Postoperative Infections After Dental Implant Placement: Prevalence, Clinical Features, and Treatment

Anti-adherence capacity of phytosphingosine on titanium surfaces

Firm soft tissue attachment on oral implant components together with good bacterial control are important prerequisites for uneventful implant healing. TiO2 coatings have been shown to enhance human gingival fibroblast attachment, but the coating does not have antimicrobial properties. Phytosphingosine (PHS) is known to have antifouling properties against the cariogenic bacterium Streptococcus mutans (S. mutans) which is also among the first colonizers on implant surfaces. This makes PHS an interesting agent to prevent microbial adhesion on dental implant surfaces. The aim of this study was to examine the impact of PHS on S. mutans and human gingival fibroblast adhesion on titanium surfaces with or without TiO2 -coating. Titanium discs (n = 99, diameter 14 mm, thickness 1 mm) were fabricated for the study. The discs were divided into four groups: (1) non-coated discs (NC), (2) titanium discs with hydrothermally induced TiO2 coatings (HT), (3) NC discs treated with PHS solution and (4) HT discs treated with PHS solution. Hydrophilicity of the discs was evaluated by water contact angle measurement. S. mutans was added on HT and NC discs with or without PHS treatment for 30 minutes and the number of attached bacteria was estimated by plate counting method. For fibroblast experiment, the cells were plated on the discs and the number of adhered fibroblasts was determined at three time points (1, 3, 6 h). Additionally, confocal microscope images were obtained to examine fibroblast and S. mutans adhesion and to evaluate cell spreading. PHS treatment significantly decreased the hydrophilicity of HT and NC titanium surfaces (p < .001). S. mutans adhesion was significantly reduced after PHS treatment on both NC (p < .001) and HT surfaces (p < .001). Fibroblast adhesion was significantly reduced in HT group at 1 and 3h time points (p < .001), situation leveling out by the 6th hour. PHS reduced the number of adhered fibroblasts to the surface at incubation times of 1 hours (p = .0011) and 3 hours (p = .0194). At the 6 hour time point the number of adhered cells was no longer reduced, but still a reduction in cell spreading on the surface was observed (p < .05). The adhesion differences were present only in HT group. The PHS treatment reduced adherence of S. mutans and fibroblasts on TiO2 coated titanium, which may result from reduced hydrophilicity of the surfaces. The dual approach of PHS treatment and TiO2 coating could provide microbial antifouling properties of dental implants but may also affect fibroblast adhesion.

Injectable bioactive scaffold able to stimulate oral bone regeneration on demand

Bone regeneration in oral surgery remains a challenge, due to the features of the oral environment, characterized by the presence of saliva and extensive interaction with external pathogens. Recent advances in this field highlighted that biomimetic apatites in which Ca2+ is replaced by Fe2+/Fe3+ ions are promising candidates to guide bone regeneration with on demand activation control. In this study the Fe-doped apatite nanoparticles (FeHA) were developed and compared with magnetite nanoparticles, as new magnetic bio-activator, to be embedded in apatitic injectable paste/cement. Upon self-hardening, the new injectable cement generates a mechanically competent 3D superparamagnetic scaffold, endowed with remote activation by using static magnetic fields. We investigated the alkaline phosphatase expression and activity, as well as the behaviour of cells, when seeded onto the scaffold. The results show the ability of the cement to stimulate cell colonization and differentiation and how, when magnetized, they can further boost such phenomena. The proposed devices, in association with a magnetic aligner, can represent a new approach in oral surgery, able to tune the bone remodelling on demand, when the regenerative potential is impaired by physiological conditions such as aging or chronic diseases.

Structure Protects Function: A Multilevel Engineered Surface Modification Renders the Surface of Titanium Dental Implants Resistant to Bacterial Colonization

The global dental implant market is projected to reach $9.5 billion by 2032, growing at a 6.5% compound annual growth rate due to the rising prevalence of dental diseases. Importantly, this growth raises concerns about postoperative infections, which present significant challenges within our healthcare system and lead to a two-thirds failure rate for infected implants. In this study, we present an innovative multilevel coating system that makes the surface of dental titanium implants resistant to bacterial colonization, thereby minimizing the risk of infection development. This multilevel coating features a nanometer-thick biohybrid coating layer combined with a microgroove surface microstructuring, creating physical barriers that enhance the stability of the biohybrids against mechanical abrasion. Our coating demonstrates excellent biocompatibility and strong antifouling properties against undiluted blood plasma proteins. Furthermore, the combination of surface microstructuring and the biohybrid coating remains stable under prolonged mechanical stress simulation and effectively repels clinically relevant bacteria, achieving a 99% reduction in bacterial colonization on the implant. These findings underscore the potential of this approach to prevent implant-associated infections and highlight the critical role of surface engineering in ensuring long-term implant performance.

Antibiotic prophylaxis in oral implant surgery in Germany: a cross-sectional study

PURPOSE

Prophylactic antibiotics are used in dental implants to reduce infection risk and implant failure, especially benefiting patients with risk factors. However, evidence suggests that using clindamycin or extending antibiotics postoperatively has an unfavorable risk-benefit ratio.

METHODS

This national cross-sectional study analyzed antibiotic prophylaxis during implant insertion across Germany. Dentists from the German Society for Oral Implantology (DGOI) provided demographic information and data on the next 10 consecutive implant patients, including age, sex, risk factors, type of implantation, and antibiotic details.

RESULTS

103 dentists participated, providing data on 1040 patients. Most dentists were male and aged 30-64. Patients were evenly split between genders, with an average age of 51 years. Antibiotics were administered in 87.6% of all cases, more frequently for patients undergoing bone augmentation (OR 7.01, p < 0.0001), immediate (OR 3.11, p = 0.002) or delayed (OR 5.30, p < 0.0001) implant insertion, and those with cardiovascular disease (OR 3.24, p = 0.009). 74.8% of implantologists tended to use antibiotic prophylaxis routinely, while the remaining implantologists decided on a case-by-case basis. Implantologists primarily used aminopenicillins for 63.8% of prescriptions and clindamycin for the remaining 35.6%. Additionally, 78.8% of patients with prophylaxis received postoperative, multi-day treatments.

CONCLUSIONS

The study reveals extensive antibiotic use for perioperative prophylaxis in implant surgery, often not justified by current recommendations, particularly concerning the choice of antibiotic (e.g., clindamycin) and duration (e.g., postoperative use). Specialized clinical guidelines and targeted training for dentists on antibiotic prophylaxis are needed.

