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Special Issue "Advanced Biomaterials and Oral Implantology"

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A special issue of Journal of Functional Biomaterials (ISSN 2079-4983). This special issue belongs to the section "Dental Biomaterials".

Deadline for manuscript submissions: 20 September 2023 | Viewed by 8109

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Special Issue Editors

Dr. Dominik Kraus

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Guest Editor

Department of Prosthodontics, Preclinical Education and Dental Materials Science, University of Bonn, Bonn, Germany
Interests: oral rehabilitation; biomaterials; periodontitis; implant dentistry

Prof. Dr. Norbert Enkling

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Guest Editor

1. Department of Prosthodontics, Preclinical Education and Dental Materials Science, University of Bonn, Bonn, Germany
2. Department of Reconstructive Dentistry and Gerodontology, Division of Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
Interests: oral rehabilitation; implant dentistry; oral function; oral surgery

Special Issue Information

Dear Colleagues,

The development of oral biomaterials has come a long way since Brånemark introduced titanium dental implants and since the concept of biocompatibility first emerged. As for today, a repertoire of customized biomaterials meet the demands of millions of patients worldwide in the realms of both prosthetics and regenerative tissue engineering. Dental implantology as well as alloplastic bone reconstruction rely on a variety of substrate materials along with different designs on the macro level and sophisticated and fine-tuned surface modifications or biochemical functionalizations to meet the requirements of their specific field of application. In many cases, there are no satisfactory alternatives to biomaterial-based oral implants that can produce the same level of long-term functionality.

However, oral implants perform in a complex environment that—besides mechanical stability and esthetics—involves the biological interaction with hard- and soft tissues, the immune system and the oral microbiome. While progress has been made in the fields of material sciences, surface biofunctionalization, manufacturing processes and the medical understanding of the involved processes in recent years, a considerable portion of oral implants still exhibit impaired (bone and periodontal) healing or fail in the long run, either due to mechanic failure, deficient tissue integration or peri-implant diseases.

This Special Issue, entitled “Advanced Biomaterials and Oral Implantation”, aims to introduce studies that reflect the progress in nanobiomaterials, polymers, drug release and surface functionalization but certainly also includes the hot topics within the clinical workflow such as immediate implant placement, immediate restoration and the digital workflow.

The main topics of this Special Issue include, but are not limited to, the following:

Advances in substrate materials, e.g., metal, bioceramics, polymer, composite;
Macro-/micro implant-surface modifications;
Surface functionalization (e.g., drug release, hormones, immobilized antibacterial agents, antimicrobial peptides);
Degradable and non-degradable alloplastic bone substitute biomaterials (biomaterial scaffolds, oral tissue engineering and bone regeneration);
Loaded bioscaffolds (and implant regenerative medicine / in bone reconstruction/regeneration);
Individualized/customized implant fabrication/reconstruction (CAD/CAM) including 3D printing;
Clinical workflow: immediate implant placement; immediate loading/restoration; digital workflow; bone management.

Dr. Dominik Kraus
Prof. Dr. Norbert Enkling
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Functional Biomaterials is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

oral implants
implant surface modifications
suface functionalization
biomaterials
clinical workflow
bone regeneration
soft tissue integration

Published Papers (9 papers)

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Open AccessArticle

AFM Analysis of a Three-Point Flexure Tested, 3D Printing Definitive Restoration Material for Dentistry

Maximilian N. Sandmair

Christoph Kleber

Dragan A. Ströbele

and

Constantin von See

J. Funct. Biomater. 2023, 14(3), 152; https://doi.org/10.3390/jfb14030152 - 10 Mar 2023

Viewed by 616

Abstract

Background: Three-dimensional printing is a rapidly developing technology across all industries. In medicine recent developments include 3D bioprinting, personalized medication and custom prosthetics and implants. To ensure safety and long-term usability in a clinical setting, it is essential to understand material specific properties. This study aims to analyze possible surface changes of a commercially available and approved DLP 3D printed definitive restoration material for dentistry after three-point flexure testing. Furthermore, this study explores whether Atomic Force Microscopy (AFM) is a feasible method for examination of 3D printed dental materials in general. This is a pilot study, as there are currently no studies that analyze 3D printed dental materials using an AFM. Methods: The present study consisted of a pretest followed by the main test. The resulting break force of the preliminary test was used to determine the force used in the main test. The main test consisted of atomic force microscopy (AFM) surface analysis of the test specimen followed by a three-point flexure procedure. After bending, the same specimen was analyzed with the AFM again, to observe possible surface changes. Results: The mean root mean square (RMS) roughness of the segments with the most stress was 20.27 nm (±5.16) before bending, while it was 26.48 nm (±6.67) afterward. The corresponding mean roughness (Ra) values were 16.05 nm (±4.25) and 21.19 nm (±5.71) Conclusions: Under three-point flexure testing, the surface roughness increased significantly. The p-value for RMS roughness was p = 0.003, while it was p = 0.006 for Ra. Furthermore, this study showed that AFM surface analysis is a suitable procedure to investigate surface changes in 3D printed dental materials. Full article

