Anhydride-functional silane immobilized onto titanium surfaces induces osteoblast cell differentiation and reduces bacterial adhesion and biofilm formation

Effect of Tribocorrosion on Mechanical Behavior of Titanium Dental Implants: An In Vitro Study

BACKGROUND/OBJECTIVES

Peri-implantitis often necessitates surgical intervention, with implantoplasty being proposed as a decontamination method in resective surgeries. This mechanical cleaning technique aims to halt disease progression by removing bacterial colonies. However, implantoplasty may compromise mechanical properties, reduce corrosion resistance, and lead to cytotoxic effects due to titanium particle release. This study aimed to evaluate the corrosion and mechanical resistance of implantoplasty-treated dental implants, with and without bacterial contamination.

METHODS

Twenty dental implants were divided into three groups: control (C), implantoplasty (IP), and implantoplasty with bacterial contamination (IPC) using Streptococcus aureus and Porphyromonas gingivalis. Scanning electron microscopy was used to assess surface morphology. Fatigue life curves were obtained using a Bionix servohydraulic machine, and electrochemical corrosion tests were conducted to measure corrosion potentials and intensities.

RESULTS

The IPC group demonstrated significantly lower fatigue resistance and higher susceptibility to corrosion compared to the control and IP groups. Fatigue life decreased by 21.7%, and corrosion current density (ICORR) increased from 0.025 μA/cm2 (control) to 0.089 μA/cm2 (IP) and 0.122 μA/cm2 (IPC). Corrosion potential (ECORR) shifted from -380 mV (control) to -450 mV (IP) and -495 mV (IPC). Surface defects caused by bacterial colonization facilitated stress concentration and crack initiation during fatigue testing.

CONCLUSIONS

Dental implants treated with implantoplasty and exposed to bacterial contamination exhibit significantly reduced mechanical and corrosion resistance. Bacterial activity exacerbates surface vulnerability, leading to titanium loss and pitting corrosion. These findings highlight the clinical implications of bacterial colonization on implantoplasty-treated surfaces.

Antibacterial coatings for dental implants: A systematic review

OBJECTIVES

Despite the high survival rates of dental implants, peri-implantitis is a prevalent complication. Peri-implantitis is related to biofilm that adheres to the surface of implants and causes peri-implant chronic inflammation and bone destruction. Different surface treatments have been proposed to prevent biofilm formation. The objective of this systematic review was analyzing different types of antimicrobial coatings and identifying the most effective one(s) to control bacterial colonization over extended periods of analysis.

DATA, SOURCES AND STUDY SELECTION

We performed a bibliographic search in Pubmed and Cochrane base of articles published after 2010 to answer, according to the PICO system, the following question: What is the most effective antibacterial surface coating for dental implants? Only papers including a minimum follow-up bacteria growth analysis for at least 48 h were selected. After selection, the studies were classified using the PRISMA system. A total of 40 studies were included.

CONCLUSIONS

Three main categories of coatings were identified: Antibacterial peptides, synthetic antimicrobial molecules (polymers, antibiotics, …), and metallic nanoparticles (silver). Antibacterial peptide coatings to modify dental implant surfaces have been the most studied and effective surface modification to control bacterial colonization over extended periods of incubation as they are highly potent, durable and biocompatible. However, more in vitro and pre-clinical studies are needed to assess their true potential as a technology for preventing peri-implant infections.

The impact of biocorrosion and titanium ions release on peri-implantitis

OBJECTIVES

Biofilm accumulation is considered the primary cause of peri-implant inflammation. Still, metallosis caused by an increased concentration of titanium ions at the site of peri-implantitis site cannot be ignored. Whether titanium ions alone or in concert with bacterial biofilm trigger inflammation and bone destruction in peri-implant tissues remains unproven.

MATERIALS AND METHODS

Articles were retrieved from PubMed/Medline, Web of Science. All studies focusing on titanium ions release in peri-implant reactions were included and evaluated.

RESULTS

Titanium implants are considered non-inert and may release titanium ions in the intraoral microenvironment, the most important of which is the acidic environment created by bacterial biofilms. Although the correlation between titanium ion release and the incidence or progression of peri-implantitis is controversial, several studies have confirmed the potential role of titanium ions. Diffusion or entry of titanium ions into the circulation may be a scavenging effect on local titanium ions but can cause systemic adverse effects. However, existing measures are not yet able to balance reducing biocorrosion and maintaining osteogenic results, and the exploration of new materials requires long-term clinical data.

CONCLUSIONS

Titanium ions have potential impacts on peri-implant tissue and systemic circulation. Titanium ions are closely associated with bacterial biofilms in the occurrence and development of periimplantitis. The preventive strategies for the release and action of titanium ions remain to be explored.

CLINICAL RELEVANCE

Our findings may provide the hope of shedding light on the pathogenesis of peri-implantitis and its treatment.

Relevant Aspects in the Mechanical and Aging Degradation of NiTi Alloy with R-Phase in Endodontic Files

One of the most important challenges in endodontics is to have files that have excellent flexibility, toughness, and high fatigue life. Superelastic NiTi alloys have been a breakthrough and the new R-phase NiTi alloys promise to further optimize the good properties of NiTi alloys. In this work, two austenitic phase endodontic files with superelastic properties (Protaper and F6) and two austenitic phase files with the R-phase (M-wire and Reciproc) have been studied. The transformation temperatures were studied by calorimetry. Molds reproducing root canals at different angles (30, 45, and 70°) were obtained with cooling and loads simulating those used in the clinic. Mechanical cycles of different files were realized to fracture. Transformation temperatures were determined at different number of cycles. The different files were heat treated at 300 and 500 °C as the aging process, and the transformation temperatures were also determined. Scanning and transmission electron microscopy was used to observe the fractography and precipitates of the files. The results show that files with the R-phase have higher fracture cycles than files with only the austenitic phase. The fracture cycles depend on the angle of insertion in the root canal, with the angle of 70° being the one with the lowest fracture cycles in all cases. The R-Phase transformation increases the energy absorbed by the NiTi to produce the austenitic to R-phase and to produce the martensitic transformation causing the increase in the fracture cycles. Mechanical cycling leads to significant increases in the transformation temperatures Ms and Af as well as Rs and Rf. No changes in the transformation temperatures were observed for aging at 300 °C, but the appearance of Ni4Ti3 precipitates was observed in the aging treatments to the Nickel-rich files that correspond to those with the R transition. These results should be considered by endodontists to optimize the type of files for clinical therapy.

