Dental implants osseointegration: in vitro, preclinical and clinical research results.

Osseointegration is described as the close contact between bone and an implant surface, and the interest on surface engineering has to be understood as an important and natural trend. The biological fixation between the dental implant surfaces and jaw bones should be considered a prerequisite for the long-term success of implant-supported prostheses. In this context, the implant surface modifications gained an important and decisive place in implant research over the last years. The bone response, which means rate, quantity and quality, is related to the implant surface properties. For example, the composition and charges are critical for protein adsorption and cell attachment. Hydrophilic surfaces seem to favor the interactions with biological fluids and cells when compared to the hydrophobic ones, and hydrophilicity is affected by the surface chemical composition. Various techniques of surface treatments have been studied and applied to improve biological surface properties, which favors the mechanism of osseointegration. This strategy aims at promoting the mechanism of osseointegration with faster and stronger bone formation, to confer better stability during the healing process, thus allowing earlier loading of the implant. Some of the objectives for the development of implant surface modifications are to improve the clinical performance in anatomical sites characterized by poor quantity or quality of bone, to accelerate the bone healing and thereby allowing immediate or early loading protocols and also stimulating bone growth in order to permit implant placement in sites that lack sufficient residual alveolar ridge, thus providing them a jumping gap ability, for example. Implant morphology influences bone metabolism: rougher surfaces stimulate differentiation, growth and attachment of bone cells, and increase mineralization; furthermore, the degree of roughness is important. Implants may have "smooth" (machined) or rough surfaces. The main methods that are reported in the literature to create implant roughness are acid etching, sandblasting, titanium plasma spraying and hydroxyapatite (HA) coating. A current tendency is the manufacturing of implants with micro and submicro (nano) topography. Furthermore, the biofunctionalization of implants surfaces, by adding different substances to improve its biological characteristics, has also been recently investigated. In this contex, aim of the present project has been focused on dental implant surface modifications in order to improve the clinical performance in areas with poor quantity or quality of bone. In detail this aim has been reached trough 3 steps: 1) in vitro studies: a) in vitro studies of osteoproperties of glass and titanium surfaces grafted with fibronectin sequence motif for integrin binding (Arg-Gly-Asp, RGD)/ human vitronectin protein (HVP) b) development of an in vitro model to evaluate the degree of implants osteointegration by passing in vivo test. 2) in vivo studies, in big animal model, dogs, of osteointegrative properties of implants with different degree of surface modification. 3) clinical research on short implants, to underline the effect of surface modifications on dental implant survival in the long term in the clinic. As final results of these studies, we can conclude that there are a huge number of types of implant surfaces in the market, from different implant manufacturers, all of them claiming to have better clinical results. It is important that the clinician choose the surface that have shown the best results in the scientific literature. The majority of currently available in vitro and in vivo studies seem to indicate that implant surfaces with micro and submicro (nano) topography bring forward benefits to the process of interaction between bone cells and implant surfaces, accelerating and increasing the quality of bone-to-implant-contact (BIC). Finally, based on the state of the art of implant development, it is possible to predict that, within some time, implant surfaces coated with substances with biomimetic capacity will be available for clinical use. This process of implant bio-functionalization aims at modulating new bone formation around implants, and it represents the next step in implant development

An Observational Cohort Study on Delayed-Onset Infections after Mandibular Third-Molar Extractions.

