Hydroxyapatite-coated implant: Clinical prognosis assessment via a retrospective follow-up study for the average of 3 years

On the Use of Nanoparticles in Dental Implants

Results obtained in physics, chemistry and materials science on nanoparticles have drawn significant interest in the use of nanostructures on dental implants. The main focus concerns nanoscale surface modifications of titanium-based dental implants in order to increase the surface roughness and provide a better bone-implant interfacial area. Surface coatings via the sol-gel process ensure the deposition of a homogeneous layer of nanoparticles or mixtures of nanoparticles on the titanium substrate. Nanotubular structures created on the titanium surface by anodic oxidation yield an interesting nanotopography for drug release. Carbon-based nanomaterials hold great promise in the field of dentistry on account of their outstanding mechanical properties and their structural characteristics. Carbon nanomaterials that include carbon nanotubes, graphene and its derivatives (graphene oxide and graphene quantum dots) can be used as coatings of the implant surface. Their antibacterial properties as well as their ability to be functionalized with adequate chemical groups make them particularly useful for improving biocompatibility and promoting osseointegration. Nevertheless, an evaluation of their possible toxicity is required before being exploited in clinical trials.

Functional engineering strategies of 3D printed implants for hard tissue replacement

Three-dimensional printing technology with the rapid development of printing materials are widely recognized as a promising way to fabricate bioartificial bone tissues. In consideration of the disadvantages of bone substitutes, including poor mechanical properties, lack of vascularization and insufficient osteointegration, functional modification strategies can provide multiple functions and desired characteristics of printing materials, enhance their physicochemical and biological properties in bone tissue engineering. Thus, this review focuses on the advances of functional engineering strategies for 3D printed biomaterials in hard tissue replacement. It is structured as introducing 3D printing technologies, properties of printing materials (metals, ceramics and polymers) and typical functional engineering strategies utilized in the application of bone, cartilage and joint regeneration.

Simultaneous Precipitation and Electrodeposition of Hydroxyapatite Coatings at Different Temperatures on Various Metal Substrates

The coating of orthopedic and dental implants with hydroxyapatite (HA) is recognized as a method to increase their integration ability. A new metal coating method, comprising simultaneous precipitation and electrodeposition, is presented. Two studies are described: the first is related to the influence of time/temperature increase on the morpho-structural characteristics of the deposited layer on the Ti substrate, while the second study presents the characteristics of the layers deposited on different metal substrates. For comparison, specimens were obtained using the classical electrochemical deposition under the same experimental conditions. The addition of Ca to the electrolyte creates more compact and more uniform coatings, while the addition of P creates more porous layers. Only a very small quantity of crystalline HA deposited on the C55, Cu, and Ni substrates when the classic electrodeposition method was employed, while using the new approach has clearly led to a larger crystalline HA amount electrodeposited on the same types of metals. With some exceptions, the advantages of using the new method are: better crystallinity, more uniform and continuous surface, higher roughness, and potentially higher anti-corrosion capabilities.

Polyphenols from Grape Pomace: Functionalization of Chitosan-Coated Hydroxyapatite for Modulated Swelling and Release of Polyphenols

Chitosan is known for its specific antibacterial mechanism and biodegradability, while polyphenols are known for their antioxidant and anti-inflammatory properties: coupling these properties on a surface for bone contact, such as hydroxyapatite, is of great interest. The system developed here allows the combination of hydroxyapatite, chitosan, and polyphenol properties in the same multifunctional biomaterial in order to modulate the host response after implantation. Crosslinked chitosan is used in this research to create a stable coating on hydroxyapatite, and then it is functionalized for a smart release of the polyphenols. The release is higher in inflammatory conditions and lower in physiological conditions. The properties of the coated and functionalized samples are characterized on the as-prepared samples and after the samples are immersed (for 24 h) in solutions, which simulate the inflammatory and physiological conditions. Characterization is performed in order to confirm the presence of polyphenols grafted within the chitosan coating, the stability of grafting as a function of pH, the morphology of the coating and distribution of polyphenols on the surface, and the redox reactivity and radical scavenging activity of the functionalized coating. All the results are in line with previous results, which show a successful coating with chitosan and functionalization with polyphenols. Moreover, the polyphenols have a different release kinetics that is faster in a simulated inflammatory environment compared to that in the physiological environment. Even after the release tests, a fraction of polyphenols are still bound on the surface, maintaining the antioxidant and radical scavenging activity for a longer time. An electrostatic bond occurs between the negative-charged polar groups of polyphenols (carboxyls and/or phenols) and the positive amide groups of the chitosan coating, and the substitution of the crosslinker by the polyphenols occurs during the functionalization process.

