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The surface modification of dental implants plays an important role in establishing a successful interaction of the implant with the surrounding tissue, as the bioactivity and osseointegration properties are strongly dependent on the physicochemical properties of the implant surface. A surface coating with bioactive molecules that stimulate the formation of a mineral calcium phosphate (CaP) layer has a positive effect on the bone bonding process, as biomineralization is crucial for improving the osseointegration process and rapid bone ingrowth. In this work, the spontaneous deposition of calcium phosphate on the titanium surface covered with chemically stable and covalently bound alendronate molecules was investigated using an integrated experimental and theoretical approach. The initial nucleation of CaP was investigated using quantum chemical calculations at the density functional theory (DFT) level. Negative Gibbs free energies show a spontaneous nucleation of CaP on the biomolecule-covered titanium oxide surface. The deposition of calcium and phosphate ions on the alendronate-modified titanium oxide surface is governed by Ca2+–phosphonate (-PO3H) interactions and supported by hydrogen bonding between the phosphate group of CaP and the amino group of the alendronate molecule. The morphological and structural properties of CaP deposit were investigated using scanning electron microscopy, energy dispersive X-ray spectroscopy, X-ray diffraction and attenuated total reflectance Fourier transform infrared spectroscopy. This integrated experimental–theoretical study highlights the spontaneous formation of CaP on the alendronate-coated titanium surface, confirming the bioactivity ability of the alendronate coating. The results provide valuable guidance for the promising forthcoming advancements in the development of biomaterials and surface modification of dental implants. [ABSTRACT FROM AUTHOR]

Currently used methods to repair craniomaxillofacial (CMF) bone and tooth defects require a multi-staged surgical approach for bone repair followed by dental implant placement. Our previously published results demonstrated significant bioengineered bone formation using human dental pulp stem cell (hDPSC)-seeded tyrosine-derived polycarbonate scaffolds (E1001(1K)-bTCP). Here, we improved upon this approach using a modified TyroFill (E1001(1K)/dicalcium phosphate dihydrate (DCPD)) scaffold-supported titanium dental implant model for simultaneous bone–dental implant repair. TyroFill scaffolds containing an embedded titanium implant, with (n = 3 each time point) or without (n = 2 each time point) seeded hDPCs and Human Umbilical Vein Endothelial Cells (HUVECs), were cultured in vitro. Each implant was then implanted into a 10 mm full-thickness critical-sized defect prepared on a rabbit mandibulee. After 1 and 3 months, replicate constructs were harvested and analyzed using Micro-CT histological and IHC analyses. Our results showed significant new bone formation surrounding the titanium implants in cell-seeded TyroFill constructs. This study indicates the potential utility of hDPSC/HUVEC-seeded TyroFill scaffolds for coordinated CMF bone–dental implant repair. [ABSTRACT FROM AUTHOR]

The surface modification of dental implants plays an important role in establishing a successful interaction of the implant with the surrounding tissue, as the bioactivity and osseointegration properties are strongly dependent on the physicochemical properties of the implant surface. A surface coating with bioactive molecules that stimulate the formation of a mineral calcium phosphate (CaP) layer has a positive effect on the bone bonding process, as biomineralization is crucial for improving the osseointegration process and rapid bone ingrowth. In this work, the spontaneous deposition of calcium phosphate on the titanium surface covered with chemically stable and covalently bound alendronate molecules was investigated using an integrated experimental and theoretical approach. The initial nucleation of CaP was investigated using quantum chemical calculations at the density functional theory (DFT) level. Negative Gibbs free energies show a spontaneous nucleation of CaP on the biomolecule-covered titanium oxide surface. The deposition of calcium and phosphate ions on the alendronate-modified titanium oxide surface is governed by Ca2+–phosphonate (-PO3H) interactions and supported by hydrogen bonding between the phosphate group of CaP and the amino group of the alendronate molecule. The morphological and structural properties of CaP deposit were investigated using scanning electron microscopy, energy dispersive X-ray spectroscopy, X-ray diffraction and attenuated total reflectance Fourier transform infrared spectroscopy. This integrated experimental–theoretical study highlights the spontaneous formation of CaP on the alendronate-coated titanium surface, confirming the bioactivity ability of the alendronate coating. The results provide valuable guidance for the promising forthcoming advancements in the development of biomaterials and surface modification of dental implants.

Abstract Background Titanium (Ti) is now widely used as implant material due to its excellent mechanical properties and superior biocompatibilities, while its inert bioactivities might lead to insufficient osseointegration, and limit its performance in dental applications. Methods We introduced a robust and simple approach of modifying titanium surfaces with polysaccharide complexes. Titanium samples were subjected to hydrothermal treatment to create a uniform porous structure on the surface, followed by coating with a bioinspired and self-assembly polydopamine layer. Strontium Eucommia Ulmoides Polysaccharide (EUP-Sr) complexes are then introduced to the polydopamine-coated porous titanium. Multiple morphological and physiochemical characterizations are employed for material evaluation, while cell proliferation and gene expression tests using macrophages, primary alveolar bone osteoblasts, and vascular endothelial cells are used to provide an overall insight into the functions of the product. The significances of statistical differences were analyzed using student’s t-test. Results Microscopic and spectrometric characterizations confirmed that the Ti surface formed a porous structure with an adequate amount of EUP-Sr loading. The attachment was attributed to hydrogen bonding between the ubiquitous glycosidic linkage of the polysaccharide complex and the ring structure of polydopamine, yet the loaded EUP-Sr complex can be gradually released, consequently benefiting the neighboring microenvironment. Cell experiments showed no cytotoxicity of the material, and the product showed promising anti-inflammation, osseointegration, and angiogenesis properties, which were further confirmed by in vivo evaluations. Conclusion We believe the EUP-Sr modified titanium implant is a promising candidate to be used in dental applications with notable osteoimmunomodulation and angiogenesis functions. And the novel technique proposed in this study would benefit the modification of metal/inorganic surfaces with polysaccharides for future research.

