Surface characteristics of dental implants: A review

Biocompatibility of titanium from the viewpoint of its surface

Among metals, Ti and majority of its alloys exhibit excellent biocompatibility or tissue compatibility. Although their high corrosion resistance is a factor in the biocompatibility of Ti and Ti alloys, it is clear that other factors exist. In this review, the corrosion resistance and passive film of Ti are compared to those of other metallic biomaterials, and their band gap energies, E_gs, are compared to discuss the role of E_g in the reactivity with living tissues. From the perspective of the material's surface, it is possible to explain the excellent biocompatibility of Ti by considering the following factors: Ti ions are immediately stabilized not to show toxicity if it is released to body fluids; good balance of positive and negative charges by the dissociation of surface hydroxyl groups on the passive film; low electrostatic force of the passive film inducing a natural adsorption of proteins maintaining their natural conformation; strong property as n-type semiconductor; lower band gap energy of the passive film on Ti generating optimal reactivity; and calcium phosphate formation is caused by this reactivity. The results suggest that due to the passive oxide film, the optimal balance between high corrosion resistance and appropriate reactivity of Ti is the predominate solution for the excellent biocompatibility of Ti.

Graphene Oxide Loaded on TiO2-Nanotube-Modified Ti Regulates the Behavior of Human Gingival Fibroblasts

Surface topography, protein adsorption, and the loading of coating materials can affect soft tissue sealing. Graphene oxide (GO) is a promising candidate for improving material surface functionalization to facilitate soft tissue integration between cells and biomaterials. In this study, TiO₂ nanotubes (TNTs) were prepared by the anodization of Ti, and TNT-graphene oxide composites (TNT-GO) were prepared by subsequent electroplating. The aim of this study was to investigate the effect of TNTs and TNT-GO surface modifications on the behavior of human gingival fibroblasts (HGFs). Commercially pure Ti and TNTs were used as the control group, and the TNT-GO surface was used as the experimental group. Scanning electron microscopy, X-ray photoelectron spectroscopy, and X-ray diffraction were used to perform sample characterization. Cell adhesion, cell proliferation, cell immunofluorescence staining, a wound-healing assay, real-time reverse-transcriptase polymerase chain reaction (RT-PCR), and Western blotting showed that the proliferation, adhesion, migration, and adhesion-related relative gene expression of HGFs on TNT-GO were significantly enhanced compared to the control groups, which may be mediated by the activation of integrin β1 and the MAPK-Erk1/2 pathway. Our findings suggest that the biological reactivity of HGFs can be enhanced by the TNT-GO surface, thereby improving the soft tissue sealing ability.

In-Vitro Phenotypic Response of Human Osteoblasts to Different Degrees of Titanium Surface Roughness

Objectives: This study aimed to investigate human osteoblast (HOB) responses towards different degrees of titanium (Ti) implant surface roughness. Methods: Four degrees of Ti surface roughness were investigated on a micrometer roughness scale: smooth (S: 0.08−0.1 µm), minimally rough (MM: 0.3−0.5 µm), moderately rough (MR: 1.2−1.4 µm), and rough (R: 3.3−3.7 µm). HOB cells were cultured, expanded, and maintained according to the supplier’s protocol. Cell proliferation and cytotoxicity were assessed at day 1, 3, 5, and 10 using alamarBlue and lactate dehydrogenase colorimetric assays. Data were analyzed with one-way ANOVA, two-way ANOVA, and Tukey’s post hoc test (p = 0.05 for all tests). Results: There was no significant difference in the cell proliferation or cytotoxicity of the HOB cells in contact with the different degrees of Ti surface roughness. There was, however, a significant time effect on cell proliferation (p < 0.0001) with different exposure durations for each roughness degree. Furthermore, a positive correlation (non-significant) between proliferation and cytotoxicity was observed for all investigated degrees of surface roughness. Conclusion: All investigated roughness degrees showed comparable HOB proliferation, with the MR surface presenting the highest percentage, followed by the R, MM, ad S, surfaces, respectively. The S surface showed the highest cytotoxic effect on HOBs; however, it did not reach the cytotoxic level suggested by the ISO for any medical device to be considered cytotoxic.

Role of chitosan in titanium coatings. trends and new generations of coatings

Survival studies of dental implants currently reach high figures. However, considering that the recipients are middle-aged individuals with associated pathologies, research is focused on achieving bioactive surfaces that ensure osseointegration. Chitosan is a biocompatible, degradable polysaccharide with antimicrobial and anti-inflammatory properties, capable of inducing increased growth and fixation of osteoblasts around chitosan-coated titanium. Certain chemical modifications to its structure have been shown to enhance its antibacterial activity and osteoinductive properties and it is generally believed that chitosan-coated dental implants may have enhanced osseointegration capabilities and are likely to become a commercial option in the future. Our review provided an overview of the current concepts and theories of osseointegration and current titanium dental implant surfaces and coatings, with a special focus on the in vivo investigation of chitosan-coated implants and a current perspective on the future of titanium dental implant coatings.

Advancing dental implants: Bioactive and therapeutic modifications of zirconia

Zirconium-based implants have gained popularity in the dental implant field owing to their corrosion resistance and biocompatibility, attributed to the formation of a native zirconia (ZrO₂) film. However, enhanced bioactivity and local therapy from such implants are desirable to enable the earlier establishment and improved long-term maintenance of implant integration, especially in compromised patient conditions. As a result, surface modification of zirconium-based implants have been performed using various physical, chemical and biological techniques at the macro-, micro-, and nano-scales. In this extensive review, we discuss and detail the development of Zr implants covering the spectrum from past and present advancements to future perspectives, arriving at the next generation of highly bioactive and therapeutic nano-engineered Zr-based implants. The review provides in-depth knowledge of the bioactive/therapeutic value of surface modification of Zr implants in dental implant applications focusing on clinical translation.

Advances and Prospects in Antibacterial-Osteogenic Multifunctional Dental Implant Surface

In recent years, dental implantation has become the preferred protocol for restoring dentition defects. Being the direct contact between implant and bone interface, osseointegration is the basis for implant exerting physiological functions. Nevertheless, biological complications such as insufficient bone volume, poor osseointegration, and postoperative infection can lead to implant failure. Emerging antibacterial-osteogenic multifunctional implant surfaces were designed to make up for these shortcomings both during the stage of forming osseointegration and in the long term of supporting the superstructure. In this mini-review, we summarized the recent antibacterial-osteogenic modifications of the dental implant surface. The effects of these modifications on biological performance like soft tissue integration, bone osteogenesis, and immune response were discussed. In addition, the clinical findings and prospects of emerging antibacterial-osteogenic implant materials were also discussed.

Biomimetic Implant Surfaces and Their Role in Biological Integration-A Concise Review

BACKGROUND

The increased use of dental implants in oral rehabilitation has been followed by the development of new biomaterials as well as improvements in the performance of biomaterials already in use. This triggers the need for appropriate analytical approaches to assess the biological and, ultimately, clinical benefits of these approaches.

AIMS

To address the role of physical, chemical, mechanical, and biological characteristics in order to determine the critical parameters to improve biological responses and the long-term effectiveness of dental implant surfaces.

DATA SOURCES AND METHODS

Web of Science, MEDLINE and Lilacs databases were searched for the last 30 years in English, Spanish and Portuguese idioms.

RESULTS

Chemical composition, wettability, roughness, and topography of dental implant surfaces have all been linked to biological regulation in cell interactions, osseointegration, bone tissue and peri-implant mucosa preservation.

