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

Advances of Hydroxyapatite Nanoparticles in Dental Implant Applications

Hydroxyapatite nanoparticles (HANPs) are becoming increasingly crucial in dental implant applications as they are highly compatible with biological systems, actively support biological processes, and closely resemble bone minerals. This review covers the latest progress in how HANPs are made, studied, and used in dentistry. It looks at critical methods for creating HANPs, such as sol-gel, microwave hydrothermal synthesis, and biomimetic approaches, and how they affect the particles' size, structure, and activity. The green synthesis method illustrated a new door to synthesize HAp for maintaining biocompatibilityand increasing antibacterial properties. The review also explores how HANPs improve the integration of implants with bone, support bone growth, and help treat sensitive teeth based on various laboratory and clinical studies. The usage of HAp in dentin and enamel shows higher potentiality through FTIR, XPS, XRD, EDS, etc., for mechanical stability and biological balance compared to natural teeth. Additionally, the use of HANPs in dental products like toothpaste and mouthwash is discussed, highlighting its potential to help rebuild tooth enamel and fight bacteria. There are some challenges for long-term usage against oral bacteria, but doping with inorganic materials, like Zn, has already solved this periodontal problem. Much more research is still essential to estimate the fabrication variation based on patient problems and characteristics. Still, it has favorable outcomes regarding its bioactive nature and antimicrobial properties. Due to their compatibility with biological tissues and ability to support bone growth, HANPs hold great promise for advancing dental materials and implant technology, potentially leading to better dental care and patient outcomes.

Influence of crown-implant ratio on photofuntcionalized short implants success rates: 5 year follow-up prospective study

OBJECTIVE

To evaluate the influence of crown-to-implant ratio(C/I) on marginal bone level changes and survival rate of implants during function.

METHODS

The study included 68 patients with completely or partial edentulous and severe vertical bone atrophy, which were restored with a single crown(46) or a partial fixed(48) denture supported by 152 short implants. Implants were divided into three groups according to the C/I ratio (1.5:1, 1,75:1, 2:1). The results were evaluated: failures of the implant, any complications, implants marginal bone loss (MBL), implants success rates the follow up for 5 years. MBL was assessed by taking x-rays after restoration fixation, after 1,3,5 years post operatively.

RESULTS

During implantation and in the post-implantation period, no serious biological or prosthetic complications were recorded. After 1 years in Group 1 mean MBL 0.86 ± 0.4 mm, after 3 years 0,98 ± 0.2 mm), after 5 years 1.05 ± 0.3 mm. After 1 years in Group 2 mean MBL 0.97 ± 0.3 mm, after 3 years 1,07 ± 0.4 mm), after 5 years MBL was 1.12 ± 0.6 mm.Аfter 1 years in Group 3 mean MBL 1,08 ± 0.6 mm, after 3 years 1,19 ± 0.2 mm, after 5 years MBL was 1.27 ± 0.3 mm. Short implants cumulative success of implantation after 5 years was 97.8% for group 1, 97.6% for group 2, and 97.3% for group 3. Patients were satisfied with the results of treatment.

CONCLUSIONS

The study showed that different C/I ratios of short implants did not affect the survival rate and their use can be considered favorable and completely justified.

CLINICAL TRIAL NUMBER

Not applicable.

Dual Antibacterial and Soft-Tissue-Integrative Effect of Combined Strontium Acetate and Silver Nitrate on Peri-Implant Environment: Insights from Multispecies Biofilms and a 3D Coculture Model

Creation of a biological seal and efficient antibacterial qualities in the peri-implant environment is essential for the success of dental implants. Therefore, novel multifunctional strategies are being developed to address these issues, aiming at the simultaneous improvement of tissue integration and hindering pathological biofilm formation. In this study, we investigated the effect of tissue-promotive strontium acetate (SrAc), antibacterial silver nitrate (AgNO3), and their combination on oral soft tissue cells and an oral multispecies biofilm not only in monoculture setups but also in a three-dimensional (3D) implant-tissue-oral bacterial-biofilm model (INTERbACT model) that takes the naturally occurring interactions into account. Application of SrAc led to improved fibroblast migration in the monoculture setting, without impairment of metabolic activity, even upon additional AgNO3 administration. Notably, the combined treatment of SrAc and AgNO3 resulted in a synergistic antibacterial effect during biofilm formation as well as on early matured biofilms. Most interestingly, the antibacterial effect of the combined treatment was even further enhanced within the coculture setup leading to increased bacterial death and decreased biofilm volume. The 3D tissue in the coculture setup underwent the combined treatment with a notable rise in CCL20 and IL-1β levels. Histologically, only the AgNO3-treated groups exhibited damage to the integrity of the epithelial barrier. Therefore, the results of this study demonstrated promising dual antibacterial and tissue-integrative characteristics of combined AgNO3 and SrAc in the dental implant environment. Additionally, the study emphasizes the importance of considering naturally occurring tissue-bacteria interactions for reliable in vitro testing of novel implant materials.

Controlling Cellular Behavior by Surface Design of Titanium-based Biomaterials

BACKGROUND/AIM

Titanium alloys, especially Ti6Al4V, are widely used in orthopedic and dental implants. Additive manufacturing has emerged as an innovative fabrication technique for titanium implants, gradually replacing traditional machining methods. A notable feature of additively manufactured medical devices is their considerable surface heterogeneity and roughness. Coating these materials to achieve physical and chemical uniformity is essential for enhancing biocompatibility. This study evaluates the combined effect of surface roughness (ranging from sub-micrometer to micrometer scale) and three nanometer-thick polyelectrolyte multilayer coatings on protein adsorption, as well as the adhesion and proliferation of normal human osteoblasts.

MATERIALS AND METHODS

The adhesion of human osteoblasts to various substrates (either uncoated or coated) was quantified using a lactate dehydrogenase assay and scanning electron microscopy. The surface density of adsorbed human serum albumin was analyzed by the Bradford assay.

RESULTS

Application of polyelectrolyte multilayer coatings significantly increased the hydrophilicity of titanium substrates without altering their sub-micrometer and micrometer roughness or topography. The coatings rich in reactive amino groups were found to enhance the adsorption of human serum albumin and promote the adhesion of osteoblasts.

CONCLUSION

The chemical composition of the surface, particularly the presence of free primary amino groups, significantly affects cellular behavior in machined, sand-blasted, and additively manufactured titanium materials, while the impact of surface roughness appears secondary. No correlation was observed between surface hydrophilicity and protein adsorption or cell attachment.

Combined Effects of Dual-Scale Modified Surface with Micro- and Nanostructures on the Cellular Biocompatibility, Osteoinduction, and Antibacterial Properties of Titanium Implants

Titanium implants are widely used in biomedical applications due to their excellent mechanical properties and biocompatibility. However, implant-associated bacterial infections and suboptimal osseointegration remain significant challenges. Recent studies have demonstrated that the interplay between micro- and nanostructures can enhance both biocompatibility and antibacterial properties. This study explores the synergistic effects of hierarchical and dual surface topography on Ti surfaces with micro- and nanostructures to demonstrate their ability to promote cellular biocompatibility and osteoinduction while simultaneously inhibiting bacterial colonization. The combination of selective laser melting (SLM) to create micro-structured surfaces and hydrothermal processes is used to generate distinctive nanopillar structures. By integrating nanoscale features that mimic the extracellular matrix with microscale topographies that influence cellular responses, we achieve a balance between enhanced osseointegration and antimicrobial performance. The physicochemical properties of these dual-scale topographies are characterized through cellular assays using dental pulp stem cells (DPSCs), demonstrating sustained support for long-term cell viability (above 78% in MTT and NR assays (p < 0.05), low levels of LDH release, and high levels of cellular migration) and osteoinduction (statistically significant (p < 0.0001) ALP activity increase and higher levels of calcified matrix deposition, upregulation of ALP and OCN genes compared with smooth surface topographies). Their antibacterial properties against S. aureus and E. coli showed a significant reduction (p < 0.05) in bacterial attachment and biofilm formation. Our findings highlight the potential of multi-scale surface modifications as a promising strategy for next-generation titanium implants, paving the way for improved clinical outcomes in orthopedic and dental applications.

[Research progress on enhancing osseointegration properties of polyetheretherketone implants through various modification methods]

This review article summarizes the current modification methods employed to enhance the osseointegration properties of polyetheretherketone (PEEK), a novel biomaterial. Our analysis highlights that strategies such as surface treatment, surface modification, and the incorporation of bioactive composites can markedly improve the bioactivity of PEEK surfaces, thus facilitating their effective integration with bone tissue. However, to ensure widespread application of PEEK in the medical field, particularly in oral implantology, additional experiments and long-term clinical evaluations are required. Looking ahead, future research should concentrate on developing innovative modification techniques and assessment methodologies to further optimize the performance of PEEK implant materials. The ultimate goal is to provide the clinical setting with even more reliable solutions.