Purpose: The aim of this study was to compare how two innovative laser titanium surfaces and sandblasted and acid-etched surfaces influence human osteoblast behavior during osteogenesis and the initial phases of bone deposition. Materials and Methods: Human osteoblasts from human adipose stem cells were sorted by flow cytometric analysis and induced to differentiate. After 40 days, the osteogenic differentiation was detected by alizarin red staining, and the alkaline phosphatase (ALP) was evaluated with western blot (WB) and real-time reverse transcriptase-polymerase chain reaction (RT-PcR) analysis. After confluence, human osteoblasts were cultured onto two different innovative laser-obtained titanium surfaces (L1 and L2) and compared with one sandblasted and acid-etched (SBAE) surface as the control. At different times, human osteoblast behavior was evaluated with cell proliferation viability assay (MTT), scanning electron microscopy (SEM), energy-dispersive x-rays (EDAX), osteogenic markers with RT-PcR, and WB analysis of matrix extracellular phosphoglycoprotein (MEPE), ALP, and osteocalcin (OCN). Results: After cell sorting, the human osteoblasts from human adipose stem cells showed increasing values of ALP mRNA and protein expression. The osteogenic differentiation was confirmed by quantitative alizarin red staining assay. Profilometric and SEM analysis showed relevant differences between SBAE, L1, and L2 specimens. After 20 days of culture onto titanium samples, SEM evaluation showed a small number of human osteoblasts and isolated sites of bone matrix deposition in SBAE specimens. At the same time, on L1 surfaces, only an osteoblast mono-layer with initial bone deposition was found, while on L2 specimens, there was a thick network with flattened large stellate cells, many cellular interconnections with strong titanium adhesion, and a large complex mineralized structure of crystal bone. After 20 days, for all titanium samples, human osteoblasts culturing EDAX analysis showed the absence of impurities and a higher bone matrix deposition in L2 specimens compared with L1 and SBAE samples. Conclusion: The innovative microtopography and nanotopography laser-induced surface showed high biocompatibility with primary human osteoblast cultures and the absence of impurities. The innovative laser texture was capable of influencing the osteogenic process, confirming the critical role of titanium surface characteristics in the cell adhesion and bone deposition during the early phases of osseointegration. The association of human adipose stem cells and titanium surfaces laser-induced with an innovative procedure could generate promising improvements and developments in orthopedics, maxillofacial, and dental implant surgery. [ABSTRACT FROM AUTHOR]

Currently used methods to repair craniomaxillofacial (CMF) bone and tooth defects require a multi-staged surgical approach for bone repair followed by dental implant placement. Our previously published results demonstrated significant bioengineered bone formation using human dental pulp stem cell (hDPSC)-seeded tyrosine-derived polycarbonate scaffolds (E1001(1K)-bTCP). Here, we improved upon this approach using a modified TyroFill (E1001(1K)/dicalcium phosphate dihydrate (DCPD)) scaffold-supported titanium dental implant model for simultaneous bone–dental implant repair. TyroFill scaffolds containing an embedded titanium implant, with (n = 3 each time point) or without (n = 2 each time point) seeded hDPCs and Human Umbilical Vein Endothelial Cells (HUVECs), were cultured in vitro. Each implant was then implanted into a 10 mm full-thickness critical-sized defect prepared on a rabbit mandibulee. After 1 and 3 months, replicate constructs were harvested and analyzed using Micro-CT histological and IHC analyses. Our results showed significant new bone formation surrounding the titanium implants in cell-seeded TyroFill constructs. This study indicates the potential utility of hDPSC/HUVEC-seeded TyroFill scaffolds for coordinated CMF bone–dental implant repair.

The success of the osseointegration process depends on the surface characteristics and chemical composition of dental implants. Therefore, the titanium dental implant was functionalised with a composite coating of alendronate and hydrolysed collagen, which are molecules with a positive influence on the bone formation. The results of the quantum chemical calculations at the density functional theory level confirm a spontaneous formation of the composite coating on the titanium implant, ∆G*INT = −8.25 kcal mol−1. The combination of the results of X-ray photoelectron spectroscopy and quantum chemical calculations reveals the structure of the coating. The alendronate molecules dominate in the outer part, while collagen tripeptides prevail in the inner part of the coating. The electrochemical stability and resistivity of the implant modified with the composite coating in a contact with the saliva depend on the chemical nature of alendronate and collagen molecules, as well as their inter- and intramolecular interactions. The formed composite coating provides a 98% protection to the implant after the 7-day immersion in the artificial saliva. From an application point of view, the composite coating could effectively promote osseointegration and improve the implant's resistivity in contact with an aggressive environment such as saliva. [ABSTRACT FROM AUTHOR]

Objectives: Soft tissue integration of dental implants lags behind natural biological integration of teeth mainly because of non-optimal surface features. Peri-implant infections resulting in loss of supporting bone jeopardize the success of implants. Our aim was to compare an anodized surface design with a turned one for a more optimal surface. Methods: Morphological and chemical structures of turned and anodized Ti surfaces (grade 5: Ti6Al4V) discs were examined by scanning electron microscopy (SEM-EDS), energy dispersive X-ray spectroscopy (EDS), and atomic force microscopy (AFM). The hydrophilic or hydrophobic features of the surfaces were determined by dynamic contact angle measurement. Results: SEM and AFM revealed significant differences in the morphology and roughness (Ra) of the samples. Anodized discs presented a granular structure, while turned ones had circular grooves. The roughness was significantly higher for the anodized samples compared to the turned ones. XPS and EDS confirmed typical elements for both Ti6Al4V samples. Due to anodization, the amount of Ti (IV) had increased and Ti (III) had decreased in the thicker oxide layer. Anodized samples resulted in a more hydrophilic surface than the turned ones. Significance: The results suggest that the tested anodized samples present optimal surface characteristics to be used as abutment material for an optimal soft tissue integration.

