Periimplantitis and Implant Body Roughness

High-Intensity Focused Ultrasound Versus Airflow® in Debriding Ti-Attached S. mutans Biofilms

INTRODUCTION AND AIMS

Effective management of biofilm-associated peri-implantitis requires the eradication of microbial biofilms to control disease progression and preserve implant osseointegration. However, achieving complete biofilm removal remains a challenge. High-intensity focused ultrasound (HIFU) is an emerging technology offering non-ionizing radiation, no extraneous materials, and minimal residuals or aerosols. This in vitro study compared the effectiveness of HIFU and a commercial air-pressured abrasive method (Airflow®) in removing Streptococcus mutans biofilms attached to Titanium (Ti) discs.

METHODS

Bacterial biofilms were grown on 36 pairs of machined (M) and roughened (R) Ti discs for 10 days. Biofilms in the test group (12 pairs) were treated with the optimized HIFU for 2 min in a water medium and the residual biofilms were examined using two imaging methods, confocal laser scanning microscopy (CLSM), scanning electron microscopy (SEM), and three quantitative methods including crystal violet (CV), 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) and flow cytometry (FCM) assays for biomass, bacterial viability, and live/dead bacterial counts respectively. The data from the test and the control samples (untreated and Airflow® treated) were subjected to ANOVA followed by post-hoc Tukey's test to determine the statistical differences between the groups.

RESULTS

Except the MTT data from M discs, the findings showed that both HIFU and Airflow® methods achieved similar levels of bacterial debridement, removing over 99% of bacteria in FCM assays (99.8 ± 0.16% versus 99.3 ± 0.49% for M discs, 99.96 ± 0.02% versus 99.5 ± 0.37% in for R discs). Complete biofilm removal was noted in HIFU-treated samples compared to the Airflow® in SEM images.

CONCLUSION AND CLINICAL RELEVANCE

Our findings indicate that both novel HIFU and traditional Airflow® methods were equally effective in removing the S. mutans biofilms from titanium disc surfaces. Further research is needed to explore the clinical application of HIFU in managing peri-implantitis.

Strength of titanium-zirconium alloy implants with a conical connection after implantoplasty

STATEMENT OF PROBLEM

Peri-implantitis occurs around dental implants, and implantoplasty has been used to address this ongoing disease; however, the changes to the physical properties of an implant after implantoplasty have not been well documented.

PURPOSE

The purpose of this in vitro study was to determine the effect of implantoplasty on fracture strength and the load required for plastic deformation after cyclic fatigue on dental implants.

MATERIAL AND METHODS

Twenty-six titanium/zirconium (TiZr) alloy implants (Roxolid Bone Level Implant; 4.1×10 mm) were embedded with 50% thread exposure and divided into 4 groups based on whether they had implantoplasty treatment by using different diamond rotary instruments and/or cyclic loading at 250 N for 2 million cycles: C0 (control, no cyclic loading), T0 (test, no cyclic loading), CM (control, cyclic loading), and TM (test, cyclic loading). After implantoplasty and/or cyclic loading, all implants underwent a load-to-failure test. The maximum fracture strength (FS) and load required for the onset of plastic deformation (PD) were recorded in Newtons. One-way ANOVA and nonparametric comparisons with control by using the Dunn and Wilcoxon method for joint ranking were used for statistical analysis.

RESULTS

The mean ±standard deviation FS for C0, CM, T0, and TM was 1465.2 ±86.4 N, 1480.7 ±64.1 N, 1299.3 ±123.8 N, and 1252.1 ±85.7 N, respectively. The mean ±standard deviation load for onset of PD for C0, CM, T0, and TM was 860.2 ±88.1 N, 797.0 ±130.5 N, 776.5 ±181.8 N, and 631.3 ±84.5 N, respectively. The TM group had a significantly lower FS and PD than the C0, CM, and T0 groups (P<.05) CONCLUSIONS: Both fracture strength (FS) and the onset of plastic deformation (PD) were significantly reduced after a TiZr alloy implant received implantoplasty and cyclic loading.

Implant Health in Treated Periodontitis Patients: A Systematic Review and Meta-Analysis

BACKGROUND

The aim of this meta-analysis was to evaluate the role of a history of periodontitis on implant failure. The two main judgment criteria studied are peri-implantitis and the survival rate. The two secondary judgment criteria studied are the mean pocket depth and the mean peri-implant bone loss.