Magnesium Infusion on Dental Implants and Its Impact on Osseointegration and Biofilm Development: A Review

Dental implants have gained global popularity as a treatment option for tooth loss. The success of dental implants depends on their optimal integration into the tissues of the alveolar bone and the periodontium. However, several factors can hinder the proper osseointegration of implants, with the growth of biofilm on the implant surface and subsequent peri-implant infections being significant concerns. To overcome this challenge, researchers have explored the incorporation of antimicrobial agents onto metallic implant surfaces to mitigate biofilm growth. Ideally these agents should promote osteogenesis while exhibiting antibacterial effects. Magnesium (Mg) has emerged as a promising dual-function implant coating due to its osteogenic and antibacterial properties. Despite several studies, the precise mechanisms behind osteoinductive and antimicrobial effect of Mg is unclear, as yet. This review aims to collate and discuss the utility of Mg as a dental implant coating, its impact on the osteogenic process, potential in mitigating microbial growth, and prospects for the future. A comprehensive literature search was conducted across several databases and the findings reveal the promise of Mg as a dual-function dental implant coating material, both as a standalone agent and in combination with other materials. The antibacterial effect of Mg is likely to be due to its (1) toxicity particularly at high concentrations, (2) the production or reactive oxygen species, and (3) pH modulation, while the osteoinductive effect is due to a complex series of cellular and biochemical pathways. Despite its potential both as a standalone and composite coating, challenges such as degradation rate, leaching, and long-term stability must be addressed. Further research is needed to understand the utility of Mg as an implant coating material, particularly in relation to its antibacterial activity, osseointegration, and longevity in the oral milieu.

Low intensity pulsed ultrasound versus low-level laser therapy on peri-implant marginal bone preservation and soft tissue healing following dental implant surgery: a randomized controlled trial

BACKGROUND

Low-intensity pulsed ultrasound (LIPUS) and low-level laser therapy (LLLT) are proposed adjunctive therapies to enhance healing after dental implant surgery. However, direct comparisons of their effects on peri-implant marginal bone preservation and soft tissue healing remain limited. This randomized controlled trial aimed to compare the effectiveness of LIPUS and LLLT on peri-implant marginal bone preservation, soft tissue healing, pain levels, and oral health-related quality of life following dental implant placement.

METHODS

This single-blind, randomized controlled trial included 63 patients undergoing maxillary or mandibular implant placement, randomly allocated to LIPUS (n = 21), LLLT (n = 21), or control (n = 21) groups. LIPUS was applied twice weekly for 4 weeks, while LLLT was administered in 4 sessions over 2 weeks post-implant. Marginal bone loss (MBL) and OHRQoL (OHIP-14) were assessed at baseline, 6, and 12 weeks. Soft tissue healing (Landry Healing Index) and pain (VAS) were evaluated at baseline, 7-, 14-, 21-, and 30-days post-implant.

RESULTS

LIPUS significantly reduced marginal bone loss at 6 weeks and 3 months post-implant compared to LLLT and control groups (p < 0.05). LLLT demonstrated superior soft tissue healing at 7-, 14-, 21-, and 30-days post-implant (p < 0.05). Both interventions significantly decreased pain intensity and improved OHRQoL at various time points compared to the control group (p < 0.05).

CONCLUSIONS

LIPUS and LLLT significantly enhance peri-implant marginal bone preservation, soft tissue healing, pain management, and OHRQoL in dental implant patients compared to standard care. LIPUS was more effective for peri-implant marginal bone preservation, while LLLT excelled in soft tissue healing.

TRIAL REGISTRATION

This study was registered at ClinicalTrials.gov (NCT05938868) on July 11, 2023.

Polydopamine-assisted dual metal ion modification of titanium: Enhancing osseointegration and antibacterial performance

Titanium (Ti) implants are widely used for tooth replacement due to their exceptional mechanical properties and high biocompatibility. However, their inherently inert surface limits osteogenic potential and makes them prone to bacterial colonization, increasing the risk of biofilm formation and implant-related infections. To address these limitations, surface modification of Ti is essential. This study aimed to enhance the surface properties of Ti by coating it with polydopamine (PDA) and further doping it with copper and calcium ions. TPDA was prepared and subsequently used to fabricate TPDA@Cu and TPDA@CuCa samples. Material characterization confirmed that TPDA@CuCa exhibited excellent surface wettability and biocompatibility, with Cu2 + and Ca2+ being continuously and stably released in liquid environments. Additionally, TPDA@CuCa significantly improved protein adsorption, facilitating favorable cellular interactions. In vitro experiments demonstrated that TPDA@CuCa exhibited strong antimicrobial activity against Escherichia coli and Staphylococcus aureus, enhanced osteoblast adhesion, mineralization, and upregulated osteogenic gene expression. This bifunctional surface modification strategy offers a promising approach to enhancing both the osteogenic and antibacterial properties of Ti implants.

Drug-Loaded Polycaprolactone/Fibroin/Polydopamine Composite Coating on an Anodized Titanium Surface with Calcium and Phosphorus Deposited Using Electrospray Technology

Due to the low bioactivity of titanium implants, the extended bone integration process after implantation substantially heightens the risk of inflammation, a primary cause of implant failure. To mitigate inflammatory responses and enhance bone integration between the implant and bone tissue, based on prior research that applied calcium phosphate (CaP) on titanium surfaces, we employed electrospraying technology to develop a drug-loaded polycaprolactone/silk fibroin/polydopamine (PCL/SF/PDA) composite coating as the second layer on top of the calcium phosphate deposition. The surface morphologies of the CaP deposits and composite coatings were characterized by SEM. The SF/PDA gel significantly increased the adhesion of the coating, thereby enhancing its clinical application potential. All materials exhibited excellent biodegradability, and their superior biocompatibility was confirmed through cell assays. Following in vitro experiments, in vivo studies were conducted using a rat cranial defect model. Micro-CT results and staining demonstrated that CaP deposition significantly accelerated bone integration between the titanium substrate and bone, while the drug-loaded polymer coating notably improved the inflammatory environment at the defect site. These findings offer new insights into the development of titanium implants.

Anti-adherence capacity of phytosphingosine on titanium surfaces

Firm soft tissue attachment on oral implant components together with good bacterial control are important prerequisites for uneventful implant healing. TiO2 coatings have been shown to enhance human gingival fibroblast attachment, but the coating does not have antimicrobial properties. Phytosphingosine (PHS) is known to have antifouling properties against the cariogenic bacterium Streptococcus mutans (S. mutans) which is also among the first colonizers on implant surfaces. This makes PHS an interesting agent to prevent microbial adhesion on dental implant surfaces. The aim of this study was to examine the impact of PHS on S. mutans and human gingival fibroblast adhesion on titanium surfaces with or without TiO2 -coating. Titanium discs (n = 99, diameter 14 mm, thickness 1 mm) were fabricated for the study. The discs were divided into four groups: (1) non-coated discs (NC), (2) titanium discs with hydrothermally induced TiO2 coatings (HT), (3) NC discs treated with PHS solution and (4) HT discs treated with PHS solution. Hydrophilicity of the discs was evaluated by water contact angle measurement. S. mutans was added on HT and NC discs with or without PHS treatment for 30 minutes and the number of attached bacteria was estimated by plate counting method. For fibroblast experiment, the cells were plated on the discs and the number of adhered fibroblasts was determined at three time points (1, 3, 6 h). Additionally, confocal microscope images were obtained to examine fibroblast and S. mutans adhesion and to evaluate cell spreading. PHS treatment significantly decreased the hydrophilicity of HT and NC titanium surfaces (p < .001). S. mutans adhesion was significantly reduced after PHS treatment on both NC (p < .001) and HT surfaces (p < .001). Fibroblast adhesion was significantly reduced in HT group at 1 and 3h time points (p < .001), situation leveling out by the 6th hour. PHS reduced the number of adhered fibroblasts to the surface at incubation times of 1 hours (p = .0011) and 3 hours (p = .0194). At the 6 hour time point the number of adhered cells was no longer reduced, but still a reduction in cell spreading on the surface was observed (p < .05). The adhesion differences were present only in HT group. The PHS treatment reduced adherence of S. mutans and fibroblasts on TiO2 coated titanium, which may result from reduced hydrophilicity of the surfaces. The dual approach of PHS treatment and TiO2 coating could provide microbial antifouling properties of dental implants but may also affect fibroblast adhesion.

Comparison of Hydrophilic Properties of Titanium and Zirconia Dental Implants' Surfaces

One of the key factors influencing osseointegration is the hydrophilicity of the surface of dental implants; high hydrophilicity is more advantageous than low hydrophilicity. This study aimed to compare the hydrophilic properties of titanium and zirconia implants from different manufacturers. An in vitro analysis was conducted on 15 implants-13 titanium and 2 zirconia-each featuring distinct compositions and surface treatments. Their hydrophilicity was assessed using the contact angle method, where a drop of saline solution was pipetted onto the apical part of the implant. For each implant, 30 contact angle measurements were taken at three different surface wetting time intervals. The contact angle is defined as the internal angle between the tangent to the surface of the liquid and the surface at the point of tangency; a smaller angle means a higher hydrophilicity. The results show that titanium implants from BTI UniCa, Nobel TiUltra, and Straumann Roxolid SLActive-which are classified as premium implants-exhibited the highest hydrophilicity. In contrast, zirconia implants demonstrated significantly lower hydrophilicity. Within this group, the Nobel Pearl implant exhibited smaller contact angles than the Bredent WhiteSKY implant. Our findings confirm that high-quality titanium implants show superior hydrophilicity, potentially improving clinical outcomes by accelerating healing and facilitating immediate loading protocols, but this could only be proven with an in vivo animal study. Conversely, the relatively lower hydrophilicity of zirconia implants highlights the need for continued advancements in zirconia composition and surface modification to optimize their osseointegration potential.

