Sandblasted and Acid Etched Titanium Dental Implant Surfaces Systematic Review and Confocal Microscopy Evaluation

Histological and scanning electron microscopy investigation of the effects of titanium surface modifications on osseointegration in rabbits

This study aimed to compare the novel Estaş Medical Anodization (EMA) surface treatment technique with the techniques commonly used in the literature and to examine their effects on osteointegration in the rabbit tibia. A total of 24 rabbits used in this study were divided into 3 groups, with 8 rabbits in each group. Using both tibias of all rabbits in the study, screws belonging to the control group were placed in the left tibia, and the right tibia belonging to the experimental group were placed. In the first 8 rabbits, a single experimental group in the right tibia were used; in the second 8 rabbits, 2 different experimental groups in the right tibia were used; and in the last 8 rabbits, 2 different experimental groups in the right tibia were used. Thus, 5 different experimental groups with 8 screws in each group and a separate control group were formed for each of them. EMA-treated surfaces were named 200-800 nm iris oxidation and 800-1200 nm gray oxidation according to the TiO2 layer thickness. Group 1 was implanted with mini-screws prepared with chemical etching+EMA iris oxidation, while group 2 was implanted with sandblasted, large-grit and acid-etched (SLA) mini screws treated with EMA gray oxidation. Group 3 was implanted with mini-screws treated with EMA gray oxidation, group 4 was implanted with mini-screws treated with chemical etching+micro-arc oxidation, and group 5 was implanted with mini-screws treated with chemical etching+EMA gray oxidation. The control group was implanted with mini-screws prepared with pure titanium. At the end of 6 weeks, osseointegration percentages were calculated and compared using histological and scanning electron microscope (SEM) analyses. The histological results confirmed the increase in osseointegration percentages in all experimental groups compared to those that received pure titanium implants (P values control group vs group 1=.005, control group vs group 2, 3, 4, 5=.001). The comparison between the groups revealed that the chemical etching+EMA gray oxidation modification technique (group 5) significantly increased osseointegration compared to the SLA+EMA gray oxidation technique (group 5 vs group 2 P=.016) and the chemical etching+EMA iris oxidation technique (group 5 vs group 1 Pp=.001). The EMA gray oxidation technique (group 3) significantly increased osseointegration compared to the chemical etching+EMA iris oxidation technique (group 1) (group 3 vs group 1 P=.043). The results of the SEM analysis showed that osseointegration was significantly increased in all experimental groups compared to that in the pure titanium (control) group (P values control group vs group 1, 2, 3=.001, control group vs Group 4,5=.006). The mean osseointegration percentage in the experimental groups was the highest in group 5, followed by group 4, group 3 and group 1 equally, and group 2. However, the differences among the experimental were not significant (group 1, group 2, group 3, group 4 vs group 5 P=.408). The EMA titanium surface modification techniques we developed significantly increased osseointegration compared to the pure titanium surface. The EMA gray oxidation technique seems to result in higher osseointegration rates than the EMA iris oxidation technique, and similar rates can be found with the SLA and chemical etching techniques. N/A.

Influence of the Surface Topography of Titanium Dental Implants on the Behavior of Human Amniotic Stem Cells

The dental implant surface plays a crucial role in osseointegration. The topography and physicochemical properties will affect the cellular functions. In this research, four distinct titanium surfaces have been studied: machined acting (MACH), acid etched (AE), grit blasting (GBLAST), and a combination of grit blasting and subsequent acid etching (GBLAST + AE). Human amniotic mesenchymal (hAMSCs) and epithelial stem cells (hAECs) isolated from the amniotic membrane have attractive stem-cell properties. They were cultured on titanium surfaces to analyze their impact on biological behavior. The surface roughness, microhardness, wettability, and surface energy were analyzed using interferometric microscopy, Vickers indentation, and drop-sessile techniques. The GBLAST and GBLAST + AE surfaces showed higher roughness, reduced hydrophilicity, and lower surface energy with significant differences. Increased microhardness values for GBLAST and GBLAST + AE implants were attributed to surface compression. Cell viability was higher for hAMSCs, particularly on GBLAST and GBLAST + AE surfaces. Alkaline phosphatase activity enhanced in hAMSCs cultured on GBLAST and GBLAST + AE surfaces, while hAECs showed no mineralization signals. Osteogenic gene expression was upregulated in hAMSCs on GBLAST surfaces. Moreover, α2 and β1 integrin expression enhanced in hAMSCs, suggesting a surface-integrin interaction. Consequently, hAMSCs would tend toward osteoblastic differentiation on grit-blasted surfaces conducive to osseointegration, a phenomenon not observed in hAECs.

Evaluation of Implant Stability Quotient of Sandblasted Acid-Etched (SAE) and Chemical-Modified SAE Dental Implants: A Clinical Study

Objectives

The goal of the current research was to assess the implant stability quotient (ISQ) of dental implants that were chemically changed with SAE and without SAE.

Materials and Methods

Patients in the current study had dental implants fitted with SAE (Group I) and chemically altered SAE (Group II). After implant implantation, resonance frequency analysis (RFA) was performed as soon as possible as well as one, three, six, nine, and twelve weeks later. Version 23.0 of SPSS Statistics for Windows was used to statistically analyze the results.

Result

In SAE dental implants (Group I), a highest RFA value of 84.1 and a minimum value of 42.2 were noted. In chemically modified implants, the SAE (group II) mean RFA value ranged from 30.3 to 87.1.

Conclusion

It has been noted that dental implants with surface treatment exhibit increased implant-bone osseointegration. Implants with hydrophilic surfaces osseointegrate more quickly than those with SAE areas.

Radiographic and histologic assessment of osseointegration for surface-treated titanium dental implants: An experimental study in dogs

Background

Modifying the dental implant's surface texture enhances its biological response to the bone and implant‒tissue interface, resulting in the successful support of forces. This study assessed the impact of sandblasting, sandblasting plus acid etching, Er,Cr:YSGG laser, and propolis implant surface treatments and occlusal load on the osseointegration of titanium dental implants in dogs.

Methods

Seventy-two titanium dental implants with a diameter of 4 mm and a length of 10 mm were divided into four groups according to implant surface modifications (n=18 for each group): group A: sandblasting plus acid etching, group B: sandblasting with Al2 O3, group C: Er,Cr:YSGG laser, group D: propolis coating. Twenty-four local breed male dogs were used. Premolar teeth (P1, P2, and P3) were extracted on the left side of the mandible, and after 12 weeks of bone healing, implants were unilaterally installed. The osseointegration at three study times from implant installation (14, 90, and 180 days) was evaluated. The dog jaws were scanned using an intraoral scanner for the virtual design of screw-retained three-unit crowns after 90 days of osseointegration. Final radiographs were taken before the animals were sacrificed at 14, 90, and 180 days, and the histological analysis was performed.

Results

Radiographic analysis showed new bone formation (NBF) along and in contact with the implant surface of the treated groups. The histological analysis after 14 days in groups A and B revealed a uniform and ongoing pattern of bone growth and many osteoblasts with few osteocytes within lacunae in new bone trabeculae. Group C showed an increase in the number of osteoblasts lining thin bone trabeculae. Group D showed a generative power concerning bone. At 90 days, there was increased bone ingrowth, and the new bone matured in all the treated implant groups. At 180 days, dense mature bone apposition was in direct contact with delayed-loaded implant surfaces.

Conclusion

A radiographic examination revealed that surface modification significantly impacted osseointegration, with a strong bond between the implant surface and the surrounding bone. The histological sections at the 14-day interval revealed obvious bone remodeling activity, especially in sandblasting plus acid etching and sandblasting-modified implant surface groups. At the 90-day interval, bone ingrowth had increased, and the new bone became mature, especially in sandblasting and propolis surface modification groups. After 180 days of the delayed-loaded implant osseointegration, differences were observed between different implant-treated groups with a remarkable remodeling of the bone, especially in the propolis coating group.