Surface treatments of Ti in the dental implant industry are performed with the aim of in-creasing its bioactivity and osseointegration capacity. Chitosan (Cht) is a polysaccharide that has been proposed as a promising biomaterial in tissue engineering and bone regeneration, due to its ability to stimulate the recruitment and adhesion of osteogenic progenitor cells. The aim of our preliminary study was to evaluate, by micro-computed tomography (micro-CT), the osseointegration and bone formation around Cht-coated implants and to compare them with conventional surface-etched implants (SLA type). Four im-plants (8.5 mm length × 3.5 mm Ø) per hemiarch, were inserted into the jaws of five dogs, divided into two groups: chitosan-coated implant group (ChtG) and control group (CG). Twelve weeks after surgery, euthanasia was performed, and sectioned bone blocks were obtained and scanned by micro-CT and two bone parameters were measured: bone in contact with the implant surface (BCIS) and peri-implant bone area (PIBA). For BCIS and PIBA statistically significant values were obtained for the ChtG group with respect to CG (p = 0.005; p = 0.014 and p < 0.001 and p = 0.002, respectively). The results, despite the limitations, demonstrated the usefulness of chitosan coatings. However, studies with larger sample sizes and adequate experimental models would be necessary to confirm the results.

Purpose: In order to promote osseointegration and shorten the healing time after dental implant operations, this study was conducted to develop a chair-side plasma treatment system in which Ti implants were used as a coaxial internal electrode to rapidly enhance their surface hydrophilicity.Methods: Surface hydrophilicity was evaluated by measurement of the water contact angle and the defined wetting time. Changes in temperature and chemical composition were analyzed using infrared thermal imaging and X-ray photoelectron spectroscopy (XPS), respectively. The biocompatibility of the treated implants was examined in an animal experiment.Results: A marked improvement of hydrophilicity was demonstrated by a decrease in the water contact angle of the treated implant to 0° and wetting of the whole surface within 3 s of water contact. The Ti implant hydrophilization mechanism was explained as a decrease in the degree of hydrocarbon contamination. The surface temperature of the treated implant was close to that of the human body, and good osseointegration was observed in the in vivo experiment.Conclusion: The plasma treatment system developed here is a promising chair-side procedure for rapidly enhancing the surface hydrophilicity of Ti implants in clinical operations without any need to consider the degradation of hydrophilicity caused by long-term storage. [ABSTRACT FROM AUTHOR]

The success of the osseointegration process depends on the surface characteristics and chemical composition of dental implants. Therefore, the titanium dental implant was functionalised with a composite coating of alendronate and hydrolysed collagen, which are molecules with a positive influence on the bone formation. The results of the quantum chemical calculations at the density functional theory level confirm a spontaneous formation of the composite coating on the titanium implant, ∆G*INT = −8.25 kcal mol−1. The combination of the results of X-ray photoelectron spectroscopy and quantum chemical calculations reveals the structure of the coating. The alendronate molecules dominate in the outer part, while collagen tripeptides prevail in the inner part of the coating. The electrochemical stability and resistivity of the implant modified with the composite coating in a contact with the saliva depend on the chemical nature of alendronate and collagen molecules, as well as their inter- and intramolecular interactions. The formed composite coating provides a 98% protection to the implant after the 7-day immersion in the artificial saliva. From an application point of view, the composite coating could effectively promote osseointegration and improve the implant’s resistivity in contact with an aggressive environment such as saliva.

In recent years, implantology has made significant progress, as it has now become a safe and predictable practice. The development of new geometries, primary and secondary, of new surfaces and alloys, has made this possible. The purpose of this review is to analyze the different alloys present on the market, such as that in zirconia, and evaluate their clinical differences with those most commonly used, such as those in grade IV titanium. The review, conducted on major scientific databases such as Scopus, PubMed, Web of Science and MDPI yielded a startling number of 305 results. After the application of the filters and the evaluation of the results in the review, only 10 Randomized Clinical Trials (RCTs) were included. Multiple outcomes were considered, such as Marginal Bone Level (MBL), Bleeding on Probing (BoP), Survival Rate, Success Rate and parameters related to aesthetic and prosthetic factors. There are currently no statistically significant differences between the use of zirconia implants and titanium implants, neither for fixed prosthetic restorations nor for overdenture restorations. Only the cases reported complain about the rigidity and, therefore, the possibility of fracture of the zirconium. Certainly the continuous improvement in these materials will ensure that they could be used safely while maintaining their high aesthetic performance.

It has been demonstrated that the osteoconductivity, hydrophilicity, and biological capacity of titanium decreases over time, and this phenomenon was described as the biological aging of titanium. The aim of this study was to evaluate whether the age of sand-blasted and acid-etched (SLA) titanium dental implants (duration from the production date until the date of dental implant surgery) affects marginal bone resorption and implant survival. This nonrandom convenience-sample retrospective pilot study was carried out in 200 implants of 64 patients. Radiographic measurements were performed on intraoral periapical radiographs. Implants were divided into 2 age groups; group 1 = 0–3 months and group 2 = 36–41 months. A P value <.05 was considered statistically significant. Of the implants, 41% (n = 82) were between 0 and 3 months old, and 59% (n = 118) were between 36 and 41 months old. All (n = 200) of the implants survived and maintained their function. The mean mesial marginal resorption measurement was 0.60 ± 0.65 mm, and the mean distal marginal resorption was 0.77 ± 1.07 mm. There was no statistically significant difference between the amount of mesial and distal marginal bone resorption according to implant age (P >.05). In SLA surface titanium implants with adequate initial primary stability and a 3-month osseointegration period before loading, biological aging of titanium did not affect implant survival and marginal bone resorption. [ABSTRACT FROM AUTHOR]

Ca-P coatings on Ti implants have demonstrated good osseointegration capability due to their similarity to bone mineral matter. Three databases (PubMed, Embase, and Web of Science) were searched electronically in February 2021 for preclinical studies in unmodified experimental animals, with at least four weeks of follow-up, measuring bone-to-implant contact (BIC). Although 107 studies were found in the initial search, only eight experimental preclinical studies were included. Adverse events were selected by two independent investigators. The risk of bias assessment of the selected studies was evaluated using the Cochrane Collaboration Tool. Finally, a meta-analysis of the results found no statistical significance between implants coated with Ca-P and implants with etched conventional surfaces (difference of means, random effects: 5.40; 99% CI: −5.85, 16.65). With the limitations of the present review, Ca-P-coated Ti surfaces have similar osseointegration performance to conventional etched surfaces. Future well-designed studies with large samples are required to confirm our findings.

