Fit and forget: The future of dental implant therapy via nanotechnology

Unlike orthopedic implants, dental implants require the orchestration of both osseointegration at the bone-implant interface and soft-tissue integration at the transmucosal region in a complex oral micro-environment with ubiquitous pathogenic bacteria. This represents a very challenging environment for early acceptance and long-term survival of dental implants, especially in compromised patient conditions, including aged, smoking and diabetic patients. Enabling advanced local therapy from the surface of titanium-based dental implants via novel nano-engineering strategies is emerging. This includes anodized nano-engineered implants eluting growth factors, antibiotics, therapeutic nanoparticles and biopolymers to achieve maximum localized therapeutic action. An important criterion is balancing bioactivity enhancement and therapy (like bactericidal efficacy) without causing cytotoxicity. Critical research gaps still need to be addressed to enable the clinical translation of these therapeutic dental implants. This review informs the latest developments, challenges and future directions in this domain to enable the successful fabrication of clinically-translatable therapeutic dental implants that would allow for long-term success, even in compromised patient conditions.

Titanate nanotubes as an efficient oral detoxifying agent against drug overdose: application in rat acetaminophen poisoning

Voluntary drug intoxication is mainly due to drug overdose or the interaction of several drugs. Coma and its associated complications such as hypoventilation, aspiration pneumopathy, and heart rhythm disorders are the main hallmarks of drug intoxication. Conventional detoxification treatments, including gastric lavage or vomiting, administration of ipecac or activated charcoal (CH), and the use of antidotes, have proven to be inefficient and are generally associated with severe adverse effects. To overcome these limitations, titanate nanotubes (TiNTs) are proposed as an efficient emerging detoxifying agent because of their tubular shape and high adsorption capacity. In the present study, the detoxifying ability of TiNTs was evaluated on paracetamol (PR)-intoxicated rats. Results indicate that the loading ability of PR into TiNTs (70%) was significantly higher than that recorded for CH (38.6%). In simulated intestinal medium, TiNTs showed a controlled drug release of less than 10% after 72 h of incubation. In PR-intoxicated rats, TiNTs treatment resulted in a 64% decrease of PR after 4 h of poisoning versus 40% for CH. Concomitantly, TiNTs efficiently reduced PR absorption by 90% after 24 h of poisoning, attenuated the elevated levels of biochemical markers (i.e., alanine aminotransferase, aspartate aminotransferase, creatinine, and TNF-α) and mitigated oxidative stress by increasing the activity of superoxide dismutase and reducing the oxidized glutathione/total glutathione ratio, suggesting a histoprotective effect of TiNTs against paracetamol-induced toxicity in rats. In addition to their safety and high stability in the entire gastro-intestinal tract, biodistribution analysis revealed that TiNTs exhibited low intestinal absorption owing to their large cluster size of compact aggregate nanomaterials across the intestinal villi hindering the absorption of paracetamol. Collectively, these data provide a new and promising solution for in vivo detoxification. TiNTs are expected to have great potential for the treatment of voluntary and accidental intoxication in emergency care.

Controlled growth of titanium dioxide nanotubes for doxorubicin loading and studies of in vitro antitumor activity

Titanium dioxide (TiO₂) materials are suitable for use as drug carriers due to their natural biocompatibility and nontoxicity. The aim of the study presented in this paper was to investigate the controlled growth of TiO₂ nanotubes (TiO₂ NTs) of different sizes via an anodization method, in order to delineate whether the size of NTs governs their drug loading and release profile as well as their antitumor efficiency. TiO₂ NTs were tailored to sizes ranging from 25 nm to 200 nm according to the anodization voltage employed. The TiO₂ NTs obtained by this process were characterized using scanning electron microscopy, transmission electron microscopy, and dynamic light scattering The larger TiO₂ NTs exhibited greatly improved doxorubicin (DOX)-loading capacity (up to 37.5 wt%), which contributed to their outstanding cell-killing ability, as evidenced by their lower half-maximal inhibitory concentration (IC50). Comparisons were carried out of cellular uptake and intracellular release rates of DOX for large and small TiO₂ NTs loaded with DOX. The results showed that the larger TiO₂ NTs represent a promising therapeutic carrier for drug loading and controlled release, which could improve cancer treatment outcomes. Therefore, TiO₂ NTs of larger size are useful substances with drug-loading potency that may be used in a wide range of medical applications.