Deep-learning performance in identifying and classifying dental implant systems from dental imaging: a systematic review and meta-analysis

Deep learning (DL) offers promising performance in computer vision tasks and is highly suitable for dental image recognition and analysis. We evaluated the accuracy of DL algorithms in identifying and classifying dental implant systems (DISs) using dental imaging. In this systematic review and meta-analysis, we explored the MEDLINE/PubMed, Scopus, Embase, and Google Scholar databases and identified studies published between January 2011 and March 2022. Studies conducted on DL approaches for DIS identification or classification were included, and the accuracy of the DL models was evaluated using panoramic and periapical radiographic images. The quality of the selected studies was assessed using QUADAS-2. This review was registered with PROSPERO (CRDCRD42022309624). From 1,293 identified records, 9 studies were included in this systematic review and meta-analysis. The DL-based implant classification accuracy was no less than 70.75% (95% confidence interval [CI], 65.6%-75.9%) and no higher than 98.19 (95% CI, 97.8%-98.5%). The weighted accuracy was calculated, and the pooled sample size was 46,645, with an overall accuracy of 92.16% (95% CI, 90.8%-93.5%). The risk of bias and applicability concerns were judged as high for most studies, mainly regarding data selection and reference standards. DL models showed high accuracy in identifying and classifying DISs using panoramic and periapical radiographic images. Therefore, DL models are promising prospects for use as decision aids and decision-making tools; however, there are limitations with respect to their application in actual clinical practice.

Boosting Titanium Surfaces with Positive Charges: Newly Developed Cationic Coating Combines Anticorrosive and Bactericidal Properties for Implant Application

Along with poor implant-bone integration, peri-implant diseases are the major causes of implant failure. Although such diseases are primarily triggered by biofilm accumulation, a complex inflammatory process in response to corrosive-related metallic ions/debris has also been recognized as a risk factor. In this regard, by boosting the titanium (Ti) surface with silane-based positive charges, cationic coatings have gained increasing attention due to their ability to kill pathogens and may be favorable for corrosion resistance. Nevertheless, the development of a cationic coating that combines such properties in addition to having a favorable topography for implant osseointegration is lacking. Because introducing hydroxyl (-OH) groups to Ti is essential to increase chemical bonds with silane, Ti pretreatment is of utmost importance to achieve such polarization. In this study, plasma electrolytic oxidation (PEO) was investigated as a new route to pretreat Ti with OH groups while providing favorable properties for implant application compared with traditional hydrothermal treatment (HT). To produce bactericidal and corrosion-resistant cationic coatings, after pretreatment with PEO or HT (Step 1), surface silanization was subsequently performed via immersion-based functionalization with 3-aminopropyltriethoxysilane (APTES) (Step 2). In the end, five groups were assessed: untreated Ti (Ti), HT, PEO, HT+APTES, and PEO+APTES. PEO created a porous surface with increased roughness and better mechanical and tribological properties compared with HT and Ti. The introduction of -OH groups by HT and PEO was confirmed by Fourier transform infrared spectroscopy and the increase in wettability producing superhydrophilic surfaces. After silanization, the surfaces were polarized to hydrophobic ones, and an increase in the amine functional group was observed by X-ray photoelectron spectroscopy, demonstrating a considerable amount of positive ions. Such protonation may explain the enhanced corrosion resistance and dead bacteria (Streptococcus aureus and Escherichia coli) found for PEO+APTES. All groups presented noncytotoxic properties with similar blood plasma protein adsorption capacity vs the Ti control. Our findings provide new insights into developing next-generation cationic coatings by suggesting that a tailorable porous and oxide coating produced by PEO has promise in designing enhanced cationic surfaces targeting biomedical and dental implant applications.

Comparison between bone-implant interfaces of microtopographically modified zirconia and titanium implants

The aim of this study was to investigate the surface characteristics and evaluate the bone-implant interfaces of injection molded zirconia implants with or without surface treatment and compare them with those of conventional titanium implants. Four different zirconia and titanium implant groups (n = 14 for each group) were prepared: injection-molded zirconia implants without surface treatment (IM ZrO₂); injection-molded zirconia implants with surface treatment via sandblasting (IM ZrO₂-S); turned titanium implants (Ti-turned); and titanium implants with surface treatments via sandblasting with large-grit particles and acid-etching (Ti-SLA). Scanning electron microscopy, confocal laser scanning microscopy, and energy dispersive spectroscopy were used to assess the surface characteristics of the implant specimens. Eight rabbits were used, and four implants from each group were placed into the tibiae of each rabbit. Bone-to-implant contact (BIC) and bone area (BA) were measured to evaluate the bone response after 10-day and 28-day healing periods. One-way analysis of variance with Tukey's pairwise comparison was used to find any significant differences. The significance level was set at α = 0.05. Surface physical analysis showed that Ti-SLA had the highest surface roughness, followed by IM ZrO₂-S, IM ZrO₂, and Ti-turned. There were no statistically significant differences (p > 0.05) in BIC and BA among the different groups according to the histomorphometric analysis. This study suggests that injection-molded zirconia implants are reliable and predictable alternatives to titanium implants for future clinical applications.

SEM Evaluation of Thermal Effects Produced by a 445 nm Laser on Implant Surfaces

The aim of this in vitro study was to evaluate thermal effects on implant surfaces using a 445 nm diode laser (Eltech K-Laser Srl, Treviso, Italy) with different power settings and irradiation modalities. Fifteen new implants (Straumann, Basel, Switzerland) were irradiated to evaluate surface alteration. Each implant was divided into two zones: the anterior and posterior areas. The anterior coronal areas were irradiated with a distance of 1 mm between the optical fiber and the implant; the anterior apical ones were irradiated with the fiber in contact with the implant. Instead, the posterior surfaces of all of the implants were not irradiated and used as control surfaces. The protocol comprised two cycles of laser irradiation, lasting 30 s each, with a one-minute pause between them. Different power settings were tested: a 0.5 W pulsed beam (T-on 25 ms; T-off 25 ms), a 2 W continuous beam and a 3 W continuous beam. Lastly, through a scanning electron microscopy (SEM) analysis, dental implants' surfaces were evaluated to investigate surface alterations. No surface alterations were detected using a 0.5 W laser beam with a pulsed mode at a distance of 1 mm. Using powers of irradiation of 2 W and 3 W with a continuous mode at 1 mm from the implant caused damage on the titanium surfaces. After the irradiation protocol was changed to using the fiber in contact with the implant, the surface alterations increased highly compared to the non-contact irradiation modality. The SEM results suggest that a power of irradiation of 0.5 W with a pulsed laser light emission mode, using an inactivated optical fiber placed 1 mm away from the implant, could be used in the treatment of peri-implantitis, since no implant surface alterations were detected.

Current Molecular, Cellular and Genetic Aspects of Peri-Implantitis Disease: A Narrative Review

(1) Background: Peri-implantitis is a multi-factorial disease with an inflammatory background that occurs in both soft and hard tissues surrounding implants. In recent years, the understanding of the cellular, molecular and genetic background of peri-implantitis has broadened. This study aims to summarize the currently available articles on the subject and highlight the most recent advances over the last 20 years. (2) Methods: For this study, the Embase and PubMed libraries were searched using the keywords: ("peri-implantitis" AND "cytokine" OR "genetics" OR "cellular") and ("peri-implantitis" AND "cytokine" OR "genetics" OR "cellular" AND "risk factors"). The search revealed a total of 3013 articles (992 from PubMed, 2021 from Embase). Following screening of the titles and abstracts and full-text reads, 55 articles were included. (3) Results: In peri-implantitis IL-6, IL-1β, TNF-α, MMP-8 and their genetic variations appear to be the most important cytokines in relation to not only pathogenesis, but also their potential diagnostic capabilities. Epithelial and inflammatory cells, along with those of the bone lineage, are prime cellular elements found in peri-implantitis. (4) Conclusions: A wide array of cells stand behind peri-implantitis, as well as cytokines and their genetic variations that take part in the process. However, the growing interest in this topic has led to the introduction of specific new diagnostic tools to enable a better understanding of patients' responses to treatment and, in turn, to even enable prediction of the risk of developing peri-implant disease.