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

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

The Effect of Implantoplasty on the Fatigue Behavior and Corrosion Resistance in Titanium Dental Implants

Implantoplasty is a technique increasingly used to remove the biofilm that causes peri-implantitis on dental implants. This technique of mechanization of the titanium surface makes it possible to eliminate bacterial colonies, but it can generate variations in the properties of the implant. These variations, especially those in fatigue resistance and electrochemical corrosion behavior, have not been studied much. In this work, fatigue tests were performed on 60 dental implants without implantoplasty, namely 30 in air and 30 in Hank's solution at 37 °C, and 60 with implatoplasty, namely 30 in air and 30 in Hank's solution at 37 °C, using triaxial tension-compression and torsion stresses simulating human chewing. Mechanical tests were performed with a Bionix servo-hydraulic testing machine and fracture surfaces were studied by scanning electron microcopyElectrochemical corrosion tests were performed on 20 dental implants to determine the corrosion potentials and corrosion intensity for control implants and implantoplasty implants. Studies of titanium ion release to the physiological medium were carried out for each type of dental implants by Inductively Coupled-Plasma Mass Spectrometry at different immersion times at 37 °C. The results show a loss of fatigue caused by the implantoplasty of 30%, observing that the nucleation points of the cracks are in the areas of high deformation in the areas of the implant neck where the mechanization produced in the treatment of the implantoplasty causes an exaltation of fatigue cracks. It has been observed that tests performed in Hank's solution reduce the fatigue life due to the incorporation of hydrogen in the titanium causing the formation of hydrides that embrittle the dental implant. Likewise, the implantoplasty causes a reduction of the corrosion resistance with some pitting on the machined surface. Ion release analyses are slightly higher in the implantoplasted samples but do not show statistically significant differences. It has been observed that the physiological environment reduces the fatigue life of the implants due to the penetration of hydrogen into the titanium forming titanium hydrides which embrittle the implant. These results should be taken into account by clinicians to determine the convenience of performing a treatment such as implantoplasty that reduces the mechanical behavior and increases the chemical degradation of the titanium dental implant.

Surface (bio)-functionalization of metallic materials: How to cope with real interfaces?

Metallic materials are an important class of biomaterials used in various medical devices, owing to a suitable combination of their mechanical properties. The (bio)-functionalization of their surfaces is frequently performed for biocompatibility requirements, as it offers a powerful way to control their interaction with biological systems. This is particularly important when physicochemical processes and biological events, mainly involving proteins and cells, are initiated at the host-material interface. This review addresses the state of "real interfaces" in the context of (bio)-functionalization of metallic materials, and the necessity to cope with it to avoid frequent improper evaluation of the procedure used. This issue is, indeed, well-recognized but often neglected and emerges from three main issues: (i) ubiquity of surface contamination with organic compounds, (ii) reactivity of metallic surfaces in biological medium, and (iii) discrepancy in (bio)-functionalization procedures between expectations and reality. These disturb the assessment of the strategies adopted for surface modifications and limit the possibilities to provide guidelines for their improvements. For this purpose, X-ray photoelectrons spectroscopy (XPS) comes to the rescue. Based on significant progresses made in methodological developments, and through a large amount of data compiled to generate statistically meaningful information, and to insure selectivity, precision and accuracy, the state of "real interfaces" is explored in depth, while looking after the two main constituents: (i) the bio-organic adlayer, in which the discrimination between the compounds of interest (anchoring molecules, coupling agents, proteins, etc) and organic contaminants can be made, and (ii) the metallic surface, which undergoes dynamic processes due to their reactivity. Moreover, through one of the widespread (bio)-functionalization strategy, given as a case study, a particular attention is devoted to describe the state of the interface at different stages (composition, depth distribution of contaminants and (bio)compounds of interest) and the mode of protein retention. It is highlighted, in particular, that the occurrence or improvement of bioactivity does not demonstrate that the chemical schemes worked in reality. These aspects are particularly essential to make progress on the way to choose the suitable (bio)-functionalization strategy and to provide guidelines to improve its efficiency.

Silver coating on dental implant-abutment connection screws as potential strategy to prevent loosening and minimizing bacteria adhesion

Introduction: One of the main problems for the long-term behavior of dental implants are loosening of the implant-abutment connection screws and bacterial infiltration. The aim of this work is to increase the screw fixation by silver coating, providing superior mechanical retaining and antibacterial effect. Methods: Eighty dental implants with their abutments and screws have been studied. Twenty screws were not coated and were used as a control while the rest of screws were silver coated by sputtering, with three different thickness: 10, 20 and 40 μm and 20 screws per each thickness. Coating morphology and thickness were determined by scanning electron microscopy using image analysis systems. The screws were tightened for each of the thicknesses and the control with two torques 15 Ncm and 20 Ncm and tested under mechanical fatigue simulating oral stresses up to a maximum of 500,000 cycles. The remaining torques at different cycles were determined with a high-sensitivity torquemeter. Cell viability assays were performed with SaOs-2 osteoblasts and microbiological studies were performed against Streptococcus gordonii and Enterococcus faecalis bacteria strains, determining their metabolic activity and viability using live/dead staining. Results: It was observed a decrease in torque as cycles increase. For a preload of 15 Ncm at 100,000 cycles, the loosening was complete and, for 20 Ncm at 500,000 cycles, 85% of torque was lost. The silver coatings retained the torque, especially the one with a thickness of 40 μm, retaining 90% of the initial torque at 500,000 cycles. It was observed that osteoblastic viability values did not reach 70%, which could indicate a slight cytotoxic effect in contact with cells or tissues; however, the screw should not be in direct contact with tissue or living cells. Silver coating induced a significant reduction of the bacteria metabolic activity for Streptococcus gordonii and Enterococcus faecalis, around 90% and 85% respectively. Discussion: Therefore, this coating may be of interest to prevent loosening of implant systems with a worthy antibacterial response.

In vitro analysis of the influence of the thermocycling and the applied force on orthodontic clear aligners

The mechanical properties of polyurethane dental aligners have been studied in an oral environment at 37°C and subjected to thermal cycling between 5°C and 55°C for long periods of time at different mechanical stresses. The aim is to determine the efficacy of the orthodontic aligner at different stress levels, the effect of thermal cycling with therapy time on tooth position correction. Sixty aligners with the same design were studied applying tensions of 0, 3 and 30 N and determining the deformation at different times from 1 to 760 h. Half of these aligners were subjected to stresses submerged in artificial saliva at 37°C and the other half were subjected to thermal cycles between 2°C and 55°C in salivary medium. Deformation was determined using a high-resolution stereo magnifier and ImageJ image analysis software. Water adsorption by the polyurethane was determined at the different test times. The results showed that in the unloaded aligners there is no appreciable deformation, but with thermal cycling there is a light shrinkage of the aligner due to the semi-crystallization process (ordering of polymeric chains) of the polyurethane. When applying loads of 3 and 30 N, creep curves with constant deformation transition zones can be seen. The transition zones decrease as the applied mechanical load increases. In addition, the significant effect of thermal cycling on the reduction of the transition zone of the aligners has been demonstrated. The transition zones are optimal for dental correction as constant stresses are exerted for tooth movement. The effect of thermal cycling shortens the constant deformation zone and reduces tooth alignment time. It was observed that the absorption of water in the aligner is constant after 1 h of immersion and does not exceed 0.4% by weight of absorbed water.

