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J. Funct. Biomater., Volume 15, Issue 6 (June 2024) – 26 articles

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11 pages, 447 KiB  
Article
Osteoinductive Properties of Autologous Dentin: An Ex Vivo Study on Extracted Teeth
by Giulia Mazzucchi, Alessia Mariano, Giorgio Serafini, Luca Lamazza, Anna Scotto d’Abusco, Alberto De Biase and Marco Lollobrigida
J. Funct. Biomater. 2024, 15(6), 162; https://doi.org/10.3390/jfb15060162 - 12 Jun 2024
Viewed by 155
Abstract
Over the last decades, a variety of biomaterials, ranging from synthetic products to autologous and heterologous grafts, have been recommended to conserve and regenerate bone tissue after tooth extraction. We conducted a biochemical study on ground extracted teeth that aimed to evaluate the [...] Read more.
Over the last decades, a variety of biomaterials, ranging from synthetic products to autologous and heterologous grafts, have been recommended to conserve and regenerate bone tissue after tooth extraction. We conducted a biochemical study on ground extracted teeth that aimed to evaluate the osteoinductive and osteoconductive potential of dentin by assessing the releases of bone morphogenetic protein (BMP-2), osteocalcin (OC) and osteonectin (ON) over time (24 h, 10 days and 28 days). Twenty-six patients, who required the extraction of nonrestorable teeth, were enrolled in the study according to the inclusion criteria, as follows: thirteen young patients 18 to 49 years of age (UNDER 50), and thirteen patients of 50 to 70 years (OVER 50); a total of twenty-six teeth were extracted, ground and analyzed by enzyme-linked immunosorbent assays (ELISA). All ground teeth released BMP-2, OC and ON at each time point; no differences were observed between the UNDER-50 and OVER-50 patients. The results of the study support the use of autologous dentin as osteoinductive material for bone regeneration procedures, irrespective of patients’ ages. Full article
(This article belongs to the Special Issue Functional Biomaterials for Regenerative Dentistry)
19 pages, 2677 KiB  
Article
Effects of Functional Biomaterials on the Attributes of Orally Disintegrating Tablets Loaded with Furosemide Nanoparticles: In Vitro and In Vivo Evaluations
by Doaa Alshora, Wejdan Alyousef and Mohamed Ibrahim
J. Funct. Biomater. 2024, 15(6), 161; https://doi.org/10.3390/jfb15060161 - 9 Jun 2024
Viewed by 425
Abstract
Furosemide (FUR) is a diuretic used to relieve edema, congestive heart failure, cirrhosis, end-stage renal disease, and hypertension. FUR is a class IV according to the Biopharmaceutics Classification System. It is practically insoluble in water. This study aimed to optimize and formulate porous [...] Read more.
Furosemide (FUR) is a diuretic used to relieve edema, congestive heart failure, cirrhosis, end-stage renal disease, and hypertension. FUR is a class IV according to the Biopharmaceutics Classification System. It is practically insoluble in water. This study aimed to optimize and formulate porous orally disintegrating tablets (ODTs) prepared by sublimation and loaded with FUR nanoparticles prepared by using a planetary ball mill. Different functional biomaterials called stabilizers were used to stabilize the nanoparticle formula. Pluronic F-127 was the optimum stabilizer in terms of particle size (354.07 ± 6.44), zeta potential (−25.3 ± 5.65), and dissolution efficiency (56.34%). The impact of the stabilizer concentration was studied as well, and a concentration of 3% showed the smallest particle size (354.07 ± 6.44), best zeta potential value (−25.3 ± 5.65), and percentage of dissolution rate (56.34%). A FUR-loaded nanoparticle formula was successfully prepared. The nanoparticle formula was stabilized by using 3% pluronic F-127, and 3% was chosen for further study of the incorporation into oral disintegration tablets prepared by the sublimation technique. The impact of the matrix sublimating agent and superdisintegrant on the ODTs’ attributes (in vitro disintegration, wetting time, and in vitro dissolution efficiency) was studied using 32 full factorial designs. In vivo, the diuretic activity was tested for the optimized FUR ODTs by calculating the Lipschitz value using rats as an animal model. The stability of the ODTs loaded with FUR nanoparticles was assessed under accelerated conditions for 6 months. Finally, the ODT formula loaded with FUR NPs showed a rapid onset of action that was significantly faster than untreated drugs. Nanonization and ODT formulation enhances the dissolution rate and bioavailability of FUR. Many factors can be controlled to achieve optimization results, including the formulation and process parameters. Full article
(This article belongs to the Special Issue Nanomaterials for Drug Targeting and Drug Delivery)
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13 pages, 1152 KiB  
Article
A Two-Stage Approach Integrating Provisional Biomaterial-Mediated Stabilization Followed by a Definitive Treatment for Managing Volumetric Muscle Loss Injuries
by Andrew R. Clark, Jonathan Kulwatno, Sergey S. Kanovka, George J. Klarmann, Claudia E. Hernandez, Roman M. Natoli, Todd O. McKinley, Benjamin K. Potter, Christopher L. Dearth and Stephen M. Goldman
J. Funct. Biomater. 2024, 15(6), 160; https://doi.org/10.3390/jfb15060160 - 6 Jun 2024
Viewed by 319
Abstract
Treatment of volumetric muscle loss (VML) faces challenges due to its unique pathobiology and lower priority in severe musculoskeletal injury management. Consequently, a need exists for multi-stage VML treatment strategies to accommodate delayed interventions owing to comorbidity management or prolonged casualty care in [...] Read more.