OBJECTIVES: The purpose of the present study was to investigate the occurrence and clinical features of delayed-onset infections after mandibular third-molar extractions. METHOD AND MATERIALS: An observational cohort study was conducted on 179 patients undergoing mandibular third-molar extraction between January 2013 and December 2015, for a total of 217 extractions. Data were recorded at the time of extraction (T0), on suture removal seven days later (T1), and 30 days after the extraction, when patients were contacted and asked about their healing process (T2). The statistical analysis was performed with nonparametric tests. A p value lower than 0.05 was considered statistically significant. RESULTS: Eight delayed-onset infections were recorded, amounting to 3.7% of all extractions. The median time elapsing from the extraction to the delayed-onset infection was 35 days (IQR 28-40; min 24-max 49). Younger age and longer surgical procedures seemed to be more often associated with this complication. CONCLUSION: Delayed-onset infections after third-molar extractions are relatively rare postoperative complications characterized by a swelling, usually with a purulent discharge. Patients should be informed of this possibility, which might develop even several weeks after the extraction

Release of VEGF from dental implant improves osteogenetic process: Preliminary in vitro tests

INTRODUCTION: During osseointegration process, the presence of an inflammatory event could negatively influence the proper osteogenetic ability of the implant surface. In order to reduce this possibility, an implementation of angiogenetic event through the release of Vascular Endothelial Growth Factor (VEGF) can be a tool as co-factor for osteoblastic differentiation. In this paper, novel dental implant surfaces enriched with VEGF have been tested. MATERIAL AND METHODS: The ability of VEGF-enriched titanium implants to improve the osteogenetic properties of Mesenchymal stem cells (MSC), also in the presence of an inflammatory environment, have been in vitro tested. Molecular biology, morphological analyses, and biochemical tests have been performed in order to confirm biological properties of these surfaces. RESULTS: Our results confirm that the presence of VEGF onto the implant surface is able not only to protect the cells from in vitro aging and from Reactive Oxygen Species (ROS) damage, but it also improves their osteogenic and endothelial differentiation, even in the presence of inflammatory cytokines. CONCLUSION: This study establishes a biologically powerful novel tool that could enhance bone repair in dental implant integration

Biocompatibility and antibacterial properties of zirconium nitride coating on titanium abutments: An in vitro study

Improving soft tissue attachment and reducing bacterial colonization on titanium abutments are key factors for the long-term maintenance of healthy soft and hard peri-implant tissues. This in vitro study was conducted to compare the biocompatibility and antibacterial activity of four different surfaces: uncoated Ti6Al4V, anodized, and coated with titanium nitride or zirconium nitride. Surface topography was investigated with a high-resolution system for measuring surface finishes. Human gingival fibroblast (HGF) adhesion and proliferation were examined using MTT assay, Scanning Electron Microscopy (SEM) imaging, immunofluorescence analysis and real-time PCR for selected target genes. The hemolysis and AMES tests were performed to assess the chemical compounds' blood compatibility and mutagenic potential, respectively. Antibacterial activity was tested against five bacterial strains isolated from the oral cavity (Streptococcus salivarius, S. sanguinis, S. mutans, S. sobrinus, S. oralis), and the percentage of dead bacteria was calculated. Roughness measurements confirmed a substantial similarity between the surfaces and their compatibility with clinical applications. MTT assay, SEM analysis and immunofluorescence staining showed adhesion and proliferation of HGFs cultured on all the examined surfaces. PCR confirmed that HGFs produced extracellular matrix components efficiently on all the surfaces. No hemolytic activity was detected, and the AMES test confirmed the surfaces' clinical safety. For all tested bacterial strains, biofilms grown on the zirconium nitride surface showed a higher percentage of dead bacteria than on the other disks. The titanium nitride surface inactivated bacterial biofilms, too, but to a lesser extent

Platform switching on wide-diameter external hex implants a finite element analysis

Objectives: The objective of this work was to use finite element analysis to compare the effect of forces coming to bear on abutments 4.1 or 5.0 mm in diameter connected to a 5.0 mm implant (i.e. with or without platform swit - ching). Study design: A 3D CAD model of a 5 x 11.5 mm external hex implant was developed, complete with a connection screw and either of two abutments, one 4.1 and the other 5 mm in diameter, to assess the influence of two loading conditions, i.e. 200 N loaded either axially or off center on the top of the abutment. Results and conclusions: In the symmetrically loaded models, greater stresses were transmitted to the bone in the area below the neck of the implant in the case of the wider-diameter abutment. When the narrower abutment was considered, the stress lines remained confined to the metal and were transferred to the bone in a more distal position. When the stresses in the bone where compared under non-symmetrical loading of the larger- and smaller-diameter abutments, the stresses reached lower values in the latter case. These findings indicate that platform switching (i.e. coupling a 4.1 mm abutment with a 5 mm implant) achieves a better, more even distribution of the peri-implant stresses deriving from simulated occlusal loads on the bone margins

