 dental casting alloys in saliva and blood at 6 and 12 months by using inductively coupled plasma mass spectroscopy

STATEMENT OF PROBLEM

The leaching of elements from long-term definitive prostheses, with saliva acting as an electrolyte, poses a biological concern. The approximate concentration in the biological samples that are considered clinically toxic ranges from 1 to 5000 nmol/L for Cr and Co, 1 to 200 nmol/L for Ni, and 1 to 20 nmol/L for Mo. While in vitro studies are available regarding the leaching of elements in artificial saliva, solutions containing protein, solutions of different pH, and different culture media, the in vivo effects of leaching in the biological sample with increasing time are unknown.

PURPOSE

The purpose of this clinical study was to quantify the Ni, Co, Cr, and Mo metals in saliva and blood before and after restoration with prostheses made from 3 different brands of dental casting alloy at 6 and 12 months.

MATERIAL AND METHODS

Three popular brands of Ni-Cr alloy with different compositions were evaluated. A total of 150 participants requiring a definitive prosthesis were enrolled and divided into 3 groups (n=50). Heavy metal levels from saliva and blood were measured by using the inductively coupled plasma mass spectroscopy method before cementation of the prosthesis and after 6 and 12 months.

RESULTS

The presence of Ni in saliva was in the range of 10.34 to 12.12 μg/L, Cr was 1.04 to 1.22 μg/L, and Mo was 1.04 to 1.08 μg/L over a period of 6 and 12 months after cementation of the metal prosthesis. The presence of Ni in blood was in the range of 6.35 to 14.45 μg/L and that of Cr was 9.09 to 16.16 μg/L over a period of 6 and 12 months after cementation. Co levels were not detected from any brands in saliva or blood, and Mo was detected only in the saliva samples.

CONCLUSIONS

Increased levels of Ni and Cr in saliva and blood from all 3 brands of base metal alloy at 6 and 12 months were observed at higher than threshold values.

Electrogalvanism in Oral Implantology: A Systematic Review

Purpose

The objective of this work is to study galvanic corrosion of different couples of prosthetic and implant alloys through the realization of a systematic review.

Materials and Methods

An electronic search was performed on Pubmed, Google Scholar, Scopus, ScienceDirect, EbscoHost, and Web of Science for published studies related to electrogalvanism in oral implantology. The keywords used were “dental implants” and “galvanic corrosion.” Two independent readers read the scientific articles.

Results

From 65 articles initially identified, only 19 articles met the eligibility criteria. The evaluation of the selected articles allowed us to determine the parameters compared, such as the resistance to galvanic corrosion, the influence of fluorine and pH on the electrochemical behavior, and the release of metal ions and their cytotoxicity. Indeed, Ti6Al4V and precious alloys coupled to titanium were found to be the most resistant to galvanic corrosion, followed by cobalt-chromium alloys and nickel-chromium alloys which were least resistant. This resistance decreases with increasing fluorine concentration and with decreasing pH of the environment. Discussion. The implant-prosthetic system's galvanic resistance is influenced by many intrinsic factors: alloy composition and surface condition, as well as extrinsic factors such as pH variations and amount of fluorine. The effects of oral electrogalvanism are essentially the result of two main criteria: effects due to electric currents generated by corrosion and effects due to the release of metal ions by corrosion.

Conclusion

To avoid this phenomenon, it is wise to follow the proposed recommendations such as the use of the minimum of distinct metals as much as possible, favoring the commercially pure titanium implant of Ti6Al4V, opting for the choice of couples, titanium/titanium, favoring daily mouthwashes of 227 ppm of fluoride, and avoiding fluorinated acid solutions.

Study of Al–SiO2 Aesthetic Composite Coating on Orthodontic Metal Archwire

Nickel–titanium orthodontic wires (NTWs) play an essential role in orthodontic treatment. However, their corrosion and aesthetic properties limit their applications. To improve the aesthetic effects of nickel–titanium orthodontic archwires, we prepared aluminium–silicon dioxide (Al–SiO2) as a biocompatible layer coated onto the NTWs. The Al–SiO2 coating was first fabricated using physical vapor deposition magnetron sputtering, and its physicochemical and biocompatibility properties were investigated. Al–SiO2 layers were well coated on the NTWs. The corrosion currents in the nickel–titanium (NiTi) control, Al–SiO2-coated NiTi experimental, stainless steel (SS) control and Al–SiO2-coated SS experimental groups were 23.72 μA cm−2, 1.21 μA cm−2, 0.22 μA cm−2 and 0.06 μA cm−2, respectively. Al–SiO2-coated NTWs with reduced corrosion current density indicated that the preparation of Al–SiO2 coating on the surface of NiTi and SS could reduce the tendency of electrochemical corrosion. The friction coefficients of orthodontic wires in the NiTi control, NiTi experimental, SS control, and SS experimental groups were 0.68, 0.46, 0.58 and 0.45, respectively. A low friction coefficient was observed in the Al–SiO2-coated NTWs, and the reduced friction coefficient improved the efficiency of orthodontics. Furthermore, the excellent biocompatibility of the NTWs and SS coated with Al–SiO2 indicates that Al–SiO2 as a novel aesthetic layer could improve the physicochemical properties of NTW and SS without causing cytotoxicity, which has considerable potential for modification of NTW and SS surfaces.