Treatment of volumetric muscle loss (VML) faces challenges due to its unique pathobiology and lower priority in severe musculoskeletal injury management. Consequently, a need exists for multi-stage VML treatment strategies to accommodate delayed interventions owing to comorbidity management or prolonged casualty care in combat settings. To this end, polyvinyl alcohol (PVA) was used at concentrations of 5%, 7.5%, and 10% to generate provisional muscle void fillers (MVFs) of varying stiffness values (1.125 kPa, 3.700 kPa, and 7.699 kPa) to stabilize VML injuries as part of a two-stage approach. These were implanted into a rat model for a duration of 4 weeks, then explanted and either left untreated (control) or treated through minced muscle grafting (MMG). Additional benchmarks included acute MMG and unrepaired groups. At the MVF explant, the 7.5% PVA group exhibited superior neuromuscular function compared to the 5% and 10% PVA groups, the least fibrosis, and the largest median myofiber size among all groups at the 12-week endpoint. Despite the 7.5% PVA’s superiority amongst the two-stage treatment groups, neuromuscular function was neither improved nor impaired relative to acute treatment benchmarks. This suggests that the future success of a two-stage VML treatment strategy will necessitate a more effective definitive intervention. Full article
2 pages, 844 KiB  
Correction
Correction: Klimek et al. A Comparison of the Structure and Selected Mechanical Properties of Cr/Co Alloys Obtained by Casting and Selective Laser Melting. J. Funct. Biomater. 2024, 15, 61
by Leszek Klimek, Barbara Bułhak and Beata Śmielak
J. Funct. Biomater. 2024, 15(6), 159; https://doi.org/10.3390/jfb15060159 - 6 Jun 2024
Viewed by 159
Abstract
In the original publication [...] Full article
(This article belongs to the Special Issue Additive Manufacturing of Dental Materials)
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20 pages, 4082 KiB  
Review
Progress in Core–Shell Magnetic Mesoporous Materials for Enriching Post-Translationally Modified Peptides
by Zhenyu Zhu, Hang Fu, Yu Zhao and Qiulin Yan
J. Funct. Biomater. 2024, 15(6), 158; https://doi.org/10.3390/jfb15060158 - 6 Jun 2024
Viewed by 267
Abstract
Endogenous peptides, particularly those with post-translational modifications, are increasingly being studied as biomarkers for diagnosing various diseases. However, they are weakly ionizable, have a low abundance in biological samples, and may be interfered with by high levels of proteins, peptides, and other macromolecular [...] Read more.
Endogenous peptides, particularly those with post-translational modifications, are increasingly being studied as biomarkers for diagnosing various diseases. However, they are weakly ionizable, have a low abundance in biological samples, and may be interfered with by high levels of proteins, peptides, and other macromolecular impurities, resulting in a high limit of detection and insufficient amounts of post-translationally modified peptides in real biological samples to be examined. Therefore, separation and enrichment are necessary before analyzing these biomarkers using mass spectrometry. Mesoporous materials have regular adjustable pores that can eliminate large proteins and impurities, and their large specific surface area can bind more target peptides, but this may result in the partial loss or destruction of target peptides during centrifugal separation. On the other hand, magnetic mesoporous materials can be used to separate the target using an external magnetic field, which improves the separation efficiency and yield. Core–shell magnetic mesoporous materials are widely utilized for peptide separation and enrichment due to their biocompatibility, efficient enrichment capability, and excellent recoverability. This paper provides a review of the latest progress in core–shell magnetic mesoporous materials for enriching glycopeptides and phosphopeptides and compares their enrichment performance with different types of functionalization methods. Full article
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12 pages, 690 KiB  
Article
In Vitro/Ex Vivo Release Study of a Ground Umbilical Cord Matrix Loaded with Dexamethasone
by Florine Grossetete, Charlotte Garot, Emmanuel Crouzet, Xavier Delavenne, Philippe Gain, Laurence Barnouin and Gilles Thuret
J. Funct. Biomater. 2024, 15(6), 157; https://doi.org/10.3390/jfb15060157 - 5 Jun 2024
Viewed by 290
Abstract
Eye drops containing steroids and antibiotics are widely used to treat a large range of ocular diseases of the ocular surface. They require frequent instillation or a high dosage, which can affect quality of life. We developed a biomaterial from human umbilical cord [...] Read more.
Eye drops containing steroids and antibiotics are widely used to treat a large range of ocular diseases of the ocular surface. They require frequent instillation or a high dosage, which can affect quality of life. We developed a biomaterial from human umbilical cord that can be loaded with drugs before being placed in the inferior conjunctival fornix. In the present work, this viro-inactivated, freeze-dried, and sterile foam was loaded with dexamethasone phosphate. We studied the release kinetic of 100 mg of biomaterial loaded with 100 µg of dexamethasone phosphate. Assays have shown that the product can be loaded with 100 µg of dexamethasone and allows a progressive release over time for at least 48 h. In addition, when compared with the instillation of the same dexamethasone quantity (100 µg), instilled regularly via eye-drop solution at 0.79 mg/mL, the drug penetration through corneal tissues was better with the dexamethasone-loaded biomaterial. Full article
(This article belongs to the Special Issue Advanced Biomaterials for Drug Delivery)
12 pages, 3169 KiB  
Article
An Investigative Study on the Oral Health Condition of Individuals Undergoing 3D-Printed Customized Dental Implantation
by Hongyang Ma, Yuqian Kou, Hongcheng Hu, Yuwei Wu and Zhihui Tang
J. Funct. Biomater. 2024, 15(6), 156; https://doi.org/10.3390/jfb15060156 - 5 Jun 2024
Viewed by 360
Abstract
Background: The advent of three-dimensional (3D) printing technology has revolutionized the field of dentistry, enabling the precise fabrication of dental implants. By utilizing 3D printing, dentists can devise implant plans prior to surgery and accurately translate them into clinical procedures, thereby eliminating the [...] Read more.
Background: The advent of three-dimensional (3D) printing technology has revolutionized the field of dentistry, enabling the precise fabrication of dental implants. By utilizing 3D printing, dentists can devise implant plans prior to surgery and accurately translate them into clinical procedures, thereby eliminating the need for multiple surgical procedures, reducing surgical discomfort, and enhancing surgical efficiency. Furthermore, the utilization of digital 3D-printed implant guides facilitates immediate restoration by precisely translating preoperative implant design plans, enabling the preparation of temporary restorations preoperatively. Methods: This comprehensive study aimed to assess the postoperative oral health status of patients receiving personalized 3D-printed implants and investigate the advantages and disadvantages between the 3D-printed implant and conventional protocol. Additionally, variance analysis was employed to delve into the correlation between periodontal status and overall oral health. Comparisons of continuous paired parameters were made by t-test. Results: The results of our study indicate a commendable one-year survival rate of over 94% for 3D-printed implants. This finding was corroborated by periodontal examinations and follow-up surveys using the Oral Health Impact Profile-14 (OHIP-14) questionnaire, revealing excellent postoperative oral health status among patients. Notably, OHIP-14 scores were significantly higher in patients with suboptimal periodontal health, suggesting a strong link between periodontal health and overall oral well-being. Moreover, we found that the operating time (14.41 ± 4.64 min) was less statistically significant than for the control group (31.76 ± 6.83 min). Conclusion: In conclusion, personalized 3D-printed implant surgery has emerged as a reliable clinical option, offering a viable alternative to traditional implant methods. However, it is imperative to gather further evidence-based medical support through extended follow-up studies to validate its long-term efficacy and safety. Full article
(This article belongs to the Special Issue Orthodontics and Oral and Maxillofacial Materials)
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14 pages, 31164 KiB  
Article
Innovative Bioactive Ca-SZ Coating on Titanium Dental Implants: A Multidimensional Structural and Elemental Analysis
by Alex Tchinda, Aurélien Didelot, Patrick Choquet, Augustin Lerebours, Richard Kouitat-Njiwa and Pierre Bravetti
J. Funct. Biomater. 2024, 15(6), 155; https://doi.org/10.3390/jfb15060155 - 5 Jun 2024
Viewed by 287
Abstract
The design of new, biomimetic biomaterials is of great strategic interest and is converging for many applications, including in implantology. This study explores a novel approach to improving dental implants. Although endosseous TA6V alloy dental implants are widely used in oral implantology, this [...] Read more.