Bioactive sphene-based ceramic coatings on cpTi substrates for dental implants: An in vitro study

Titanium implant surface modifications have been widely investigated to favor the process of osseointegration. The present work aimed to evaluate the effect of sphene (CaTiSiO5) biocoating, on titanium substrates, on the in vitro osteogenic differentiation of Human Adipose-Derived Stem Cells (hADSCs). Sphene bioceramic coatings were prepared using preceramic polymers and nano-sized active fillers and deposited by spray coating. Scanning Electron Microscopy (SEM) analysis, surface roughness measurements and X-ray diffraction analysis were performed. The chemical stability of the coatings in Tris-HCl solution was investigated. In vitro studies were performed by means of proliferation test of hADSCs seeded on coated and uncoated samples after 21 days. Methyl Thiazolyl-Tetrazolium (MTT) test and immunofluorescent staining with phalloidin confirmed the in vitro biocompatibility of both substrates. In vitro osteogenic differentiation of the cells was evaluated using Alizarin Red S staining and quantification assay and real-time PCR (Polymerase Chain Reaction). When hADSCs were cultured in the presence of Osteogenic Differentiation Medium, a significantly higher accumulation of calcium deposits onto the sphene-coated surfaces than on uncoated controls was detected. Osteogenic differentiation on both samples was confirmed by PCR. The proposed coating seems to be promising for dental and orthopedic implants, in terms of composition and deposition technology

Peri-Implant Bone Loss and Overload: A Systematic Review Focusing on Occlusal Analysis through Digital and Analogic Methods.

The present review aimed to assess the possible relationship between occlusal overload and peri-implant bone loss. In accordance with the PRISMA guidelines, the MEDLINE, Scopus, and Cochrane databases were searched from January 1985 up to and including December 2021. The search strategy applied was: (dental OR oral) AND implants AND (overload OR excessive load OR occlusal wear) AND (bone loss OR peri-implantitis OR failure). Clinical studies that reported quantitative analysis of occlusal loads through digital contacts and/or occlusal wear were included. The studies were screened for eligibility by two independent reviewers. The quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. In total, 492 studies were identified in the search during the initial screening. Of those, 84 were subjected to full-text evaluation, and 7 fulfilled the inclusion criteria (4 cohort studies, 2 cross-sectional, and 1 case-control). Only one study used a digital device to assess excessive occlusal forces. Four out of seven studies reported a positive correlation between the overload and the crestal bone loss. All of the included studies had moderate to serious overall risk of bias, according to the ROBINS-I tool. In conclusion, the reported data relating the occlusal analysis to the peri-implant bone level seem to reveal an association, which must be further investigated using new digital tools that can help to standardize the methodology

Silver Nanoparticles in Alveolar Bone Surgery Devices

Silver (Ag) ions have well-known antimicrobial properties and have been applied as nanostrategies in many medical and surgical fields, including dentistry. The use of silver nanoparticles (Ag NPs) may be an option for reducing bacterial adhesion to dental implant surfaces and preventing biofilm formation, containing the risk of peri-implant infections. Modifying the structure or surface of bone grafts and membranes with Ag NPs may also prevent the risk of contamination and infection that are common when alveolar bone augmentation techniques are used. On the other hand, Ag NPs have revealed some toxic effects on cellsin vitroandin vivoin animal studies. In this setting, the aim of the present paper is to summarize the principle behind Ag NP-based devices and their clinical applications in alveolar bone and dental implant surgery