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Tang K, Luo ML, Zhou W, Niu LN, Chen JH, Wang F. The integration of peri-implant soft tissues around zirconia abutments: Challenges and strategies. Bioact Mater 2023; 27:348-361. [PMID: 37180640 PMCID: PMC10172871 DOI: 10.1016/j.bioactmat.2023.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/23/2023] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Stable soft tissue integration around the implant abutment attenuates pathogen penetration, protects underlying bone tissue, prevents peri-implantitis and is essential in maintaining long-term implant stability. The desire for "metal free" and "aesthetic restoration" has favored zirconia over titanium abutments, especially for implant restorations in the anterior region and for patients with thin gingival biotype. Soft tissue attachment to the zirconia abutment surface remains a challenge. A comprehensive review of advances in zirconia surface treatment (micro-design) and structural design (macro-design) affecting soft tissue attachment is presented and strategies and research directions are discussed. Soft tissue models for abutment research are described. Guidelines for development of zirconia abutment surfaces that promote soft tissue integration and evidence-based references to inform clinical choice of abutment structure and postoperative maintenance are presented.
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Affiliation(s)
- Kai Tang
- National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology &Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Meng-Lin Luo
- Institute of Stomatology & Oral Maxilla Facial Key Laboratory, The First Medical Center, Chinese PLA General Hospital & Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wei Zhou
- National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology &Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Li-Na Niu
- National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology &Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Ji-Hua Chen
- National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology &Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
- Corresponding author.
| | - Fu Wang
- National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology &Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
- Corresponding author.
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Histologic Evaluation of Soft Tissues around Dental Implant Abutments: A Narrative Review. MATERIALS 2022; 15:ma15113811. [PMID: 35683109 PMCID: PMC9181750 DOI: 10.3390/ma15113811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 01/28/2023]
Abstract
The basis for dental implant success comes not only with the titanium implant osseointegration but also depends on other factors such as the development of a soft tissue barrier, which protects the peri-implant bone from the oral environment. The characteristics of surfaces in contact with peri-implant soft tissues may affect the capacity of peri-implant mucosal cells to create a tight seal around the implant, thus influencing long-term implant success. Many histological studies on animals have been conducted on different materials to better understand their influence on peri-implant soft tissues, with the limitation that results from animal studies cannot be fully translated in humans. The aim of this review paper was to analyze the literature focusing on histological clinical studies in humans which have examined different materials or different surface treatments and their effects on peri-implant soft tissues. The research was conducted according to the following PICO question: “Do different implant/abutment materials affect peri-implant soft tissues adhesion and health?”. Nine articles were analyzed in this review. The results of this review show the influence of different abutment materials on the peri-implant soft tissues, and the need of further research regarding the effect that abutment materials, surface treatments, and surface properties have on soft tissues.
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Mukaddam K, Astasov-Frauenhoffer M, Fasler-Kan E, Marot L, Kisiel M, Steiner R, Sanchez F, Meyer E, Köser J, Bornstein MM, Kühl S. Novel Titanium Nanospike Structure Using Low-Energy Helium Ion Bombardment for the Transgingival Part of a Dental Implant. NANOMATERIALS (BASEL, SWITZERLAND) 2022; 12:1065. [PMID: 35407183 PMCID: PMC9000873 DOI: 10.3390/nano12071065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023]
Abstract
AIM(S) The aim of the study was to fabricate a nanospike surface on a titanium alloy surface using a newly established method of low-energy helium ion bombardment. Various methods to achieve nanospike formation on titanium have been introduced recently, and their antibacterial properties have been mainly investigated with respect to Escherichia coli and Staphylococcus aureus. Oral pathogens such as Porphyromonas gingivalis play an important role in the development of peri-implantitis. For that reason, the antibacterial properties of the novel, nanostructured titanium surface against P. gingivalis were assessed, and a possible effect on the viability of gingival fibroblasts was evaluated. MATERIALS AND METHODS Helium sputtering was employed for developing titanium surfaces with nanospikes of 500 nm (ND) in height; commercially available smooth-machined (MD) and sandblasted and acid-etched titanium disks (SLA) were used as controls. Surface structure characterization was performed through scanning electron microscopy (SEM) and atomic force microscopy (AFM). Following incubation with P. gingivalis, antibacterial properties were determined via conventional culturing and SEM. Additionally, the viability of human gingival fibroblasts (HGFs) was tested through MTT assay, and cell morphology was assessed through SEM. RESULTS SEM images confirmed the successful establishment of a nanospike surface with required heights, albeit with heterogeneity. AFM images of the 500 nm nanospike surface revealed that the roughness is dominated by large-scale hills and valleys. For frame sizes of 5 × 5 μm and smaller, the average roughness is dominated by the height of the titanium spikes. ND successfully induces dysmorphisms within P. gingivalis cultures following the incubation period, while conventional culturing reveals a 17% and 20% reduction for ND compared to MD and SLA, respectively. Moreover, the nanospike surfaces did not affect the viability of human growth fibroblasts despite their sharp surface. CONCLUSION(S) This study successfully developed a novel titanium-nanospike-based structuration technique for titanium surfaces. In addition, the nanospikes did not hinder gingival fibroblast viability. Enhanced antimicrobial effects for such a novel nanospike-based resurfacing technique can be achieved through further optimizations for nanospike spacing and height parameters.
