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Inert ceramic implants suffer from significant complications such as lack of osseointegration, biofilm formation, and infections, necessitating the development of novel materials with both osteogenic and antibacterial properties to prevent implant failure. In this study, we aimed to multifunctionalize a tridimensional macroporous alumina scaffold with a biomimetic calcium phosphate (CaP) coating combined with a silver-based extra-thin film to enhance bioactivity and provide an additional antibacterial effect. The porous alumina scaffolds were fabricated through a powder metallurgy technique, followed by biomimetic deposition and DC magnetron sputtering. The coatings were characterized using SEM/EDS and AFM measurements to examine their morphology and topography. To evaluate the osteoconductive response of the materials, in vitro tests were conducted by immersing the samples in Simulated Body Fluid (SBF). The bioactivity tests revealed that the CaP-AgO coating, in line with the roughness surface and free surface energy values, exhibited a higher Ca/P ratio formation. This indicated an increased affinity for apatite adhesion, ultimately leading to a higher osseointegration ability compared to the CaP-Ag coating. Furthermore, the CaP-AgO coating demonstrated superior activity against S. aureus. These findings demonstrate the potential of the multifunctional coatings to address the challenges associated with inert ceramic implants by promoting bioactivity and combating bacterial infections. [ABSTRACT FROM AUTHOR]

BackgroundMethodResultConclusionLysophosphatidic acid (LPA), a simple bioactive lysophospholipid, has been reported to regulate bone homeostasis and bone remodeling. This study aimed to elucidate the function and intrinsic mechanism of LPA in osseointegration in murine models.We constructed immediate implant models in murine maxillae. Micro-CT, H&E staining, and PCR assays were performed to evaluate the effects of LPA on osseointegration. Furthermore, Prx1-Cre;Yapf/f mice and Sp7-Cre;Yapf/f mice were generated to investigate the role of YAP on LPA-induced osseointegration.In this study, we identified that LPA might promote bone deposition on the tissue-implant interface and improve osseointegration. In addition, conditional knockout of YAP from MCSs and pre-osteoblasts blunts LPA-induced osteogenesis and osseointegration in mice.Our data demonstrated that LPA-YAP signaling is particularly important to regulate osseointegration, which expands our understanding of LPA and provide the potential of LPA to be used in osseointegration. [ABSTRACT FROM AUTHOR]

Primary dental implant stability is critical to enable osseointegration. We assessed the primary stability of our newly designed dental implant. We used the calf rib bone animal model. Our implant has an outside tapered screw with two inside barrettes that deploy with a second screw situated at the implant's crown. We used ten calf ribs with III/IV bone density and inserted ten implants per rib. We deployed the barrettes in the calf rib's transversal direction to support against the nearby cortical bone. We measured the primary implant's stability with resonance frequency analysis and collected the Implant Stability Quota (ISQ) in the transverse and longitudinal calf rib planes before (PRE) and after (POS) deploying the barrette. The mean ISQ was PRE 84.00 ± 3.56 and POS 84.73 ± 4.53 (p = 0.84) in the longitudinal plane and PRE 81.80 ± 2.74 and POS 83.53 ± 4.53 (0.27) in the transverse plane. The barrettes' insertion increases our dental implant primary stability by 11% in the transverse plane and 2% in the longitudinal plane. Our dental implant ISQ values are in the higher range than those reported in the literature and reflect high primary stability after insertion. The barrette deployment improves the dental implant's primary stability, particularly in the direction in which it deploys (transverse plane). [ABSTRACT FROM AUTHOR]

Estrogen deficiency, coupled with a cafeteria diet (CD), can impair peri-implant bone repair, posing a significant challenge to implant success in affected individuals. Thus, it is crucial to explore strategies for implant functionalization and systemic treatments that could alleviate these bone alterations. This study aimed to assess peri-implant bone repair in ovariectomized (OVX) rats subjected to a CD, with a focus on implants functionalized with genistein (GEN), compared to conventional implants (CONV), and the effects of systemic treatment with risedronate sodium (RIS). In total, thirty-six female rats were assigned to three groups: rats with estrogen (SHAM), rats with estrogen deficiency and CD (OVX-CD), rats with estrogen deficiency, CD, and systemic RIS treatment (OVX-CD-RIS). All rats underwent bilateral extraction of the first upper molars followed by implant installation. Each group was further subdivided based on implant type: conventional implants (CONV) or GEN-functionalized implants, resulting in six subgroups (n = 6). The study employed several analyses, including reverse torque testing, microcomputed tomography (Micro-CT), epifluorescence microscopy, and molecular assays. The main result demonstrated that the OVX-CD-RIS/GEN subgroup exhibited significantly higher reverse torque values, indicating stronger implant stability. Micro-CT scans revealed a greater bone volume in the OVX-CD-RIS/GEN subgroup compared to other subgroups. Epifluorescence microscopy also demonstrated an increased mineral apposition rate in both the OVX-CD/GEN and OVX-CD-RIS/GEN subgroups. Molecular analysis indicated elevated expression levels of osteocalcin, alkaline phosphatase, and vascular endothelial growth factor in the OVX-CD-RIS/GEN subgroup. In conclusion, the combined treatment of systemic RIS and GEN-functionalized implants significantly enhanced peri-implant bone repair, offering a promising strategy to improve implant outcomes in postmenopausal women with metabolic syndrome. [ABSTRACT FROM AUTHOR]

Tissue engineering is aimed to regenerate damaged or lost tissues by exploiting polymeric scaffolds, proper cells, and growth factors. Both hard and soft tissue damages in proposed implant sites are the main issues before implant therapy. They are usually caused by trauma, infection/periodontal disease, and atrophy. Bone tissue engineering using alloplastic biomaterials and polymeric scaffolds have been shown to be able to regenerate bone defects with comparable bone density at peri-implant defect sites. In addition, natural scaffolds, collagen matrices, and polymeric matrices have been developed to regenerate soft tissue to cover implant sites. Although the results of pre-clinical studies have shown the potential of tissue engineering in the regeneration of peri-implant defects, the clinical studies are limited to make a conclusion regarding the clinical benefits of hard and soft tissue engineering in peri-implant defects. Hard and soft tissue damages in peri-implant defect sites are managed with tissue engineering. By using various scaffolds/biomaterials, proper cells and growth factors have been shown to be able to regenerate bone defects and regenerate soft tissue to cover implant sites. (Created with BioRender.com) [ABSTRACT FROM AUTHOR]

Background: Transalveolar sinus floor elevation (TSFE) is a surgical technique for the placement of dental implants in patients with reduced height of the maxillary posterior alveolar bone. This study aims to demonstrate the clinical outcomes of TSFE using the minimal invasive sinus elevation (MISE) technique in partially and totally edentulous maxillary patients. Methods: This prospective clinical study followed STROBE guidelines. TSFE was performed using the MISE technique with the simultaneous placement of implants. Dental implants were loaded at 6 months. Maxillary vertical bone gain was measured by CBCT, and marginal bone loss was assessed by periapical radiographs. Results: Ninety-one patients, with a mean age of 62.1 ± 11.8 years, were treated with TSFE and the placement of 107 implants, with a mean follow-up of 96.2 ± 11.7 months. An increase of 4.3 ± 0.4 mm in bone height was achieved, with a dental implant cumulative survival rate of 97.2%. Peri-implantitis was observed in 9.3% of implants, and membrane perforation occurred in 7.7% of cases. Technical complications were noted in 5.5% of patients. Conclusions: Within the limitations of this clinical study, it can be concluded that the MISE technique is a successful protocol for the placement of implants in the posterior maxilla with reduced height of the alveolar ridge, with a rate of biological and prosthetic complications below 10% over an average follow-up period of 8 years. [ABSTRACT FROM AUTHOR]

Hyperglycemia-induced oxidative stress (OS) plays a crucial role in implant osseointegration and often results in implant failure in patients with diabetes. Implants modified with cerium nanoparticles (CeO 2 -NPs) have gained significant attention owing to their remarkable oxidase-mimetic activity and therapeutic potential. Increasing the Ce3+ content and oxygen vacancy concentration in CeO 2 -NPs enhances the catalytic activity of CeO 2 -NPs. In this study, we synthesized lanthanide (La)/manganese (Mn) -doped CeO 2 -NPs composite coatings (La-CNPs and Mn-CNPs) on alkali-etched Ti substrates using a one-step hydrothermal method. Our findings indicate that the integration of La/Mn doping, in conjunction with a titanium dioxide carrier, augmented both the Ce3+ content and the oxygen vacancy concentration in La-CNPs and Mn-CNPs. By analyzing their electronic energy band structures, we found that La-CNPs exhibited superior catalase activity, whereas Mn-CNPs outperformed them in terms of superoxide dismutase activity. Under OS conditions, La-CNPs and Mn-CNPs (especially Mn-CNPs) markedly reduced intracellular reactive oxygen species levels in MC3T3-E1 cells, promoting their proliferation and osteogenic differentiation. Complementing these in vitro observations, in vivo trials underscored the capability of Mn-CNPs to enhance osteointegration in surrounding implants in diabetic rat models. Consequently, Mn-CNPs coatings present a promising avenue for augmenting the efficacy of implant therapies, especially in patients with diabetes. [ABSTRACT FROM AUTHOR]

