The Effects of Titanium Implant Surface Topography on Osseointegration: Literature Review

Effects of dental implant surface treated with sandblasting large grit acid-etching and femtosecond laser on implant stability, marginal bone volume, and histological results in a rabbit model

PURPOSE

The purpose of this study was to compare the surface characteristics and healing patterns after implantation of implants treated with SLA and those treated with both SLA and femtosecond laser.

MATERIALS AND METHODS

A total of 10 male New Zealand white rabbits were used to compare recovery levels between implants treated with SLA (SLA group) and those treated with both SLA and femtosecond laser (SF group). The implants' surface characteristics were determined through topographic evaluation, element analysis, surface roughness, and wettability evaluation. In total, 4 implants were placed in each rabbit (2 in each tibia), with 20 implants per treatment group. Using the implant stability quotient (ISQ), marginal bone volume, and histological analysis (bone-to-implant contact (BIC), bone volume/tissue volume (BV/TV)), and post implantation outcomes were assessed. Outcome data were analyzed using independent t-tests, Mann-Whitney U tests, Wilcoxon signed-rank tests, and one-way ANOVA (α = 0.05).

RESULTS

No significant differences were noted between SLA and SF groups in terms of ISQ, marginal bone volume, BIC, and BV/TV (P > .05). However, significant differences in ISQ were observed within each group over time (P < .05). Furthermore, significant differences were noted in the marginal bone volume of the SF group (P < .05) and the BV/TV of the SLA group between weeks 4 and 6 (P < .05).

CONCLUSION

Surface treatment via SLA and femtosecond laser is feasible compared with SLA treatment alone in terms of ISQ, marginal bone volume, BIC, and BV/TV. However, further clinical research is warranted.

Surface Topography Has Less Influence on Peri-Implantitis than Patient Factors: A Comparative Clinical Study of Two Dental Implant Systems

OBJECTIVES

This study aims to assess the risk of peri-implantitis (PI) onset among different implant systems and evaluate the severity of the disease from a population of patients treated in a university clinic. Furthermore, this study intends to thoroughly examine the surface properties of the implant systems that have been identified and investigated.

MATERIAL AND METHODS

Data from a total of six hundred and 14 patients were extracted from the Institute of Clinical Dentistry, Dental Faculty, University of Oslo. Subject- and implant-based variables were collected, including the type of implant, date of implant installation, medical records, recall appointments up to 2022, periodontal measurements, information on diabetes, smoking status, sex, and age. The outcome of interest was the diagnosis of PI, defined as the occurrence of bleeding on probing (BoP), peri-implant probing depth (PD) ≥ 5 mm, and bone loss (BL). Data were analyzed using multivariate linear and logistic regression. Scanning electron microscopy, light laser profilometer, and X-ray photoelectron spectroscopy were utilized for surface and chemical analyses.

RESULTS

Among the patients evaluated, 6.8% were diagnosed with PI. A comparison was made between two different implant systems: Dentsply Sirona, OsseospeedTM and Straumann SLActive, with mean follow-up times of 3.84 years (SE: 0.15) and 3.34 years (SE: 0.15), respectively. The surfaces have different topographies and surface chemistry. However, no significant association was found between PI and implant surface/system, including no difference in the onset or severity of the disease. Nonetheless, plaque control was associated with an increased risk of developing PI, along with the gender of the patient. Furthermore, patients suffering from PI exhibited increased BL in the anterior region.

CONCLUSION

No differences were observed among the evaluated implant systems, although the surfaces have different topography and chemistry. Factors that affected the risk of developing PI were plaque index and male gender. The severity of BL in patients with PI was more pronounced in the anterior region. Consequently, our findings show that success in implantology is less contingent on selecting implant systems and more on a better understanding of patient-specific risk factors, as well as on implementing biomaterials that can more effectively debride dental implants.

On the Use of Nanoparticles in Dental Implants

Results obtained in physics, chemistry and materials science on nanoparticles have drawn significant interest in the use of nanostructures on dental implants. The main focus concerns nanoscale surface modifications of titanium-based dental implants in order to increase the surface roughness and provide a better bone-implant interfacial area. Surface coatings via the sol-gel process ensure the deposition of a homogeneous layer of nanoparticles or mixtures of nanoparticles on the titanium substrate. Nanotubular structures created on the titanium surface by anodic oxidation yield an interesting nanotopography for drug release. Carbon-based nanomaterials hold great promise in the field of dentistry on account of their outstanding mechanical properties and their structural characteristics. Carbon nanomaterials that include carbon nanotubes, graphene and its derivatives (graphene oxide and graphene quantum dots) can be used as coatings of the implant surface. Their antibacterial properties as well as their ability to be functionalized with adequate chemical groups make them particularly useful for improving biocompatibility and promoting osseointegration. Nevertheless, an evaluation of their possible toxicity is required before being exploited in clinical trials.

