Recent advancements in surface modifications of dental implants.

OBJECTIVE: Implantology is one of the most investigated topics in modern dentistry. The current review was planned to systematically summarise all industrial, mass production and experimental trends in dental implant manufacturing relative primarily to their surface modification conducted between January 2017 and January 2020. MATERIALS AND METHODS: The review was conducted in Army Medical College, National University of Medical Sciences, Rawalpindi, Armed Forces Institute Of Dentistry, Combined Military Hospital, Rawalpindi, Foundation University College of Dentistry, Fauji Foundation Hospital, Islamabad, and the Higher Education Commission Library, Islamabad. Literature was searched on PubMed, Scopus, Medline, Cochrane and Science Direct databases. The key words employed were "dental Implants", "surface modification", "surface morphology", "surface treatment" and "surface augmentation". RESULTS: A total of 38 articles were short-listed and reviewed in detail. There was abundant evidence suggesting the importance of these surface modifications on improving the implant success. Several strategies have been suggested to modify the implant surface topography as well as surface chemistry in order to achieve a micro-porous structure with nano-scale architecture, with increased bio-activity; hydrophilicity and anti-bacterial properties. CONCLUSIONS: There has been commendable success with many of these strategies in laboratories. However, following the success in ex-vivo studies, very few of these surface modalities have found their way to clinical set-ups.

A micromorphological/microbiological pilot study assessing three methods for the maintenance of the implant patient.

OBJECTIVE: The aim of this study was to evaluate and compare the effectiveness of the ultrasonic piezoelectric inserts of EMS Steel Tip A, EMS Peek, and IS-TiP-STS-3E© in reducing peri-implant bacterial load without compromising the surface of implants during professional oral hygiene in the follow-up. MATERIALS AND METHODS: Thirteen implants were examined (Winsix, Biosafin, Ancona, Italy). The implants were divided into five groups and analyzed with a SEM microscope and microbiological analysis to evaluate the possible modification of structure and the bacterial load reduction. RESULTS: The control and A, B, and C test groups were initially contaminated in vitro with Streptococcus mutans. Subsequently, the A, B, and C test groups were treated by an only expert operator in standard conditions. Test groups A, B, and C were inoculated for 3 hr and, furthermore, microbiologically analyzed. CONCLUSION: The gold standard of an implant maintenance is a significant reduction of the bacterial load without becoming aggressive. According to our results, despite the limitations of the study, the authors recommend the least aggressive IS-TiP-STS-3E© , but combined with an antimicrobial agent to reduce the bacterial load, because the IS-TiP-STS-3E© did not show appreciable results versus the EMS Peek in reducing the bacterial load.

In Vitro Assessment of the Functional Dynamics of Titanium with Surface Coating of Hydroxyapatite Nanoparticles.

Manipulation of implant surface characteristics constitutes a promising strategy for improving cell growth and tissue response on a variety of materials with different surface topographies. Mesenchymal progenitor cells with a capacity to respond to titanium surface stimuli and differentiate into osteoblasts were used to perform comparative tests between two different implant topographies, including their functional interaction with pre-osteoblasts directly seeded onto the implants. Functional analysis of nanostructured implant surfaces was performed by in vitro assay analysis. The machined surface of titanium implants (mach group) was used as a control and compared with a nanoparticle HA activated surface implant (nano group), developed by the deposition of pure crystalline hydroxyapatite. Cell culture on the nano group surface resulted in higher cell adhesion and cultured osteoblast viability compared with the mach group. Scanning electron microscope (SEM) images revealed a stable interaction, indicated by the presence of focal cell adhesion formation. These results together with positive mineralization assays showed the nano group to be an excellent scaffold for bone-implant integration.

Desenvolvimento da peri-implantite induzida por ligadura em diferentes superfícies de implantes osseointegrados: análise clínica e radiográfica em cães / Development of peri-implantitis ligature-induced at different surfaces of osseointegrated implants: clinical and radiographic analyze in dogs

Foram avaliados, clínica e radiograficamente, as reações de quatro diferentes superfícies de implante frente ao desenvolvimento e progressão da peri-implantite: Ticp: titânio comercialmente puro; TPS: titânio revestido com plasma spray de titânio; HA: hidroxiapatita; Ost. Superfícies tratadas com ácidos. Para tanto, foram utilizados seis cães, cujos prémolares inferiores e superiores foram extraídos. Decorridos 90 dias, os implantes foram aleatoriamente colocados, e iniciou-se o controle químico e mecânico do biofilme bacteriano; após o período de osseointegração (90 dias) foram colocados os conectores, e após 45 dias da colocação dos conectores, iniciou-se a indução da peri-implantite por meio de ligaduras de fio de algodão (suspensão do controle do biofilme bacteriano), e os primeiros exames clínicos (profundidade de sondagem, sangramento à sondagem, índices de placa e sangramento, e mobilidade) e radiográficos (perda óssea) foram realizados. Esses parâmetros foram novamente avaliados após 20, 40 e 60 dias, quando da troca das lidaguras. A análise dos resultados não demonstrou diferença significante entre as superfícies, em nenhum dos parâmetros analisados, com exceção da mobilidade (avaliada pelo Periotest) e perda óssea, que foram menores nos implantes TPS. Concluiu-se que as superfícies apresentam comportamento semelhante durante a indução da periimplantite, com exceção no parâmetros mobilidade e perda óssea, que apresentaram os implantes TPS com comportamento superior

The reactions of four different implant surfaces were evaluated in regard to the development and progression of peri-implantitis: titanium commercially pure (Ticp), titanium plasma spray (TPS) hidroxiapatite coated (HA) and acid attached surfaces (Ost). Six dogs had their premolars extracted. After 90 days, the implants were ramdonly placed and the dogs receive soft diet, chemical and mechanical plaque control; after the osseointegration period (90 days), the healing abutments were placed. After the healing period (45 days), the plaque control was suspended, and cotton ligatures were installed when the first clinical (probing depth, bleeding on probing, plaque index, bleeding index, and mobility) and radiographic (bone loss) exams were taken. These parameters were re-exanimate after 20, 40 and 60 days, when the ligatures were changed. The results did not show significant differences between the surfaces in any parameter observed except for the mobility )(evaluated with Periotest) , and bone loss. These two parameters had the TPS surface with the lower rates. It was conclude that the surfaces show similar behavior during the induction of peri-implantitis, except for the mobility and bone loss parameters witch the TPS implants had better behavior