Protein-coated nanostructured surfaces affect the adhesion of Escherichia coli

Developing new implant surfaces with anti-adhesion bacterial properties used for medical devices remains a challenge. Here we describe a novel study investigating nanotopography influences on bacterial adhesion on surfaces with controlled interspatial nanopillar distances. The surfaces were coated with proteins (fibrinogen, collagen, serum and saliva) prior to E. coli-WT adhesion under flow conditions. PiFM provided chemical mapping and showed that proteins adsorbed both between and onto the nanopillars with a preference for areas between the nanopillars. E. coli-WT adhered least to protein-coated areas with low surface nanopillar coverage, most to surfaces coated with saliva, while human serum led to the lowest adhesion. Protein-coated nanostructured surfaces affected the adhesion of E. coli-WT.

Ceragenin CSA-44 as a Means to Control the Formation of the Biofilm on the Surface of Tooth and Composite Fillings

Recurrent oral infections, as manifested by endodontic and periodontal disease, are often caused by Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans). Here, we assessed the anti-biofilm activity of ceragenin CSA-44 against these microbes growing as a biofilm in the presence of saliva on the surface of human teeth and dental composite (composite filling) subjected to mechanical stresses. Methods: Biofilm mass analysis was performed using crystal violet (CV) staining. The morphology, viscoelastic properties of the biofilm after CSA-44 treatment, and changes in the surface of the composite in response to biofilm presence were determined by AFM microscopy. Results: CSA-44 prevented biofilm formation and reduced the mass of biofilm formed by tested microorganisms on teeth and dental composite. Conclusion: The ability of CSA-44 to prevent the formation and to reduce the presence of established biofilm on tooth and composite filling suggests that it can serve as an agent in the development of new methods of combating oral pathogens and reduce the severity of oral infections.

Metal Release and Surface Degradation of Fixed Orthodontic Appliances during the Dental Levelling and Aligning Phase: A 12-Week Study

The purpose of the present study is twofold: (i) to assess the salivary nickel, chromium, and iron concentrations and (ii) to characterize the surface microstructure of the typical commercially available Ni-containing metallic appliances during the first 12-week orthodontic treatment period. A total of 85 unstimulated saliva samples were collected from patients before treatment, after 2 days, and after 1, 4, and 12 weeks. Salivary ion concentrations were determined by inductively coupled plasma optical emission spectroscopy, and data were analyzed with the Statistical Package for Social Sciences (IBM SPSS) software. The recorded mean metal concentrations were in the ranges of 132–175 µg/L for Ni, 171–192 µg/L for Cr, and 826–1023 µg/L for Fe. No statistically significant variations were observed between the different study times, and the null hypothesis (the concentrations of metallic ions in patients’ saliva did not significantly change after the placement of the orthodontic appliances) was accepted (p > 0.05). Mean salivary metallic ions were below toxic levels, and no adverse clinical reactions were registered. The intraoral surface degradation of the fixed components was corroborated by optical microscopy, scanning electron microscopy, and energy dispersive spectrometry. Microstructural analysis after complete orthodontic procedure confirmed different corrosion types, from pitting to biocorrosion.

Electronic properties and surface potential evaluations at the protein nano-biofilm/oxide interface: Impact on corrosion and biodegradation

The formation of a protein nano-biofilm, which exhibits a special electronic behavior, on the surface of metals or oxide biomaterials considerably influences the crucial subsequent interactions, particularly the corrosion and biodegradation processes. This study discusses the impact of electrical surface potential (ESP) of a single or nano-biofilm of albumin protein on the electrochemical interactions and electronic property evolutions (e.g., charge carriers, space charge capacitance (SCC), and band bending) occurring on the surface oxide of CoCrMo implants. Scanning Kelvin probe force microscopy (SKPFM) results indicated that ESP or surface charge distribution on a single or nano-biofilm of the albumin protein is lower than that of a CoCrMo complex oxide layer, which hinders the charge transfer at the protein/electrolyte interface. Using a complementary approach, which involved performing Mott-Schottky analysis at the electrolyte/protein/oxide interface, it was revealed that the albumin protein significantly increases the SCC magnitude and number of n-type charge carrier owing to increased band bending at the SCC/protein interface; this facilitated the acceleration of metal ion release and metal-protein complex formation. The nanoscale SKPFM and electrochemical analyses performed in this study provide a better understanding of the role of protein molecules in corrosion/biodegradation of metallic biomaterials at the protein nano-biofilm/oxide interface.