Flumequine-loaded titanate nanotubes as antibacterial agents for aquaculture farms

Flumequine (FLUM), a quinolone-derived antibiotic is one of the most prescribed drugs in aquaculture farms. However, its intensive use becomes worrisome because of its environmental risks and the emergence of FLUM-resistant bacteria. To overcome these problems we propose in this study the encapsulation and the delivery of FLUM by titanate nanotubes (TiNTs). Optimal FLUM loading was reached by suspending the dehydrated powder nanomaterials (FLUM : TiNTs ratio = 1 : 5) in ethanol. The drug entrapment efficiency was calculated to be 80% approximately with a sustained release in PBS at 37 °C up to 5 days. Then FLUM@TiNTs was evaluated for both its in vitro drug release and antimicrobial activity against Escherichia coli (E. coli). Spectacularly high antibacterial activity compared to those of free FLUM antibiotic was obtained confirming the efficiency of TiNTs to protect FLUM from rapid degradation and transformation within bacteria improving thereby its antibacterial effect. Indeed FLUM@TiNTs was efficient to decrease gradually the bacterial viability to reach ≈5% after 5 days versus ≈75% with free FLUM. Finally, the ex vivo permeation experiments on sea bass (Dicentrachus labrax) intestine shows that TiNTs act to increase the intestinal permeation of FLUM during the experiment. Indeed the encapsulated FLUM flux increased 12 fold (1.46 μg cm² h⁻¹) compared to the free antibiotic (0.18 μg cm² h⁻¹). Thanks to its physical properties (diameter 10 nm, tubular shape…) and its high stability in the simulated intestinal medium, TiNTs are easy internalized by enterocytes, thus involving an endocytosis mechanism, and then improve intestinal permeation of FLUM. Taken together, FLUM@TiNTs hold potential as an effective approach for enhancing the antimicrobial activity of FLUM and pave the way not only for future pharmacokinetic studies in the treatment and targeting of fish infections but also for instating of novel strategies that overcome the challenges associated with the abusive use of antibiotics in fish farming.

Flumequine (FLUM), a quinolone-derived antibiotic is one of the most prescribed drugs in aquaculture farms.

Analytical Techniques for the Characterization of Bioactive Coatings for Orthopaedic Implants

The development of bioactive coatings for orthopedic implants has been of great interest in recent years in order to achieve both early- and long-term osseointegration. Numerous bioactive materials have been investigated for this purpose, along with loading coatings with therapeutic agents (active compounds) that are released into the surrounding media in a controlled manner after surgery. This review initially focuses on the importance and usefulness of characterization techniques for bioactive coatings, allowing the detailed evaluation of coating properties and further improvements. Various advanced analytical techniques that have been used to characterize the structure, interactions, and morphology of the designed bioactive coatings are comprehensively described by means of time-of-flight secondary ion mass spectrometry (ToF-SIMS), X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FTIR), atomic force microscopy (AFM), scanning electron microscopy (SEM), transmission electron microscopy (TEM), 3D tomography, quartz crystal microbalance (QCM), coating adhesion, and contact angle (CA) measurements. Secondly, the design of controlled-release systems, the determination of drug release kinetics, and recent advances in drug release from bioactive coatings are addressed as the evaluation thereof is crucial for improving the synthesis parameters in designing optimal bioactive coatings.

Dental Implant Nano-Engineering: Advances, Limitations and Future Directions

Titanium (Ti) and its alloys offer favorable biocompatibility, mechanical properties and corrosion resistance, which makes them an ideal material choice for dental implants. However, the long-term success of Ti-based dental implants may be challenged due to implant-related infections and inadequate osseointegration. With the development of nanotechnology, nanoscale modifications and the application of nanomaterials have become key areas of focus for research on dental implants. Surface modifications and the use of various coatings, as well as the development of the controlled release of antibiotics or proteins, have improved the osseointegration and soft-tissue integration of dental implants, as well as their antibacterial and immunomodulatory functions. This review introduces recent nano-engineering technologies and materials used in topographical modifications and surface coatings of Ti-based dental implants. These advances are discussed and detailed, including an evaluation of the evidence of their biocompatibility, toxicity, antimicrobial activities and in-vivo performances. The comparison between these attempts at nano-engineering reveals that there are still research gaps that must be addressed towards their clinical translation. For instance, customized three-dimensional printing technology and stimuli-responsive, multi-functional and time-programmable implant surfaces holds great promise to advance this field. Furthermore, long-term in vivo studies under physiological conditions are required to ensure the clinical application of nanomaterial-modified dental implants.