Zirconium Dental Implants as Potential Optical Waveguides in Photodynamic Inactivation of Bacterial Biofilms-A Pilot Study

In patients with predisposing risk factors, bacterial colonization of dental implants can lead to periimplantitis (PI). Established individual treatment protocols can be effective, but antimicrobial resistance (AMR) and biofilm formation may impede successful treatment, therefore requiring surgical intervention. Photodynamic Inactivation (PDI) combined with optical waveguides could eradicate such pathogens without the risk of new AMR emergence and reduce the need for surgery. In this pilot study, we investigated the waveguiding function of light-transmitting zirconium dioxide (ZrO2) dental implants of different diameters by quantifying their transmission spectrum, fraction of transmitted red-light intensity, and potential polarizing properties. In addition, PDI experiments involving in vitro grown Staphylococcus epidermidis biofilms on ZrO2 and titanium alloy (TAV) discs were performed. Colonized discs were treated with Methylene Blue (MB) photosensitizer before red-light illumination (670 nm) at various intensities. A reduction in bacterial colony-forming units (CFUs) of up to 85% was observed on ZrO2 discs. Meanwhile, the biofilms grown on TAV discs showed no significant reduction in CFUs. These findings make ZrO2 a potential candidate in augmentative PDI treatment of PI. The successful use of PDI combined with waveguiding ZrO2 dental implants can support the reduction in antibiotic prescriptions, thus advancing the WHO's One Health approach of antibiotic stewardship.

Deep Neural Networks Based on Sp7 Protein Sequence Prediction in Peri-Implant Bone Formation

Objective: Peri-implant bone regeneration is crucial for dental implant success, particularly in managing peri-implantitis, which causes inflammation and bone loss. SP7 (Osterix) is vital for osteoblast differentiation and bone matrix formation. Advances in deep neural networks (DNNs) offer new ways to analyze protein sequences, potentially improving our understanding of SP7's role in bone formation. This study aims to develop and utilize DNNs to predict the SP7 protein sequence and understand its role in peri-implant bone formation. Materials: and Methods: Sequences were retrieved from UniProt IDs Q8TDD2 and Q9V3Z2 using the UniProt dataset. The sequences were Sp7 fasta sequences. These sequences were located, and their quality was assessed. We built an architecture that can handle a wide range of input sequences using a DNN technique, with computing needs based on the length of the input sequences. Results: Protein sequences were analyzed using a DNN architecture with ADAM optimizer over 50 epochs, achieving a sensitivity of 0.89 and a specificity of 0.82. The receiver operating characteristic (ROC) curve demonstrated high true-positive rates and low false-positive rates, indicating robust model performance. Precision-recall analysis underscored the model's effectiveness in handling imbalanced data, with significant area under the curve (AUC-PR). Epoch plots highlighted consistent model accuracy throughout training, confirming its reliability for protein sequence analysis. Conclusion: The DNN employed with ADAM optimizer demonstrated robust performance in analyzing protein sequences, achieving an accuracy of 0.85 and high sensitivity and specificity. The ROC curve highlighted the model's effectiveness in distinguishing true positives from false positives, which is essential for reliable protein classification. These findings suggest that the developed model is promising for enhancing predictive capabilities in computational biology and biomedical research, particularly in protein function prediction and therapeutic development applications.

Loading Pressure Induced by 4 mm Implants on the Inferior Alveolar Nerve: A 3D Finite Element Analysis Model

Background/Objectives: One of the most serious complications following implant placement in the atrophic posterior mandible is injury to the inferior alveolar nerve (IAN), which can also happen during occlusal loading of the implants. This study investigates the effects of 4 mm implant stress transmission to the inferior alveolar nerve during occlusal loading in cases of severe posterior mandibular atrophy. Methods: The computer-aided design (CAD) model was created and modified through Direct Modeling techniques. The structure of cortical and trabecular bones was simplified, and it was modeled as a cylinder block. Finite element analysis (FEA) was carried out in 3D to investigate the pressure distribution over the IAN at different implant-to-nerve distances (1.5 mm, 0.5 mm, and 0.1 mm), and stress and strain deformations were simulated in the mandibular model. Results: The results of the pressure analysis on the inferior alveolar nerve indicate that the pressure distribution at different implant-to-nerve distances (1.5 mm, 0.5 mm, and 0.1 mm) is consistently below 0.026 MPa, which corresponds to the maximum pressure range that may block nerve impulses. This occurs even at the theoretical and simulated distance of 0.1 mm, suggesting that cortical bone stiffness plays a crucial role in mitigating stress at reduced implant-to-nerve proximities. Conclusions: Within the limits of this study, ultra-short implants can be placed even less than 0.5 mm (up to 0.1 mm under the 3D-FEA hypothesis) above the inferior alveolar nerve under the 3D-FEA hypothesis, while maintaining pressure below the threshold value. This is due to the rigidity of the cortical bone, which helps to reduce pressure transmission to the nerve. These findings may expand the indications for ultra-short implants, even in mandibles with a residual bone height of just 4 mm.

Spatially distributed and interconnected porous architectures for dental implants

PURPOSE

Patients with pre-existing medical conditions that impair bone integrity face challenges in dental implant success due to compromised osseointegration. This study evaluates three titanium interconnected porous architectures: the TPMS solid gyroid, TPMS sheet gyroid, and Voronoi stochastic lattice. We aim to assess manufacturability, design controllability, and cellular interactions to identify an optimal architecture that enhances cellular behavior with the potential to strengthen bone-to-implant contact.

METHODS

Three porous architectures were designed and compared: the two variants of the uniform, periodic triply periodic minimal surface (TPMS) gyroid, and the random, non-uniform Voronoi stochastic lattice. The porous constructs were fabricated using selective laser melting (SLM) and evaluated using microcomputed tomography (microCT) for porosity, manufacturability, and permeability. In vitro experiments used primary bone marrow stromal cells (BMSCs) isolated from 8-week-old wild type C57BL6/J mice. These cells were seeded onto the SLM-fabricated porous architectures and evaluated for adhesion using scanning electron microscopy (SEM) and RNA extraction. Cell trajectory was profiled using fluorescent confocal microscopy.

RESULTS

Selective laser melting (SLM) successfully fabricated all three porous architectures, with the TPMS solid gyroid exhibiting the highest manufacturing resolution, controllability, and the most uniform pore distribution. Computational fluid dynamics (CFD) analysis showed that its permeability outperformed both the TPMS sheet gyroid and stochastic Voronoi architectures. In vitro cell culturing demonstrated superior cell behavior in the TPMS solid gyroid scaffold. RNA quantification after 72 h of culture showed that cells are most adherent to the TPMS solid gyroid, demonstrating a 4-fold increase in RNA quantity compared to the fully dense (control). Additionally, cell trajectory analysis indicated enhanced cell infiltration and cellularization within the pore channels for the TPMS solid gyroid architecture.

CONCLUSION

This research demonstrates that inducing an interconnected porous architecture into a titanium construct enhances cellular behavior compared to a traditional dense implant. The TPMS solid gyroid architecture showed superior manufacturability, making it a promising solution to improve dental implant success in patients with compromised bone integrity.

Efficacy of biofilm decontamination methods of dental implant surfaces: A systematic review of in vitro studies

This systematic review examines the decontamination techniques used to clean titanium (Ti) implant surfaces covered with in vitro bacterial biofilms. The selected studies were gathered from the PubMed and Web of Science databases. These include in vitro studies investigating decontamination methods used to clean Ti implant surfaces coated with bacterial biofilms until January 2024. The determined studies were filtered according to the PRISMA guidelines, and the Science in Risk Assessment and Policy (SciRAP) was used to assess the reporting and methodological quality of the included studies. A total of 634 full-length peer-reviewed articles were identified. After excluding duplicate papers between the databases and screening according to the predefined inclusion and exclusion criteria, 13 studies were included. The decontamination methods investigated included mechanical, chemical, and physical methods, either as a single or in a combined approach. Significant variability was observed among the included studies. Combining the mechanical and physical methods with a chemical yielded the most significant reduction in both single- and multiple-species biofilms. The current results do not indicate that any single decontamination technique is more effective than others in eradicating bacterial biofilm from Ti surfaces; the combined approach was more advantageous than the single ones.

The Phase-Transited Lysozyme Coating Modified Small Intestinal Submucosa Membrane Loaded with Calcium and Zinc Ions for Enhanced Bone Regeneration

Bone defects caused by severe trauma, tumors, infections and diseases remain a global challenge due to limited natural regeneration capacity of bone tissue in large-scale or complex injuries. Guided bone regeneration (GBR) has emerged as a pivotal technique in addressing these issues, relying on barrier membranes to facilitate osteoprogenitor cell infiltration. Current clinical GBR membranes function solely as physical barriers, lacking antibacterial and osteoinductive properties, which underscores the need for advanced alternatives. This study focuses on resorbable GBR membranes made from small intestinal submucosa (SIS), known for biocompatibility and tissue regeneration but hindered by low mechanical strength and rapid degradation. In addition, SIS lacks both antibacterial properties and strong osteogenic capabilities. Enhancements involve crosslinking treatment and dual incorporation of calcium (Ca2+) and zinc (Zn2+), which address the physical property shortcomings and synergistically boost osteoinductivity by activating osteogenic signaling pathways. Additionally, phase-transited lysozyme (PTL) nanofilm technique enables efficient ion loading and controlled release, while offering antibacterial properties. In this study, a multifunctional SIS membrane is constructed by PTL-ions layers, providing a potential solution to the challenge of clinical bone defects.

