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Objective: To assess the clinical, radiographic and patient‐reported outcomes (PROMs) of posterior zirconia and titanium implants at 1 year of implant loading. Materials and Methods: Forty‐two patients with two adjacent missing teeth were enrolled in a randomized controlled trial with a within‐subject controlled design. Each patient received one zirconia (Zr) and one titanium (Ti) implant, with the mesial and distal positions randomized. The implant restoration consisted of multiple layered zirconia, with the buccal aspect veneered. In group Zr, the restoration was intraorally cemented onto the one‐piece Zr implant, whereas in group Ti, the restoration was extraorally cemented onto the titanium base abutment and intraorally screw‐retained onto the Ti implant. Examinations were performed following restoration delivery at baseline (BL) and at 1 year. Measurements included clinical parameters, radiographic outcomes (MBL) and PROMs. Results: Bleeding on probing showed an increase from BL to 1 year (34 ± 30% for Zr; 25 ± 21% for Ti). MBL remained stable with minimal changes from BL to 1 year, measuring 0.1 ± 0.4 mm (mean ± SD) for Zr and −0.1 ± 0.7 mm for Ti. Veneering fractures were the most frequent technical complication and amounted to 17.5% in group Zr and 5% in group Ti (p =.100). Patients preferred Zr implants for their soft tissue color, with a significant difference in perception between patients and clinicians (p <.017). Conclusion: The study showed that both Zr and Ti implants had similar clinical outcomes, despite a high prevalence of mucositis and a few technical complications. Both implant types demonstrated stable marginal bone levels and similar patient‐reported outcome measures. [ABSTRACT FROM AUTHOR]

Dental implants are considered a superior option for the replacement of missing teeth. However, the invasive nature of the surgical procedure often results in significant postoperative inflammation, and the prolonged healing period of 3–6 months presents a notable disadvantage. High mobility group box 1 (HMGB1) is a critical mediator of acute inflammation following surgical injury, which can hinder the onset of osseointegration. This study aims to examine whether the inhibition of HMGB1 can mitigate acute inflammation and subsequently enhance osseointegration. The findings indicate that HMGB1 inhibition markedly reduces inflammation and promotes bone repair in murine models. Further in vitro investigations into the regulatory mechanisms of HMGB1 in macrophages reveal its role in increasing Yes-associated protein (YAP) activity, which contributes to pro-inflammatory polarization. Additionally, conditioned media derived from macrophages influenced by HMGB1 significantly impair the migratory and osteogenic capabilities of bone marrow-derived mesenchymal stem cells, which are essential for bone regeneration. In vivo experiments further validate that the administration of exogenous HMGB1 exacerbates postoperative acute inflammation and obstructs osseointegration. The study concludes that inhibiting HMGB1 fosters an anti-inflammatory polarization of macrophages, leading to diminished postoperative acute inflammation and expedited osseointegration around dental implants in mice. [Display omitted] • HMGB1 promotes macrophages proinflammatory polarization by activating YAP. • HMGB1-YAP activated macrophages impede mesenchymal stem cell osteogenesis. • HMGB1 inhibition reduces the inflammatory factors release in mice. • Early inflammation resolution boosts osseointegration around implants in mice. [ABSTRACT FROM AUTHOR]

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Titanium and titanium alloys are the prevailing dental implant materials owing to their favorable mechanical properties and biocompatibility, but how roughness dictates the biological response is still a matter of debate. In this study, laser texturing was used to generate eight paradigmatic roughened surfaces, with the aim of studying the early biological response elicited on MC3T3-E1 pre-osteoblasts. Prior to cell tests, the samples underwent SEM analysis, optical profilometry, protein adsorption assay, and optical contact angle measurement with water and diiodomethane to determine surface free energy. While all the specimens proved to be biocompatible, supporting similar cell viability at 1, 2, and 3 days, surface roughness could impact significantly on cell adhesion. Factorial analysis and linear regression showed, in a robust and unprecedented way, that an isotropic distribution of deep and closely spaced valleys provides the best condition for cell adhesion, to which both protein adsorption and surface free energy were highly correlated. Overall, here the authors provide, for the first time, a thorough investigation of the relationship between roughness parameters and osteoblast adhesion that may be applied to design and produce new tailored interfaces for implant materials. [ABSTRACT FROM AUTHOR]

Titanium has been widely used in orthopedics and dental implants due to its excellent biocompatibility and mechanical properties. However, the surface of titanium is biologically inert and lacks biological activity, resulting in poor integration between titanium-based implants and surrounding natural bone tissue, which is a common challenge in its clinical application. Surface modification is currently an effective means to improve the biocompatibility and bioactivity of titanium implants. The natural tissues of the human body are assembled from nanomodules, so from a biomimetic perspective, nanostructures should have better biological activity. TiO2 nanotubes have unique physical and chemical properties due to their elastic modulus, large specific surface area, and regular hollow structure similar to those of bone tissue. This study used anodic oxidation technology to prepare TiO2 nanotubes on the surface of titanium. The surface properties of the nanotubes were evaluated using field emission scanning electron microscopy (FE-SEM), X-ray diffraction (XRD), atomic force microscopy profilometry, contact angle measurements, etc. The corrosion resistance was tested using an electrochemical workstation. The results indicate that anodic oxidation can be used to successfully prepare titanium dioxide nanotube arrays on the surface of titanium. The nanotubes not only exhibit a good structure but also improve the surface hydrophilicity and corrosion resistance of titanium, thereby demonstrating potential for clinical application. [ABSTRACT FROM AUTHOR]

Hydrophilicity/hydrophobicity-or wettability-is a key surface characterization metric for titanium used in dental and orthopedic implants. However, the effects of hydrophilicity/hydrophobicity on biological capability remain uncertain, and the relationships between surface wettability and other surface parameters, such as topography and chemistry, are poorly understood. The objective of this study was to identify determinants of surface wettability of titanium and establish the reliability and validity of the assessment. Wettability was evaluated as the contact angle of ddH2O. The age of titanium specimens significantly affected the contact angle, with acid-etched, microrough titanium surfaces becoming superhydrophilic immediately after surface processing, hydrophobic after 7 days, and hydrorepellent after 90 days. Similar age-related loss of hydrophilicity was also confirmed on sandblasted supra-micron rough surfaces so, regardless of surface topography, titanium surfaces eventually become hydrophobic or hydrorepellent with time. On age-standardized titanium, surface roughness increased the contact angle and hydrophobicity. UV treatment of titanium regenerated the superhydrophilicity regardless of age or surface roughness, with rougher surfaces becoming more superhydrophilic than machined surfaces after UV treatment. Conditioning titanium surfaces by autoclaving increased the hydrophobicity of already-hydrophobic surfaces, whereas conditioning with 70% alcohol and hydrating with water or saline attenuated pre-existing hydrophobicity. Conversely, when titanium surfaces were superhydrophilic like UV-treated ones, autoclaving and alcohol cleaning turned the surfaces hydrorepellent and hydrophobic, respectively. UV treatment recovered hydrophilicity without exception. In conclusion, surface roughness accentuates existing wettability and can either increase or decrease the contact angle. Titanium must be age-standardized when evaluating surface wettability. Surface conditioning techniques significantly but unpredictably affect existing wettability. These implied that titanium wettability is significantly influenced by the hydrocarbon pellicle and other contaminants inevitably accumulated. UV treatment may be an effective strategy to standardize wettability by making all titanium surfaces superhydrophilic, thereby allowing the characterization of individual surface topography and chemistry parameters in future studies.

Abstract Background A strong seal of soft-tissue around dental implants is essential to block pathogens from entering the peri-implant interface and prevent infections. Therefore, the integration of soft-tissue poses a challenge in implant-prosthetic procedures, prompting a focus on the interface between peri-implant soft-tissues and the transmucosal component. The aim of this study was to analyse the effects of sandblasted roughness levels on in vitro soft-tissue healing around dental implant abutments. In parallel, proteomic techniques were applied to study the interaction of these surfaces with human serum proteins to evaluate their potential to promote soft-tissue regeneration. Results Grade-5 machined titanium discs (MC) underwent sandblasting with alumina particles of two sizes (4 and 8 μm), resulting in two different surface types: MC04 and MC08. Surface morphology and roughness were characterised employing scanning electron microscopy and optical profilometry. Cell adhesion and collagen synthesis, as well as immune responses, were assessed using human gingival fibroblasts (hGF) and macrophages (THP-1), respectively. The profiles of protein adsorption to the surfaces were characterised using proteomics; samples were incubated with human serum, and the adsorbed proteins analysed employing nLC–MS/MS. hGFs exposed to MC04 showed decreased cell area compared to MC, while no differences were found for MC08. hGF collagen synthesis increased after 7 days for MC08. THP-1 macrophages cultured on MC04 and MC08 showed a reduced TNF-α and increased IL-4 secretion. Thus, the sandblasted topography led a reduction in the immune/inflammatory response. One hundred seventy-six distinct proteins adsorbed on the surfaces were identified. Differentially adsorbed proteins were associated with immune response, blood coagulation, angiogenesis, fibrinolysis and tissue regeneration. Conclusions Increased roughness through MC08 treatment resulted in increased collagen synthesis in hGF and resulted in a reduction in the surface immune response in human macrophages. These results correlate with the changes in protein adsorption on the surfaces observed through proteomics.