Titanium Boston keratoprosthesis with corneal cell adhesive and bactericidal dual coating

The Boston keratoprosthesis (BKPro) is a medical device used to restore vision in complicated cases of corneal blindness. This device is composed by a front plate of polymethylmethacrylate (PMMA) and a backplate usually made of titanium (Ti). Ti is an excellent biomaterial with numerous applications, although there are not many studies that address its interaction with ocular cells. In this regard, despite the good retention rates of the BKPro, two main complications compromise patients' vision and the viability of the prosthesis: imperfect adhesion of the corneal tissue to the upside of the backplate and infections. Thus, in this work, two topographies (smooth and rough) were generated on Ti samples and tested with or without functionalization with a dual peptide platform. This molecule consists of a branched structure that links two peptide moieties to address the main complications associated with BKPro: the well-known RGD peptide in its cyclic version (cRGD) as cell pro-adherent motif and the first 11 residues of lactoferrin (LF1-11) as antibacterial motif. Samples were physicochemically characterized, and their biological response was evaluated in vitro with human corneal keratocytes (HCKs) and against the gram-negative bacterial strain Pseudomonas aeruginosa. The physicochemical characterization allowed to verify the functionalization in a qualitative and quantitative manner. A higher amount of peptide was anchored to the rough surfaces. The studies performed using HCKs showed increased long-term proliferation on the functionalized samples. Gene expression was affected by topography and peptide functionalization. Roughness promoted α-smooth muscle actin (α-SMA) overexpression, and the coating notably increased the expression of extracellular matrix components (ECM). Such changes may favour the development of unwanted fibrosis, and thus, corneal haze. In contrast, the combination of the coating with a rough topography decreased the expression of α-SMA and ECM components, which would be desirable for the long-term success of the prosthesis. Regarding the antibacterial activity, the functionalized smooth and rough surfaces promoted the death of bacteria, as well as a perturbation in their wall definition and cellular morphology. Bacterial killing values were 58 % for smooth functionalised and 68 % for rough functionalised samples. In summary, this study suggests that the use of the dual peptide platform with cRGD and LF1-11 could be a good strategy to improve the in vitro and in vivo performance of the rough topography used in the commercial BKPro.

Advanced surface engineering of titanium materials for biomedical applications: From static modification to dynamic responsive regulation

Titanium (Ti) and its alloys have been widely used as orthopedic implants, because of their favorable mechanical properties, corrosion resistance and biocompatibility. Despite their significant success in various clinical applications, the probability of failure, degradation and revision is undesirably high, especially for the patients with low bone density, insufficient quantity of bone or osteoporosis, which renders the studies on surface modification of Ti still active to further improve clinical results. It is discerned that surface physicochemical properties directly influence and even control the dynamic interaction that subsequently determines the success or rejection of orthopedic implants. Therefore, it is crucial to endow bulk materials with specific surface properties of high bioactivity that can be performed by surface modification to realize the osseointegration. This article first reviews surface characteristics of Ti materials and various conventional surface modification techniques involving mechanical, physical and chemical treatments based on the formation mechanism of the modified coatings. Such conventional methods are able to improve bioactivity of Ti implants, but the surfaces with static state cannot respond to the dynamic biological cascades from the living cells and tissues. Hence, beyond traditional static design, dynamic responsive avenues are then emerging. The dynamic stimuli sources for surface functionalization can originate from environmental triggers or physiological triggers. In short, this review surveys recent developments in the surface engineering of Ti materials, with a specific emphasis on advances in static to dynamic functionality, which provides perspectives for improving bioactivity and biocompatibility of Ti implants.

Bacterial Adhesion of TESPSA and Citric Acid on Different Titanium Surfaces Substrate Roughness: An In Vitro Study with a Multispecies Oral Biofilm Model

This in vitro study analyzed the influence of substrate roughness on biofilm adhesion and cellular viability over triethoxysilylpropyl succinic anhydride silane (TESPSA)- and citric acid (CA)-coated surfaces at 12 and 24 h, respectively. A multispecies biofilm composed of S. oralis, A. naslundii, V. parvula, F. nucleatum, P. intermedia, P. gingivalis, P. endodontalis and F. alocis was developed over titanium discs grouped depending on their roughness (low, medium, high) and antibacterial coating (low-TESPSA, medium-TESPSA, high-TESPSA, and CA). The biofilm was quantified by means of quantitative polymerase chain reaction (PCR) and viability PCR and assessed through confocal laser scanning microscope (CLSM). Quantitative PCR revealed no significant differences in bacterial adhesion and biofilm mortality. CA was the surface with the lowest bacterial counts and highest mortality at 12 and 24 h, respectively, while high harbored the highest amount of biofilm at 24 h. By CLSM, CA presented significant amounts of dead cells compared to medium-TESPSA and high-TESPSA. A significantly greater volume of dead cells was found at 12 h in low-TESPSA compared to medium-TESPSA, while CA also presented significant amounts of dead cells compared to medium-TESPSA and high-TESPSA. With regard to the live/dead ratio, low-TESPSA presented a significantly higher ratio at 12 h compared to medium-TESPSA and high-TESPSA. Similarly, CA exhibited a significantly higher live/dead ratio compared to medium-TESPSA and high-TESPSA at 12 h. This multispecies in vitro biofilm did not evidence clear antiadhesive and bactericidal differences between surfaces, although a tendency to reduce adhesion and increase antibacterial effect was observed in the low-TESPSA and CA.

Investigation of the Influence of Roughness and Dental Implant Design on Primary Stability via Analysis of Insertion Torque and Implant Stability Quotient: An In Vitro Study

In the placement of dental implants, the primary fixation between the dental implant and the bone is of great importance and corresponds to compressive mechanical fixation that aims to prevent micromovement of the implant. The aim of this research was to determine the role of roughness and the type of dental implant (tissue-level or bone-level) in implant stability, measured using resonance frequency analysis (RFA) and insertion torque (IT). We analyzed 234 titanium dental implants, placed in fresh calf ribs, at the half-tissue level and half-bone level. The implant surface was subjected to grit-blasting treatments with alumina particles of 120, 300, and 600 μm at a projection pressure of 2.5 bar, resulting in three types of roughness. Roughness was determined via optical interferometry. The wettability of the surfaces was also determined. Implant stability was measured using a high-precision torquemeter to obtain IT, and RFA was used to determine the implant stability quotient (ISQ). The results show that rough surfaces with Sa values of 0.5 to 4 μm do not affect the primary stability. However, the type of implant is important; bone-level implants obtained the highest primary stability values. A good correlation between the primary stability values obtained via IT and ISQ was demonstrated. New in vivo studies are necessary to know whether these results can be maintained in the long term.