The design of new, biomimetic biomaterials is of great strategic interest and is converging for many applications, including in implantology. This study explores a novel approach to improving dental implants. Although endosseous TA6V alloy dental implants are widely used in oral implantology, this material presents significant challenges, notably the prevalence of peri-implantitis. Therefore, in this study, we investigate a new advance in the design of hybrid medical devices. This involves the design of a Ca-SZ coating deposited by PVD on a TA6V substrate. This approach aims to overcome the inherent limitations of each of these materials, namely TA6V’s susceptibility to peri-implantitis on the one hand and zirconia’s excessively high Young’s modulus compared with bone on the other, while benefiting from their respective advantages, such as the ductility of TA6V and the excellent biocompatibility of zirconia, offering relevant prospects for the design of high-performance implantable medical devices. This study integrates characterisation techniques, focusing on the structural and elemental analysis of the Ca-SZ coating by XRD and TEM. The results suggest that this coating combines a tetragonal structure, a uniform morphology with no apparent defects, a clean interface highlighting good adhesion, and a homogeneous composition of calcium, predisposing it to optimal biocompatibility. All of these findings make this innovative coating a particularly suitable candidate for application in dental implantology. Full article
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14 pages, 3746 KiB  
Article
Functionalized Surface Coatings for Rigid Contact Lenses
by Roeya Refaei, Kyueui Lee, Goun Amy Lee, Paul Demian, Fouad El Mansouri, Phillip B. Messersmith, Mouad Lamrani, Mohamed Khaddor and Nabil Allali
J. Funct. Biomater. 2024, 15(6), 154; https://doi.org/10.3390/jfb15060154 - 5 Jun 2024
Viewed by 387
Abstract
This research evolves into a comparative study of three different phenolic composites as coatings for rigid contact lenses, with a particular emphasis on enhancing their antifouling properties and hydrophobicity. The primary layer, comprised of diverse phenolic compounds, serves as a sturdy foundation. An [...] Read more.
This research evolves into a comparative study of three different phenolic composites as coatings for rigid contact lenses, with a particular emphasis on enhancing their antifouling properties and hydrophobicity. The primary layer, comprised of diverse phenolic compounds, serves as a sturdy foundation. An exclusive secondary layer, featuring synthetic peptoids, is introduced to further minimize biofouling. Validated through X-ray photoelectron spectroscopy, the surface analysis confirms the successful integration of the polyphenolic layers and the subsequent grafting of peptoids onto the lens surface. The efficacy of the proposed coatings is substantiated through protein adsorption tests, providing definitive evidence of their antifouling capabilities. This research employs a nuanced assessment of coating performance, utilizing the quantification of fluorescence intensity to gauge effectiveness. Additionally, contact angle measurements offer insights into wettability and surface characteristics, contributing to a comprehensive understanding of the coating’s practicality. Full article
(This article belongs to the Section Biomaterials and Devices for Healthcare Applications)
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13 pages, 2498 KiB  
Article
Evidence of Lysosomal β-Hexosaminidase Enzymatic Activity Associated with Extracellular Vesicles: Potential Applications for the Correction of Sandhoff Disease
by Eleonora Calzoni, Giada Cerrotti, Krizia Sagini, Federica Delo, Sandra Buratta, Roberto Maria Pellegrino, Husam B. R. Alabed, Federica Fratini, Carla Emiliani and Lorena Urbanelli
J. Funct. Biomater. 2024, 15(6), 153; https://doi.org/10.3390/jfb15060153 - 4 Jun 2024
Viewed by 243
Abstract
Extracellular vesicles (EVs) can be isolated from biological fluids and cell culture medium. Their nanometric dimension, relative stability, and biocompatibility have raised considerable interest for their therapeutic use as delivery vehicles of macromolecules, namely nucleic acids and proteins. Deficiency in lysosomal enzymes and [...] Read more.
Extracellular vesicles (EVs) can be isolated from biological fluids and cell culture medium. Their nanometric dimension, relative stability, and biocompatibility have raised considerable interest for their therapeutic use as delivery vehicles of macromolecules, namely nucleic acids and proteins. Deficiency in lysosomal enzymes and associated proteins is at the basis of a group of genetic diseases known as lysosomal storage disorders (LSDs), characterized by the accumulation of undigested substrates into lysosomes. Among them, GM2 gangliosidoses are due to a deficiency in the activity of lysosomal enzyme β-hexosaminidase, leading to the accumulation of the GM2 ganglioside and severe neurological symptoms. Current therapeutic approaches, including enzyme replacement therapy (ERT), have proven unable to significantly treat these conditions. Here, we provide evidence that the lysosomal β-hexosaminidase enzyme is associated with EVs released by HEK cells and that the EV-associated activity can be increased by overexpressing the α-subunit of β-hexosaminidase. The delivery of EVs to β-hexosaminidase-deficient fibroblasts results in a partial cross-correction of the enzymatic defect. Overall findings indicate that EVs could be a source of β-hexosaminidase that is potentially exploitable for developing therapeutic approaches for currently untreatable LSDs. Full article
(This article belongs to the Special Issue Nanostructured Materials/Biomaterials for Healthcare Applications)
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14 pages, 8373 KiB  
Article
Enhancing Antimicrobial Performance of Gauze via Modification by Ag-Loaded Polydopamine Submicron Particles
by Junnan Cui, Haobo Shu, Panpan Zhu, Zhimin Cao, Shuilin Wang and Pan Cao
J. Funct. Biomater. 2024, 15(6), 152; https://doi.org/10.3390/jfb15060152 - 2 Jun 2024
Viewed by 322
Abstract
Silver nanoparticles (AgNPs) are known for their antibacterial properties and their ability to promote wound healing. By incorporating silver nanoparticles into medical gauze, the resulting composite material shows promise as an advanced wound dressing. However, clinical applications are hindered by challenges related to [...] Read more.