CONCLUSION

Techniques involving subtractive and additive methods, especially those involving laser treatment or embedding of bioactive nanoparticles, have demonstrated promising results. However, the literature is heterogeneous regarding study design and methodology, which limits comparisons between studies and the definition of the critical determinants of optimal cell response.

Influence of Surface Roughness on Biodegradability and Cytocompatibility of High-Purity Magnesium

High-purity magnesium (Mg) is a promising biodegradable metal for oral and maxillofacial implants. Appropriate surface roughness plays a critical role in the degradation behavior and the related cellular processes of biodegradable Mg-based metals. Nevertheless, the most optimized surface roughness has been questionable, especially for Mg-based oral and maxillofacial implants. Three representative scales of surface roughness were investigated in this study, including smooth (Sa < 0.5 µm), moderately rough (Sa between 1.0−2.0 µm), and rough (Sa > 2.0 µm). The results indicated that the degradation rate of the Mg specimen in the cell culture medium was significantly accelerated with increased surface roughness. Furthermore, an extract test revealed that Mg with different roughness did not induce an evident cytotoxic effect. Nonetheless, the smooth Mg surface had an adversely affected cell attachment. Therefore, the high-purity Mg with a moderately rough surface exhibited the most optimized balance between biodegradability and overall cytocompatibility.

Surface Structure of Zirconia Implants: An Integrative Review Comparing Clinical Results with Preclinical and In Vitro Data

Background: The purpose of this review was to analyze and correlate the findings for zirconia implants in clinical, preclinical and in vitro cell studies in relation to surface structure. Methods: Electronic searches were conducted to identify clinical, preclinical and in vitro cell studies on zirconia implant surfaces. The primary outcomes were mean bone loss (MBL) for clinical studies, bone-to-implant contact (BIC) and removal torque (RT) for preclinical studies and cell spreading, cell proliferation and gene expression for cell studies. The secondary outcomes included comparisons of data found for those surfaces that were investigated in all three study types. Results: From 986 screened titles, 40 studies were included for data extraction. In clinical studies, only micro-structured surfaces were investigated. The lowest MBL was reported for sandblasted and subsequently etched surfaces, followed by a sinter and slurry treatment and sandblasted surfaces. For BIC, no clear preference of one surface structure was observable, while RT was slightly higher for micro-structured than smooth surfaces. All cell studies showed that cell spreading and cytoskeletal formation were enhanced on smooth compared with micro-structured surfaces. Conclusions: No correlation was observed for the effect of surface structure of zirconia implants within the results of clinical, preclinical and in vitro cell studies, underlining the need for standardized procedures for human, animal and in vitro studies.

The influence of implant design on implant stability in low-density bone under guided surgical template in inexperienced surgeons: A pilot randomized controlled clinical trial using resonance frequency analysis

INTRODUCTION

There are several factors that greatly influence implant stability with implant design being a paramount factor; however, few studies investigate its impact.

AIM

To investigate the implant stability in relation to two different implant designs, a cylindrical shaped single-threaded design (CS/ST) and a tapered shaped double-threaded design (TS/DT) using resonance frequency analysis over the first 8 weeks after implantation.

MATERIALS AND METHODS

Twenty-eight implants were randomly allocated using computer-generated random numbers into two groups and were placed as single tooth implant in the posterior arch in human jaw as specimens. iCAT™ CBCT scan (Hatfield, PA) was used to determine the bone density according to Misch's Bone classification. The osseotomy sites were prepared and implants were placed with guided surgical template by inexperienced surgeons which were prepared with the same implant planning software (3shape® implant studio). The implant stability was measured using the resonance frequency analysis Osstell® ISQ (Osstell AB, Sweden) on the implant level over the first 8 weeks at three different time intervals. A mean implant stability quotient (ISQ) value was recorded at each measurement time points. The first ISQ of each implant recorded at the time of implant placement were considered as baseline and were the so-called primary stability.

RESULTS

All 28 dental implants were analyzed. A similar pattern of implant stability changes was observed in both implant designs. A significant decreased was found at the first 4 weeks after implantation (p < 0.05) before ascending to maximum cumulative stability by the eighth week (p < 0.05). Between the two groups, TS/DT group had a higher mean ISQ values than that of the CS/ST group at all three observation periods but did not reach statistical significance (p = 0.69). Regarding different types of bone, TS/DT showed a significant difference in mean ISQ values in D4 bone. To date, all 28 implants are in function with no failure/and or complications.

CONCLUSIONS

The difference in implant design did not significantly influence the implant stability. TS/DT shows superiority over CS/ST when placed in D4 bone and offer a significant advantage due to their positive bounce back of the ISQ values by the eighth week after implant installation.

CLINICAL TRIAL REGISTRATION

TCTR20211020005.

Trace elements released from dental implants with periimplantitis: a cohort study

BACKGROUND

Pure titanium and Ti6Al4V alloy have been in use as dental implant contemporarily. Trace element release from implant bodies is a possible health problem. Well-healed and osseointegrated intrabony implants are only in contact with bone and blood, but in the case of periimplantitis, the possibility of corrosion and the release of trace elements from dental implant surfaces increases due to contact with external factors.

AIMS

The aim of this study is to evaluate the trace element levels in the blood serum and saliva of patients who have dental implants with periimplantitis compared with the control group.

METHODS

This study included 25 patients diagnosed with periimplantitis and 25 participants with healthy osseointegrated implants as the control group. The trace element levels in blood serum and saliva were measured by inductively coupled plasma-mass spectrometry (ICP-MS) and results were analyzed statistically.

RESULTS

There is no statistically significant difference between groups for saliva samples except the aluminum (Al) levels of the study group are significantly lower than the control group (p < 0.05) and the mercury (Hg) levels of the study group are significantly higher than the control group (p < 0.05). On the other hand, there is a significant decrease in titanium (Ti), chromium (Cr), and iodine (I) in the blood serum samples of the study group (p < 0.05). There is no significant difference between the groups for other measured trace elements in the blood serum (p > 0.05).

CONCLUSION

There is no statistically significant increase in titanium or aluminum levels in the study group compared with the control group.

Titanium Dental Implants: An Overview of Applied Nanobiotechnology to Improve Biocompatibility and Prevent Infections

This review addresses the different aspects of the use of titanium and its alloys in the production of dental implants, the most common causes of implant failures and the development of improved surfaces capable of stimulating osseointegration and guaranteeing the long-term success of dental implants. Titanium is the main material for the development of dental implants; despite this, different surface modifications are studied aiming to improve the osseointegration process. Nanoscale modifications and the bioactivation of surfaces with biological molecules can promote faster healing when compared to smooth surfaces. Recent studies have also pointed out that gradual changes in the implant, based on the microenvironment of insertion, are factors that may improve the integration of the implant with soft and bone tissues, preventing infections and osseointegration failures. In this context, the understanding that nanobiotechnological surface modifications in titanium dental implants improve the osseointegration process arouses interest in the development of new strategies, which is a highly relevant factor in the production of improved dental materials.

Modification of Zirconia Implant Surfaces by Nd:YAG Laser Grooves: Does It Change Cell Behavior?