(This article belongs to the Special Issue Advanced Biomaterials and Oral Implantology)

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Open AccessArticle

Effect of Implantoplasty on Roughness, Fatigue and Corrosion Behavior of Narrow Diameter Dental Implants

Octavi Camps-Font

Jorge Toledano-Serrabona

Ana Juiz-Camps

Javier Gil

Maria Angeles Sánchez-Garcés

Rui Figueiredo

Cosme Gay-Escoda

and

Eduard Valmaseda-Castellón

J. Funct. Biomater. 2023, 14(2), 61; https://doi.org/10.3390/jfb14020061 - 21 Jan 2023

Viewed by 956

Abstract

Implantoplasty (IP) is used in dental implants with peri-implantitis and aims to remove threads and polish rough surfaces in order to prevent bacterial colonization. As a result of this procedure, implant strength might be compromised. We tested 20 tapered screw-shaped Ti6Al4V dental implants with a simulated bone loss of 50%. Ten implants underwent IP and 10 served as controls. Surface topography (S_a, S_z, S_sk, and S_dr) was analyzed with a confocal optical microscope. Subsequently, a minimum of four series of cyclic loads were applied with a servo-hydraulic mechanical testing machine (5 × 10⁶ cycles at 15 Hz, between a maximal nominal value–starting at 529 N in the IP group and 735 N in the control group–and 10% of that force). We recorded the number of cycles until failure and the type of failure. Implant failure was analyzed by visual inspection and scanning electron microscopy. Open circuit potential and potenctiodynamic tests were carried out with high precision potentiostat using Hank’s solution at 37 °C to evaluate the effect of the implantoplasty on the corrosion resistance. Implantoplasty significantly reduced the surface topography values (median) and interquartile range (IQR); S_a from 1.76 (IQR = 0.11) to 0.49 (IQR = 0.16), S_z from 20.98 (IQR = 8.14) to 8.19 (IQR = 4.16), S_sk from 0.01 (IQR = 0.34) to −0.74 (IQR = 0.53) and S_dr from 18.20 (IQR = 2.26) to 2.67 (IQR = 0.87). The fatigue limits of the control and implantoplasty groups were 551 N and 529 N, respectively. The scanning electron micrographs showed fatigue striations indicating fatigue failure. Besides, the fractographic analysis revealed a typical brittle intergranular fracture mechanism. The infinite life range of the dental implants evaluated was largely above the threshold of usual chewing forces. Implantoplasty seems to render a fairly smooth surface and has a limited impact on fatigue resistance. In addition, implantoplasty produces a decrease in the corrosion resistance of the implant. Corrosion current density from 0.019 μA/cm² for as-received to 0.069 μA/cm² in the interface smooth-roughened dental implant. These places between the machining and the rough area of the implant are the most susceptible, with the appearance of pitting. Full article

(This article belongs to the Special Issue Advanced Biomaterials and Oral Implantology)

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Open AccessArticle

One-Piece Zirconia Oral Implants for Single Tooth Replacement: Five-Year Results from a Prospective Cohort Study

Ralf-Joachim Kohal

Felix Burkhardt

Jerome Chevalier

Sebastian Berthold Maximilian Patzelt

and

Frank Butz

J. Funct. Biomater. 2023, 14(2), 116; https://doi.org/10.3390/jfb14020116 - 19 Feb 2023

Viewed by 937

Abstract

The intention of this 5-year prospective cohort investigation was to clinically and radiographically investigate the outcomes of a one-piece zirconia implant system for single tooth replacement. Sixty-five patients received a total of 66 single-tooth implants. All implants immediately received temporary restorations and were finally restored with all-ceramic crowns. Follow-ups were performed at the prosthetic delivery, after 1, 3, and 5 years. Peri-implant and dental soft-tissue parameters were evaluated and patient-reported outcomes recorded. To monitor peri-implant bone remodelling, standardised radiographs were taken at the implant insertion and at the 1-, 3-, and 5-year follow-ups. In the course of 5 years, 14 implants were lost, resulting in a cumulative implant survival rate of 78.2%. The mean marginal bone loss from the implant insertion to the 5-year follow-up amounted to 1.12 mm. Probing depth, clinical attachment level, bleeding, and plaque index increased over time. In 91.5% of the implants, the papilla index showed levels of 1 or 2, respectively. At the end of the study, the patient satisfaction was higher compared to the pre-treatment measurements. Due to the low survival rate after five years and the noticeably high frequency of advanced bone loss observed in this study, the implant has not met the launch criteria, as it would have not been recommended for routine clinical use. Full article