ZrO2/ZnO/TiO2 Nanocomposite Coatings on Stainless Steel for Improved Corrosion Resistance, Biocompatibility, and Antimicrobial Activity

The ultrathin nanocomposite coatings made of zirconium oxide (ZrO₂), zinc oxide (ZnO), and titanium oxide (TiO₂) on stainless steel (SS) were prepared by the radio frequency sputtering method, and the effects of the nanocomposite coating on corrosion protection and antibacterial activities of nanocomposite coated SS were investigated. Scanning electron microscopy was conducted to observe surface morphology of nanocomposite coatings with distinct distribution of grains with the formation on SS substrate. From the electrochemical impedance spectroscopy results, ZrO₂/ZnO/TiO₂ nanocomposite coating showed excellent corrosion protection performance at 37 °C during immersion in simulated body fluid and saliva solution for 12 and 4 weeks, respectively. The impedance of ZrO₂/ZnO/TiO₂ (40/10/50) nanocomposite coated SS exhibited values about 5 orders of magnitude higher than that of uncoated SS with polarization at the low-frequency region. Cell viability of ZrO₂/ZnO/TiO₂ nanocomposite coated SS was examined under mouse fibroblasts culture (L929), and it was observed that the nanocomposite coating improves proliferation through effective cellular attachment compared to uncoated SS. From the antimicrobial activity results, ZrO₂/ZnO/TiO₂ nanocomposite-coated SS showed killing efficiency of 81.2% and 72.4% against Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus, respectively.

The Impact of Early Saliva Interaction on Dental Implants and Biomaterials for Oral Regeneration: An Overview

The presence of saliva in the oral environment is relevant for several essential health processes. However, the noncontrolled early saliva interaction with biomaterials manufactured for oral rehabilitation may generate alterations in the superficial properties causing negative biological outcomes. Therefore, the present review aimed to provide a compilation of all possible physical-chemical-biological changes caused by the early saliva interaction in dental implants and materials for oral regeneration. Dental implants, bone substitutes and membranes in dentistry possess different properties focused on improving the healing process when in contact with oral tissues. The early saliva interaction was shown to impair some positive features present in biomaterials related to quick cellular adhesion and proliferation, such as surface hydrophilicity, cellular viability and antibacterial properties. Moreover, biomaterials that interacted with contaminated saliva containing specific bacteria demonstrated favorable conditions for increased bacterial metabolism. Additionally, the quantity of investigations associating biomaterials with early saliva interaction is still scarce in the current literature and requires clarification to prevent clinical failures. Therefore, clinically, controlling saliva exposure to sites involving the application of biomaterials must be prioritized in order to reduce impairment in important biomaterial properties developed for rapid healing.

Salivary pH Effect on Orthodontic Appliances: In Vitro Study of the SS/DLC System

Stainless steels (SS) are the most-used alloys for manufacturing fixed orthodontic appliances due to their attractive set of mechanical properties, biocompatibility, and high corrosion resistance. Nevertheless, during regular orthodontic treatments–taking at least around 2 years–the intraoral environment inevitably degrades these bioalloys, releasing metallic ions into the oral cavity. In the first part of this in vitro study, the corrosion resistance of commercial SS appliances (brackets, tubes, and bands) was evaluated in Fusayama-Meyer artificial saliva at pH values of 2.3 and 6.8 over the course of 30 days. As expected, the results corroborated that salivary pH highly influences corrosion behaviour. Released Ni, Cr, and Fe were within dietary intake values. In the second part, a novel approach for oral corrosion prevention based on the chemical inertness of DLC materials is presented. SS surfaces were functionalized with biocompatible a-C:H-sputtered coatings and submitted to the same experimental conditions. The anticorrosion ability of this system was demonstrated, preventing the pitting corrosion that occurred on the SS substrates. Despite the galvanic coupling effect due to the presence of the Cr-based interlayer, this study enhanced the potential use of the reactive sputter-deposited a-C:H coatings in orthodontics.