The aim of this study was to evaluate gingival fibroblasts and human osteoblasts’ response to textured Nd:YAG laser microgrooves, with different dimensions, on zirconia implant surfaces. A total of 60 zirconia disks (8 mm in diameter and 2 mm in thickness) were produced and divided between four study groups (N = 15): three laser-textured (widths between 125.07 ± 5.29 μm and 45.36 ± 2.37 μm and depth values from 50.54 ± 2.48 μm to 23.01 ± 3.79 μm) and a control group without laser treatment. Human osteoblasts and gingival fibroblasts were cultured on these surfaces for 14 days. FEG-SEM (Field Emission Gun–Scanning Electron Microscope) images showed cellular adhesion at 24 h, with comparable morphology in all samples for both cell types. A similar cell spreading within the grooves and in the space between them was observed. Cell viability increased over time in all study groups; however, no differences were found between them. Additionally, proliferation, ALP (Alkaline phosphatase) activity, collagen type I, osteopontin and interleukin levels were not significantly different between any of the study groups for any of the cell types. Analysis of variance to compare parameters effect did not reveal statistically significant differences when comparing all groups in the different tests performed. The results obtained revealed similar cell behavior based on cell viability and differentiation on different microtopographic laser grooves, compared to a microtopography only established by sandblasting and acid-etching protocol, the reference surface treatment on zirconia dental implants.

Osseointegration of a New, Ultrahydrophilic and Nanostructured Dental Implant Surface: A Comparative In Vivo Study

This study compared the osseointegration of acid-etched, ultrahydrophilic, micro- and nanostructured implant surfaces (ANU) with non-ultra-hydrophilic, microstructured (SA) and non-ultrahydrophilic, micro- and nanostructured implant surfaces (AN) in vivo. Fifty-four implants (n = 18 per group) were bilaterally inserted into the proximal tibia of New Zealand rabbits (n = 27). After 1, 2, and 4 weeks, bone-implant contact (BIC, %) in the cortical (cBIC) and spongious bone (sBIC), bone chamber ingrowth (BChI, %), and the supra-crestal, subperiosteal amount of newly formed bone, called percentage of linear bone fill (PLF, %), were analyzed. After one week, cBIC was significantly higher for AN and ANU when compared to SA (p = 0.01 and p = 0.005). PLF was significantly increased for ANU when compared to AN and SA (p = 0.022 and p = 0.025). After 2 weeks, cBIC was significantly higher in SA when compared to AN (p = 0.039) and after 4 weeks, no significant differences in any of the measured parameters were found anymore. Ultrahydrophilic implants initially improved osseointegration when compared to their non-ultrahydrophilic counterparts. In accordance, ultrahydrophilic implants might be appropriate in cases with a necessity for an accelerated and improved osseointegration, such as in critical size alveolar defects or an affected bone turnover.

Integration of collagen fibers in connective tissue with dental implant in the transmucosal region

Dental implants have been widely accepted as an ideal therapy to replace the missing teeth for its good performance in aspects of mechanical properties and aesthetic outcomes. Its restorative success is contributed by not only the successful osseointegration of the implant but also the tight soft tissue integration, especially the collagen fibers, in the transmucosal region. Soft tissue attaching to the dental implant/abutment is overall similar, but in some aspects distinct with that seen around natural teeth and soft tissue integration can be enhanced via several surface modification methods. This review is going to focus on the current knowledge of the transmucosal zone around the dental implants (compared with natural teeth), and latest strategies in use to fine-tune the collagen fibers assembly in the connective tissue, in an attempt to enhance soft tissue integration.

Human Gingival Fibroblast and Osteoblast Behavior on Groove-Milled Zirconia Implant Surfaces

Two type of cells representing periodontal hard tissues (osteoblasts) and soft tissues (fibroblasts) were evaluated in response to microgroove-milled zirconia surfaces. A total of 90 zirconia discs were randomly assigned to four width-standardized milling microgroove-textured groups and a control group without grooves (UT). The sandblast and acid-etch protocol were applied to all samples. Both cell lines were cultured on zirconia discs from 1 day up to 14 days. Cell morphology and adhesion were evaluated after 1 day of culturing. Cell viability and proliferation of the cells were measured. Alkaline phosphatase activity, collagen I, osteopontin, interleukin 1β and interleukin 8 secretions were assessed at predefined times. The results obtained were presented in the form of bar graphs as means and standard deviations. Multi comparisons between groups were evaluated using two-away ANOVA or Mann−Whitney tests, and a p-value < 0.05 was established. Group comparisons with regard to cell viability, proliferation and secretion of collagen I, interleukin-1β and interleukin 8 revealed no statistically significant differences. The alkaline phosphatase activity and osteopontin secretion were significantly higher in the group with a large groove compared to the small one and the control group. Nevertheless, the viability of gingival and bone cells did not appear to be affected by the milled microgroove texture compared to the conventional sandblasted and acid-etched texture, but they seem to influence osteoblasts’ cellular differentiation.

Surgical Applications of Materials Engineered with Antimicrobial Properties

The infection of surgically placed implants is a problem that is both large in magnitude and that broadly affects nearly all surgical specialties. Implant-associated infections deleteriously affect patient quality-of-life and can lead to greater morbidity, mortality, and cost to the health care system. The impact of this problem has prompted extensive pre-clinical and clinical investigation into decreasing implant infection rates. More recently, antimicrobial approaches that modify or treat the implant directly have been of great interest. These approaches include antibacterial implant coatings (antifouling materials, antibiotics, metal ions, and antimicrobial peptides), antibacterial nanostructured implant surfaces, and antibiotic-releasing implants. This review provides a compendium of these approaches and the clinical applications and outcomes. In general, implant-specific modalities for reducing infections have been effective; however, most applications remain in the preclinical or early clinical stages.

Latest Trends in Surface Modification for Dental Implantology: Innovative Developments and Analytical Applications

An increase in the world population and its life expectancy, as well as the ongoing concern about our physical appearance, have elevated the relevance of dental implantology in recent decades. Engineering strategies to improve the survival rate of dental implants have been widely investigated, focusing on implant material composition, geometry (usually guided to reduce stiffness), and interface surrounding tissues. Although efforts to develop different implant surface modifications are being applied in commercial dental prostheses today, the inclusion of surface coatings has gained special interest, as they can be tailored to efficiently enhance osseointegration, as well as to reduce bacterial-related infection, minimizing peri-implantitis appearance and its associated risks. The use of biomaterials to replace teeth has highlighted the need for the development of reliable analytical methods to assess the therapeutic benefits of implants. This literature review considers the state-of-the-art strategies for surface modification or coating and analytical methodologies for increasing the survival rate for teeth restoration.

Antibacterial and Fluorescence Staining Properties of an Innovative GTR Membrane Containing 45S5BGs and AIE Molecules In Vitro

This study aimed to add two functional components-antibacterial 45S5BGs particles and AIE nanoparticles (TPE-NIM⁺) with bioprobe characteristics-to the guided tissue regeneration (GTR) membrane, to optimize the performance. The PLGA/BG/TPE-NIM⁺ membrane was synthesized. The static water contact angle, morphologies, and surface element analysis of the membrane were then characterized. In vitro biocompatibility was tested with MC3T3-E1 cells using CCK-8 assay, and antibacterial property was evaluated with Streptococcus mutans and Porphyromonas gingivalis by the LIVE/DEAD bacterial staining and dilution plating procedure. The fluorescence staining of bacteria was observed by Laser Scanning Confocal Microscope. The results showed that the average water contact angle was 46°. In the cytotoxicity test, except for the positive control group, there was no significant difference among the groups (p > 0.05). The antibacterial effect in the PLGA/BG/TPE-NIM⁺ group was significantly (p < 0.01), while the sterilization rate was 99.99%, better than that in the PLGA/BG group (98.62%) (p < 0.01). Confocal images showed that the membrane efficiently distinguished G⁺ bacteria from G^- bacteria. This study demonstrated that the PLGA/BG/TPE-NIM⁺ membrane showed good biocompatibility, efficient sterilization performance, and surface mineralization ability and could be used to detect pathogens in a simple, fast, and wash-free protocol.