Calcium‐dependent antimicrobials: Nature‐inspired materials and designs

Bacterial infection remains a major complication answering for the failures of various implantable medical devices. Tremendous extraordinary advances have been published in the design and synthesis of antimicrobial materials addressing this issue; however, the clinical translation has largely been blocked due to the challenge of balancing the efficacy and safety of these materials. Here, calcium's biochemical features, natural roles in pathogens and the immune systems, and advanced uses in infection medications are illuminated, showing calcium is a promising target for developing implantable devices with less infection tendency. The paper gives a historical overview of biomedical uses of calcium and summarizes calcium's merits in coordination, hydration, ionization, and stereochemistry for acting as a structural former or trigger in biological systems. It focuses on the involvement of calcium in pathogens' integrity, motility, and metabolism maintenance, outlining the potential antimicrobial targets for calcium. It addresses calcium's uses in the immune systems that the authors can learn from for antimicrobial synthesis. Additionally, the advances in calcium's uses in infection medications are highlighted to sketch the future directions for developing implantable antimicrobial materials. In conclusion, calcium is at the nexus of antimicrobial defense, and future works on taking advantage of calcium in antimicrobial developments are promising in clinical translation.

Bioactive coating provides antimicrobial protection through immunomodulation and phage therapeutics

Medical implant-associated infections (IAI) is a growing threat to patients undergoing implantation surgery. IAI prevention typically relies on medical implants endowed with bactericidal properties achieved through surface modifications with antibiotics. However, the clinical efficacy of this traditional paradigm remains suboptimal, often necessitating revision surgery and posing potentially lethal consequences for patients. To bolster the existing anti-IAI arsenal, we propose herein a chitosan-based bioactive coating, i.e., ChitoAntibac, which exerts bacteria-inhibitory effects either through immune modulation or phage-directed microbial clearance, without relying on conventional antibiotics. The immuno-stimulating effects and phage-induced bactericidal properties can be tailored by engineering the loading dynamic of macrophage migration inhibitory factor (MIF), which polarizes macrophages towards the proinflammatory subtype (M1) with enhanced bacterial phagocytosis, and Staphylococcal Phage K, resulting in rapid and targeted pathogenic clearance (>99.99%) in less than 8 h. Our innovative antibacterial coating opens a new avenue in the pursuit of effective IAI prevention through immuno-stimulation and phage therapeutics.

Enhancement of in vitro antibacterial activity and bioactivity of iodine-loaded titanium by micro-scale regulation using mixed-acid treatment

Postoperative infection and subsequent device loss are serious complications in the use of titanium dental implants and plates for jawbone reconstruction. We have previously reported that NaOH-CaCl2 -thermal-ICl3 -treated titanium (NaCaThIo) has a nano-scale surface and exhibits antibacterial activity against Staphylococcus aureus. The present study examined the surface properties of mixed-acid treated and then iodine-treated titanium (MA-NaCaThIo), and evaluated oral antibacterial activity and cytotoxicity compared with the results obtained with NaCaThIo. MA-NaCaThIo formed a surface layer with a nano-scale network structure having microscale irregularities, and both the thickness of the surface layer (1.49 ± 0.16 μm) and the average surface roughness (0.35 ± 0.03 μm) were significantly higher than those of NaCaThIo. Furthermore, MA-NaCaThIo maintained high hydrophilicity with a contact angle of 7.5 ± 1.7° even after 4 weeks, as well as improved apatite formation, iodine ion release, and antibacterial activity against Prevotella intermedia compared to NaCaThIo. Cell culture test revealed that MA-NaCaThIo exhibited no cytotoxicity against MG-63 and Vero cells, while increased cell proliferation, ALP activity and mineralization of MG-63 compared to NaCaThIo. This treated titanium is expected to be useful for the development of next-generation titanium devices having both bone-bonding and antibacterial properties.

Effects of the application of low-temperature atmospheric plasma on titanium implants on wound healing in peri-implant connective tissue in rats

PURPOSE

This study aimed to clarify the effects of surface modification of titanium (Ti) implants by low-temperature atmospheric pressure plasma treatment on wound healing and cell attachment for biological sealing in peri-implant soft tissue.

METHODS

Hydrophilization to a Ti disk using a handheld low-temperature atmospheric pressure plasma device was evaluated by a contact angle test and compared with an untreated group. In in vivo experiments, plasma-treated pure Ti implants using a handheld plasma device (experimental group: PL) and untreated implants (control group: Cont) were placed into the rat upper molar socket, and samples were harvested at 3, 7 and 14 days after surgery. Histological evaluation was performed to assess biological sealing, collagen- and cell adhesion-related gene expression by reverse transcription quantitative polymerase chain reaction, collagen fiber detection by Picrosirius Red staining, and immunohistochemistry for integrins.

RESULTS

In in vivo experiments, increased width of the peri-implant connective tissue (PICT) and suppression of epithelial down growth was observed in PL compared with Cont. In addition, high gene expression of types I and XII collagen at 7 days and acceleration of collagen maturation was recognized in PL. Strong immunoreaction of integrin α2, α5, and β1 was observed at the implant contact area of PICT in PL.

CONCLUSIONS

The handheld low-temperature atmospheric pressure plasma device provided hydrophilicity on the Ti surface and maintained the width of the contact area of PICT to the implant surface as a result of accelerated collagen maturation and fibroblast adhesion, compared to no plasma application.

Etiology, pathology, and host-impaired immunity in medical implant-associated infections

Host impaired immunity and pathogens adhesion factors are the key elements in analyzing medical implant-associated infections (MIAI). The infection chances are further influenced by surface properties of implants. This review addresses the medical implant-associated pathogens and summarizes the etiology, pathology, and host-impaired immunity in MIAI. Several bacterial and fungal pathogens have been isolated from MIAI; together, they form cross-kingdom species biofilms and support each other in different ways. The adhesion factors initiate the pathogen's adherence on the implant's surface; however, implant-induced impaired immunity promotes the pathogen's colonization and biofilm formation. Depending on the implant's surface properties, immune cell functions get slow or get exaggerated and cause immunity-induced secondary complications resulting in resistant depression and immuno-incompetent fibro-inflammatory zone that compromise implant's performance. Such consequences lead to the unavoidable and straightforward conclusion for the downstream transformation of new ideas, such as the development of multifunctional implant coatings.

Efficacy and safety of using antibiotics to prevent post-operative complications in oral implant treatment: evidence-based review

AIMS

To identify and critically appraise available evidence on the efficacy and safety of antibiotics in preventing complications following oral implant placement treatment.