Background: Socket sealing following flapless immediate implant placement involves placing a barrier membrane to prevent the ingrowth of bacteria or contaminants to the dental implant during the early phase of healing. Dense Polytetrafluorethylene membranes have been the gold standard socket sealing barrier due to their impermeability to the oral flora, which allows for undisturbed implant healing. The search for a more cost-efficient material for sealing the socket without compromising implant osseointegration was sought. This study aims to evaluate the effectiveness of socket sealing after immediate implant placement in the premolar/molar region using a gelatin sponge, as opposed to a dense Polytetrafluorethylene membrane, and its impact on clinical implant osseointegration. Materials and methods: The study was conducted on 20 patients, comprising 12 males and 8 females with an age range of 25–60 years. Those meeting the eligibility criteria of immediate implant placement were selected and divided equally into two groups. A control group, where an immediate implant and a dense polytetrafluorethylene membrane were used, and a test group where an immediate implant and a gelatin sponge was used. Exclusion criteria included smokers, presence of systemic or metabolic conditions, or a local pathology that would contraindicate implant placement. Teeth were extracted using a flapless approach. Implants were placed, and sockets were sealed using the allocated barrier. In the control group, the membrane was removed after 4 weeks. For the test group, the gelatin sponge was left to resorb spontaneously. After 4 months, implants were uncovered, and a 30 N/cm reverse torque test was applied to assess the clinical osseointegration. Results: All implants healed uneventfully, without any radiographic evidence of bone loss. There was no clinical or radiographic difference between the outcomes in the control and the test groups. For the 20 dental implants subjected to a 30 N/cm reverse torque test, clinical integration was observed. Conclusion: Within the limitations of this study, both dense polytetrafluorethylene membranes and gelatin sponges are effective methods for socket sealing, allowing for successful osseointegration following flapless immediate implant placement in posterior sites, with gelatin sponge offering easier handling and a reduced cost compared to dense polytetrafluorethylene. A larger study sample to verify the outcomes of this stud is recommended. [ABSTRACT FROM AUTHOR]

Objective Lower-extremity transcutaneous osseointegration is a rehabilitation alternative to socket-suspended prostheses. The rehabilitation process, philosophies, and routines remain under-described. This review, primarily, identifies commonalities and differences among protocols. Secondarily, strategies are proposed to streamline future research of post-osseointegration surgery rehabilitation. Methods Two differently-phrased queries of Google Scholar, Pubmed, Embase, and Web of Science were performed. First using either "osseointegration" or "osseointegrated" or "bone anchored prosthesis" AND [last name]. Second, replacing author name with "physical therapy" or "rehabilitation". Six hundred eighty-eight articles were identified describing lower-extremity rehabilitation following osseointegration. Following software-based deduplication, manual abstract and full-text review, article reference evaluation, and use of Google Scholar's "Cited by" feature, 35 studies were fully analyzed. First, a consolidated summary was made of protocols focusing on stages, timing, and other descriptions of postoperative rehabilitation. Subsequently, strengths and limitations of protocols were considered to propose potential strategies to investigate and optimize postoperative rehabilitation. Results All articles describe rehabilitation having this same order of goal progression: from surgery to gradual weight bearing and final goal of independent ambulation. The most impactful difference influencing the stated final goal of independent ambulation was whether one or two surgical stages were performed. No articles reported patient success rate achieving proposed goals and timing, or challenges during rehabilitation. Therefore, the first research suggestion is to investigate actual success rates achieving proposed goals and timing. Second, to further explore rehabilitation of performance deficits, beyond unaided ambulation. Finally, to incorporate technology such as mobility trackers to more objectively understand prosthesis use and mobility. Conclusion All lower-extremity osseointegration rehabilitation literature recommends identical goal progression order. No studies evaluate patient challenges or variation. Understanding and addressing such challenges may enhance postoperative rehabilitation. Impact This article consolidates published rehabilitation protocols post-osseointegration surgery. Specific analysis and experimentation of the protocols may enhance the uniformity and potential of patient rehabilitation. [ABSTRACT FROM AUTHOR]

Background/Objectives: In the last decades, dental implant surfaces have been evolving to increase success and implant survival rates. More studies evaluating outcomes with implants with ultra-hydrophilic multi-zone anodized surfaces are necessary. The aim of this study is to evaluate the short-term outcome of implants of conical connection with anodized ultra-hydrophilic surfaces for support of single teeth and partial rehabilitations. Methods: In this retrospective study, patients received parallel-walled implants with a gradually anodized surface. The primary outcome measure was implant survival. Secondary outcome measures were marginal bone loss and mechanical and biological complications. This study included 253 conical connection implants with anodized ultra-hydrophilic surfaces, placed in 145 patients (71 males and 74 females; average age: 55.8 years). Sixty patients presented comorbidities, and 19 patients presented smoking habits. Results: Ten patients (15 implants) were lost to follow-up. Two implants failed in two patients, resulting in a cumulative survival rate of 99.2%, with 98.5% and 100% for males and females, respectively, and 99.1% and 100% for single teeth and partial rehabilitations, respectively. The average marginal bone loss was 0.52 mm at 1 year, with 0.60 mm and 0.42 mm for males and females, respectively, and 0.52 mm and 0.50 mm for single teeth and partial rehabilitations, respectively. The rate of mechanical complications was 4.8% and 3.2% at patient and implant levels, respectively. Biological complications occurred in one patient (0.7%) at one implant (0.4%). Conclusions: These results indicate that the use of implants with ultra-hydrophilic multi-zone anodized surfaces for single teeth and partial rehabilitations is viable in the short term. [ABSTRACT FROM AUTHOR]

This study compares the heat generated during bone drilling using different protocols and implant systems, first in vitro and then in vivo with an animal model. In the experimental phase, thermal data were collected using an infrared camera while preparing implant beds in bone similes. The heat generated by a one-drill protocol with a new-generation drill bit and the Straumann BLT sequential drilling protocol was evaluated. The experimental study was then replicated in an animal model to assess the impact of these protocols on early osseointegration, measured by bone-to-implant contact (BIC) at three weeks post-surgery for Straumann BLT SLActive and Medentika Quattrocone implants. The results showed the BLT sequential protocol generated significantly more heat during drilling in bone similes compared to the new-generation drill bit. In the animal model, a histological analysis revealed a trend favoring shorter drilling protocols, with reduced drilling times and a potential advantage for osseointegration, though the BIC differences were not statistically significant. These findings suggest that minimizing the number of drilling steps and thermal stress may enhance osseointegration more effectively than advanced implant surface treatments. This aligns with emerging views on the importance of optimized drilling protocols and designs to reduce heat generation and better preserve surrounding bone structure. [ABSTRACT FROM AUTHOR]

Sandblasting and acid etching are common procedures used to treat implant surfaces, enhancing osseointegration and improving clinical success rates. This clinical study aimed to evaluate the long-term outcomes of sandblasted and acid-etched implants. A total of 303 implants were placed in 114 partially and totally edentulous patients using a two-stage surgical technique and an early loading protocol (6–8 weeks). Clinical findings for implants and prosthetics were evaluated over a 12-year follow-up period. A total of 12 implants (3.9%) failed, with 3 failures occurring during the healing period before loading and 9 due to peri-implantitis. The cumulative survival rate for all implants was 96.1%. A total of 156 prostheses were placed on 300 implants, 87 single crowns, 45 partial fixed bridges, 9 full-arch fixed restorations, and 15 overdentures. The mean marginal bone loss was 1.18 mm. (SD. 0.64 mm.). Thirty-nine implants (13%) in twenty-four patients exhibited peri-implantitis. Technical complications, including prosthetic screw loosening or fracture, ceramic chipping, and acrylic fractures, were observed in 24 subjects (21.1%). Sandblasted and acid-etched surface implants placed in the maxilla and mandible reported favorable outcomes and stable tissue conditions with an early loading protocol. [ABSTRACT FROM AUTHOR]

The metastable β-Ti21S alloy exhibits a lower elastic modulus than Ti-6Al-4V ELI while maintaining high mechanical strength and ductility. To address stress shielding, this study explores the integration of lattice structures within prosthetics, which is made possible through additive manufacturing. Continuous adhesion between the implant and bone is essential; therefore, auxetic bow-tie structures with a negative Poisson's ratio are proposed for regions under tensile stress, while Triply Periodic Minimal Surface (TPMS) structures with a positive Poisson's ratio are recommended for areas under compressive stress. This research examines the manufacturability and quasi-static mechanical behaviour of two auxetic bow-tie (AUX 2.5 and AUX 3.5) and two TPMS structures (TPMS 2.5 and TPMS 1.5) in β-Ti21S alloy produced via laser powder bed fusion. Micro-CT reveals printability issues in TPMS 1.5, affecting pore size and reducing fatigue resistance compared to TPMS 2.5. AUX 3.5's low stiffness matches cancellous bone but shows insufficient yield strength and fatigue resistance for femoral implants. Biological tests confirm non-toxicity and enhanced cell activity in β-Ti21S structures. The study concludes that the β-Ti21S alloy, especially with TPMS 2.5 structures, demonstrates promising mechanical and biological properties for femoral implants. However, challenges like poor printability in TPMS 1.5 are acknowledged and should be addressed in future research. [ABSTRACT FROM AUTHOR]