Improved Mechanical Properties of Ultra-High Shear Force Mixed Reduced Graphene Oxide/Hydroxyapatite Nanocomposite Produced Using Spark Plasma Sintering

The addition of nanomaterials, such as graphene and graphene oxide, can improve the mechanical properties of hydroxyapatite (HA) nanocomposites (NCPs). However, both the dispersive state of the starting materials and the sintering process play central roles in improving the mechanical properties of the final HA NCPs. Herein, we studied the mechanical properties of a reduced graphene oxide (r-GO)/HA NCP, for which an ultra-high shear force was used to achieve a nano-sized mixture through the dispersion of r-GO. A low-temperature, short-duration spark plasma sintering (SPS) process was used to realize high-density, non-decomposing r-GO/HA NCPs with an improved fracture toughness of 97.8% via the addition of 0.5 wt.% r-GO. Greater quantities of r-GO improve the hardness and the fracture strength. The improved mechanical properties of r-GO/HA NCPs suggest their future applicability in biomedical engineering, including use as sintered bodies in dentistry, plasma spray-coatings for metal surfaces, and materials for 3D printing in orthopedics.

Micro-Nano Surface Characterization and Bioactivity of a Calcium Phosphate-Incorporated Titanium Implant Surface

The surface topography of dental implants and micro-nano surface characterization have gained particular interest for the improvement of the osseointegration phases. The aim of this study was to evaluate the surface micro-nanomorphology and bioactivity (apatite forming ability) of Ossean^® surface, a resorbable blast medium (RBM) blasted surface further processed through the incorporation of a low amount of calcium phosphate. The implants were analyzed using environmental scanning electronic microscopy (ESEM), connected to Energy dispersive X-ray spectroscopy (EDX), field emission gun SEM-EDX (SEM-FEG) micro-Raman spectroscopy and X-ray photoelectron spectroscopy (XPS) before and after immersion in weekly refreshed Hank’s balanced salt solution (HBSS) for 28 days. The analysis of the samples before immersion showed a moderately rough surface, with micropits and microgrooves distributed on all of the surface; EDX microanalysis revealed the constitutional elements of the implant surface, namely titanium (Ti), aluminum (Al) and vanadium (V). Limited traces of calcium (Ca) and phosphorous (P) were detected, attributable to the incorporated calcium phosphate. No traces of calcium phosphate phases were detected by micro-Raman spectroscopy. ESEM analysis of the implant aged in HBSS for 28 days revealed a significantly different surface, compared to the implant before immersion. At original magnifications <2000×, a homogeneous mineral layer was present on all the surface, covering all the pits and microgrooves. At original magnifications ≥10,000×, the mineral layer revealed the presence of small microspherulites. The structure of these spherulites (approx. 2 µm diameter) was observed in nanoimmersion mode revealing a regular shape with a hairy-like contour. Micro-Raman analysis showed the presence of B-type carbonated apatite on the implant surface, which was further confirmed by XPS analysis. This implant showed a micro-nano-textured surface supporting the formation of a biocompatible apatite when immersed in HBSS. These properties may likely favor bone anchorage and healing by stimulation of mineralizing cells.

The Influence of Nanostructured Hydroxyapatite Surface in the Early Stages of Osseointegration: A Multiparameter Animal Study in Low-Density Bone

Background and Objective

The success rates of dental implants in low-density bone have been reported as a challenge, especially for early or immediate loading in the maxilla posterior area. Nanoscale architecture affects the roughness, surface area, surface energy of the implant and can enhance osseointegration. This study aimed to evaluate the implant-surface topography and biomechanical, histomorphometric, and histological bone responses to a new nanostructured hydroxyapatite surface placed in the iliac crest of sheep.