Some commercial dental implants contain aluminum, which represents a potential risk to health, since aluminum is associated with neurodegenerative diseases such as Alzheimer’s disease. Therefore, control of the chemical composition as well as the surface characteristics of implants is necessary, and one approach is functionalization of the implant’s surface by bio(organic) molecules. Hydrolyzed collagen molecules were self-assembled on the titanium implant containing aluminum. Density Functional Theory calculation results indicated an exergonic reaction (ΔG*INT = −6.45 kcal mol−1) between the implant surface and the chosen hydrolyzed collagen molecules, while electrochemical impedance spectroscopy results pointed to improved anti-corrosion properties of the modified implant surface (protective effectiveness, η = 98.5%) compared to the unmodified implant surface. During immersion in an artificial saliva (7 days), the hydrolyzed collagen-modified implant remained stable, which is crucial for minimizing the possible negative biological effects on patient’s health.

Sandblasting (grit-blasting) is a commonly used surface treatment method for roughening the surface of titanium dental implants. Today, alumina (Al2O3) grits with various sizes are widely used for this purpose, due to their good surface roughening effects. However, sandblasting with Al2O3 grits also introduces impurities to the surface of the Ti implant, which may adversely affect the osseointegration process of the implant. This raises the question as to the use of Al2O3 as the most suitable type of sandblasting grit, considering the contaminations to the titanium implant in addition to roughening effects. This study evaluates Al2O3, a silicon-based (silica, SiO2) glass and Al metal grits in terms of both roughing effects and contamination to the titanium implant surface. Thirty commercially pure grade 2 (CP2) titanium plates were grit-blasted using various grits. Surface roughness average (R a) of all grit-blasted plate was measured. In addition, SEM/EDX analysis was performed to detect the morphology and elements on the titanium specimen surface before and after sandblasting. Results showed that each type of grits has its own advantages and disadvantages. This said, Al2O3 might be the most suitable material among the three tested grit materials for sandblasting a titanium dental implant surface. [ABSTRACT FROM AUTHOR]

Surface modifications of dental implants are of vital importance to enhance osseointegration and improve their corrosion resistance. This study characterized the surface properties of boron nitride (BN) coated titanium implants and their corrosion behaviors. Pretreated implant surfaces were coated successfully with BN by RF-magnetron sputtering system. Surface morphology and elemental composition of uncoated and BN-coated implant surfaces were examined by using X-ray photoelectron spectroscopy (XPS) and scanning electron microscope (SEM) coupled with energy dispersive X-ray spectrometer (EDS). The corrosion tests were performed by use of artificial saliva. The tri-dimensional topography of the uncoated sandblasted, large-grit, acid-etched (SLA) implant surface showing sponge-like characteristics, revealed characteristic differences at micro level after BN-coating. It had more holes and peaks in addition to the sponge-like characteristics which further improved its surface microroughness. Boron-to-nitrogen ratio of the coated surface was obtained in the range of 0.8–1.6. The BN-coated SLA implant had no weight loss in the corrosion test. However, the surface characteristics of implants before coating had an impact on corrosion behavior of other implant types. The results demonstrated that titanium implants can be coated with BN successfully and this coating improves the surface properties of dental implants. [ABSTRACT FROM AUTHOR]

Abstract This work reports the development of a novel method to treat a commercially TiUnite® implant to detach its tightly bonded surface oxide layer. The implant was anodized in a fluorine-containing electrolyte (usually for TiO 2 nanotubes preparation) at 50 V for 2 h, which resulted in detachment of the coating. High-quality coating cross-sectional samples were prepared with detached coating fragments. Both the exposed titanium substrate and the detached coating were analyzed by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX). It was interesting to find that the coating-substrate interface exhibited a specific “mortise-tenon” anchorage structure. For comparison, focused ion beam (FIB) method was also conducted and the results revealed uneven bonding interface, specific internal pores distribution and varied coating thickness of the oxide coating. EDX results reported to existence of Ga+ ion in the coating after FIB treatment while the novel method would increase the O element content. The novel method gave a brand new angle for detection of TiUnite implant and enhanced the understanding of its coating-substrate interface features unprecedentedly. It provides a novel and economy method for research, development and evaluation of coated titanium-based implant. Graphical abstract Unlabelled Image Highlights • Coatings on TiUnite® implant were detached by anodization in F− containing electrolyte. • A “mortise-tenon” anchorage structure of the coating interface was first revealed. • It provides a novel and economy method for coating evaluation of titanium implant. [ABSTRACT FROM AUTHOR]

Organophosphorus compounds, like bisphosphonates, drugs for treatment and prevention of bone diseases, have been successfully applied in recent years as bioactive and osseoinductive coatings on dental implants. An integrated experimental-theoretical approach was utilized in this study to clarify the mechanism of bisphosphonate-based coating formation on dental implant surfaces. Experimental validation of the alendronate coating formation on the titanium dental implant surface was carried out by X-ray photoelectron spectroscopy and contact angle measurements. Detailed theoretical simulations of all probable molecular implant surface/alendronate interactions were performed employing quantum chemical calculations at the density functional theory level. The calculated Gibbs free energies of (TiO2)10–alendronate interaction indicate a more spontaneous exergonic process when alendronate molecules interact directly with the titanium surface via two strong bonds, Ti–N and Ti–O, through simultaneous participation common to both phosphonate and amine branches. Additionally, the stability of the alendronate-modified implant during 7 day-immersion in a simulated saliva solution has been investigated by using electrochemical impedance spectroscopy. The alendronate coating was stable during immersion in the artificial saliva solution and acted as an additional barrier on the implant with overall resistivity, R ~ 5.9 MΩ cm2.