Background Prosthetic joint infection is a serious complication that can arise after total joint replacement surgery. When bacteria colonise an orthopaedic implant, they form biofilms that protect them from their environment, making them difficult to remove. Treatment is further complicated by a global rise of antimicrobial resistance. These protective mechanisms make treatment of prosthetic joint infection increasingly complex. Non-contact induction heating is an upcoming technology that uses heat to eradicate bacteria that are present on the surface of metallic implants. This study aims to provide insight into the feasibility of using non-contact induction heating on metallic implants that are in direct contact with other biomaterials, such as coatings composed of hydroxyapatite and bone cement composed of poly (methyl methacrylate) (PMMA). Methods Characterisation of hydroxyapatite coatings and adhesion strength tests were conducted according to standards set by the International Organisation for Standardisation (ISO 13779-2). The fixation strength of acrylic bone cement was tested according to an adapted method from ISO. Results It was found that non-contact induction heating did not significantly affect the adhesion strength of hydroxyapatite coatings. In contrast to hydroxyapatite coatings, acrylic bone cement softened temporarily as the temperature exceeded the glass transition temperature (83.38 ± 10.88°C). However, the induction heating temperature had no significant effect on the fixation strength after the cement was allowed to cool down. Conclusion This study shows the feasibility of using non-contact induction heating up to 80°C when bone cement or ceramic coatings are present in contact with infected metallic implants.

Objective. This study aims to assess the composition of scattered particles generated in proton therapy for tumors situated proximal to some titanium (Ti) dental implants. The investigation involves decomposing the mixed field and recording Linear Energy Transfer (LET) spectra to quantify the influence of metallic dental inserts located behind the tumor. Approach. A therapeutic conformal proton beam was used to deliver the treatment plan to an anthropomorphic head phantom with two types of implants inserted in the target volume (made of Ti and plastic, respectively). The scattered radiation resulted during the irradiation was detected by a hybrid semiconductor pixel detector MiniPIX Timepix3 that was placed distal to the Spread-out Bragg peak. Visualization and field decomposition of stray radiation were generated using algorithms trained in particle recognition based on artificial intelligence neural networks (AI NN). Spectral sensitive aspects of the scattered radiation were collected using two angular positions of the detector relative to the beam direction: 0° and 60°. Results. Using AI NN, 3 classes of particles were identified: protons, electrons & photons, and ions & fast neutrons. Placing a Ti implant in the beam's path resulted in predominantly electrons and photons, contributing 52.2% of the total number of detected particles, whereas for plastic implants, the contribution was 65.4%. Scattered protons comprised 45.5% and 31.9% with and without metal inserts, respectively. The LET spectra were derived for each group of particles identified, with values ranging from 0.01 to 7.5 keV μ m−1 for Ti implants/plastic implants. The low-LET component was primarily composed of electrons and photons, while the high-LET component corresponded to protons and ions. Significance. This method, complemented by directional maps, holds the potential for evaluating and validating treatment plans involving stray radiation near organs at risk, offering precise discrimination of the mixed field, and enhancing in this way the LET calculation. [ABSTRACT FROM AUTHOR]

Postoperative bacterial infection of titanium implants is a common clinical complication. In this paper, arrays of oxygen-deficient barium titanate nanorods (BaTiO3-x) were constructed on the Ti surface by hydrothermal and annealing treatments. The synthesis of BaTiO3 nanorods was confirmed using scanning electron microscopy, transmission electron microscopy, and X-ray diffractometry, and the presence of oxygen vacancies was confirmed using X-ray photoelectron spectroscopy. The reactive oxygen species (ROS) generation ability of BaTiO3-x nanorod arrays under ultrasound was verified using methyl violet (MV) as a trapping agent. The results show that BaTiO3-x nanorod arrays can effectively generate hydroxyl radicals (·OH) under ultrasonic (US) irradiation. Antibacterial experiments were conducted with Staphylococcus aureus (S. aureus), and the antibacterial capacity of BaTiO3-x nanorod arrays under US was investigated by the plate spread method. The results showed that the antibacterial rate of BaTiO3-x against S. aureus reached 90.92% after 15 min of US irradiation. This study provides ideas for the preparation of antimicrobial coatings on titanium implant surfaces and lays the foundation for expanding US-responsive antimicrobial coatings. [ABSTRACT FROM AUTHOR]

Objective: The goal of this systematic review and meta-analysis was to assess whether there were clinically relevant differences in the treatment of edentulous areas comparing zirconia (Zr) and titanium (Ti) dental implants. The null hypothesis is that no differences can be observed in terms of the clinical parameters; the positive hypothesis I is that Zr implants have generally better results compared to Ti implants; and the positive hypothesis II is that Ti implants have a generally superior result than Zr implants. Methods: This review work was registered on the PROSPERO platform, and its development was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The electronic search process was conducted on three databases (PubMed/Scopus/Web of Science), including randomized controlled trials (RCTs) from the past 10 years (up to April 2024). Identified articles were analyzed and included/excluded based on pre-defined selection and exclusion criteria. The quality assessment and risk of bias were evaluated using a Cochrane risk-of-bias assessment tool specifically designed for randomized trials (RoB2). A meta-analysis was conducted to correlate different treatment options based on the described outcomes; a random-effects model was used in the analysis of the variables. The analysis of heterogeneity was conducted by means of Cochran's Q-test and Higgins' I2 statistic. Results: Six RCTs were enrolled; 152 patients (90 males and 62 females) and 448 implants (267 Zr and 181 Ti) were included. Dental implant placement involved both the maxillary and mandibular arches. The implant sites showed heterogeneity in receiving Zr and Ti dental implants; in particular, 22 dental implants were placed in the mid-palatal region and 426 dental implants in the alveolar region (255 were in Zr and 171 in Ti). Regarding the success rate, it was better for Zr but with no statistical difference (p > 0.05); bleeding on probing had slight differences between Ti with 0.34% ± 0.42 and Zr with 0.26% ± 0.36 (p > 0.05); plaque score showed 0.46 ± 0.47 for Ti compared to 0.44 ± 0.49 for Zr (p > 0.05); no statistically significant difference was observed for pink esthetic score (PES). Statistically significant results were found for survival rate, which favored Ti implants (77.6%) compared to Zr (70.3%) (p < 0.05), and for marginal bone loss, which showed less loss in Ti implants (0.18 mm ± 0.47) compared to 0.42 mm ± 0.40 in Zr at 12 months (p < 0.001). Conclusions: The present systematic review and meta-analysis identified the positive hypothesis I and rejected the null and positive hypothesis II; it was possible to conclude that Ti dental implants have a better survival rate and less marginal bone loss than Zr dental implants after 1-year follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Smart multifunctional surfaces targeting intricate biological events or versatile therapeutic strategies are imminent to achieve long-term transmucosal implant success. Methods: This study used dopamine (DA), graphene oxide (GO), and type IV collagen (COL-IV) to construct multilayer nanofilms (DGCn) based on their universal adhesive and biomimetic properties to design a versatile and bioactive titanium implant. The characterization of DGCn on different titanium surfaces was performed, and its loading capacity, release profile, in situ gene delivery, and in vitro biological properties were preliminarily evaluated. Results: Our results demonstrate that hydrogenated TiO2 nanotubes (H) provide a better platform for the DGC[sub n] coating than machined Ti and air-TiO2 nanotubes. The H-DGC10 displayed the most stable surface with excellent loading capacity, sustained-release profile, and in situ gene transfection efficiency; this could be due to the high specific surface area of H and GO, as well as the functional groups in H, DA, and GO. Moreover, the H-DGC10 exhibited good biocompatibility for human oral epithelial cells and promoted the expression of integrin β4 and laminin 332, both being hemidesmosome-related proteins. Discussion: Our findings suggest that H-DGCn can be designed as a smart multifunctional interface for titanium implants to achieve long-term transmucosal implant success and aid in versatile therapeutic strategies. [ABSTRACT FROM AUTHOR]