Experimental Study Regarding the Behavior at Different pH of Two Types of Co-Cr Alloys Used for Prosthetic Restorations

Cobalt-chromium (Co-Cr) alloys are widely utilized in dentistry. The salivary pH is a significant factor, which affects the characteristics and the behavior of dental alloys through corrosion. This study aimed to evaluate the corrosion behavior in artificial saliva with different pH values (3, 5.7, and 7.6) of two commercial Co-Cr dental alloys manufactured by casting and by milling. Corrosion resistance was determined by the polarization resistance technique, and the tests were carried out at 37 ± 1 °C, in Carter Brugirard artificial saliva. After the electrochemical parameters, it can be stated that the cast Co-Cr alloy has the lowest corrosion current density, the highest polarization resistance, and the lowest speed of corrosion in artificial saliva with pH = 7.6. In the case of milled Co-Cr alloy, the same behavior was observed, but in artificial saliva with pH = 5.7, it recorded the most electropositive values of open circuit potential and corrosion potential. Although both cast and milled Co-Cr alloys presented a poorer corrosion resistance in artificial saliva with a more acidic pH value, the milled Co-Cr alloy had better corrosion behavior, making this alloy a better option for the prosthetic treatment of patients suffering from GERD.

Can a-C:H-Sputtered Coatings Be Extended to Orthodontics?

Hydrogenated amorphous carbon (a-C:H) coatings are attractive materials for protecting metallic surfaces in extreme biological environments like the human oral cavity, due to the unusual combination of mechanical properties, superior bioinertness, and relative easier and cheaper production. In this work, two a-C:H coatings were deposited on AISI 316L substrates by reactive magnetron sputtering with two CH4 flows to assess if this outstanding system could extend its application range to orthodontics. A 30-day immersion test in Fusayama-Meyer artificial saliva was conducted to mimic an extreme acidic intraoral pH. Extracts were quantified and used to perform in vitro assays with mono- and co-cultures of macrophages and fibroblast to assess cell viability, while mechanical and structural behaviors were studied by nanoindentation and visible Raman. The empirically estimated H contents of ~28 and 40 at.% matched the hard and soft a-C:H coating regimes of 18 and 7 GPa, respectively. After immersion, no important structural/mechanical modifications occurred, regardless of the H content, without corrosion signs, delamination, or coating detachment. However, the adhesion-promoting Cr-based interlayer seems to reduce corrosion resistance via galvanic coupling. The highest biocompatibility was found for a-C:H coatings with the lowest H content. This study indicates that sputtered a-C:H are promising surface materials in orthodontics.

Influence of Conventional or Invisalign Orthodontic Treatment on Mineral and Trace Element Salivary Levels: Longitudinal Study with Total Reflection X-ray Fluorescence

This work aimed to evaluate the salivary concentration of chemical elements in patients undergoing orthodontic treatment with fixed orthodontic appliances and removable aligners. Twelve Angle Class I and II orthodontic patients undergoing treatment with conventional fixed appliances and 15 patients treated with removable aligners provided unstimulated whole saliva samples before treatment (pre) and after 3 months of treatment (post). The concentration and secretion rate of chemical elements in saliva were determined by total reflection X-ray fluorescence. Differences from pre to post and between groups were determined with the paired T test or Wilcoxon test, and two-way ANOVA, considering P < 0.05. The concentrations of S, Cl, and K decreased, while Zn increased significantly (P < 0.05) between pre and post treatment with the fixed appliance treatment. The salivary secretion rate of S was decreased from pre to post in the fixed appliance group. No differences in the concentration and secretion rate of chemical elements were detected from pre to post in the Invisalign group. Fe secretion rate presented an interaction between time and treatment, with lower secretion at post (P = 0.02) in the Invisalign group. Increased Br secretion rate and decreased Rb, Fe, P, and K in Invisalign patients suggested a better salivary electrolyte profile regarding periodontal bone remodeling. No significant alterations in ions associated with metal corrosion and inflammatory reactions were detected in orthodontic patients under dental plaque control.

Assessing the Potential Association Between Microbes and Corrosion of Intra-Oral Metallic Alloy-Based Dental Appliances Through a Systematic Review of the Literature

Objective: Systematic review assessing the association between oral microorganisms and corrosion of intra-oral metallic alloy-based dental appliances.

Design: PubMed, Scopus, and Web of Science were searched using keyword combinations such as microbes and oral and corrosion; microbes and dental and corrosion; microorganisms and oral and corrosion; microorganisms and dental and corrosion.

Results: Out of 141 articles, only 25 satisfied the selection criteria. Lactobacillus reuteri, Streptococcus mutans, Streptococcus sanguis, Streptococcus mitis, Streptococcus sobrinus, Streptococcus salivarius, sulfate-reducing bacteria, sulfate oxidizing bacteria, Veilonella, Actinomyces, Candida albicans were found to have a potential association with corrosion of intraoral metallic alloys such as stainless steel, titanium, nickel, cobalt-chromium, neodymium-iron-boron magnets, zirconia, amalgam, copper aluminum, and precious metal alloys.