Research to Clinics: Clinical Translation Considerations for Anodized Nano-Engineered Titanium Implants

Titania nanotubes (TNTs) fabricated on titanium orthopedic and dental implants have shown significant potential in "proof of concept" in vitro, ex vivo, and short-term in vivo studies. However, most studies do not focus on a clear direction for future research towards clinical translation, and there exists a knowledge gap in identifying key research challenges that must be addressed to progress to the clinical setting. This review focuses on such challenges with respect to anodized titanium implants modified with TNTs, including optimized fabrication on clinically utilized microrough surfaces, clinically relevant bioactivity assessments, and controlled/tailored local release of therapeutics. Further, long-term in vivo investigations in compromised animal models under loading conditions are needed. We also discuss and detail challenges and progress related to the mechanical stability of TNT-based implants, corrosion resistance/electrochemical stability, optimized cleaning/sterilization, packaging/aging, and nanotoxicity concerns. This extensive, clinical translation focused review of TNTs modified Ti implants aims to foster improved understanding of key research gaps and advances, informing future research in this domain.

Orchestrating soft tissue integration at the transmucosal region of titanium implants

Osseointegration at the bone-implant interface and soft tissue integration (STI) at the trans-mucosal region are crucial for the long-term success of dental implants, especially in compromised patient conditions. The STI quality of conventional smooth and bio-inert titanium-based implants is inferior to that of natural tissue (i.e. teeth), and hence various surface modifications have been suggested. This review article compares and contrasts the various modification strategies (physical, chemical and biological) utilized to enhance STI of Ti implants. It also details the STI challenges associated with conventional Ti-based implants, current surface modification strategies and cutting-edge nano-engineering solutions. The topographical, biological and therapeutic advances achievable via electrochemically anodized Ti implants with TiO₂ nanotubes/nanopores are highlighted. Finally, the status and future directions of such nano-engineered implants is discussed, with emphasis on bridging the gap between research and clinical translation.

Overview of Antibacterial Strategies of Dental Implant Materials for the Prevention of Peri-Implantitis

As dental implants have become one of the main treatment options for patients with tooth loss, the number of patients with peri-implant diseases has increased. Similar to periodontal diseases, peri-implant diseases have been associated with dental plaque formation on implants. Unconventional approaches have been reported to remove plaque from infected implants, but none of these methods can completely and permanently solve the problem of bacterial invasion. Fortunately, the constant development of antibacterial implant materials is a promising solution to this situation. In this review, the development and study of different antibacterial strategies for dental implant materials for the prevention of peri-implantitis are summarized. We hope that by highlighting the advantages and limitations of these antimicrobial strategies, we can assist in the continued development of oral implant materials.

Cyanocobalamin Ultraflexible Lipid Vesicles: Characterization and In Vitro Evaluation of Drug-Skin Depth Profiles

Atopic dermatitis (AD) and psoriasis are the most common chronic inflammatory skin disorders, which importantly affect the quality of life of patients who suffer them. Among other causes, nitric oxide has been reported as part of the triggering factors in the pathogenesis of both conditions. Cyanocobalamin (vitamin B₁₂) has shown efficacy as a nitric oxide scavenger and some clinical trials have given positive outcomes in its use for treating skin pathologies. Passive skin diffusion is possible only for drugs with low molecular weights and intermediate lipophilicity. Unfortunately, the molecular weight and hydrophilicity of vitamin B₁₂ do not predict its effective diffusion through the skin. The aim of this work was to design new lipid vesicles to encapsulate the vitamin B₁₂ to enhance its skin penetration. Nine prototypes of vesicles were generated and characterized in terms of size, polydispersity, surface charge, drug encapsulation, flexibility, and stability with positive results. Additionally, their ability to release the drug content in a controlled manner was demonstrated. Finally, we found that these lipid vesicle formulations facilitated the penetration of cyanocobalamin to the deeper layers of the skin. The present work shows a promising system to effectively administer vitamin B₁₂ topically, which could be of interest in the treatment of skin diseases such as AD and psoriasis.