The improvement of peri-implant epithelium (PIE) adhesion to titanium (Ti) may promote Ti dental implant stability. This study aims to investigate whether there is a positive effect of Ti hydrothermally treated (HT) with calcium chloride (CaCl2), zinc chloride (ZnCl2), and strontium chloride (SrCl2) on promoting PIE sealing. We analyzed the response of a rat oral epithelial cell (OEC) culture and performed an in vivo study in which the maxillary right first molars of rats were extracted and replaced with calcium (Ca)-HT, zinc (Zn)-HT, strontium (Sr)-HT, or non-treated control (Cont) implants. The OEC adhesion on Ca-HT and Zn-HT Ti plates had a higher expression of adhesion proteins than cells on the Cont and Sr-HT Ti plates. Additionally, the implant PIE of the Ca-HT and Zn-HT groups revealed better expression of immunoreactive laminin-332 (Ln-322) at 2 weeks after implantation. The Ca-HT and Zn-HT groups also showed better attachment at the implant–PIE interface, which inhibited horseradish peroxidase penetration. These results demonstrated that the divalent cations of Ca (Ca2+) and Zn (Zn2+)-HT improve the integration of epithelium around the implant, which may facilitate the creation of a soft barrier around the implant to protect it from foreign body penetration.

Dental implants have become the mainstream strategy for oral restoration, and implant materials are the most important research hot spot in this field. So far, Ti implants dominate all kinds of implants. The surface properties of the Ti implant play decisive roles in osseointegration and antibacterial performance. Surface modifications can significantly change the surface micro/nanotopography and composition of Ti implants, which will effectively improve their hydrophilicity, mechanical properties, osseointegration performance, antibacterial performance, etc. These optimizations will thus improve implant success and service life. In this paper, the latest surface modification techniques of Ti dental implants are systematically and comprehensively reviewed. The various biomedical functionalities of surface modifications are discussed in-depth. Finally, a profound comment on the challenges and opportunities of this frontier is proposed, and the most promising directions for the future were explored.

Various metal coated implants have been tested against dental pathogens which causes increased biofilm formation and lead to failure of dental implants. The possibility of using nanoparticle together with native biomolecules to enhance the activity of such bioactive compound is also in progress. In this study we tested the efficacy of Ag conjugated chitosan nanoparticles as a prospective coating material of titanium dental implants. Known bioactive molecule chitosan was extracted from A. flavus Af09 and conjugated with Ag nanoparticle. Fully characterized Ag-chitosan nanoparticle had a sound inhibitory effect on the growth of two major dental pathogens S. mutans and P. gingivalis . It not only inhibits the adhesion of these two tested bacteria but also able to reduce the biofilm formation. Apart from this, nanoparticle was also able to inhibit the QS production in bacteria tested in this study. Naturally extracted chitosan has been known for its antibacterial activity for a different group of bacteria. Nanoparticles are the good option to enhance the biocompatibility. No cell cytotoxicity of nanoparticle indicates its biocompatibility and coating of titanium dental implants with Ag-chitosan may have an added advantage on the corrosion resistance of dental implants and also augments the passivating effect of these implants. [ABSTRACT FROM AUTHOR]

Preservation of implant biocompatibility following peri-implantitis treatments is a crucial issue in odontostomatological practice, being closely linked to implant re-osseointegration. Our aim was to assess the responses of osteoblast-like Saos2 cells and adult human bone marrow-mesenchymal stromal cells (MSCs) to oxidized titanium surfaces (TiUnite®, TiU) pre-treated with a 808 ± 10 nm GaAlAs diode laser operating in non-contact mode, in continuous (2 W, 400 J/cm2; CW) or pulsed (20 kHz, 7 μs, 0.44 W, 88 J/cm2; PW) wave, previously demonstrated to have a strong bactericidal effect and proposed as optional treatment for peri-implantitis. The biocompatibility of TiU surfaces pre-treated with chlorhexidine digluconate (CHX) was also evaluated. In particular, in order to mimic the in vivo approach, TiU surfaces were pre-treated with CHX (0.2%, 5 min); CHX and rinse; and CHX, rinse and air drying. In some experiments, the cells were cultured on untreated TiU before being exposed to CHX. Cell viability (MTS assay), proliferation (EdU incorporation assay; Ki67 confocal immunofluorescence analysis), adhesion (morphological analysis of actin cytoskeleton organization), and osteogenic differentiation (osteopontin confocal immunofluorescence analysis; mineralized bone-like nodule formation) analyses were performed. CHX resulted cytotoxic in all experimental conditions. Diode laser irradiation preserved TiU surface biocompatibility. Notably, laser treatment appeared even to improve the known osteoconductive properties of TiU surfaces. Within the limitations of an in vitro experimentation, this study contributes to provide additional experimental basis to support the potential use of 808 ± 10 nm GaAlAs diode laser at the indicated irradiation setting, in the treatment of peri-implantitis and to discourage the use of CHX. [ABSTRACT FROM AUTHOR]

Background: Titanium has been the most popular material of choice for dental implantology over the past few decades. Its properties have been found to be most suitable for the success of implant treatment. But recently, zirconia is slowly emerging as one of the materials which might replace the gold standard of dental implant, i.e., titanium. Materials and Methods: Literature was searched to retrieve information about zirconia dental implant and studies were critically analyzed. PubMed database was searched for information about zirconia dental implant regarding mechanical properties, osseointegration, surface roughness, biocompatibility, and soft tissue health around it. The literature search was limited to English language articles published from 1975 to 2015. Results: A total of 45 papers met the inclusion criteria for this review, among the relevant search in the database. Conclusion: Literature search showed that some of the properties of zirconia seem to be suitable for making it an ideal dental implant, such as biocompatibility, osseointegration, favourable soft tissue response and aesthetics due to light transmission and its color. At the same time, some studies also point out its drawbacks. It was also found that most of the studies on zirconia dental implants are short-term studies and there is a need for more long-term clinical trials to prove that zirconia is worth enough to replace titanium as a biomaterial in dental implantology. [ABSTRACT FROM AUTHOR]