METHODS

An electronic search was performed using PubMed, Ovid MEDLINE and Cochrane Library databases up to July/21 for the purpose of answering the research question: In[healthy adults treated with dental implants]the use of[different antibiotics before or immediately after treatment]in comparison to[treatment without antibiotics]is safe and effective in terms of[infection, pain, swelling, wound dehiscence, soft tissue healing, early/late implant failure]? Following the Best Evidence Topic methodology, the included studies were categorised based on the Oxford Centre for Evidence-Based Medicine (OCEBM) ratings. The critical appraisal skills programme CASP checklist was used for the methodological analysis. The risk of bias assessment was performed according to the Cochrane Methodology for Systematic Reviews of Interventions.

RESULTS

26 of the 245 initially identified articles met our inclusion criteria for analysis after applying rigorous filters. The included human studies demonstrated significant methodological heterogeneity, precluding meta-analysis. These studies spanned evidence levels II to IV, as per OCEBM 2011 classifications, with the United States contributing the most studies (19.2%, n = 5), all at level III. The United Kingdom and Spain followed with three studies each (11.5% each), two from the UK and one from Spain classified at level II. Most studies had less than 1 year of follow-up (21%). Our analysis included 26 studies, with 38 antibiotic patient groups totalling 7459 patients. Amoxicillin was the predominant antibiotic, with various dosage regimens. Complications were observed in studies across different amoxicillin regimens at a cumulative incidence of 5%.

CONCLUSION

The evidence on antibiotics to prevent implant failure presents uncertain and heterogeneous findings. High-risk bias and underpowered studies were prevalent. Future research should prioritise multicentre, double-blinded RCTs with larger samples and longer follow-ups. Structured methodologies, antibiotic stewardship, and adherence to guidelines are needed. Amoxicillin (2 g) was commonly prescribed, but guidelines recommend 3 g, which results in relatively low complications yet there is limited evidence to support it. Clindamycin was favoured for penicillin allergies, but caution is advised due to potential implant failure risk. Consistent use of antiseptic mouthwash was observed. Future research should explore alternatives to antibiotics and antibiotic stewardship. Establishing a well-funded research consortium could yield conclusive results for clinical practice.

Analyzing the Causes and Frequency of Early Dental Implant Failure among Iranians: An Epidemiological Study

Aim

The rate of early dental implant failure (DIF) has increased in recent years, though the risk factors associated with this primary failure remain unclear. This study aimed to determine the rate of early implant failure and identify contributing factors. It was conducted from March 2018 to 2020 in Mashhad, Iran.

Method

This observational study examined the records of 983 implants from the Implant Department of Mashhad Dental School. Variables considered included age, gender, systemic diseases, smoking habits, implant type and size, and surgery-related factors. Data were analyzed using Chi-square, Mann-Whitney U, and Fisher exact tests in SPSS V22, with a p-value of 0.05 or less considered statistically significant.

Result

Of the 983 implants, 42 (4.3%) experienced early failure. The study population consisted of 555 (56.5%) females and 428 (43.5%) males, with an average age of 49.34 ± 13.67 years. A significant correlation was found between surgical complications (e.g., fracture of implant fixtures and inferior alveolar nerve exposure) and implant loading time (Yes or No) with early DIF (p=0.05 and p < 0.01, respectively). However, no significant correlation was observed between early failure and factors such as age, gender, smoking habits, systemic diseases, implant dimensions, or manufacturer.

Conclusion

Surgical complications and loading time may be the most critical factors contributing to early implant failure. Therefore, we suggest dentists pay attention to the mentioned factors in the surgical protocols and their relationship. Further prospective studies on risk factors that could affect early implant failure are needed.

Efficacy of pure beta tricalcium phosphate graft in dentoalveolar surgery: a retrospective evaluation based on serial radiographic images

BACKGROUND

The use of beta-tricalcium phosphate (beta-TCP) in dental surgery is limited owing to its rapid absorption compared to mixed formulations of hydroxyapatite. However, newly developed pure beta-TCP crystals have demonstrated slow absorption; hence, they last longer within the defect and act as a scaffold until new bone formation. The oral environment is unique and can prove unfavorable for bone grafts due to the high infection rate in the oral cavity and the fragile condition of the oral mucosa. The aim of this study was to evaluate the feasibility of using pure beta-TCP bone grafts in various dental treatments.

METHODS

Panoramic X-ray images of 25 patients who underwent bone grafting during dental surgery were analyzed. A specially treated pure beta-TCP crystal, Neo Bone® (Neo Bone®, SN Biologics Co., Ltd, Seoul, Korea), was used in this study. The bone density at the graft site was compared with that of the surrounding bone using the ImageJ software (Wayne Rasband, NIH USA).

RESULTS

Six months after surgery, the bone graft density was similar to that of the surrounding bone in 20 patients and increased in 5 patients. No adverse effects, such as infection, dehiscence, or graft failure, were observed.

CONCLUSION

The newly developed pure beta-TCP crystal was slowly absorbed and served as support until new bone formation at the defect site, thus demonstrating its potential for use in various oral conditions requiring bone grafting.

Comparative Efficacy of Different Amoxicillin Dosing Regimens in Preventing Early Implant Failure—A Systematic Review with Network Meta-Analysis

This systematic review and network meta-analysis aimed to assess the comparative efficacy and safety of antibiotics to prevent early implant failure in patients undergoing dental implant surgery. Methods: The review was registered in PROSPERO [CRD42022319385]. A search was conducted for trials published in Medline, Cochrane, PubMed, and Scopus. A network meta-analysis was performed on the data from randomized controlled trials. Agents were ranked according to their effectiveness based on outcomes (implant failure, prosthetic failure, postsurgical complications, and adverse effects) using the surface under the cumulative ranking [SUCRA]. Results: A total of 15 articles were included in the quantitative analysis. When compared to the placebo, 2 g of amoxicillin given 1 h preoperatively (RR = 0.42 (95%CI: 0.27, 0.67)), 2 g of amoxicillin given 1 h preoperatively with postoperative 500 mg thrice for 5 days (RR = 0.36 (95%CI: 0.15, 0.87)), and post-operative amoxicillin with clavulanic acid 625 mg 3 times daily for 5 days (RR = 0.38 (95%CI: 0.16, 0.90)) were effective in reducing early implant failures. In addition, 2 g of amoxicillin given 1 h preoperatively (RR = 0.42 (95%CI: 0.25, 0.73)) was the only protocol that was significant in the pairwise meta-analysis results. However, sensitivity analysis, which excluded trials with a high risk of bias, showed that none of the protocols were statistically significant in reducing early implant failure. Conclusions: A single 2 g dose of preoperative amoxicillin significantly reduces early implant failure in healthy individuals. More high-quality trials are required to establish this recommendation, as the quality of this evidence is weak.