Old is Gold: Electrolyte Aging Influences the Topography, Chemistry, and Bioactivity of Anodized TiO2 Nanopores

Titanium dioxide (TiO₂) nanostructures including nanopores and nanotubes have been fabricated on titanium (Ti)-based orthopedic/dental implants via electrochemical anodization (EA) to enable local drug release and enhanced bioactivity. EA using organic electrolytes such as ethylene glycol often requires aging (repeated anodization of nontarget Ti) to fabricate stable well-ordered nanotopographies. However, limited information is available with respect to its influence on topography, chemistry, mechanical stability, and bioactivity of the fabricated structures. In the current study, titania nanopores (TNPs) using a similar voltage/time were fabricated using different ages of electrolyte (fresh/0 h to 30 h aged). Current density vs time plots of EA, changes in the electrolyte (pH, conductivity, and Ti/F ion concentration), and topographical, chemical, and mechanical characteristics of the fabricated TNPs were compared. EA using 10-20 h electrolytes resulted in stable TNPs with uniform size and improved alignment (parallel to the underlying substrate microroughness). Additionally, to evaluate bioactivity, primary human gingival fibroblasts (hGFs) were cultured onto various TNPs in vitro. The findings confirmed that the proliferation and morphology of hGFs were enhanced on 10-20 h aged electrolyte anodized TNPs. This pioneering study systematically investigates the optimization of anodization electrolyte toward fabricating nanoporous implants with desirable characteristics.

Zn capped Al2O3 and TiO2 nanoporous arrays as pH sensitive drug delivery systems: a combined experimental and simulation study

pH sensitive nanotube arrays based on Zn capped Al₂O₃ and TiO₂ were reported for the release of vitamin C in an experimental/theoretical study using MD simulations.

Engineered titanium implants for localized drug delivery: recent advances and perspectives of Titania nanotubes arrays

INTRODUCTION

Therapeutics delivery to bones to treat skeletal diseases or prevent postsurgical infections is challenging due to complex and solid bone structure that limits blood supply and diffusion of therapeutics administered by systemic routes to reach effective concentration. Titanium (Ti) and their alloys are employed as mainstream implant materials in orthopedics and dentistry; having superior mechanical/biocompatibility properties which could provide an alternative solution to address this problem.

AREAS COVERED

This review presents an overview of recent development of Ti drug-releasing implants, with emphasis on nanoengineered Titania nanotubes (TNTs) structures, for solving key problems to improve implants osseointegration, overcome inflammation and infection together with providing localized drug delivery (LDD) for bone diseases including cancer. Critical analysis of the advantages/disadvantages of developed concepts is discussed, their drug loading/releasing performances and specific applications.

EXPERT OPINION

LDD to bones can address many disorders and postsurgical conditions such as inflammation, implants rejection and infection. To this end, TNTs-Ti implants represent a potential promise for the development of new generation of multifunctional implants with drug release functions. Even this concept is extensively explored recently, there is a strong need for more preclinical studies using animal models to confirm the long-term safety and stability of TNTs-Ti implants for real-life medical applications.

Temperature-Gating Titania Nanotubes Regulate Migration of Endothelial Cells

External stimuli-responsive biomaterials represent a type of promising candidates for addressing the complexity of biological systems. In this study, a platform based on the combination of temperature-sensitive polymers and a nanotube array was developed for loading sphingosine 1-phosphate (S1P) and regulating the migration of endothelial cells (ECs) at desired conditions. The localized release dosage of effectors could be controlled by the change of environmental temperature. At a culture temperature above the lower critical solution temperature, the polymer "gatekeeper" with a collapsed conformation allowed the release of S1P, which in turn enhanced the migration of ECs. The migration rate of single cells was significantly enhanced up to 58.5%, and the collective migration distance was also promoted to 25.1% at 24 h and 33.2% at 48 h. The cell morphology, focal adhesion, organization of cytoskeleton, and expression of genes and proteins related to migration were studied to unveil the intrinsic mechanisms. The cell mobility was regulated by the released S1P, which would bind with the S1PR1 receptor on the cell membrane and trigger the Rho GTPase pathway.

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.

A visible-light-controlled platform for prolonged drug release based on Ag-doped TiO2 nanotubes with a hydrophobic layer

In this work, a visible-light-controlled drug release platform was constructed for localized and prolonged drug release based on two-layer titania nanotubes (TNTs) fabricated using by an in situ voltage up-anodization process. The visible-light photocatalytic activity is improved by loading Ag onto the TNTs by NaBH4 reduction. Then, the TNTs containing Ag nanoparticles were modified with dodecanethiol (NDM) to create a hydrophobic layer. To demonstrate the visible-light-controlled drug release, the Zn2+ release behavior of the samples was investigated. In the initial 12 h, TNTs without NDM displayed a faster release rate with 29.4% Zn2+ release, which was more than three times that of the TNTs with NDM (8.7% Zn2+ release). Upon visible-light illumination, drug release from the sample coated with NDM was shown to increase due to the photocatalytic decomposition of NDM. The amount of released Zn2+ for this sample increased up to 71.9% within 12 h, indicating visible-light-controlled drug release. This drug release system may exhibit promising application as a localized, prolonged drug delivery platform.