The Impact of Implant Surface Modifications on the Osseointegration Process: An Overview

Osseointegration is critical to the long-term success of endosseous dental implants. Surface factors such as roughness, topography, energy, and composition considerably impact this process. Several ways have been used to optimize surface roughness, increase surface area, and improve osseointegration. Subtractive processes such as alumina and titanium dioxide blasting, acid treatment, anodization, and laser peeling are widely utilized. Many additive techniques change implant surfaces, including plasma-sprayed hydroxyapatite, vacuum deposition, sol-gel, dip coating, electrolytic procedures, and nano-hydroxyapatite coating. Recently, biomimetic implant surfaces with calcium phosphate coatings have been created under physiological settings. These coatings can transport osteogenic agents such as bone morphogenetic proteins, growth differentiation factors, and bioactive medications, including bisphosphonates, gentamicin, and tetracycline. Advances in technology have considerably broadened the methods for surface modification of endosseous dental implants. This article provides a comprehensive overview of various surface modification techniques and current trends in oral implantology.

Vitamin D Screening and Supplementation-A Novel Approach to Higher Success: An Update and Review of the Current Literature

In recognizing the critical role of vitamin D in bone metabolism and osseointegration, research aims to identify whether preoperative vitamin D deficiency serves as a risk factor for early implant failure. By analyzing patient outcomes and their serum vitamin D levels, studies seek to establish evidence-based recommendations for vitamin D assessment and management in the preoperative period, with the ultimate goal of enhancing implant success rates and patient outcomes in dental implantology. Given these insights, it is important for clinicians to incorporate the preoperative evaluation of vitamin D serum levels into their standard protocol for patients undergoing dental implant procedures. The objective of this study is to review and investigate the correlation between early dental implant failure (EDIF) and reduced serum levels of vitamin D, and to evaluate the potential benefits of preoperative screening and supplementation of vitamin D in patients undergoing dental implant surgery. A literature review was performed using a selected database-PubMed, Google Scholar, Cochrane, and SCOPUS-to assess the effect of vitamin D3 level on EDIF and biological factors (i.e., peri-implant bone level). Studies were limited to peer-reviewed, indexed journals. Subsequently, a hypothesis was proposed that vitamin D3 supplementation would mitigate the negative effect of vitamin D3 deficiency. The potential benefit of vitamin D3 supplementation-systemic and topical-was assessed in terms of bone-to-implant contact (BIC) and peri-implant bone level. The deleterious effects of low vitamin D serum levels on osseointegration of dental implants and immune system modulation are increasingly accepted. Evidence has displayed that deficiency of this vitamin can result in impaired peri-implant bone formation. Vitamin D deficiency resulted in nearly a fourfold increase in overall EDIF incidence. Presurgical supplementation of vitamin D3 demonstrated increased levels of implant osseointegration, increased bone-implant contact, enhanced bone level maintenance, and decreased EDIF even in at-risk demographics (i.e., diabetic subjects). The findings of this study reinforce the role of vitamin D in dental implant osseointegration. Our study, particularly, emphasizes the necessity of vitamin D supplementation for individuals with sub-physiologic vitamin D serum levels (≤ 30 ng/mL) and those within specific risk categories: smokers, diabetics, obese individuals, and those with compromised immune systems. Adopting a proactive management plan, including screening and supplementation in these patients, may substantially enhance the clinical outcomes in dental implant surgery.

Mirror-polished ceria-stabilized zirconia/alumina nanocomposite enhances gingival junctional epithelial cell adhesion

OBJECTIVES

The aim of this study was to determine the optimal surface roughness (Ra) of ceria-stabilized zirconia/alumina nanocomposite (Ce-TZP/Al₂O₃) implants for mouse gingival junctional epithelial cell (JE-1) adhesion and soft tissue sealing in vitro.

METHODS

Titanium and Ce-TZP/Al₂O₃ disks were prepared, mechanically polished (M), and mirror-polished (Mr). The surface morphology of each disk was evaluated, and the Ra was measured using scanning electron microscopy and atomic force microscopy. JE-1 cells were cultured on each disk, and cell proliferation was assessed by measuring the absorbance using the MTS assay. We also analyzed the expression of the adhesion proteins Laminin-5, Integrin β4, and Cadherin-1 using immunostaining and quantitative reverse transcription-polymerase chain reaction (qRT-PCR). The adhesion strength of the JE-1 cells to each disk was measured using a shaking stimulation test.

RESULTS

M disks had rough surfaces, whereas Mr disks had smooth morphologies. JE-1 cell proliferation was proportional to the culture time, and the Mr disks showed higher values than the M disk. Immunofluorescence and qRT-PCR showed that expression of Laminin-5 and Integrin β4 was higher with Mr disks than with M on the Ce-TZP/Al₂O₃ disks. The oscillatory stimulation test also showed that the adhesive strength of JE-1 cells was significantly higher with Mr than with M on the Ce-TZP/Al₂O₃ disks.

CONCLUSIONS

Mirror polishing of Ce-TZP/Al₂O₃ disks enhances epithelial cell proliferation and adhesion more than mechanical polishing. These findings have implications for the optimization of implant surface characteristics to improve epithelial sealing.

Antibacterial and Antibiofilm Activity of Layers Enriched with Silver Nanoparticles on Orthodontic Microimplants

Orthodontic microimplants have revolutionized anchorage in orthodontics but remain vulnerable to microbial colonization, potentially leading to infection and failure. Surface modifications incorporating silver nanoparticles (AgNPs) offer antimicrobial benefits, providing long-term protection against bacterial infections, while improving partial osseointegration. This study investigates hybrid coatings enriched with AgNPs, calcium (Ca), and phosphorus (P) to improve antimicrobial efficacy and reduce biofilm formation. Microimplants fabricated from the Ti6Al4V alloy were divided into six groups with varying surface treatments, including etching in hydrofluoric acid and hybrid layers containing 0.5 mol% AgNPs and CaP. Antibacterial activity was evaluated using agar diffusion and biofilm formation assays against S. aureus, E. coli, and S. mutans. Surface roughness was analyzed and correlated with biofilm formation. The model assessing the impact of biomaterials on S. aureus biofilm revealed a strong association (R2 = 0.94), with biomaterial choice significantly influencing biofilm formation. The model for E. coli biofilm exhibited exceptional predictability (R2 = 0.99). The model for S. mutans biofilm demonstrated an association (R2 = 0.68). Hybrid coatings exhibited a promising antimicrobial activity. Biofilm formation was higher on microimplants with rougher surfaces. Hybrid coatings enriched with AgNPs and CaP enhance antimicrobial properties and partially reduce biofilm formation. It is suggested that the optimization of microimplant surface areas varies according to function. An enhanced performance can be achieved by maintaining a smooth surface for soft tissue contact, while incorporating a rough surface enriched with bactericidal and bioactive modifiers for bone contact areas.

Enhancing Implantable Medical Devices: Surface Functionalization of Titanium with Quaternary Ammonium Salts for Antibacterial Adhesion Properties

Bacterial colonization of titanium-based materials used in implantable medical devices represents a significant challenge in the dental and orthopedic fields, often leading to infections and implant failure. This study reports the surface modification of titanium discs with ammonium salts containing carbon atom chains of different lengths (from 6 to 12) to provide antibacterial properties to the modified metal surfaces while maintaining their biocompatibility. The chemically modified samples have been characterized by ATR-FTIR and SEM-EDX analyses and evaluated for roughness and hydrophilic behavior. This surface modification not only provides hydrophobic properties to titanium surfaces but also introduces a hindering environment for bacterial adhesion. Antibacterial tests performed against methicillin-sensitive and methicillin-resistant Staphylococcus aureus strains demonstrated a proportional increase in antibacterial activity with increasing carbon chain length. The best antibacterial performance is reported for the sample containing 12 carbon atoms (Ti-ADTEAB), which showed inhibition values of 87.5 and 86.6% for the sensitive and resistant strains, respectively. The results suggest that this surface modification could lead to a new generation of implantable medical devices with improved patient outcomes by reducing the risk of postoperative infections.

Comparison Between Micro- and Micro-Nano Surface Texturization in the Initial Osseointegration Process: An Experimental In Vitro and In Vivo Preclinical Study

BACKGROUND

The physicochemical changes of the surface aim to improve cell adhesion, proliferation, and differentiation, that is, better biological interaction with the cells and, consequently, with the peri-implant tissues. In the present study, implants with the same macrogeometry were compared in vitro and in vivo, but with two different surfaces: micro-rough and a new micro-nano-rough surface.