Silver nanoparticles (AgNPs) are known for their antibacterial properties and their ability to promote wound healing. By incorporating silver nanoparticles into medical gauze, the resulting composite material shows promise as an advanced wound dressing. However, clinical applications are hindered by challenges related to the stability of silver nanoparticle loading on the gauze as nanoparticle leaching can compromise antibacterial efficacy. In this study, silver nanoparticles were immobilized onto polydopamine (PDA) submicron particles, which were then used to modify medical gauze. Energy dispersive spectroscopy (EDS) was employed to analyze the elemental distribution on the modified gauze, confirming successful surface modification. The antibacterial properties of the modified gauze were assessed using a laser scanning confocal microscope (CLSM). The results demonstrated a significant reduction in the adhesion rates of Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) by 99.1% and 63%, respectively, on the PDA–Ag-modified gauze. Optical density (OD) measurements at 590 nm indicated that the modified gauze effectively inhibited biofilm formation, underscoring its potent antimicrobial capabilities. Further antibacterial efficacy was evaluated by diluting and plating co-cultured bacterial solutions with the modified dressing, followed by 24 h incubation and colony counting. The gauze exhibited an antibacterial efficiency of 99.99% against E. coli and 99.8% against S. aureus. Additionally, cell compatibility tests, involving the co-culture of PDA–Ag composites with human cells, demonstrated excellent biocompatibility. These findings suggest that PDA–Ag-modified medical gauze holds significant potential for the treatment of infected wounds, offering a promising solution to improve wound care through enhanced antimicrobial activity and biocompatibility. Full article
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16 pages, 2286 KiB  
Systematic Review
Unlocking the Future: Bioprinting Salivary Glands—From Possibility to Reality
by Dobromira Shopova, Antoniya Yaneva, Anna Mihaylova, Atanaska Dinkova and Desislava Bakova
J. Funct. Biomater. 2024, 15(6), 151; https://doi.org/10.3390/jfb15060151 - 1 Jun 2024
Viewed by 294
Abstract
Salivary gland biofabrication represents a promising avenue in regenerative medicine, aiming to address the challenges of salivary gland dysfunction caused by various factors such as autoimmune diseases and radiotherapy. This review examines the current state of bioprinting technology, biomaterials, and tissue engineering strategies [...] Read more.
Salivary gland biofabrication represents a promising avenue in regenerative medicine, aiming to address the challenges of salivary gland dysfunction caused by various factors such as autoimmune diseases and radiotherapy. This review examines the current state of bioprinting technology, biomaterials, and tissue engineering strategies in the context of creating functional, implantable salivary gland constructs. Key considerations include achieving vascularization for proper nutrient supply, maintaining cell viability and functionality during printing, and promoting tissue maturation and integration with surrounding tissues. Despite the existing challenges, recent advancements offer significant potential for the development of personalized therapeutic options to treat salivary gland disorders. Continued research and innovation in this field hold the potential to revolutionize the management of salivary gland conditions, improving patient outcomes and quality of life. This systematic review covers publications from 2018 to April 2024 and was conducted on four databases: Google Scholar, PubMed, EBSCOhost, and Web of Science. The key features necessary for the successful creation, implantation and functioning of bioprinted salivary glands are addressed. Full article
(This article belongs to the Section Synthesis of Biomaterials via Advanced Technologies)
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23 pages, 6703 KiB  
Review
Enhancing Guided Bone Regeneration with a Novel Carp Collagen Scaffold: Principles and Applications
by Michele Bujda and Karel Klíma
J. Funct. Biomater. 2024, 15(6), 150; https://doi.org/10.3390/jfb15060150 - 1 Jun 2024
Viewed by 286
Abstract
Bone defects resulting from trauma, surgery, and congenital, infectious, or oncological diseases are a functional and aesthetic burden for patients. Bone regeneration is a demanding procedure, involving a spectrum of molecular processes and requiring the use of various scaffolds and substances, often yielding [...] Read more.
Bone defects resulting from trauma, surgery, and congenital, infectious, or oncological diseases are a functional and aesthetic burden for patients. Bone regeneration is a demanding procedure, involving a spectrum of molecular processes and requiring the use of various scaffolds and substances, often yielding an unsatisfactory result. Recently, the new collagen sponge and its structural derivatives manufactured from European carp (Cyprinus carpio) were introduced and patented. Due to its fish origin, the novel scaffold poses no risk of allergic reactions or transfer of zoonoses and additionally shows superior biocompatibility, mechanical stability, adjustable degradation rate, and porosity. In this review, we focus on the basic principles of bone regeneration and describe the characteristics of an “ideal” bone scaffold focusing on guided bone regeneration. Moreover, we suggest several possible applications of this novel material in bone regeneration processes, thus opening new horizons for further research. Full article
(This article belongs to the Section Bone Biomaterials)
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14 pages, 860 KiB  
Article
Comparison between Conventional and Digital Workflow in Implant Prosthetic Rehabilitation: A Randomized Controlled Trial
by Massimo Corsalini, Giuseppe Barile, Francesco Ranieri, Edvige Morea, Tommaso Corsalini, Saverio Capodiferro and Rosario Roberto Palumbo
J. Funct. Biomater. 2024, 15(6), 149; https://doi.org/10.3390/jfb15060149 - 31 May 2024
Viewed by 200
Abstract
The progress of digital technologies in dental prosthodontics is fast and increasingly accurate, allowing practitioners to simplify their daily work. These technologies aim to substitute conventional techniques progressively, but their real efficiency and predictability are still under debate. Many systematic reviews emphasize the [...] Read more.