Tailoring the immuno-responsiveness of anodized nano-engineered titanium implants

Owing to its biocompatibility and corrosion resistance, titanium is one of the most commonly used implantable biomaterials. Numerous in vitro and in vivo investigations have established that titanium surfaces with a nanoscale topography outperform conventional smooth or micro-rough surfaces in terms of achieving desirable bonding with bone (i.e. enhanced bioactivity). Among these nanoscale topographical modifications, ordered nanostructures fabricated via electrochemical anodization, especially titania nanotubes (TNTs), are particularly attractive. This is due to their ability to augment bioactivity, deliver drugs and the potential for easy/cost-effective translation into the current implant market. However, the potential of TNT-modified implants to modulate the host immune-inflammatory response, which is critical for achieving timely osseointegration, remains relatively unexplored. Such immunomodulatory effects may be achieved by modifying the physical and chemical properties of the TNTs. Furthermore, therapeutic/bioactive enhancements performed on these nano-engineered implants (such as antibacterial or osteogenic functions) are likely to illicit an immune response which needs to be appropriately controlled. The lack of sufficient in-depth studies with respect to immune cell responses to TNTs has created research gaps that must be addressed in order to facilitate the design of the next generation of immuno-modulatory titanium implants. This review article focuses on the chemical, topographical and mechanical features of TNT-modified implants that can be manipulated in order to achieve immuno-modulation, as well as providing an insight into how modulating the immune response can augment implant performance.

Methacrylate-Stitched β-Cyclodextrin Embedded with Nanogold/Nanotitania: A Skin Adhesive Device for Enhanced Transdermal Drug Delivery

Transdermal (TD) drug delivery is a more attractive technique for drug delivery compared to oral and intravenous injection. However, the permeation of drug molecules across the skin is difficult due to the presence of highly ordered lipid barrier. This study details the development of a novel TD system, which has the potential to simultaneously enhance the skin permeability and adhesion behavior. Ibuprofen (IP) was selected as model drug. The ability of gold nanoparticle (AuNP) and hydrophobic titanium nanotube (TNT) to enhance the skin permeability was explored. Additionally, β-cyclodextrin (βCD), which can exceptionally encapsulate poorly water-soluble drugs, is grafted with methacrylates to improve the skin adhesion property. Finally, Au-TNT nanocomposite was deposited onto methacrylate-grafted βCD matrix. The developed material was characterized through NMR spectroscopy, infrared spectroscopy, scanning electron microscopy, transmission electron microscopy, X-ray diffraction, and Raman spectroscopy. The characteristics of the film, including water vapor permeability (WVP), thermomechanical properties, etc., were examined in terms of Au-TNT content. The TD delivery of IP with different concentrations of Au-TNT was evaluated via an in vitro skin permeation study through rat skin. It is revealed that the prepared TD film exhibited an improved drug-delivery performance due to the synergistic action of AuNP and hydrophobic TNT. The cumulative percent of IP delivered across the skin is extremely depending on nanofiller content, lipophilicity, and thickness of the membrane, and the device incorporated with 4.0% Au-TNT displayed the best performance. In addition, a study on storage stability was performed by storing the films for 2 months at different temperatures. The study revealed that the device possessed excellent storage stability when stored at low temperature. The developed film offers excellent WVP, drug encapsulation efficiency, thermomechanical properties, and skin adhesion behavior. Moreover, the device was cosmetically attractive, noncytotoxic, and resistant to microbial growth and hence extremely reliable for skin application. The developed skin permeation strategy may open new avenues in TD drug delivery.

