Influence of Cu, Au and Ag on structural and surface properties of bioactive coatings based on titanium

Surface modifications and coatings to improve osseointegration and antimicrobial activity on titanium surfaces: A statistical review over the last decade

Background

Titanium (Ti) is commonly employed therapeutically in many medical sectors associated with bone healing because of its superior mechanical properties and capacity to osseointegrate in the host bone tissue. The titanium surfaces may now be functionalized to offer additional and potentially valuable features. This review article discusses many titanium implant surface modifications, emphasizing their biological significance and the challenges that each one mainly addresses. Before reviewing the genuine reason for titanium surface modification in implanted devices, we briefly explore the process of osseointegration, enhancement of antibacterial properties, biocompatibility, and the historical significance of titanium as an implantable material, and the significant challenges involved. The various physical and chemical alterations that could take place on Ti surfaces are next examined. The rest of our talk will focus on creating inorganic and organic coatings for implanted Ti devices. Finally, we present a synopsis of the surface modification strategies currently being evaluated in clinical settings.

Target

This systematic review aims to evaluate research on titanium implants with significant surface modifications, coatings, and antibacterial capabilities.

Methods

Following the PRISMA paradigm, we searched for three electronic databases (Web of Science, PubMed Central, and Google Scholar) using the keywords "titanium implants," "titanium surface modification," and "titanium osseointegration," and "titanium antibacterial activity."

Results

We identified 1,39,336 articles overall that were published between 2012 and 2021, and we then focused on 8917 articles that concentrated on a particular topic. Clear inclusion and exclusion criteria were used in a rigorous screening procedure. Articles that didn't meet certain requirements (were irrelevant, used incorrect techniques, had unsuitable data values, or were only brief letters or communications) were eliminated. Finally, 120 research publications in total are taken into account for this extensive systematic review.

Conclusion

The report summarises current information on titanium implants with significant surface modifications, antibacterial activity, and coatings. It also gives some strong recommendations for future study topics.

Near-infrared light-responsive copper-cerium bimetallic oxide nanozyme with antibacterial and antioxidant abilities for periodontitis therapy

Periodontitis, a chronic inflammatory disease of the supporting tissue around teeth, is triggered by periodontal pathogens. Clinical treatments face the problem of bacterial resistance and most therapies focus on a single function, lacking the multifunctional treatment of antibacterial, antioxidant, anti-inflammatory, and osteogenic properties. In our study, we developed a copper-cerium bimetallic oxide (CuCeOx) nanozyme with near-infrared (NIR) light responsiveness for the periodontitis therapy. Under the excitation of 808 nm NIR light, CuCeOx displayed excellent photodynamic and photothermal activities, efficiently generating reactive oxygen species (ROS) and heat. After the treatment of the CuCeOx/NIR system, the inhibition rate of Porphyromonas gingivalis (P. gingivalis), the main periodontitis pathogen, reached 98.69 ± 0.23 % in vitro. Without the NIR light irradiation, CuCeOx, acting as a nanozyme, exhibited enzyme-like activity in scavenging ROS, effectively alleviating the cellular oxidative stress. Furthermore, CuCeOx significantly mitigated the cellular inflammatory response induced by lipopolysaccharide (LPS) and promoted osteogenesis under the oxidative stress condition. Notably, the CuCeOx exhibited excellent blood compatibility (hemolysis < 5 %). The efficacy of the CuCeOx/NIR system in vivo was also investigated. H&E staining results demonstrated a significant reduction in periodontal tissue inflammation following treatment. Micro-CT analysis revealed that CuCeOx effectively inhibited the alveolar bone loss. Additionally, we found CuCeOx regulated the Nrf2/HO-1 signaling pathway both in vitro and in vivo. In conclusion, the multifunctional nanomaterial CuCeOx provides a promising strategy for the treatment of periodontitis.

Impact of carbon and platinum protective layers on EDS accuracy in FIB cross-sectional analysis of W/Hf/W thin-film multilayers

Achieving high-quality cross sections is essential for accurate analysis of multilayer coatings. One method of performing such cross sections is focused ion beam, where sample protection from ion damage in the form of protective layers applied by FEBID and FIBID methods is used. Due to the lack of comparative summaries of different layers applied by these methods, especially in the context of cross-sectional analysis and elemental analysis of the cross-section, it was decided to address the effect of the protective layer on the reliability of EDS analysis. This study compares the effectiveness of platinum and carbon protective layers in creating cross sections for W/Hf/W samples. The effect of protective layers on elemental mapping and elemental analysis accuracy was evaluated. This study highlights the importance of protective layer selection in providing reliable EDS analysis of cross sections.