Osteoblastic and Bacterial Response of Hybrid Dental Implants

Bacterial infections in dental implants generate peri-implantitis disease that causes bone loss and the mobility of the dental implant. It is well known that specific ranges of roughness favor the proliferation of bacteria, and it is for this reason that new dental implants called hybrids have appeared. These implants have a smooth area in the coronal part and a rough surface in the apical part. The objective of this research is the physico-chemical characterization of the surface and the osteoblastic and microbiological behavior. One-hundred and eighty discs of titanium grade 3 with three different surfaces (smooth, smooth-rough, and completely rough) were studied. The roughness was determined by white light interferometry, and the wettability and surface energy by the sessile drop technique and the application of Owens and Wendt equations. Human osteoblast SaOS-2 was cultured to determine cell adhesion, proliferation, and differentiation. Microbiological studies were performed with two common bacterial strains in oral infection, E. faecalis and S. gordonii, at different times of culture. The roughness obtained for the smooth surface was Sa = 0.23 and for the rough surface it was 1.98 μm. The contact angles were more hydrophilic for the smooth surface (61.2°) than for the rough surface (76.1°). However, the surface energy was lower for the rough surface (22.70 mJ/m²) in both its dispersive and polar components than the smooth surface (41.77 mJ/m²). Cellular activity in adhesion, proliferation, and differentiation was much higher on rough surfaces than on smooth surfaces. After 6 h of incubation, the osteoblast number in rough surfaces was more than 32% higher in relation to the smooth surface. The cell area in smooth surfaces was higher than rough surfaces. The proliferation increased and the alkaline phosphatase presented a maximum after 14 days, with the mineral content of the cells being higher in rough surfaces. In addition, the rough surfaces showed greater bacterial proliferation at the times studied and in the two strains used. Hybrid implants sacrifice the good osteoblast behavior of the coronal part of the implant in order to obstruct bacterial adhesion. The following fact should be considered by clinicians: there is a possible loss of bone fixation when preventing peri-implantitis.

Comparison of the Antibacterial Effect of Silver Nanoparticles and a Multifunctional Antimicrobial Peptide on Titanium Surface

Titanium implantation success may be compromised by Staphylococcus aureus surface colonization and posterior infection. To avoid this issue, different strategies have been investigated to promote an antibacterial character to titanium. In this work, two antibacterial agents (silver nanoparticles and a multifunctional antimicrobial peptide) were used to coat titanium surfaces. The modulation of the nanoparticle (≈32.1 ± 9.4 nm) density on titanium could be optimized, and a sequential functionalization with both agents was achieved through a two-step functionalization method by means of surface silanization. The antibacterial character of the coating agents was assessed individually as well as combined. The results have shown that a reduction in bacteria after 4 h of incubation can be achieved on all the coated surfaces. After 24 h of incubation, however, the individual antimicrobial peptide coating was more effective than the silver nanoparticles or their combination against Staphylococcus aureus. All tested coatings were non-cytotoxic for eukaryotic cells.

Relevant Aspects of Titanium Topography for Osteoblastic Adhesion and Inhibition of Bacterial Colonization

The influence of the surface topography of dental implants has been studied to optimize titanium surfaces in order to improve osseointegration. Different techniques can be used to obtain rough titanium, however, their effect on wettability, surface energy, as well as bacterial and cell adhesion and differentiation has not been studied deeply. Two-hundred disks made of grade 4 titanium were subjected to different treatments: machined titanium (MACH), acid-attacked titanium (AE), titanium sprayed with abrasive alumina particles under pressure (GBLAST), and titanium that has been treated with GBLAST and then subjected to AE (GBLAST + AE). The roughness of the different treatments was determined by confocal microscopy, and the wettability was determined by the sessile drop technique; then, the surface energy of each treatment was calculated. Osteoblast-like cells (SaOs-2) were cultured, and alkaline phosphatase was determined using a colorimetric test. Likewise, bacterial strains S. gordonii, S. oralis, A. viscosus, and E. faecalis were cultured, and proliferation on the different surfaces was determined. It could be observed that the roughness of the GBLAST and GBLAS + AE was higher, at 1.99 and 2.13 μm of Ra, with respect to the AE and MACH samples, which were 0.35 and 0.20 μm, respectively. The abrasive treated surfaces showed lower hydrophilicity but lower surface energy. Significant differences could be seen at 21 days between SaOS-2 osteoblastic cell adhesion for the blasted ones and higher osteocalcin levels. However, no significant differences in terms of bacterial proliferation were observed between the four surfaces studied, demonstrating the insensitivity of bacteria to topography. These results may help in the search for the best topographies for osteoblast behavior and for the inhibition of bacterial colonization.

Influence of antibacterial surface treatment on dental implants on cell viability: A systematic review

There is no consensus in the literature about the best non-cytotoxic antibacterial surface treatment for dental implants. Critically evaluate the existing literature and answer the question: "which surface treatment for dental implants made of titanium and its alloys has the greatest non-cytotoxic antibacterial activity for osteoblastic cells?" This systematic review was registered in the Open Science Framework (osf.io/8fq6p) and followed the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols. The search strategy was applied to four databases. Articles were selected that evaluated in both studies the properties of 1) antibacterial activity and 2) cytotoxicity on osteoblastic cells of titanium and their alloy dental implants when treated superficially. Systematic reviews, book chapters, observational studies, case reports, articles that studied non-dental implants, and articles that evaluated only the development of surface treatment were excluded. The Joanna Briggs Institute, a quasi-experimental study assessment tool, was adapted to assess the risk of bias. The search strategy found 1178 articles in the databases after removing duplicates in EndNote Web, resulting in 1011 articles to be evaluated by title and abstract, of which 21 were selected for full reading, of which 12 were included by eligibility criteria, and nine were excluded. Quantitative synthesis could not be performed due to the heterogeneity of the data (surface treatment, antibacterial assay, bacteria strain, cell viability assay, and cell type). Risk of bias assessment showed that ten studies were classified as low risk and two studies as moderate risk. The evaluated literature allowed us to conclude that: 1) The literature surveyed did not allow answering the question due to the heterogeneity of the studies; 2) Ten of the 12 studies evaluated presented surface treatments with non-cytotoxic antibacterial activity; 3) Adding nanomaterials, QPEI, BG, and CS, reduce the chances of bacterial resistance by controlling their adhesion by electrical forces.