Background: A strong seal of soft-tissue around dental implants is essential to block pathogens from entering the peri-implant interface and prevent infections. Therefore, the integration of soft-tissue poses a challenge in implant-prosthetic procedures, prompting a focus on the interface between peri-implant soft-tissues and the transmucosal component. The aim of this study was to analyse the effects of sandblasted roughness levels on in vitro soft-tissue healing around dental implant abutments. In parallel, proteomic techniques were applied to study the interaction of these surfaces with human serum proteins to evaluate their potential to promote soft-tissue regeneration. Results: Grade-5 machined titanium discs (MC) underwent sandblasting with alumina particles of two sizes (4 and 8 μm), resulting in two different surface types: MC04 and MC08. Surface morphology and roughness were characterised employing scanning electron microscopy and optical profilometry. Cell adhesion and collagen synthesis, as well as immune responses, were assessed using human gingival fibroblasts (hGF) and macrophages (THP-1), respectively. The profiles of protein adsorption to the surfaces were characterised using proteomics; samples were incubated with human serum, and the adsorbed proteins analysed employing nLC–MS/MS. hGFs exposed to MC04 showed decreased cell area compared to MC, while no differences were found for MC08. hGF collagen synthesis increased after 7 days for MC08. THP-1 macrophages cultured on MC04 and MC08 showed a reduced TNF-α and increased IL-4 secretion. Thus, the sandblasted topography led a reduction in the immune/inflammatory response. One hundred seventy-six distinct proteins adsorbed on the surfaces were identified. Differentially adsorbed proteins were associated with immune response, blood coagulation, angiogenesis, fibrinolysis and tissue regeneration. Conclusions: Increased roughness through MC08 treatment resulted in increased collagen synthesis in hGF and resulted in a reduction in the surface immune response in human macrophages. These results correlate with the changes in protein adsorption on the surfaces observed through proteomics. [ABSTRACT FROM AUTHOR]

In this work, we show the in vitro anticancer potential of surgical wires, obtained from zinc (ZnMg0.004) or magnesium (MgCa0.7) alloys by spatial technology comprising casting, extrusion, and final drawing processes. We also present the selective anticancer effects of applied soluble multilayer nanocoatings of zinc and magnesium onto titanium surfaces using the pulse laser deposition method. In the latter, the titanium samples were produced via 3D printing using the selective laser melting method and coated with various combinations of zinc and magnesium layers. For cytotoxicity studies, human dental pulp-derived stem cells (hDPSCs) and human osteosarcoma SaOS-2 cell line were used as representatives of healthy and cancer cells. Cells were examined against the 0.3–3.0 cm2/mL material extract ratios obtained from experimental and steel surgical wires, the latter being the current clinical industry standard. The MgCa0.7 alloy wires were approx. 1.5 times more toxic to cancer cells at all examined extract ratios vs. the extracts from steel surgical wires that exhibited comparable toxicity towards healthy and cancer cells. The ZnMg0.004 alloy wires displayed increased toxicity towards cancer cells with decreasing extract ratios. This was also reflected in the increased anticancer effectiveness, calculated based on the viability ratio of healthy cells to cancer cells, from 1.1 to 4.0 times. Healthy cell viability remained at 80–100%, whereas cancer cell survival fluctuated at 20–75%, depending on the extract ratio. Furthermore, the culture of normal or cancer cells on the surface of Zn/Mg-coated titanium allowed us to select combinations of specific coating layers that yielded a comparable anticancer effectiveness to that observed with the experimental wires that ranged between 2 and 3. Overall, this work not only demonstrates the substantial anticancer properties of the studied wires but also indicates that similar anticancer effects can be replicated with appropriate nanocoatings on titanium samples. We believe that this work lays the groundwork for the future potential development of the category of new implants endowed with anticancer properties. [ABSTRACT FROM AUTHOR]

The reconstruction of orbital fracture sequelae is a major challenge due to concerns regarding surgical approach and implant stability. Few anatomical sites of such minute size have presented with as much variation in treatment as the orbital floor fractures and related sequelae. Our patient developed sequelae of an orbital fracture over the last 3 years, presenting with dystopia, ophthalmoplegia, and diplopia in the supra- and lateroversion and aesthetic impairment. The variety of implant materials for reconstruction after orbital fractures is extensive, and the decision as to which material to use continues to be debated. The continuing development of computer-aided diagnosis and management and the construction of stereolithographic models offer comparable reproduction of anatomical detail. This technology is described in relation to the planning of trauma surgery and sequelae and the planning of ablative surgery for malignant neoplasms of the head and neck. The use of specific 3D printed titanium implants for bone defects was first reported in cranial reconstruction in 2012, and several studies have reported their use in orbital fractures. The advantages of this implant were increased stiffness, preventing shape loss during placement, a precise fit, and decreased surgical time. However, in the existing literature, the one-piece implant done in this way was a precise fit; therefore, it is possible that navigation between intraoperative anatomical landmarks is lost. However, in cases where reconstruction is difficult, such as extensive orbital wall fractures and large orbital sequelae, the 3D printed implant has been helpful in decreasing surgical time and can be accessed by a limited surgical approach with a precise fit. Our clinical case involved a 37-year-old male patient who experienced severe physical aggression in 2020, amid the COVID-19 pandemic. At the time, due to the overwhelming healthcare demands and resource constraints imposed by the pandemic, immediate surgical intervention for the correction of the fracture was not feasible. As a result of this delay, the patient developed sequelae of the orbital fracture over the last 3 years.

IntroductionWhile titanium and its alloys exhibit excellent biocompatibility and corrosion resistance, their polished surfaces can hinder fast and effective osseointegration and other biological processes, such as angiogenesis, due to their inert and hydrophobic properties. Despite being commonly used for orthopedic implants, research focuses on developing surface treatments to improve osseointegration, promoting cell adhesion and proliferation, as well as increasing protein adsorption capacity. This study explores a chemical treatment intended for titanium-based implants that enhances tissue integration without compromising the mechanical properties of the Ti6Al4V substrate. However, recognizing that inflammation contributes to nearly half of early implant failures, we assessed the impact of this treatment on T-cell viability, cytokine production, and phenotype.MethodsTi6Al4V with extra low interstitial (ELI) content discs were treated with hydrofluoric acid followed by a controlled oxidation step in hydrogen peroxide that creates a complex surface topography with micro- and nano-texture and modifies the chemistry of the surface oxide layer. The acid etched surface contains an abundance of hydroxyl groups, crucial for promoting bone growth and apatite precipitation, while also enabling further functionalization with biomolecules.ResultsWhile cell viability remained high in both groups, untreated discs triggered an increase in Th2 cells and a decrease of the Th17 subset. Furthermore, peripheral blood mononuclear cells exposed to untreated discs displayed a rise in various pro-inflammatory and anti-inflammatory cytokines compared to the control and treated groups. Conversely, the treated discs showed a similar profile to the control, both in terms of immune cell subset frequencies and cytokine secretion.DiscussionThe dysregulation of the cytokine profile upon contact with untreated Ti6Al4V-ELI discs, namely upregulation of IL-2 could be responsible for the decrease in Th17 frequency, and thus might contribute to implant-associated bacterial infection. Interestingly, the chemical treatment restores the immune response to levels comparable to the control condition, suggesting the treatment’s potential to mitigate inflammation by enhancing biocompatibility.

There are numerous variables governing the formation of new bone around a dental implant. Of those variables, the implant surface is an important factor influencing the quality of osseointergration. Numerous techniques and materials have been used to alter the surface of an implant to enhance osseointergration and improve the survival and success rate. One such modification is utilizing graphene to modify the surface of an implant. This paper summarizes data collected form articles published in online databases in the past 10 years about the various means of modifying the implant surfaces and provides an in-depth review of the impact of graphene incorporation in dental implants.The document comprised of different sections and emphasized on the use of graphene as an implant surface coating material. The role of graphene on flexural strength, hardness and corrosion resistance have been discussed under mechanical properties whereas the potential of this combination on the osteogenesis, osseointergration and soft tissue seal is covered under biological properties. Lastly, how this combination acts as a drug delivery carrier and renders antimicrobial property has been addressed under pharmacological properties.This review has highlighted the various applications of graphene in the field of implant dentistry. It has outlined the various implant surface modifying methods and thrown light on the various affect this combination has on the mechanical, biological and pharmacological properties. Considering the various research done on the material, it can be concluded that graphene does have a bright future in implant dentistry and continued research in this area will provide fruitful benefits.