METHODS

An electronic search was performed via five databases (MEDLINE, Embase, ScienceDirect, LILACS and the Cochrane Library) and was supplemented by manual searching. The search was undertaken in June 2024.

RESULTS

Of 10 775 potentially eligible articles, 8 were included in the qualitative analysis and 10 in the quantitative synthesis.

CONCLUSIONS

This meta-analysis suggests that a history of periodontitis has a significant impact on the rate of peri-implantitis, survival rate, mean bone loss and pocket depth.

Roughness affects the response of human fibroblasts and macrophages to sandblasted abutments

BACKGROUND

A strong seal of soft-tissue around dental implants is essential to block pathogens from entering the peri-implant interface and prevent infections. Therefore, the integration of soft-tissue poses a challenge in implant-prosthetic procedures, prompting a focus on the interface between peri-implant soft-tissues and the transmucosal component. The aim of this study was to analyse the effects of sandblasted roughness levels on in vitro soft-tissue healing around dental implant abutments. In parallel, proteomic techniques were applied to study the interaction of these surfaces with human serum proteins to evaluate their potential to promote soft-tissue regeneration.

RESULTS

Grade-5 machined titanium discs (MC) underwent sandblasting with alumina particles of two sizes (4 and 8 μm), resulting in two different surface types: MC04 and MC08. Surface morphology and roughness were characterised employing scanning electron microscopy and optical profilometry. Cell adhesion and collagen synthesis, as well as immune responses, were assessed using human gingival fibroblasts (hGF) and macrophages (THP-1), respectively. The profiles of protein adsorption to the surfaces were characterised using proteomics; samples were incubated with human serum, and the adsorbed proteins analysed employing nLC-MS/MS. hGFs exposed to MC04 showed decreased cell area compared to MC, while no differences were found for MC08. hGF collagen synthesis increased after 7 days for MC08. THP-1 macrophages cultured on MC04 and MC08 showed a reduced TNF-α and increased IL-4 secretion. Thus, the sandblasted topography led a reduction in the immune/inflammatory response. One hundred seventy-six distinct proteins adsorbed on the surfaces were identified. Differentially adsorbed proteins were associated with immune response, blood coagulation, angiogenesis, fibrinolysis and tissue regeneration.

CONCLUSIONS

Increased roughness through MC08 treatment resulted in increased collagen synthesis in hGF and resulted in a reduction in the surface immune response in human macrophages. These results correlate with the changes in protein adsorption on the surfaces observed through proteomics.

Cytocompatibility, antibacterial, and corrosion properties of chitosan/polymethacrylates and chitosan/poly(4-vinylpyridine) smart coatings, electrophoretically deposited on nanosilver-decorated titania nanotubes

The development of novel implants subjected to surface modification to achieve high osteointegration properties at simultaneous antimicrobial activity is a highly current problem. This study involved different surface treatments of titanium surface, mainly by electrochemical oxidation to produce a nanotubular oxide layer (TNTs), a subsequent electrochemical reduction of silver nitrate and decoration of a nanotubular surface with silver nanoparticles (AgNPs), and finally electrophoretic deposition (EPD) of a composite of chitosan (CS) and either polymethacrylate-based copolymer Eudragit E 100 (EE100) or poly(4-vinylpyridine) (P4VP) coating. The effects of each stage of this multi-step modification were examined in terms of morphology, roughness, wettability, corrosion resistance, coating-substrate adhesion, antibacterial properties, and osteoblast cell adhesion and proliferation. The results showed that the titanium surface formed nanotubes (inner diameter of 97 ± 12 nm, length of 342 ± 36 nm) subsequently covered with silver nanoparticles (with a diameter of 88 ± 8 nm). Further, the silver-decorated nanotubes were tightly coated with biopolymer films. Most of the applied modifications increased both the roughness and the surface contact angle of the samples. The deposition of biopolymer coatings resulted in reduced burst release of silver. The coated samples revealed potent antimicrobial activity against both Gram-positive and Gram-negative bacteria. Total elimination (99.9%) of E. coli was recorded for a sample with CS/P4VP coating. Cytotoxicity results using hFOB 1.19, a human osteoblast cell line, showed that after 3 days the tested modifications did not affect the cellular growth according to the titanium control. The proposed innovative multilayer antibacterial coatings can be successful for titanium implants as effective postoperative anti-inflammation protection.