In-situ formation of Ag nanoparticles in the MAO coating during the processing of cp-Ti

Silver nanoparticle (Ag-NP) containing antibacterial micro-arc oxidation (MAO) coatings have already been synthesized over titanium-based materials via the MAO process employed in silver acetate (AgC₂H₃O₂) containing electrolyte. However, the way of incorporation and in-situ formation of Ag-NPs within the MAO coating have not been documented yet. Present work was initiated to reveal the mechanism of Ag-NP formation within the MAO coatings. Thus, the structure of the MAO coating fabricated on commercial purity titanium in the AgC₂H₃O₂-containing electrolyte was investigated by electron microscopy techniques. To this end, the cross-sectional high-resolution electron microscopy studies were carried out on lamella cut out with the focused ion beam technique, and these investigations were backed by X-ray photoelectron spectroscopy measurements of chemical composition on the surface of the MAO coating. These studies revealed that Ag is dispersed in the form of nanoparticles throughout the coating and that a higher density was confirmed closer to the micro-pores.

Microbial resistance to nanotechnologies: An important but understudied consideration using antimicrobial nanotechnologies in orthopaedic implants

Microbial resistance to current antibiotics therapies is a major cause of implant failure and adverse clinical outcomes in orthopaedic surgery. Recent developments in advanced antimicrobial nanotechnologies provide numerous opportunities to effective remove resistant bacteria and prevent resistance from occurring through unique mechanisms. With tunable physicochemical properties, nanomaterials can be designed to be bactericidal, antifouling, immunomodulating, and capable of delivering antibacterial compounds to the infection region with spatiotemporal accuracy. Despite its substantial advancement, an important, but under-explored area, is potential microbial resistance to nanomaterials and how this can impact the clinical use of antimicrobial nanotechnologies. This review aims to provide a better understanding of nanomaterial-associated microbial resistance to accelerate bench-to-bedside translations of emerging nanotechnologies for effective control of implant associated infections.

Dental Implant Survival after Postoperative Infection

Purpose

Early postoperative infection can lead to dental implant failure. This study aimed to evaluate the frequency of failed and survived implants after acute postoperative infection and the related factors.

Materials and Methods

This cross-sectional cohort evaluated early infection after dental implant surgery. The study variables included the site of implant placement, age and gender of patients, bone augmentation, postoperative antibiotic therapy, smoking, and time of infection occurrence or diagnosis. Failed and survived implants were the outcome of the study. The patients were studied in 2 groups of survived implants (group 1) and failed implants (group 2).

Results

Thirty-four (3.46%) out of 980 patients developed a postoperative infection following implant placement, which included 25 males and 9 females. Ten implants (29.4%) survived (group 1), and 24 implants (70.6%) failed (group 2). There were significant differences between the 2 groups regarding the number of smoker patients, fresh socket or delayed implant placement, patients who received bone graft, and the meantime of diagnosis (P < 0.05). Regarding the covariates, the Kaplan-Meier analysis showed that the risk of implant failure in patients who did not receive postoperative antibiotic therapy increased by 1.1 times (hazard ratio) when infection occurred four days after surgery. In patients who received postoperative antibiotics, the risk of failure increased when infection occurred after 6 days in smokers and after 9 days in non-smokers.

Conclusion

Considering the study results, it seems that smoking, early infection, fresh socket placement, and placement of implants along with bone substitutes may increase the failure rate after acute infection in dental implant placement.

Development of a new preclinical model to study early implant loss: a validation study in the beagle dog

Objectives

To develop a new preclinical model to study early implant loss, where local infection conditions would impair the implant osseointegration.

Materials and methods

Forty-eight smooth, 2.9-mm diameter experimental implants were placed in the mandible of 8 beagle dogs (3 in each side). In half of the animals (test group, n = 24 implants), the implants received ligatures around the implant-abutment connection. In the other half, no ligatures were placed (control group, n = 24 implants). Four weeks later, implants were extracted in a flapless approach and standard 3.3-mm diameter SLActive implants were placed into the same osteotomy site without any further drilling. Eight weeks after the second implantation, animals were sacrificed and analyzed in terms of implant survival.

Results

After 8 weeks of healing, 4 implants were lost in the control group and 14 in the test group. This corresponded to a 17.4% of early implant loss in the control group and 58.3% in the test. Most of the early failures occurred within the first 5 weeks of healing.

Conclusions

Implants placed in a pre-contaminated site present higher early loss than those placed in a non-contaminated site. This study represents a valid and robust preclinical model to study mechanisms and reduction of early implant loss as new technologies become available.

Clinical relevance

Scientific rationale for the study: There is lack of animal models to study early implant loss. Thus, a proposal of a new model is presented. With the validation of this model, new technologies can be implemented to prevent early implant loss.

Lyophilized Human Bone Allograft as an Antibiotic Carrier: An In Vitro and In Vivo Study

Background: Antibiotics delivered from implanted bone substitute materials (BSM) can potentially be used to prevent acute infections and biofilm formation, providing high concentrations of antibiotics at the surgical site without systemic toxicity. In addition, BSM should allow osteoconductivity supporting bone healing without further surgery. Promising results have been achieved using lyophilized bone allografts mixed with antibiotics. Methods: In this study specially prepared human bone allografts were evaluated as an antibiotic carrier in vitro and in vivo. The efficacy of different antibiotic-impregnated bone allografts was measured by drug release tests in vitro and in vivo and bacterial susceptibility tests using four bacterial species usually responsible for implant-associated infections. Results: The loading procedures of allograft bone substitutes with antibiotics were successful. Some of the antibiotic concentrations exceeded the MIC90 for up to 7 days in vitro and for up to 72 h in vivo. The susceptibility tests showed that S. epidermidis ATCC 12228 was the most susceptible bacterial species in comparison to the other strains tested for all antibiotic substances. Vancomycin and rifampicin showed the best results against standard and patient-isolated strains in vitro. In vivo, new bone formation was comparable in all study groups including the control group without antibiotic loading. Conclusions: Human bone allografts showed the capacity to act as customized loaded antibiotic carriers to prevent acute infections and should be considered in the management of bone infections in combination with systemic antimicrobial therapy.