(This article belongs to the Special Issue Advanced Biomaterials and Oral Implantology)

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Open AccessEditor’s ChoiceArticle

Effects of Different Titanium Surface Treatments on Adhesion, Proliferation and Differentiation of Bone Cells: An In Vitro Study

and

J. Funct. Biomater. 2022, 13(3), 143; https://doi.org/10.3390/jfb13030143 - 05 Sep 2022

Viewed by 1360

Abstract

The objective of this study was to evaluate the impacts of different sandblasting procedures in acid etching of Ti6Al4V surfaces on osteoblast cell behavior, regarding various physicochemical and topographical parameters. Furthermore, differences in osteoblast cell behavior between cpTi and Ti6Al4V SA surfaces were evaluated. Sandblasting and subsequent acid etching of cpTi and Ti6Al4V discs was performed with Al₂O₃ grains of different sizes and with varying blasting pressures. The micro- and nano-roughness of the experimental SA surfaces were analyzed via confocal, atomic force and scanning electron microscopy. Surface free energy and friction coefficients were determined. hFOB 1.19 cells were seeded to evaluate adhesion, proliferation and osteoblastic differentiation for up to 12 d via crystal violet assays, MTT assays, ALP activity assays and Alizarin Red staining assays. Differences in blasting procedures had significant impacts on surface macro- and micro-topography. The crystal violet assay revealed a significant inverse relationship between blasting grain size and hFOB cell growth after 7 days. This trend was also visible in the Alizarin Red assays staining after 12 d: there was significantly higher biomineralization visible in the group that was sandblasted with smaller grains (F180) when compared to standard-grain-size groups (F70). SA samples treated with reduced blasting pressure exhibited lower hFOB adhesion and growth capabilities at initial (2 h) and later time points for up to 7 days, when compared to the standard SA surface, even though micro-roughness and other relevant surface parameters were similar. Overall, etched-only surfaces consistently exhibited equivalent or higher adhesion, proliferation and differentiation capabilities when compared to all other sandblasted and etched surfaces. No differences were found between cpTi and Ti6Al4V SA surfaces. Subtle modifications in the blasting protocol for Ti6Al4V SA surfaces significantly affect the proliferative and differentiation behavior of human osteoblasts. Surface roughness parameters are not sufficient to predict osteoblast behavior on etched Ti6Al4V surfaces. Full article

(This article belongs to the Special Issue Advanced Biomaterials and Oral Implantology)

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Open AccessArticle

Outcomes and Complications of 33 Soft-Milled Cobalt-Chromium-Ceramic Full-Arch Screw-Retained Implant-Supported Prostheses: A Retrospective Study with up to 10-Year Follow-Up

and

J. Funct. Biomater. 2023, 14(3), 157; https://doi.org/10.3390/jfb14030157 - 16 Mar 2023

Viewed by 553

Abstract

This retrospective study assessed outcomes and complications related to implants and prostheses in edentulous patients treated with soft-milled cobalt-chromium-ceramic full-arch screw-retained implant-supported prostheses (SCCSIPs). After the final prosthesis was delivered, patients participated in an annual dental check-up program, including clinical and radiographic assessments. Outcomes of implants and prostheses were evaluated, and biological and technical complications were categorized as major or minor. Implant and prosthesis cumulative survival rates were assessed using the life table analysis. A total of twenty-five participants (mean age 63.6 ± 7.3 years) with 33 SCCSIPs were observed for a mean of 68.9 ± 27.9 months (range 1–10 years). A total of 7 out of 245 implants were lost, with no effect on prosthesis survival, leading to cumulative survival rates of 97.1% for implants and 100% for prostheses. The most recurrent minor and major biological complications were soft tissue recession (9%) and late implant failure (2.8%). Among 25 technical complications, porcelain fracture was the only major technical complication, requiring prosthesis removal (1%). Porcelain chipping was the most frequent minor technical complication, affecting 21 crowns (5.4%), which required polishing only. At the end of the follow-up, 69.7% of the prostheses were free of technical complications. Within the limitations of this study, SCCSIP showed promising clinical performance after 1–10 years. Full article