Background. Modifying the dental implant’s surface texture enhances its biological response to the bone and implant‒tissue interface, resulting in the successful support of forces. This study assessed the impact of sandblasting, sandblasting plus acid etching, Er,Cr:YSGG laser, and propolis implant surface treatments and occlusal load on the osseointegration of titanium dental implants in dogs. Methods. Seventy-two titanium dental implants with a diameter of 4 mm and a length of 10 mm were divided into four groups according to implant surface modifications (n=18 for each group): group A: sandblasting plus acid etching, group B: sandblasting with Al2 O3 , group C: Er,Cr:YSGG laser, group D: propolis coating. Twenty-four local breed male dogs were used. Premolar teeth (P1, P2, and P3) were extracted on the left side of the mandible, and after 12 weeks of bone healing, implants were unilaterally installed. The osseointegration at three study times from implant installation (14, 90, and 180 days) was evaluated. The dog jaws were scanned using an intraoral scanner for the virtual design of screw-retained three-unit crowns after 90 days of osseointegration. Final radiographs were taken before the animals were sacrificed at 14, 90, and 180 days, and the histological analysis was performed. Results. Radiographic analysis showed new bone formation (NBF) along and in contact with the implant surface of the treated groups. The histological analysis after 14 days in groups A and B revealed a uniform and ongoing pattern of bone growth and many osteoblasts with few osteocytes within lacunae in new bone trabeculae. Group C showed an increase in the number of osteoblasts lining thin bone trabeculae. Group D showed a generative power concerning bone. At 90 days, there was increased bone ingrowth, and the new bone matured in all the treated implant groups. At 180 days, dense mature bone apposition was in direct contact with delayed-loaded implant surfaces. Conclusion. A radiographic examination revealed that surface modification significantly impacted osseointegration, with a strong bond between the implant surface and the surrounding bone. The histological sections at the 14-day interval revealed obvious bone remodeling activity, especially in sandblasting plus acid etching and sandblasting-modified implant surface groups. At the 90-day interval, bone ingrowth had increased, and the new bone became mature, especially in sandblasting and propolis surface modification groups. After 180 days of the delayed-loaded implant osseointegration, differences were observed between different implant-treated groups with a remarkable remodeling of the bone, especially in the propolis coating group.

Titanium implants undergo an aging process through surface hydrocarbon deposition, resulting in decreased wettability and bioactivity. Plasma treatment was shown to significantly reduce surface hydrocarbons, thus improving implant hydrophilicity and enhancing the osseointegration process. This study investigates the effect of plasma surface treatment on bone-to-implant contact (BIC) of implants presenting a nanostructured calcium-incorporated surface (XPEED®). Following a Randomized Controlled Trial (RCT) design, patients undergoing implant surgery in the posterior maxilla received additional plasma-treated (n = 7) or -untreated (n = 5) 3.5 × 8 mm implants that were retrieved after a 4-week healing period for histological examination. Histomorphometric analysis showed that plasma-treated implants exhibited a 38.7% BIC rate compared to 22.4% of untreated implants (p = 0.002), indicating enhanced osseointegration potential. Histological images also revealed increased bone formation and active osteoblastic activity around plasma-treated implants when compared to untreated specimens. The findings suggest that plasma treatment improves surface hydrophilicity and biological response, facilitating early bone formation around titanium implants. This study underscores the importance of surface modifications in optimizing implant integration and supports the use of plasma treatment to enhance osseointegration, thereby improving clinical outcomes in implant dentistry and offering benefits for immediate and early loading protocols, particularly in soft bone conditions. [ABSTRACT FROM AUTHOR]

Investigating the role of surface-modified 3D printed titanium implants in modulating oral soft tissue closure and antimicrobial properties. Eighteen 6-month-old healthy adult New Zealand White rabbits were selected as experimental animals, the left and right mandibular teeth of each experimental animal were randomly divided into two groups, and the bilateral first premolar teeth were extracted after general anesthesia, and one implant was implanted into each of the magnesium/zinc ionized surface-treated group (experimental group) and the surface-untreated group (control group), with a total of 36 implants, i.e., 18 implants for the experimental group and 18 implants for the control group. Bilateral mandibular samples from both groups were removed after 2 and 4 weeks of implantation to investigate the attachment and spreading of human gingival fibroblasts (HGFs) on the surface of the samples, their proliferative and migratory behaviors as well as the expression levels of related gene proteins (CoL-1 and TGF-β), and HE staining of the soft tissues of the samples and inflammatory cell counts. After 2 and 4 weeks of implantation, the experimental group's HGFs adhesion and spreading were significantly better than that of the control group, the migration and proliferation of HGFs were significantly greater than that of the control group (p <.05), and the expression of CoL-1 and TGF-β genes was significantly higher than that of the control group (p <.05), and the inflammatory cell count was significantly smaller than that of the control group (p <.05). Surface modification by magnesium and zinc ions enhances the sealing performance and antimicrobial performance of 3D printed titanium implants in oral soft tissues, with significant effects. [ABSTRACT FROM AUTHOR]

Background. Modifying the dental implant's surface texture enhances its biological response to the bone and implant?tissue interface, resulting in the successful support of forces. This study assessed the impact of sandblasting, sandblasting plus acid etching, Er,Cr:YSGG laser, and propolis implant surface treatments and occlusal load on the osseointegration of titanium dental implants in dogs. Methods. Seventy-two titanium dental implants with a diameter of 4 mm and a length of 10 mm were divided into four groups according to implant surface modifications (n = 18 for each group): group A: sandblasting plus acid etching, group B: sandblasting with Al2O3, group C: Er,Cr:YSGG laser, group D: propolis coating. Twenty-four local breed male dogs were used. Premolar teeth (P1, P2, and P3) were extracted on the left side of the mandible, and after 12 weeks of bone healing, implants were unilaterally installed. The osseointegration at three study times from implant installation (14, 90, and 180 days) was evaluated. The dog jaws were scanned using an intraoral scanner for the virtual design of screw-retained three-unit crowns after 90 days of osseointegration. Final radiographs were taken before the animals were sacrificed at 14, 90, and 180 days, and the histological analysis was performed. Results. Radiographic analysis showed new bone formation (NBF) along and in contact with the implant surface of the treated groups. The histological analysis after 14 days in groups A and B revealed a uniform and ongoing pattern of bone growth and many osteoblasts with few osteocytes within lacunae in new bone trabeculae. Group C showed an increase in the number of osteoblasts lining thin bone trabeculae. Group D showed a generative power concerning bone. At 90 days, there was increased bone ingrowth, and the new bone matured in all the treated implant groups. At 180 days, dense mature bone apposition was in direct contact with delayed-loaded implant surfaces. Conclusion. A radiographic examination revealed that surface modification significantly impacted osseointegration, with a strong bond between the implant surface and the surrounding bone. The histological sections at the 14-day interval revealed obvious bone remodeling activity, especially in sandblasting plus acid etching and sandblasting-modified implant surface groups. At the 90-day interval, bone ingrowth had increased, and the new bone became mature, especially in sandblasting and propolis surface modification groups. After 180 days of the delayed-loaded implant osseointegration, differences were observed between different implant-treated groups with a remarkable remodeling of the bone, especially in the propolis coating group. [ABSTRACT FROM AUTHOR]

Titanium and titanium alloys are the prevailing dental implant materials owing to their favorable mechanical properties and biocompatibility, but how roughness dictates the biological response is still a matter of debate. In this study, laser texturing was used to generate eight paradigmatic roughened surfaces, with the aim of studying the early biological response elicited on MC3T3-E1 pre-osteoblasts. Prior to cell tests, the samples underwent SEM analysis, optical profilometry, protein adsorption assay, and optical contact angle measurement with water and diiodomethane to determine surface free energy. While all the specimens proved to be biocompatible, supporting similar cell viability at 1, 2, and 3 days, surface roughness could impact significantly on cell adhesion. Factorial analysis and linear regression showed, in a robust and unprecedented way, that an isotropic distribution of deep and closely spaced valleys provides the best condition for cell adhesion, to which both protein adsorption and surface free energy were highly correlated. Overall, here the authors provide, for the first time, a thorough investigation of the relationship between roughness parameters and osteoblast adhesion that may be applied to design and produce new tailored interfaces for implant materials.