Objectives: This controlled preclinical study analyzed the effect of implant surface characteristics on osseointegration and crestal bone formation in a grafted dehiscence defect minipig model. Material and Methods: A standardized 3 mm × 3 mm acute‐type buccal dehiscence minipig model grafted with deproteinized bovine bone mineral and covered with a porcine collagen membrane after 2 and 8 weeks of healing was utilized. Crestal bone formation was analyzed histologically and histomorphometrically to compare three implant groups: (1) a novel, commercially available, gradient anodized (NGA) implant, to two custom‐made geometric replicas of implant "1," (2) a superhydrophilic micro‐rough large‐grit sandblasted and acid‐etched surface, and (3) a relatively hydrophobic micro‐rough large‐grit sandblasted and acid‐etched surface. Results: At 2 and 8 weeks, there was no difference between the amount and height of newly formed bone (NBH, new bone height; BATA, bone area to total area) for any of the groups (p > 0.05). First bone‐to‐implant contact (fBIC) and vertical bone creep (VBC) at 2 and 8 weeks were significantly increased for Groups 2 and 3 compared to Group 1 (p < 0.05). At 8 weeks, osseointegration in the dehiscence (dehiscence bone‐implant‐contact; dBIC) was significantly higher for Groups 2 and 3 compared to Group 1 (p < 0.05). Conclusions: The amount of newly formed bone (BATA) and NBH was not influenced by surface type. However, moderately rough surfaces demonstrated significantly superior levels of osseointegration (dBIC) and coronal bone apposition (fBIC) in the dehiscence defect compared to the NGA surface at 2 and 8 weeks. Trial Registration: For this type of study, clinical trial registration is not required. This study was conducted at the Biomedical Department of Lund University (Lund, Sweden) and approved by the local Ethics Committee of the University (M‐192‐14) [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore multiple effects of hyperbranched poly‐l‐lysine (HBPL) titanium (Ti) surfaces on osseointegration, bacteriostasis, and anti‐inflammation across three different animal models. Methods: Ti surfaces were covalently modified with HBPL, with uncoated surfaces as controls. Characterization included scanning electron microscopy (SEM) and surface chemistry and elemental analysis (EDX). Ti and Ti‐HBPL implants were placed in conventional canine edentulous sites, post‐operative infection canine edentulous sites, and diabetic rat tibias. Implants from canine edentulous models were analyzed using micro‐CT and histomorphometry to assess osseointegration at 8 weeks. Post‐operative infection beagles were used to evaluate antibacterial efficacy through clinical parameters and bacterial cultures at 1 week. In diabetic rats, micro‐CT and histomorphometry were performed at 8 weeks. Results: HBPL was uniformly grafted on Ti‐HBPL surfaces. Ti‐HBPL surfaces showed higher bone volume/total volume (BV/TV, p < 0.001), bone‐implant contact (BIC%, p < 0.001), and trabecular number (Tb.N, p < 0.01) in beagles. Besides, it displayed higher BIC% (p < 0.001) and bone area fraction occupancy (BAFO%, p < 0.01) in hard tissue sections. In an infected model, Ti‐HBPL surfaces exhibited lower bleeding on probing (BOP, p < 0.001), and plaque index (DI, p < 0.01), with reduced bacterial colony formation (p < 0.001) compared to the control group. In diabetic rats, Ti‐HBPL surfaces showed an increase in BV/TV (p < 0.01) and Tb.N (p < 0.001), downregulated TNF‐α and IL‐1β (p < 0.01), and upregulated IL‐10 (p < 0.01) and osteocalcin (OCN) expression (p < 0.01). Conclusions: HBPL‐Ti surfaces demonstrated enhanced osseointegration, bacteriostasis, and anti‐inflammatory effects in vivo. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the biocompatibility and osseointegration of novel titanium (Ti) implants with a perforated part with high surface roughness (Ra >4 μm) and a smooth solid part (test group), as compared to smooth solid Ti implants (control group; Ra < 0.8 μm). Test and control implants were implanted in rabbit femurs. After 4 and 15 weeks, host tissue reaction and quality of tissue formed were evaluated with histopathology, while micro‐CT scans were used to quantitatively assess bone–implant contact (BIC), surrounding bone formation, and bone ingrowth. After 4 and 15 weeks, minimal host reaction was found in the test group. Histopathological analysis showed new bone formation around the implants in both the test and control groups after 4 weeks. Furthermore, additional bone growth was often observed within the holes of the test implants. After 15 weeks, the test implants showed high bone ingrowth and the presence of mature bone in direct contact with the implant surface, whereas, bone ingrowth was poorer for the control group with 30% of the control implants, showing larger gaps at the bone–implant interface. Quantitative micro‐CT analysis revealed comparable BIC and bone formation in both groups at 4 weeks, but higher BIC and more bone formation in the test group than in the control group after 15 weeks. No significant differences were observed in any of the analyses. In conclusion, partially perforated, high‐roughness Ti implants showed excellent osseointegration and minimal host reaction, indicating their potential for orthopedic applications in bone repair and regeneration. [ABSTRACT FROM AUTHOR]

Introduction Osseointegration is an innovative procedure to attach an external prosthetic device directly to the skeleton. The technique has been shown to improve physical function and quality of life relative to conventional socket prosthetic devices. While much of the research in osseointegration has focused on functional outcomes, less is known regarding perioperative pain management. The purpose of this study was to describe perioperative and postoperative pain management approaches received by patients undergoing osseointegration procedures at a tertiary medical center. Materials and Methods This retrospective study was determined to be exempt from Institutional Review Board review by the Walter Reed National Military Medical Center Department of Research Programs. Perioperative and postoperative pain management approaches received by 41 patients who underwent 76 staged osseointegration procedures from 2016 to 2021 at Walter Reed National Military Medical Center were described. Results Pain management approaches included perioperative ketamine (51% stage I, 55% stage II), epidurals (76% stage I, 77% stage II) with a median of 3-4 days across stages, peripheral nerve catheters (27% stage I, 16% stage II), and/or single-shot peripheral nerve block (<10% across stages). The median morphine equivalent dose provided during surgery was 65 mg across both stages, with 56% and 54% of patients also requiring opioid medication in the post-anesthesia care unit. In 11 of 76 (15%) procedures, patients required an increase in the rate or concentration of epidural or peripheral nerve catheter infusion. In six (8%) unique recovery periods, patients experienced a dislodged catheter. In 27 of 76 (36%) unique recovery periods, patients experienced a significant increase in postoperative pain requiring acute pain service intervention in the form of catheter adjustment, intravenous pain medications, and/or the addition of intravenous patient-controlled analgesia. Adequate pain control was achieved with minimal epidural or peripheral nerve catheter trouble-shooting and a bolus for 24 patients (89% requiring intervention). Summed 24-hour pain scores (SPI24) did not vary across stages. SPI24 was positively correlated with opioid doses received. Patients with single, relative to multiple, limb amputations had similar SPI24 values (P  > .05). Conclusions Variability in pain management requirements calls forth opportunities to optimize osseointegration analgesia care and future research. As osseointegration becomes more accessible, the need for optimizing pain management through patient-centered research becomes more salient. [ABSTRACT FROM AUTHOR]

EMG feedback improves force control of a myoelectric hand prosthesis by conveying the magnitude of the myoelectric signal back to the users via tactile stimulation. The present study aimed to test if this method can be used by a participant with a high-level amputation, and whose muscle used for prosthesis control (pectoralis major) was not intuitively related to hand function. Vibrotactile feedback was delivered to the participant's torso, while the control was tested using EMG from three different muscles. The participant completed four experimental sessions of a force-matching task with a prosthesis. The performance was evaluated by computing the target force success rate. The results of session 1 showed that the participant could effectively employ EMG feedback after only brief training. Session 2 demonstrated that EMG feedback benefited force control, increasing the success rate by approx. 30%. Finally, after proper training (sessions 3 and 4), the participant's performance when using the muscle on the amputated side was similar to that achieved with the muscles on the contralateral side. Overall, the study results indicate that EMG feedback can be used in high-level amputations, despite the extent of the injury and non-intuitive control. [ABSTRACT FROM AUTHOR]