Novel Utilization of Therapeutic Coatings Based on Infiltrated Encapsulated Rose Bengal Microspheres in Porous Titanium for Implant Applications

Despite the increasing progress achieved in the last 20 years in both the fabrication of porous dental implants and the development of new biopolymers for targeting drug therapy, there are important issues such as bone resorption, poor osseointegration, and bacterial infections that remain as critical challenges to avoid clinical failure problems. In this work, we present a novel microtechnology based on polycaprolactone microspheres that can adhere to porous titanium implant models obtained by the spacer holder technique to allow a custom biomechanical and biofunctional balance. For this purpose, a double emulsion solvent evaporation technique was successfully employed for the fabrication of the microparticles properly loaded with the antibacterial therapeutic agent, rose bengal. The resulting microspheres were infiltrated into porous titanium substrate and sintered at 60 °C for 1 h, obtaining a convenient prophylactic network. In fact, the sintered polymeric microparticles were demonstrated to be key to controlling the drug dissolution rate and favoring the early healing process as consequence of a better wettability of the porous titanium substrate to promote calcium phosphate nucleation. Thus, this joint technology proposes a suitable prophylactic tool to prevent both early-stage infection and late-stage osseointegration problems.

A two-phase and long-lasting multi-antibacterial coating enables titanium biomaterials to prevent implants-related infections

In clinical work, the main challenges for titanium (Ti) implantation are bacterial infection and aseptic loosening, which severely affect the survival rate of implants. The first 4 weeks post-operation is the infection peak phase of implants. Inhibiting implant infection caused by bacteria adhesion and proliferation during the early phase as well as promoting subsequent osteointegration is essential for implant success. Herein, we constructed a quaternary ammonium carboxymethyl chitosan (QCMC), collagen (COL Ⅰ) and hydroxyapatite (HAP) multilayers coating on Ti substrates via a modified layer-by-layer (LBL) technique and polymerization of dopamine. The QCMC/COL/HAP coating exhibited a multi-antibacterial property with a two-phase function: (1) At the first 4 weeks post-operation, the covalently bonded QCMC could be slowly degraded and demonstrated both contact-killing and release-killing properties during the infection peak phase; (2) At the second phase, osteogenesis and osseointegration-promotion capabilities were enhanced by HAP under the effective control of infection. The multifilm coating was degraded for more than 45 days under the action of collagenase Ⅰ, and displayed good biocompatibility in vivo and in vitro. Most importantly, the coating exhibited a long-lasting antibacterial activity for more than 3 months, against the main pathogenic bacteria of peri-implant infections. Both in vitro studies and in vivo animal models revealed a desirable osteogenic differentiation capacity of Ti-CCH. Therefore, our study reports a two-phase, long-lasting multi-antibacterial coating on Ti-CCH and indicates potential applications of the modified LBL strategy in orthopaedic fields, which is enlightening for developing practical implant and scaffold materials.

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Developing a QCMC/COL/HAP multifilm coating via modified layer-by-layer technique and self-polymerization of dopamine.

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The QCMC/COL/HAP coating exhibited desirable mechanical properties and excellent biocompatibility.

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The release kinetics endowed the QCMC/COL/HAP coating with multi-antibacterial activity at the first phase after operation.

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The QCMC/COL/HAP coating could improve osseointegration at the second phase of post-operation.

Osteoblastic Cell Responses of Copper Nanoparticle Coatings on Ti-6Al-7Nb Alloy Using Electrophoretic Deposition Method

Aim

To investigate and compare the cell cytotoxicity, proliferation, cell attachment, and morphology of human fetal osteoblasts (hFOB) cells of coated samples (titanium nanocopper (Ti Cu), titanium nanohydroxyapatite (Ti HA) and titanium nanocopper ion doped hydroxyapatite (Ti Cu/HA) and uncoated samples (Ti) in order to assess the suitability of these surface modifications on Ti-6Al-7Nb for dental implant application.

Materials and Methods

The cytotoxicity was studied by examining the hFOB cell response by MTT assessment. The cell morphology was evaluated by inverted microscopy and observed under scanning electronic microscopy (SEM).

Results

MTT assay results displayed that the Cu content on the surface of Ti-6Al-7Nb alloys did not produce any cytotoxic effect on cell viability. The cell viability rate in all samples ranges from 97% to 126%, indicating that hFOB cells grew at a high proliferation rate. However, no significant differences in cell viability were observed between Ti and Ti Cu and between Ti HA and Ti Cu/HA groups. Microscopic examination demonstrated no difference in the cell morphology of hFOB among all samples. In addition, SEM observation indicated favorable adhesion and spreading of the cells on the coated and uncoated samples.

Conclusions

The surface modification of Ti-6Al-7Nb alloy with Cu, HA, and Cu/HA exhibits good cell biocompatibility, and the Cu has no influence on the cell proliferation and differentiation of hFOB.

Hydroxyapatite Pellets as Versatile Model Surfaces for Systematic Adhesion Studies on Enamel: A Force Spectroscopy Case Study

Research into materials for medical application draws inspiration from naturally occurring or synthesized surfaces, just like many other research directions. For medical application of materials, particular attention has to be paid to biocompatibility, osseointegration, and bacterial adhesion behavior. To understand their properties and behavior, experimental studies with natural materials such as teeth are strongly required. The results, however, may be highly case-dependent because natural surfaces have the disadvantage of being subject to wide variations, for instance in their chemical composition, structure, morphology, roughness, and porosity. A synthetic surface which mimics enamel in its performance with respect to bacterial adhesion and biocompatibility would, therefore, facilitate systematic studies much better. In this study, we discuss the possibility of using hydroxyapatite (HAp) pellets to simulate the surfaces of teeth and show the possibility and limitations of using a model surface. We performed single-cell force spectroscopy with single Staphylococcus aureus cells to measure adhesion-related parameters such as adhesion force and rupture length of cell wall proteins binding to HAp and enamel. We also examine the influence of blood plasma and saliva on the adhesion properties of S. aureus. The results of these measurements are matched to water wettability, elemental composition of the samples, and the change in the macromolecules adsorbed over time on the surface. We found that the adhesion properties of S. aureus were similar on HAp and enamel samples under all conditions: Significant decreases in adhesion strength were found equally in the presence of saliva or blood plasma on both surfaces. We therefore conclude that HAp pellets are a good alternative for natural dental material. This is especially true when slight variations in the physicochemical properties of the natural materials may affect the experimental series.