Zirconia Dental Implants: A Closer Look at Surface Condition and Intrinsic Composition by SEM-EDX

Modern dental implantology is based on a set of more or less related first-order parameters, such as the implant surface and the intrinsic composition of the material. For decades, implant manufacturers have focused on the research and development of the ideal material combined with an optimal surface finish to ensure the success and durability of their product. However, brands do not always communicate transparently about the nature of the products they market. Thus, this study aims to compare the surface finishes and intrinsic composition of three zirconia implants from three major brands. To do so, cross-sections of the apical part of the implants to be analyzed were made with a micro-cutting machine. Samples of each implant of a 4 to 6 mm thickness were obtained. Each was analyzed by a tactile profilometer and scanning electron microscope (SEM). Compositional measurements were performed by X-ray energy-dispersive spectroscopy (EDS). The findings revealed a significant use of aluminum as a chemical substitute by manufacturers. In addition, some manufacturers do not mention the presence of this element in their implants. However, by addressing these issues and striving to improve transparency and safety standards, manufacturers have the opportunity to provide even more reliable products to patients.

Influence of surface characteristics of implant materials on MRSA biofilm formation and effects of antimicrobial treatment

Introduction

One of the main causes of treatment failure in bacterial prosthetic joint infections (PJI) is biofilm formation. The topography of the biofilm may be associated with susceptibility to antimicrobial treatment. The aims of this study were to assess differences in topography of biofilms on different implant materials and the correlation thereof with susceptibility to antimicrobial treatment.

Methods

Methicillin-resistant Staphylococcus aureus (MRSA) 7-day mature biofilms were generated on disks made from titanium alloys (Ti-6Al-7Nb and Ti-6Al-4V), synthetic polymer and orthopedic bone cement, commonly used in implant surgery. The surface topography of these implant materials and the biofilms cultured on them was assessed using atomic force microscopy. This provided detailed images, as well as average roughness (Ra) and peak-to-valley roughness (Rt) values in nanometers, of the biofilm and the material surfaces. Bacterial counts within biofilms were assessed microbiologically. Antimicrobial treatment of biofilms was performed by 24-h exposure to the combination of rifampicin and ciprofloxacin in concentrations of 1-, 5- and 10-times the minimal bactericidal concentration (MBC). Finally, treatment-induced differences in bacterial loads and their correlation with biofilm surface parameters were assessed.

Results

The biofilm surfaces on titanium alloys Ti-6Al-7Nb (Ra = 186 nm) and Ti-6Al-4V (Ra = 270 nm) were less rough than those of biofilms on silicone (Ra = 636 nm). The highest roughness was observed for biofilms on orthopedic bone cement with an Ra of 1,551 nm. Interestingly, the roughness parameters of the titanium alloys themselves were lower than the value for silicone, whereas the surface of the bone cement was the roughest. Treatment with 1- and 5-times the MBC of antibiotics resulted in inter-material differences in colony forming units (CFU) counts, ultimately showing comparable reductions of 2.4-3.0 log CFU/mL at the highest tested concentration. No significant differences in bacterial loads within MRSA biofilms were observed between the various implant materials, upon exposure to increasing concentrations of antibiotics.

Discussion

The surface parameters of MRSA biofilms were determined by those of the implant materials on which they were formed. The antibiotic susceptibility of MRSA biofilms on the various tested implant materials did not differ, indicating that the efficacy of antibiotics was not affected by the roughness of the biofilm.

Impact of machined versus structured implant shoulder designs on crestal bone level changes: a randomized, controlled, multicenter study

Purpose

The collar region of an implant is its connection to the oral cavity. A balance between osseointegration on one hand and the absence of plaque accumulation on the other hand is necessary for successful implantation. It is yet to be determined which implant collar design, polished or rough, is best to stabilize the crestal bone level, avoiding peri-implantitis and subsequent risk of implant loss. The aim of this study was to investigate the influence of the architecture of the collar region on marginal bone and soft tissue response.