AimMethodsResultsConclusionsWe aimed to investigate whether α-ketoglutarate (AKG) can promote autophagic activity under a peri-implant condition to enhance the osseointegration of dental implant in rats with osteoporosis (OP).Con, Model and AKG groups were established for the random allocation of thirty rats (n = 10). Their bone metabolism indicators were measured. The peri-implant bone morphology was detected by toluidine blue staining, the peri-implant bone tissue healing was detected, and the implant torque was measured.In comparison to the Con group, the bone metabolism indicators [bone volume/tissue volume ratio (BV/TV), trabecular number (Tb.N), and osseointegration index (OI)], bone-implant contact (BIC) rate, bone mass in the cancellous area, dislocation torque, protein and mRNA expressions of bone morphogenetic protein-2 (BMP-2), RUNX2 and Beclin1, and LC3II/LC3I ratio in bone tissues decreased significantly in the Model group, with a significant enlargement of trabecular space (Tb.Sp) (p < 0.05). In comparison with the Model group, the AKG group had significant increases in Tb.N, BV/TV, OI, BIC rate, bone mass in the cancellous area, dislocation torque, mRNA plus protein expressions of BMP-2, Runt-related transcription factor 2 and Beclin1, and LC3II/light chain 3I ratio in bone tissues, in addition to a significant reduction of Tb.Sp (p < 0.05).AKG may relieve the bone metabolism disorders and enhance the osteogenic differentiation and osseointegration of implants in OP rats by promoting peri-implant autophagy. [ABSTRACT FROM AUTHOR]

The most time-consuming aspect of dental prosthesis installation is the osseointegration of a metal implant with bone tissue. The acceleration of this process may be achieved through the use of extracorporeal shock wave therapy. The objective of this study is to investigate the conditions for osseointegration of the second premolar implant in the mandibular segment through the use of a poroelastic model implemented in the movable cellular automaton method. The mandibular segment under consideration includes a spongy tissue layer, 600 µm in thickness, covered with a cortical layer, 400 µm in thickness, and a gum layer, 400 µm in thickness. Furthermore, the periodontal layers of the roots of the first premolar and first molar were considered, while the implant of the second premolar was situated within a shell of specific tissue that corresponded to the phase of osseointegration. The model was subjected to both physiological loading and shock wave loading across the three main phases of osseointegration. The resulting fields of hydrostatic pressure and interstitial fluid pressure were then subjected to analysis in accordance with the mechanobiological principles. The results obtained have indicated that low-intensity shock wave therapy can accelerate and promote direct osseointegration: 0.05–0.15 mJ/mm2 in the first and second phases and less than 0.05 mJ/mm2 in the third phase. In comparison to physiological loads (when bone tissue regeneration conditions are observed only around the implant distal end), shock waves offer the primary advantage of creating conditions conducive to osseointegration along the entire surface of the implant simultaneously. This can significantly influence the rate of implant integration during the initial osteoinduction phase and, most crucially, during the longest final phase of bone remodeling. [ABSTRACT FROM AUTHOR]

Nanotechnology, delving into the realm of nanometric structures, stands as a transformative force in orthopedics, reshaping diagnostics, and numerous regenerative interventions. Commencing with diagnostics, this scientific discipline empowers accurate analyses of various diseases and implant stability, heralding an era of unparalleled precision. Acting as carriers for medications, nanomaterials introduce novel therapeutic possibilities, propelling the field towards more targeted and effective treatments. In arthroplasty, nanostructural modifications to implant surfaces not only enhance mechanical properties but also promote superior osteointegration and durability. Simultaneously, nanotechnology propels tissue regeneration, with nanostructured dressings emerging as pivotal elements in accelerating wound healing. As we navigate the frontiers of nanotechnology, ongoing research illuminates promising avenues for further advancements, assuring a future where orthopedic practices are not only personalized but also highly efficient, promising a captivating journey through groundbreaking innovations and tailored patient care. [ABSTRACT FROM AUTHOR]

Periimplantitis represents an inflammatory disease of the soft and hard tissues surrounding the osseointegrated dental implant, triggering progressive damage to the alveolar bone. Cumulative data have revealed that periimplantitis plays a crucial part in implant failure. Due to the strategic roles of autophagy and its upstream coordinator, the AKT/mTOR pathway, in inflammatory responses, the crosstalk between them in the context of periimplantitis should become a key research target, as it opens up an area of interesting data with clinical significance. Therefore, in this article, we aimed to briefly review the existing data concerning the complex roles played by ROS in the interplay between the AKT/mTOR signaling pathway and autophagy in periimplantitis, in each of the main cell types involved in periimplantitis pathogenesis and evolution. Knowing how to modulate specifically the autophagic machinery in each of the cellular types involved in the healing and osseointegration steps post implant surgery can help the clinician to make the most appropriate post-surgery decisions. These decisions might be crucial in order to prevent the occurrence of periimplantitis and ensure the proper conditions for effective osseointegration, depending on patients' clinical particularities. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Material and Methods Results Conclusion Primary stability (PS) is a key factor for promoting osseointegration and long‐term success of dental implants particularly for immediate loading protocols. Beyond the current assessments of PS, an accurate pre‐operative evaluation of PS would contribute to the improvement of surgical planning and treatment outcome. This study used biomechanical testing and homogenized finite element (hFE) analysis to objectively measure PS in the laboratory, and digitally estimate PS from prior μCT reconstructions.Thirty‐five bone samples extracted from the jaws of two donors were examined. Twenty‐two were finally evaluated for PS. After scanning of the samples with μCT, implants were inserted by two experienced surgeons, and various metrics such as μCT‐based bone volume fraction (BV/TV), insertion torque (IT), and resonance frequency analysis (RFA) were assessed to determine PS. Mechanical tests were conducted to measure ultimate force (UFexp) as an objective indicator of PS while the hFE simulations were performed to estimate this same ultimate force (UFsim).Higher correlation was found between UFsim and UFexp (R2 = 0.85) than between BV/TV and UFexp (R2 = 0.61), IT and UFexp (R2 = 0.50), and RFA and UFexp (R2 = 0.38). All variables demonstrated a statistically significant linear correlation with UFexp (p < 0.01).UFsim turns out to be a more reliable and objective indicator of PS than IT and RFA. The hFE analysis requires prior μCT reconstructions and is currently limited by numerical convergence problems. Despite these limitations, pre‐operative hFE analysis emerges as a promising tool with a higher accuracy for estimation of PS than state of care techniques. [ABSTRACT FROM AUTHOR]

With the improvement of implant design and the expansion of application scenarios, orthopedic implants have become a common surgical option for treating fractures and end‐stage osteoarthritis. Their common goal is rapidly forming and long‐term stable osseointegration. However, this fixation effect is limited by implant surface characteristics and peri‐implant bone tissue activity. Therefore, this review summarizes the strategies of interface engineering (osteogenic peptides, growth factors, and metal ions) and treatment methods (porous nanotubes, hydrogel embedding, and other load‐release systems) through research on its biological mechanism, paving the way to achieve the adaptation of both and coordination between different strategies. With the transition of the osseointegration stage, interface engineering strategies have demonstrated varying therapeutic effects. Especially, the activity of osteoblasts runs almost through the entire process of osseointegration, and their physiological activities play a dominant role in bone formation. Furthermore, diseases impacting bone metabolism exacerbate the difficulty of achieving osseointegration. This review aims to assist future research on osseointegration engineering strategies to improve implant‐bone fixation, promote fracture healing, and enhance post‐implantation recovery. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Materials and Methods Results Conclusion Variations in transmucosal abutment contour design may affect the outcomes of implant therapy. This randomized controlled trial was primarily aimed at testing the effect that CAD/CAM zirconia abutments with either a concave or linear divergent transmucosal morphology have on peri‐implant mucosal dynamics and indicators of peri‐implant health at 1 year after final implant‐supported prosthesis insertion in the anterior maxilla.Following computer‐guided implant placement and osseointegration, eligible subjects were randomized into either the experimental (concave morphology) or the control (linear divergent morphology) group. A comprehensive set of outcomes of interest related to peri‐implant soft tissue dynamics, phenotypical features, and indicators of peri‐implant health were assessed at different time points over a 1‐year period after insertion of the final restoration.Out of 60 initially recruited subjects, a total of 54 completed the study (n = 29 in the experimental group concave/n = 25 in the control group). Overall implant survival and restoration rates between master impression and 12 months were 100% and 98.2%, respectively. Although a trend for coronal migration of the buccal mucosa zenith, gain in mucosal thickness, and increased probing depth and bleeding on probing was observed in both groups, these changes were clinically negligible, and no substantial differences were observed between study groups regardless of variations in transmucosal abutment morphology.The use of either linear divergent or concave custom CAD/CAM zirconia abutments in a screw‐retained, delayed loading approach yielded no significant differences. [ABSTRACT FROM AUTHOR]