A mass balance analysis of the tribocorrosion process of titanium alloys using a single micro-asperity: Voltage and solution effects on plastic deformation, oxide repassivation, and ion dissolution

Within modular taper junctions of total hip implants (THA), nominally "smooth" metallic surfaces contain multiple micro-asperities that slide, are plastically deformed, have their oxide film surfaces disrupted and corrode during the fretting corrosion processes. In this work, a mass/volume balance approach is developed and used to assess the contribution of individual components of wear and corrosion to the entirety of the single-asperity tribocorrosion process for the popular THA alloy, Ti-6Al-4V. This analysis measures the total volume change (trough) in the surface due to low cycle single asperity fretting corrosion and compares it to the measured pileup volume which is comprised of plastic deformation, metal particles and oxide particles, plus the fretting current and the concentration of solution-bound species. A simple 17 μm spherical geometry diamond asperity was used and the trough volume, pileup volume, fretting currents and ion concentrations were measured to assess their contribution to the fretting corrosion process. The effects fretting in or out of solution (phosphate buffered saline), and the role of electrode potential, e.g., freely corroding or forced potential (-1.0 V, 0 V, and +1.0 V vs Ag/AgCl) were investigated. Under constant 30 mN loading, 100 cycles duration, 3 Hz cyclic frequency and 80 μm sliding amplitude, the volume abraded, fretting currents, ion release, and pileup volume were all recorded. Damage was analyzed and quantified using digital optical microscopy (DOM), atomic force microscopy (AFM), scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS), and inductive coupled plasma mass spectrometry (ICP-MS). The results were analyzed with ANOVA statistics (α = 0.05). The extent of wear damage (asperity trough volume) is as follows: air = Ecorr, air > -1.0 V = 0 V = +1.0 V. As the amount of pileup volume decreased between conditions, visible oxide generation increased, with V > 0 V having more oxide debris generation and air fretting resulting in the least oxide (and most plastic deformation). Ions in solution were not significant, accounting for less than 1% of the damage. Volume analysis showed trough volumes and pileup volumes were very close to one another and were dominated by plastic deformation. Synergy between wear and corrosion were not observed in this work.

Synthetic materials in craniofacial regenerative medicine: A comprehensive overview

The state-of-the-art approach to regenerating different tissues and organs is tissue engineering which includes the three parts of stem cells (SCs), scaffolds, and growth factors. Cellular behaviors such as propagation, differentiation, and assembling the extracellular matrix (ECM) are influenced by the cell's microenvironment. Imitating the cell's natural environment, such as scaffolds, is vital to create appropriate tissue. Craniofacial tissue engineering refers to regenerating tissues found in the brain and the face parts such as bone, muscle, and artery. More biocompatible and biodegradable scaffolds are more commensurate with tissue remodeling and more appropriate for cell culture, signaling, and adhesion. Synthetic materials play significant roles and have become more prevalent in medical applications. They have also been used in different forms for producing a microenvironment as ECM for cells. Synthetic scaffolds may be comprised of polymers, bioceramics, or hybrids of natural/synthetic materials. Synthetic scaffolds have produced ECM-like materials that can properly mimic and regulate the tissue microenvironment's physical, mechanical, chemical, and biological properties, manage adherence of biomolecules and adjust the material's degradability. The present review article is focused on synthetic materials used in craniofacial tissue engineering in recent decades.

Corrosion Behavior of Titanium Dental Implants with Implantoplasty

The procedure generally used to remove bacterial biofilm adhering to the surface of titanium on dental implants is implantoplasty. This treatment is based on the machining of the titanium surface to remove bacterial plaque. In this study, we used 60 grade 4 titanium implants and performed the implantoplasty protocol. Using X-ray diffraction, we determined the stresses accumulated in each of the as-received, machined and debris implants. The resistance to corrosion in open circuit and potentiodynamically in physiological medium has been determined, and the corrosion potentials and intensities have been determined. Tests have been carried out to determine ion release by ICP-MS at different immersion times. The results show that the corrosion resistance and the release of titanium ions into the medium are related to the accumulated energy or the degree of deformation. The titanium debris exhibit compressive residual stresses of −202 MPa, the implant treated with implantoplasty −120 MPa, and as-received −77 MPa, with their corrosion behavior resulting in corrosion rates of 0.501, 0.77, and 0.444 mm/year, respectively. Debris is the material with the worst corrosion resistance and the one that releases the most titanium ions to the physiological medium (15.3 ppb after 21 days vs. 7 ppb for as-received samples). Pitting has been observed on the surface of the debris released into the physiological environment. This behavior should be taken into account by clinicians for the good long-term behavior of implants with implantoplasty.

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.

Bioactive Coatings on Titanium: A Review on Hydroxylation, Self-Assembled Monolayers (SAMs) and Surface Modification Strategies

Titanium (Ti) and its alloys have been demonstrated over the last decades to play an important role as inert materials in the field of orthopedic and dental implants. Nevertheless, with the widespread use of Ti, implant-associated rejection issues have arisen. To overcome these problems, antibacterial properties, fast and adequate osseointegration and long-term stability are essential features. Indeed, surface modification is currently presented as a versatile strategy for developing Ti coatings with all these challenging requirements and achieve a successful performance of the implant. Numerous approaches have been investigated to obtain stable and well-organized Ti coatings that promote the tailoring of surface chemical functionalization regardless of the geometry and shape of the implant. However, among all the approaches available in the literature to functionalize the Ti surface, a promising strategy is the combination of surface pre-activation treatments typically followed by the development of intermediate anchoring layers (self-assembled monolayers, SAMs) that serve as the supporting linkage of a final active layer. Therefore, this paper aims to review the latest approaches in the biomedical area to obtain bioactive coatings onto Ti surfaces with a special focus on (i) the most employed methods for Ti surface hydroxylation, (ii) SAMs-mediated active coatings development, and (iii) the latest advances in active agent immobilization and polymeric coatings for controlled release on Ti surfaces.

Plasma surface modification strategies for the preparation of antibacterial biomaterials: A review of the recent literature

Plasma-based strategies offer several advantages for developing antibacterial biomaterials and can be used directly or combined with other surface modification techniques. Direct plasma strategies can be classified as plasma surface modifications that derive antibacterial property by tailoring surface topography or surface chemistry. Nano patterns induced by plasma modification can exhibit antibacterial property and promote the adhesion and proliferation of mammalian cells, creating antibacterial and biocompatible surfaces. Antibacterial effect by tailoring surface chemistry via plasma can be attained by either creating bacteriostatic surfaces or bactericidal surfaces. Plasma-assisted strategies incorporate plasma processes in combination with other surface modification techniques. Plasma coating can serve as a drug-eluting reservoir and diffusion barrier. The plasma-functionalized surface can serve as a platform for grafting antibacterial agents, and plasma surface activation can improve the adhesion of polymeric layers with antibacterial properties. This article critically reviews plasma-based strategies reported in the recent literature for the development of antibacterial biomaterial surfaces. Studies using both atmospheric and low-pressure plasmas are included in this review. The findings are discussed in terms of the trends in material and precursor selection, modification stability, antibacterial efficacy, the choice of bacterial strains tested, cell culture findings, critical aspects of in vitro performance testing and in vivo experimental design.