Methods

This prospective, randomized, clinically controlled multicenter study included 58 patients undergoing dental implant treatment using a pair of dental implants with either machined or rough-surfaced shoulder regions. Patients were clinically and radiologically examined for bone level height and signs of inflammation after 6, 12 and 24 months.

Results

No implant was lost within the 2 years of follow-up (100% survival rate). No significant differences on crestal bone loss (machined neck: 0.61 mm ± 0.28 mm, rough neck 0.58 mm ± 0.24 mm) and on soft tissue response (probing depth 3–6 mm with bleeding on probing 7.6% in machined-neck implants and in 8.3% in rough neck implants) were observed between implants with machined and roughened neck after 2 years.

Conclusions

Machined and roughened neck implants achieved equally good results concerning peri-implant bone loss, the rate of peri-implantitis and implant survival rate/hard and soft tissue integration. None of the two collar designs showed a clear advantage in peri-implant reaction.

Trial registration German Clinical Trials Register, DKRS00029033. Registered 09 May 2022—Retrospectively registered, http://www.dkrs.de

Supplementary Information

The online version contains supplementary material available at 10.1186/s40729-022-00432-4.

Lipidome profiling with Raman microspectroscopy identifies macrophage response to surface topographies of implant materials

Biomaterial characteristics such as surface topographies have been shown to modulate macrophage phenotypes. The standard methodologies to measure macrophage response to biomaterials are marker-based and invasive. Raman microspectroscopy (RM) is a marker-independent, noninvasive technology that allows the analysis of living cells without the need for staining or processing. In the present study, we analyzed human monocyte-derived macrophages (MDMs) using RM, revealing that macrophage activation by lipopolysaccharides (LPS), interferons (IFN), or cytokines can be identified by lipid composition, which significantly differs in M0 (resting), M1 (IFN-γ/LPS), M2a (IL-4/IL-13), and M2c (IL-10) MDMs. To identify the impact of a biomaterial on MDM phenotype and polarization, we cultured macrophages on titanium disks with varying surface topographies and analyzed the adherent MDMs with RM. We detected surface topography-induced changes in MDM biochemistry and lipid composition that were not shown by less sensitive standard methods such as cytokine expression or surface antigen analysis. Our data suggest that RM may enable a more precise classification of macrophage activation and biomaterial-macrophage interaction.

Effects of toothbrush abrasion on surface and antibacterial properties of hydroxyapatite-tryptophan complex with gray titania

Photocatalysts have attracted attention in the medical field for their antibacterial effects. However, typical photocatalysts are activated by ultraviolet rays, which may have adverse effects. Therefore, we focused on a new photocatalyst that is activated by visible light, hydroxyapatite (HAp), and amino acid complex with gray titania, and evaluated its antibacterial effects against Porphyromonas gingivalis and effect by toothbrushing. The test sample was a titanium alloy substrate, and four surface treatments were applied: (1) substrate only, (2) substrate with HAp complex, (3) substrate with HAp complex with gray titania, and (4) HAp-tryptophan complex with gray titania (TR). These surface treatments were evaluated with or without toothbrushing (8 total groups). Surface roughness (Sa), fluorescent X-ray analysis (XRF), and scanning electron microscopy (SEM) were used to evaluate surface properties. To investigate antibacterial effects, each sample was seeded with P. gingivalis, irradiated with red light, and total viable bacterial count was determined. For Sa measurement, TR showed no significant difference after toothbrushing. However, in XRF and SEM observation, TR exhibited peeling of the applied coating after toothbrushing. In the antibacterial test, TR showed a decrease in P. gingivalis under no toothbrushing condition. Conversely, with toothbrushing, the TR coating appeared to peel. However, no significant difference in P. gingivalis count was observed among all groups. HAp-tryptophan complex with gray titania coating showed an antibacterial effect against P. gingivalis when irradiated with visible light. However, toothbrushing can result in coat peeling and consequently reduce the antibacterial effect.

Hard tissue volumetric and soft tissue contour linear changes at implants with different surface characteristics after experimentally induced peri-implantitis: an experimental in vivo investigation

OBJECTIVE

To evaluate the hard tissue volumetric and soft tissue contour linear changes in implants with two different implant surface characteristics after a ligature-induced peri-implantitis.