This study investigates the effects of two parathyroid hormone (PTH) analogs, rhPTH(1-34) and dimeric R25CPTH(1-34), on bone regeneration and osseointegration in a postmenopausal osteoporosis model using beagle dogs. Twelve osteoporotic female beagles were subjected to implant surgeries and assigned to one of three groups: control, rhPTH(1-34), or dimeric R25CPTH(1-34). Bone regeneration and osseointegration were evaluated after 10 weeks using micro-computed tomographic (micro-CT), histological analyses, and serum biochemical assays. Results showed that the rhPTH(1-34) group demonstrated superior improvements in bone mineral density, trabecular architecture, and osseointegration compared to controls, while the dimeric R25CPTH(1-34) group exhibited similar, though slightly less pronounced, anabolic effects. Histological and TRAP assays indicated both PTH analogs significantly enhanced bone regeneration, especially in artificially created bone defects. The findings suggest that both rhPTH(1-34) and dimeric R25CPTH(1-34) hold potential as therapeutic agents for promoting bone regeneration and improving osseointegration around implants in osteoporotic conditions, with implications for their use in bone-related pathologies and reconstructive surgeries. [ABSTRACT FROM AUTHOR]

Background and Objectives: Pterygoid implants represent an alternative approach for rehabilitation of posterior maxilla, and it challenges the standard procedures such as sinus lifting which has high morbidity and long healing time. There is limited data in the literature regarding the use of surgical guide to increase the success rate of pterygoid implants. Therefore, this study compared the results of pterygoid implants placed with or without surgical guide. In addition, evaluation of the effect of smoking on the success rate of pterygoid implants was a secondary aim. Methods: A prospective interventional study in which patients receiving free-hand (without surgical guide) pterygoid implants, designated as control group (12 participants, 19 implants) was compared to patients receiving guided pterygoid implants (9 participants, 11 implants). In both groups, standard two-piece implants were used. Osteointegration was tested clinically by reverse torqueing at 25 N/cm after 3 months from surgery. Results: In the free-hand group, 18 implants osseointegrated with 1 implant failed, and in the guided group, 9 implants osseointegrated with 2 implants failed. There was no statistically significant difference regarding implant success rate between the two groups. In addition, smoking did not show statistically significant correlation with implant success. Conclusion: Both groups showed high but similar success rate. As surgical guide did not increase the success rate of pterygoid implants, surgeons need to consider cost/benefit analysis of guided surgery in pterygoid implants. In addition, smoking did not result in increase of pterygoid implant failure, making its use within these patients recommended. [ABSTRACT FROM AUTHOR]

Background: Identifying patients with a strong pro-inflammatory phenotype may allow clinicians to underpin high-risk individuals based on early inflammatory marker profiles and to personalize approaches to preventative treatments. Aim: The objective of this systematic review is to synthesize the results of previous studies on osseointegration to show which pro-inflammatory cytokines and chemokines have been detected and quantified during the initial phase of osseointegration. Material and methods: PubMed, Embase, Scopus, ISI Web of Science, and Cochrane Library were searched for articles published until August 2024. A descriptive summary was produced to explain study variations, including patients' characteristics and results. The methodological quality of each included study was assessed based on Downs and Black's checklist. Results: 30 studies were selected for inclusion. In total, 710 patients received 1329 implants (an average of 1.87 implants per participant). A total of 32 biomarkers were analyzed. The overall trend observed in levels of pro-inflammatory cytokines and chemokines appears to be an early peak, followed by a progressive reduction in levels throughout the observation periods. Conclusions: The available evidence suggests that a strong expression of pro-inflammatory biomarkers is a feature of osseointegration, and an over- or underexpression of certain biomarkers could have an effect on early marginal bone levels. Several of these markers are mechanistically implicated with implant pathology; however, the prognostic value of early cytokine expression and correlation with long-term clinical outcomes requires further research. [ABSTRACT FROM AUTHOR]

Objective: The aim of this non‐inferiority randomized clinical trial was to compare the surgical and healing complications, vertical bone gain, and volumetric bone changes after vertical ridge augmentation using two different approaches: customized Ti‐reinforced d‐PTFE mesh versus customized CAD/CAM Ti‐mesh. Materials and Methods: Fifty patients with vertical bone defects were randomly treated with Ti‐reinforced d‐PTFE mesh (control group) or CAD/CAM Ti‐mesh (test group) and a mix of autogenous bone and deproteinized bovine bone matrix. Surgical and healing complication rates (SCR‐HCR), vertical bone gain (VBG), regenerated bone volume (RBV), and regeneration rates (RR and ERR) were recorded and analysed [significance level (α) of 0.05]. Results: Of the 50 patients, 48 underwent bone augmentation surgery. SCR were 4% and 12% in PTFE and Ti‐mesh, whereas HCR were 12.5% and 8.3%. VBG were 5.79 ± 1.71 mm (range: 3.2–8.8 mm) in the PTFE group and 5.18 ± 1.61 mm (range: 3.1–8.0 mm) in the Ti‐mesh group (p =.233), whereas RBV were 1.46 ± 0.48 cc and 1.26 ± 0.55. RR was 99.5% and 87.0%, demonstrating a statistically significant difference (p =.013). Finally, the values related to pseudo‐periosteum, bone density, and implant stability were similar in the two study groups. Osseointegration rates were 98.2% and 98.3%. Conclusions: This study confirmed the non‐inferiority of customized CAD/CAM titanium meshes with respect to reinforced PTFE meshes in terms of surgical and healing complications. Although PTFE meshes showed higher vertical bone gain and regeneration rates than Ti‐meshes, no significant differences were found. [ABSTRACT FROM AUTHOR]

3D-printed microporous titanium scaffolds enjoy good biointegration with the residuum's soft and bone tissues, and they promote excellent biomechanical properties in attached prostheses. Implant-associated infection, however, remains a major clinical challenge. Silver-based implant coatings can potentially reduce bacterial growth and inhibit biofilm formation, thereby reducing the risk of periprosthetic infections. In the current study, a 1-µm thick silver coating was prepared on the surface of a 3D-printed microporous titanium alloy with physical vapor deposition (PVD), with a final silver content of 1.00 ± 02 mg/cm2. Cell viability was evaluated with an MTT assay of MC3T3-E1 osteoblasts and human dermal fibroblasts cultured on the surface of the implants, and showed low cytotoxicity for cells during the 14-day follow-up period. Quantitative real-time polymerase chain reaction (RT-PCR) analysis of the relative gene expression of the extracellular matrix components (fibronectin, vitronectin, type I collagen) and cell adhesion markers (α2, α5, αV, β1 integrins) in dermal fibroblasts showed that cell adhesion was not reduced by the silver coating of the microporous implants. An RT-PCR analysis of gene expression related to osteogenic differentiation, including TGF-β1, SMAD4, osteocalcin, osteopontin, and osteonectin in MC3T3-E1 osteoblasts, demonstrated that silver coating did not reduce the osteogenic activity of cells and, to the contrary, enhanced the activity of the TGF-β signaling pathway. For representative sample S5 on day 14, the gene expression levels were 7.15 ± 0.29 (osteonectin), 6.08 ± 0.12 (osteocalcin), and 11.19 ± 0.77 (osteopontin). In conclusion, the data indicate that the silver coating of the microporous titanium implants did not reduce the biointegrative or osteoinductive properties of the titanium scaffold, a finding that argues in favor of applying this coating in designing personalized osseointegrated implants. [ABSTRACT FROM AUTHOR]

Conventional insertion torque and pull‐out tests are destructive and unsuitable for clinical bone screw fixation. This study evaluates screw stability using acoustic modal analysis (AMA) and Periotest compared to traditional methods in an ex vivo animal model. Titanium self‐tapping screws (STS) and nonself‐tapping screws (N‐STS) were implanted in the proximal tibia of 12 rabbits. Four testing methods were used to assess screw stability: peak insertion torque (PIT) during implantation, AMA for natural frequency (NF), Periotest for Periotest value (PTV), and pull‐out test for peak pullout force (PPF). Euthanization was performed at 0 (primary stability), 4, and 8 weeks (secondary stability). No significant difference in primary stability was found between STS and N‐STS except for AMA (STS: NF 2434 ± 67 Hz, N‐STS: NF 2572 ± 43 Hz; p = 0.62). Secondary stability increased significantly over time for both screw types (4‐week: NF 3687 ± 36 vs. 3408 ± 45 Hz, PTV 1.4 ± 1.6 vs. −1.5 ± 1.8, PPF 236 ± 29 vs. 220 ± 34 N; 8‐week: NF 3890 ± 39 vs. 3613 ± 31 Hz, PTV −3.2 ± 2.5 vs. −2 ± 4.3, PPF 248 ± 25 vs. 289 ± 28 N). Higher NF values for given PTV/PPF indicate potential clinical advantages. Significant differences between primary and secondary stabilities suggest osteointegration was mainly achieved in the 4‐week group. [ABSTRACT FROM AUTHOR]