(This article belongs to the Special Issue Advanced Biomaterials and Oral Implantology)

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Open AccessArticle

Marginal Bone Level and Biomechanical Behavior of Titanium-Indexed Abutment Base of Conical Connection Used for Single Ceramic Crowns on Morse-Taper Implant: A Clinical Retrospective Study

Sergio Alexandre Gehrke

Antonio Scarano

Guillermo Castro Cortellari

Gustavo Vicentis Oliveira Fernandes

Alfredo Mikail Melo Mesquita

and

Marco Aurélio Bianchini

J. Funct. Biomater. 2023, 14(3), 128; https://doi.org/10.3390/jfb14030128 - 26 Feb 2023

Cited by 1 | Viewed by 1002

Abstract

The goal of this retrospective clinical study was to evaluate the behavior of Morse-taper indexed abutments by analyzing the marginal bone level (MBL) after at least 12 months of function. Patients rehabilitated with single ceramic crowns between May 2015 and December 2020 received single Morse-taper connection implants (DuoCone implant) with two-piece straight abutment baseT used for at least 12 months, presenting periapical radiograph immediately after crown installation were enrolled. The position of the rehabilitated tooth and arch (maxilla or mandible), crown installation period, implant dimensions, abutment transmucosal height, installation site (immediate implant placement or healed area), associated with bone regeneration, immediate provisionalization, and complications after installation of the final crown were analyzed. The initial and final MBL was evaluated by comparing the initial and final X-rays. The level of significance was α = 0.05. Seventy-five patients (49 women and 26 men) enrolled had a mean period of evaluation of 22.7 ± 6.2 months. Thirty-one implant-abutment (IA) sets had between 12–18 months, 34 between 19–24 months, and 44 between 25–33 months. Only one patient failed due to an abutment fracture after 25 months of function. Fifty-eight implants were placed in the maxilla (53.2%) and 51 in the mandible (46.8%). Seventy-four implants were installed in healed sites (67.9%), and 35 were in fresh socket sites (32.1%). Thirty-two out of these 35 implants placed in fresh sockets had the gap filled with bone graft particles. Twenty-six implants received immediate provisionalization. The average MBL was −0.67 ± 0.65 mm in mesial and −0.70 ± 0.63 mm in distal (p = 0.5072). The most important finding was the statistically significant difference comparing the values obtained for MBL between the abutments with different transmucosal height portions, which were better for abutments with heights greater than 2.5 mm. Regarding the abutments’ diameter, 58 had 3.5 mm (53.2%) and 51 had 4.5 mm (46.8%). There was no statistical difference between them, with the following means and standard deviation, respectively, −0.57 ± 0.53 mm (mesial) and −0.66 ± 0.50 mm (distal), and −0.78 ± 0.75 mm (mesial) and −0.746 ± 0.76 mm (distal). Regarding the implant dimensions, 24 implants were 3.5 mm (22%), and 85 implants (78%) had 4.0 mm. In length, 51 implants had 9 mm (46.8%), 25 had 11 mm (22.9%), and 33 implants were 13 mm (30.3%). There was no statistical difference between the abutment diameters (p > 0.05). Within the limitations of this study, it was possible to conclude that better behavior and lesser marginal bone loss were observed when using abutment heights greater than 2.5 mm of transmucosal portion and when placed implants with 13 mm length. Furthermore, this type of abutment showed a little incidence of failures within the period analyzed in our study. Full article

(This article belongs to the Special Issue Advanced Biomaterials and Oral Implantology)

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Open AccessArticle

Long-Term Stability of Hydrothermally Aged and/or Dynamically Loaded One-Piece Diameter Reduced Zirconia Oral Implants