Background Prosthetic joint infection is a serious complication that can arise after total joint replacement surgery. When bacteria colonise an orthopaedic implant, they form biofilms that protect them from their environment, making them difficult to remove. Treatment is further complicated by a global rise of antimicrobial resistance. These protective mechanisms make treatment of prosthetic joint infection increasingly complex. Non-contact induction heating is an upcoming technology that uses heat to eradicate bacteria that are present on the surface of metallic implants. This study aims to provide insight into the feasibility of using non-contact induction heating on metallic implants that are in direct contact with other biomaterials, such as coatings composed of hydroxyapatite and bone cement composed of poly (methyl methacrylate) (PMMA). Methods Characterisation of hydroxyapatite coatings and adhesion strength tests were conducted according to standards set by the International Organisation for Standardisation (ISO 13779-2). The fixation strength of acrylic bone cement was tested according to an adapted method from ISO. Results It was found that non-contact induction heating did not significantly affect the adhesion strength of hydroxyapatite coatings (p=0.697). In contrast to hydroxyapatite coatings, acrylic bone cement softened temporarily as the temperature exceeded the glass transition temperature (83.38 ± 10.88°C). However, the induction heating temperature had no significant effect on the fixation strength after the cement was allowed to cool down (p=0.535). Conclusion This study shows the feasibility of using non-contact induction heating up to 80°C when bone cement or ceramic coatings are present in contact with infected metallic implants.

This study explores the enhancement of biocompatible titanium‐based implants through surface functionalization for improved bone healing. Specifically, a near‐beta type Ti‐13Nb‐13Zr alloy is 3D printed using laser powder bed fusion and subsequently textured using nanosecond (ns) and picosecond (ps) direct laser interference patterning (DLIP) to create single‐scale and multi‐scale surface textures. On these textures, the cell behavior, morphology, metabolic activity and osteogenic differentiation potential of human bone marrow stromal cells are assessed using fluorescence microscopy and MTS assays. Moreover, tissue non‐specific alkaline phosphatase activity served as an early osteoblast production marker. Compared to untextured specimens, both types of textures exhibited higher metabolic activity and cell proliferation. Single‐scale ns‐DLIP textures encouraged cell extensions anchored in groove regions, while ps‐DLIP textures with hierarchical structures promoted cell extensions attaching to nanostructures on sidewalls. The groove width and nanotopographies in groove areas facilitated cell spreading. Surface topography, roughness, and surface chemistry (surface energy, wettability) influenced cell adhesion, proliferation, and differentiation. A comprehensive evaluation of DLIP‐generated surface textures, including their topography and chemical states, complements the factors affecting in vitro cell behavior. Overall, this research demonstrates the potential of surface‐functionalized 3Dprinted titanium for a novel generation of biocompatible implants. [ABSTRACT FROM AUTHOR]

Bone fractures can lead to disability and a prolonged rehabilitation period. In some patients, the risk of complications can increase if the healing process is not efficacious or if the metallic implants are loose. Photobiomodulation is a physiotherapeutic method of treatment that can stimulate the cell proliferation and reduce the simpthomatology. We evaluated the effect of LASER therapy on the osseointegration of smooth titanium implants in 12 female rats that suffered fractures on both tibiae. The LASER therapy was performed second day after surgery on half of the rats on both tibia for 7 sessions, every 48 hours. Both tibia were removed in the control and experimental group at 2,4 and 6 weeks after finalizing the last photobiomodulation session. The methods of assesment were micro-CT scans, histology and mechanical tests. The mechanical tests show better bone/implant stability in favor of the experimental group at all 3 times of tissue prelevation. Histological fidings show more bone lamellas in the experimental group after 2 weeks, but no significant differences afterward. The micro-CT imaging show no significant differences between the 2 groups. LASER therapy could prove as an important tool in orthopedic patients and can potentially reduce the rehabilitation time. [ABSTRACT FROM AUTHOR]

In head and neck cancer patients receiving dental implants prior to radiotherapy, backscatter from titanium increases the radiation dose close to the surface, and may affect the osseointegration. The dose-dependent effects of ionizing radiation on human osteoblasts (hOBs) were investigated. The hOBs were seeded on machined titanium, moderately rough fluoride-modified titanium, and tissue culture polystyrene, and cultured in growth- or osteoblastic differentiation medium (DM). The hOBs were exposed to ionizing γ-irradiation in single doses of 2, 6 or 10 Gy. Twenty-one days post-irradiation, cell nuclei and collagen production were quantified. Cytotoxicity and indicators of differentiation were measured and compared to unirradiated controls. Radiation with backscatter from titanium significantly reduced the number of hOBs but increased the alkaline phosphatase activity in both types of medium when adjusted to the relative cell number on day 21. Irradiated hOBs on the TiF-surface produced similar amounts of collagen as unirradiated controls when cultured in DM. The majority of osteogenic biomarkers significantly increased on day 21 when the hOBs had been exposed to 10 Gy, while the opposite or no effect was observed after lower doses. High doses reinforced with backscatter from titanium resulted in smaller but seemingly more differentiated subpopulations of osteoblasts. [ABSTRACT FROM AUTHOR]

Introduction: Laser micromachining of titanium and its alloys can create micro-grooves with sizes similar to cell diameter of about 10 μm. Its coating with arginine-glycine-aspartic acid (RGD) may enhance cellular spreading and adhesion. This study aimed to evaluate the effect of laser micro-grooving and laser micro-grooving combined with RGD coating on the strength of the dental implants/bone interface using destructive mechanical pullout testing in experimental animals. Materials and methods: In this study, the test groups consisted of 1.5-mm diameter, 5-mm long laser-grooved and laser-grooved/RGD coated titanium alloy (Ti–6Al–4 V) rods, and the control group included plain titanium alloy (Ti–6Al–4 V) rods. These rods were implanted in the mandibles of New Zealand white rabbits for 2, 4, and 6 weeks. After sacrifice, the test and control specimens were retrieved for mechanical pullout testing. The DMA 7-e was used to pull the titanium rods out of the bone, the probe position was plotted versus time graph to monitor the test progression, and the static modulus versus time graph was viewed; such graphs was then transformed into tables. The results were analyzed using the Mann-Whitney test. Results: The laser-grooved/RGD coated rods had significantly higher pull-out strength than the laser-grooved and control rods. Additionally, the laser-grooved rods had significantly higher pull-out strength than control rods. Conclusion: Two novel surface treatments were used: laser micro-grooving and tri peptide RGD coating, both of which had different effects on the dental implant interface. Laser grooving improved peri-implant bone healing, whereas RGD coating facilitated earlier bone–implant adhesion and better mineralization.

In this work, we show the in vitro anticancer potential of surgical wires, obtained from zinc (ZnMg0.004) or magnesium (MgCa0.7) alloys by spatial technology comprising casting, extrusion, and final drawing processes. We also present the selective anticancer effects of applied soluble multilayer nanocoatings of zinc and magnesium onto titanium surfaces using the pulse laser deposition method. In the latter, the titanium samples were produced via 3D printing using the selective laser melting method and coated with various combinations of zinc and magnesium layers. For cytotoxicity studies, human dental pulp-derived stem cells (hDPSCs) and human osteosarcoma SaOS-2 cell line were used as representatives of healthy and cancer cells. Cells were examined against the 0.3–3.0 cm2/mL material extract ratios obtained from experimental and steel surgical wires, the latter being the current clinical industry standard. The MgCa0.7 alloy wires were approx. 1.5 times more toxic to cancer cells at all examined extract ratios vs. the extracts from steel surgical wires that exhibited comparable toxicity towards healthy and cancer cells. The ZnMg0.004 alloy wires displayed increased toxicity towards cancer cells with decreasing extract ratios. This was also reflected in the increased anticancer effectiveness, calculated based on the viability ratio of healthy cells to cancer cells, from 1.1 to 4.0 times. Healthy cell viability remained at 80–100%, whereas cancer cell survival fluctuated at 20–75%, depending on the extract ratio. Furthermore, the culture of normal or cancer cells on the surface of Zn/Mg-coated titanium allowed us to select combinations of specific coating layers that yielded a comparable anticancer effectiveness to that observed with the experimental wires that ranged between 2 and 3. Overall, this work not only demonstrates the substantial anticancer properties of the studied wires but also indicates that similar anticancer effects can be replicated with appropriate nanocoatings on titanium samples. We believe that this work lays the groundwork for the future potential development of the category of new implants endowed with anticancer properties.