Research progress on antibacterial activity of medical titanium alloy implant materials

Titanium and its alloys are the preferred materials for medical implants. However, easy infection is a fatal shortcoming of Ti implants. Fortunately, the ongoing development of antibacterial implant materials is a promising solution, and Ti alloys with antibacterial properties hold immense potential for medical applications. In this review, we briefly outline the mechanisms of bacterial colonization and biofilm formation on implants; discuss and classify the major antimicrobials currently in use and development, including inorganic and organic antimicrobials; and describe the important role of antimicrobials in the development of implant materials for clinical applications. Strategies and challenges related to improving the antimicrobial properties of implant materials as well as the prospects of antibacterial Ti alloys in the medical field are also discussed.

Ultraviolet Light-Based Micropattern Printing on Titanium Surfaces to Promote Early Osseointegration

Patterned interfaces are widely used for surface modification of biomaterials because of a morphological unit similar to that of native tissue. However, engineering fast and cost-effective high-resolution micropatterns directly onto titanium surfaces remains a grand challenge. Herein, a simply designed ultraviolet (UV) light-based micropattern printing to obtain geometrical patterns on implant interfaces is fabricated by utilizing customized photomasks and titanium dioxide (TiO2 ) nanorods as a photo-responsive platform. The technique manipulates the cytoskeleton of micropatterning cells on the surface of TiO2 nanorods. The linear pattern surface shows the elongated morphology and parallel linear arrangements of human mesenchymal stem cells (hMSCs), significantly enhancing their osteogenic differentiation. In addition to the upregulated expression of key osteo-specific function genes in vitro, the accelerated osseointegration between the implant and the host bone is obtained in vivo. Further investigation indicates that the developed linear pattern surface has an outstanding effect on the cytoskeletal system, and finally activates Yes-Associated Protein (YAP)-mediated mechanotransduction pathways, initiating hMSCs osteogenic differentiation. This study not only offers a microfabrication method that can be extended to fabricate various shape- and size-controlled micropatterns on titanium surfaces, but also provides insight into the surface structure design for enhanced bone regeneration.

Hydrogen Gas Sensing Properties of Mixed Copper-Titanium Oxide Thin Films

Hydrogen is an efficient source of clean and environmentally friendly energy. However, because it is explosive at concentrations higher than 4%, safety issues are a great concern. As its applications are extended, the need for the production of reliable monitoring systems is urgent. In this work, mixed copper-titanium oxide ((CuTi)Ox) thin films with various copper concentrations (0-100 at.%), deposited by magnetron sputtering and annealed at 473 K, were investigated as a prospective hydrogen gas sensing material. Scanning electron microscopy was applied to determine the morphology of the thin films. Their structure and chemical composition were investigated by X-ray diffraction and X-ray photoelectron spectroscopy, respectively. The prepared films were nanocrystalline mixtures of metallic copper, cuprous oxide, and titanium anatase in the bulk, whereas at the surface only cupric oxide was found. In comparison to the literature, the (CuTi)Ox thin films already showed a sensor response to hydrogen at a relatively low operating temperature of 473 K without using any extra catalyst. The best sensor response and sensitivity to hydrogen gas were found in the mixed copper-titanium oxides containing similar atomic concentrations of both metals, i.e., 41/59 and 56/44 of Cu/Ti. Most probably, this effect is related to their similar morphology and to the simultaneous presence of Cu and Cu₂O crystals in these mixed oxide films. In particular, the studies of surface oxidation state revealed that it was the same for all annealed films and consisted only of CuO. However, in view of their crystalline structure, they consisted of Cu and Cu₂O nanocrystals in the thin film volume.