The progress of digital technologies in dental prosthodontics is fast and increasingly accurate, allowing practitioners to simplify their daily work. These technologies aim to substitute conventional techniques progressively, but their real efficiency and predictability are still under debate. Many systematic reviews emphasize the lack of clinical RCTs that compare digital and traditional workflow. To address this evidence, we conducted a three-arm designed clinical RCT, which compares fully digital, combined digital, and analogic and fully analog workflows. We aimed to compare the clinical properties of each workflow regarding interproximal (IC) and occlusal contact (OC), marginal fit, impression time (IT), and patient satisfaction through a VAS scale. In total, 72 patients were included in the study. The IC and OC of the digital workflow were better than the others (p < 0.001), which obtained similar results. No difference between implant–abutment fit was observed (p = 0.5966). The IT was shorter in the digital workflow than the others (p < 0.001), which were similar. Patient satisfaction was higher in the digital workflow than in the conventional one. Despite the limitations, this study’s results support better accuracy and patient tolerance of digital workflow than of conventional techniques, suggesting it as a viable alternative to the latter when performed by clinicians experienced in digital dentistry. Full article
(This article belongs to the Special Issue New Trends in Biomaterials and Implants for Dentistry (2nd Volume))
14 pages, 4868 KiB  
Article
Laser Ablation Facilitates Implantation of Dynamic Self-Regenerating Cartilage for Articular Cartilage Regeneration
by Yingfang Fan, Fernando P. S. Guastaldi, Gem Runyan, Ying Wang, William A. Farinelli, Mark A. Randolph and Robert W. Redmond
J. Funct. Biomater. 2024, 15(6), 148; https://doi.org/10.3390/jfb15060148 - 29 May 2024
Viewed by 323
Abstract
Objectives: This study investigated a novel strategy for improving regenerative cartilage outcomes. It combines fractional laser treatment with the implantation of neocartilage generated from autologous dynamic Self-Regenerating Cartilage (dSRC). Methods: dSRC was generated in vitro from harvested autologous swine chondrocytes. Culture was performed [...] Read more.
Objectives: This study investigated a novel strategy for improving regenerative cartilage outcomes. It combines fractional laser treatment with the implantation of neocartilage generated from autologous dynamic Self-Regenerating Cartilage (dSRC). Methods: dSRC was generated in vitro from harvested autologous swine chondrocytes. Culture was performed for 2, 4, 8, 10, and 12 weeks to study matrix maturation. Matrix formation and implant integration were also studied in vitro in swine cartilage discs using dSRC or cultured chondrocytes injected into CO2 laser-ablated or mechanically punched holes. Cartilage discs were cultured for up to 8 weeks, harvested, and evaluated histologically and immunohistochemically. Results: The dSRC matrix was injectable by week 2, and matrices grew larger and more solid with time, generating a contiguous neocartilage matrix by week 8. Hypercellular density in dSRC at week 2 decreased over time and approached that of native cartilage by week 8. All dSRC groups exhibited high glycosaminoglycan (GAG) production, and immunohistochemical staining confirmed that the matrix was typical of normal hyaline cartilage, being rich in collagen type II. After 8 weeks in cartilage lesions in vitro, dSRC constructs generated a contiguous cartilage matrix, while isolated cultured chondrocytes exhibited only a sparse pericellular matrix. dSRC-treated lesions exhibited high GAG production compared to those treated with isolated chondrocytes. Conclusions: Isolated dSRC exhibits hyaline cartilage formation, matures over time, and generates contiguous articular cartilage matrix in fractional laser-created microenvironments in vitro, being well integrated with native cartilage. Full article
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15 pages, 4041 KiB  
Article
Analysis of Gingival Fibroblasts Behaviour in the Presence of 3D-Printed versus Milled Methacrylate-Based Dental Resins—Do We Have a Winner?
by Veaceslav Saramet, Miruna S. Stan, Alexandra Ripszky Totan, Ana Maria Cristina Țâncu, Bianca Voicu-Balasea, Dan Sebastian Enasescu, Florentina Rus-Hrincu and Marina Imre
J. Funct. Biomater. 2024, 15(6), 147; https://doi.org/10.3390/jfb15060147 - 28 May 2024
Viewed by 397
Abstract
Computer-aided design and computer-aided manufacturing (CAD/CAM) techniques are based on either subtractive (milling prefabricated blocks) or additive (3D printing) methods, and both are used for obtaining dentistry materials. Our in vitro study aimed to investigate the behavior of human gingival fibroblasts exposed to [...] Read more.
Computer-aided design and computer-aided manufacturing (CAD/CAM) techniques are based on either subtractive (milling prefabricated blocks) or additive (3D printing) methods, and both are used for obtaining dentistry materials. Our in vitro study aimed to investigate the behavior of human gingival fibroblasts exposed to methacrylate (MA)-based CAD/CAM milled samples in comparison with that of MA-based 3D-printed samples to better elucidate the mechanisms of cell adaptability and survival. The proliferation of human gingival fibroblasts was measured after 2 and 24 h of incubation in the presence of these samples using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, and the membrane integrity was assessed through the lactate dehydrogenase release. The level of reactive oxygen species, expression of autophagy-related protein LC3B-I, and detection of GSH and caspase 3/7 were evaluated by fluorescence staining. The MMP-2 levels were measured using a Milliplex MAP kit. The incubation with MA-based 3D-printed samples significantly reduced the viability, by 16% and 28% from control after 2 and 24 h, respectively. There was a 25% and 55% decrease in the GSH level from control after 24 h of incubation with the CAD/CAM milled and 3D-printed samples, respectively. In addition, higher levels of LC3B-I and MMP-2 were obtained after 24 h of incubation with the MA-based 3D samples compared to the CAD/CAM milled ones. Therefore, our results outline that the MA-CAD/CAM milled samples displayed good biocompatibility during 24-h exposure, while MA-3D resins are proper for short-term utilization (less than 24 h). Full article
(This article belongs to the Section Dental Biomaterials)
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12 pages, 1486 KiB  
Article
Biocompatibility of Subperiosteal Dental Implants: Changes in the Expression of Osteogenesis-Related Genes in Osteoblasts Exposed to Differently Treated Titanium Surfaces
by Marco Roy, Elisa Chelucci, Alessandro Corti, Lorenzo Ceccarelli, Mauro Cerea, Barbara Dorocka-Bobkowska, Alfonso Pompella and Simona Daniele
J. Funct. Biomater. 2024, 15(6), 146; https://doi.org/10.3390/jfb15060146 - 27 May 2024
Viewed by 347
Abstract
The use of endosseous dental implants may become unfeasible in the presence of significant maxillary bone atrophy; thus, surgical techniques have been proposed to promote bone regeneration in such cases. However, such techniques are complex and may expose the patient to complications. Subperiosteal [...] Read more.