Osseointegration of dental, craniofacial, and orthopedic implants is critical for their long-term success. Multifunctional surface treatment of implants was found to significantly improve cell adhesion and induce osteogenic differentiation of dental-derived stem cells in vitro. Moreover, local and sustained release of antibiotics via nanolayers from the surface of implants can present unparalleled therapeutic benefits in implant dentistry. Here, we present a layer-by-layer surface treatment of titanium implants capable of incorporating BMP-2-mimicking short peptides and gentamicin to improve their osseointegration and antibacterial features. Additionally, instead of conventional surface treatments, we employed polydopamine coating before layer-by-layer assembly to initiate the formation of the nanolayers on rough titanium surfaces. Cytocompatibility analysis demonstrated that modifying the titanium implant surface with layer-by-layer assembly did not have adverse effects on cellular viability. The implemented nanoscale coating provided sustained release of osteoinductive peptides with an antibacterial drug. The surface-functionalized implants showed successful osteogenic differentiation of periodontal ligament stem cells and antimicrobial activity in vitro and increased osseointegration in a rodent animal model 4 wk postsurgery as compared with untreated implants. Altogether, our in vitro and in vivo studies suggest that this approach can be extended to other dental and orthopedic implants since this surface functionalization showed improved osseointegration and an enhanced success rate.

The failure of a titanium implant is often attributed to inflammatory reactions following implantation. This study focuses on the synthesis of a polyethylene glycol (PEG) layer on porous titanium dioxide (TiO2) coatings using plasma electrolytic oxidation (PEO). This PEG layer serves as a foundation for a drug-eluting platform designed to respond to pH stimuli during inflammation. Betamethasone (BET), a widely used anti-inflammatory drug, was loaded onto the pH-responsive functional PEG layers. The application of the PEG-BET layer onto TiO2 coatings through the vacuum dip coating method resulted in a pH-sensitive sustained release of BET over a 30-day period. Notably, the release rates were 81% at pH 5.0 and 55% at pH 7.2. Electrochemical corrosion tests conducted in both normal and acidic inflammatory solutions demonstrated that duplex composite coatings offer superior protection compared to simple oxide coatings. In a pH 5.0 solution, corrosion current density measurements revealed values of 1.75 μA cm−2 (PEO/PEG-BET), 8.87 μA cm−2 (PEO), and 49.17 μA cm−2 (bare titanium). These results highlight the effectiveness of the PEO/PEG-BET layer in sealing pores within PEO coatings, subsequently reducing the infiltration of corrosive ions in inflammatory environments.

Titanium has been widely used in orthopedics and dental implants due to its excellent biocompatibility and mechanical properties. However, the surface of titanium is biologically inert and lacks biological activity, resulting in poor integration between titanium-based implants and surrounding natural bone tissue, which is a common challenge in its clinical application. Surface modification is currently an effective means to improve the biocompatibility and bioactivity of titanium implants. The natural tissues of the human body are assembled from nanomodules, so from a biomimetic perspective, nanostructures should have better biological activity. TiO2 nanotubes have unique physical and chemical properties due to their elastic modulus, large specific surface area, and regular hollow structure similar to those of bone tissue. This study used anodic oxidation technology to prepare TiO2 nanotubes on the surface of titanium. The surface properties of the nanotubes were evaluated using field emission scanning electron microscopy (FE-SEM), X-ray diffraction (XRD), atomic force microscopy profilometry, contact angle measurements, etc. The corrosion resistance was tested using an electrochemical workstation. The results indicate that anodic oxidation can be used to successfully prepare titanium dioxide nanotube arrays on the surface of titanium. The nanotubes not only exhibit a good structure but also improve the surface hydrophilicity and corrosion resistance of titanium, thereby demonstrating potential for clinical application.

AbstractIn head and neck cancer patients receiving dental implants prior to radiotherapy, backscatter from titanium increases the radiation dose close to the surface, and may affect the osseointegration. The dose-dependent effects of ionizing radiation on human osteoblasts (hOBs) were investigated. The hOBs were seeded on machined titanium, moderately rough fluoride-modified titanium, and tissue culture polystyrene, and cultured in growth- or osteoblastic differentiation medium (DM). The hOBs were exposed to ionizing γ-irradiation in single doses of 2, 6 or 10 Gy. Twenty-one days post-irradiation, cell nuclei and collagen production were quantified. Cytotoxicity and indicators of differentiation were measured and compared to unirradiated controls. Radiation with backscatter from titanium significantly reduced the number of hOBs but increased the alkaline phosphatase activity in both types of medium when adjusted to the relative cell number on day 21. Irradiated hOBs on the TiF-surface produced similar amounts of collagen as unirradiated controls when cultured in DM. The majority of osteogenic biomarkers significantly increased on day 21 when the hOBs had been exposed to 10 Gy, while the opposite or no effect was observed after lower doses. High doses reinforced with backscatter from titanium resulted in smaller but seemingly more differentiated subpopulations of osteoblasts.

Post-surgery microbial infections are still one of the main reasons for implant failure, which results in very high physical and psychological pain for the patient and an increased cost for the healthcare system. A polymer nanocomposite antibacterial coating on titanium implants represents a valuable alternative to the more expensive and energy-consuming technological solutions nowadays used. In this regard, a sprayable thermoset nanocomposite composed of silanized-terminals polyethylene glycol (PEG)/ZnO nanoparticle is herein proposed. Initially, PEG’s terminals’ solvent-free silanization and curing are studied by Fourier Transform Infrared and μRaman spectroscopies. Scanning Electron Microscope investigations and scratch tests have shown that the spraying procedure optimization and the oxidation treatment of the titanium substrate lead to a homogeneous coverage and improved adhesion of the coatings. The antibacterial activity is tested against not only both S. aureus and P. aeruginosa bacterial American Type Culture Collection strains, but also using very aggressive antibiotic-resistant clinical strains. Interestingly, antibacterial activity, evaluated by time-killing tests, is observed for all tested bacterial strains. Live/dead tests further confirm that 5 wt% of ZnO allows obtaining a bacteriostatic activity within 24 h, whereas a complete growth inhibition (bactericidal activity) of both tested strains is observed for coatings with 20 wt% of ZnO nanoparticles. [ABSTRACT FROM AUTHOR]

During plasma electrolytic oxidation (PEO) process, molten oxide is rapidly solidified through arc discharges in order to create in-situ ceramic TiO 2 coatings on titanium alloy substrates. PEO coatings made on biomedical titanium alloys may have limited protection efficiency in organic acid-containing biological solutions due to their inherent porosity. In order to elevate the anticorrosion performance of these coatings, a second layer can be applied to the top surface of the PEO coatings to seal the cracks and pores by other surface engineering methods. In current work, the reduced graphene oxide (rGO) nanosheets were electrophoretically deposited on the Ti–6Al–4V substrate involving an intermediate TiO 2 oxide layer applied PEO process. Electrochemical measurements in palmitic acid-containing biological media showed that the duplex TiO 2 /rGO coating has higher compactness and better corrosion performance than simple TiO 2 coating. Indeed, the synthesis of the TiO 2 /rGO coating on the Ti alloy results in a decrease in the corrosion current density (2.19 μA‧cm−2) in comparison with the simple TiO2 coating (9.85 μA‧cm−2) in an acidic media. [ABSTRACT FROM AUTHOR]

Laser micromachining of titanium and its alloys can create micro-grooves with sizes similar to cell diameter of about 10 μm. Its coating with arginine-glycine-aspartic acid (RGD) may enhance cellular spreading and adhesion. This study aimed to evaluate the effect of laser micro-grooving and laser micro-grooving combined with RGD coating on the strength of the dental implants/bone interface using destructive mechanical pullout testing in experimental animals. In this study, the test groups consisted of 1.5-mm diameter, 5-mm long laser-grooved and laser-grooved/RGD coated titanium alloy (Ti–6Al–4 V) rods, and the control group included plain titanium alloy (Ti–6Al–4 V) rods. These rods were implanted in the mandibles of New Zealand white rabbits for 2, 4, and 6 weeks. After sacrifice, the test and control specimens were retrieved for mechanical pullout testing. The DMA 7-e was used to pull the titanium rods out of the bone, the probe position was plotted versus time graph to monitor the test progression, and the static modulus versus time graph was viewed; such graphs was then transformed into tables. The results were analyzed using the Mann-Whitney test. The laser-grooved/RGD coated rods had significantly higher pull-out strength than the laser-grooved and control rods. Additionally, the laser-grooved rods had significantly higher pull-out strength than control rods. Two novel surface treatments were used: laser micro-grooving and tri peptide RGD coating, both of which had different effects on the dental implant interface. Laser grooving improved peri -implant bone healing, whereas RGD coating facilitated earlier bone–implant adhesion and better mineralization. [ABSTRACT FROM AUTHOR]