Conclusion: The included studies inferred an association between oral microorganisms and intra-oral metallic alloys-based dental appliances, although, it is vital to acknowledge that most studies in the review employed an in-vitro simulation of the intra-oral condition.

Highly efficient antibiofilm and antifungal activity of green propolis against Candida species in dentistry materials

This study evaluated the effect of green propolis extract on the adhesion and biofilm formation of Candida species in dentistry materials. Phytochemical analysis of green propolis extract was performed by high-performance liquid chromatography. Adhesion was quantified by counting the number of yeast cells adherent to dental material fragments in a Neubauer chamber. Biofilm formation was determined by counting colony-forming units recovered from dental material fragments. The intensity of biofilm adhesion was classified as negative, weak, moderate, strong, or very strong. Fifteen compounds, mainly flavonoids, were identified in green propolis extract. All strains adhered to and formed biofilms on the surfaces of the orthodontic materials studied. On steel and resin, yeast cell adhesion intensities were weak at all incubation times, except for those of Candida parapsilosis and C. tropicalis, which were moderate at 12 h. At 24 and 48 h, C. albicans formed biofilms on steel with moderate adhesion affinities; at 24 and 48 h, C. parapsilosis formed biofilms with very strong affinities. C. tropicalis formed biofilms with strong and very strong affinities at 24 and 48 h, respectively. On resin, all species displayed strong affinity for biofilm formation at 24 and 48 h, except for C. tropicalis, which displayed very strong affinity at only 48 h. Green propolis extract displayed antifungal activity and inhibited both adhesion and biofilm formation at 2.5 μg/mL. This study reinforces the idea that green propolis has antifungal activity and interferes with the virulence of Candida species.

In vitro investigations on retention force behavior of conventional and modern double crown systems

OBJECTIVE

This study aimed to investigate the effects of long-term use on the retention force and wear behavior of double crown systems.

METHODS

Based on a common double crown design sixty pairs of telescopic crowns were fabricated and divided into six groups, each consisting ten samples: "Gold standard" cast gold alloy primary and secondary crown (GG) and cast non-precious alloy (NN), computer-aided design (CAD)/computer-aided manufacturing (CAM)-milled zirconia primary crown and galvanoformed secondary crown (ZG), CAD/CAM-milled non-precious alloy primary and secondary crown (CC NN), CAD/CAM-milled zirconia primary crown and non-precious alloy secondary crown (CC ZN) and CAD/CAM-milled zirconia primary crown and polyetheretherketone (PEEK) secondary crown (CC ZP). In the constant presence of artificial saliva, all samples were subjected to 10,000 joining-separation cycles at a velocity of 120 mm/min. Wear was analyzed by reflected light microscopy and confocal microscopy before and after artificial aging.

RESULTS

Retention force losses were observed in each group after long-term use, with significant losses in the groups ZG and CC ZP (p_ZG = 0.01, p_{CC ZP} = 0.049). During artificial aging, no significant differences in pull-off force were recorded for groups GG, NN and CC ZN. Regarding wear, merely the Y-TZP primary crowns of the CC ZP group displayed no surface changes.

SIGNIFICANCE

All tested production methods and material combinations seem to be suitable for clinical practice. CAD/CAM technology allows similarly predictable results to be achieved as the gold standard. Confocal microscopy is recommended for surface examinations of double crowns.

Novel Orthodontic Cement Comprising Unique Imidazolium-Based Polymerizable Antibacterial Monomers

White spot lesions (WSLs) can develop quickly and compromise the successful outcome of the orthodontic treatment. Orthodontic bonding cement with the capability to prevent or mitigate WSLs could be beneficial, especially for patients with high risk of caries. This study explored novel mono- and di-imidazolium-based polymerizable antibacterial monomers and evaluated orthodontic cement compositions comprising such novel monomers. Their antibacterial potentials, mechanical properties, and shear bond strength (SBS) to bovine enamel were investigated. Statistical tests were applied to SBS and mechanical tests (one-way ANOVA and Tukey’s test). For antibacterial resins C (ABR-C) and E (ABR-E), their minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against cariogenic Streptococcus mutans bacterial strain UA159 were found to be 4 μg/mL and 8 μg /mL, respectively. The loss of dry mass from completely demineralized dentin beams in buffer solutions pre-dipped into ABR-C and ABR-E resins is much less than that in control buffer (artificial saliva) only. For unfilled resins comprising up to 12 wt % ABR-C, no significant decreases in flexural strength or modulus were observed. For experimental cements incorporating 1–4 wt % ABR-C, there was no drastic compromise to the SBS to enamel except for 3 wt % ABR-C. Furthermore, their SBS was all comparable to the commercially available orthodontic cements. The ISO-22196 antimicrobial test against S. aureus showed significant levels of antibacterial effects—up to over 5 logs of microorganism reduction exhibited by ABR-C-containing experimental cements. The imidazolium-based polymerizable monomers could be utilized to functionalize orthodontic bonding cement with steady antibacterial activity and develop a potential strategy to counteract WSLs.