Magnetron Sputtering of Transition Metals as an Alternative Production Means for Antibacterial Surfaces

In the light of the SARS-CoV-2 pandemic and growing numbers of bacteria with resistance to antibiotics, the development of antimicrobial coatings is rising worldwide. Inorganic coatings are attractive because of low environmental leakage and wear resistance. Examples for coatings are hot metal dipping or physical vapor deposition of nanometer coatings. Here, magnetron sputtering of various transition metals, such as gold, ruthenium and tantalum, was investigated. Metal films were characterized by scanning electron microscopy (SEM), atomic force microscopy (AFM) and energy dispersive X-ray spectroscopy (EDX). We investigated the growth of Pseudomonas aeruginosa isolated from household appliances on different sputter-coated metal surfaces. The fine-grained nanometric structure of these metal coatings was between 14 nm (tantalum) and 26 nm (gold) and the roughness was in a range of 164 pm (ruthenium) to 246 pm (gold). Antibacterial efficacy of metal surfaces followed the order: gold > tantalum > ruthenium. Interestingly, gold had the strongest inhibitory effect on bacterial growth, as analyzed by LIVE/DEAD and CFU assay. High-magnification SEM images showed dead bacteria characterized by shrinkage induced by metal coatings. We conclude that sputtering might be a new application for the development of antimicrobial surfaces on household appliances and or surgical instruments.

Thermal activation of Ti(1-x)Au(x) thin films with enhanced hardness and biocompatibility

The lifetime of orthopaedic implants can be extended by coating the softer Ti₆Al₄V alloy with harder biocompatible thin films. In this work, thin films of Ti_(1-x)Au_(x) are grown on Ti₆Al₄V and glass substrates by magnetron sputtering in the entire x = 0–1 range, before their key biomechanical properties are performance tuned by thermal activation. For the first time, we explore the effect of in-situ substrate heating versus ex-situ post-deposition heat-treatment, on development of mechanical and biocompatibility performance in Ti–Au films. A ∼250% increase in hardness is achieved for Ti–Au films compared to bulk Ti₆Al₄V and a ∼40% improvement from 8.8 GPa as-grown to 11.9 and 12.3 GPa with in-situ and ex-situ heat-treatment respectively, is corelated to changes in structural, morphological and chemical properties, providing insights into the origins of super-hardness in the Ti rich regions of these materials. X-ray diffraction reveals that as-grown films are in nanocrystalline states of Ti–Au intermetallic phases and thermal activation leads to emergence of mechanically hard Ti–Au intermetallics, with films prepared by in-situ substrate heating having enhanced crystalline quality. Surface morphology images show clear changes in grain size, shape and surface roughness following thermal activation, while elemental analysis reveals that in-situ substrate heating is better for development of oxide free Ti₃Au β-phases. All tested Ti–Au films are non-cytotoxic against L929 mouse fibroblast cells, while extremely low leached ion concentrations confirm their biocompatibility. With peak hardness performance tuned to >12 GPa and excellent biocompatibility, Ti–Au films have potential as a future coating technology for load bearing medical implants.

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Combined study on biocompatibility and mechanical performance of Ti–Au films.

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Reports on effect of varying of thermal activation on quality of Ti–Au film structure.

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Clear development of super-hard β-Ti₃Au phase with in-situ thermal activation.

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Peak hardness value > 12 GPa attained for Ti rich films with ex-situ thermal activation.

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All Ti–Au films highly biocompatible with safe cytotoxic profile against L929 cells.

Injectable hydrogel for postoperative synergistic photothermal-chemodynamic tumor and anti-infection therapy

Tumor surgery is usually accompanied by neoplasm residual, tissue defects, and multi-drug resistant bacterial infection, causing high tumor recurrence, low survival rate, and chronic wounds. Herein, a light-activated injectable hydrogel based on bioactive nanocomposite system is developed by incorporating Ag₂S nanodots conjugated Fe-doped bioactive glass nanoparticles (BGN-Fe-Ag₂S) into biodegradable PEGDA and AIPH solution for inhibiting tumor growth, treating bacterial infection, and promoting wound healing. Under laser irradiation, the photothermal effect mediated by Ag₂S nanodots would trigger the decomposition of AIPH, generating alkyl radicals to initiate the gelation of PEGDA. The in-situ gelatinized hydrogel, with outstanding photothermal effect and chemodynamic effect derived from the doped Fe in BGN-Fe-Ag₂S, can not only eliminate multidrug-resistant bacteria but also efficiently ablated tumor during treatment. Moreover, the hydrogel significantly accelerated wound healing with more skin appendages in the full-thickness cutaneous wounds model because of the hydrolysis of bioactive glass. These results manifest that this multifunctional hydrogel is a suitable biomaterial to inhibit tumor proliferation and overcome tissue bacterial infection after surgical removal of tumors.