MATERIALS AND METHODS

A total of 90 implants were used, 10 of which were used for in vitro surface characterization (n = 5 per group) through scanning electron microscopy (SEM), atomic force microscopy (AFM), and surface roughness measurements. For in vivo tests, 80 implants (n = 40 per group) were used in 20 rabbits (n = 2 implants per tibia). Two experimental groups were created: a control group, where the implants had a surface treated by sandblasting with titanium oxide microparticles, and a test group, where the implants were sandblasted using the same process as the previous group plus acid conditioned. The implant stability quotient (ISQ) was measured by resonance frequency (initially and at both euthanasia times). Animals were euthanized 3 and 5 weeks after implantation (n = 10 animals per time). Ten samples from each group at each time point were evaluated by removal torque (RTv). Another ten samples from each group were evaluated histologically and histomorphometrically, measuring the percentage of bone-to-implant contact (%BIC) and the bone area fraction occupancy (%BAFO).

RESULTS

In vitro, it was possible to observe a more homogeneous surface for the test group compared to the control group. ISQ values showed statistical differences at both 3 and 5 weeks (test > control). For RTv, the values were: 44.5 ± 4.25 Ncm (control group) and 48.6 ± 3.17 Ncm (test group) for the time of 3 weeks; 64.3 ± 4.50 Ncm (control group) and 76.1 ± 4.18 Ncm (test group) at 5 weeks. The %BIC and %BAFO values measured in both groups and at both times did not show significant differences (p > 0.05).

CONCLUSIONS

The higher removal torque and ISQ values presented in the samples from the test group compared to the control group indicate that there was an acceleration in the mineralization process of the newly formed bone matrix.

Osteoblast cell behavior on polyetheretherketone dental implant surfaces treated with different grit size aluminum oxide particles: An in vitro analysis

STATEMENT OF PROBLEM

The hydrophobic and bioinert nature of polyetheretherketone (PEEK) implants needs to be addressed for successful osseointegration.

PURPOSE

The purpose of this in vitro study was to evaluate the osteoblast cell behavior on PEEK implant surfaces treated with airborne-particle abrasion using different grit size aluminum oxide (Al2O3) particles.

MATERIAL AND METHODS

Disk-shaped specimens (n=96) were prepared from medical grade PEEK rods and were distributed into 4 groups (n=24) of untreated PEEK (PEEK 0), airborne-particle abrasion using 50-μm Al2O3 particles (PEEK 50), airborne-particle abrasion using 110-μm Al2O3 particles (PEEK 110), and airborne-particle abrasion using 150-μm Al2O3 particles (PEEK 150). The surface characteristics were assessed using water contact angle (WCA) measurements and scanning electron microscopy (SEM). MG-63 osteoblast cells were cultured, and the biocompatibility of PEEK was assessed using a CellTiter-blue cell viability assay and florescence staining at day 1, 3, and 7. The specimens were stained with Alizarin red to assess the osteoblast cell differentiation on day 10 and 14. The Levene test was used to test the homogeneity of variances. One-way and Welch ANOVA with post hoc corrections were used to assess the overall statistical significance of differences among the groups (α=.05).

RESULTS

The lowest mean WCA was demonstrated in PEEK 150 (49.25 ±5.51) and the highest in PEEK 0 (89.14 ±4.24) (P<.001). SEM images of PEEK 150 illustrated a more complex structure with a large area of globular outcroppings throughout the surface. PEEK 150 showed the highest cell metabolic activity at each time point with florescence staining showing a substantial cell confluence at day 3 and 7. Although PEEK 150 did not show a significant increase in cell proliferation, the number of cells attached was significantly higher than other groups (P<.05). PEEK 110 and 150 also showed a substantial increase in the extent of mineralization.

CONCLUSIONS

Airborne-particle abrasion using moderate Al2O3 grit size (110- or 150-μm) improved the hydrophilicity and osteoblast cell behavior on PEEK implants.

Antibacterial Properties of PMMA/ZnO(NanoAg) Coatings for Dental Implant Abutments

Infections continue to pose significant challenges in dentistry, necessitating the development of innovative solutions that can effectively address these issues. This study focuses on creating coatings made from polymethyl methacrylate (PMMA) enriched with zinc oxide-silver composite nanoparticles, layered to Ti6Al4V-titanium alloy substrates. The application of these materials aims to create a solution for the abutments utilized in complete dental implant systems, representing the area most susceptible to bacterial infections. The nanoparticles were synthesized using a hydrothermal method, optimized through specific temperature and pressure parameters to achieve effective morphologies and sizes that enhance antibacterial efficacy. The layers were applied to the titanium substrate using the spin coating technique, chosen for its advantages and compatibility with the materials involved. Comprehensive analyses were conducted on the antimicrobial powders, including X-ray diffraction, Fourier transform infrared spectroscopy, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Furthermore, the PMMA-based coatings incorporating antimicrobial nanoparticles were evaluated to ensure uniformity and homogeneity across the titanium alloy surface by IR mapping and SBF immersion-SEM analysis. The antimicrobial activity of the samples was demonstrated with impressive results against Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans, as assessed through biofilm modulation studies. The biocompatibility of the samples was validated through in vitro cell-based assays, which demonstrated excellent compatibility between PMMA-based coatings and human preosteoblasts, confirming their potential suitability for future use in dental implants.

A comprehensive review on the State of the Art in the research and development of poly-ether-ether-ketone (PEEK) biomaterial-based implants

Polyetheretherketone (PEEK) is a preferred high-performance polymer in the spine, orthopedic, and craniomaxillofacial implant industry. However, despite its commendable mechanical properties, its bioinert nature limits the implants from integrating with neighboring tissues, impacting the implant's long-term performance. To address this limitation, various kinds of surface functionalization techniques have been developed over the years. Noteworthy efforts have been made to incorporate bioactive fillers in the PEEK matrix to develop standalone bioactive composites. In personalized medicine, significant advances have been made in the 3D Printing of PEEK implants. 3D-printed PEEK implants are now being developed at Point-of-Care, significantly reducing manufacturing and logistic time. Given the recent clinical follow-up updates and advancements in PEEK-based implants, PEEK implants are witnessing an important phase in its history. Recognizing this vital phase, this paper aims to comprehensively review the advancements of PEEK implants over the past decade. The review starts with an overview of the clinical impact of varying PEEK implants, followed by PEEK's surface functionalization techniques and engineering of PEEK-based bioactive composites. Next, this review describes the advancements made in the 3D printing of PEEK implants and points out the essential considerations that should be considered when developing 3D-printed PEEK-based implants. Finally, the review ends with an estimated projection about the future of PEEK-based implants. Readers are expected to gain an all-encompassing and in-depth understanding of PEEK biomedical implants' past, present, and future, enabling researchers to advance the research and development of PEEK-based implants in the required direction. STATEMENT OF SIGNIFICANCE: PEEK is a preferred high-performance polymer in the implant industry, with notable benefits over metallic and ceramic implants, such as bone-matching stiffness and durability. Significant strides have been made in the last decade to make PEEK implants bioactive and utilize 3D Printing to develop patient-specific implants. Given the recent advancements in PEEK-based implants, this review aims to provide an all-encompassing and in-depth understanding of PEEK biomedical implants' past, present, and future. It will comprehensively discuss the know-how gained from the clinical follow-up, the strategies to address the limitations of PEEK implants, and the essential considerations in 3D Printing of PEEK implants. This review will enable researchers to advance the research and development of PEEK implants in the required direction.

The Role of Implant Coronal Surface Properties on Early Adhesion of Streptococcus Oralis-An In Vitro Comparative Study

Dental implant coronal surfaces designed with the primary goal of maintaining crestal bone levels may also promote bacterial adhesion, leading to soft tissue inflammation and peri-implant bone loss. Achieving an optimal surface roughness that minimizes bacterial adhesion while preserving crestal bone is crucial. It is hypothesized that a specific threshold surface roughness value may exist below which, and above which, initial bacterial adhesion does not statistically change. This study evaluated 12 commercially available and 2 custom-designed implant surfaces for their physicochemical properties and initial bacterial adhesion, as represented by Streptococcus oralis (S. oralis) the dominant initial colonizer of the successive waves of bacterial consortia that result in plaque and biofilm formation. Implants were immersed in a S. oralis suspension for 4 h, after which microbial viability was assessed. Marked differences were observed in surface roughness, chemical composition, and wettability, and S. oralis adhesion. Surfaces with Sa > 1 μm had significantly more adherent bacteria after 4 h compared to those with Sa < 1 μm, despite complexity. Adding nanotopography to dual-acid etched surfaces further reduced bacterial adhesion compared to surfaces without these features. The role of chemical composition and wettability was less influential than roughness. In conclusion, there is a cut-off threshold roughness around Sa = 1 μm, above which the adhesion of bacteria increases significantly to a plateau level; while below which, bacterial adhesion is equivalent to a machined surface despite the surface texture of the implant collar.