Objectives: Soft tissue integration of dental implants lags behind natural biological integration of teeth mainly because of non-optimal surface features. Peri-implant infections resulting in loss of supporting bone jeopardize the success of implants. Our aim was to compare an anodized surface design with a turned one for a more optimal surface., Methods: Morphological and chemical structures of turned and anodized Ti surfaces (grade 5: Ti6Al4V) discs were examined by scanning electron microscopy (SEM-EDS), energy dispersive X-ray spectroscopy (EDS), and atomic force microscopy (AFM). The hydrophilic or hydrophobic features of the surfaces were determined by dynamic contact angle measurement., Results: SEM and AFM revealed significant differences in the morphology and roughness (R a ) of the samples. Anodized discs presented a granular structure, while turned ones had circular grooves. The roughness was significantly higher for the anodized samples compared to the turned ones. XPS and EDS confirmed typical elements for both Ti6Al4V samples. Due to anodization, the amount of Ti (IV) had increased and Ti (III) had decreased in the thicker oxide layer. Anodized samples resulted in a more hydrophilic surface than the turned ones., Significance: The results suggest that the tested anodized samples present optimal surface characteristics to be used as abutment material for an optimal soft tissue integration., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

In recent years, implantology has made significant progress, as it has now become a safe and predictable practice. The development of new geometries, primary and secondary, of new surfaces and alloys, has made this possible. The purpose of this review is to analyze the different alloys present on the market, such as that in zirconia, and evaluate their clinical differences with those most commonly used, such as those in grade IV titanium. The review, conducted on major scientific databases such as Scopus, PubMed, Web of Science and MDPI yielded a startling number of 305 results. After the application of the filters and the evaluation of the results in the review, only 10 Randomized Clinical Trials (RCTs) were included. Multiple outcomes were considered, such as Marginal Bone Level (MBL), Bleeding on Probing (BoP), Survival Rate, Success Rate and parameters related to aesthetic and prosthetic factors. There are currently no statistically significant differences between the use of zirconia implants and titanium implants, neither for fixed prosthetic restorations nor for overdenture restorations. Only the cases reported complain about the rigidity and, therefore, the possibility of fracture of the zirconium. Certainly the continuous improvement in these materials will ensure that they could be used safely while maintaining their high aesthetic performance. [ABSTRACT FROM AUTHOR]

Recent advances in biomaterials' research suggest that electrical charges on a dental implant surface significantly improve its osseointegration to living bone, as a result of selective osteoblast activation and fibroblast inhibition. This study aims at investigating the possibility of using sandblasting to modify the electrical charges on the surface of titanium materials. Our experiments used A1203 grits to blast on CP2 titanium plates, for durations between 3 and 30 s. After sandblasting, Ti surfaces were measured for their electrostatic voltage. The results indicate a novel finding, i.e. negative static charges are generated on the titanium surface, which may stimulate osteoblast activity to promote osseointegration around dental implant surface. This finding may at least partially explain the good osseointegration results of sandblasted titanium dental implants, in addition to other known reasons, such as topological changes on the implant's surface. However, the static charges accumulated on the titanium surface during sandblasting decayed to a lower level with time. It remains a challenging task to seek ways to retain these charges after quantification of desired level of negative charges needed to promote osteoblast activity for osseointegration around dental implants. [ABSTRACT FROM AUTHOR]

Objective: The surgical exposure of dental implants can be performed by means of scalpel, punch, or, with less bleeding, by means of CO2 laser. Possible overheating of the peri-implant bone tissue should be avoided. The goal of this study was to examine the temperature changes on implants under CO2 laser irradiation (Luxar CO220 SP laser from POLYMED, Glattbrugg, Switzerland). Study design: Straumann implants were irradiated with continuous wave (cw), continuous wave with super-pulse (cw/sp), and pulsed wave (pw). The irradiation power was 4, 5, 6, 7, 8, 9, and 10 W and the irradiation times were 10, 20, 30, and 60 s. Similar temperature changes occurred in cw/sp mode and cw mode, but substantially higher temperatures appeared in pulsed wave mode. Results: The quickest temperature changes were observed with cw/sp irradiation (+0.5°C to +41.1°C, depending on the irradiation parameters). Beyond 20 s and 8 W irradiation, a rise exceeding 10°C on the implant surface was found. Conclusions: Implant diameter and length as well as the setting parameters of the CO2 laser (irradiation power, irradiation time, and irradiation mode) are important factors to consider so that risk-free implant exposure can be accomplished. Ignoring these factors causes a risk of pathological heating of the irradiated implants and thus the surrounding tissue, which can result in the loss of an implant. [ABSTRACT FROM AUTHOR]

The osseointegration capability of titanium implants is related to their chemical composition and surface roughness. The combination of grit-blasting and micro-arc oxidation had been used to produce the improved implant surfaces. The ceramic particles were projected to titanium implants at high velocity to get high surface roughness. Then the surface of implants was modified by micro-arc oxidation treatment. A porous TiO2 layer was formed on the surface after the oxidation treatment. The surface structure of oxidized implants exhibited nanometer-sized pores with an average diameter of 0.2 µm. The TiO2 passive layer of the implant surface can attribute to the excellent biocompatibility. The high roughness (Ra = 0.182 µm) formed by grit-blasting maximizes the interlocking between mineralized bone and the surface of implants. Surface roughness in the manometer range formed by micro-arc oxidation would play an important role in the adsorption of proteins, adhesion of osteoblastic cell and thus the rate of osseointegration. [ABSTRACT FROM AUTHOR]