Effectiveness of a Nanohydroxyapatite-Based Hydrogel on Alveolar Bone Regeneration in Post-Extraction Sockets of Dogs with Naturally Occurring Periodontitis

Pathological mandibular fracture after dental extraction usually occurs in dogs with moderate to severe periodontitis. A nanohydroxyapatite-based hydrogel (HAP hydrogel) was developed to diminish the limitations of hydroxyapatite for post-extraction socket preservation (PSP). However, the effect of the HAP hydrogel in dogs has still not been widely investigated. Moreover, there are few studies on PSP in dogs suffering from clinical periodontitis. The purpose of this study was to evaluate the effectiveness of the HAP hydrogel for PSP in dogs with periodontitis. In five dogs with periodontitis, the first molar (309 and 409) of each hemimandible was extracted. Consequently, all the ten sockets were filled with HAP-hydrogel. Intraoral radiography was performed on the day of operation and 2, 4, 8 and 12 weeks post operation. The Kruskal-Wallis test and paired t-test were adopted for alveolar bone regeneration analysis. The results demonstrated that the radiographic grading, bone height measurement, and bone regeneration analysis were positively significant at all follow-up times compared to the day of operation. Moreover, the scanning electron microscopy with energy-dispersive X-ray spectroscopy imaging after immersion showed a homogeneous distribution of apatite formation on the hydrogel surface. Our investigation suggested that the HAP hydrogel effectively enhances socket regeneration in dogs with periodontitis and can be applied as a bone substitute for PSP in veterinary dentistry.

Application of Antimicrobial Peptides on Biomedical Implants: Three Ways to Pursue Peptide Coatings

Biofilm formation and inflammations are number one reasons of implant failure and cause a severe number of postoperative complications every year. To functionalize implant surfaces with antibiotic agents provides perspectives to minimize and/or prevent bacterial adhesion and proliferation. In recent years, antimicrobial peptides (AMP) have been evolved as promising alternatives to commonly used antibiotics, and have been seen as potent candidates for antimicrobial surface coatings. This review aims to summarize recent developments in this field and to highlight examples of the most common techniques used for preparing such AMP-based medical devices. We will report on three different ways to pursue peptide coatings, using either binding sequences (primary approach), linker layers (secondary approach), or loading in matrixes which offer a defined release (tertiary approach). All of them will be discussed in the light of current research in this area.

Rat peri-implant soft tissue specifically expressed CXCL2 on titanium implant during wound healing

Many of genes specifically expressed in peri-implant soft tissue (PIST) selected by microarray analysis are involved in the inflammatory response. This study investigated the gene expression and localization of PIST-specific inflammatory markers in PIST during wound healing. Pure titanium implants were implanted into the rat upper mandibular socket to create PIST. Samples were harvested from PIST as an experimental group, and tooth extracted area of oral mucosa tissue (OMT) and healthy periodontal tissue (PT) as control groups. The gene expressions of four standard inflammatory markers and nine PIST-specific inflammatory markers including chemokine (C-X-C motif) ligand 2 (CXCL2) during wound healing were examined. Immunoreactions of CXCL2 and immune cells in PIST and control tissues were compared. During wound healing, gene expression of PIST-specific inflammatory markers was higher in PIST than in OMT (p < .05), but there were no significant differences in the expression of standard inflammatory markers. The molecule CXCL2 was expressed locally at the implant-connective tissue interface, and localization of immune cells closely matched the CXCL2 expression pattern. In PIST, seven of PIST-specific inflammatory markers were expressed specifically and strongly during wound healing and their expression was maintained until the end of healing. Furthermore, CXCL2 expression was due to the creation of the implant-connective tissue interface, and it established a unique defense mechanism in PIST that was not apparent in OMT or PT.

A novel chlorhexidine-hexametaphosphate coating for titanium with antibiofilm efficacy and stem cell cytocompatibility

Dental implants are an increasingly popular way to replace missing teeth. Whilst implant survival rates are high, a small number fail soon after placement, with various factors, including bacterial contamination, capable of disrupting osseointegration. This work describes the development of chlorhexidine-hexametaphosphate coatings for titanium that hydrolyse to release the antiseptic agent chlorhexidine. The aim was to develop a coating for titanium that released sufficient chlorhexidine to prevent biofilm formation, whilst simultaneously maintaining cytocompatibility with cells involved in osseointegration. The coatings were characterised with respect to physical properties, after which antibiofilm efficacy was investigated using a multispecies biofilm model, and cytocompatibility determined using human mesenchymal stem cells. The coatings exhibited similar physicochemical properties to some implant surfaces in clinical use, and significantly reduced formation of multispecies biofilm biomass up to 72 h. One coating had superior cytocompatibility, with mesenchymal stem cells able to perform normal functions and commence osteoblastic differentiation, although at a slower rate than those grown on uncoated titanium. With further refinement, these coatings may have application in the prevention of bacterial contamination of dental implants at the time of surgery. This could aid a reduction in rates of early implant failure.

Effectiveness of Antibacterial Surfaces in Osseointegration of Titanium Dental Implants: A Systematic Review

Titanium (Ti) dental implant failure as a result of infection has been established at 40%, being regarded as one of the most habitual and untreatable problems. Current research is focused on the design of new surfaces that can generate long-lasting, infection-free osseointegration. The purpose of our study was to assess studies on Ti implants coated with different antibacterial surfaces, assessing their osseointegration. The PubMed, Web of Science and Scopus databases were electronically searched for in vivo studies up to December 2020, selecting six studies that met the inclusion criteria. The quality of the selected studies was assessed using the ARRIVE (Animal Research: Reporting of In Vivo Experiments) criteria and Systematic Review Center for Laboratory animal Experimentation's (SYRCLE's) risk of bias tool. Although all the included studies, proved greater osseointegration capacity of the different antibacterial surfaces studied, the methodological quality and experimental models used in some of them make it difficult to draw predictable conclusions. Because of the foregoing, we recommend caution when interpreting the results obtained.