Single Teeth and Partial Implant Rehabilitations Using Ultra-Hydrophilic Multi-Zone Anodized Surface Implants: A Retrospective Study with 1-Year Follow-Up

Background/Objectives: In the last decades, dental implant surfaces have been evolving to increase success and implant survival rates. More studies evaluating outcomes with implants with ultra-hydrophilic multi-zone anodized surfaces are necessary. The aim of this study is to evaluate the short-term outcome of implants of conical connection with anodized ultra-hydrophilic surfaces for support of single teeth and partial rehabilitations. Methods: In this retrospective study, patients received parallel-walled implants with a gradually anodized surface. The primary outcome measure was implant survival. Secondary outcome measures were marginal bone loss and mechanical and biological complications. This study included 253 conical connection implants with anodized ultra-hydrophilic surfaces, placed in 145 patients (71 males and 74 females; average age: 55.8 years). Sixty patients presented comorbidities, and 19 patients presented smoking habits. Results: Ten patients (15 implants) were lost to follow-up. Two implants failed in two patients, resulting in a cumulative survival rate of 99.2%, with 98.5% and 100% for males and females, respectively, and 99.1% and 100% for single teeth and partial rehabilitations, respectively. The average marginal bone loss was 0.52 mm at 1 year, with 0.60 mm and 0.42 mm for males and females, respectively, and 0.52 mm and 0.50 mm for single teeth and partial rehabilitations, respectively. The rate of mechanical complications was 4.8% and 3.2% at patient and implant levels, respectively. Biological complications occurred in one patient (0.7%) at one implant (0.4%). Conclusions: These results indicate that the use of implants with ultra-hydrophilic multi-zone anodized surfaces for single teeth and partial rehabilitations is viable in the short term.

Implant Surface Decontamination Methods That Can Impact Implant Wettability

This review addresses the effects of various decontamination methods on the wettability of titanium and zirconia dental implants. Despite extensive research on surface wettability, there is still a significant gap in understanding how different decontamination techniques impact the inherent wettability of these surfaces. Although the literature presents inconsistent findings on the efficacy of decontamination methods such as lasers, air-polishing, UV light, and chemical treatments, the reviewed studies suggest that decontamination alters in vitro hydrophilicity. Post-decontamination surface chemistry must be carefully considered when selecting optimal surface treatments for implant materials. Further in vitro investigations are essential to determine which approaches best enhance surface wettability, potentially leading to improved implant-tissue interactions in clinical settings.

Microstructural and Surface Texture Evaluation of Orthodontic Microimplants Covered with Bioactive Layers Enriched with Silver Nanoparticles

Bacterial infections are a common cause of clinical complications associated with the use of orthodontic microimplants. Biofilm formation on their surfaces and subsequent infection of peri-implant tissues can result in either exfoliation or surgical removal of these medical devices. In order to improve the properties of microimplants, hybrid coatings enriched with silver nanoparticles, calcium, and phosphorus were investigated. The present study aimed to assess the microstructure of commercially available microimplants composed of a medical TiAlV (Ti6Al4V) alloy covered with organic-inorganic layers obtained by the sol-gel method using the dip-coating technique. The microstructures and elemental surface compositions of the sterile, etched, and layer-modified microimplants were characterized by scanning electron microscopy with X-ray energy-dispersive spectroscopy (SEM-EDS). Elements such as silver (Ag), calcium (Ca), phosphorus (P), silicon (Si), oxygen (O), and carbon (C) were detected on the microimplant's surface layer. The SEM observations revealed that control microimplants (unetched) had smooth surfaces with only manufacturing-related embossing, while etching in hydrofluoric acid increased the surface roughness and introduced fluoride onto the microimplants. Layers with only silver nanoparticles reduced the roughness of the implant surface, and no extrusion was observed, while increased roughness and emerging porosity were observed when the layers were enriched with calcium and phosphorus. The highest roughness was observed in the microimplants etched with AgNPs and CaP, while the AgNPs-only layer showed a reduction in the roughness average parameter due to lower porosity. Enhancing the effectiveness of microimplants can be achieved by applying selective surface treatments to different parts. By keeping the outer tissue contact area smooth while making the bone contact area rough to promote stronger integration with bone tissue, the overall performance of the implants can be significantly improved.

The Influence of Patient-, Site-, and Implant-Related Factors on Marginal Bone Levels of Dental Implants in a Rural Population in China: A Retrospective Study

OBJECTIVES

Limited research is available on implant treatment outcomes in rural populations. This may be due to the presence of various barriers, such as access to oral health care, resources, health literacy, and education. The aim of this study was to evaluate the influence of patient-, site-, and implant-related factors on marginal bone levels of dental implants in a rural population in China.

MATERIAL AND METHODS

A retrospective study was conducted using data from a private dental office. Subjects included in this study received dental implants as part of their routine dental treatment. Information on age, gender, smoking status, diabetes, heart disease, jaw location, restorative type, loading protocol, survival rate, implant length, and diameter was collected. Marginal bone loss was recorded as the largest value at either the mesial or distal aspect on peri-apical radiographs. Descriptive and inferential statistics were performed along with linear regression analysis.

RESULTS

Overall, 428 implants were placed in 90 subjects over an average follow-up period of 453 days. No implant failures were recorded. The average marginal bone loss was 0.10 mm, with 80.6% of implants showing no marginal bone loss. The extent of marginal bone loss was greater in the mandible (0.13 ± 0.25) than in the maxilla (0.08 ± 0.19). An increase in implant diameter by 1 mm resulted in 0.08 mm of marginal bone loss, indicating wider diameter implants are associated with more bone loss. Age was also positively correlated with marginal bone loss, increasing by 0.002 mm per year. No differences were found for gender, smoking, diabetes, heart disease, restoration type, and immediate loading.

CONCLUSIONS

Dental implant therapy in a rural Chinese population demonstrated high survival rates and minimal marginal bone loss. Factors such as age, implant location, and diameter influenced bone loss. This study fills a critical gap in understanding implant outcomes specifically within rural settings, highlighting the need for tailored approaches to enhance patient access and care in these communities. Further research is needed to explore these relationships and assess implant outcomes in rural populations.

Wirelessly Actuated Microfluidic Pump and Valve for Controlled Liquid Delivery in Dental Implants

Enabling minimally invasive and precise control of liquid release in dental implants is crucial for therapeutic functions such as delivering antibiotics to prevent biofilm formation, infusing stem cells to promote osseointegration, and administering other biomedicines. However, achieving controllable liquid cargo release in dental implants remains challenging due to the lack of wireless and miniaturized fluidic control mechanisms. Here wireless miniature pumps and valves that allow remote activation of liquid cargo delivery in dental implants, actuated and controlled by external magnetic fields (<65 mT), are reported. A magnet-screw mechanism in a fluidic channel to function as a piston pump, alongside a flexible magnetic valve designed to open and close the fluidic channel, is proposed. The mechanisms are showcased by storing and releasing of liquid up to 52 µL in a dental implant. The liquid cargos are delivered directly to the implant-bone interface, a region traditionally difficult to access. On-demand liquid delivery is further showed by a metal implant inside both dental phantoms and porcine jawbones. The mechanisms are promising for controllable liquid release after implant placement with minimal invasion, paving the way for implantable devices that enable long-term and targeted delivery of therapeutic agents in various bioengineering applications.

Comparison of osseointegration in commercial SLA-treated dental implants with different surface roughness: a pilot study in beagle dogs

PURPOSE

This pilot study investigated the effect of surface roughness on osseointegration by comparing two types of commercial SLA-treated dental implants with different surface roughness levels: moderately rough (Sa = 1 - 2 µm) and rough surfaces (Sa > 2 µm).

MATERIALS AND METHODS

Two implant groups were studied: TS (rough surface) and ADD (moderately rough surface) groups. Surface characteristics were analyzed using optical profilometry and SEM. In vitro studies using BRITER cells assessed cell adhesion, proliferation, and osteogenic differentiation through CCK-8 assay and qRT-PCR for osteopontin (OPN), osteocalcin (OCN), and alkaline phosphatase (ALP) expression. The in vivo study involved 12 implants (six per group) placed in mandibular defects of two beagle dogs. After 8 weeks, histomorphometric analysis evaluated bone to implant contact (BIC) and inter-thread bone density (ITBD). Statistical analysis used Student's t-test and two-way ANOVA for in vitro data, and Mann-Whitney U test for in vivo data.

RESULTS

Surface analysis revealed Sa values of 2.50 ± 0.27 µm for the TS group and 1.80 ± 0.06 µm for the ADD group. In vitro studies showed no significant differences in cell adhesion and proliferation between the groups (P > .05). However, gene expression patterns differed, with ADD group showing higher OPN expression (P < .001) and TS group showing higher ALP expression (P < .01). The in vivo study revealed no statistically significant differences in BIC and ITBD between the two groups (P > .05).

CONCLUSION

Surface roughness influenced osteoblast differentiation in vitro, but did not significantly affect osseointegration outcomes in vivo. Both moderately rough and rough surfaces appeared to support comparable levels of osseointegration. Larger studies are needed to confirm these findings and determine optimal implant surface characteristics.

Application of Collagen Matrix in Peri-Implant Dehiscence Defect: A Case Series

During implant placement, dehiscence defects can result in complications such as mucosal recession and peri-implantitis. Whereas guided bone regeneration (GBR) is a common approach to managing these defects, it is often complex and time-intensive. This case series evaluates an alternative method using a collagen matrix (Collagen Graft2) applied to peri-implant dehiscence defects without GBR. Through three case series, this approach effectively preserves buccal contour, enhances gingival thickness, and supports bone regeneration, leading to favorable peri-implant conditions. These findings suggest that collagen matrix application is a viable and less invasive option for treating peri-implant dehiscence defects; however, further studies are required to validate these results.