Enhancement in Sustained Release of Antimicrobial Peptide from Dual-Diameter-Structured TiO2 Nanotubes for Long-Lasting Antibacterial Activity and Cytocompatibility

Novel films on Ti-based orthopedic implants for localized antimicrobial delivery, which comprises dual-diameter TiO₂ nanotubes with the inner layers of compact and fluorine-free oxide tightly bonding to Ti, were formed by voltage-increased anodization with F^- sedimentation procedure. The nanotubes were closely aligned and structured with upper 35 and 70 nm diametric tubes as nanocaps, respectively, and the underlying 140 nm diametric tubes as nanoreservoirs. Followed by loading ponericin G1 (a kind of antimicrobial peptide (AMP)) into the dual-diameter nanotubes with vacuum-assisted physisorption, the resultant films were investigated for loading efficiency and release kinetics of AMP, antibacterial activity against Staphylococcus aureus, and osteoblastic compatibility, together with the AMP-loaded single-diameter (140 nm) nanotube film. The loaded films had no statistical difference in the loading efficiency of AMP and revealed burst release within 6 h followed by steady release of AMP in phosphate-buffered solution. At day 42, almost all of AMP was released from the single-diameter nanotube film. However, the dual-diameter nanotube films loaded with AMP still showed sustained release at least up to 60 days, and the sustained efficacy was enhanced with decreasing diameter of nanocaps. In the case of nominal AMP loading amount of 125 μg, the resultant 35 nm capped dual-diameter nanotube film exhibited significant short- and long-term (even for 49 days) antibacterial activity not only against planktonic bacteria, which is ascribed to the release-killing efficacy of AMP, but also against adhered bacteria, which is ascribed to the AMP-derived killing efficacy and the nanocaps-derived adhesion resistance. Moreover, this loaded film presented cytocompatibility comparative to that of Ti but higher than that of the other AMP-loaded films. Increasing the nominal loading amount of AMP to 200 μg improved antibacterial activity but gave rise to obvious cytotoxicity of the loaded films.

Dental implants modified with drug releasing titania nanotubes: therapeutic potential and developmental challenges

INTRODUCTION

The transmucosal nature of dental implants presents a unique therapeutic challenge, requiring not only rapid establishment and subsequent maintenance of osseointegration, but also the formation of resilient soft tissue integration. Key challenges in achieving long-term success are sub-optimal bone integration in compromised bone conditions and impaired trans-mucosal tissue integration in the presence of a persistent oral microbial biofilm. These challenges can be targeted by employing a drug-releasing implant modification such as TiO₂ nanotubes (TNTs), engineered on titanium surfaces via electrochemical anodization. Areas covered: This review focuses on applications of TNT-based dental implants towards achieving optimal therapeutic efficacy. Firstly, the functions of TNT implants will be explored in terms of their influence on osseointegration, soft tissue integration and immunomodulation. Secondly, the developmental challenges associated with such implants are reviewed including sterilization, stability and toxicity. Expert opinion: The potential of TNTs is yet to be fully explored in the context of the complex oral environment, including appropriate modulation of alveolar bone healing, immune-inflammatory processes, and soft tissue responses. Besides long-term in vivo assessment under masticatory loading conditions, investigating drug-release profiles in vivo and addressing various technical challenges are required to bridge the gap between research and clinical dentistry.

Titania nanotubes for orchestrating osteogenesis at the bone-implant interface

Titanium implants can fail due to inappropriate biomechanics at the bone-implant interface that leads to suboptimal osseointegration. Titania nanotubes (TNTs) fabricated on Ti implants by the electrochemical process have emerged as a promising modification strategy to facilitate osseointegration. TNTs enable augmentation of bone cell functions at the bone-implant interface and can be tailored to incorporate multiple functionalities including the loading of active biomolecules into the nanotubes to target anabolic processes in bone conditions such as osteoporotic fractures. Advanced functions can be introduced, including biopolymers, nanoparticles and electrical stimulation to release growth factors in a desired manner. This review describes the application of TNTs for enhancing osteogenesis at the bone-implant interface, as an alternative approach to systemic delivery of therapeutic agents.

Functionalization of Calcium Sulfate/Bioglass Scaffolds with Zinc Oxide Whisker

There are urgent demands for satisfactory antibacterial activity and mechanical properties of bone scaffolds. In this study, zinc oxide whisker (ZnOw) was introduced into calcium sulfate/bioglass scaffolds. Antimicrobial behavior was analyzed using Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). The results showed that the scaffolds presented a strong antibacterial activity after introducing ZnOw, due to the antibacterial factors released from the degradation of ZnO. Moreover, ZnOw was also found to have a distinct reinforcing effect on mechanical properties. This was ascribed to whisker pull-out, crack bridging, crack deflection, crack branching and other toughening mechanisms. In addition, the cell culture experiments showed that the scaffolds with ZnOw had a good biocompatibility.