Fabrication of Antibacterial Metal Surfaces Using Magnetron-Sputtering Method

One-hundred-nanometer films consisting of silver, copper, and gold nanocrystallites were prepared, and their antibacterial properties were quantitatively measured. The magnetron-sputtering method was used for the preparation of the metallic films over the glass plate. Single- and double-layer films were manufactured. The films were thoroughly characterized with the XRD, SEM, EDS, and XPS methods. The antibacterial activity of the samples was investigated. Gram-negative Escherichia coli, strain K12 ATCC 25922 (E. coli), and Gram-positive Staphylococcus epidermidis, ATCC 49461 (S. epidermidis), were used in the microbial tests. The crystallite size was about 30 nm in the cases of silver and gold and a few nanometers in the case of copper. Significant oxidation of the copper films was proven. The antibacterial efficacy of the tested samples followed the order: Ag/Cu > Au/Cu > Cu. It was concluded that such metallic surfaces may be applied as contact-killing materials for a more effective fight against bacteria and viruses.

Antibacterial metals and alloys for potential biomedical implants

Metals and alloys, including stainless steel, titanium and its alloys, cobalt alloys, and other metals and alloys have been widely used clinically as implant materials, but implant-related infection or inflammation is still one of the main causes of implantation failure. The bacterial infection or inflammation that seriously threatens human health has already become a worldwide complaint. Antibacterial metals and alloys recently have attracted wide attention for their long-term stable antibacterial ability, good mechanical properties and good biocompatibility in vitro and in vivo. In this review, common antibacterial alloying elements, antibacterial standards and testing methods were introduced. Recent developments in the design and manufacturing of antibacterial metal alloys containing various antibacterial agents were described in detail, including antibacterial stainless steel, antibacterial titanium alloy, antibacterial zinc and alloy, antibacterial magnesium and alloy, antibacterial cobalt alloy, and other antibacterial metals and alloys. Researches on the antibacterial properties, mechanical properties, corrosion resistance and biocompatibility of antibacterial metals and alloys have been summarized in detail for the first time. It is hoped that this review could help researchers understand the development of antibacterial alloys in a timely manner, thereby could promote the development of antibacterial metal alloys and the clinical application.

A Simple Cerium Coating Strategy for Titanium Oxide Nano-tubes' Bioactivity Enhancement

Despite the well-known favorable chemical and mechanical properties of titanium-based materials for orthopedic and dental applications, poor osseointegration of the implants, bacteria adhesion, and excessive inflammatory response from the host remain major problems to be solved. Here, the antioxidant and anti-inflammatory enzyme-like abilities of ceria (CeO_x) were coupled to the advantageous features of titanium nanotubes (TiNTs). Cost-effective and fast methods, such as electrochemical anodization and drop casting, were used to build active surfaces with enhanced bioactivity. Surface composition, electrochemical response, and in vitro ability to induce hydroxyapatite (HA) precipitation were evaluated. The amount of cerium in the coating did not significantly affect wettability, yet a growing ability to induce early HA precipitation from simulated body fluid (SBF) was observed as the oxide content at the surface increased. The presence of 4%wt CeO_x was also able to stimulate rapid HA maturation in a (poorly) crystalline form, indicating an interesting potential to induce rapid in vivo osseointegration process.

Synthesis of bioactive glass-based coating by plasma electrolytic oxidation: Untangling a new deposition pathway toward titanium implant surfaces

HYPOTHESIS

Although bioactive glass (BG) particle coatings were previously developed by different methods, poor particle adhesion to surfaces and reduced biological effects because of glass crystallization have limited their biomedical applications. To overcome this problem, we have untangled, for the first time, plasma electrolytic oxidation (PEO) as a new pathway for the synthesis of bioactive glass-based coating (PEO-BG) on titanium (Ti) materials.

EXPERIMENTS

Electrolyte solution with bioactive elements (Na₂SiO₃-5H₂O, C₄H₆O₄Ca, NaNO₃, and C₃H₇Na₂O₆P) was used as a precursor source to obtain a 45S5 bioglass-like composition on a Ti surface by PEO. Subsequently, the PEO-BG coating was investigated with respect to its surface, mechanical, tribological, electrochemical, microbiological, and biological properties, compared with those of machined and sandblasted/acid-etched control surfaces.