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.

Endowing Orthopedic Implants' Antibacterial, Antioxidation, and Osteogenesis Properties Through a Composite Coating of Nano-Hydroxyapatite, Tannic Acid, and Lysozyme

There is a substantial global market for orthopedic implants, but these implants still face the problem of a high failure rate in the short and long term after implantation due to the complex physiological conditions in the body. The use of multifunctional coatings on orthopedic implants has been proposed as an effective way to overcome a range of difficulties. Here, a multifunctional (TA@HA/Lys)_n coating composed of tannic acid (TA), hydroxyapatite (HA), and lysozyme (Lys) was fabricated in a layer-by-layer (LBL) manner, where TA deposited onto HA firmly stuck Lys and HA together. The deposition of TA onto HA, the growth of (TA@HA/Lys)_n, and multiple related biofunctionalities were thoroughly investigated. Our data demonstrated that such a hybrid coating displayed antibacterial and antioxidant effects, and also facilitated the rapid attachment of cells [both mouse embryo osteoblast precursor cells (MC3T3-E1) and dental pulp stem cells (DPSCs)] in the early stage and their proliferation over a long period. This accelerated osteogenesis in vitro and promoted bone formation in vivo. We believe that our findings and the developed strategy here could pave the way for multifunctional coatings not only on orthopedic implants, but also for additional applications in catalysts, sensors, tissue engineering, etc.

Silane-Coating Strategy for Titanium Functionalization Does Not Impair Osteogenesis In Vivo

Silane-coating strategy has been used to bind biological compounds to the titanium surface, thereby making implant devices biologically active. However, it has not been determined if the presence of the silane coating itself is biocompatible to osseointegration. The aim of the present study was to evaluate if silane-coating affects bone formation on titanium using a rabbit model. For this, titanium screw implants (3.75 by 6 mm) were hydroxylated in a solution of H₂SO₄/30% H₂O₂ for 4 h before silane-coating with 3-aminopropyltriethoxysilane (APTES). A parallel set of titanium screws underwent only the hydroxylation process to present similar acid-etched topography as a control. The presence of the silane on the surface was checked by x-ray photoelectron spectroscopy (XPS), with scanning electron microscopy (SEM) and atomic force microscopy (AFM). A total of 40 titanium screws were implanted in the tibia of ten New Zealand rabbits in order to evaluate bone-to-implant contact (BIC) after 3 weeks and 6 weeks of healing. Silane-coated surface presented higher nitrogen content in the XPS analysis, while micro- and nano-topography of the surface remained unaffected. No difference between the groups was observed after 3 and 6 weeks of healing (p > 0.05, independent t-test), although an increase in BIC occurred over time. These results indicate that silanization of a titanium surface with APTES did not impair the bone formation, indicating that this can be a reliable tool to anchor osteogenic molecules on the surface of implant devices.

Membrane perturbation, altered morphology and killing of Staphylococcus epidermidis upon contact with a cytocompatible peptide-based antibacterial surface

One possibility to prevent prosthetic infections is to produce biomaterials resistant to bacterial colonization by anchoring membrane active antimicrobial peptides (AMPs) onto the implant surface. In this perspective, a deeper understanding of the mode of action of the immobilized peptides should improve the development of AMP-inspired infection-resistant biomaterials. The aim of the present study was to characterize the bactericidal mechanism against Staphylococcus epidermidis of the AMP BMAP27(1-18), immobilized on titanium disks and on a model resin support, by applying viability counts, Field Emission Scanning Electron Microscopy (FE-SEM), and a fluorescence microplate assay with a membrane potential-sensitive dye. The cytocompatibility to osteoblast-like MG-63 cells was investigated in monoculture and in co-culture with bacteria. The impact of peptide orientation was explored by using N- and C- anchored analogues. On titanium, the ∼50 % drop in bacteria viability and dramatically affected morphology indicate a contact-killing action exerted by the N- and C-immobilized peptides to the same extent. As further shown by the fluorescence assay with the resin-anchored peptides, the bactericidal effect was mediated by rapid membrane perturbation, similar to free peptides. However, at peptide MBC resin equivalents the C-oriented analogue proved more effective with more than 99 % killing and maximum fluorescence increase, compared to half-maximum fluorescence with more than 90 % killing produced by the N-orientation. Confocal microscopy analyses revealed 4-5 times better MG-63 cell adhesion on peptide-functionalized titanium both in monoculture and in co-culture with bacteria, regardless of peptide orientation, thus stimulating further studies on the effects of the immobilized BMAP27(1-18) on osteoblast cells.

Development of a facile fluorophosphonate-functionalised titanium surface for potential orthopaedic applications

Background

Aseptic loosening of total joint replacements (TJRs) continues to be the main cause of implant failures. The socioeconomic impact of surgical revisions is hugely significant; in the United Kingdom alone, it is estimated that £137 m is spent annually on revision arthroplasties. Enhancing the longevity of titanium implants will help reduce the incidence and overall cost of failed devices.

Methods

In realising the development of a superior titanium technology, we exploited the natural affinity of titanium for phosphonic acids and developed a facile means of coating the metal with (3S)1-fluoro-3-hydroxy-4-(oleoyloxy)butyl-1-phosphonate (FHBP), a phosphatase-resistant analogue of lysophosphatidic acid (LPA). Importantly LPA and selected LPA analogues like FHBP synergistically cooperate with calcitriol to promote human osteoblast formation and maturation.

Results

Herein, we provide evidence that simply immersing titanium in aqueous solutions of FHBP afforded a surface that was superior to unmodified metal at enhancing osteoblast maturation. Importantly, FHBP-functionalised titanium remained stable to 2 years of ambient storage, resisted ∼35 kGy of gamma irradiation and survived implantation into a bone substitute (Sawbone™) and irrigation.

Conclusion

The facile step we have taken to modify titanium and the robustness of the final surface finish are appealing properties that are likely to attract the attention of implant manufacturers in the future.

The translational potential of this article

We have generated a functionalised titanium (Ti) surface by simply immersing Ti in aqueous solutions of a bioactive lipid. As a facile procedure it will have greater appeal to implant manufacturers compared to onerous and costly developmental processes.