Silver Nanoparticles in Dental Applications: A Descriptive Review

Silver nanoparticles have been a recent focus of many researchers in dentistry, and their potential uses and benefits have drawn attention in dentistry and medicine. The fabrication and utilization of nanoscale substances and structures are at the core of the rapidly developing areas of nanotechnology. They are often used in the dental industry because they prevent bacteria from making nanoparticles, oxides, and biofilms. They also stop the metabolism of bacteria. Silver nanoparticles (AgNPs) are a type of zero-dimensional material with different shapes. Dentistry has to keep up with changing patient needs and new technology. Silver nanoparticles (AgNPs) can be used in dentistry for disinfection and preventing infections in the oral cavity. One of the most interesting metallic nanoparticles used in biomedical applications is silver nanoparticles (AgNPs). The dental field has found promising uses for silver nanoparticles (AgNPs) in the elimination of plaque and tartar, as well as the elimination of bacterial and fungal infections in the mouth. The incorporation of AgNPs into dental materials has been shown to significantly enhance patients' oral health, leading to their widespread use. This review focuses on AgNP synthesis, chemical properties, biocompatibility, uses in various dental fields, and biomaterials used in dentistry. With an emphasis on aspects related to the inclusion of silver nanoparticles, this descriptive review paper also intends to address the recent developments of AgNPs in dentistry.

Impact of bisphosphonate drugs on dental implant healing and peri-implant hard and soft tissues: a systematic review

Objective

Implantology represents the gold standard for oral rehabilitation, unfortunately, often, despite there are no local contraindications to this type of rehabilitation, there are uncertainties regarding the general health of our patients. Many patients nowadays take bisphosphonate drugs, often without first seeking advice from an oral surgeon or a dentist. The purpose of this review is precisely to highlight any contraindications to this type of treatment reported in the literature, in patients who take or have taken bisphosphonate drugs.

Methods

For this study the scientific information sources were consulted using as search terms “(“bisphosphonate AND “dental implant”)”, obtaining 312 results, these were subsequently skimmed according to the inclusion and exclusion criteria, and further evaluated their relevance to the study and the presence of requested outcomes.

Results

Only 9 manuscripts (RCTs, Multicentric studies and Clinical Trials) were included in this review, as they respected the parameters of this review, they were analyzed and it was possible to draw important results from them. Surely from this study it is understood that the use of bisphosphonate drugs does not represent an absolute contraindication to implant therapy, it is evident how adequate pharmacological prophylaxis, and an adequate protocol reduce the risks regarding implant failures. Furthermore, the values of marginal bone loss over time seem, even if not statistically significant, to be better in implant rehabilitation with bisphosphonate drugs association. Only a few molecules like risedronate, or corticosteroids, or some conditions like smoking or diabetes have shown a high risk of surgical failure.

Conclusion

Although this study considered different studies for a total of 378 patients and at least 1687 different dental implants, showing better results in some cases for dental implant therapy in cases of bisphosphonate intake, further clinical, randomized and multicentric studies are needed, with longer follow-ups, to fully clarify this situation which often negatively affects the quality of life of our patients and places clinicians in the face of doubts.

Osseointegration Levels of Implants Placed With Allogenic and Xenogenic Bone Ring: An Experimental Biomechanical Analysis

This in vivo study aimed to do a biomechanical analysis of the early period bone-implant connection of titanium implants simultaneously inserted with xsenogenic and allogenic bone ring. In this study, 28 Sprague Dawley female rats were used. Four rats were killed to obtain an allogenic bone ring, and after this, the remaining rats were divided into control (n=8), xsenogenic (n=8), and allogenic (n=8) bone ring groups. Titanium-machined surfaced implants were integrated right tibias of the rats. In controls, only implants were integrated into right tibias. In the greft groups, the implants were integrated simultaneously with bone rings. After 2 weeks of the experimental period, the rats were killed ,and titanium implants and surrounding bone tissues were removed for biomechanic analysis. After biomechanical reverse torque analysis bone-implant connection was determined as Newton/cm2; in controls 3.26 (1.2 to 4.5), in allogenic ring group 3.37 (2 to 4.4), in xsenogenic ring group 5.93 (2.8 to 10). Statistically significant differences were not detected between the groups (P>0.05). Within the limitation of this study, both allogenic and xsenogenic bone grafts could be successfully used in bone augmentation in implant surgery.

Surface roughness and characteristics of CAD/CAM zirconia and glass ceramics after combined treatment procedures

BACKGROUND

The roughening of the inner surface of a fixed ceramic restoration is an important factor for the bonding process. The aim of this study is to investigate the effect of combined surface treatments (acid etching, air-abrasion and Er: YAG Laser) on surface roughness of CAD/CAM fabricated zirconia (ZrO₂) and lithium-disilicate glass ceramics (LDS).

METHODS

Sixty ZrO₂ (Ceramill Zi) and LDS (IPS e.max CAD) specimens, (5 mm in width, 5 mm in length and 1.5 mm in height) were fabricated using CAD/CAM and sintered according to the manufacturer's instructions. All specimens subjected to three surface treatment combinations; etching with 4% hydrofluoric acide (HF), airborne-particle abrasion with 110-μm alumina (Al₂O₃) (AP) and Er:YAG laser (Er:YAG) (Group A-HF + AP; Group B-Er:YAG + AP, and Group C-Er:YAG + HF). Perthometer was used to measure the surface roughness of the specimens before and after the tretments.

RESULTS

Group A presented the highest Ra (LDS 0.81 ± 0.27 and ZrO₂ 0.67 ± 0.21 after treatment) and Group C the lowest (LDS 0.45 ± 0.13 and ZrO₂ 0.26 ± 0.07, after treatment). Compared with before treatment, the Ra were significantly different only in Group A both ZrO₂ and LDS after treatment (p < 0.05). Qualitative SEM images suggested the surface topography of the ZrO₂ was smoother than the LDS. Less surface changes were observed in the Er:YAG combined procedures than HF + AP.

CONCLUSIONS

HF + AP was significantly succesful in modifying the ceramic surface. Er:YAG did not sufficiently promote the surface topography, even if combined with any other treatments. Overall, surface tretments on ZrO₂ not easier than LDS.

Electrolytic Cleaning and Regenerative Therapy of Peri-implantitis in the Esthetic Area: A Case Report

Implantology represents the gold standard in oral rehabilitation. Unfortunately, a new pathology begins to show itself to clinicians that no longer affects only and solely the supporting tissues of the tooth but also dental implants and peri-implantitis. In this study, we present a case report regarding a tissue regeneration maneuver involving dental implants. The clinical and radiographic results are encouraging, regarding the use of these techniques on implant surfaces. Surely, the advent of new biomaterials and surgical techniques will make this practice safe and predictable.

Role of nanostructured materials in hard tissue engineering

The rise in the use of biomaterials in bone regeneration in the last decade has exponentially multiplied the number of publications, methods, and approaches to improve and optimize their functionalities and applications. In particular, biomimetic strategies based on the self-assembly of molecules to design, create and characterize nanostructured materials have played a very relevant role. We address this idea on four different but related points: self-setting bone cements based on calcium phosphate, as stable tissue support and regeneration induction; metallic prosthesis coatings for cell adhesion optimization and prevention of inflammatory response exacerbation; bio-adhesive hybrid materials as multiple drug delivery localized platforms and finally bio-inks. The effect of the physical, chemical, and biological properties of the newest biomedical devices on their bone tissue regenerative capacity are summarized, described, and analyzed in detail. The roles of experimental conditions, characterization methods and synthesis routes are emphasized. Finally, the future opportunities and challenges of nanostructured biomaterials with their advantages and shortcomings are proposed in order to forecast the future directions of this field of research.

Endosseous Dental Implant Materials and Clinical Outcomes of Different Alloys: A Systematic Review

In recent years, implantology has made significant progress, as it has now become a safe and predictable practice. The development of new geometries, primary and secondary, of new surfaces and alloys, has made this possible. The purpose of this review is to analyze the different alloys present on the market, such as that in zirconia, and evaluate their clinical differences with those most commonly used, such as those in grade IV titanium. The review, conducted on major scientific databases such as Scopus, PubMed, Web of Science and MDPI yielded a startling number of 305 results. After the application of the filters and the evaluation of the results in the review, only 10 Randomized Clinical Trials (RCTs) were included. Multiple outcomes were considered, such as Marginal Bone Level (MBL), Bleeding on Probing (BoP), Survival Rate, Success Rate and parameters related to aesthetic and prosthetic factors. There are currently no statistically significant differences between the use of zirconia implants and titanium implants, neither for fixed prosthetic restorations nor for overdenture restorations. Only the cases reported complain about the rigidity and, therefore, the possibility of fracture of the zirconium. Certainly the continuous improvement in these materials will ensure that they could be used safely while maintaining their high aesthetic performance.