Novel Rat Model of Embolic Cerebral Ischemia Using a Radiopaque Blood Clot and a Microcatheter Under Fluoroscopy

Conventional rat models of thromboembolic stroke do not allow control of infarct size or spontaneous recanalization. We aimed to develop a novel rat thromboembolic stroke model that ensures highly reproducible infarct sizes and locations within the MCA territory and does not require arterial ligation. Twenty male Sprague-Dawley rats and two sham-operated rats were included. A microcatheter was navigated from the caudal ventral artery to the internal carotid artery using digital subtraction angiography. A blood clot (diameter, 0.86 mm; length, 3 mm) containing zirconium dioxide was advanced in the catheter. Fluoroscopy was performed at 1, 3, 6, and 24 h after stroke model creation, and TTC staining was conducted at 24 h. Neurological deficit scores were measured. In all embolized rats, the ACA and MCA bifurcation were selective. Median operating time was 6 min. The position of the radiopaque blood clot remained unchanged for 24 h after model creation in 19/20 rats. Median infarct volume was 242 mm3 (IQR, 239-262 mm3). We present a novel rat model of highly reproducible focal infarct in only the MCA territory. Fluoroscopy effectively identified any blood clot migration. This model could contribute to the development of new thrombolytic agents.

Evaluation of the In Vitro Behavior of Electrochemically Deposited Plate-like Crystal Hydroxyapatite Coatings

The purpose of coatings is to protect or enhance the functionality of the substrate material, irrespective of the field in which the material was designed. The use of coatings in medicine is rapidly expanding with the objective of enhancing the osseointegration ability of metallic materials such as titanium. The aim of this study was to obtain biomimetic hydroxyapatite (HAp)-based coatings on titanium by using the pulsed galvanostatic method. The morphology of the HAp-based coatings revealed the presence of very thin and wide plate-like crystals, grown perpendicular to the Ti substrate, while the chemical composition highlighted a Ca/P ratio of 1.66, which is close to that of stoichiometric HAp (1.67). The main phases and chemical bonds identified confirmed the presence of the HAp phase in the developed coatings. A roughness of 228 nm and a contact angle of approx. 17° were obtained for the HAp coatings, highlighting a hydrophilic character. In terms of biomineralization and electrochemical behavior, it was shown that the HAp coatings have significantly enhanced the titanium properties. Finally, the in vitro cell tests carried out with human mesenchymal stem cells showed that the Ti samples coated with HAp have increased cell viability, extracellular matrix, and Ca intracellular deposition when compared with the uncoated Ti, indicating the beneficial effect.

Surface engineering of orthopedic implants for better clinical adoption

Musculoskeletal disorders are on the rise, and despite advances in alternative materials, treatment for orthopedic conditions still heavily relies on biometal-based implants and scaffolds due to their strength, durability, and biocompatibility in load-bearing applications. Bare metallic implants have been under scrutiny since their introduction, primarily due to their bioinert nature, which results in poor cell-material interaction. This challenge is further intensified by mechanical mismatches that accelerate failure, tribocorrosion-induced material degradation, and bacterial colonization, all contributing to long-term implant failure and posing a significant burden on patient populations. Recent efforts to improve orthopedic medical devices focus on surface engineering strategies that enhance the interaction between cells and materials, creating a biomimetic microenvironment and extending the service life of these implants. This review compiles various physical, chemical, and biological surface engineering approaches currently under research, providing insights into their potential and the challenges associated with their adoption from bench to bedside. Significant emphasis is placed on exploring the future of bioactive coatings, particularly the development of smart coatings like self-healing and drug-eluting coatings, the immunomodulatory effects of functional coatings and biomimetic surfaces to tackle secondary infections, representing the forefront of biomedical surface engineering. The article provides the reader with an overview of the engineering approaches to surface modification of metallic implants, covering both clinical and research perspectives and discussing limitations and future scope.

Advances in osteoimmunomodulation of biomaterials after intrabone implantation: focus on surface hydrophilicity

Biomaterials intended for intrabone implantation are extensively utilized in orthopedic and dental applications. Their surface properties, particularly hydrophilicity, significantly influence the biological interactions surrounding the implant, ultimately determining the implant's in vivo fate. Recently, the role of osteoimmunomodulation in these implantable biomaterials has been recognized for its importance in regulating biomaterial-mediated osteogenesis. Consequently, it is imperative to elucidate the correlation between hydrophilicity and the immune response for the development of osteoimmunomodulatory implants. Herein, this review highlights recent advances in osteoimmunomodulation of biomaterials after intrabone implantation from a novel perspective-surface hydrophilicity, and summarizes the series of immune reactions and subsequent bone remodeling that occur in response to hydrophilic implants, focusing on protein adsorption, the behaviors of major immune cells, and osteoimmunomodulation-enhanced angiogenesis and osteogenesis. Hydrophilic biomaterials have the capacity to alter the surrounding immune microenvironment and accelerate the process of material-tissue bonding, thereby facilitating the successful integration of biomaterials with tissue. Collectively, the authors hope that this article provides strategies for modulating hydrophilicity to achieve osteoimmunomodulatory performance and further promotes the development of novel implantable biomaterials for orthopedic and dental applications.

Histomorphometric Analysis of Osseointegrated Intraosseous Dental Implants Using Undecalcified Specimens: A Scoping Review

Bone histology and histomorphometry are reliable diagnostic tools for the assessment of the bone-implant interface, material safety and biocompatibility, and tissue response. They allow for the qualitative and quantitative analysis of undecalcified bone specimens. This scoping review aims to identify the most common staining techniques, study models for in vivo experiments, and histomorphometric parameters used for quantitative bone evaluation of osseointegrated dental implants in the last decade. The Web of Science, PubMed, and Scopus databases were searched on 1 July 2024 for relevant articles in English, published in the last ten years, and the data were exported to an MS Excel spreadsheet. A total of 115 studies met the eligibility criteria and were included in the present review. The results indicate that the most common study models are dogs, rabbits, and pigs. Some of the most frequently used methods for the assessment of the bone-implant interface are the Toluidine blue, Stevenel's blue with Van Gieson, and Levai-Laczko stainings. The results from this study demonstrate that the most commonly used histomorphometric parameters in implant dentistry are the bone-to-implant contact (BIC), bone area fraction occupancy (BAFO), bone area (BA), and bone density (BD). This review presents the recent trends in histomorphometric analysis of dental implants and identifies some research gaps that necessitate further research.

Antimicrobial peptide GL13K-Modified titanium in the epigenetic regulation of osteoclast differentiation via H3K27me3

Implant surface designs have advanced to address challenges in oral rehabilitation for healthy and compromised bone. Several studies have analyzed the effects of altering material surfaces on osteogenic differentiation. However, the crucial role of osteoclasts in osseointegration has often been overlooked. Overactive osteoclasts can compromise implant stability. In this study, we employed a silanization method to alter pure titanium to produce a surface loaded with the antimicrobial peptide GL13K that enhanced biocompatibility. Pure titanium (Ti), silanization-modified titanium, and GL13K-modified titanium (GL13K-Ti) were co-cultured with macrophages. Our findings indicated that GL13K-Ti partially inhibited osteoclastogenesis and expression of osteoclast-related genes and proteins by limiting the formation of the actin ring, an important structure for osteoclast bone resorption. Our subsequent experiments confirmed the epigenetic role in regulating this process. GL13K-Ti was found to impact the degree of methylation modifications of H3K27 in the NFATc1 promoter region following RANKL-induced osteoclastic differentiation. In conclusion, our study unveils the potential mechanism of methylation modifications, a type of epigenetic regulatory modality, on osteoclastogenesis and activity on the surface of a material. This presents novel concepts and ideas for further broadening the clinical indications of oral implants and targeting the design of implant surfaces.

Bioactive surface modifications on dental implants: a systematic review and meta-analysis of osseointegration and longevity

BACKGROUND

Bioactive surface modifications have been proposed to enhance osseointegration and longevity of dental implants. This study aimed to systematically review and perform a meta-analysis on the effectiveness of various bioactive coatings in promoting bone integration and improving implant longevity.

METHODS

A systematic review was conducted, including studies that investigated bioactive surface modifications on titanium dental implants. Outcomes of interest were bone-to-implant contact (BIC) and implant longevity over a 30-day period. Data were extracted and analyzed using RevMan 5 (version 5.4.1), with forest plots generated to represent the mean difference (MD) and 95% confidence intervals (CI) under a random effects model.

RESULTS

The meta-analysis showed a significant improvement in BIC for surface-modified implants, with an overall MD of 7.29 (95% CI [2.94, 11.65]). Heterogeneity analysis indicated moderate heterogeneity (Tau² = 18.57, Chi² = 16.08, df = 8, P = 0.04, I² = 50%). The test for overall effect yielded Z = 3.28 (P = 0.001). For implant longevity, the overall MD was 7.52 (95% CI [3.18, 11.85]), with moderate heterogeneity (Tau² = 17.28, Chi² = 14.95, df = 8, P = 0.06, I² = 47%). The test for overall effect yielded Z = 3.40 (P = 0.0007).

CONCLUSION

Bioactive surface changes significantly improved osseointegration and lifespan of dental implants. Collagen-based coatings consistently encouraged early bone integration, while BMP-2 combinations were effective for osseointegration. Optimizing bioactive agent doses and combinations was critical for achieving desired outcomes.