The Effects of Titanium Surfaces Modified with an Antimicrobial Peptide GL13K by Silanization on Polarization, Anti-Inflammatory, and Proinflammatory Properties of Macrophages

The polarization of macrophages and its anti-inflammatory and proinflammatory properties play a significant role in host response after implant placement to determine the outcome of osseointegration and long-term survival. In the previous study, we immobilized an antimicrobial peptide, GL13K, onto titanium surfaces to provide immune regulation property. In the herein presented study, we aimed at investigating whether GL13K immobilized titanium surface could improve osteogenesis and reduce the inflammatory reaction around the biomaterials by altering macrophage response. We evaluated the cell proliferation of the different phenotypes of macrophages seeded in GL13K-coated titanium surface, which indicated an inhibition of M1 macrophages and a good cytocompatibility to M2 macrophages. Then, we measured the inflammatory and anti-inflammatory activity of the M1 and M2 macrophages seeded on the GL13K-coated titanium surfaces. The results of the enzyme-linked immunosorbent assay and quantitative reverse transcription-polymerase chain reaction showed that the group with the GL13K modified surface had a downregulation in the expression level of the tumor necrosis factor-α and interleukin-1β in M1 macrophages and an upregulation of IL-10 and transforming growth factor-β3 (TGF-β3) levels in M2 macrophages. This study demonstrated that the GL13K modified titanium surfaces can regulate macrophages' polarization and the expression of inflammatory and anti-inflammatory effects, reducing the effects of the inflammatory process, which may promote the process of bone regeneration and osseointegration.

New Bactericide Orthodonthic Archwire: NiTi with Silver Nanoparticles

A potential new bactericide treatment for NiTi orthodontic archwires based in the electrodeposition of silver nanoparticles on the surface was studied. Twenty-five archwires were treated by electrodeposition, obtaining nanoparticles of silver embedded on the archwire surface. These were evaluated in order to investigate the possible changes on the superelastic characteristics (critical temperatures and stresses), the nickel ion release, and the bacteria culture behavior. The chemical composition was analyzed by Energy Dispersive X-Ray Spectroscopy-microanalysis; the singular temperatures of the martensitic transformation were obtained by a flow calorimeter. Induced martensitic transformation stresses were obtained by mechanical testing apparatus. Nickel ion release was analyzed by inductively coupled plasma-mass spectrometry (ICP-MS) equipment using artificial saliva solution at 37 °C. Bacterial tests were studied with the most used oral bacterial strains: Streptococcus sanguinis and Lactobacillus salivarius. NiTi samples were immersed in bacterial suspensions for 2 h at 37 °C. Adhered bacteria were separated and seeded on agar plates: Tood-Hewitt (TH) and Man-Rogosa-Sharpe (MRS) for S. sanguinis and for L.salivarius, respectively. These were then incubated at 37 °C for 1 day and the colonies were analyzed. The results showed that the transformation temperatures and the critical stresses have not statistically significant differences. Likewise, nickel ion release at different immersion times in saliva at 37 °C does not present changes between the original and treated with silver nanoparticles archwires. Bacteria culture results showed that the reduction of the bacteria due to the presence to the nanoparticles of silver is higher than 90%. Consequently, the new treatment with nanoparticles of silver could be a good candidate as bactericidic orthodontic archwire.

Polyethylene Glycol Pulsed Electrodeposition for the Development of Antifouling Coatings on Titanium

Titanium dental implants are widely used for the replacement of damaged teeth. However, bacterial infections at the interface between soft tissues and the implant can impair the functionality of the device and lead to failure. In this work, the preparation of an antifouling coating of polyethylene glycol (PEG) on titanium by pulsed electrodeposition was investigated in order to reduce Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) adhesion while maintaining human fibroblast adhesion. Different pulsed conditions were prepared and characterized by contact angle, Focused Ion Beam (FIB), Fourier Transformed Infrared Spectroscopy in the Attenuated Total Reflectance mode (ATR-FTIR), and X-ray photoelectron spectroscopy (XPS). XPS tested fibronectin adsorption. S. aureus, E. coli and human fibroblast adhesion was tested in vitro in both mono and co-culture settings. Physicochemical characterization proved useful for confirming the presence of PEG and evaluating the efficiency of the coating methods. Fibronectin adsorption decreased for all of the conditions, but an adsorption of 20% when compared to titanium was maintained, which supported fibroblast adhesion on the surfaces. In contrast, S. aureus and E. coli attachment on coated surfaces decreased up to 90% vs. control titanium. Co-culture studies with the two bacterial strains and human fibroblasts showed the efficacy of the coatings to allow for eukaryotic cell adhesion, even in the presence of pre-adhered bacteria.

Antibacterial Properties of Triethoxysilylpropyl Succinic Anhydride Silane (TESPSA) on Titanium Dental Implants

Infections related to dental implants are a common complication that can ultimately lead to implant failure, and thereby carries significant health and economic costs. In order to ward off these infections, this paper explores the immobilization of triethoxysilylpropyl succinic anhydride (TESPSA, TSP) silane onto dental implants, and the interaction of two distinct monospecies biofilms and an oral plaque with the coated titanium samples. To this end, titanium disks from prior machining were first activated by a NaOH treatment and further functionalized with TESPSA silane. A porous sodium titanate surface was observed by scanning electron microscopy and X-ray photoelectron spectroscopy analyses confirmed the presence of TESPSA on the titanium samples (8.4% for Ti-N-TSP). Furthermore, a lactate dehydrogenase assay concluded that TESPSA did not have a negative effect on the viability of human fibroblasts. Importantly, the in vitro effect of modified surfaces against Streptococcus sanguinis, Lactobacillus salivarius and oral plaque were studied using a viable bacterial adhesion assay. A significant reduction was achieved in all cases but, as expected, with different effectiveness against simple mono-species biofilm (ratio dead/live of 0.4) and complete oral biofilm (ratio dead/live of 0.6). Nevertheless, this approach holds a great potential to provide dental implants with antimicrobial properties.

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.

Multifunctional Coatings and Nanotopographies: Toward Cell Instructive and Antibacterial Implants

In biomaterials science, it is nowadays well accepted that improving the biointegration of dental and orthopedic implants with surrounding tissues is a major goal. However, implant surfaces that support osteointegration may also favor colonization of bacterial cells. Infection of biomaterials and subsequent biofilm formation can have devastating effects and reduce patient quality of life, representing an emerging concern in healthcare. Conversely, efforts toward inhibiting bacterial colonization may impair biomaterial-tissue integration. Therefore, to improve the long-term success of medical implants, biomaterial surfaces should ideally discourage the attachment of bacteria without affecting eukaryotic cell functions. However, most current strategies seldom investigate a combined goal. This work reviews recent strategies of surface modification to simultaneously address implant biointegration while mitigating bacterial infections. To this end, two emerging solutions are considered, multifunctional chemical coatings and nanotopographical features.