Despite the success of standard antiseptic irrigation solutions in reducing periprosthetic joint infection (PJI) rates, there is still a need for more effective solutions. Synergistic use of povidone‐iodine (PI) and hydrogen peroxide (H2O2) has shown promising results; however, the optimal solution concentration balancing bactericidal activity and osseointegration remains unknown. This study aims to evaluate the impact of these antiseptic irrigation solutions on osseointegration and the bone–implant interface strength in vivo. Forty C57BL/6 mice underwent bilateral tibial implantation surgery and were randomly allocated into three groups receiving 0.3% PI, 10% PI mixed with 3% H2O2, or saline as irrigation solutions intraoperatively. Assessments were performed on postoperative Days 1 and 28, including plain radiographs, microcomputed tomography (microCT) evaluation, histological analysis, immunohistochemistry, and biomechanical pull‐out testing. No wound complications were observed. MicroCT scans revealed no differences in peri‐implant trabecular bone parameters. Biomechanical pull‐out testing showed no differences in the bone–implant interface strength across groups. Histological analysis indicated no differences in bone and bone marrow percentage areas among treatment groups. Immunohistochemical analysis demonstrated no differences among groups in peri‐implant osteocalcin, osterix, or endomucin‐positive cells. In conclusion, using either antiseptic irrigation solution showed no differences in osseointegration parameters compared to the control group, demonstrating safety and the absence of toxicity. Clinical Relevance: Dilute 0.3% povidone‐iodine and a 1:1 combination of 10% povidone‐iodine mixed with 3% hydrogen peroxide can be safely used during primary and revision total joint arthroplasty without compromising osseointegration or causing wound complications. [ABSTRACT FROM AUTHOR]

Objectives: Vitamin D deficiency may influence dental implant osseointegration unfavourably. The aim of this study was to compare dental implant stabilities of patients with different levels of vitamin D and investigate the effects of vitamin D supplementation. Materials and methods: One hundred and twenty-nine patients who underwent dental implantation were grouped regarding vitamin D levels and supplement use: Group A; vitamin D deficiency and supplement usage, Group B; insufficiency with supplement usage, Group C; insufficiency without supplements and Group D; vitamin D sufficiency. Resonance frequency analysis (RFA) measurements were performed at baseline and 3 months. Patients with vitamin D deficiency (Group A) and insufficiency (Group B) were prescribed supplements by specialists. Pearson correlation analysis was used to examine an association between vitamin D levels and implant stability. Results: Primary stability of Group D (76.34 ± 6.55) was significantly higher than Groups A, B and C at baseline (p < 0.05). At 3 months, Group C scored significantly lower than the other groups (p < 0.05). The results revealed a correlation between serum levels of vitamin D and RFA measurements at 3 months (p < 0.05). Conclusion: It was observed that high vitamin D levels influenced implant stabilities positively, as evidenced by higher Implant Stability Quotient values. Low levels of vitamin D may be associated with a decrease in implant stability. Statement of Clinical Relevance: Vitamin D, concerning its impact on bone metabolism, is currently of particular interest in implant dentistry. The lower stability scores in patients with vitamin D deficiency reinforce the recommendation of Vitamin D supplementation when treating those patients with dental implants. [ABSTRACT FROM AUTHOR]

Background: Active recruitment of osteogenic cells by secreted signaling factors, such as stromal-cell-derived factor 1 (SDF-1), has recently been proposed as a novel strategy to enhance osseointegration. However, the intrinsic importance of the SDF-1/C-X-C chemokine receptor type 4 (CXCR4) axis in promoting osseointegration is unknown. To study the role of SDF-1/CXCR4 in osseointegration, we blocked the SDF-1/CXCR4 pathway in a murine tibial implant model through repeated administrations of an antibody against SDF-1. Methods: Using our previously described murine tibial implant model (N = 24), mice were randomized into an anti-SDF-1 group and a control group (N = 12/group). Intraperitoneal injections of CXCL12/SDF-1 monoclonal antibody (84 µg/mouse) or mouse IgG1 isotype were administered on days 2, 4, 7, 10, 13, 16, 19, 22, and 25 post-surgery. Mice were euthanized 4 weeks post-surgery. Peri-implant bone mass and architecture were determined through microcomputed tomography (µ-CT). Bone implant strength was detected through implant pull-out testing. Results: Inhibition of the SDF-1/CXCR4 pathway significantly reduced host bone–implant interface strength but did not significantly change the cancellous architecture surrounding the implant. Conclusion: SDF-1/CXCR4 is an important pathway to achieve maximum implant osseointegration. However, inhibition of the pathway did not completely eliminate osseointegration. [ABSTRACT FROM AUTHOR]

The article aims to design and develop a topology-optimized endosseous cuspid tooth implant of the maxilla region. The manuscript presents a numerical analysis of the resulting von Mises stresses and effective strain resulting in the topology-optimized implant with occlusal loading of 110 N. Solid Isotropic Material with Penalization (SIMP) method is employed for topology optimization and four different models, namely model-1, model-2, model-3, and model-4, are developed based on volume reduction rates of 8%, 16%, 24%, and 32%, respectively. FEA results highlight that the maximum stress and strain in the screw increases with volume reduction rates. The comparative analyses of the resulting stresses in the compact and cancellous bone along with the strain in the screw led to the conclusion that model-1, model-2, and model-3 resulted in moderate stresses on compact and cancellous bone compared to the original model of the implant. However, the screw and bones are subjected to maximum stress and strain in the model-4. The study concludes that model-2, with 16% reduced volume and 14.2% reduced mass as compared to the original implant, may be considered as the optimized design of the model. The resulting model offers a significant reduction in the weight and volume with a minor increase in effective stress and strain without negatively impacting the functionality and bio-mechanical performance of the implant. The optimized dental implant prototype is also fabricated as a proof of concept by the Fused Deposition Modelling process. [ABSTRACT FROM AUTHOR]

Purpose: This multicenter cross‐sectional clinical study aimed to evaluate the membrane perforation rate during transcrestal sinus floor elevation (TSFE) using osseodensification (OD) burs and assess risk factors associated with the procedure. Materials and Methods: This study was conducted in six centers, following ethical standards and approved by local committees. It included patients over 18 years old missing maxillary posterior teeth with crestal residual bone height (RBH) ≥2 and ≤6 mm. Preoperative evaluations were done, including CBCT scans, to assess bone dimensions and sinus health. All centers and surgeons followed a standardized surgical protocol for TSFE using OD burs. Surgical complications, particularly sinus membrane perforations, were recorded and analyzed. Factors such as implant site, premolars or molars, as well as, healed or fresh socket, along with initial RBH were evaluated for their impact on membrane perforation rate. Descriptive statistics, χ2, and logistic regression analysis were used to analyze the data. Results: A total of 621 subjects with an average age of 57.9 years were included. Sinus lifting was performed at 670 sites, with 621 implants placed in the maxilla. The majority of sinus lifts were done in the molar region (76.87%) and in healed bone sites (74.33%). The average RBH was 5.1 mm (ranging from 2 to 7 mm). Sinus membrane perforation occurred in 49 cases (7.31%). RBH ≤3 mm posed a risk factor for sinus membrane perforations followed by RBH >3 and ≤5 mm. Tooth region and implant site were not associated as risk factors for sinus membrane perforation. Conclusion: OD drilling used for TSFE resulted in low membrane perforation rate. Challenging scenarios of severe posterior maxillary atrophy presented as risk factors for increased perforation rate. [ABSTRACT FROM AUTHOR]

The inadequate osseointegration of titanium implants remains a significant challenge in orthopedics, limiting the long-term efficacy of prostheses and medical devices. It has been determined that biological aging of the titanium surface compromises the implant–bone tissue interaction due to increased hydrophobicity and accumulation of organic molecules. To address this issue, an innovative strategy has been proposed: the biofunctionalization of Ti6Al4V surfaces utilizing biomass derived from Chlorella sorokiniana UTEX 1230 and Synechococcus sp. PCC 7002. This research was structured to encompass microalgal culture optimization through biocompatibility evaluation of biofunctionalized surfaces. Biofunctionalization stages were analyzed using contact angle measurements, EDS, SEM, and cellular assays. It was observed that piranha solution activation generated a hydrophilic surface, while silanization was more efficient in samples treated for 14 h. It was found that Synechococcus sp. PCC 7002 presented a higher biomass concentration on the surface compared to C. sorokiniana UTEX 1230. Cytotoxicity assays revealed that the coating with Synechococcus sp. PCC 7002 was potentially non-cytotoxic, with a cell viability of 86.8%. SEM images showed a significant number of cells adhered to the treated sample. In conclusion, the potential of using microalgal biomass to biofunctionalize titanium surfaces has been demonstrated, offering an innovative alternative to improve implant–tissue interaction and, consequently, the osseointegration process in orthopedic applications. [ABSTRACT FROM AUTHOR]