Design and Evaluation of Web-Based Dental Implant Registry (DIR) for Better Clinical Outcomes

Introduction

Identification of dental implant system in undocumented patients is a major challenge for dentists due to the vast variety of tools and technologies that are used in dental care. It also takes a long time to identify the type of connection or length and diameter of implant. To obtain accurate and timely information, it is necessary to have a Dental Implant Registry (DIR). In the present study, a DIR was designed, developed, and evaluated at the Dental Implant Research Center of Tehran University of Medical Sciences.

Materials and Methods

This is an applied, developmental, and cross-sectional study that was conducted between 2018 and 2020. In the present study, after determining the objectives of DIR system, its conceptual model was designed by EDraw Max 7.9 software. Then, the registry was developed in Visual Studio 2018 environment with the C# programming language and, finally, it was evaluated by Nielsen's ten principles of usability assessment.

Results

After creating the registry, its data entry search and report functions were tested. Also, in the exploratory evaluation, the highest number of problems related to the principles of system clarity and compatibility between the system and real world was identified.

Conclusion

The web-based DIR created in C# programming language has the ability to gather data, provide report with different access levels, and send text messages to patients for follow-up. This tool enables physicians to quickly identify the components of dental implant. The web-based DIR also provides support for health research, quality assessment, and dental performance assessment.

Superhydrophilic multifunctional nanotextured titanium dental implants: in vivo short and long-term response in a porcine model

Current clinical demand in dental implantology is for a multifunctional device with optimum mechanical properties, improved biocompatibility and bioactivity, and having differential interactions with cells and pathogenic agents. This would minimise bacterial infection, biofilm formation and modulate inflammation, leading to a fast and durable osseointegration. The present study intends to establish the multifunctional behaviour of surface modified titanium dental implants that are superhydrophilic, with unique micro-nano or nanoscale topographies, developed by a facile hydrothermal technique. Here, the short and long-term performances of these textured implants are tested in a split mouth design using a porcine model, in pre- and post-loaded states. Quantitative and qualitative analyses of the bone implant interphase are performed through μ-CT and histology. Parameters that evaluate bone mineral density, bone contact volume and bone implant contact reveal enhanced bone apposition with better long-term response for the nano and micro-nano textured surfaces, compared to the commercial microtextured implant. Concurrently, the nanoscale surface features on implants reduced bacterial attachment by nearly 90% in vivo, outperforming the commercial variant. This preclinical evaluation data thus reveal the superiority of nano/micro-nano textured designs for clinical application and substantiate their improved osseointegration and reduced bacterial adhesion, thus proposing a novel dental implant with multifunctional characteristics.

Enhanced Extracellular Matrix Deposition on Titanium Implant Surfaces: Cellular and Molecular Evidences

The surface structure of the titanium dental implants can modulate the activity of mesenchymal stem cells in order to promote the upregulation of osteoblastic related genes and the release of extracellular matrix (ECM) components. The present work was focused on the in vitro evaluation of the interaction of human periodontal ligament stem cells (hPDLSCs) and two different implant titanium surfaces topography (CTRL and TEST). This study was aimed at analyzing the cytotoxicity of the dental implant surfaces, the cellular adhesion capacity, and the improvement in the release of ECM molecules in an in vitro model. These parameters were carried out by means of the microscopic evaluation, viability assays, immunofluorescence, Western blot and RT-PCR investigations. The knowledge of the cell/implant interaction is essential for implant healing in order to obtain a more performing surfaces that promote the ECM release and provide the starting point to initiate the osseointegration process.

Professional Mechanical Tooth Cleaning Method for Dental Implant Surface by Agar Particle Blasting

Oral dysfunction due to peri-implantitis and shortened life of implants has become a major concern. Self-care and removal of oral biofilms by professional mechanical tooth cleaning (PMTC) are indispensable for its prevention. However, if the surface roughness of the implant is increased, it may result in the adhesion of biofilm in the oral cavity. Therefore, the PMTC method can serve for long-term implant management. Calcium carbonate (CaCO₃) has been used as a cleaning method for implant surfaces; however, there is concern that the implant surface roughness could increase due to particle collision. Therefore, in this study, to establish a blasting cleaning method that does not adversely affect the implant surface, a new blasting cleaning method using agar particles was devised and its practical application examined. When the simulated stains were blasted with white alumina (WA) abrasive grains and CaCO₃ particles, the simulated stains were almost removed, the surface roughness changed to a satin-finished surface—which was thought to be due to fine scratches—and the surface roughness increased. Most of the simulated stains were removed on the surface of the sample blasted with glycine particles and agar particles. Conversely, the gloss of the sample surface was maintained after cleaning, and the increase in surface roughness was slight.

Galvanic Corrosion of Ti Dental Implants Coupled to CoCrMo Prosthetic Component

Dental implant systems are composed of an implant, prosthetic components, and a crown. Since the implants are made of commercially pure Ti (cp Ti) and prosthetic components are often made of Ti and CoCrMo alloys, a galvanic couple between these two devices may lead to galvanic corrosion, ions release, and even loss of the implant. This study aimed to investigate the corrosion resistance and measure the galvanic potential between cp Ti alloys (annealed microstructured cp Ti G4 and cold-worked nanostructured cp Ti G4) and a CoCrMo alloy. The corrosion resistance has been characterized by measuring the open circuit potential, the potentiodynamic polarization, the potentiostatic polarization, and the zero-resistance current. The cp Ti has been tested before and after a surface acid treatment. The samples' surfaces have been examined by scanning electron microscopy, and their surface roughness has been measured by a 3D optical profilometer. The polarization results showed that the CoCrMo alloy showed lower corrosion resistance than cp Ti. The surface acid treatment improves dental implant corrosion resistance. The galvanic analysis showed that the cp Ti without surface treatment behaved as an anode and after the acid treatment has a cathodic behavior in relation to the CrCoMo alloy. The highest value of galvanic current was cp TiG4 acid etched in contact with CoCrMo, in pH 2 solution. The galvanic couple with the lowest current has been the nanostructured cp Ti in contact with CoCrMo alloy.

Osteosphere Model to Evaluate Cell-Surface Interactions of Implantable Biomaterials

Successful biomaterials for bone tissue therapy must present different biocompatible properties, such as the ability to stimulate the migration and proliferation of osteogenic cells on the implantable surface, to increase attachment and avoid the risks of implant movement after surgery. The present work investigates the applicability of a three-dimensional (3D) model of bone cells (osteospheres) in the evaluation of osteoconductive properties of different implant surfaces. Three different titanium surface treatments were tested: machined (MA), sandblasting and acid etching (BE), and Hydroxyapatite coating by plasma spray (PSHA). The surfaces were characterized by Scanning Electron Microscopy (SEM) and atomic force microscopy (AFM), confirming that they present very distinct roughness. After seeding the osteospheres, cell–surface interactions were studied in relation to cell proliferation, migration, and spreading. The results show that BE surfaces present higher densities of cells, leaving the aggregates towards than titanium surfaces, providing more evidence of migration. The PSHA surface presented the lowest performance in all analyses. The results indicate that the 3D model allows the focal analysis of an in vitro cell/surfaces interaction of cells and surfaces. Moreover, by demonstrating the agreement with the clinical data observed in the literature, they suggest a potential use as a predictive preclinical tool for investigating osteoconductive properties of novel biomaterials for bone therapy.