Laser Structured Dental Zirconium for Soft Tissue Cell Occupation—Importance of Wettability Modulation

Various approaches are being pursued to physico-chemically modify the zirconia neck region of dental implants to improve the integration into the surrounding soft tissue. In this study, polished zirconia discs were laser microstructured with periodic cavities and convex waves. These zirconia samples were additionally activated by argon plasma using the kINPen^®09. The surface topography was characterized by scanning electron microscopy and the surface wettability by water contact angle. The in vitro study with human gingival fibroblasts (HGF-1) was focused on cell spreading, morphology, and actin cytoskeleton organization within the first 24 h. The laser-induced microstructures were originally hydrophobic (e.g., 60 µm cavities 138.4°), but after argon plasma activation, the surfaces switched to the hydrophilic state (60 µm cavities 13.7°). HGF-1 cells adhered flatly on the polished zirconia. Spreading is hampered on cavity structures, and cells avoid the holes. However, cells on laser-induced waves spread well. Interestingly, argon plasma activation for only 1 min promoted adhesion and spreading of HGF-1 cells even after 2 h cultivation. The cells crawl and grow into the depth of the cavities. Thus, a combination of both laser microstructuring and argon plasma activation of zirconia seems to be optimal for a strong gingival cell attachment.

Citric Acid in the Passivation of Titanium Dental Implants: Corrosion Resistance and Bactericide Behavior

The passivation of titanium dental implants is performed in order to clean the surface and obtain a thin layer of protective oxide (TiO2) on the surface of the material in order to improve its behavior against corrosion and prevent the release of ions into the physiological environment. The most common chemical agent for the passivation process is hydrochloric acid (HCl), and in this work we intend to determine the capacity of citric acid as a passivating and bactericidal agent. Discs of commercially pure titanium (c.p.Ti) grade 4 were used with different treatments: control (Ctr), passivated by HCl, passivated by citric acid at 20% at different immersion times (20, 30, and 40 min) and a higher concentration of citric acid (40%) for 20 min. Physical-chemical characterization of all of the treated surfaces has been carried out by scanning electronic microscopy (SEM), confocal microscopy, and the 'Sessile Drop' technique in order to obtain information about different parameters (topography, elemental composition, roughness, wettability, and surface energy) that are relevant to understand the biological response of the material. In order to evaluate the corrosion behavior of the different treatments under physiological conditions, open circuit potential and potentiodynamic tests have been carried out. Additionally, ion release tests were realized by means of ICP-MS. The antibacterial behavior has been evaluated by performing bacterial adhesion tests, in which two strains have been used: Pseudomonas aeruginosa (Gram-) and Streptococcus sanguinis (Gram+). After the adhesion test, a bacterial viability study has been carried out ('Life and Death') and the number of colony-forming units has been calculated with SEM images. The results obtained show that the passivation with citric acid improves the hydrophilic character, corrosion resistance, and presents a bactericide character in comparison with the HCl treatment. The increasing of citric acid concentration improves the bactericide effect but decreases the corrosion resistance parameters. Ion release levels at high citric acid concentrations increase very significantly. The effect of the immersion times studied do not present an effect on the properties.

The Effect of Ultraviolet Treatment on TiO2 Nanotubes: A Study of Surface Characteristics, Bacterial Adhesion, and Gingival Fibroblast Response

Titanium dioxide (TiO2) nanotubes are emerging as a provocative target for oral implant research. The aim of this study was to evaluate the effect of UV on the wettability behavior, bacterial colonization, and fibroblast proliferation rate of TiO2 nanotube surfaces prepared using different anodization voltages and aimed for use as implant abutment materials. Four different experimental materials were prepared: (1) TiO2 nanotube 10 V; (2) TiO2 nanotube 15 V; (3) TiO2 nanotube 20 V; and (4) commercial pure titanium as a control group. TiO2 nanotube arrays were prepared in an aqueous electrolyte solution of hydrofluoric acid (HF, 0.5 vol.%). Different anodization voltages were used to modify the morphology of the TiO2 nanotubes. Equilibrium contact angles were measured using the sessile drop method with a contact angle meter. The investigated surfaces (n = 3) were incubated at 37 °C in a suspension of Streptococcus mutans (S. mutans) for 30 min for bacterial adhesion and 3 days for biofilm formation. Human gingival fibroblasts were plated and cultured on the experimental substrates for up to 7 days and the cell proliferation rate was assessed using the AlamarBlue assayTM (BioSource International, Camarillo, CA, USA). The data were analyzed using one-way ANOVA followed by Tukey’s post-hoc test. Water contact angle measurements on the TiO2 after UV treatment showed an overall hydrophilic behavior regardless of the anodization voltage. The ranking of the UV-treated surfaces of experimental groups from lowest to highest for bacterial adhesion was: TiO2 nanotube 20 V < Ti and TiO2 nanotube 15 V < TiO2 nanotube 10 V (p < 0.05), and for bacterial biofilm formation was: TiO2 nanotube 20 V-TiO2 nanotube 10 V < Ti-TiO2 nanotube 15 V (p < 0.05). Fibroblast cell proliferation was lower on TiO2 nanotube surfaces throughout the incubation period and UV light treatment showed no enhancement in cellular response. UV treatment enhances the wettability behavior of TiO2 nanotube surfaces and could result in lower bacterial adhesion and biofilm formation.

Cellular properties of human gingival fibroblasts on novel and conventional implant-abutment materials

OBJECTIVES

To characterize human-gingival-fibroblast-(HGFs) viability, proliferation and adhesion on polymer-infiltrated-ceramic-network-(PICN), polyetheretherketone-(PEEK), hydroxyapatite-reinforced-polyetheretherketone-(HA-PEEK), polyetherketoneketone-(PEKK), as well as conventional titanium-(Ti) and zirconia ceramic-(Zr) implant materials in-vitro.

METHODS

Six materials (n = 40/group, 240 specimens) were standardized for surface roughness, assessed employing water contact angle measurements (WCA) and loaded with HGFs. HGF viability and proliferation were assessed at 24 and 72 h. Cell adhesion strength was evaluated after 24 h exposure to lateral shear forces using a shaking-device at 320 and 560-rpm.and qualitatively tested by scanning-electron-microscopy-(SEM) at 3, 24 and 72 h.

RESULTS

PICN demonstrated the lowest mean WCA (48.2 ± 6.3º), followed by Zr (73.8 ± 5.1º), while HA-PEEK showed the highest WCA (87.2 ± 1.5º; p ≤ 0.05). After 24 h, Zr showed the highest mean HGFs-viability rate (88 ± 14%), while PEKK showed the lowest one (78 ± 7%). At 72 h, Zr continued to show the highest HGF-viability (80 ± 6%) compared to PEKK (67.5 ± 6%) and PEEK (67%±5). SEM did not reveal differences between different materials with respect to cell attachment at 3, 24 or 72 h. At 320 rpm shaking, HGFs showed to be best attached to PICN (mean%-of-detached-cells ± SD; 26 ± 11%) and worst to PEEK (54 ± 18%). At 560 rpm shaking, Zr showed the least detached cells (32 ± 4%), while HA-PEEK revealed the highest number of detached cells (58 ± 3%; ANOVA/Tukey-post-hoc-test, differences not statistically significant).