The use of endosseous dental implants may become unfeasible in the presence of significant maxillary bone atrophy; thus, surgical techniques have been proposed to promote bone regeneration in such cases. However, such techniques are complex and may expose the patient to complications. Subperiosteal implants, being placed between the periosteum and the residual alveolar bone, are largely independent of bone thickness. Such devices had been abandoned due to the complexity of positioning and adaptation to the recipient bone site, but are nowadays witnessing an era of revival following the introduction of new acquisition procedures, new materials, and innovative manufacturing methods. We have analyzed the changes induced in gene and protein expression in C-12720 human osteoblasts by differently surface-modified TiO2 materials to verify their ability to promote bone formation. The TiO2 materials tested were (i) raw machined, (ii) electropolished with acid mixture, (iii) sand-blasted + acid-etched, (iv) AlTiColorTM surface, and (v) anodized. All five surfaces efficiently stimulated the expression of markers of osteoblastic differentiation, adhesion, and osteogenesis, such as RUNX2, osteocalcin, osterix, N-cadherin, β-catenin, and osteoprotegerin, while cell viability/proliferation was unaffected. Collectively, our observations document that presently available TiO2 materials are well suited for the manufacturing of modern subperiosteal implants. Full article
(This article belongs to the Special Issue Orthodontic Biomaterials: From the Past to the Present)
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44 pages, 2422 KiB  
Review
Towards Stem Cell Therapy for Critical-Sized Segmental Bone Defects: Current Trends and Challenges on the Path to Clinical Translation
by Jolene Quek, Catarina Vizetto-Duarte, Swee Hin Teoh and Yen Choo
J. Funct. Biomater. 2024, 15(6), 145; https://doi.org/10.3390/jfb15060145 - 27 May 2024
Viewed by 648
Abstract
The management and reconstruction of critical-sized segmental bone defects remain a major clinical challenge for orthopaedic clinicians and surgeons. In particular, regenerative medicine approaches that involve incorporating stem cells within tissue engineering scaffolds have great promise for fracture management. This narrative review focuses [...] Read more.
The management and reconstruction of critical-sized segmental bone defects remain a major clinical challenge for orthopaedic clinicians and surgeons. In particular, regenerative medicine approaches that involve incorporating stem cells within tissue engineering scaffolds have great promise for fracture management. This narrative review focuses on the primary components of bone tissue engineering—stem cells, scaffolds, the microenvironment, and vascularisation—addressing current advances and translational and regulatory challenges in the current landscape of stem cell therapy for critical-sized bone defects. To comprehensively explore this research area and offer insights for future treatment options in orthopaedic surgery, we have examined the latest developments and advancements in bone tissue engineering, focusing on those of clinical relevance in recent years. Finally, we present a forward-looking perspective on using stem cells in bone tissue engineering for critical-sized segmental bone defects. Full article
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11 pages, 2873 KiB  
Article
Effect of Bleaching Agents on Composite Resins with and without Bis-GMA: An In Vitro Study
by María Melo, Bianca Dumitrache, James Ghilotti, José Luis Sanz and Carmen Llena
J. Funct. Biomater. 2024, 15(6), 144; https://doi.org/10.3390/jfb15060144 - 27 May 2024
Viewed by 421
Abstract
The objective was to evaluate the change in color, hardness, and roughness produced by carbamide peroxide (CP) at two different concentrations on two resins. The 16% or 45% CP was applied to 66 resin discs with and without Bis-GMA. The color was measured [...] Read more.
The objective was to evaluate the change in color, hardness, and roughness produced by carbamide peroxide (CP) at two different concentrations on two resins. The 16% or 45% CP was applied to 66 resin discs with and without Bis-GMA. The color was measured with a spectrophotometer, and ΔEab and ΔE00 were calculated. Microhardness tester and SEM were used. In both composites, the a* and b* coordinates tended to be red and yellow, respectively, and were significant in the Bis-GMA group (p < 0.05). The ΔEab and ΔE00 were higher in the composite with Bis-GMA, regardless of the treatment received (p < 0.05). The microhardness was reduced in both composites regardless of the PC concentration compared to the control (p < 0.05). The 45% CP reduced the microhardness in the resin group with Bis-GMA compared to 16% CP (p < 0.001) but was not significant in the resin without Bis-GMA (p = 1). An increase in roughness was directly proportional to the concentration of CP, and it was more notable in the composite without Bis-GMA. The composite with Bis-GMA showed a greater tendency to darken than the one without Bis-GMA. The surface hardness of the composite was reduced in both composites and was not influenced by CP concentration in the composite without Bis-GMA. Bleaching is a common procedure nowadays. It is important to know how CP affects composites to establish a prognosis of the treatments in terms of color change, roughness, and hardness. Full article
(This article belongs to the Special Issue Biomaterials in Dentistry 2024)
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15 pages, 4316 KiB  
Article
Simulation of Orbital Fractures Using Experimental and Mathematical Approaches: A Pilot Study
by Patrik Eiba, Karel Frydrysek, Behrad Zanganeh, Daniel Cepica, Pavel Marsalek, Petr Handlos, Juraj Timkovic, Jan Stembirek, Jakub Cienciala, Arnost Onderka, Michal Brezik and Ondrej Mizera
J. Funct. Biomater. 2024, 15(6), 143; https://doi.org/10.3390/jfb15060143 - 26 May 2024
Viewed by 524
Abstract
This contribution gives basic information about the mechanical behavior of the facial part of the human skull cranium, i.e., the splanchnocranium, associated with external loads and injuries caused mainly by brachial violence. The main areas suffering from such violence include the orbit, frontal, [...] Read more.
This contribution gives basic information about the mechanical behavior of the facial part of the human skull cranium, i.e., the splanchnocranium, associated with external loads and injuries caused mainly by brachial violence. The main areas suffering from such violence include the orbit, frontal, and zygomatic bones. In this paper, as a first approach, brachial violence was simulated via quasi-static compression laboratory tests, in which cadaveric skulls were subjected to a load in a testing machine, increasing till fractures occurred. The test skulls were also used for research into the dynamic behavior, in which experimental and numerical analyses were performed. A relatively high variability in forces inducing the fractures has been observed (143–1403 N). The results lay the basis for applications mainly in forensic science, surgery, and ophthalmology. Full article
14 pages, 829 KiB  
Article
Induction of Apoptosis with Silver Nanoparticles Obtained Using Thermophilic Bacteria
by Kotryna Čekuolytė, Diana Šapaitė, Estera Žemgulytė, Renata Gudiukaitė and Eglė Lastauskienė
J. Funct. Biomater. 2024, 15(6), 142; https://doi.org/10.3390/jfb15060142 - 24 May 2024
Viewed by 264
Abstract
Yeasts resistant to antifungals have become an increasing risk to human health. One of the best antimicrobial properties is reported to be present in silver nanoparticles (AgNPs); however, little is known about the antimicrobial potential of AgNPs produced using thermophilic bacteria. How AgNPs [...] Read more.