Effect of Primary Stabilisation on Osseointegration of Implants With Local and Systemic Zoledronic Acid Application

ABSTRACT

Primary stabilization (PS) is defined as initial tight fit during the surgical placement of an implant. Tight implant placement is quite difficult in cases where bone quality and quantity are insufficient. Zoledronic acid (ZA) is a powerful bisphosphonate that prevents bone resorption. The aim of this study is to investigate the effect of local and systemic ZA application on osseointegration in titanium implants with and without PS. Male Sprague Dawley rats were divided into 2 main groups, with PS, PS + (n = 24), and without primary stabilisation, PS - (n = 24). These main groups were divided into control (n = 8), 2 mg/1 mL local ZA (n = 8) and 0.1 mg/kg systemic ZA (n = 8) groups. All of the subjects were sacrificed after a 4-week recovery period. Bone implant connection (BIC) and thread filling (TF) (%) of the samples was analyzed according to the non-decalcified histological analysis method. In terms of BIC percentages and TF, statistically significant differences were found between the groups with and without PS and between the ZA treatment groups (P < 0.05). The common effect of PS and ZA use on the percentage of BIC was found to be statistically significant (P < 0.05). The common effect of PS and acid type on TF was not statistically significant (P < 0.05). Within the limitations of this study, it may be concluded that systemic and local administration of ZA may increase implant osseointegration.

The role of autophagy in the process of osseointegration around titanium implants with micro-nano topography promoted by osteoimmunity

Osteoimmunity plays an important role in the process of implant osseointegration. Autophagy is a conservative metabolic pathway of eukaryotic cells, but whether the interaction between autophagy and osteoimmunity plays a key role in osseointegration remains unclear. In this study, we prepared smooth titanium disks and micro-nano topography titanium disks, to study the immune microenvironment of RAW264.7 cells, and prepared the conditioned medium to study the effect of immune microenvironment on the osteogenesis and autophagy of MC3T3-E1 cells. Autophagy inhibitor 3-MA was used to inhibit autophagy to observe the change of expression of osteogenic markers. The results showed that the micro-nano topography titanium disks could stimulate RAW264.7 cells to differentiate into M2 type, forming an anti-inflammatory immune microenvironment; compared with the control group, the anti-inflammatory immune microenvironment promoted the proliferation and differentiation of osteoblasts better. The anti-inflammatory immune environment activated the autophagy level of osteoblasts, while the expression of osteogenic markers was down-regulated after inhibition of autophagy. These results indicate that anti-inflammatory immune microenvironment can promote cell proliferation and osteogenic differentiation, autophagy plays an important role in this process. This study further explains the mechanism of implant osseointegration in osteoimmune microenvironment, and provides reference for improving implant osseointegration.

Osseointegration of Sandblasted and Acid-Etched Implant Surfaces. A Histological and Histomorphometric Study in the Rabbit

Titanium surface is an important factor in achieving osseointegration during the early wound healing of dental implants in alveolar bone. The purpose of this study was to evaluate sandblasted-etched surface implants to investigate the osseointegration. In the present study, we used two different types of sandblasted-etched surface implants, an SLA™ surface and a Nanoblast Plus™ surface. Roughness and chemical composition were evaluated by a white light interferometer microscope and X-ray photoelectron spectroscopy, respectively. The SLA™ surface exhibited the higher values (Ra 3.05 μm) of rugosity compared to the Nanoblast Plus™ surface (Ra 1.78 μm). Both types of implants were inserted in the femoral condyles of ten New Zealand white rabbits. After 12 weeks, histological and histomorphometric analysis was performed. All the implants were osseointegrated and no signs of infection were observed. Histomorphometric analysis revealed that the bone–implant contact % (BIC) ratio was similar around the SLA™ implants (63.74 ± 13.61) than around the Nanoblast Plus™ implants (62.83 ± 9.91). Both implant surfaces demonstrated a favorable bone response, confirming the relevance of the sandblasted-etched surface on implant osseointegration.

Factors Influencing Marginal Bone Loss around Dental Implants: A Narrative Review

Implant supported dental prostheses are increasingly used in dental practice. The aim of this narrative review is to present the influence of transmucosal surface of prosthetic abutment and implant on peri-implant tissue. The article describes causes of bone loss around the dental implant. Moreover, properties of different materials are compared and discussed. The advantages, disadvantages, and biomechanical concept of different implant-abutment connections are presented. The location of connections in relation to the bone level and the influence of microgap between the abutment and implant are described. Additionally, the implant abutments for cemented and screwed prosthetic restorations are compared. The influence of implant and abutment surface at the transmucosal level on peri-implant soft tissue is discussed. Finally, the biological aspect of abutment-implant connection is analyzed.

Comparison of the Stability of Sandblasted, Large-Grit, and Acid-Etched Treated Mini-Screws With Two Different Surface Roughness Values: A Histomorphometric Study

PURPOSE

To evaluate the effects of 2 different surface roughness values produced by sandblasted, large-grit, and acid-etched treatments at different loading conditions on the stability of mini-screws.

MATERIAL AND METHODS

A total of 56 mini-screws (Group 1; 28 with Ra value of 1 μm, Group 2; 28 with Ra value of 1.5 μm) were inserted into the tibia of fourteen New Zealand rabbits. Surface analysis was performed before the placement of the miniscrews using multi-technique characterization. The mini-screws were loaded with 500 grf after different healing times: unloaded, immediate, 4 and 8 weeks. Resonance frequency analyses were performed immediately after mini-screw placement and at the end of loading. Biomechanical and histomorphometric analyses were also performed at the end of the loading period.

RESULTS

All mini-screws preserved their stability at the end of the loading period. However, the resonance frequency analyses showed higher implant stability quotient scores for 8-week group, unlike the immediate loading and unloaded groups (P < 0.05). According to the infinite focus microscopy results, prolongation of healing time resulted in a greater bone area on the loaded mini-screws in Group 2 (P < 0.05). Similarly, the histomorphometric analysis revealed higher bone-to-implant contact values in the 8-week group. There was no significant difference in the stability between the miniscrews with the Ra values of 1 and 1.5 μm.

CONCLUSIONS

Sandblasted, large-grit, and acid-etched treated mini-screws showed significantly higher stability with healing time under heavy forces. Sandblasted, large-grit, and acid-etched treated mini-screws can be removed without fracture of the screw or the bone surfaces.

Integration of Dental Implants in Conjunction with EDTA-Conditioned Dentin Grafts: An Experimental Study

This study was undertaken to investigate the integration of titanium micro-implants installed in conjunction with previously dentin-grafted areas and to study the morphological appearance, mineral content, and healing pattern of xenogenic EDTA-conditioned dentin blocks and granules grafted to cavities in the tibial bone of rabbits. Demineralized and non-demineralized dentin blocks and granules from human premolars were implanted into cavities prepared on the lateral aspects of the tibias of rabbits. After a healing period of six months, micro-implants were installed at each surgical site. Histological examinations were carried out after 24 weeks. Characterization of the EDTA-conditioned dentin blocks was performed by means of light microscopy, dental X-rays, scanning electron microscopy, and energy dispersive X-ray analysis (EDX). No implants were found to be integrated in direct contact with the dentin particles or blocks. On the EDTA-conditioned dentin surface, the organic marker elements C and N dominated, as revealed by EDX. The hydroxyapatite constituents Ca and P were almost absent on the dentin surface. No statistically significant difference was observed between the EDTA-conditioned and non-demineralized dentin, as revealed by BIC and BA. The bone-inductive capacity of the dentin material seemed limited, although demineralization by means of EDTA indicated higher BIC and BA values in conjunction with the installed implants in the area. A 12 h EDTA treatment did not fully decalcify the grafts, as revealed by X-ray analysis.

In Vivo and In Vitro Analyses of Titanium-Hydroxyapatite Functionally Graded Material for Dental Implants

Purpose

The stress shielding effect caused due to the mechanical mismatch between the solid titanium and the surrounding bone tissue warrants the utilization of a mechanically and biologically compatible material such as the titanium-hydroxyapatite (Ti-HA) functionally graded material (FGM) for dental implants. This study is aimed at fabricating a Ti-HA FGM with superior mechanical and biological properties for dental implantation.

Materials and Methods

We fabricated a Ti-HA FGM with different Ti volume fractions (VFs) using HA and Ti powders. Ti-HA was characterized by studying its mechanical properties. Cytotoxicity was examined using a Cell Counting Kit-8 assay and an LDH cell cytotoxicity assay. Scanning electron microscopy was performed on an XL30 environmental scanning electron microscope (ESEM). Alkaline phosphatase (ALP) and transforming growth factor (TGF-β1) expressions were quantitatively monitored using enzyme-linked immunosorbent assay (ELISA) kits. The expressions of TGF-β receptors and ALP genes were measured using real-time polymerase chain reaction. The Ti-HA FGM dental implants were placed in beagle dogs. Microcomputed tomography (CT) and hard tissue slices were performed to evaluate the bone-implant contact (BIC) and bone volume over total volume (BV/TV).