Methods

Ten female sheep (2–4 years) received 30 implants (n=10/group): HAnano^® coated (Epikut Plus^®, S.I.N. Implant System, Sao Paulo, SP, Brazil), SLActive (BLX^®, Straumann, Basel, Switzerland), and TiUnite (NobelActive^®, Nobel Biocare, Göteborg, Sweden) surfaces. Scanning electron microscopy with energy-dispersive spectroscopy evaluated the implant surface topography, the insertion torque value, and resonance frequency analysis evaluated the primary stability, bone-implant contact, and bone-area fraction occupancy were evaluated after 14 and 28 days after implant placement.

Results

The surface morphology was considerably comparable between the implant groups’; however, the TiUnite^® group presented a remarkable different surface. The SLActive^® and TiUnite^® groups presented an insertion torque average of 74 (±8.9) N/cm that was similar to that of HAnano^® 72 (±8.3) N/cm (p >0.05). The resonance frequency evaluated with Osstell^®/SmartPeg^® or Penguin^®/MulTipeg^® showed similar results when assessing implants from the same group. BIC and BAFO significantly increased (p<0.05) throughout the experimental periods to all groups, but BIC and BAFO values were similar among the implants at the same time point. After 4 weeks, bone-implant contact was higher than 80% of the total length analyzed. New bone occupies around 60% of analyzed area around the implants.

Conclusion

HAnano^® coated surface promoted comparable osseointegration as SLActive and TiUnite in the sheep model. The three tested surfaces showed comparable osseointegration at the early stages of low-density bone repair in the sheep model.

Titanium Alloys for Dental Implants: A Review

The topic of titanium alloys for dental implants has been reviewed. The basis of the review was a search using PubMed, with the large number of references identified being reduced to a manageable number by concentrating on more recent articles and reports of biocompatibility and of implant durability. Implants made mainly from titanium have been used for the fabrication of dental implants since around 1981. The main alloys are so-called commercially pure titanium (cpTi) and Ti-6Al-4V, both of which give clinical success rates of up to 99% at 10 years. Both alloys are biocompatible in contact with bone and the gingival tissues, and are capable of undergoing osseointegration. Investigations of novel titanium alloys developed for orthopaedics show that they offer few advantages as dental implants. The main findings of this review are that the alloys cpTi and Ti-6Al-4V are highly satisfactory materials, and that there is little scope for improvement as far as dentistry is concerned. The conclusion is that these materials will continue to be used for dental implants well into the foreseeable future.

Achievements in the Topographic Design of Commercial Titanium Dental Implants: Towards Anti-Peri-Implantitis Surfaces

Titanium and its alloys constitute the gold standard materials for oral implantology in which their performance is mainly conditioned by their osseointegration capacity in the host's bone. We aim to provide an overview of the advances in surface modification of commercial dental implants analyzing and comparing the osseointegration capacity and the clinical outcome exhibited by different surfaces. Besides, the development of peri-implantitis constitutes one of the most common causes of implant loss due to bacteria colonization. Thus, a synergic response from industry and materials scientists is needed to provide reliable technical and commercial solutions to this issue. The second part of the review focuses on an update of the recent findings toward the development of new materials with osteogenic and antibacterial capacity that are most likely to be marketed, and their correlation with implant geometry, biomechanical behavior, biomaterials features, and clinical outcomes.

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

The field of dental implantology has made progress in recent years, allowing safer and predictable oral rehabilitations. Surely the rehabilitation times have also been reduced, thanks to the advent of the new implant surfaces, which favour the osseointegration phases and allow the clinician to rehabilitate their patients earlier. To carry out this study, a search was conducted in the Pubmed, Embase and Elsevier databases; the articles initially obtained according to the keywords used numbered 283, and then subsequently reduced to 10 once the inclusion and exclusion criteria were applied. The review that has been carried out on this type of surface allows us to fully understand the features and above all to evaluate all the advantages or not related. The study materials also are supported by a manufacturing company, which provided all the indications regarding surface treatment and confocal microscopy scans. In conclusion, we can say that, thanks to these new surfaces, it has been possible to shorten the time necessary to obtain osseointegration and, therefore, secondary stability on the part of implants. The surfaces, therefore, guarantee an improved cellular adhesion and thanks to the excellent wettability all the biological processes that derive from it, such as increases in the exposed implant surface, resulting in an increase in bone-implant contact (BIC).