Yeasts resistant to antifungals have become an increasing risk to human health. One of the best antimicrobial properties is reported to be present in silver nanoparticles (AgNPs); however, little is known about the antimicrobial potential of AgNPs produced using thermophilic bacteria. How AgNPs cause cell death is different depending on the type of the cell, and the mode of death induced is cell-type specific. Apoptosis, one of the types of regulated cell death, can be extremely useful in the fight against infection because surrounding cells that have phagocytic activity can efficiently absorb the apoptotic bodies formed during apoptosis. In the course of this work, for the first time, comprehensive antifungal studies of AgNPs were performed using thermophilic Geobacillus spp. bacteria against Candida guilliermondii, also with the addition of the model yeast Saccharomyces cerevisiae. The determined minimal inhibitory concentrations (MICs) were 10 μg/mL against C. guilliermondii and 50 μg/mL against S. cerevisiae for Geobacillus sp. strain 25 AgNPs, and for Geobacillus sp. 612 the MICs were 5 μg/mL and 25 μg/mL, respectively. It was shown for the first time that the exposure of the yeast cells leads to caspase activation in both S. cerevisiae and C. guilliermondii after exposure to Geobacillus spp. AgNPs. Also, a statistically significant change in the number of cells with permeable membranes was detected. Moreover, it was shown that the antimicrobial effect of the AgNPs is related to ROS generation and lipid peroxidation in C. guilliermondii yeast. Full article
(This article belongs to the Section Antibacterial Biomaterials)
22 pages, 3618 KiB  
Article
Elasticity Modification of Biomaterials Used in 3D Printing with an Elastin–Silk-like Recombinant Protein
by Violetta Cecuda-Adamczewska, Agnieszka Romanik-Chruścielewska, Katarzyna Kosowska, Iwona Sokołowska, Natalia Łukasiewicz, Paulina Korycka, Katarzyna Florys-Jankowska, Agnieszka Zakrzewska, Michał Wszoła and Marta Klak
J. Funct. Biomater. 2024, 15(6), 141; https://doi.org/10.3390/jfb15060141 - 24 May 2024
Viewed by 388
Abstract
The recombinant structural protein described in this study was designed based on sequences derived from elastin and silk. Silk–elastin hybrid copolymers are characterized by high solubility while maintaining high product flexibility. The phase transition temperature from aqueous solution to hydrogel, as well as [...] Read more.
The recombinant structural protein described in this study was designed based on sequences derived from elastin and silk. Silk–elastin hybrid copolymers are characterized by high solubility while maintaining high product flexibility. The phase transition temperature from aqueous solution to hydrogel, as well as other physicochemical and mechanical properties of such particles, can differ significantly depending on the number of sequence repeats. We present a preliminary characterization of the EJ17zipR protein obtained in high yield in a prokaryotic expression system and efficiently purified via a multistep process. Its addition significantly improves biomaterial’s rheological and mechanical properties, especially elasticity. As a result, EJ17zipR appears to be a promising component for bioinks designed to print spatially complex structures that positively influence both shape retention and the internal transport of body fluids. The results of biological studies indicate that the addition of the studied protein creates a favorable microenvironment for cell adhesion, growth, and migration. Full article
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14 pages, 2779 KiB  
Article
Fabrication of a Triple-Layer Bionic Vascular Scaffold via Hybrid Electrospinning
by Feier Ma, Xiaojing Huang and Yan Wang
J. Funct. Biomater. 2024, 15(6), 140; https://doi.org/10.3390/jfb15060140 - 23 May 2024
Viewed by 373
Abstract
Tissue engineering aims to develop bionic scaffolds as alternatives to autologous vascular grafts due to their limited availability. This study introduces a novel wet-electrospinning fabrication technique to create small-diameter, uniformly aligned tubular scaffolds. By combining this innovative method with conventional electrospinning, a bionic [...] Read more.
Tissue engineering aims to develop bionic scaffolds as alternatives to autologous vascular grafts due to their limited availability. This study introduces a novel wet-electrospinning fabrication technique to create small-diameter, uniformly aligned tubular scaffolds. By combining this innovative method with conventional electrospinning, a bionic tri-layer scaffold that mimics the zonal structure of vascular tissues is produced. The inner and outer layers consist of PCL/Gelatin and PCL/PLGA fibers, respectively, while the middle layer is crafted using PCL through Wet Vertical Magnetic Rod Electrospinning (WVMRE). The scaffold’s morphology is analyzed using Scanning Electron Microscopy (SEM) to confirm its bionic structure. The mechanical properties, degradation profile, wettability, and biocompatibility of the scaffold are also characterized. To enhance hemocompatibility, the scaffold is crosslinked with heparin. The results demonstrate sufficient mechanical properties, good wettability of the inner layer, proper degradability of the inner and middle layers, and overall good biocompatibility. In conclusion, this study successfully develops a small-diameter tri-layer tubular scaffold that meets the required specifications. Full article
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10 pages, 759 KiB  
Article
Effect of Calcium Silicate-Based Intracanal Medicament and Calcium Hydroxide on Growth Factor TGF-β1 Release from Root Canal Dentine
by Goda Bilvinaite, Saulius Drukteinis, Egidijus Simoliunas, Matthias Widbiller and Simas Sakirzanovas
J. Funct. Biomater. 2024, 15(6), 139; https://doi.org/10.3390/jfb15060139 - 22 May 2024
Viewed by 374
Abstract
Effective root canal disinfection and the subsequent release of natural growth factors from dentin are crucial to the success of regenerative endodontic procedures. This study evaluated the effect of newly introduced calcium silicate-based temporary intracanal medicament Bio-C Temp and calcium hydroxide-based material UltraCal [...] Read more.