We examined the distribution of substance P and neurokinin-1 (NK1) receptors and substance-P-containing nerve fibers in the peri-implant mucosa around titanium dental implants in rats. Immunohistochemistry and immunocytochemistry revealed that substance-P-immunoreactive nerve fibers abundantly innervated the peri-implant epithelium (PIE) compared with other epithelia of the peri-implant mucosa. NK1 receptor mRNA and protein expression in the peri-implant mucosa were confirmed by reverse transcription with the polymerase chain reaction and immunoblotting. Immunoelectron microscopy revealed that NK1 receptor immunoreactivity was preferentially localized in peri-implant epithelial cells. NK1-receptor-positive products were found on the plasma membrane and in vesicles and granules in PIE cells. Neutrophils and intraepithelial nerve axons in the PIE were positive for the NK1 receptor. NK1 receptor immunoreactivity was also detected in endothelial cells, fibroblasts, and nerve fibers in the connective tissue beneath the PIE. These findings suggest that peri-implant tissue receives sensory information through regenerated nerves expressing substance P and the NK1 receptor. In the peri-implant mucosa, the substance P/NK1 receptor system may play a role in pain transmission, the endocytosis of neutrophils, the extravasation of crevicular fluid, and the migration of macrophages and neutrophils in response to neurogenic inflammation, as in healthy gingiva. [ABSTRACT FROM AUTHOR]

Objectives: The surface properties of titanium dental implants are key parameters for rapid and intimate bone–implant contact. The osseointegration of four implant surfaces was studied in the femoral epiphyses of rabbits. Material and methods: Titanium implants were either grit-blasted with alumina or biphasic calcium phosphate (BCP) ceramic particles, coated with a thin octacalcium phosphate (OCP) layer, or prepared by large-grit sand blasting and acid-etched (SLA). After 2 and 8 weeks of implantation, the bone-implant contact and bone growth inside the chambers were compared. Scanning electron microscopy (SEM) and profilometry showed distinct microtopographies. Results: The alumina-Ti, BCP-Ti and OCP-Ti groups had similar average surface roughness in the 1–2 μm range whereas the SLA surface was significantly higher with a roughness averaging 4.5 μm. Concerning the osseointegration, the study demonstrated a significantly greater bone-to-implant contact for both the SLA and OCP-Ti surfaces as compared with the grit-blasted surfaces, alumina- and BCP-Ti at both 2 and 8 weeks of healing. Conclusion: In this animal model, a biomimetic calcium phosphate coating gave similar osseointegration to the SLA surface. This biomimetic coating method may enhance the apposition of bone onto titanium dental implants. [ABSTRACT FROM AUTHOR]

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Objectives: In this study, quantification of backscatter doses between scattering titanium dental implant and the thermoluminescent dosimeter (TLD100) radiation detector at axial beam irradiation-angle range of 0–90° in head and neck radiotherapy is done to evaluate irradiation angle dependency of dose enhancement contributing to osteoradionecrosis. Methods: A cylindrical titanium dental implant with diameter of 4 mm and length of 9 mm was implanted into a specially-designed human mandible phantom with a TLD100 chip placed on the buccal site and irradiated with 6 MV X, 25 MV X and Co-60 gamma sources at 19 different irradiation angles. Results: Dose enhancement on a buccal site of the titanium implant depends on the incident beam angle. At angles of 65°, 60° and 40° the maximum detected scatter doses over the titanium implant are 36%, 32% and 23% for Co-60 gamma, 6 MV X-ray and 25 MV X-ray, respectively. The dose enhancement at different beam angles was less pronounced in 25 MV X and more pronounced in Co-60 gamma irradiation. Conclusions: For the different radiation beams studied, the irradiation angle between scattering titanium dental implants and the central axis does not significantly affect the total dose that may lead to osteoradionecrosis of the mandible. [ABSTRACT FROM AUTHOR]

Abstract: Laminin-5 (Ln-5) is an important molecule associated with epithelial cell adhesion and migration. In the gingiva around the tooth, Ln-5 localizes within basement membranes between the junctional epithelium (JE) and the tooth or connective tissue. Recently, we reported that in the oral mucosa around a dental implant, Ln-5 is expressed within the basement membranes at the implant-peri-implant epithelium (PIE) interface, and at the PIE–connective tissue interface. However, the ultrastructural localization of Ln-5 within or along the PIE has not yet been reported. Therefore, peri-implant oral mucosa was treated with anti-Ln-5 ( chain) antibody and examined using immuno-electron microscopy. Ln-5 was localized in the cells of the innermost-third layer and basal layer of the PIE. A 100-nm-wide Ln-5-positive internal basal lamina (basement membrane) and hemidesmosomes as adhesion structures were formed at the apical portion of the implant–PIE interface. However, at the upper-middle portion of the interface, these adhesion structures were not observed. Furthermore, at the PIE–connective tissue interface, the Ln-5-positive external basal lamina (basement membrane) and hemidesmosomes were partially deficient. Judging from these findings, we concluded that Ln-5 contributes to the attachment of the PIE to the titanium surface, and that PIE attached to titanium at the apical portion of the dental implant–PIE interface. [Copyright &y& Elsevier]

Laminin-5 (Ln-5), a component of the basement membrane (BM), regulates epithelial cell migration and adhesion. This study used anti-Ln-5 (γ2chain) antibody to investigate the distribution of Ln-5 during the formation of peri-implant epithelium (PIE) in rats, and compared it to the distribution of Ln-5 during oral mucosa formation after tooth extraction. One day after extraction, the junctional epithelium (JE) had disappeared. After 3 days, new epithelium formed from the oral sulcular epithelium (OSE) and extended horizontally over the wound with Ln-5-positive cells at the leading edge. After 5 days, the epithelium extending from the OSE on each side of the wound joined and formed additional new epithelium. The new epithelium expressed Ln-5 in the BM. After 1–2 weeks, the oral epithelium (OE) extending from the sides of the wound joined in the center. Thereafter, OSE and new epithelium disappeared, and only OE remained covering the wound. Three days after implantation (titanium), no JE remained. New epithelium formed from the keratinized OSE extending apically with Ln-5-positive cells. After 1–2 weeks, the new epithelium became the PIE and spread further apically facing the implant surface. Ln-5 was expressed at the PIE-connective tissue interface, but not at the implant-PIE interface. Finally, after 4 weeks, Ln-5 was expressed at the implant-PIE interface, and the PIE was non-keratinized epithelium. These findings suggest that Ln-5 induces cell migration during PIE formation, and that PIE originates from OSE. Furthermore, they support the hypothesis that Ln-5 contributes to the attachment of PIE to titanium, regardless of the delay in the synthesis and deposition of Ln-5 at the titanium-PIE interface. [Copyright &y& Elsevier]