MATERIAL AND METHODS

In eight beagle dogs, implants with the same size and diameter but distinct surface characteristics were placed in the healed mandibular sites. Test implants had an external monolayer of multi-phosphonate molecules (B+), while control implants were identical but without the phosphonate-rich surface. Once the implants were osseointegrated, oral hygiene was interrupted and peri-implantitis was induced by placing subgingival ligatures. After 16 weeks, the ligatures were removed and peri-implantitis progressed spontaneously. Bone to implant contact (BIC) and bone loss (BL) were assessed three-dimensionally with Micro-Ct (μCT). Dental casts were optically scanned and the obtained digitalized standard tessellation language (STL) images were used to assess the soft tissue vertical and horizontal contour linear changes.

RESULTS

Reduction of the three-dimensional BIC percentage during the induction and progression phases of the experimental peri-implantitis was similar for both the experimental and control implants, without statistically significant differences between them. Soft tissue analysis revealed for both implant groups an increase in horizontal dimension after the induction of peri-implantitis, followed by a decrease after the spontaneous progression period. In the vertical dimension, a soft tissue dehiscence was observed in both groups, being more pronounced at the buccal aspect.

CONCLUSIONS

The added phosphonate-rich surface did not provide a more resistant environment against experimental peri-implantitis, when assessed by the changes in bone volume and soft tissue contours.

CLINICAL RELEVANCE

Ligature-induced peri-implantitis is a validated model to study the tissue changes occurring during peri-implantitis. It was hypothesized that a stronger osseointegration mediated by the chemical bond of a phosphonate-rich implant surface would develop an environment more resistant to the inflammatory changes occurring after experimental peri-implantitis. These results, however, indicate that the hard and soft tissue destructive changes occurring at both the induction and progression phases of experimental peri-implantitis were not influenced by the quality of osseointegration.

Stem-cell-derived ECM sheet-implant complexes for enhancing osseointegration

Numerous treatment methods have been developed to modify the surface of dental implants to improve cell migration and proliferation, removal torque, and osseointegration. Recent studies have constructed cell sheet-implant complexes with enhanced osteogenic capabilities. However, these complexes have some limitations, such as requirements for complex preparation processes, cell vitality maintenance, strict preservation conditions, and the induction of immunogenicity. Extracellular matrix (ECM) sheets without cells may be a more desirable material. To date, the effect of ECM sheets on implant osseointegration has not been reported. In this study, we fabricated ECM sheet-implant complexes through the combination of rat bone marrow mesenchymal stem cell (BMSC)-derived ECM sheets with sandblasted, large-grit, acid-etched (SLA) implants. These complexes were characterized by light microscopy, scanning electron microscopy (SEM), and immunofluorescence (IF) assays. The adhesion, proliferation, and osteogenic differentiation of BMSCs cultured on ECM sheets were detected in vitro. Then, the ECM sheet-implant complexes were transplanted into the metaphysis of the tibias of rats to evaluate the implant osseointegration in vivo. The results showed that ECM sheets were successfully constructed and showed significantly improved adhesion and proliferation. BMSCs cultured on ECM sheets upregulated the expression levels of the osteogenic-related genes alkaline phosphatase (ALP), bone morphogenetic protein 2 (BMP2), and runt-related transcription factor 2 (Runx2) compared to controls. In vivo, ECM sheet-implant complexes demonstrated superior new bone formation. Our findings proved that the BMSC-derived ECM sheets promoted osseointegration in vitro and in vivo. The current study indicated that the ECM sheet could be an ideal tissue engineering material, and ECM sheet-implant complexes could provide a strategy with low immunogenicity and easy storage and transportation. This research provides a novel strategy for the development of implant surface modification approaches.