The aim of this finite element analysis (FEA) was to investigate the distribution of von Mises stress within dental implant components, as well as trabecular and cortical bone. The study considered various bone qualities that influence cortical thickness in contact with the implant, specifically examining cortical thicknesses of 0.5, 1.5, and 3 mm, corresponding to Bergkvist's classifications IV, III, and II, respectively. A simplified 3D model of the bone was developed for the analysis. Two short implants were inserted into the model: one with a 30° inclined abutment (IA) and another positioned at a 30° angle featuring a straight abutment (II). A vertical force (120 N) was applied to the upper surface of the abutments. FEA software was employed to assess the stresses on the peri-implant tissues and the implants. The findings indicated that a reduction in cortical bone thickness results in an increase in stress within the cortical bone. For IA, the stresses recorded 32.56, 56.12, and 96.14 MPa for cortical thicknesses of 3, 1.5, and 0.5 mm, respectively. Conversely, II exhibited increased stresses across all bone qualities (52.32, 76.15, and 126.32 MPa for the same cortical thicknesses). It is advisable to avoid II in cases of poor bone quality and thin cortical due to the heightened risk of overload-induced bone resorption; however, it may be preferable to use IA in scenarios involving good bone quality and thicker cortical. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that 1–2 mm of bone width at the buccal and lingual aspect is required for a successful long‐term implant outcome. Low levels of evidence support this minimum threshold of bone width. This prospective study aimed at evaluating the outcome of implants placed in alveolar ridges with limited bucco‐oral dimensions. Materials and Methods: One‐hundred implants (dia. 3.5 mm) were placed in 28 patients with narrow alveolar ridge dimensions (<4.5 mm width) without augmentation procedures and conventionally loaded. Intra‐oral radiographs were taken at implant placement and abutment connection and at 1, 2, 3, 5 and 10 years of follow‐up. At the 10‐year follow‐up (21 patients; 75 implants), full‐mouth periodontal charting was performed, and the peri‐implant keratinized tissue width and attachment type were recorded. Two calibrated periodontists analysed the peri‐implant bone changes. Results: After 10 years, all implants showed successful osseointegration and a cumulative survival rate of 100%. The implants were placed 0.85 mm ± 0.89 mm subcrestally. After 10 years, the marginal bone was located 1.59 ± 2.11 mm apical to the implant shoulder. Throughout this period of follow‐up, the mean annual marginal bone loss was 0.094 mm. Furthermore, 84% of implants in 72% of patients presented with bleeding on probing. Conclusion: After 10 years of functional loading, implants placed in alveolar ridges with limited bucco‐oral dimensions (≤4.5 mm) exhibited only minimum marginal bone loss. [ABSTRACT FROM AUTHOR]

[Display omitted] • An emodin-conjugated Mn-doped titanium dioxide nanorod array is designed and prepared on titanium. • The grafting of emodin enhances the sonocatalytic performance. • The hybrid nanoplatform can stimulate macrophages to polarize to display potent phagocytosis to MRSA. • The nanoplatform exhibits excellent anti-biofilm activity under ultrasound. Emodin (ED), as a traditional Chinese medicine, possesses a variety of biological activities and is also one of natural sonosensitizer. Whether emodin could react with titanium dioxide to enhance the sonodynamic activity for safely treating osteomyelitis remains to be explored. Hence, an ED-conjugated Mn-doped titanium dioxide (TOM) nanorod array is designed and prepared on titanium to eliminate bacterial infections under ultrasound (US) treatment. The doping of Mn and the formation of an inorganic–organic interfacial between ED and TOM cause an imbalance in the interfacial charge and reduce the band gap of TOM, thereby increasing the production of reactive oxygen species (ROS) under US. The generated ROS effectively destroys the bacterial cell membrane, accelerating Mn ions intake and thereby inducing ferroptosis-like death of MRSA. Moreover, the hybrid coating activates cAMP and cGMP-PKG pathways to modulate M1 polarization of macrophages to display potent phagocytosis to bacteria. After eliminating the bacterial infection, the coating also can facilitate macrophage M2 polarization to promote osteogenic differentiation. Overall, the Chinese medicine enhanced sonodynamic and immunotherapy have great promise in treating bacterial-infected osteomyelitis. [ABSTRACT FROM AUTHOR]

Background: Early reconstruction of the skull represents the gold standard after resection of bone infiltrating cranial tumors. Customized hydroxyapatite porous ceramics are an excellent option for covering skull bone defects. The authors illustrate the surgical technique and investigate the effectiveness of the "one-step" procedure in terms of aesthetic results and early degree of osteointegration. Method: A prospective study was conducted, including all patients operated on for skull bone infiltrating lesions at our center between January 2020 and June 2022. Stereolithography was the technique used for shaping the epoxy-resin model, suitable for both designing the craniotomy and manufacturing the custom-made hydroxyapatite prosthesis. Clinical outcome, results of early (6-week) and late (3-month) osteointegration evaluated on CT and MRI, and level of patient satisfaction measured by the FACE-Q questionnaire were reported. Results: Fourteen patients (13 adults and a 7-year-old boy) and a total of 15 implants were included. The average percentage of early osteointegration calculated at the edge of the prosthesis, was 72.2%, that increased to 82.6% after 3 months. Patient-reported outcomes indicated a high level of satisfaction across all patients. Conclusions: "One-step" resection and reconstruction using customized hydroxyapatite porous implants for treatment of skull infiltrating tumors is a safe, simple and effective technique, in particular when the bone defect is large. Bone regeneration around and inside the prosthesis seems to start early after surgery. [ABSTRACT FROM AUTHOR]

Biomedical coatings were elaborated by pulsed electrodeposition with hydrogen peroxide (H 2 O 2) into electrolytes on Ti 6 Al 4 V substrates, and the effect of H 2 O 2 concentration on the electrolyte and the heat treatment was studied. The experimental procedures employed in this study produce a consistent hydroxyapatite coating. This coating is well-suited for use in bio-implants, as it enhances the integration of the implant with surrounding bone tissue and improves the mechanical performance. The coatings' surface morphology and chemical composition were assessed using scanning electron microscopy (SEM) in conjunction with energy-dispersive X-ray spectroscopy (EDXS) for x-ray microanalysis. X-ray diffraction (XRD) was also utilized to identify the phases and composition of the coatings. Nanoindentation and scratch tests were conducted to analyze the nanomechanical properties and adhesion behavior. Potentiodynamic polarization was employed in the Ringer solution to evaluate the corrosion resistance and replicate the conditions of the human body environment. The results of our thorough investigation revealed that employing pulsed electrodeposition with 9 % H 2 O 2 in the electrolyte, combined with subsequent heat treatment, facilitated the creation of coatings comprising two distinct phases: stoichiometric hydroxyapatite (HAP) and β-tricalcium phosphate (β-TCP). Our meticulous research underscores the significance of this process in achieving these specific coating compositions. Under these tests listed above, this composite demonstrated favorable mechanical properties (E = 30.45 GPa and H = 72.2 MPa). It also exhibited superior scratch adhesion and a critical load of 23 MPa and 12 N, respectively. Additionally, an improvement in tribological comportment was observed, and the wear volume decreased from 4.15 106 μm3 to 2.44 106 μm3. The HAP coating heat treated with 9 % H 2 O 2 exhibited the highest corrosion resistance, with E corr at −0.189 V/SCE and i corr at −1.11 μA cm−2 [ABSTRACT FROM AUTHOR]

Two cases of calcified bone and dental tissue integration with titanium implants are presented, along with a review of the literature on their experimental and clinical implications. First, histological analyses of a titanium implant extracted from a patient with iimplant disease revealed the integration of both dental and bone tissue on the implant's surface. Secondly, a biocompatibility study in an animal model documented two implants in contact with tooth roots. Samples from both animal and human models demonstrated simultaneous osseointegration and dental tissue neoformation, with the latter attributed to the activity of cementoblasts. The literature review confirms the formation of cementum around dental implants in contact with teeth. Certain clinical reports have proposed the insertion of implants into bone sites containing impacted teeth as a conservative treatment alternative, avoiding the need for tooth extraction surgery and demonstrating the successful integration of teeth, bone, and dental implants. Furthermore, the documented natural formation of periodontal tissues around dental implants provided a foundation for tissue engineering studies aimed at realizing implant–bone relationships similar to those of natural bone–tooth structures. The primary challenges remain the long-term preservation of periodontal-like tissue formed on implants and the imparting of functional proprioceptive properties. [ABSTRACT FROM AUTHOR]

This study evaluated the bone-to-implant contact (BIC) of various surface-treated dental implants using high-resolution micro-CT in rabbit bone, focusing on the effects of different treatments on osseointegration and implant stability before and after bone demineralization. Six male New Zealand White rabbits were used. Four implant types were tested: machined surface with anodizing, only etching, sandblasting with Al2O3 + etching, and sandblasting with TiO2 + etching. Implants were scanned with high-resolution micro-CT before and after demineralization. Parameters like implant volume, surface area, and BIC were determined using specific software tools. During demineralization, the BIC changed about 6% for machined surface with anodizing, 5% for only etching, 4% for sandblasting with Al2O3 + etching, and 10% for sandblasting with TiO2 + etching. Demineralization reduced BIC percentages, notably in the machined surface with anodizing and sandblasting with TiO2 + etching groups. Etching and sandblasting combined with etching showed higher initial BIC compared to anodizing alone. Demineralization negatively impacted the BIC across all treatments. This study underscores the importance of surface modification in implant integration, especially in compromised bone. Further research with larger sample sizes and advanced techniques is recommended. [ABSTRACT FROM AUTHOR]