FINDINGS

PEO treatment produced a coating with complex surface topography, Ti crystalline phases, superhydrophilic status, chemical composition, and oxide layer similar to that of 45S5-BG (~45.0Si, 24.5 Ca, 24.5Na, 6.0P w/v%). PEO-BG enhanced Ti mechanical and tribological properties with higher corrosion resistance. Furthermore, PEO-BG had a positive influence in polymicrobial biofilms, by reducing pathogenic bacterial associated with biofilm-related infections. PEO-BG also showed higher adsorption of blood plasma proteins without cytotoxic effects on human cells, and thus may be considered a promising biocompatible approach for biomedical implants.

Silver-based antibacterial strategies for healthcare-associated infections: Processes, challenges, and regulations. An integrated review

Healthcare-associated infections (HCAIs) are a major cause of morbidity and mortality worldwide. One of the main routes of transmission is by contact with contaminated surfaces, where nosocomial pathogens form sessile communities called biofilms. When forming biofilms, these pathogens are extremely resistant to antibiotics and standard cleaning procedures. In this regard, in order to eliminate the extent of biofilm formation on these surfaces, intensive efforts have been deployed, particularly in recent years, to develop new antibacterial surfaces containing silver or silver compounds, which can be used to prevent the formation of biofilm. In this review, recent developments in the design and manufacturing of silver-based antibacterial surfaces are described in detail. Up-to-date toxicity and governmental regulations are then extensively presented. Finally, based on current research in this promising field, the main challenges and perspectives for their effective implementation are discussed.

Engineering High-Resolution Micropatterns Directly onto Titanium with Optimized Contact Guidance to Promote Osteogenic Differentiation and Bone Regeneration

Topographical cues play an important role in directing cell behavior, and thus, extensive research efforts have been devoted to fabrication of surface patterns and exploring the contact guidance effect. However, engineering high-resolution micropatterns directly onto metallic implants remains a grand challenge. Moreover, there still lacks evidence that allows translation of in vitro screening to in vivo tissue response. Herein, we demonstrate a fast, cost-effective, and feasible approach to the precise fabrication of shape- and size-controlled micropatterns on titanium substrates using a combination of photolithography and inductively coupled plasma-based dry etching. A titanium TopoChip containing 34 microgrooved patterns with varying geometry parameters and a flat surface as the control was designed for a high-throughput in vitro study of the contact guidance of osteoblasts. The correlation between the surface pattern dimensions, cell morphological characteristics, proliferation, and osteogenic marker expression was systematically investigated in vitro. Furthermore, the surface with the highest osteogenic potential in vitro along with representative controls was evaluated in rat cranial defect models. The results show that microgrooved pattern parameters have almost no effect on osteoblast proliferation but significantly regulate the cell morphology, orientation, focal adhesion (FA) formation, and osteogenic differentiation in vitro. In particular, a specific groove pattern with a ridge width of 3 μm, groove width of 7 μm, and depth of 2 μm can most effectively align the cells through regulating the distribution of FAs, resulting in an anisotropic actin cytoskeleton, and thereby promoting osteogenic differentiation. In vivo, microcomputed tomography and histological analyses show that the optimized pattern can apparently stimulate new bone formation. This study not only offers a microfabrication method that can be extended to fabricate various shape- and size-controlled micropatterns on titanium alloys but also provides insight into the surface structure design of orthopedic and dental implants for enhanced bone regeneration.

Effect of heat treatment on the bio-corrosion properties and wear resistance of antibacterial Co-29Cr-6Mo-xCu alloys

Co-Cr-Mo alloys have been widely used in hip implants due to their good corrosion resistance and good wear resistance. However, complaint is still raising due to infection and inflammation. The addition of Cu has been proven to be an effective way to develop a new kind of Co-based alloy with good antibacterial properties. In this paper, the effect of heat treatment on the corrosion property, the tribology property and the antibacterial property of Cu containing Co-based alloys were investigated in detail. The microstructure observation showed that the as-cast alloys mainly consisted of a dendritic matrix with carbide dispersion at grain boundaries and a fine Cu-rich phase in the matrix and at the carbide/matrix interface. The carbide precipitates and the distribution of Cu phases affected significantly the friction coefficient and wear resistance of Co-xCu alloy. Annealing at 1060 °C/24 h promoted the precipitation of carbide and in turn increased the hardness and wear resistance markedly. Heat treatments, including annealing, solid solution and ageing treatment, enhanced the corrosion resistance of Co-xCu alloy without reduction in antibacterial properties. However, the addition of Cu increased the corrosion resistance and antibacterial properties but reduced the wear resistance especially at high Cu content.