Ralf-Joachim Kohal

Anja Trinkner

Felix Burkhardt

Sebastian Berthold Maximilian Patzelt

and

J. Funct. Biomater. 2023, 14(3), 123; https://doi.org/10.3390/jfb14030123 - 24 Feb 2023

Viewed by 538

Abstract

The aim of this in vitro study was to evaluate the long-term stability of one-piece diameter reduced zirconia oral implants under the influence of loading and artificial aging in a chewing simulator as well as the fracture load in a static loading test. Thirty-two one-piece zirconia implants with a diameter of 3.6 mm were embedded according to the ISO 14801:2016 standard. The implants were divided into four groups of eight implants. The implants of group DLHT were dynamically loaded (DL) in a chewing simulator for 10⁷ cycles with a load of 98 N and simultaneously hydrothermally aged (HT) using a hot water bath at 85 °C. Group DL was only subjected to dynamic loading and group HT was exclusively subjected to hydrothermal aging. Group 0 acted as a control group: no dynamical loading, no hydrothermal ageing. After exposure to the chewing simulator, the implants were statically loaded to fracture in a universal testing machine. To evaluate group differences in the fracture load and bending moments, a one-way ANOVA with Bonferroni correction for multiple testing was performed. The level of significance was set to p < 0.05. In the static loading test, group DLHT showed a mean fracture load of 511 N, group DL of 569 N, group HT of 588 N and control group 0 of 516 N. The average bending moments had the following values: DLHT: 283.5 Ncm; DL: 313.7 Ncm; HT: 324.4 Ncm; 0: 284.5 Ncm. No significant differences could be found between the groups. Hydrothermal aging and/or dynamic loading had no significant effect on the stability of the one-piece diameter reduced zirconia implants (p > 0.05). Within the limits of this investigation, it can be concluded that dynamic loading, hydrothermal aging and the combination of loading and aging did not negatively influence the fracture load of the implant system. The artificial chewing results and the fracture load values indicate that the investigated implant system seems to be able to resist physiological chewing forces also over a long service period. Full article

(This article belongs to the Special Issue Advanced Biomaterials and Oral Implantology)

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Open AccessArticle

Assessing the Cleanliness of Dental Implants Using Scanning Electron Microscopy and Energy-Dispersive X-ray Spectroscopy Analysis—A SEM and EDS In Vitro Study

Tarek Mtanis

Ameer Biadsee

and

Zeev Ormianer

J. Funct. Biomater. 2023, 14(3), 172; https://doi.org/10.3390/jfb14030172 - 22 Mar 2023

Viewed by 526

Abstract

A wide variety of titanium (Ti) alloy dental implant systems are available and as a result, choosing the correct system has become a challenge. Cleanliness of the dental implant surface affects osseointegration but surface cleanliness may be jeopardized during manufacturing. The purpose of this study was to assess the cleanliness of three implant systems. Fifteen implants per system were examined with scanning electron microscopy to identify and count foreign particles. Particle chemical composition analysis was performed with energy-dispersive X-ray spectroscopy. Particles were categorized according to size and location. Particles on the outer and inner threads were quantitatively compared. A second scan was performed after exposing the implants to room air for 10 min. Carbon, among other elements, was found on the surface of all implant groups. Zimmer Biomet dental implants had higher particle numbers than other brands. Cortex and Keystone dental implants showed similar distribution patterns. The outer surface had higher particle numbers. Cortex dental implants were the cleanest. The change in particle numbers after exposure was not significant (p > 0.05). Conclusion: Most of the implants studied were contaminated. Particle distribution patterns vary with the manufacturer. The wider and outer areas of the implant have a higher probability of contamination. Full article

(This article belongs to the Special Issue Advanced Biomaterials and Oral Implantology)

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Open AccessArticle

One-Piece Zirconia Oral Implants for the Support of Three-Unit Fixed Dental Prostheses: Three-Year Results from a Prospective Case Series

Ralf-Joachim Kohal

Kirstin Vach

Frank Butz

Benedikt Christopher Spies

Sebastian Berthold Maximilian Patzelt

and

Felix Burkhardt

J. Funct. Biomater. 2023, 14(1), 45; https://doi.org/10.3390/jfb14010045 - 13 Jan 2023

Viewed by 995

Abstract

The objective was to investigate the clinical and radiological outcome of one-piece zirconia oral implants to support three-unit fixed dental prostheses (FDP) after three years in function. Twenty-seven patients were treated with a total of 54 implants in a one-stage surgery and immediate provisionalization. Standardized radiographs were taken at implant placement, after one year and after three years, to evaluate peri-implant bone loss. Soft-tissue parameters were also assessed. Linear mixed regression models as well as Wilcoxon Signed Rank tests were used for analyzing differences between groups and time points (p < 0.05). At the three-year evaluation, one implant was lost, resulting in a cumulative survival rate of 98.1%. The mean marginal bone loss amounted to 2.16 mm. An implant success grade I of 52% (bone loss of ≤2 mm) and success grade II of 61% (bone loss of ≤3 mm) were achieved. None of the evaluated baseline parameters affected bone loss. The survival rate of the zirconia implants was comparable to market-available titanium implants. However, an increased marginal bone loss was observed with a high peri-implantitis incidence and a resulting low implant success rate. Full article

(This article belongs to the Special Issue Advanced Biomaterials and Oral Implantology)

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