SIGNIFICANCE

Dental implant abutment materials and their wettability strongly affect HGF proliferation and adhesion properties. Although, PICN showed the best wettability properties, Zr exhibited the strongest adhesion strength at high shaking. Within the current study's limitations, Zr remains the most biocompatible abutment material.

A Clinical and Radiographic Evaluation of Zirconia Dental Implants: 10-Year Follow-Up

PURPOSE

The aim is to evaluate the survival and success rates, as well as the marginal bone loss (MBL) and periodontal indexes, of zirconia implants with 10-year follow-up.

MATERIALS AND METHODS

10 patients were selected and 26 one-piece zirconia implants were used for the rehabilitation of single tooth or partially edentulous ridge. After 10 years, a clinical-radiographic evaluation was performed in order to estimate peri-implant tissue health and marginal bone loss.

RESULTS

The survival and success rates were 100%. The average marginal bone loss from baseline to 120 months after surgery was 0.92 ± 0.97 mm.

CONCLUSION

One-piece zirconia dental implants are characterised by high biocompatibility, low plaque adhesion, and absence of microgap that can be related to the clinical success of these implants.

Histomorphometric assessment of implant coated with mixture of nano-alumina and fluorapatite in rabbits

Background

The application of nanoscale surface modification was found to be useful in the improvement of osseointegration of endosseous dental implants. The fluorapatite (FA)/alumina (Al₂O₃) mixture is recognized for its outstanding bioinertia and can significantly increase the biocompatibility and bioactivity of biomaterials.

Objective

The aim of the present work was to evaluate the bone response to nano-alumina- and fluorapatite-coated dental implants using rabbit tibiae.

Material and Methods

The coating was performed using the dip-coating method. Commercially pure titanium screw-type implants were used as a control group. The coated implants were the experimental group. Each group consisted of 12 screws that were surgically implanted in 6 healthy New Zealand rabbits. Histological and histomorphometric evaluations were performed at the bone to implant contact (BIC) interface, bone fraction area occupancy (BAFO) and fibrous tissue at 2 and 6 weeks of healing.

Results

This analysis showed that the coated implants had more rapid osseointegration than the control group, with a significant difference after 2 and 6 weeks of healing for both groups. The histomorphometric evaluation demonstrated higher values for BIC% and BAFO% and lower values of fibrous tissue in the mixture-coated Ti implants than in the control group.

Conclusion

The current study suggested that the nano-alumina and fluorapatite mixture coating is a favourable candidate for rapid osseointegration over uncoated implants.

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.

Peri-implant bone preservation of a novel, self-cutting, and fully tapered implant in the healed crestal ridge of minipigs: submerged vs. transgingival healing

OBJECTIVES

The aim of this study was to assess the influence of transgingival compared with submerged healing on peri-implant bone maintenance around a novel, fully tapered implant in a healed crestal ridge in minipigs.

MATERIALS AND METHODS

In each of 12 minipigs, two implants (Straumann® BLX, Roxolid® SLActive®, Ø 3.75 × 8 mm) were placed. Implants were either left for submerged or for transgingival healing for 12 weeks. Measurements performed were bone-to-implant contact (BIC), first bone-to-implant contact (fBIC), bone area to total area (BATA), perpendicular bone crest to implant shoulder (pCIS), bone height change from placement, and bone overgrowth (for submerged implants).

RESULTS

No significant differences were found between transgingival and submerged healing in any of the measured parameters, except for BATA on the buccal aspect in which significantly more bone formation was found for the transgingival healing group. For both groups, there was a gain in crestal bone height during the 12-week healing period.

CONCLUSIONS

Loaded compared with unloaded implants displayed comparable levels of osseointegration and equivalent marginal bone levels. This qualifies the implant placement protocol with respect to the osteotomy dimensions and subcrestal placement protocol for immediate loading.

CLINICAL RELEVANCE

The here presented results related to osseointegration and crestal bone maintenance after submerged or transgingival healing have demonstrated a high level of consistency in the used in vivo translational model. The obtained results support the translation of the novel implant type in conjunction with the developed surgical workflow and placement protocol into further clinical investigation and use.

An improved osseointegration of metal implants by pitavastatin loaded multilayer films with osteogenic and angiogenic properties

An increasing number of works have highlighted the importance of metal implants surface modification in enhancing bone defect healing through the synergistic osteogenesis-angiogenesis regulation. Studies have shown that pitavastatin has the effect of promoting osteogenesis and angiogenesis. However, how to prepare pitavastatin functionalized implants and how pitavastatin regulates the synergies of osteogenesis and angiogenesis around implants as well as the related mechanisms remain unclear. In the present study, multilayer films with osteogenic and angiogenic properties were constructed on pure titanium substrates via the layer-by-layer assembly of pitavastatin-loaded β-cyclodextrin grafted chitosan and gelatin. In vitro experiments demonstrated that locally applied pitavastatin could dramatically enhance osteogenic potential of mesenchymal stem cells (MSCs) and angiogenic potential of endothelial cells (ECs). Moreover, pitavastatin loaded multilayer films could regulate the paracrine signaling mediated crosstalk between MSCs and ECs, and indirectly increase the angiogenic potential of MSCs and osteogenic potential of ECs via multiple paracrine signaling. The results of subcutaneous and femur implantation confirmed that locally released pitavastatin had potentially triggered a chain of biological events: mobilizing endogenous stem cells and ECs to the implant-bone interface, in turn facilitating coupled osteogenesis and angiogenesis, and eventually enhancing peri-implant osseointegration. This study enlarges the application scope of pitavastatin and provides an optional choice for developing a multifunctional bioactive coating on the surfaces of mental implants.

Design, Synthesis, and Preliminary Evaluation for Ti-Mo-Zr-Ta-Si Alloys for Potential Implant Applications

Considering the future trends of biomaterials, current studies are focused on the corrosion resistance and the mechanical properties of new materials that need to be considered in the process of strengthening alloys with additive non-toxic elements. Many kinds of titanium alloys with different biocompatible elements (Mo, Si, Zr, etc.,) have been recently developed for their similar properties with human bone. Four new different alloys were obtained and investigated regarding their microstructure, mechanical, chemical, and biological behavior (in vitro and in vivo evaluation), the alloys are as follows: Ti15Mo7Zr15Ta, Ti15Mo7Zr15Ta0.5Si, Ti15Mo7Zr15Ta0.75Si, and Ti15Mo7Zr15Ta1Si. There were changes with the addition of the silicon element such as the hardness and the modulus of elasticity increased. An MTT assay confirmed the in vitro cytocompatibility of the prepared alloys.