Owing to their mechanical resilience and non-toxicity, titanium implants are widely applied as the major treatment modality for the clinical intervention against bone fractures. However, the intrinsic bioinertness of Ti and its alloys often impedes the effective osseointegration of the implants, leading to severe adverse complications including implant loosening, detachment, and secondary bone damage. Consequently, new Ti implant engineering strategies are urgently needed to improve their osseointegration after implantation. Remarkably, metalorganic frameworks (MOFs) are a class of novel synthetic material consisting of coordinated metal species and organic ligands, which have demonstrated a plethora of favorable properties for modulating the interfacial properties of Ti implants. This review comprehensively summarizes the recent progress in the development of MOF-coated Ti implants and highlights their potential utility for modulating the bio-implant interface to improve implant osseointegration, of which the discussions are outlined according to their physical traits, chemical composition, and drug delivery capacity. A perspective is also provided in this review regarding the current limitations and future opportunities of MOF-coated Ti implants for orthopedic applications. The insights in this review may facilitate the rational design of more advanced Ti implants with enhanced therapeutic performance and safety. [ABSTRACT FROM AUTHOR]

Hydrophilicity/hydrophobicity—or wettability—is a key surface characterization metric for titanium used in dental and orthopedic implants. However, the effects of hydrophilicity/hydrophobicity on biological capability remain uncertain, and the relationships between surface wettability and other surface parameters, such as topography and chemistry, are poorly understood. The objective of this study was to identify determinants of surface wettability of titanium and establish the reliability and validity of the assessment. Wettability was evaluated as the contact angle of ddH2O. The age of titanium specimens significantly affected the contact angle, with acid-etched, microrough titanium surfaces becoming superhydrophilic immediately after surface processing, hydrophobic after 7 days, and hydrorepellent after 90 days. Similar age-related loss of hydrophilicity was also confirmed on sandblasted supra-micron rough surfaces so, regardless of surface topography, titanium surfaces eventually become hydrophobic or hydrorepellent with time. On age-standardized titanium, surface roughness increased the contact angle and hydrophobicity. UV treatment of titanium regenerated the superhydrophilicity regardless of age or surface roughness, with rougher surfaces becoming more superhydrophilic than machined surfaces after UV treatment. Conditioning titanium surfaces by autoclaving increased the hydrophobicity of already-hydrophobic surfaces, whereas conditioning with 70% alcohol and hydrating with water or saline attenuated pre-existing hydrophobicity. Conversely, when titanium surfaces were superhydrophilic like UV-treated ones, autoclaving and alcohol cleaning turned the surfaces hydrorepellent and hydrophobic, respectively. UV treatment recovered hydrophilicity without exception. In conclusion, surface roughness accentuates existing wettability and can either increase or decrease the contact angle. Titanium must be age-standardized when evaluating surface wettability. Surface conditioning techniques significantly but unpredictably affect existing wettability. These implied that titanium wettability is significantly influenced by the hydrocarbon pellicle and other contaminants inevitably accumulated. UV treatment may be an effective strategy to standardize wettability by making all titanium surfaces superhydrophilic, thereby allowing the characterization of individual surface topography and chemistry parameters in future studies. [ABSTRACT FROM AUTHOR]

Zirconia implants have gained popularity for their aesthetic appeal and biocompatibility, making them a preferred choice for anterior teeth replacement. This study explores the interaction between telomere length and inflammatory biomarkers in seven cases of zirconia implant placement to gain insights into postoperative cellular aging, inflammatory responses, and long-term outcomes. Zirconia implants offer advantages over titanium implants, as they do not corrode or release metal ions, leading to potential inflammation and implant failure. Monitoring immune and inflammatory biomarkers is essential to assess inflammation initiation, severity, and progression. C-reactive protein (CRP) and pro-inflammatory cytokines, like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), play crucial roles in host immune responses, while anti-inflammatory cytokines, including interleukin-10 (IL-10), regulate and dampen immune responses. Achieving a delicate balance between pro- and anti-inflammatory cytokines is vital for maintaining a healthy immune response and preventing chronic inflammatory conditions. Telomeres, protective structures present at chromosome ends, influence cellular aging and mitochondrial function. Shorter telomeres are associated with impaired mitochondrial function, increased oxidative stress, and cellular senescence, while longer telomeres are linked to reduced inflammation and improved immune function. Understanding these mechanisms is essential for addressing age-related conditions and promoting overall well-being. In this case series, we investigated the interaction between telomere length and inflammatory biomarkers in patients who received zirconia dental implants. The study aims to improve our understanding of postoperative cellular aging, inflammatory responses, and the biocompatibility of zirconia implants, potentially leading to improved treatment protocols and patient outcomes. This innovative assessment of telomere length and inflammatory biomarkers in the context of zirconia implants provides novel insights into the field of dental implantology. By exploring the effects of zirconia implants on cellular health and inflammation, this study contributes to advancements in implant technology and patient care. [ABSTRACT FROM AUTHOR]

Objective: The influence of radiation backscatter from titanium on DNA damage and migration capacity of human osteoblasts (OBs) and mesenchymal stem cells (MSCs) may be critical for the osseointegration of dental implants placed prior to radiotherapy. In order to evaluate effects of radiation backscatter, the immediate DNA damage and migration capacity of OBs and MSCs cultured on titanium or plastic were compared after exposure to ionizing irradiation. Materials and methods: Human OBs and MSCs were seeded on machined titanium, moderately rough fluoride-modified titanium, or tissue culture polystyrene, and irradiated with nominal doses of 2, 6, 10, or 14 Gy. Comet assay was performed immediately after irradiation, while a scratch wound healing assay was initiated 24 h post-irradiation. Fluorescent live cell imaging documented the migration. Results: DNA damage increased with higher dose and with backscatter from titanium, and MSCs were significantly more affected than OBs. All doses of radiation accelerated the cell migration on plastic, while only the highest dose of 10 Gy inhibited the migration of both cell types on titanium. Conclusions: High doses (10 Gy) of radiation inhibited the migration capacity of both cell types on titanium, whereas lower doses (2 and 6 Gy) did not affect the migration of either OBs or MSCs. Clinical relevance: Fractionated doses of 2 Gy/day, as distributed in conventional radiotherapy, appear not to cause severe DNA damage or disturb the migration of OBs or MSCs during osseointegration of dental implants. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of trichostatin A (TSA) on titanium implant (TI) osseointegration in ovariectomized rats. Methods 3-Month-old female Sprague-Dawley rats (n=30) were randomly divided into Sham group (n=5) and OVX group (n=25). After 3 months of normal feeding, 5 rats in each group were randomly selected and were sacrificed. The distal femurs were harvested for evaluation with high-resolution micro-CT. HE staining was used to verify the establishment of osteoporosis model. TI was inserted bilaterally in the femoral metaphyseal region of remaining rats in OVX group. All the TI implanted rats were randomly divided into 2 groups: Control group (n=10) and TSA group (n=10). The rats in TSA group were intraperitoneally injected trichostatin A for 4 weeks. The rats in Control group were intraperitoneally injected the same amount of normal saline. All the rats were sacrificed after the drug treatment and the distal femurs were harvested for evaluation with high-resolution micro-CT, HE staining, and Masson staining. The serum of the rats was examined using ELISA. Results Compared with those in Sham group, micro-CT results showed that bone mineral density (BMD), bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), and connective density (Conn.D) in OVX group decreased (P<0.05), and trabecular separation (Tb.Sp) and structure model index (SMI) increased (P<0.05) in OVX group. HE staining results showed that Tb.N in OVX group significantly decreased. Compared with those in the Control group, BMD, BV/TV, Tb.Th, and Tb.N increased in TSA group (P<0.05), and Tb.Sp and SMI decreased (P<0.05). HE staining and Masson staining results showed that Tb.N and new bone increased in TSA group. ELISA results showed that bone morphogenesis-related proteins bone morphogenetic protein-2 (BMP2) and serum osteocalcin (OCN) increased in TSA group. Conclusion TSA improves TI implant osseointegration by promoting bone trabecular formation in OVX rats by up-regulating the key proteins of bone formation OCN and BMP2. [ABSTRACT FROM AUTHOR]