Electrochemical Behavior of Ti6Al4V Alloy Used in Dental Implants Immersed in Streptococcus gordonii and Fusobacterium nucleatum Solutions

The titanium alloy, Ti6Al4V, is used in dentistry for dental implants because of its excellent resistance to corrosion and its high biocompatibility. However, periimplantitis is considered the main reason for treatment failure. The Ti6Al4V alloy was used to study the corrosion behavior for dental implant applications, using an experimental arrangement of three electrodes with the bacteria Streptococcus gordonii and Fusobacterium nucleatum, in addition to Ringer's lactate as electrolytes, at 37 °C and a pH of 5.6. Their electrochemical behavior was studied by open circuit potential (OCP) and cyclic potentiodynamic polarization (CPP) according to ASTM G3-14 and ASTM G61-11, respectively. Scanning electron microscopy (SEM) was employed to determine the morphology of the alloy studied. An experimental model, in situ, was established with the bacteria present in an oral environment to understand the electrochemical behavior of the alloy used in dental implants. The greatest corrosion in Ti6Al4V alloy was produced by the medium that contained the bacterium Streptococcus gordonii, which is considered a primary colonizer. In addition, the Ti6Al4V alloy presented uniform corrosion in the three solutions at the different exposure times showing a negative hysteresis in CPP.

Functional Coatings for Orthodontic Archwires-A Review

In this literature review, the current state-of-art of coatings for orthodontic archwires’ increasing antimicrobial and relevant mechanical properties, such as surface topography, friction or corrosion resistance, has been presented. There is a growing request for orthodontic appliances, therefore, most researchers focus on innovative functional coatings to cover orthodontic archwires and brackets. Orthodontic appliances are exposed to the unfavorable oral cavity environment, consisting of saliva flow, food, temperature and appliance force. As a consequence, friction or biocorrosion processes may occur. This can affect the functionality of the orthodontic elements, causing changes in their microstructure, surface topography and mechanical properties. Furthermore, the material which the orthodontic archwire is made from is of particular importance in terms of the possible corrosion resistance. This is especially important for patients who are hypersensitive to metals, for example, nickel, which causes allergic reactions. In the literature, there are some studies, carried out in vitro and in vivo, mostly examining the antibacterial, antiadherent, mechanical and roughness properties of functional coatings. They are clinically acceptable but still some properties have to be studied and be developed for better results. In this paper the influence of additives such as nanoparticles of silver and nitrogen-doped TiO₂ applied on orthodontic brackets by different methods on the antimicrobial properties was analyzed. Future improvement of coating techniques as well as modification of the archwire composition can reduce the release of nickel ions and eliminate friction and bacterial adhesion problems, thus accelerating treatment time.

The corrosion resistance, cytotoxicity, and antibacterial properties of lysozyme coatings on orthodontic composite arch wires

Objective: The corrosion resistance of new orthodontic composite arch wires (CAWs), which have excellent mechanical properties in a simulated oral environment, must be improved. This study explored the susceptibility to corrosion, in vitro cytotoxicity, and antibacterial properties of lysozyme-coated CAWs. Methods: Lysozyme coating of laser-welded CAW surfaces was prepared by liquid phase deposition. Four groups of CAW specimens were prepared: uncoated CAWs and CAWs coated with 20, 40, and 60 g L⁻¹ lysozyme. The surface morphology of the lysozyme coatings was characterized by atomic force microscopy. The samples were immersed in artificial saliva (AS) for 2 weeks, and corrosion morphology was then observed by scanning electron microscopy. Corrosion behavior was characterized according to weight loss and electrochemical properties. The cytotoxicity and antibacterial properties of lysozyme-coated CAWs were assessed by cell counting kit-8 assay and a live/dead bacterial test, respectively. Results: Surfaces in the three lysozyme coating groups exhibited film-like deposition, the thickness of which increased with the lysozyme concentration. Surface pitting and copper ion precipitation decreased with increasing lysozyme concentration in coatings. The corrosion tendency declined as the corrosion and pitting potentials decreased. The corrosion morphology and electrochemical parameters together indicated that lysozyme coatings increased corrosion resistance. The coatings also reduced cytotoxicity to L-929 cells and increased anti-Staphylococcus aureus ability. Conclusions: Lysozyme coating of CAW surfaces by liquid phase deposition improved the corrosion resistance of CAWs. The protective coatings improved biocompatibility and endowed the CAW surfaces with certain degrees of anti-Staphylococcus aureus activity. Different lysozyme concentrations had different protective effects, with 40 g L⁻¹ maybe being the ideal lysozyme concentration for CAW coatings.