Impact of sterilization treatments on biodegradability and cytocompatibility of zinc-based implant materials

Biodegradable zinc (Zn) and Zn-based alloys have been recognized as promising biomaterials for biomedical implants. Sterilization is an essential step in handling Zn-based implants before their use in clinical practice and there are various sterilization methods are available. However, how these treatments influence the Zn-based biomaterials remains unknown and is of critical relevance. In this study, three commonly-applied standard sterilization methods, namely gamma irradiation, hydrogen peroxide gas plasma and steam autoclave, were used on pure Zn and Zn3Cu (wt%) alloy. The treated Zn and ZnCu alloy were investigated to compare the different influences of sterilizations on surface characteristics, transient and long-term degradation behavior and cytotoxicity of Zn and Zn alloy. Our results indicate that autoclaving brought about apparently a formation of inhomogeneous zinc oxide film whereas the other two methods produced no apparent alterations on the material surfaces. Consequently, the samples after autoclaving showed significantly faster degradation rates and more severe localized corrosion, especially for the ZnCu alloy, owing to the incomplete covering and unstable zinc oxide layer. Moreover, the autoclave-treated Zn and ZnCu alloy exhibited apparent cytotoxic effects towards fibroblasts, which may be due to the excessive Zn ion releasing and its local concentration exceeds the cellular tolerance capacity. In contrast, gamma irradiation and hydrogen peroxide gas plasma had no apparent adverse effects on the biodegradability and cytocompatibility of Zn and ZnCu alloy. Our findings may have significant implications regarding the selection of suitable sterilization methods for Zn-based implant materials among others.

Polycrystalline diamond coating on 3D printed titanium scaffolds: Surface characterisation and foreign body response

Titanium-based implants are the leading material for orthopaedic surgery, due to their strength, versatility, fabrication via additive manufacturing and invoked biological response. However, the interface between the implant and the host tissue requires improvement to better integrate the implant material and mitigate foreign body response. The interface can be manipulated by changing the surface energy, chemistry, and topography of the Titanium-based implant. Recently, polycrystalline diamond (PCD) has emerged as an exciting coating material for 3D printed titanium scaffolds showing enhanced mammalian cell functions while inhibiting bacterial attachment in vitro. In this study, we performed in-depth characterisation of PCD coatings investigating the surface topography, thickness, surface energy, and compared its foreign body response in vivo with uncoated titanium scaffold. Coating PCD onto titanium scaffolds resulted in a similar microscale surface roughness (RMS_(PCD-coated) = 24 μm; RMS_(SLM-Ti) = 28 μm), increased nanoscale roughness (RMS_(PCD-coated) = 35 nm; RMS_(SLM-Ti) = 66 nm) and a considerable decrease in surface free energy (E_(PCD-coated) = 4 mN m^-1; E_(SLM-Ti) = 16 mN m^-1). These surface property changes were supported by X-ray photoelectron spectroscopy (XPS) and Raman spectroscopy as corresponding to observed surface chemistry changes induced by the coating. The underlying mechanism of how the diamond coatings chemical and physical properties changes the wettability of implants was examined. In vivo, the coated scaffolds induced similar level of fibrous encapsulation with uncoated scaffolds. This study thus provides further insight into the physicochemical characteristics of PCD coatings, adding evidence to the promising potential of PCD-coatings of medical implants.

Microbial Biofilm Decontamination on Dental Implant Surfaces: A Mini Review

Introduction

After insertion into the bone, implants osseointegrate, which is required for their long-term success. However, inflammation and infection around the implants may lead to implant failure leading to peri-implantitis and loss of supporting bone, which may eventually lead to failure of implant. Surface chemistry of the implant and lack of cleanliness on the part of the patient are related to peri-implantitis. The only way to get rid of this infection is decontamination of dental implants.

Objective

This systematic review intended to study decontamination of microbial biofilm methods on titanium implant surfaces used in dentistry.

Methods

The electronic databases Springer Link, Science Direct, and PubMed were explored from their inception until December 2020 to identify relevant studies. Studies included had to evaluate the efficiency of new strategies either to prevent formation of biofilm or to treat matured biofilm on dental implant surfaces.

Results and Discussion

In this systematic review, 17 different groups of decontamination methods were summarized from 116 studies. The decontamination methods included coating materials, mechanical cleaning, laser treatment, photodynamic therapy, air polishing, anodizing treatment, radiation, sonication, thermal treatment, ultrasound treatment, chemical treatment, electrochemical treatment, antimicrobial drugs, argon treatment, and probiotics.

Conclusion

The findings suggest that most of the decontamination methods were effective in preventing the formation of biofilm and in decontaminating established biofilm on dental implants. This narrative review provides a summary of methods for future research in the development of new dental implants and decontamination techniques.

Synthesis and Characterization of a Novel Biocompatible Alloy, Ti-Nb-Zr-Ta-Sn

Many current-generation biomedical implants are fabricated from the Ti-6Al-4V alloy because it has many attractive properties, such as low density and biocompatibility. However, the elastic modulus of this alloy is much larger than that of the surrounding bone, leading to bone resorption and, eventually, implant failure. In the present study, we synthesized and performed a detailed analysis of a novel low elastic modulus Ti-based alloy (Ti-28Nb-5Zr-2Ta-2Sn (TNZTS alloy)) using a variety of methods, including scanning electron microscopy, transmission electron microscopy, X-ray diffraction, and tensile test. Additionally, the in vitro biocompatibility of the TNZTS alloy was evaluated using SCP-1, SaOs-2, and THP-1 cell lines and primary human osteoblasts. Compared to Ti-6Al-4V, the elastic modulus of TNZTS alloy was significantly lower, while measures of its in vitro biocompatibility are comparable. O₂ plasma treatment of the surface of the alloy significantly increased its hydrophilicity and, hence, its in vitro biocompatibility. TNZTS alloy specimens did not induce the release of cytokines by macrophages, indicating that such scaffolds would not trigger inflammatory responses. The present results suggest that the TNZTS alloy may have potential as an alternative to Ti-6Al-4V.

Influence of Nano, Micro, and Macro Topography of Dental Implant Surfaces on Human Gingival Fibroblasts

Current research on dental implants has mainly focused on the influence of surface roughness on the rate of osseointegration, while studies on the development of surfaces to also improve the interaction of peri-implant soft tissues are lacking. To this end, the first purpose of this study was to evaluate the response of human gingival fibroblasts (hGDFs) to titanium implant discs (Implacil De Bortoli, Brazil) having different micro and nano-topography: machined (Ti-M) versus sandblasted/double-etched (Ti-S). The secondary aim was to investigate the effect of the macrogeometry of the discs on cells: linear-like (Ti-L) versus wave-like (Ti-W) surfaces. The atomic force microscopy (AFM) and scanning electron microscopy (SEM) analysis showed that the Ti-S surfaces were characterized by a significantly higher micro and nano roughness and showed the 3D macrotopography of Ti-L and Ti-W surfaces. For in vitro analyses, the hGDFs were seeded into titanium discs and analyzed at 1, 3, and 5 days for adhesion and morphology (SEM) viability and proliferation (Cck-8 and MTT assays). The results showed that all tested surfaces were not cytotoxic for the hGDFs, rather the nano-micro and macro topography favored their proliferation in a time-dependent manner. Especially, at 3 and 5 days, the number of cells on Ti-L was higher than on other surfaces, including Ti-W surfaces. In conclusion, although further studies are needed, our in vitro data proved that the use of implant discs with Ti-S surfaces promotes the adhesion and proliferation of gingival fibroblasts, suggesting their use for in vivo applications.

Analysis of the influence of surface treatment by high-power laser irradiation on the surface properties of titanium dental implants: A systematic review

STATEMENT OF PROBLEM

High-power laser irradiation may be a promising treatment for titanium dental implant surfaces. However, systematic reviews of the influence of high-power laser irradiation on the different properties of titanium surfaces are lacking.