Development of Robust Chitosan–Silica Class II Hybrid Coatings with Antimicrobial Properties for Titanium Implants

The purpose of this study was to develop robust class II organic–inorganic films as antibacterial coatings on titanium alloy (Ti6Al4V) implants. Coating materials were prepared from organic chitosan (20–80 wt.%) coupled by 3-glycydoxytrimethoxysilane (GPTMS) with inorganic tetraethoxysilane (TEOS). These hybrid networks were imbedded with antimicrobial silver nanoparticles (AgNPs) and coated onto polished and acid-etched Ti6Al4V substrates. Magic-angle spinning nuclear magnetic resonance (13CMAS-NMR), attenuated total reflectance Fourier-transform infrared spectroscopy (ATR-FTIR) and the ninhydrin assay, confirmed the presence and degree of covalent crosslinking (91%) between chitosan and GPTMS. Scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) identified surface roughness and microtopography on thin films and confirmed homogeneous distribution of elements throughout the coating. Cross-hatch and tensile adhesion testing demonstrated the robustness and adherence (15–20 MPa) of hybrid coatings to acid-etched titanium substrates. Staphylococcus aureus and Escherichia coli cultures and their biofilm formation were inhibited by all hybrid coatings. Antibacterial effects increased markedly for coatings loaded with AgNPs and appeared to increase with chitosan content in biofilm assays. These results are promising in the development of class II hybrid materials as robust and highly adherent antibacterial films on Ti6Al4V implants.

Risk factors in bone augmentation procedures

Bone augmentation is an extremely common procedure in implant dentistry today because of significant advancements with reactive biomaterials, a better understanding of the mechanism of action that is found with growth factors contained in platelets, and improvements in surgical techniques. The expectation is for the surgeon to place the dental implant in the position that best serves the requirements of the prosthetic restorations. With the increasing demands that patients have for ideal prosthetic results, surgeons are expected to predictably augment both hard and soft tissues to provide the anticipated esthetic and functional outcomes. Bone grafting can be performed before, during, and after the implant placement; however, these augmentation procedures come with increased cost, the risk of complications such as infection or failure, and lengthening of the total treatment time. In addition, a plethora of grafting materials are available commercially, where they are often inadequately studied, or there is minimal information regarding their predictability or long-term success, or ability to support dental implants. It is clear that although the surgical field has seen major progress since early implant surgical techniques in the 1980s, major challenges still exist with hard tissue augmentation procedures. This review will discuss these challenges that are increased and often specific to bone graft healing, and which are becoming more common as implant site development often requires bone augmentation to improve volume or contour deficiencies. The risk factors that patients may present with that will affect outcomes with bone augmentation procedures are identified, and recommendations for the prevention of complications or managing complications once they have occurred are provided.

Attitudes of dental implantologists in Spain to prescribing antibiotics, analgesics and anti-inflammatories in healthy patients

Background

The implantologists frequently prescribe antibiotics, analgesics and anti-inflammatories in dental implant surgery. The aims of this study were to evaluate the attitudes of implantologists in Murcia (Spain) to prescribing antibiotics, analgesics and anti-inflammatories in healthy patients during different implant dentistry procedures, and to see how these are influenced by individual dentist’s academic level, professional experience, and ongoing training (attending courses or reading scientific literature on medication use)

Material and Methods

This cross-sectional study included a total of 200 implantologists from the Murcia area (Spain), who each completed a two-page questionnaire consisting of 26 questions.

Results

The implant procedure in which most dentists (n=97) prescribed antibiotics was multiple implant surgery with flap raising, in which 55.6% of these 97 respondents used a prophylactic antibiotic regime for 7 days after implant placement. All subjects (n=200) prescribed analgesics for eight out of the eleven procedures included in the survey and anti-inflammatories in six. Dentists with higher academic levels or longer professional experience prescribed more antibiotics, but those who underwent continuous training (attending courses or reading scientific literature) reduced antibiotic prescription.

Conclusions

Dentists often prescribed antibiotics, analgesics and anti-inflammatories in almost all implant procedures in healthy patients, but ongoing training reduced the frequency of antibiotic prescription in some procedures.

Key words:Antibiotics, analgesics, anti-inflammatories, dental implant, oral surgery.

Multilayered composite coatings of titanium dioxide nanotubes decorated with zinc oxide and hydroxyapatite nanoparticles: controlled release of Zn and antimicrobial properties against Staphylococcus aureus

Purpose: This study aimed to decorate the surface of TiO₂ nanotubes (TiO₂ NTs) grown on medical grade Ti-6Al-4V alloy with an antimicrobial layer of nano zinc oxide particles (nZnO) and then determine if the antimicrobial properties were maintained with a final layer of nano-hydroxyapatite (HA) on the composite.

Methods: The additions of nZnO were attempted at three different annealing temperatures: 350, 450 and 550 °C. Of these temperatures, 350°C provided the most uniform and nanoporous coating and was selected for antimicrobial testing.

Results: The LIVE/DEAD assay showed that ZnCl₂ and nZnO alone were >90% biocidal to the attached bacteria, and nZnO as a coating on the nanotubes resulted in around 70% biocidal activity. The lactate production assay agreed with the LIVE/DEAD assay. The concentrations of lactate produced by the attached bacteria on the surface of nZnO-coated TiO₂ NTs and ZnO/HA-coated TiO₂ NTs were 0.13±0.03 mM and 0.37±0.1 mM, respectively, which was significantly lower than that produced by the bacteria on TiO₂ NTs alone, 1.09±0.30 mM (Kruskal–Wallis, P<0.05, n=6). These biochemical measurements were correlated with electron micrographs of cell morphology and cell coverage on the coatings.

Conclusion: nZnO on TiO₂ NTs was a stable and antimicrobial coating, and most of the biocidal properties remained in the presence of nano-HA on the coating.

UV light assisted antibiotics for eradication of in vitro biofilms

The overuse of antibiotics is accelerating the bacterial resistance, and therefore there is a need to reduce the amount of antibiotics used for treatment. Here, we demonstrate in vitro that specific wavelengths in a narrow range around 296 nm are able to eradicate bacteria in the biofilm state (grown for 24 hours) more effectively, than antibiotics and the combination of irradiation and antibiotics is even better, introducing a novel concept light assisted antibiotics. The investigated wavelength range was 249 nm to 338 nm with an approximate step of 5 nm. The novel concept that consists of a UV irradiation treatment followed by a tobramycin treatment can significantly reduce the amount of antibiotics needed for eradicating mature bacterial biofilms. The efficiency of the proposed light assisted antibiotics method was compared to combinatory antibiotic treatment and highly concentrated antibiotic monotherapy. The eradication efficacies, on mature biofilms, achieved by light assisted antibiotic and by the antibiotic monotherapy at approximately 10-fold higher concentration, were equivalent. The present achievement could motivate the development of light assisted antibiotic treatments for treating infections.