Surface treatments of Ti in the dental implant industry are performed with the aim of in-creasing its bioactivity and osseointegration capacity. Chitosan (Cht) is a polysaccharide that has been proposed as a promising biomaterial in tissue engineering and bone regeneration, due to its ability to stimulate the recruitment and adhesion of osteogenic progenitor cells. The aim of our preliminary study was to evaluate, by micro-computed tomography (micro-CT), the osseointegration and bone formation around Cht-coated implants and to compare them with conventional surface-etched implants (SLA type). Four im-plants (8.5 mm length × 3.5 mm Ø) per hemiarch, were inserted into the jaws of five dogs, divided into two groups: chitosan-coated implant group (ChtG) and control group (CG). Twelve weeks after surgery, euthanasia was performed, and sectioned bone blocks were obtained and scanned by micro-CT and two bone parameters were measured: bone in contact with the implant surface (BCIS) and peri-implant bone area (PIBA). For BCIS and PIBA statistically significant values were obtained for the ChtG group with respect to CG ( p = 0.005; p = 0.014 and p < 0.001 and p = 0.002, respectively). The results, despite the limitations, demonstrated the usefulness of chitosan coatings. However, studies with larger sample sizes and adequate experimental models would be necessary to confirm the results., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 López-Valverde, López-Valverde, Cortés, Rodríguez, Macedo De Sousa and Aragoneses.)

Fusobacterium nucleatum (F. nucleatum) is a gram-negative obligate anaerobe bacterium that threatens human periodontal health. It can cause many oral diseases, including periodontitis, gingivitis and peri-implantitis, and even some diseases such as colorectal cancer are related to it. This paper aims to develop a novel and simple surface modification method for anti-Fusobacterium nucleatum on titanium, i.e., the material for implants. In this study, different concentrations (0.0–1.0%) of PHMB were dip-coated on the titanium surface. The surface properties were examined with the aid of Scanning electron microscopy, Energy-dispersive X-ray spectroscopy, Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy, and the antibacterial property against F. nucleatum was investigated using colony-forming unit. It was found that the PHMB successfully formed a self-assembled coating on the titanium surface and the PHMB-coated titanium had a strong capability of inhibiting F. nucleatum. Even though differences were found among the several concentrations, PHMB exhibited promising results as a simple coating strategy for dental implants. [ABSTRACT FROM AUTHOR]

Pure titanium alloys are commonly employed in construction of dental implants, given their advantageous features including resistance to corrosion, mechanical strength, flexibility, and bioavailability. The purpose of this study was to evaluate the surface characteristics of Ti6Al4V alloy disks upon sand-blasted, large-grit acid-etching, and/or selective laser melting applications and to assess whether and how these surface modifications affect the attachment, viability, metabolic activity, and osteoblastic differentiation of Saos-2 osteosarcoma cells. We manufactured Ti6Al4V alloy disks and divided them into four groups (non-treated, SLA-treated, Ti6Al4V ELI alloy-coated (SLM treated), and SLM+SLA-treated). The topographic analysis was carried using AFM and SEM and chemical content was evaluated by EDX. EDS. Adherence and viability of Saos-2 cells seeded onto disks were investigated via SEM and fluorescent microscopy. To assess the metabolic activity of Saos-2 cells, MTT assay was conducted and the osteoblastic differentiation interpreted via monitoring alkaline phosphatase activity. According to data acquired using AFM and SEM, the control group had the smoothest surfaces, with a lower Ra value. The roughest surface was obtained with SLM and SLA dual-treated disks. The osteoblastic activity of Saos-2 cells on the surface of dual-treated disks was higher than the other groups. Therefore, the surface of SLM+SLA-treated disks conferred a suitable environment for Saos-2 cells to adhere, proliferate, and show higher metabolic activity. We concluded that Ti6Al4V alloy disks covered with Ti6Al4V ELI alloy and subjected to SLA surface treatment may be promising to manufacture dental implants with improved adaptability, bioavailability, and osseointegration. • Surface topographies of Ti6Al4V disks subjected to various coatings were evaluated using AFM and SEM. • MTT and ALP assays were performed to reveal osteoblastic differentiation onto Saos-2 cells planted Ti6Al4V disks. • Cell adhesion increased in direct proportion to the thickness of the Ti6Al4V disks. • SLM+SLA treatment is a preferable surface construction since the morphology of osteoblasts is positively affected. • The success of dental implant surface is related to its chemical properties along its micro-morphological nature. [ABSTRACT FROM AUTHOR]

Ca-P coatings on Ti implants have demonstrated good osseointegration capability due to their similarity to bone mineral matter. Three databases (PubMed, Embase, and Web of Science) were searched electronically in February 2021 for preclinical studies in unmodified experimental animals, with at least four weeks of follow-up, measuring bone-to-implant contact (BIC). Although 107 studies were found in the initial search, only eight experimental preclinical studies were included. Adverse events were selected by two independent investigators. The risk of bias assessment of the selected studies was evaluated using the Cochrane Collaboration Tool. Finally, a meta-analysis of the results found no statistical significance between implants coated with Ca-P and implants with etched conventional surfaces (difference of means, random effects: 5.40; 99% CI: −5.85, 16.65). With the limitations of the present review, Ca-P-coated Ti surfaces have similar osseointegration performance to conventional etched surfaces. Future well-designed studies with large samples are required to confirm our findings. [ABSTRACT FROM AUTHOR]