PURPOSE

The purpose of this systematic review was to analyze the influence of surface treatment by high-power laser irradiation on the surface properties of titanium and its alloys.

MATERIAL AND METHODS

The PubMed, LILACS, COCHRANE library, and Science Direct databases were searched, and articles published in the last 10 years were included. Of the 725 articles initially identified, 27 were selected after full reading and the application of inclusion and exclusion criteria.

RESULTS

The studies evaluated showed that laser irradiation treatment, depending on the settings and parameters used, promoted changes in the surface properties of titanium. In general, lower speed and a higher number of scans increased roughness. Laser surface treatment promoted the inclusion of more oxygen and improved the wetting capacity of titanium. Additionally, laser treatment improved the adherence of coatings.

CONCLUSIONS

Changes in the surface properties of titanium after laser treatment have been demonstrated. However, determining protocols with specific parameters is necessary to optimize the results.

Multi-objective design optimization of dental implant geometrical parameters

In-silico investigations are becoming an integral part of the development of novel biomedical devices, including dental implants. Using computer simulations can streamline the process by tuning different geometrical and structural features, emphasizing the osseointegration of the implant design a priori, leading to the optimal designs in preparation for in-vivo trails. This research aims to elucidate the interrelationship between 12 geometrical variables that holistically define the shape of the implant. The approach to achieve optimality hinged on coupling the finite element analysis results with the fractional factorial design method. The latter was used to determine the most influential variables during the screening process, followed by the parameter optimization process using the response surface method, regarding four different objectives, namely: bone-implant contact area, volume of trabecular bone dead cells, volume of cortical bone dead cells, and axial displacement. This resulted in reducing the number of virtual experiments and substantially decreasing the computational cost without compromising the accuracy of the solution. It was found that the optimized values improved the performance significantly. The validity of all models was verified by comparing optimized responses with simulation results. A sensitivity analysis was performed on all five optimized models to address the effect of friction coefficient on the implant-bone joint interaction. It was shown that the mechanical behavior of implant-bone would be independent in higher friction coefficients. The significance of this study is demonstrated in determining the most effective and optimized values of all possible geometrical parameters considering their singular or interactive effects.

Analysis and Comparison of the Corrosive Behavior of Nickel-Based and Cobalt-Based Dental Alloys

Nickel-based and cobalt-based metal alloys are frequently used in dentistry. The introduction of various elements in the alloy changes its characteristics, and a thorough study of each alloy should be completed to determine its appropriate corrosion resistance and biocompatibility in contact with physiological fluids. There are scarce investigations on these widely used dental alloys in Ringer solution, and findings in this research bring new experimental data and information. The present study evaluated and compared the corrosion behavior of six NiCr- and two CoCr-based dental materials in Ringer solution, using the following techniques: potentiostatic polarization curves (chronoamperometry), microstructural analysis, and EIS (electrochemical impedance spectroscopy). The results obtained in this investigation showed that in the NiCr-based specimens Ni4, Ni5, and Ni6 the stability of the passive layer was destroyed after polarization and a development and growth of stable pits was found in the microstructural analysis after electrochemical treatment. In terms of susceptibility to corrosion, two different groups of specimens were derived from this investigation. A first group which included the two CoCr (Co1 and Co2) and three of the six NiCr alloys studied (Ni1, Ni2, and Ni3). A second group with the other NiCr alloys investigated Ni4, Ni5, and Ni6.

Human osteoblast and fibroblast response to oral implant biomaterials functionalized with non-thermal oxygen plasma

Plasma-treatment of oral implant biomaterials prior to clinical insertion is envisaged as a potential surface modification method for enhanced implant healing. To investigate a putative effect of plasma-functionalized implant biomaterials on oral tissue cells, this investigation examined the response of alveolar bone osteoblasts and gingival fibroblasts to clinically established zirconia- and titanium-based implant surfaces for bone and soft tissue integration. The biomaterials were either functionalized with oxygen-plasma in a plasma-cleaner or left untreated as controls, and were characterized in terms of topography and wettability. For the biological evaluation, the cell adhesion, morphogenesis, metabolic activity and proliferation were examined, since these parameters are closely interconnected during cell-biomaterial interaction. The results revealed that plasma-functionalization increased implant surface wettability. The magnitude of this effect thereby depended on surface topography parameters and initial wettability of the biomaterials. Concerning the cell response, plasma-functionalization of smooth surfaces affected initial fibroblast morphogenesis, whereas osteoblast morphology on rough surfaces was mainly influenced by topography. The plasma- and topography-induced differential cell morphologies were however not strong enough to trigger a change in proliferation behaviour. Hence, the results indicate that oxygen plasma-functionalization represents a possible cytocompatible implant surface modification method which can be applied for tailoring implant surface wettability.

Innovative surfaces and alloys for dental implants: What about biointerface-safety concerns?

OBJECTIVES

The present review article aimed to discuss the recent technologies employed for the development of dental implants, mainly regarding innovative surface treatments and alternative alloys, emphasizing the bio-tribocorrosion processes.

METHODS

An electronic search applying specific MeSH terms was carried out in PubMed and Google Scholar databases to collect data until August 2021, considering basic, pre-clinical, clinical and review studies. The relevant articles (n=111), focused on innovative surface treatments for dental implants and their potential undesirable biological effects, were selected and explored.

RESULTS

Novel texturization methodologies for dental implants clearly provided superficial and structural atomic alterations in micro- and nanoscale, promoting different mechanical-chemical interactions when applied in the clinical set. Some particulate metals released from implant surfaces, their degradation products and/or contaminants exhibited local and systemic reactions after implant installation and osseointegration, contributing to unexpected treatment drawbacks and adverse effects. Therefore, there is an urgent need for development of pre-clinical and clinical platforms for screening dental implant devices, to predict the biointerface reactions as early as possible during the development phases.

SIGNIFICANCE

Modern surface treatments and innovative alloys developed for dental implants are not completely understood regarding their integrity during long-term clinical function, especially when considering the bio-tribocorrosion process. From this review, it is possible to assume that degradation and contamination of dental surfaces might be associated within peri-implant inflammation and cumulative long-lasting systemic toxicity. The in-depth comprehension of the biointerface modifications on these novel surface treatments might preclude unnecessary expenses and postoperative complications involving osseointegration failures.

Bone Response to Conventional Titanium Implants and New Zirconia Implants Produced by Additive Manufacturing

The aim of the present study was to evaluate the in vivo bone response to an additively manufactured zirconia surface compared to osseointegration into titanium (Ti) surfaces. Scanning electron microscopy, confocal laser scanning microscopy, and electron spectroscopy for chemical analysis were performed to assess the surface characteristics of implant specimens. For the in vivo evaluation, eight Ti implants and eight 3D-printed zirconia implants were used. The surface of four Ti implants was sandblasted, large-grit, and acid-etched (Ti-SLA group), while those of the other four Ti implants were left untreated (Ti-turned group). The zirconia implants had no further surface modification. Implants were placed into the tibiae of four rabbits; two received the Ti-SLA and zirconia implants and the other two received Ti-turned and zirconia implants. The experimental animals were sacrificed after four weeks of surgery, and the undecalcified microscopic slides were prepared. The bone–implant interface was analyzed by histomorphometry to evaluate the bone response. The degree of surface roughness showed that Ti-SLA was the highest, followed by zirconia and Ti-turned surfaces. The 3D-printed zirconia surface showed similar bone-to-implant contact to the Ti-turned surface, and Ti-SLA had the most bone-to-implant contact. The additively manufactured zirconia implant surface is biocompatible with respect to osseointegration compared to the commercially pure Ti surface.