The corrosion resistance of new orthodontic composite arch wires (CAWs), which have excellent mechanical properties in a simulated oral environment, must be improved.

Antimicrobial and Physicochemical Properties of Artificial Saliva Formulations Supplemented with Core-Shell Magnetic Nanoparticles

Saliva plays a crucial role in oral cavity. In addition to its buffering and moisturizing properties, saliva fulfills many biofunctional requirements, including antibacterial activity that is essential to assure proper oral microbiota growth. Due to numerous extra- and intra-systemic factors, there are many disorders of its secretion, leading to oral dryness. Saliva substitutes used in such situations must meet many demands. This study was design to evaluate the effect of core-shell magnetic nanoparticles (MNPs) adding (gold-coated and aminosilane-coated nanoparticles NPs) on antimicrobial (microorganism adhesion, biofilm formation), rheological (viscosity, viscoelasticity) and physicochemical (pH, surface tension, conductivity) properties of three commercially available saliva formulations. Upon the addition of NPs (20 µg/mL), antibacterial activity of artificial saliva was found to increase against tested microorganisms by 20% to 50%. NPs, especially gold-coated ones, decrease the adhesion of Gram-positive and fungal cells by 65% and Gram-negative bacteria cells by 45%. Moreover, the addition of NPs strengthened the antimicrobial properties of tested artificial saliva, without influencing their rheological and physicochemical properties, which stay within the range characterizing the natural saliva collected from healthy subjects.

The Influence of Mucin-Based Artificial Saliva on Properties of Polycaprolactone and Polylactide

Polycaprolactone (PCL) and polylactide (PLA) are the two most common biodegradable polymers with potential use in oral applications. Both polymers undergo mainly slow hydrolytic degradation in the human body. However, specific conditions of the oral cavity, like elevated temperature, low pH, and presence of saliva affect the rate of hydrolysis. The study examined the properties of solid samples of PCL and PLA subjected to degradation in phosphate buffered saline (PBS) and artificial saliva (AS) at temperatures of 37 or 42 °C, and pH values 2 or 7.4. A number of tests were performed, including measurement of the degree of swelling, weight loss, molecular weight, differential scanning calorimetry, and thermogravimetry of polymers, as well as hardness and tensile strength. Additionally, topography and stiffness of surfaces using atomic force microscopy are presented. It has been noticed that in the artificial saliva, the processes of polymer degradation occur slightly more slowly, and the effects of temperature and pH are less pronounced. We believe that a layer of porcine gastric mucin from artificial saliva that adsorbed on the surface of polymers may have a key role in the observed differences; this layer resembles protective mucin coating tissues in the oral cavity.

Negative influence of biofilm on CoCrMo corrosion

Minimal studies exist investigating biofilm-induced corrosion of orthopaedic implants. This study investigates potential contributions of Pseudomonas aeruginosa and Staphylococcus aureus biofilms on corrosion resistance of CoCrMo under static and fretting conditions. Biofilms were cultured on CoCrMo coupons for either 4 weeks (static culture) or 6 days (fretting culture; pin-on-disk with a Ti6Al4V hemispherical tip pin). Morphology of biofilms and corrosion of coupon surfaces were analyzed via SEM. Open circuit potential and electrochemical impedance spectroscopy measurements were collected for corrosion performance evaluation. Results showed no visible corrosion on coupon surfaces in static culture, which suggests these biofilms alone do not induce severe corrosion under the conditions of this study. However, electrochemical data showed biofilm presence lowered coupon electrochemical impedance in static and fretting cultures, suggesting resistive and capacitive characteristics of the metal oxide-biofilm-media interface were altered. Under fretting, the P. aeruginosa group exhibited a distinct damage morphology and Co:Cr:Mo ratio within the wear scar when compared with S. aureus and the bacteria-free control. These differences suggest the presence of P. aeruginosa biofilms may negatively impact corrosion resistance at the fretting interface. Taken together these results demonstrate biofilms can contribute to implant corrosion by influencing the electrochemical impedance of implant metal surfaces.