Mechanotransducive surfaces for enhanced cell osteogenesis, a review

Novel strategies employing mechano-transducing materials eliciting biological outcomes have recently emerged for controlling cellular behaviour. Targeted cellular responses are achieved by manipulating physical, chemical, or biochemical modification of material properties. Advances in techniques such as nanopatterning, chemical modification, biochemical molecule embedding, force-tuneable materials, and artificial extracellular matrices are helping understand cellular mechanotransduction. Collectively, these strategies manipulate cellular sensing and regulate signalling cascades including focal adhesions, YAP-TAZ transcription factors, and multiple osteogenic pathways. In this minireview, we are providing a summary of the influence that these materials, particularly titanium-based orthopaedic materials, have on cells. We also highlight recent complementary methodological developments including, but not limited to, the use of metabolomics for identification of active biomolecules that drive cellular differentiation.

An Update on Implant-Associated Malignancies and Their Biocompatibility

Implanted medical devices are widely used across various medical specialties for numerous applications, ranging from cardiovascular supports to orthopedic prostheses and cosmetic enhancements. However, recent observations have raised concerns about the potential of these implants to induce malignancies in the tissues surrounding them. There have been several case reports documenting the occurrence of cancers adjacent to these devices, prompting a closer examination of their safety. This review delves into the epidemiology, clinical presentations, pathological findings, and hypothesized mechanisms of carcinogenesis related to implanted devices. It also explores how the surgical domain and the intrinsic properties and biocompatibility of the implants might influence the development of these rare but serious malignancies. Understanding these associations is crucial for assessing the risks associated with the use of medical implants, and for developing strategies to mitigate potential adverse outcomes.

Analyzing the Surface Topography of Hafnium Nitride Coating on Titanium Screws: An In Vitro Analysis

Background The use of surface coatings to enhance the properties lacking in titanium has attracted significant focus in recent times. Hafnium nitride (HfN) coatings could be explored as promising in the osteoinductive properties of titanium implants. HfN exhibits excellent mechanical attributes, such as hardness and wear resistance, and is often used as a coating on high-end equipment for protection. The findings from this research may carve a new path for the production and optimization of HfN coatings to enhance the longevity and augment properties of implant materials. Thus, the present study was orchestrated to elucidate the surface morphology of HfN coating, ultimately contributing to the advancement of dental implant biomaterials. Materials and methods A total of twenty samples of medical grade commercially pure titanium screws (2 mm diameter and 7 mm length) were procured from G. R. Bioure Surgical System Pvt. Ltd., Ravali, Uttar Pradesh, India, and ten samples were reacted with HfN (0.1 M) (Nano Research Elements, Kurukshetra, Haryana, India) in 100% ethanol and stirred continuously for about 48 hours. Then these screw samples were immersed in the prepared colloidal suspension and sintered for two hours at 400 degrees centigrade. The implant screws were affixed onto metal supports. The magnifications for photomicrographs at ×30, ×200, ×1,500, ×3,000, and ×5,000 were standardized. Elementary semi-quantitative analysis of both dental implants was conducted using energy-dispersive X-ray spectrometry (EDX) coupled with the field emission scanning electron microscope (FE-SEM) equipment (JEOL Ltd., Akishima, Tokyo, Japan). The software used for the analysis of the obtained images is SEM Center. Results The surface analysis using the scanning electron microscope (SEM) showed the coating of HfN over titanium screws. The difference in surface morphology of both the group of implant screws can be visualized under 40.0 and 10.0 mm working distance (WD) for both groups. The surface analysis using the EDX of uncoated titanium screws shows five elements in the spectrum: titanium (Ti), oxygen (O), aluminum (Al), carbon (C), and vanadium (V). The EDX of the HfN-coated screws has two additional metals dispersed in the spectrum, hafnium (Hf). The element characteristics are tabulated with their apparent concentration, k ratio, line type, weight percentage, standard label, and factory label for uncoated titanium screws and HfN-coated titanium screws. Conclusion The study evaluated HfN coating over medical grade commercially pure titanium. The surface topography of coated versus uncoated was visualized. The scanning electron microscope (SEM) images showed a homogenous coating over the titanium surfaces, and the EDX showed elemental dispersion of the coated implant. The study aims to provide a comprehensive understanding of the coating's surface morphology, which will aid in the development of more durable and biocompatible implants. This thereby provides a promising scope for further research of this novel metal coating for use in the biomedical sectors, specifically for dental implants.