The Role of Biomaterials and Biocompatible Materials in Implant-Supported Dental Prosthesis

The dental implant is one of the appropriate instances of the different dental materials and their application, which is the combined procedure of technology and science in physics, biomechanics, and surface chemistry from macroscale to nanoscale surface engineering and manufactured technologies. In recent decades, biomaterials in implant therapy promote bone response and biomechanical ability, which is long-term from surgical equipment to final prosthetic restoration. Biomaterials have a crucial role in rehabilitating the damaged structure of the tooth and supplying acceptable outcomes correlated with clinical performance. There are some challenges in implantation such as bleeding, mobility, peri-implant infections, and the solution associated with modern strategies which are regarded to biomaterials. Various materials have been known as promising candidates for coatings of dental implants which contain polyhydroxyalkanoates, calcium phosphate, carbon, bisphosphonates, hydroxyapatite, bone stimulating factors, bioactive glass, bioactive ceramics, collagen, chitosan, metal and their alloys, fluoride, and titanium/titanium nitride. It is pivotal that biomaterials should be biodegradable; for example, polyhydroxyalkanoates are biodegradable; also, they do not have bad effects on tissues and cells. Despite this, biomaterials have important roles in prosthetic conditions such as dental pulp regeneration, the healing process, and antibacterial and anti-inflammatory effects. In this review study, the role of biocompatible materials in dental implants is investigated in in vitro and in vivo studies.

Laser surface treatment on Yttria-stabilized zirconia dental implants: Influence on cell behavior

Yttria-stabilized zirconia (YSZ) is being proposed as an alternative material to Titanium for dental implants due to its aesthetic and biocompatibility properties. However, is it yet to define the optimal surface treatment to improve YSZ bioactivy. Texturization is a promising approach, but the biological role of patterned YSZ surfaces in cell cultures is yet to be determined. Thus, cellular behavior of osteoblasts and fibroblasts in contact with groove-texturized YSZ surfaces was investigated. YSZ discs were groove-textured by conventional milling and Nd:YAG laser. All samples including control were sandblasted and acid-etched. Human osteoblasts and fibroblasts were cultured on discs for 14 days. Morphology and cellular adhesion were observed. Cell viability, interleukin-1β, osteopontin, collagen type I prodution, alkaline phosphatase activity, and interleukin-8 were measured. YSZ texturization by conventional milling improved osteoblasts viability and differentiation when compared to laser texturization. Fibroblasts behavior did not seem to be influenced by the texturing technique. Compared to sandblasting and acid etching currently used as gold standard for zirconia dental implants no superiority of macrotexturization was found.

Early Biological Response of an Ultra-Hydrophilic Implant Surface Activated by Salts and Dry Technology: An In-Vitro Study

The use of dental implants has grown over the years and has led to higher success rates. To further enhance surgical outcomes, many research groups and companies have shifted their focus to surfaces roughness, wettability and chemistry. In a recent study a new dry salt bioactivate surface has been described from a chemical and physical point of view. The aim of this study is to evaluate the osteogenic response of pre-osteoblast cell lines to dry bioactivated surface. MC3T3-E1 osteogenic cell lines were cultured on SM (sandblasted and dual acid-etched surface) and HNS (SM surface with dry salts bioactive technology). Cell adhesion assay, proliferation assay and cell morphology were performed. Osteogenic activity was performed using Alizarin Red S and alkaline phosphatase. The results showed that SM surface determines a slighter but significant increase in cell adhesion and proliferation in a shorter time compared to HNS. On the contrary, HNS surface has long and intertwining filopodia that could be a response to surface HNS-topography that results in a higher stage of differentiation. The nature of the HNS surface is more prone to determine massive deposition of calcium minerals. This study is the first investigating the role of this interesting dry-salts bioactive surface during the first phase of healing and its potential biochemical advantage could be validated by future animal studies with the aim of evaluate the rate of bone implant contact in the early stages of healing.

Bone Density around Titanium Dental Implants Coating Tested/Coated with Chitosan or Melatonin: An Evaluation via Microtomography in Jaws of Beagle Dogs

Peri-implant bone density plays an important role in the osseointegration of dental implants. The aim of the study was to evaluate via micro-CT, in Hounsfield units, the bone density around dental implants coated with chitosan and melatonin and to compare it with the bone density around implants with a conventional etched surface after 12 weeks of immediate post-extraction placement in the jaws of Beagle dogs. Six dogs were used, and 48 implants were randomly placed: three groups—melatonin, chitosan, and control. Seven 10 mm × 10 mm regions of interest were defined in each implant (2 in the crestal zone, 4 in the medial zone, and 1 in the apical zone). A total of 336 sites were studied with the AMIDE tool, using the Norton and Gamble classification to assess bone density. The effect on bone density of surface coating variables (chitosan, melatonin, and control) at the crestal, medial, and apical sites and the implant positions (P2, P3, P4, and M1) was analyzed at bivariate and multivariate levels (linear regression). Adjusted effects on bone density did not indicate statistical significance for surface coatings (p = 0.653) but did for different levels of ROIs (p < 0.001) and for positions of the implants (p = 0.032). Micro-CT, with appropriate software, proved to be a powerful tool for measuring osseointegration.

Facile distribution of an alkaline microenvironment improves human bone marrow mesenchymal stem cell osteogenesis on a titanium surface through the ITG/FAK/ALP pathway

Purpose

Osseointegration at the titanium surface-bone interface is one of the key factors affecting the success rate of dental implants. However, the titanium surface always forms a passive oxide layer and impacts bone marrow–derived mesenchymal stem cell (BMSC) osteogenic differentiation after exposure to the atmosphere, which further leads to poor osseointegration. Given that wet storage helps prevent titanium aging and that weakly alkaline conditions stimulate BMSC osteogenic differentiation, the aim of the present study was to explore whether sodium bicarbonate, a well-known hydrogen ion (pH) buffer, forms an alkaline microenvironment on titanium surfaces to promote BMSC osteogenic differentiation.

Material and methods

In this work, sand-blasted and acid-etched (SLA) titanium discs were soaked in 20 mM, 50 mM, 100 mM, and 200 mM sodium bicarbonate at room temperature for 5 min without rinsing. The influence of this surface modification on BMSC adhesion, proliferation, and osteogenic differentiation was measured. Additionally, cellular osteogenic differentiation–associated signaling pathways were evaluated.

Results

We showed that titanium discs treated with sodium bicarbonate created an extracellular environment with a higher pH for BMSCs than the normal physiological value for 5 days, strongly promoting BMSC osteogenic differentiation via the activation of integrin-focal adhesion kinase-alkaline phosphatase (Itg-FAK-ALP). In addition, the proliferation and adhesion of BMSCs were increased after alkaline treatment. These cellular effects were most significant with 100 mM sodium bicarbonate.

Conclusion

The results indicated that the titanium surface treated with sodium bicarbonate improved BMSC osteogenic differentiation mainly by creating an alkaline microenvironment, which further activated the Itg-FAK-ALP signaling pathway.

Clinical relevance

Surfaces modified with 100 mM sodium bicarbonate had the highest initial pH value and thus showed the greatest potential to improve BMSC performance on titanium surfaces, identifying a novel conservation method for dental implants.