Cu@Au(Ag)/Pt nanocomposite as peroxidase mimic and application of Cu@Au/Pt in colorimetric detection of glucose and l-cysteine

Nanomaterial-based artificial peroxidase has attracted extensive interests due to their distinct advantages over natural counterpart. Cu@Au/Pt and Cu@Ag/Pt nanocomposite with rambutan-like structure were prepared and discovered to function like peroxidase, which was illustrated by catalyzing the oxidation reaction of 3,3′,5,5′-tetramethylbenzidine (TMB) accompanied with a blue color change. Steady-state investigation indicates that the catalytic kinetics of Cu@Au/Pt and Cu@Ag/Pt all followed typical Michaelis–Menten behaviors and Cu@Au/Pt showed a strong affinity for H₂O₂, while Cu@Ag/Pt showed strong affinity for TMB. The color change and absorbance intensity strongly depend on the concentration of H₂O₂, thus the direct determination of H₂O₂ and indirect detection of glucose were demonstrated using Cu@Au/Pt with a detection limit of 1.5 μM and 6 μM, respectively. What is more important, the method was applied for detection of glucose in 50% fetal bovine serum with a detection limit of 80 μM, which is much lower than the lowest glucose content in blood for diabetes (7 mM). Moreover, the Cu@Au/Pt nanocomposite were also successfully applied for sensing l-cysteine because of the inhibition effect. Considering the good peroxidase-like activity and novel structure, Cu@Au(Ag)/Pt is expected to have a wide range of applications in bioassays and biocatalysis.

Cu@Au(Ag)/Pt nanocomposite possess good peroxidase-like activity and can be used for detection of glucose and l-cysteine.

A critical review of multifunctional titanium surfaces: New frontiers for improving osseointegration and host response, avoiding bacteria contamination

Evolution of metal implants progressively shifted the focus from adequate mechanical strength to improved biocompatibility and absence of toxicity and, finally, to fast osseointegration. Recently, new frontiers and challenges of Ti implants have been addressed to improvement of bioactivity, fighting of bacterial infection and biofilm formation, as well as modulation of inflammation. This is closely related to the clinical demand of multifunctional implants able to simultaneously have a number of specific responses with respect to body fluids, cells (osteoblasts, fibroblasts, macrophages) and pathogenic agents (bacteria, viruses). This complex system of multiple biological stimuli and surface responses is a major arena of the current research on biomaterials and biosurfaces. This review covers the strategies explored to this purpose since 2010 in the case of Ti and Ti alloys, considering that the number of related papers doubled about in the last seven years and no review has comprehensively covered this engaging research area yet. The different approaches followed for producing multifunctional Ti-based surfaces involve the use of thick and thin inorganic coatings, chemical surface treatments, and functionalization strategies coupled with organic coatings.

STATEMENT OF SIGNIFICANCE

According to the clinical demand of multifunctional implants able to simultaneously have a number of specific responses with respect to body fluids, cells and pathogenic agents, new frontiers of Ti implants have been addressed to improvement of bioactivity, fighting of bacterial infection and biofilm formation, as well as modulation of inflammation. Literature since 2010 is here reviewed. Several strategies for getting bioactive and antibacterial actions on Ti surfaces have been suggested, but they still need to be optimized with respect to several concerns. A further step will be to combine on the same surface a proven ability of modulation of inflammatory response. The achievement of multifunctional surfaces able to modulate inflammation and to promote osteogenesis is a grand challenge.

Silver bullets: A new lustre on an old antimicrobial agent

Silver was widely used in medicine to treat bacterial infections in the 19th and early 20th century, up until the discovery and development of the first modern antibiotics in the 1940s, which were markedly more effective. Since then, every new antibiotic introduced to the clinic has led to an associated development of drug resistance. Today, the threat of extensive bacterial resistance to antibiotics has reignited interest in alternative strategies to treat infectious diseases, with silver regaining well-deserved renewed attention. Silver ions are highly disruptive to bacterial integrity and biochemical function, with comparatively minimal toxicity to mammalian cells. This review focuses on the antimicrobial properties of silver and their use in synergistic combination therapy with traditional antibiotic drugs.