Results

The density and mechanical properties of the Ti-HA exhibited various graded distributions corresponding to VF. Based on the results of the Cell Counting Kit-8 (CCK-8) and lactate dehydrogenase (LDH) assays, the difference in cytotoxicity between the two groups was statistically nonsignificant (P = 0.11). The ALP and TGF-β1 levels were slightly upregulated. The transcript levels of ALP and TGF-βRI were higher in the Ti-HA groups than in the Ti group at 7 days, whereas the transcript levels of TGF-βRII exhibited no obvious increase. The BIC did not exhibit significant differences between the Ti and Ti-HA FGM groups (P = 0.0504). BV/TV showed the Ti-HA FGM group had better osteogenesis (P = 0.04).

Conclusion

Ti-HA FGM contributes to the osteogenesis of dental implants in vivo and in vitro.

Surface Treatment of the Dental Implant with Hyaluronic Acid: An Overview of Recent Data

Recently, interest has grown by focusing on the evaluation of a molecule already produced in the human body such as hyaluronic acid (HA), as an application to the surface of the titanium implant. Its osteo-conductive characteristics and positive interaction with the progenitor cells responsible for bone formation, consequently, make it responsible for secondary stability. The aim of this work was to analyze the various surface treatments in titanium implants, demonstrating that the topography and surface chemistry of biomaterials can correlate with the host response; also focusing on the addition of HA to the implant surface and assessing the biological implications during early stages of recovery. Used as a coating, HA acts on the migration, adhesion, proliferation and differentiation of cell precursors on titanium implants by improving the connection between implant and bone. Furthermore, the improvement of the bioactivity of the implant surfaces through HA could therefore facilitate the positioning of the dental prosthesis precisely in the early loading phase, thus satisfying the patients’ requests. It is important to note that all the findings should be supported by further experimental studies in animals as well as humans to evaluate and confirm the use of HA in any field of dentistry.

Dental Pulp Stem Cells on Implant Surface: An In Vitro Study

In the field of biology and medicine, one hears often about stem cells and their potential. The dental implant new surfaces, subjected to specific treatments, perform better and allow for quicker healing times and better clinical performance. The purpose of this study is to evaluate from a biological point of view the interaction and cytotoxicity between stem cells derived from dental pulp (DPSCs) and titanium surfaces. Through the creation of complex cells/implant, this study is aimed at analyzing the cytotoxicity of dental implant surfaces (Myth (Maipek Manufacturer Industrial Care, Naples, Italy)) and the adhesion capacity of cells on them and at considering the essential factors for implant healing such as osteoinduction and vasculogenesis. These parameters are pointed out through histology (3D cell culture), immunofluorescence, proliferation assays, scanning electron microscopy, and PCR investigations. The results of the dental implant surface and its interaction with the DPSCs are encouraging, obtaining results increasing the mineralization of the tissues. The knowledge of this type of interaction, highlighting its chemical and biological features, is certainly also an excellent starting point for the development of even more performing surfaces for having better healing in the oral surgical procedures related to dental implant positioning.

Effects of Surface Modification on Adsorption Behavior of Cell and Protein on Titanium Surface by Using Quartz Crystal Microbalance System

Primary stability and osseointegration are major challenges in dental implant treatments, where the material surface properties and wettability are critical in the early formation of hard tissue around the implant. In this study, a quartz crystal microbalance (QCM) was used to measure the nanogram level amount of protein and bone marrow cells adhered to the surfaces of titanium (Ti) surface in real time. The effects of ultraviolet (UV) and atmospheric-pressure plasma treatment to impart surface hydrophilicity to the implant surface were evaluated. The surface treatment methods resulted in a marked decrease in the surface carbon (C) content and increase in the oxygen (O) content, along with super hydrophilicity. The results of QCM measurements showed that adhesion of both adhesive proteins and bone marrow cells was enhanced after surface treatment. Although both methods produced implants with good osseointegration behavior and less reactive oxidative species, the samples treated with atmospheric pressure plasma showed the best overall performance and are recommended for clinical use. It was verified that QCM is an effective method for analyzing the initial adhesion process on dental implants.

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

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

Development of a Surface-Functionalized Titanium Implant for Promoting Osseointegration: Surface Characteristics, Hemocompatibility, and In Vivo Evaluation

This study aimed to evaluate the impact of surface-modified biomedical titanium (Ti) dental implant on osseointegration. The surfaces were modified using an innovative dip-coating technique (IDCT; sandblasted, large-grit, and acid-etched, then followed by coating with the modified pluronic F127 biodegradable polymer). The surface morphology and hemocompatibility evaluations were investigated by field-emission scanning electron microscopy, while the contact analysis was observed by goniometer. The IDCT-modified Ti implant was also implanted in patients with missing teeth by single-stage surgical procedure then observed immediately and again four months after placement by cone-beam computerized tomography (CBCT) imaging. It was found that the IDCT-modified Ti implant was rougher than the dental implant without surface modification. Contact angle analysis showed the IDCT-modified Ti implant was lower than the dental implant without surface modification. The hemocompatibility evaluations showed greater red blood cell aggregation and fibrin filament formation on the IDCT-modified Ti implant. The radiographic and CBCT image displayed new bone formation at four months after the IDCT-modified Ti implant placement. Therefore, this study suggests that the IDCT-modified Ti dental implant has great potential to accelerate osseointegration.

Peri-Implant Diseases: Diagnosis, Clinical, Histological, Microbiological Characteristics and Treatment Strategies. A Narrative Review

Since the use of dental implants is continuously increasing, it is imperative for dental practitioners to understand the nature and treatment of peri-implant diseases. The purpose of this manuscript is to comprehensively review peri-implant diseases, their characteristics, as well as their non-surgical and surgical treatment. To that end, the current literature was searched and a narrative review was conducted. It is essential that the case definitions described in the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions are used to diagnose and classify peri-implant health, peri-implant mucositis and peri-implantitis. While recent epidemiologic studies on peri-implant diseases exist, there is great heterogeneity in the definition of these conditions. Several risk factors and indicators are reported in the literature, with smoking and diabetes being the most universally accepted. In peri-implant mucositis, non-surgical treatment seems to be sufficient. However, for the treatment of peri-implantitis, a surgical approach, which includes open-flap debridement, apically positioned flap and guided bone regeneration, is considered more appropriate. A great variety of adjuncts to mechanical treatment have been reported with controversial results. Finally, studies comparing results from different peri-implantitis treatments are warranted in randomized controlled clinical trials in order to provide stronger evidence-based approaches.

Multicenter clinical trial on dental implants survival rate: a FDS76® study

BACKGROUND

Implantology, thanks to its predictability in oral rehabilitations, has become a widespread method for rehabilitating edentulous patients, offering excellent patient satisfaction. Improving the quality of oral health, especially if rehabilitation involves minimal short and long-term complications, leads to an improvement in the quality of life of our patients.

METHODS

This clinical study was conducted to evaluate the short and long-term complications (up to 18 months) of implant-prosthetic rehabilitations performed with a new dental implant (FDS76^®, Italy).

RESULTS

The results showed a limited number of complications or implant failures.

CONCLUSIONS

Knowing the latter could certainly help improve both surgical and dental materials performance.

Multicenter clinical trial on dental implants survival rate: a FDS76® study

BACKGROUND

Implantology, thanks to its predictability in oral rehabilitations, has become a widespread method for rehabilitating edentulous patients, offering excellent patient satisfaction. Improving the quality of oral health, especially if rehabilitation involves minimal short and long-term complications, leads to an improvement in the quality of life of our patients.

METHODS

This clinical study was conducted to evaluate the short and long-term complications (up to 18 months) of implant-prosthetic rehabilitations performed with a new dental implant (FDS76^®, Italy).

RESULTS

The results showed a limited number of complications or implant failures.

CONCLUSIONS

Knowing the latter could certainly help improve both surgical and dental materials performance.