Effective root canal disinfection and the subsequent release of natural growth factors from dentin are crucial to the success of regenerative endodontic procedures. This study evaluated the effect of newly introduced calcium silicate-based temporary intracanal medicament Bio-C Temp and calcium hydroxide-based material UltraCal XS on the release of transforming growth factor β1 (TGF-β1) from root canal dentin. Twenty-two intact and fully developed human premolars from patients aged 15–18 were shaped and irrigated according to the current clinical recommendations. The teeth were then gently split in half, and the root canal dentin of paired samples was covered with Bio-C Temp or UltraCal XS. After 3 weeks of incubation, the specimens were conditioned with 17% EDTA and the collected solution was subjected to the quantification of the released TGF-β1 by performing an ELISA. One-way analysis of variance (ANOVA), followed by Tukey’s test, was selected to determine the statistically significant differences between the groups at the 0.95 confidence level. The highest mean value of released TGF-β1 (1993.1 pg/mL) was detected in the control group, where the root canal dentin was conditioned with 17% EDTA alone. Regarding the experimental groups, Bio-C Temp released a statistically significantly higher amount of TGF-β1 (282.14 pg/mL) compared to UltraCal XS (114.28 pg/mL; p = 0.0158). Bio-C Temp affected the release of growth factors from root canal dentin less than UltraCal XS and may therefore serve as an intracanal medicament for regenerative endodontic procedures. Full article
(This article belongs to the Special Issue Advanced Materials for Clinical Endodontic Applications II)
17 pages, 1040 KiB  
Article
Biomolecule-Producing Probiotic Bacterium Lactococcus lactis in Free or Nanoencapsulated Form for Endometritis Treatment and Fertility Improvement in Buffaloes
by Nesrein M. Hashem, Walaa M. Essawi, Azza S. El-Demerdash and Ali Ali El-Raghi
J. Funct. Biomater. 2024, 15(6), 138; https://doi.org/10.3390/jfb15060138 - 21 May 2024
Viewed by 403
Abstract
A Lactococcus (L.) lactis strain producing antimicrobial and anti-inflammatory biomolecules (mainly 1,4-Diaza-2,5-dioxobicyclo[4.3.0]nonanes and pyrazine-derivatives) was tested for its capacity to cure clinical endometritis in buffaloes compared to conventional antibiotic-based treatment. Clinical endometritis-diagnosed buffaloes (n = 16/group) were infused intrauterine with four [...] Read more.
A Lactococcus (L.) lactis strain producing antimicrobial and anti-inflammatory biomolecules (mainly 1,4-Diaza-2,5-dioxobicyclo[4.3.0]nonanes and pyrazine-derivatives) was tested for its capacity to cure clinical endometritis in buffaloes compared to conventional antibiotic-based treatment. Clinical endometritis-diagnosed buffaloes (n = 16/group) were infused intrauterine with four doses of 109 CFU-free (FLC group) or nanoencapsulated L. lactis (NLC group) and compared to those that received three doses of saline + a single dose of 500 mg cephapirin benzathin (AB group) or four doses of saline (control, C group) every other day. Endometrium samples were analyzed for cytological (polymorphonuclear cells, PMN), bacteriological, and proinflammatory mRNA expression. Uterine wash and blood samples were collected to determine proinflammatory cytokine concentrations and metabolites in the blood samples. The reproductive performance of buffaloes was assessed. Compared to the C group, the AB and NLC groups had the lowest percentage of PMN, followed by those in the FLC group (p < 0.05). All treated buffaloes had significantly lower numbers of pathogens than the control buffaloes. Compared to control, all treatments significantly down-regulated endometrial proinflammatory encoding mRNA expression. The concentrations of IL1B, TNFAIP7, and leukocyte esterase activity in the uterine washings were significantly decreased in the AB and NLC groups compared to the C and FLC groups. All treatments significantly decreased concentrations of serum proinflammatory cytokines compared to control. Both the AB and NLC groups had significantly lower concentrations of serum NEFA than the C and FLC groups. The percentage of control buffaloes having an echogenic uterus and PVD score > 2 was significantly higher than those in the treated buffaloes with higher numbers of corpora lutea, higher conception rates, and shorter days open than control buffaloes (p < 0.05). In conclusion, L. lactis-producing antimicrobial and anti-inflammatory metabolites reduce uterine inflammatory responses and improve fertility in buffaloes. Full article
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22 pages, 6790 KiB  
Systematic Review
Molar Distalization by Clear Aligners with Sequential Distalization Protocol: A Systematic Review and Meta-Analysis
by Christie Shen, Tiffany H. Park, Chun-Hsi Chung and Chenshuang Li
J. Funct. Biomater. 2024, 15(6), 137; https://doi.org/10.3390/jfb15060137 - 21 May 2024
Viewed by 457
Abstract
Introduction: With the popularity of clear aligners, the sequential distalization protocol has been more commonly used for molar distalization. However, the amount of molar distalization that can be achieved, as well as the accompanying side effects on the sagittal dimension, are unclear. Methods: [...] Read more.
Introduction: With the popularity of clear aligners, the sequential distalization protocol has been more commonly used for molar distalization. However, the amount of molar distalization that can be achieved, as well as the accompanying side effects on the sagittal dimension, are unclear. Methods: Registered with PROSPERO (CRD42023447211), relevant original studies were screened from seven databases (MEDLINE [PubMed], EBSCOhost, Web of Science, Elsevier [SCOPUS], Cochrane, LILACS [Latin American and Caribbean Health Sciences Literature], and Google Scholar) supplemented by a manual search of the references of the full-reading manuscripts by two investigators independently. A risk of bias assessment was conducted, relevant data were extracted, and meta-analysis was performed using RStudio. Results: After the screening, 13 articles (11 involving maxillary distalization, two involving mandibular distalization) met the inclusion criteria. All studies had a high or medium risk of bias. The meta-analysis revealed that the maxillary first molar (U6) mesiobuccal cusp was distalized 2.07 mm [1.38 mm, 2.77 mm] based on the post-distalization dental model superimposition, and the U6 crown was distalized 2.00 mm [0.77 mm, 3.24 mm] based on the post-treatment lateral cephalometric evaluation. However, the U6 mesiobuccal root showed less distalization of 1.13 mm [−1.34 mm, 3.60 mm], indicating crown distal tipping, which was validated by meta-analysis (U6-PP angle: 2.19° [1.06°, 3.33°]). In addition, intra-arch anchorage loss was observed at the post-distalization time point (U1 protrusion: 0.39 mm [0.27 mm, 0.51 mm]), which was corrected at the post-treatment time point (incisal edge-PTV distance: −1.50 mm [−2.61 mm, −0.39 mm]). Conclusion: About 2 mm maxillary molar distalization can be achieved with the sequential distalization protocol, accompanied by slight molar crown distal tipping. Additional studies on this topic are needed due to the high risk of bias in currently available studies. Full article
(This article belongs to the Special Issue Advanced Materials and Technologies in Orthodontics)
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