Antifouling Behavior of Copper-Modified Titania Nanotube Surfaces

Titanium and its alloys are commonly used to fabricate orthopedic implants due to their excellent mechanical properties, corrosion resistance, and biocompatibility. In recent years, orthopedic implant surgeries have considerably increased. This has also resulted in an increase in infection-associated revision surgeries for these implants. To combat this, various approaches are being investigated in the literature. One of the approaches is modifying the surface topography of implants and creating surfaces that are not only antifouling but also encourage osteointegration. Titania nanotube surfaces have demonstrated a moderate decrease in bacterial adhesion while encouraging mesenchymal stem cell adhesion, proliferation, and differentiation, and hence were used in this study. In this work, titania nanotube surfaces were fabricated using a simple anodization technique. These surfaces were further modified with copper using a physical vapor deposition technique, since copper is known to be potent against bacteria once in contact. In this study, scanning electron microscopy was used to evaluate surface topography; energy-dispersive X-ray spectroscopy and X-ray photoelectron spectroscopy were used to evaluate surface chemistry; contact angle goniometry was used to evaluate surface wettability; and X-ray diffraction was used to evaluate surface crystallinity. Antifouling behavior against a gram-positive and a gram-negative bacterium was also investigated. The results indicate that copper-modified titania nanotube surfaces display enhanced antifouling behavior when compared to other surfaces, and this may be a potential way to prevent infection in orthopedic implants.

Laser-Induced µ-Rooms for Osteocytes on Implant Surface: An In Vivo Study

Laser processing of dental implant surfaces is becoming a more widespread replacement for classical techniques due to its undeniable advantages, including control of oxide formation and structure and surface relief at the microscale. Thus, using a laser, we created several biomimetic topographies of various shapes on the surface of titanium screw-shaped implants to research their success and survival rates. A distinctive feature of the topographies is the presence of "µ-rooms", which are special spaces created by the depressions and elevations and are analogous to the µ-sized room in which the osteocyte will potentially live. We conducted the comparable in vivo study using dental implants with continuous (G-topography with µ-canals), discrete (S-topography with μ-cavities), and irregular (I-topography) laser-induced topographies. A histological analysis performed with the statistical method (with p-value less than 0.05) was conducted, which showed that G-topography had the highest BIC parameter and contained the highest number of mature osteocytes, indicating the best secondary stability and osseointegration.

Effect of Surface Tooling Techniques of Medical Titanium Implants on Bacterial Biofilm Formation In Vitro

The aim of this study was to assess the biofilm formation of Streptococcus mutans, Staphylococcus aureus, Enterococcus faecalis, and Escherichia coli on titanium implants with CAD-CAM tooling techniques. Twenty specimens of titanium were studied: Titanium grade 2 tooled with a Planmeca CAD-CAM milling device (TiGrade 2), Ti6Al4V grade 5 as it comes from CAD-DMLS device (computer aided design-direct metal laser sintering device) (TiGrade 5), Ti6Al4V grade 23 as it comes from a CAD-CAM milling device (TiGrade 23), and CAD-DMLS TiGrade 5 polished with an abrasive disc (TiGrade 5 polished). Bacterial adhesion on the implants was completed with and without saliva treatment to mimic both extraoral and intraoral surgical methods of implant placement. Five specimens/implant types were used in the bacterial adhesion experiments. Autoclaved implant specimens were placed in petri plates and immersed in saliva solution for 30 min at room temperature and then washed 3×with 1 ×PBS. Bacterial suspensions of each strain were made and added to the specimens after saliva treatment. Biofilm was allowed to form for 24 h at 37 °C and the adhered bacteria was calculated. Tooling techniques had an insignificant effect on the bacterial adhesion by all the bacterial strains studied. However, there was a significant difference in biofilm formation between the saliva-treated and non-saliva-treated implants. Saliva contamination enhanced S. mutans, S. aureus, and E. faecalis adhesion in all material types studied. S. aureus was found to be the most adherent strain in the saliva-treated group, whereas E. coli was the most adherent strain in the non-saliva-treated group. In conclusion, CAD-CAM tooling techniques have little effect on bacterial adhesion. Saliva coating enhances the biofilm formation; therefore, saliva contamination of the implant must be minimized during implant placement. Further extensive studies are needed to evaluate the effects of surface treatments of the titanium implant on soft tissue response and to prevent the factors causing implant infection and failure.