Comparison between four different implant surface debridement methods: an in-vitro experimental study

BACKGROUND

Peri-implantitis treatment is a very challenging topic to discuss. What is certain is that preventive/supportive therapy plays a key-role in peri-implant tissues' health maintenance and non-surgical implant surface mechanical debridement remains one of the solid pillars in the therapeutic pathway. In this perspective, many surface decontaminating methods have been proposed and tested to remove hard and soft bacterial deposits. The aim of this study was to compare four different commonly used non-surgical implant debridement methods in terms of cleaning potential in vitro, using a peri-implant pocket-simulating model.

METHODS

Sixty-four dental implants were ink-stained and placed into a simulated peri-implant pocket. Samples were then divided into four groups and treated with different debridement methods: stainless-steel ultrasonic tip (PS), peek-coated ultrasonic tip (PI), sub-gingival air-polishing with erythritol powder (EHX) and sub-gingival air-polishing with glycine powder (GLY). For each treatment group, half of the samples were treated for 5 seconds and the other half for 45 seconds. High-resolution images were taken using a digital microscope and later analyzed with a light processing software for measuring the cleaned area percentage (ink-free). Two different images were captured for every sample: a first image with the implant positioned perpendicular to the microscope lenses (90°) and a second one with the implant placed with a 45° vertical angulation, with the smooth neck towards the ground. Percentage of removed ink was statistically modelled using a generalized linear mixed model with the implant as a random (clustering) factor.

RESULTS

A paired comparison between all treatments in terms of debridement potential (cleaned area percentage) was performed. In 5s and with 90° sample angulation EHX/PS comparison showed an odds ratio of 2.75 (P<0.001), PI/EHX an OR of 0.20 (P<0.001), GLY/PS an OR of 2.90 (P<0.001), PI/GLY an OR of 0.19 (P<0.001) and PI/PS an OR of 0.56 (P=0.105). With the same sample angulation and 45s treatment time, the OR was 6.97 (P<0.001) for EHX/PS comparison, 0.14 (P<0.001) for PI/EHX comparison, 4.99 (P<0.001) for GLY/PS, 0.19 (P<0.001) for PI/GLY and 0.95 for PI/PS (P =0.989). With 5s of treatment time and 45° sample angulation, EHX/PS comparison shows a 3.19 odds ratio (P<0.001), PI/EHX a 0.14 odds ratio (P<0.001), GLY/PS a 3.06 odds ratio (P<0.001), PI/GLY a 0.15 odds ratio (P<0.001) and PI/PS a 0.46 odds ratio (P=0.017). With the same sample angulation but 45s treatment time, EHX/PS comparison produced an odds ratio of 4.90 (P<0.001), PI/EHX an OR of 0.20 (P<0.001), GLY/PS an OR of 8.74 (P<0.001), PI/GLY an OR of 0.11 (P<0.001) and PI/PS an OR 0.96 of (P =0.996).

CONCLUSIONS

Among the four treatments considered, air-polishing therapy represents the best one in terms of ink removal from the implant surface. Furthermore, increasing the treatment time to 45 seconds, air-polishing resulted considerably more efficient.

The Bacterial Anti-Adhesive Activity of Double-Etched Titanium (DAE) as a Dental Implant Surface

This work aimed to compare the capability of Streptococcus oralis to adhere to a novel surface, double-etched titanium (DAE), in respect to machined and single-etched titanium. The secondary outcome was to establish which topographical features could affect the interaction between the implant surface and bacteria. The samples’ superficial features were characterized using scanning electron microscopy (SEM) and energy dispersive x-ray spectrometry (EDS), and the wetting properties were tested through sessile methods. The novel surface, the double-etched titanium (DAE), was also analyzed with atomic force microscopy (AFM). S. oralis was inoculated on discs previously incubated in saliva, and then the colony-forming units (CFUs), biomass, and cellular viability were measured at 24 and 48h. SEM observation showed that DAE was characterized by higher porosity and Oxygen (%) in the superficial layer and the measurement of the wetting properties showed higher hydrophilicity. AFM confirmed the presence of a higher superficial nano-roughness. Microbiological analysis showed that DAE discs, coated by pellicle’s proteins, were characterized by significantly lower CFUs at 24 and 48 h with respect to the other two groups. In particular, a significant inverse relationship was shown between the CFUs at 48 h and the values of the wetted area and a direct correlation with the water contact angle. The biomass at 24 h was slightly lower on DAE, but results were not significant concerning the other groups, both at 24 and 48 h. The DAE treatment not only modifies the superficial topography and increased hydrophilicity, but it also increases the Oxygen percentage in the superficial layer, which could contribute to the inhibition of S. oralis adhesion. DAE can be considered a promising treatment for titanium implants to counteract a colonization pioneer microorganism, such as S. oralis.

Exosomes Enhance Adhesion and Osteogenic Differentiation of Initial Bone Marrow Stem Cells on Titanium Surfaces

Successful osseointegration involves the biological behavior of bone marrow stem cells (BMSCs) on an implant surface; however, the role of BMSC-derived extracellular vesicles (EVs)/exosomes in osseointegration is little known. This study aimed to: (i) explore the interaction force between exosomes (Exo) and cells on a titanium surface; (ii) discuss whether the morphology and biological behavior of BMSCs are affected by exosomes; and (iii) preliminarily investigate the mechanism by which exosomes regulate cells on Ti surface. Exosomes secreted by rat BMSCs were collected by ultracentrifugation and analyzed using transmission electron microscopy and nanoparticle tracking analysis. Confocal fluorescence microscopy, scanning electron microscopy, Cell Counting Kit-8 (CCK-8), quantitative real-time polymerase chain reaction techniques, and alkaline phosphatase bioactivity, Alizarin Red staining, and quantification were used to investigate the exosomes that adhere to the Ti plates under different treatments as well as the morphological change, adhesion, spread, and differentiation of BMSCs. We found that exosomes were efficiently internalized and could regulate cell morphology and promoted the adhesion, spreading, and osteogenic differentiation of BMSCs. These were achieved partly by activating the RhoA/ROCK signaling pathway. Our discovery presents a new insight into the positive regulatory effect of exosomes on the biological behaviors of BMSCs on Ti surface and provides a novel route to modify the surface of a Ti implant.

Surface Modified Techniques and Emerging Functional Coating of Dental Implants

Dental implants are widely used in the field of oral restoration, but there are still problems leading to implant failures in clinical application, such as failed osseointegration, marginal bone resorption, and peri-implantitis, which restrict the success rate of dental implants and patient satisfaction. Poor osseointegration and bacterial infection are the most essential reasons resulting in implant failure. To improve the clinical outcomes of implants, many scholars devoted to modifying the surface of implants, especially to preparing different physical and chemical modifications to improve the osseointegration between alveolar bone and implant surface. Besides, the bioactive-coatings to promote the adhesion and colonization of ossteointegration-related proteins and cells also aim to improve the osseointegration. Meanwhile, improving the anti-bacterial performance of the implant surface can obstruct the adhesion and activity of bacteria, avoiding the occurrence of inflammation related to implants. Therefore, this review comprehensively investigates and summarizes the modifying or coating methods of implant surfaces, and analyzes the ossteointegration ability and anti-bacterial characteristics of emerging functional coatings in published references.

Bioengineering Methods of Analysis and Medical Devices: A Current Trends and State of the Art

Implantology, prosthodontics, and orthodontics in all their variants, are medical and rehabilitative medical fields that have greatly benefited from bioengineering devices of investigation to improve the predictability of clinical rehabilitations. The finite element method involves the simulation of mechanical forces from an environment with infinite elements, to a simulation with finite elements. This editorial aims to point out all the progress made in the field of bioengineering and medicine. Instrumental investigations, such as finite element method (FEM), are an excellent tool that allows the evaluation of anatomical structures and any facilities for rehabilitation before moving on to experimentation on animals, so as to have mechanical characteristics and satisfactory load cycle testing. FEM analysis contributes substantially to the development of new technologies and new materials in the biomedical field. Thanks to the 3D technology and to the reconstructions of both the anatomical structures and eventually the alloplastic structures used in the rehabilitations it is possible to consider all the mechanical characteristics, so that they could be analyzed in detail and improved where necessary.