In vitro evaluation of a multispecies oral biofilm over antibacterial coated titanium surfaces

Peri-implantitis is an infectious disease that affects the supporting soft and hard tissues around dental implants and its prevalence is increasing considerably. The development of antibacterial strategies, such as titanium antibacterial-coated surfaces, may be a promising strategy to prevent the onset and progression of peri-implantitis. The aim of this study was to quantify the biofilm adhesion and bacterial cell viability over titanium disc with or without antibacterial surface treatment. Five bacterial strains were used to develop a multispecies oral biofilm. The selected species represent initial (Streptococcus oralis and Actinomyces viscosus), early (Veillonella parvula), secondary (Fusobacterium nucleatum) and late (Porphyromonas gingivalis) colonizers. Bacteria were sequentially inoculated over seven different types of titanium surfaces, combining different roughness level and antibacterial coatings: silver nanoparticles and TESPSA silanization. Biofilm formation, cellular viability and bacterial quantification over each surface were analyzed using scanning electron microscopy, confocal microscopy and real time PCR. Biofilm formation over titanium surfaces with different bacterial morphologies could be observed. TESPSA was able to significantly reduce the cellular viability when compared to all the surfaces (p < 0.05). Silver deposition on titanium surface did not show improved results in terms of biofilm adhesion and cellular viability when compared to its corresponding non-coated surface. The total amount of bacterial biofilm did not significantly differ between groups (p > 0.05). TESPSA was able to reduce biofilm adhesion and cellular viability. However, silver deposition on titanium surface seemed not to confer these antibacterial properties.

Silane coatings of metallic biomaterials for biomedical implants: A preliminary review

In response to increased attention in literature, this work provides a qualitative review surrounding the application of silane-based coatings of metallic biomaterials for biomedical implants. Included herein is both a brief summary of existing knowledge and concepts regarding silane-based thin films, along with an analysis of recent peer-reviewed publications and advances towards their practical application for biomedical coatings. Specifically, the review identifies innovative silane-based coatings according to their molecular identity and film structure and analyses their impact on the biocorrosion resistance, protein adsorption, cell viability, and antimicrobial properties of the overall coated implant. It is shown that a range of common silanes clearly exhibit promising properties for biomedical implant coatings, but further work is needed, particularly on mechanisms of physiological interaction and characteristic effects of silane functional groups, before seeing clinical use. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2901-2918, 2018.

Chitosan coating as an antibacterial surface for biomedical applications

Background and objectives

A current public health issue is preventing post-surgical complications by designing antibacterial implants. To achieve this goal, in this study we evaluated the antibacterial activity of an animal-free chitosan grafted onto a titanium alloy.

Methods

Animal-free chitosan binding on the substrate was performed by covalent link via a two-step process using TriEthoxySilylPropyl Succinic Anhydride (TESPSA) as the coupling agent. All grafting steps were studied and validated by means of X-ray Photoelectron Spectroscopy (XPS), Time-of-Flight secondary ion mass spectrometry (ToF-SIMS) analyses and Dynamic-mode Secondary Ion Mass Spectrometry (DSIMS). The antibacterial activity against Escherichia coli and Staphylococcus aureus strains of the developed coating was assessed using the number of colony forming units (CFU).

Results

XPS showed a significant increase in the C and N atomic percentages assigned to the presence of chitosan. A thick layer of polymer deposit was detected by ToF-SIMS and the results obtained by DSIMS measurements are in agreement with ToF-SIMS and XPS analyses and confirms that the coating synthesis was a success. The developed coating was active against both gram negative and gram positive tested bacteria.

Conclusion

The success of the chitosan immobilization was proven using the surface characterization techniques applied in this study. The coating was found to be effective against Escherichia coli and Staphylococcus aureus strains.

Regenerating Bone via Multifunctional Coatings: The Blending of Cell Integration and Bacterial Inhibition Properties on the Surface of Biomaterials

In dentistry and orthopedics, it is well accepted that implant fixation is a major goal. However, an emerging concern is bacterial infection. Infection of metallic implants can be catastrophic and significantly reduce patient quality of life. Accordingly, in this work, we focus on multifunctional coatings to simultaneously address and mitigate both these problems. We have developed a tailor-made peptide-based chemical platform that integrates the well-known RGD cell adhesive sequence and the lactoferrin-derived LF1-11 antimicrobial peptide. The platform was covalently grafted on titanium via silanization and the functionalization process characterized by contact angle, XPS, and QCM-D. The presence of the platform statistically improved the adhesion, proliferation and mineralization of osteoblast-like cells compared to control surfaces. At the same time, colonization by representative bacterial strains was significantly reduced on the surfaces. Furthermore, the biological potency of the multifunctional platform was verified in a co-culture in vitro model. Our findings demonstrate that this multifunctional approach can be useful to functionalize biomaterials to both improve cell integration and reduce the risk of bacterial infection.

Cell Guidance on Nanostructured Metal Based Surfaces

Metal surface nanostructuring to guide cell behavior is an attractive strategy to improve parts of medical implants, lab-on-a-chip, soft robotics, self-assembled microdevices, and bionic devices. Here, we discus important parameters, relevant trends, and specific examples of metal surface nanostructuring to guide cell behavior on metal-based hybrid surfaces. Surface nanostructuring allows precise control of cell morphology, adhesion, internal organization, and function. Pre-organized metal nanostructuring and dynamic stimuli-responsive surfaces are used to study various cell behaviors. For cells dynamics control, the oscillating stimuli-responsive layer-by-layer (LbL) polyelectrolyte assemblies are discussed to control drug delivery, coating thickness, and stiffness. LbL films can be switched "on demand" to change their thickness, stiffness, and permeability in the dynamic real-time processes. Potential applications of metal-based hybrids in biotechnology and selected examples are discussed.

Evaluation of bone loss in antibacterial coated dental implants: An experimental study in dogs

The aim of this study was to evaluate the in vivo effect of antibacterial modified dental implants in the first stages of peri-implantitis. Thirty dental implants were inserted in the mandibular premolar sites of 5 beagle dogs. Sites were randomly assigned to Ti (untreated implants, 10units), Ti_Ag (silver electrodeposition treatment, 10units), and Ti_TSP (silanization treatment, 10units). Coated implants were characterized by scanning electron microscopy, interferometry and X-ray photoelectron spectroscopy. Two months after implant insertion, experimental peri-implantitis was initiated by ligature placement. Ligatures were removed 2months later, and plaque formation was allowed for 2 additional months. Clinical and radiographic analyses were performed during the study. Implant-tissue samples were prepared for micro computed tomography, backscattered scanning electron microscopy, histomorphometric and histological analyses and ion release measurements. X-ray, SEM and histology images showed that vertical bone resorption in treated implants was lower than in the control group (P<0.05). This effect is likely due to the capacity of the treatments to reduce bacteria colonization on the implant surface. Histological analysis suggested an increase of peri-implant bone formation on silanized implants. However, the short post-ligature period was not enough to detect differences in clinical parameters among implant groups. Within the limits of this study, antibacterial surface treatments have a positive effect against bone resorption induced by peri-implantitis.

Enhanced osteoblast adhesion on amino-functionalized titanium surfaces through combined plasma enhanced chemical vapor deposition (PECVD) method

A combined PECVD method has been developed to introduce amino-groups onto titanium implants for the better improvement of osseointegration.