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Affiliation(s)
- Khaled Mukaddam
- Department of Oral Surgery, University Center for Dental Medicine Basel (UZB), University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland;
| | - Monika Astasov-Frauenhoffer
- Department Research, University Center for Dental Medicine Basel (UZB), University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland;
| | - Elizaveta Fasler-Kan
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland;
- Department of Pediatric Surgery, Children’s Hospital, Inselspital Bern, University of Bern and Department of Biomedical Research, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Laurent Marot
- Department of Physics, University of Basel, Klingelbergstraße 82, 4056 Basel, Switzerland; (L.M.); (M.K.); (R.S.); (F.S.); (E.M.)
| | - Marcin Kisiel
- Department of Physics, University of Basel, Klingelbergstraße 82, 4056 Basel, Switzerland; (L.M.); (M.K.); (R.S.); (F.S.); (E.M.)
| | - Roland Steiner
- Department of Physics, University of Basel, Klingelbergstraße 82, 4056 Basel, Switzerland; (L.M.); (M.K.); (R.S.); (F.S.); (E.M.)
| | - Fabien Sanchez
- Department of Physics, University of Basel, Klingelbergstraße 82, 4056 Basel, Switzerland; (L.M.); (M.K.); (R.S.); (F.S.); (E.M.)
| | - Ernst Meyer
- Department of Physics, University of Basel, Klingelbergstraße 82, 4056 Basel, Switzerland; (L.M.); (M.K.); (R.S.); (F.S.); (E.M.)
| | - Joachim Köser
- Institut für Chemie und Bioanalytik, Hochschule für Life Sciences, Hofackerstrasse 30, 4132 Muttenz, Switzerland;
| | - Michael M. Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel (UZB), University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland;
| | - Sebastian Kühl
- Department of Oral Surgery, University Center for Dental Medicine Basel (UZB), University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland;
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Burkhardt F, Harlass M, Adolfsson E, Vach K, Spies BC, Kohal RJ. A Novel Zirconia-Based Composite Presents an Aging Resistant Material for Narrow-Diameter Ceramic Implants. MATERIALS 2021; 14:ma14092151. [PMID: 33922688 PMCID: PMC8122934 DOI: 10.3390/ma14092151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 01/23/2023]
Abstract
A novel ceria-stabilized zirconia-alumina-aluminate composite (Ce-TZP-comp) that is not prone to aging presents a potential alternative to yttrium-stabilized zirconia for ceramic oral implants. The objective of this study was to evaluate the long-term stability of a one-piece narrow-diameter implant made of Ce-TZP-comp. Implant prototypes with a narrow (3.4 mm) and regular (4.0 mm) diameter were embedded according to ISO 14801, and subgroups (n = 8) were subsequently exposed to dynamic loading (107 cycles, 98N) and/or hydrothermal treatment (aging, 85 °C). Loading/aging was only applied as a combined protocol for the 4.0 mm diameter implants. One subgroup of each diameter remained untreated. One sample was cross-sectioned from each subgroup and evaluated with a scanning electron microscope for phase-transformation of the lattice. Finally, the remaining samples were loaded to fracture. A multivariate linear regression model was applied for statistical analyses (significance at p < 0.05). All samples withstood the different loading/aging protocols and no transformation propagation was observed. The narrow diameter implants showed the lowest fracture load after combined loading/aging (628 ± 56 N; p < 0.01), whereas all other subgroups exhibited no significantly reduced fracture resistance (between 762 ± 62 and 806 ± 73 N; p > 0.05). Therefore, fracture load values of Ce-TZP-comp implants suggest a reliable intraoral clinical application in the anterior jaw regions.
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Affiliation(s)
- Felix Burkhardt
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (F.B.); (M.H.); (B.C.S.)
| | - Markus Harlass
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (F.B.); (M.H.); (B.C.S.)
| | | | - Kirstin Vach
- Medical Center—University of Freiburg, Institute for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104 Freiburg, Germany;
| | - Benedikt Christopher Spies
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (F.B.); (M.H.); (B.C.S.)
| | - Ralf-Joachim Kohal
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (F.B.); (M.H.); (B.C.S.)
- Correspondence:
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