Endo and Exoskeleton: New Technologies on Composite Materials

The developments in the field of rehabilitation are proceeding hand in hand with those of cybernetics, with the result of obtaining increasingly performing prostheses and rehabilitations for patients. The purpose of this work is to make a brief exposition of new technologies regarding composites materials that are used in the prosthetic and rehabilitative fields. Data collection took place on scientific databases, limited to a collection of data for the last five years, in order to present news on the innovative and actual materials. The results show that some of the most commonly used last materials are glass fibers and carbon fibers. Even in the robotics field, materials of this type are beginning to be used, thanks above all to the mechanical performances they offer. Surely these new materials, which offer characteristics similar to those in humans, could favor both the rehabilitation times of our patients, and also a better quality of life.

Reliability of a Virtual Prosthodontic Project Realized through a 2D and 3D Photographic Acquisition: An Experimental Study on the Accuracy of Different Digital Systems

AIMS

The study aims to assess the accuracy of digital planning in dentistry, evaluating the characteristics of different intraoral 3D scanners and comparing it with traditional imaging 2D recording methods. Specifically, using computer aided design (CAD) software and measuring inside CAD software, authors want to verify the reliability of different models obtained with different techniques and machines.

METHODS

12 patients that needed aesthetic restorative treatment were enrolled in the study. All the patients underwent recording data of the height and width dental elements 1.1, 1.2, and 1.3 size using different technologies and comparing 2D with 3D methods. A T test was then applied in order to verify whether there was a statistically significant difference between the measurements obtained, comparing the different tools data (Emerald, TRIOS, Photogrammetry and DSS (Digital Smile System)) with the reference values.

RESULTS

No significant differences emerged in the measurements made with the different scanners (Trios 3Shape ®, Planmeca Emerald ®) and photogrammetry. Therefore, what should be underlined regarding the 2D measurements is the speed and simplicity compared to all 3D techniques, so this work can help to better define the field of application and the limits connected to 2D techniques, giving a good window of the technique.

CONCLUSIONS

The low number of patients is not sufficient to provide statistically significant results, but the digital planning future prospects seem to be promising. This study results highlighted how a photogrammetric scanner for dental arches would only have a much smaller shooting field size and greater accuracy. Despite these considerations, the photogrammetric facial scanner provided excellent results for the measurement of individual teeth, showing a great versatility of use.

Influence of In-Situ Electrochemical Oxidation on Implant Surface and Colonizing Microorganisms Evaluated by Scanning Electron Microscopy

Peri-implantitis is a worldwide increasing health problem, caused by infection of tissue and bone around an implant by biofilm-forming microorganisms. Effects of peri-implantitis treatment using mechanical debridement, air particle abrasion and electrochemical disinfection on implant surface integrity were compared. Dental implants covered with bacterial biofilm were cleaned using mechanical debridement and air particle abrasion. In addition, implants were disinfected using a novel electrochemical technique based on an array of boron-doped diamond (BDD) coated electrodes. Following treatment and preparation, the implants were inspected by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX). Mechanical debridement led to changes in surface topography destroying the manufacturer's medium-rough surface by scratch formation. Air particle abrasion led to accumulation of the abrasive used on the implant surface. With both treatment options, appearance of bacteria and yeasts was not affected. In contrast, electrochemical disinfection did not cause alterations of the implant surface but resulted in distorted microbial cells. Electrochemical disinfection of implant surfaces using BDD electrodes may constitute a promising treatment option for cleaning dental implant surfaces without negatively affecting materials and surface properties.

In Vitro Effects of Cyclic Dislodgement on Retentive Properties of Various Titanium-Based Dental Implant Overdentures Attachment System

The purpose of this study was to evaluate the change in the retentive forces of four different titanium-based implant attachment systems during the simulation of insert–removal cycles in an artificial oral environment. Five types of titanium-based dental implant attachment systems (Locator, Kerator, O-ring, EZ-Lock, and Magnetic) were studied (n = 10). The specimens underwent insert–removal cycles in artificial saliva, and the retentive force was measured following 0, 750, 1500, and 2250 cycles. Significant retention loss was observed in all attachment systems, except the magnetic attachments, upon completion of 2250 insertion and removal cycles, compared to the initial retentive force (p < 0.05). A comparison of the initial retentive forces revealed the highest value for Locator, followed by the Kerator, O-ring, EZ-Lock, and Magnetic attachments. Furthermore, Kerator demonstrated the highest retentive loss, followed by Locator, O-ring, EZ-Lock, and Magnetic attachments after 2250 cycles (p < 0.05). In addition, the Locator and Kerator systems revealed significant decrease in retentive forces at all measurement points (p < 0.05). The retention force according to the insert–removal cycles were significantly different according to the types of dental implant attachment systems.

Prosthetic and Mechanical Parameters of the Facial Bone under the Load of Different Dental Implant Shapes: A Parametric Study

In recent years the science of dental materials and implantology have taken many steps forward. In particular, it has tended to optimize the implant design, the implant surface, or the connection between implant and abutment. All these features have been improved or modified to obtain a better response from the body, better biomechanics, increased bone implant contact surface, and better immunological response. The purpose of this article, carried out by a multidisciplinary team, is to evaluate and understand, through the use also of bioengineering tests, the biomechanical aspects, and those induced on the patient's tissues, by dental implants. A comparative analysis on different dental implants of the same manufacturer was carried out to evaluate biomechanical and molecular features. Von Mises analysis has given results regarding the biomechanical behavior of these implants and above all the repercussions on the patient's tissues. Knowing and understanding the biomechanical characteristics with studies of this type could help improve their characteristics in order to have more predictable oral rehabilitations.

Cytokine Profile in Patients with Aseptic Loosening of Total Hip Replacements and Its Relation to Metal Release and Metal Allergy

Metal release from total hip replacements (THRs) is associated with aseptic loosening (AL). It has been proposed that the underlying immunological response is caused by a delayed type IV hypersensitivity-like reaction to metals, i.e., metal allergy. The purpose of this study was to investigate the immunological response in patients with AL in relation to metal release and the prevalence of metal allergy. THR patients undergoing revision surgery due to AL or mechanical implant failures were included in the study along with a control group consisting of primary THR patients. Comprehensive cytokine analyses were performed on serum and periimplant tissue samples along with metal analysis using inductive coupled plasma mass spectrometry (ICP-MS). Patient patch testing was done with a series of metals related to orthopedic implant. A distinct cytokine profile was found in the periimplant tissue of patients with AL. Significantly increased levels of the proinflammatory cytokines IL-1β, IL-2, IL-8, IFN-γ and TNF-α, but also the anti-inflammatory IL-10 were detected. A general increase of metal concentrations in the periimplant tissue was observed in both revision groups, while Cr was significantly increased in patient serum with AL. No difference in the prevalence of metal sensitivity was established by patch testing. Increased levels of IL-1β, IL-8, and TNF-α point to an innate immune response. However, the presence of IL-2 and IFN-γ indicates additional involvement of T cell-mediated response in patients with AL, although this could not be detected by patch testing.

X-ray Computed Tomography for Characterization of Expanded Polystyrene (EPS) Foam

Expanded polystyrene (EPS) foam is widely used in building and construction applications for thermal and acoustic insulation. This material is nearly transparent for X-rays, making it difficult to characterize its pore structure in 3D with X-ray tomography. Because of this difficulty, the pore network is often not investigated and is, thus, poorly known. Since this network controls different physical properties, such as the sound absorption, it is crucial to understand its overall structure. In this manuscript, we show how to reveal the pore network of EPS foams through the combination of high resolution X-ray tomography (micro-CT) and saturation techniques. The foams were saturated with CsCl-brine, which acts as a contrasting agent in X-ray micro-CT imaging. This allowed us to separate the beads, making up the foam, from the pore network. Based on the 3D micro-CT results, we were able to assess a representative elementary volume for the polystyrene, which allows for calculating the acoustical parameters from the Johnson–Champoux–Allard (JCA) model, the pore and bead size distribution. The 3D data was also used as input to simulate sound absorption curves. The parametric study showed that an increase in the bead size influenced the sound absorption of the material. We showed that, by doubling the diameter of beads, the absorption coefficient was doubled in certain ranges of frequency.