Artificial Saliva: Challenges and Future Perspectives for the Treatment of Xerostomia

The chronic sensation of a dry mouth is a disease condition called xerostomia and affects a large part of the population. Xerostomia is associated with decreased secretion, or more often, qualitative changes in saliva proteins and immunoglobulin concentrations that develop as a result of salivary gland dysfunction. Several reasons causing dry mouth were described, and usually, they include taking medications, diseases or radiotherapy. In some situations, when it is difficult to use salivary stimulants or salivary gland damage is irreversible, the only option might seem to be saliva substitutes. The paper presents the most important aspects considering saliva preparations. The rheological and lubricating properties and the reconstruction of the complex saliva structure has been the main purpose of research. The biological properties of saliva preparations were also widely discussed. As part of the work, the antimicrobial effect of three commercial saliva preparations was tested. Finally, inadequate antimicrobial properties against the strains isolated from the oral cavity were demonstrated. The development of salivary substitutes, in particular, the improvement of antimicrobial properties, can be achieved using nanotechnology, including drug delivery systems containing nanocarriers.

Morphological and kinetic study of oral keratinocytes assembly on reconstituted basement membrane: Effect of TEGDMA

OBJECTIVE

Open wounds of oral cavity require rapid healing. The cytotoxic monomer, triethylene glycol dimethacrylate (TEGDMA) can leach out from dental restoratives, reach the oral epithelial barrier and trigger an immune response. It is speculated that low and moderate concentrations of TEGDMA (0.5 and 1.5 mmol/L, respectively) influence the assembly kinetics and morphology of the keratinocyte layers overlying the extracellular matrix (ECM) in vivo. A three-dimensional cell system composed of immortalized oral keratinocytes (iMOK) cultured on reconstituted basement membrane (ECM) was used to investigate the development of epithelial layers upon exposure to TEGDMA.

METHODS

Adherence and opposing movement of adjacent keratinocytes using actin protrusions (lamellipodia and filopodia) to create spheroids, and their fusion capacity to establish subsequent layers were tested at different time points. Fluorescent, confocal, differential interference contrast microscopy and image processing were employed to quantify the morphological modifications over time.

RESULTS

Increasing concentrations of TEGDMA decreased the number of viable cells that utilized the actin protrusions and led to a delay in the communication/interaction among cells. Consequently, cells assembly was affected and the formation of more than a single layer prevented. Areas of basal-like proliferating cells were replaced with the increasing areas of non-replicating large cell population and extended gaps.

CONCLUSIONS

These findings suggest that TEGDMA may prevent rapid sealing of open wounds by keratinocytes and suppress the establishment of a resistant and impermeable barrier against pathogen internalization. The iMOK-ECM-based platform facilitated the validation and quantification of solubilized dental materials impact on the reconstitution of epithelial layer.

Effect of Saliva and Mucin-Based Saliva Substitutes on Fretting Processes of 316 Austenitic Stainless Steel

The paper presents the results of research of the fretting process of 316 austenitic stainless steel in the environment of natural saliva and mucin-based saliva preparations. The aim of the work was the evaluation of synthetic saliva preparations on biomaterial wear during fretting and fretting-corrosion. The fretting process, in the oscillatory micro-movements conditions, occurs in the joints of removable dentures, especially during the chewing phase. Fretting usually leads to the intensification of fatigue damage processes of materials. Experimental research, through rheological, fretting, fretting-corrosion, and microscopic analysis were performed. Tests indicate that natural saliva and saliva preparations are similar in terms of viscoelastic properties. The statistically significant proposed saliva solutions reduced the material wear in comparison to dry sliding, which is important in the case of people with saliva secretion problem. The addition of xanthan gum to the artificial saliva composition improved rheological characteristics, but on the other hand, led to an increase of secondary wear. It was confirmed by the volumetric wear of the samples and evaluation of energy dissipated during friction. Fretting-corrosion processes were explained by a mechanism related to crevice corrosion supported by friction.

Current Trends in Metallic Orthopedic Biomaterials: From Additive Manufacturing to Bio-Functionalization, Infection Prevention, and Beyond

There has been a growing interest in metallic biomaterials during the last five years, as recent developments in additive manufacturing (=3D printing), surface bio-functionalization techniques, infection prevention strategies, biodegradable metallic biomaterials, and composite biomaterials have provided many possibilities to develop biomaterials and medical devices with unprecedented combinations of favorable properties and advanced functionalities. Moreover, development of biomaterials is no longer separated from the other branches of biomedical engineering, particularly tissue biomechanics, musculoskeletal dynamics, and image processing aspects of skeletal radiology. In this editorial, I will discuss all the above-mentioned topics, as they constitute some of the most important trends of research on metallic biomaterials. This editorial will, therefore, serve as a foreword to the papers appearing in a special issue covering the current trends in metallic biomaterials.