The paradigm shift for drug delivery systems for oral and maxillofacial implants

Along with the development of nanotechnological strategies for biomaterials associated with the prevention of infections, a myriad of clinically unproven techniques have been described to date. In this work, the aim was to perform a critical analysis of the literature available concerning antibacterial biomaterials for oral implantology and to provide a practical derivation for such a purpose. As anti-adhesive strategies may affect osseointegration, they should no longer be recommended for inclusion in this class of biomaterials, despite promising results in biomedical engineering for other, non-bone load bearing organs. Targeted, antibacterial drug delivery is most likely desirable in the case of intraosseous implants. Interfering factors such as the oral cavity environment, saliva, the bacterial microbiome, as well as, the characteristics of the alveolar mucosa and peri-implant space must be taken into account when calculating the local pharmacokinetics for antibacterial coatings. Effective release is crucial for tailoring antibacterial implant longevity providing minimal inhibitory concentration (MIC) for the desired amount of time, which for oral implants, should be at least the cumulative time for the osseointegration period and functional loading period within the tissues. These parameters may differ between the implant type and its anatomical site. Also, the functional drug concentration in the peri-implant space should be calculated as the amount of the drug released from the implant surface including the concentration of the drug inactivated by biological fluids of the peri-implant space or saliva flow throughout the effective release time.

Antibiotic prescription for the prevention and treatment of postoperative complications after routine dental implant placement. A cross-sectional study performed in Spain

Background

As there are no established guidelines for antibiotic prescription after dental implant placement a study was made to determine the current prescribing habits of several groups of practitioners regarding antibiotics to prevent and/or treat postoperative complications — early failures and infections — in relation to routine dental implant placement.

Material and Methods

An electronic survey was sent to postgraduate students and professionals with experience in routine dental implant placement who practice in Spain. The questions asked were related to whether antibiotics were routinely prescribed either pre- or postoperatively to prevent and/or treat postoperative complications during routine dental implant placement, and, if so, what antibiotics, dosage, frequency, and duration were used. Descriptive and bivariate analyses of the data were performed.

Results

Two hundred and forty-seven responses were obtained. Preventively, 17 respondents (6.9%) prescribed antibiotics only preoperatively (95% confidence interval (CI): 3.7 to 10.0%), 100 (40.5%) preferred to give them exclusively during the postoperative period (95%CI 34.4 to 46.6%) and 94 practitioners (38.1%) prescribed antibiotics both pre- and post-operatively (95%CI 32.0 to 44.1%). The most common preoperative regime was amoxicillin 2 g given orally 1 hour before the procedure (21.6%, n = 24) following amoxicillin 750 mg given orally 1 day prior to surgery (21.6%, n = 24). The most common routine postoperative regime was amoxicillin 750 mg given orally for 7 days (34.0%, n = 66). To treat postoperative infections during the osseointegration period, 233 respondents (93.2%) prescribed antibiotics (95%CI 91.4 to 97.2%). The most common regime used was amoxicillin and potassium clavulanate 875/125 mg, given orally for 7 days (51.9%, n = 121).

Conclusions

There is no consensus among dental clinicians regarding antibiotic use during routine dental implant placement to prevent postoperative complications and/or early failures. Moreover, the most commonly-prescribed regimes differ from that recommend in the latest published studies.

Key words:Antibiotics, dental implants, oral implantology, complications, postoperative wound infection, early failure.

Is there a consensus on antibiotic usage for dental implant placement in healthy patients?

This systematic review aimed to determine whether there is consensus for antibiotic prescription in healthy patients undergoing implant placement. A search of PubMed, Embase and Medline databases was conducted in January 2016 to find published journal articles on the use of antibiotics in implant placement, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were prospective human clinical trials investigating antibiotic usage during implant placement. Fifteen studies were deemed suitable. In 13 studies, no statistical difference was found between antibiotic use and the incidence of prosthetic failure, implant failure and early postoperative infections. These were rated as having low to high risk bias. Contrary results were reported in two studies, both of which were rated as having a high potential for bias. In conclusion, antibiotic use in healthy patients for the prophylaxis of surgical infection associated with dental implant placement does not appear to improve clinical outcomes. Practitioners should apply principles of antimicrobial stewardship and not use antibiotics as a routine measure in healthy patients.

Effect of ultraviolet treatment on bacterial attachment and osteogenic activity to alkali-treated titanium with nanonetwork structures

Purpose

Alkali-treated titanium with nanonetwork structures (TNS) possesses good osteogenic activity; however, the resistance of this material to bacterial contamination remains inadequate. As such, TNS implants are prone to postoperative infection. In this work, we attempted to alter the biological properties of TNS by treatment with short-duration high-intensity ultraviolet (UV) irradiation.

Methods

TNS discs were treated with UV light (wavelength =254 nm, strength =100 mW/cm²) for 15 minutes using a UV-irradiation machine. We carried out a surface characterization and evaluated the discs for bacterial film formation, protein adsorption, and osteogenic features.

Results

The superhydrophilicity and surface hydrocarbon elimination exhibited by the treated material (UV-treated titanium with a nanonetwork structure [UV-TNS]) revealed that this treatment effectively changed the surface characteristics of TNS. Notably, UV-TNS also showed reduced colonization by Actinomyces oris during an initial attachment period and inhibition of biofilm formation for up to 6 hours. Moreover, compared to conventional TNS, UV-TNS showed superior osteogenic activity as indicated by increased levels of adhesion, proliferation, alkaline phosphatase activity, osteogenic factor production, and osteogenesis-related gene expression by rat bone marrow mesenchymal stem cells (rBMMSCs). This inverse relationship between bacterial attachment and cell adhesion could be due to the presence of electron–hole pairs induced by high-intensity UV treatment.

Conclusion

We suggest that simple UV treatment has great clinical potential for TNS implants, as it promotes the osseointegration of the TNS while reducing bacterial contamination, and can be conducted chair-side immediately prior to implantation.

Osteomyelitis of the Mandible after Dental Implants in an Immunocompetent Patient

Dental implants are now broadly used to replace missing teeth, and the presence of infectious complications is rising. Dental implant therapy as a local risk factor for the onset of osteomyelitis and its management have not been widely explored. Here, we report an unusual case of mandibular suppurative osteomyelitis caused by Streptococcus intermedius in a healthy and immunocompetent patient secondary to mandibular implants. We describe how surgery combined with systemic application of antibiotics allowed conservation of the dental implants in the mandibular bone, discuss the probable source of contamination, and present the follow-up of the osteomyelitis.