Evaluation of osteogenic and antibacterial properties of strontium/silver-containing porous TiO2 coatings prepared by micro-arc oxidation

Ti and Ti alloys are bioinert materials and two frequent problems associated with them are bacterial infection and lack of osteogenic potential for rapid bone integration. To overcome the problems, the present study incorporated strontium (Sr) and silver (Ag) simultaneously into porous TiO₂ coatings through a single-step technique, micro-arc oxidation (MAO). Incorporation of Sr and Ag brought no significant changes to coating micromorphology and physicochemical properties, but endowed TiO₂ coatings with both strong antibacterial activity and osteogenic ability. Antibacterial activity increased with Ag contents in the coatings. When Ag content reached 0.58 wt%, the coating showed both excellent short-term (100.0%) and long-term (77.6%) antibacterial activities. Sr/Ag-containing coatings with 18.23 wt% Sr and 0.58 wt% Ag also presented good cytocompatibility for preosteoblast adhesion and proliferation, and promoted preosteoblast osteogenic differentiation both short-termly and long-termly. However, higher Ag content (1.29 wt%) showed toxic effects to preosteoblasts. In summary, MAO is a simple and effective way to incorporate Sr and Ag into porous TiO₂ coatings and Sr/Ag-containing TiO₂ coating with 18.5 wt% Sr and 0.58 wt% Ag has both good osteogenic activity and strong antibacterial capability short-termly and long-termly. Therefore, such coatings are valuable for clinical application to strengthen osseointegration and long-term high quality use of titanum implants.

Complications of Fixed Full-Arch Implant-Supported Metal-Ceramic Prostheses

We aimed to assess the biological and mechanical-technical complications and survival rate of implants of full-arch metal-ceramic prostheses, during five years of follow-up. 558 implants (of three different brands) retaining 80 full-arch metal-ceramic prostheses were placed in 65 patients, all of whom were examined annually for biological and mechanical-technical complications during the five years of follow-up. Descriptive statistics and univariate logistic regression were calculated. The cumulative survival rate of the implants was 99.8%, and 98.8% prosthesis-based. Mucositis was the most frequent of the biological complications and peri-implantitis was recorded as 13.8% at restoration-level, 16.9% at patient level and 2.0% at implant level. An implant length greater than 10 mm was shown to be a protective factor against biological complications. The mechanical-technical complications were associated with implant diameter, abutment/implant connection and retention system. Loss of screw access filling was the most frequent prosthetic complication, followed by the fracture of the porcelain. Full-arch metal-ceramic prostheses show a high prevalence of implant and prosthesis survival, with few biological and mechanical-technical complications.

Surface modification of titanium manufactured through selective laser melting inhibited osteoclast differentiation through mitogen-activated protein kinase signaling pathway

Selective laser melting used in manufacturing custom-made titanium implants becomes more popular. In view of the important role played by osteoclasts in peri-implant bone resorption and osseointegration, we modified selective laser melting-manufactured titanium surfaces using sandblasting/alkali-heating and sandblasting/acid-etching, and investigated their effect on osteoclast differentiation as well as their underlying mechanisms. The properties of the surfaces, including elements, roughness, wettability and topography, were analyzed. We evaluated the proliferation and morphology of primary mouse bone marrow-derived monocytes, as well as induced osteoclasts derived from bone marrow-derived monocytes, on samples. Then, osteoclast differentiation was determined by the tartrate-resistant acid phosphatase activity assay, calcitonin receptors immunofluorescence staining and the expression of osteoclast-related genes. The results showed that sandblasting/alkali-heating established nanonet structure with the lowest water contact angle, and both sandblasting/alkali-heating and sandblasting/acid-etching significantly decreased surface roughness and heterogeneity compared with selective laser melting. Surface modifications of selective laser melting-produced titanium altered bone marrow-derived monocyte morphology and suppressed bone marrow-derived monocyte proliferation and osteoclastogenesis in vitro (sandblasting/alkali-heating>sandblasting/acid-etching>selective laser melting). These surface modifications reduced the activation of extracellular signal-regulated kinase and c-Jun N-terminal kinases compared to native-selective laser melting. Sandblasting/alkali-heating additionally blocked tumor necrosis factor receptor-associated factor 6 recruitment. The results suggested that sandblasting/alkali-heating and sandblasting/acid-etching modifications on selective laser melting titanium could inhibit osteoclast differentiation through suppressing extracellular signal-regulated kinase and c-Jun N-terminal kinase phosphorylation in mitogen-activated protein kinase signaling pathway and provide a promising technique which might reduce peri-implant bone resorption for optimizing native-selective laser melting implants.