Effect of Er,Cr:YSGG Laser Irradiation on the Surface Modification and Cell Adhesion on Titanium Discs: An In Vitro Study

This study evaluates the potential of erbium, chromium-doped:yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser irradiation to modify the titanium surface for optimal seeding of fibroblasts and osteoblasts in the treatment of peri-implantitis. Titanium discs were treated using the Er,Cr:YSGG laser, an ultrasonic device with a stainless tip, or titanium scalers. Changes in surface properties were analyzed by profilometer and scanning electron microscopy (SEM). Murine fibroblast and osteoblast adhesion and proliferation were evaluated qualitatively and quantitatively at 24 and 72 h. Profilometric surface topography and SEM showed that titanium scalers and ultrasonic debridement techniques significantly changed the structure of the machined and rough titanium surfaces. The Er,Cr:YSGG laser irradiation, on the other hand, did not alter titanium microstructures. The Er,Cr:YSGG laser irradiation with the 40 Hz group showed a significantly higher attached fibroblast cell numbers than the titanium scaler group at 72 h after treatment (p = 0.023). Additionally, the number of the attached osteoblasts in the Er,Cr:YSGG laser irradiation with the 40 Hz group was significantly higher than that of the no-treatment groups 24 h after treatment (p = 0.045). The Er,Cr:YSGG laser effectively promoted adherence of fibroblasts and osteoblasts to the titanium surface without significantly altering the titanium surface, suggesting its superiority for treating peri-implantitis.

Application of nanoparticles as surface modifiers of dental implants for revascularization/regeneration of bone

BACKGROUND

Osseointegrated dental implants are widely established as a first-choice treatment for the replacement of missing teeth. Clinical outcomes are however often compromised by short or longer-term biological complications and pathologies. Nanoparticle-coated materials represent a very active research area with the potential to enhance clinical outcomes and reduce complications of implant therapy. This scoping review aimed to summarize current research on various types of nanoparticles (NPs) used as surface modifiers of dental implants and their potential to promote biological and clinical outcomes.

METHODS

A systematic electronic search was conducted in SCOPUS, PubMed and Google Scholar aiming to identify in vivo, in situ, or in vitro studies published between 2014 and 2024. Inclusion and exclusion criteria were determined and were described in the methods section.

RESULTS

A total of 169 articles (44 original papers from Scopus and PubMed, and 125 articles from Google Scholar) were identified by the electronic search. Finally, 30 studies fit the inclusion criteria and were further used in this review. The findings from the selected papers suggest that nanoparticle-coated dental implants show promising results in enhancing bone regeneration and promoting angiogenesis around the implant site. These effects are due to the unique physicochemical properties of nanoparticle-coated implants and the controlled release of bioactive molecules from nanoparticle-modified surfaces.

CONCLUSION

Nanoscale modifications displayed unique properties which could significantly enhance the properties of dental implants and further accelerate revascularization, and osseointegration while facilitating early implant loading. Yet, since many of these findings were based on in-vitro/in-situ systems, further research is required before such technology reaches clinical application.

Five- and 18-Year Outcome of Two Cases with Full-Arch Rehabilitations Ad modum All-on-4 in the Presence of Challenging Conditions

Placing implants in fresh postextraction sites is a borderline rehabilitation procedure. The purpose of this report is to describe the pre-, per-, and postoperative procedures for maintaining long-term stability of two full-arch rehabilitations through the All-on-4 protocol, performed in the presence of challenging conditions. Two patients were referred for full-arch rehabilitation with immediate function, with both patients presenting infection in the jaws: patient 1 with an implant (position #45) inserted in a cystic cavity; patient 2 with one implant (position #24) inserted transsinus after the removal of a cyst on the base of the maxillary sinus and another implant (position #15) inserted with a dehiscence. Both patients received a preoperative dental hygiene appointment, a regenerative surgical protocol, and were enrolled in a postoperative maintenance protocol. After surgery a provisional prosthesis was provided ensuring immediate function, and 6 months after surgery, the final prosthesis was delivered. During the follow-up appointments (final follow-up at 5 and 18 years), the implants were stable, and no infection was observed for both patients. The present case report describes two full-arch rehabilitations in immediate function, supported by dental implants inserted in the presence of challenging conditions that do not represent the norm, rather are highly demanding for the clinical team, warranting caution in the interpretation of the results.

Effects of handheld nonthermal plasma on the biological responses, mineralization, and inflammatory reactions of polyaryletherketone implant materials

Background/purpose

The handheld nonthermal plasma (HNP) treatment may alter the surface properties, bone metabolism, and inflammatory reactions of polyaryletherketone (PAEK) dental implant materials. This study tested whether the HNP treatment might increase the biocompatibility, surface hydrophilicity, surface free energies (SFEs), and the cell adhesion and mineralization capability of PAEK materials.

Materials and methods

Disk-shaped samples of titanium (Ti), zirconia (Zr), polyetheretherketone (PEEK [PE]), and polyetherketoneketone (PEKK [PK]) were subjected to HNP treatment and termed as TiPL, ZrPL, PEPL, and PKPL, respectively. Water-surface reactions were examined using a goniometer. MG-63 cells were cultured on all samples to assess the cell viability, cytotoxicity, cell attachment, and mineralization characteristics. The expression of pro-inflammatory cytokines (tumor necrosis factor-alpha and interleukin-6) and key mineralization markers (alkaline phosphatase [ALKP], osteopontin [OPN], and dentin matrix protein 1 [DMP1]) was measured using enzyme-linked immunosorbent assay kits.

Results

The HNP-treated samples exhibited significantly enhanced surface hydrophilicities and SFEs compared to the untreated samples. The cell viability remained high across all samples, indicating no cytotoxic effects. The HNP treatment significantly enhanced MG-63 cell adherence and proliferation. Elevated levels of ALKP and OPN were observed for the plasma-treated PEPL and PKPL specimens, while DMP1 levels increased significantly only in the PKPL specimen. Pro-inflammatory cytokine levels were low across all samples, suggesting no inflammatory response.

Conclusion

The HNP-treated PAEKs have enhanced the surface hydrophilicity and SFEs as well as superior cell adhesion and mineralization capability, and thus may be good clinical dental implant materials.

The Oral Microbiome of Peri-Implant Health and Disease: A Narrative Review

Peri-implantitis disease has increased significantly over the last years, resulting in increased failure of implants. Many factors may play a role in implant complications and failure, including ones related to the oral microbiota. This literature review aims to summarize the current knowledge of microbiome of implants in health and disease, focusing not only on the presence/absence of specific microbiota or on their relative abundance, but also on their phenotypic expression and their complex relationships with the host. The authors examined the MEDLINE database and identified key topics about peri-implant oral microbiome in health and disease. The peri-implant microbiome differs from that of the tooth, both in health and disease, as they are structurally and chemically different. The adhesion and formation of the peri-implant biofilm can be affected by the surface energy, topography, wettability, and electrochemical charges of the implant surface. In addition, the morphogenesis of the tissues surrounding the dental implant also differs from the tooth, making the dental implant more susceptible to bacterial infection. This interplay between the microbiome and the host immune system in peri-implant infections still needs to be elucidated.

Clinical outcomes and supragingival microbiota analysis around dental implants and teeth in patients with a history of periodontitis: a preliminary study of 6 months follow-up

OBJECTIVES

To investigate the supragingival microbiome surrounding dental implants and neighbouring tooth in periodontitis history and periodontally healthy patients.

METHODS

Subjects with a history of periodontitis (test) and periodontally healthy subjects (control) received one of two types of dental implants with different surface characteristics: sandblasted acid-etched (SLA) or precision dimension laser-treated (PDL). Periodontal clinical measurements were collected at baseline (V1), 3 months after implant placement (V4), at zirconia crown placement (V6) and 3 months after zirconia crown placement (V8). Supragingival bacterial microbiota was studied using Illumina MiSeq sequencing.

RESULTS

Supragingival microbial community on SLA implants in test group significantly differed to control group at V8 (p < 0.05). A longitudinal shift displaying microbial dysbiosis occurred on SLA implants (p < 0.05) and adjacent teeth (p < 0.05) among test patients from V6 to V8. On PDL implants and the adjacent tooth, no significant difference between test and control groups from V6 to V8 (p > 0.05). Co-occurrence network in test group of SLA implants and the adjacent tooth at V8 showed increased disease-associated bacteria and reduced health-associated bacteria. Health-associated bacteria were dominant in control group of SLA implants at V8.

CONCLUSION

The surface characteristics and prosthetic components of dental implants may be important risk factors in patients with a history of periodontitis.

CLINICAL RELEVANCE

Dysbiosis of supragingival microbiome may predispose dental implants to peri-implant diseases. Thus, a strict supportive periodontal care plan is imperative to prevent early onset of biological complications.

Dental Implant Surface Topography and Stability With Resonance Frequency Analysis: An Overview and Case Report

Dental implants are fixtures that replace a natural tooth that has been missing. The outcome depends on the safety and longevity of the bone-implant relationship. The process of direct and strong anchoring of an implant due to the surrounding bone tissue growing around it is called osseointegration. The establishment of an osseointegrated contact depends on a variety of systemic and local variables and diagnostic methods. Resonance frequency analysis is one of the methods used to analyze implant stability. The surface topography, mainly surface texture and roughness, also helps in promoting a favorable interaction between the implant and biological tissues. This case report aimed to indicate the importance of implant surfaces showing primary and secondary stability and implant stability quotient (ISQ) values that can be analyzed by resonance frequency analysis (RFA) using the Osstell implant device, which can be a useful tool used to determine the risk of failure.