The Bumpy Road to Stem Cell Therapies: Rational Design of Surface Topographies to Dictate Stem Cell Mechanotransduction and Fate

Cells sense and respond to a variety of physical cues from their surrounding microenvironment, and these are interpreted through mechanotransductive processes to inform their behavior. These mechanisms have particular relevance to stem cells, where control of stem cell proliferation, potency, and differentiation is key to their successful application in regenerative medicine. It is increasingly recognized that surface micro- and nanotopographies influence stem cell behavior and may represent a powerful tool with which to direct the morphology and fate of stem cells. Current progress toward this goal has been driven by combined advances in fabrication technologies and cell biology. Here, the capacity to generate precisely defined micro- and nanoscale topographies has facilitated the studies that provide knowledge of the mechanotransducive processes that govern the cellular response as well as knowledge of the specific features that can drive cells toward a defined differentiation outcome. However, the path forward is not fully defined, and the "bumpy road" that lays ahead must be crossed before the full potential of these approaches can be fully exploited. This review focuses on the challenges and opportunities in applying micro- and nanotopographies to dictate stem cell fate for regenerative medicine. Here, key techniques used to produce topographic features are reviewed, such as photolithography, block copolymer lithography, electron beam lithography, nanoimprint lithography, soft lithography, scanning probe lithography, colloidal lithography, electrospinning, and surface roughening, alongside their advantages and disadvantages. The biological impacts of surface topographies are then discussed, including the current understanding of the mechanotransductive mechanisms by which these cues are interpreted by the cells, as well as the specific effects of surface topographies on cell differentiation and fate. Finally, considerations in translating these technologies and their future prospects are evaluated.

Enhancement of Intracellular Calcium Ion Mobilization by Moderately but Not Highly Positive Material Surface Charges

Electrostatic forces at the cell interface affect the nature of cell adhesion and function; but there is still limited knowledge about the impact of positive or negative surface charges on cell-material interactions in regenerative medicine. Titanium surfaces with a variety of zeta potentials between −90 mV and +50 mV were generated by functionalizing them with amino polymers, extracellular matrix proteins/peptide motifs and polyelectrolyte multilayers. A significant enhancement of intracellular calcium mobilization was achieved on surfaces with a moderately positive (+1 to +10 mV) compared with a negative zeta potential (−90 to −3 mV). Dramatic losses of cell activity (membrane integrity, viability, proliferation, calcium mobilization) were observed on surfaces with a highly positive zeta potential (+50 mV). This systematic study indicates that cells do not prefer positive charges in general, merely moderately positive ones. The cell behavior of MG-63s could be correlated with the materials’ zeta potential; but not with water contact angle or surface free energy. Our findings present new insights and provide an essential knowledge for future applications in dental and orthopedic surgery.

A Novel Cytocompatibility Strengthening Strategy of Ultrafine-Grained Pure Titanium

Ultrafine-grained pure (UFG) titanium processed by equal channel angular pressing possesses mechanical properties comparable to those of Ti-6Al-4V and features more favorable friction resistance, biocompatibility, and corrosion resistance than does commercially pure (CP) titanium. Nevertheless, UFG titanium is still a bio-inert material with a lack of bone-inducing ability. Here, TiO₂-hydroxyapatite (TiO₂-HA) coatings were fabricated on CP titanium and UFG titanium through combining micro-arc oxidation and hydrothermal treatment together to improve their cytocompatibility. The results indicate that, compared with conventional coatings that use CP titanium as the substrate, such coatings formed on the UFG titanium possess additional hydrophilicity and in vitro cytocompatibility. The fantastic hierarchical structure of the UFG TiO₂-HA coating (UG-MH coating), including microscale and nanoscale pores and short column-shaped and sheet-shaped HA grains with varying geometric shapes, excellent hydrophilicity, and high polar force, enhances the mutual effects between the osteoblasts and titanium implant since it provides an adequate microenvironment for the ingrowth of osteoblasts, inducing osteoblast adhesion, proliferation, and differentiation. The UG-MH coating has a synergistic effect due to its fantastic hydrophilic hierarchical structure and high polar force on the up-regulated expression of cytoskeletal actin proteins as well as osteocalcin, protein kinase C (PKC), nuclear factor of activated T-cells (NFAT), and Wnt5, enabling osteoblasts to differentiate via the Wnt calcium-dependent signaling pathway. This study highlights the idea that the modified UFG titanium will be more suitable than CP titanium in dental and orthopedic applications.