An in vivo animal model of a weight‐bearing intra‐articular implant is crucial to the study of implant osseointegration and aseptic loosening caused by osseointegration failure. Osseointegration, defined as a direct structural and functional attachment between living bone tissue and the surface of a load‐carrying implant, is essential for implant stability and considered a prerequisite for the long‐term clinical success of implants in total joint arthroplasty. Compared to large animal models, murine models offer extensive genetic tools for tracing cell differentiation and proliferation. The 18‐ to 22‐week‐old C57BL/6J background mice underwent either press‐fitted or loose implantation of a titanium implant, achieving osseointegration or fibrous integration. A protocol was developed for both versions of the procedure, including a description of the relevant anatomy. Samples were subjected to microcomputed tomography and underwent biomechanical testing to access osseointegration. Lastly, samples were fixed and embedded for histological evaluation. The absence of mineralized tissue and weakened maximum pull‐out force in loose implantation samples indicated that these implants were less mechanically stable compared to the control at 4 weeks postoperation. Histological analysis demonstrated extensive fibrotic tissue in the peri‐implant area of loose implantation samples and excellent implant osseointegration in press‐fitted samples at 4 weeks. Both mechanically stable and unstable hemiarthroplasty models with either osseous ingrowth or a robust periprosthetic fibrosis were achieved in mice. We hope that this model can help address current limitations for in vivo study of aseptic loosening and lead to necessary translational benefits. [ABSTRACT FROM AUTHOR]

Background: The current murine models of peri-implant osseointegration failure are associated with wear particles. However, the current clinical osseointegration failure is not associated with wear particles. Here, we develop a murine model of osseointegration failure not associated with wear particles and validate it by comparing the cellular composition of interfacial tissues with human samples collected during total joint arthroplasty revision for aseptic loosening. Materials and Methods: Thirty-two 16-week-old female C57BL/6 mice underwent implantation with a press-fitted roughened titanium implant (Control, n = 11) to induce normal osseointegration and a press-fitted smooth polymethylmethacrylate implant (PMMA, n = 11), a loosely fitted smooth titanium implant (Smooth-Ti, n = 5) or a loosely fitted roughened titanium implant (Overdrill, n = 5) to induce osseointegration failure. Pullout testing was used to determine the strength of the bone–implant interface (n = 6 of each for Control and PMMA groups) at 2 weeks after implantation. Histology (n = 2/group) and immunofluorescence (n = 3/group) were used to determine the cellular composition of bone–implant interfacial tissue, and this was compared with two human samples. Results: Osseointegration failure was confirmed with grossly loosening implants and the presence of fibrous tissue identified via histology. The maximum pullout load in the PMMA group was 87% lower than in the Control group (2.8 ± 0.6 N vs. 21 ± 1.5 N, p < 0.001). With immunofluorescence, abundant fibroblasts (PDGFRα+ TCF4+ and PDGFRα+ Pu1+) were observed in osseointegration failure groups and the human samples, but not in controls. Interestingly, CD146+PDGFRα+ and LepR+PDGFRα+ mesenchymal progenitors, osteoblasts (OPN+), vascular endothelium (EMCN+) cells were observed in all groups, indicating dynamic osteogenic activity. Macrophages, only M2, were observed in conditions producing fibrous tissue. Conclusions: In this newly developed non-wear-particle-related murine osseointegration failure model, the cellular composition of human and murine interfacial tissue implicates specific populations of fibroblasts in fibrous tissue formation and implies that these cells may derive from mesenchymal stem cells. [ABSTRACT FROM AUTHOR]

Bone histology and histomorphometry are reliable diagnostic tools for the assessment of the bone–implant interface, material safety and biocompatibility, and tissue response. They allow for the qualitative and quantitative analysis of undecalcified bone specimens. This scoping review aims to identify the most common staining techniques, study models for in vivo experiments, and histomorphometric parameters used for quantitative bone evaluation of osseointegrated dental implants in the last decade. The Web of Science, PubMed, and Scopus databases were searched on 1 July 2024 for relevant articles in English, published in the last ten years, and the data were exported to an MS Excel spreadsheet. A total of 115 studies met the eligibility criteria and were included in the present review. The results indicate that the most common study models are dogs, rabbits, and pigs. Some of the most frequently used methods for the assessment of the bone–implant interface are the Toluidine blue, Stevenel's blue with Van Gieson, and Levai–Laczko stainings. The results from this study demonstrate that the most commonly used histomorphometric parameters in implant dentistry are the bone-to-implant contact (BIC), bone area fraction occupancy (BAFO), bone area (BA), and bone density (BD). This review presents the recent trends in histomorphometric analysis of dental implants and identifies some research gaps that necessitate further research. [ABSTRACT FROM AUTHOR]

Background: Bioactive surface modifications have been proposed to enhance osseointegration and longevity of dental implants. This study aimed to systematically review and perform a meta-analysis on the effectiveness of various bioactive coatings in promoting bone integration and improving implant longevity. Methods: A systematic review was conducted, including studies that investigated bioactive surface modifications on titanium dental implants. Outcomes of interest were bone-to-implant contact (BIC) and implant longevity over a 30-day period. Data were extracted and analyzed using RevMan 5 (version 5.4.1), with forest plots generated to represent the mean difference (MD) and 95% confidence intervals (CI) under a random effects model. Results: The meta-analysis showed a significant improvement in BIC for surface-modified implants, with an overall MD of 7.29 (95% CI [2.94, 11.65]). Heterogeneity analysis indicated moderate heterogeneity (Tau² = 18.57, Chi² = 16.08, df = 8, P = 0.04, I² = 50%). The test for overall effect yielded Z = 3.28 (P = 0.001). For implant longevity, the overall MD was 7.52 (95% CI [3.18, 11.85]), with moderate heterogeneity (Tau² = 17.28, Chi² = 14.95, df = 8, P = 0.06, I² = 47%). The test for overall effect yielded Z = 3.40 (P = 0.0007). Conclusion: Bioactive surface changes significantly improved osseointegration and lifespan of dental implants. Collagen-based coatings consistently encouraged early bone integration, while BMP-2 combinations were effective for osseointegration. Optimizing bioactive agent doses and combinations was critical for achieving desired outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of liraglutide on osteogenesis in human alveolar bone marrow mesenchymal stem cells (BMSCs) and the influence of liraglutide on implant–bone integration in rats with T2DM. Subjects and methods: Extracting BMSCs from the alveoli of diabetic patients treated with insulin. BMSCs were treated with different concentrations of liraglutide. Osteogenesis and the underlying mechanism were investigated via ALP detection, ALP staining, Alizarin Red S staining, Western blotting, and RT‐PCR. Liraglutide was given to Wistar and GK rats after implantation, and new bone formation around the implants was analyzed via micro‐CT. Implant–bone integration in rats was investigated via toluidine blue staining. Results: Liraglutide enhanced osteogenesis in BMSCs via the BMP2/Smad/Runx2 signaling pathway. The optimal concentration of liraglutide that promoted osteogenesis was 10−8 mol/L. At concentrations higher than 10−7 mol/L, liraglutide had a negative effect on BMSCs. At a concentration of 10−8 mol/L liraglutide, BMSCs and diabetes mellitus–bone marrow stromal cells (DM‐BMSCs) showed optimal osteogenesis. Liraglutide promoted implant–bone integration and new bone formation in Wistar and GK rats. Conclusions: Liraglutide not only promotes osteogenesis of BMSCs in normoglycemic individuals but also enhances osteogenesis of BMSCs in diabetic patients treated with insulin and enhances osseointegration in rats. [ABSTRACT FROM AUTHOR]

Bacterial infections leading to implant failure pose a significant global health issue. Despite its antimicrobial properties, nanosilver is not commonly used in commercially available titanium implant coatings. This underutilization stems from an insufficient understanding of fundamental factors, such as particle size, coating, composition, and stability that dictate the antimicrobial performance of nanosilver coatings. A deeper understanding of these factors is crucial for designing effective nanosilver coatings to prevent biofilm formation on implants. Without this knowledge, nanosilver technology risks being merely a marketing tool rather than a functional component in medical devices. Another limiting factor is the potential cytotoxicity of nanosilver coatings, which necessitates a delicate balance between anti-biofilm activity and host tissue toxicity. Addressing these issues could involve the development of multifunctional coatings as well as the optimization of manufacturing processes with a specific focus on the durability of the coatings. Furthermore, to demonstrate the efficacy of these coatings, rigorous in vitro and in vivo assessments are required. As our understanding of the fundamental parameters of nanosilver coatings improves and we find ways to mitigate their toxicity, their utilization will be strengthened by clinicians and approved by regulatory agencies. The development of personalized implant coatings with well-defined nanosilver properties and multiple functionalities will further advance the field and address the challenge of implant failure. [ABSTRACT FROM AUTHOR]