Background/Objective: Platelet derived extracellular vesicles (pEV) are promising therapeutical tools for bone healing applications. In fact, several in vitro studies have already demonstrated the efficacy of Extracellular Vesicles (EV) in promoting bone regeneration and repair in various orthopedic models. Therefore, to evaluate the translational potential in this field, an in vivo study was performed. Methods: Here, we used hyaluronic acid (HA) gels formulated with pEVs, as a way to directly apply pEVs and retain them at the bone defect. In this study, pEVs were isolated from Platelet Lysate (PL) through size exclusion chromatography and used to formulate 2% HA gels. Then, the gels were locally applied on the tibia cortical bone defect of New Zeland White rabbits before the surgical implantation of coin-shaped titanium implants. After eight weeks, the bone healing process was analyzed through biomechanical, micro-CT, histological and biochemical analysis. Results: Although no biomechanical differences were observed between pEV formulated gels and non-formulated gels, biochemical markers of the wound fluid at the interface presented a decrease in Lactate dehydrogenase (LDH) activity and alkaline phosphatase (ALP) activity for pEV HA treated implants. Moreover, histological analyses showed that none of the treatments induced an irritative effect and, a decrease in the fibrotic response surrounding the implant for pEV HA treated implants was described. Conclusion: In conclusion, pEVs improve titanium implants biocompatibility at the bone–implant interface, decreasing the necrotic effects of the surgery and diminishing the fibrotic layer associated to the implant encapsulation that can lead to implant failure.

This document is a corrigendum for an article titled "Fabrication and surface characterization of titanium dioxide nanotubes on titanium implants." The corrigendum acknowledges that the funder, National Science Foundation of China (82160415), was omitted from the original article. The correct funding statement is provided, along with apologies for the error. The corrigendum does not affect the scientific conclusions of the original article. [Extracted from the article]

Titanium implants undergo an aging process through surface hydrocarbon deposition, resulting in decreased wettability and bioactivity. Plasma treatment was shown to significantly reduce surface hydrocarbons, thus improving implant hydrophilicity and enhancing the osseointegration process. This study investigates the effect of plasma surface treatment on bone-to-implant contact (BIC) of implants presenting a nanostructured calcium-incorporated surface (XPEED®). Following a Randomized Controlled Trial (RCT) design, patients undergoing implant surgery in the posterior maxilla received additional plasma-treated (n = 7) or -untreated (n = 5) 3.5 × 8 mm implants that were retrieved after a 4-week healing period for histological examination. Histomorphometric analysis showed that plasma-treated implants exhibited a 38.7% BIC rate compared to 22.4% of untreated implants (p = 0.002), indicating enhanced osseointegration potential. Histological images also revealed increased bone formation and active osteoblastic activity around plasma-treated implants when compared to untreated specimens. The findings suggest that plasma treatment improves surface hydrophilicity and biological response, facilitating early bone formation around titanium implants. This study underscores the importance of surface modifications in optimizing implant integration and supports the use of plasma treatment to enhance osseointegration, thereby improving clinical outcomes in implant dentistry and offering benefits for immediate and early loading protocols, particularly in soft bone conditions.

Abstract Post‐surgery microbial infections are still one of the main reasons for implant failure, which results in very high physical and psychological pain for the patient and an increased cost for the healthcare system. A polymer nanocomposite antibacterial coating on titanium implants represents a valuable alternative to the more expensive and energy‐consuming technological solutions nowadays used. In this regard, a sprayable thermoset nanocomposite composed of silanized‐terminals polyethylene glycol (PEG)/ZnO nanoparticle is herein proposed. Initially, PEG's terminals' solvent‐free silanization and curing are studied by Fourier Transform Infrared and µRaman spectroscopies. Scanning Electron Microscope investigations and scratch tests have shown that the spraying procedure optimization and the oxidation treatment of the titanium substrate lead to a homogeneous coverage and improved adhesion of the coatings. The antibacterial activity is tested against not only both S. aureus and P. aeruginosa bacterial American Type Culture Collection strains, but also using very aggressive antibiotic‐resistant clinical strains. Interestingly, antibacterial activity, evaluated by time‐killing tests, is observed for all tested bacterial strains. Live/dead tests further confirm that 5 wt% of ZnO allows obtaining a bacteriostatic activity within 24 h, whereas a complete growth inhibition (bactericidal activity) of both tested strains is observed for coatings with 20 wt% of ZnO nanoparticles.

Despite the high biocompatibility of titanium and its alloys, the need to remove titanium implants is increasingly being debated due to the potential for adverse effects associated with long-term retention. Therefore, new solutions are being sought to enhance the biocompatibility of titanium implants. One of them is to increase the thickness of the passive layer of the implant made of titanium dioxide. We were the first to evaluate the effect of hard-anodized (type II) Ti-6Al-4V alloy discs on the cytotoxicity, mitochondrial function, and redox balance of fibroblasts mitochondria compared to standard-anodized (type III) and non-anodized discs. The study used fibroblasts obtained from human gingival tissue. The test discs were applied to the bottom of 12-well plates. Cells were cultured for 24 h and 7, 14, and 21 days and mitochondria were isolated. We demonstrated the occurrence of oxidative stress in the mitochondria of fibroblasts of all tested groups, regardless of the presence and type of anodization. Type II anodization prevented changes in complex II activity (vs. control). The lowest degree of citrate synthase inhibition occurred in mitochondria exposed to titanium discs with type II anodization. In the last phase of culture, the presence of type II anodization reduced the degree of cytochrome c oxidase inhibition compared to the other tests groups and the control group, and prevented apoptosis. Throughout the experiment, the release of titanium, aluminium, and vanadium ions from titanium discs with a hard-anodized passive layer was higher than from the other titanium discs, but decreased with time. The obtained results proved the existence of dysfunction and redox imbalance in the mitochondria of fibroblasts exposed to hard-anodized titanium discs, suggesting the need to search for new materials perhaps biodegradable in tissues of the human body. [ABSTRACT FROM AUTHOR]

Poor osseointegration of the implant and the occurrence of infection are important causes of endosseous implant failure. The ideal implant material should have excellent osteogenic and antibacterial properties to reduce the time to osseointegration and to prevent the occurrence of infection. Surface microstructures and antibacterial coatings have been successful in improving the biocompatibility of implants. However, due to the limitations of microfabrication techniques and the complexity of material-cell interactions, it is challenging to prepare implants with bifunctional effects. In this study, we prepared a new bifunctional surface containing Ti–Cl microstructure on a titanium alloy substrate by anodic oxidation using an economical and efficient sodium chloride solution as the electrolyte, and then investigated its antibacterial effect and its influence on the biological behavior of human mesenchymal stem cells (hMSCs). The results showed that the anodized surface was distributed with irregular microstructures, and the roughness and wettability of the surface increased compared to the smooth control TC4. The anodized surface can promote the proliferation, adhesion and spreading of hMSCs as well as the secretion of ALP, suggesting a better potential to promote cell osteogenic differentiation. In addition, the chloride formed on the surface after anodic oxidation makes the titanium alloy have a certain antibacterial effect on Staphylococcus aureus (S.aureus) and Escherichia coli (E.coli). This research could set the groundwork for the study of micro-manufacturing technology and pave the way for future implant surface design. [ABSTRACT FROM AUTHOR]

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Osteonecrosis of the femoral head (ONFH) is a common but sophisticated multifactorial disease. In this study, the genomic characteristics of ONFH from the sequencing is first analyzed. Excepting ischemia and inflammation, some of differentially expressed genes (DEGs) are connected with autophagy. So, they are taken as the breakthrough points to design an auto polymerization coating of caffeic acid with grafting deferoxamine (DFO) and strontium on Ti substrate. In vitro cells and in vivo immunofluorescence and immunohistochemical results prove that the modified Ti can upregulate the expression of HIF‐1α in mesenchymal stem cells (MSCs) and human umbilical vein endothelial cells (HUVECs) by receptors of TGF‐β and TNFR on cell membrane. Interestingly, in MSCs, the upregulated HIF‐1α can promote autophagy to some extent by HIF‐1α/BNIP2 pathway. Meanwhile, appropriate autophagy and HIF‐1α can regulate MSCs proliferation and osteogenic differentiation by STAT3/Notch pathway. However, in HUVECs, although autophagy increases slightly, the upregulated HIF‐1α prefers to increase its downstream target gene VEGF and accelerate angiogenesis by the pathway of HIF‐1α/VEGF. The results of in vivo implantation show that the modified Ti substrate can effectively enhance the integration effect of the implant by osteogenesis and angiogenesis. More significantly, the modified Ti can retard the further deterioration of ONFH by regulation of key genes. [ABSTRACT FROM AUTHOR]