Search Results (62)

Porosity and roughened surfaces of implant materials have been shown to lead to improved cellular attachment and enhanced osseointegration. These topography changes in the surface also aid in the mechanical interlocking of the material to the bone. Polyetheretherketone (PEEK) has emerged as a popular alternative to titanium-based implants due to its lack of stress-shielding effect, radiolucency, and high chemical resistance. However, PEEK is bioinert, thus requiring surface modifications to elicit appropriate cellular responses that lead to successful osteointegration of the material in vivo. Sulfonation is a process used to modify the surface of PEEK, which can be controlled by varying parameters such as soak time and soak temperature, thereby fabricating a porous surface on the material. This work aimed to ensure the repeatability of a previously optimized sulfonated and hydrothermally treated PEEK surface and subsequently observe the mechanical properties, bacterial attachment, and cellular response of pre-osteoblast MC3T3-E1 cells on the surface. This study found that while all PEEK surfaces had similar cell and Staphylococcus aureus attachment, the sulfonated and hydrothermally treated PEEK (peak mean load of 605 N, p ≤ 0.0001) and the sulfonated only PEEK (peak mean load of 495 N, p = 0.0240) had a higher level of performance in expulsion testing than smooth PEEK due to its mechanical interlocking ability. Imaging and contact angle analysis confirm that a surface with repeatable porosity can be achieved. Full article

Implant primary stability is a prerequisite for obtaining osseointegration and clinical success. Insertion torque (IT) is measured during implant placement and is expressed in Ncm. It represents the quantification of the frictional force experienced by the implant as it progresses apically through a rotational motion along its axis. Usually, to achieve osseointegration, a value within the range of 20–40 Ncm is desirable. Below a threshold of 20 Ncm, implants have a decrease in survival rate, while implant stability is guaranteed above 20 Ncm. The main goal of this study was to evaluate whether high values of IT affect osseointegration, implant health, and healing, by highlighting the positive and negative effects of IT > 50 Ncm on peri-implant bone, soft tissues, and long-term stability. This scoping review considered randomized clinical trials, observational studies, and cohort studies. Studies failing to meet the predefined inclusion criteria were excluded from the analysis. The review process adhered to the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines. Ultimately, a total of 11 studies were included in the final synthesis. Based on the studies included, the literature suggests that high values of IT guarantee adequate primary stability and better osseointegration. However, high IT is significantly associated with greater marginal bone loss, depending on bone density. Accordingly, IT values > 50 Ncm may provoke greater compressive forces with a negative impact on the jawbone. An elevated strain on the bone can induce necrosis and ischemia, due to an alteration of circulation, which in turn is responsible for marginal bone loss and reduced osseointegration. Lack of osseointegration ultimately leads to an early implant failure. As concerns soft tissue recession, a higher decrease is measured in implants placed with high-insertion torque. Nonetheless, additional clinical trials are warranted to assess long-term outcomes, quantify the incidence of these complications, and explore the impact of emerging clinical variables. Full article

Objectives: This study aims to investigate the underlying causes of dental implant failure, focusing on implant-related complications and associated risk factors. Understanding these factors will help improve treatment planning and enhance implant success rates. Methods: A retrospective case-control study was conducted using clinical, medical, surgical, and radiographic records of patients who underwent dental implant removal due to complications. Key factors analyzed included patient-related variables (age, gender, medical conditions, periodontal disease), implant-related factors (implant site, implant system, restoration status), and procedural aspects (previous surgical interventions and reasons for implant removal). Results: The findings revealed that implant type (p = 0.004) and type of restoration (p = 0.001) significantly influenced implant survival. Gender (p = 0.001), medical conditions, smoking status (p = 0.004), and restoration status (p = 0.005) were significantly associated with specific failure mechanisms. Lack of osseointegration (36.4%) and absence of primary stability (22.4%) were the predominant causes of implant failure. Prior surgical interventions (p = 0.001) and decisions for re-implantation (p = 0.005) significantly affected implant removal frequency. Conclusions: Implant survival is influenced by multiple factors, with implant type, restoration type, and gender playing key roles in failure outcomes. Patient-specific risk assessment, particularly regarding medical conditions and smoking, meticulous surgical technique, and appropriate prosthetic planning, is vital for improving implant longevity and minimizing failure rates. Full article

Implant-associated infections (IAIs) are major complications in dental and orthopedic implants, potentially compromising osseointegration and eventually causing implant loosening or removal. Thus, early prevention of bacterial adhesion and biofilm formation is critical for successful long-term osseointegration. Polyetheretherketone (PEEK) exhibits excellent physicochemical properties and an elastic modulus similar to bone tissue, making it a promising material for dental and orthopedic implants. However, its inherent lack of antibacterial properties limits its ability to prevent IAIs. Herein, an antibacterial coating with controlled drug release and excellent biocompatibility is designed by immobilizing minocycline (Mino)-doped carboxymethyl chitosan (CMCS) onto the PEEK surface via a polydopamine (PDA)-mediated Michael addition and Schiff base reaction. The coating is characterized by SEM, XPS, water contact angle measurements, and in vitro Mino release assays. Antibacterial activity is evaluated using the zone of inhibition (ZOI), turbidity, and colony counting assays, while biocompatibility is assessed through a SEM analysis of cell morphology and CCK-8 assay. The results show that the Mino-modified coating is successfully fabricated on the PEEK surface, achieving sustained Mino release for up to 14 days. Among the three Mino concentrations, the PEEK-0.5Mino group demonstrates the best balance of antibacterial activity and biocompatibility, highlighting its potential for preventing IAIs in orthopedic and dental applications. Full article

Objective: A peri-implant gap or a “jumping gap” between an implant surface and the buccal bone can often complicate the successful integration of dental implants, impairing osseointegration and long-term implant stability. Although various techniques and materials are available for managing this gap, there is no consensus on the most effective approach. The current literature lacks standardized, evidence-based guidelines for selecting the optimal technique or material for managing peri-implant gaps, especially following immediate implant placement. This systematic review aims to evaluate the efficacy of various techniques and materials to manage the peri-implant gap to improve the implant stability, bone preservation, and esthetic outcomes using the PROSPERO registration number CRD42024508852. Methods: A comprehensive search of the MEDLINE, Embase, and Cochrane databases was conducted, and various studies were selected, including 11 randomized clinical trials that investigated different grafting materials and techniques for managing the gap between the implant and the buccal plate. The selected studies were assessed for the risk of bias, and the data were extracted based on primary outcomes such as implant stability, bone density, and esthetic parameters. Results: The findings indicate that xenografts and alloplastic grafts were superior in preserving bone volume compared to platelet-rich fibrin. Techniques like the socket shield and immediate provisional prothesis methods showed promise in maintaining soft tissue and bone integrity. However, heterogeneity across the studies limits definitive conclusions. Conclusions: Further high-quality research is needed to establish standardized guidelines for peri-implant gap management. The selection of techniques and materials should be tailored to individual patient needs. Full article

In the design of mandibular implants, the application of previous research findings, which highlight the significance of asymmetric occlusal load transfer schemes, is often lacking. The generated identical oblique occlusal force for maximum muscle efficiency may not be the sole criterion for assessing the load-bearing capacity of a mandibular prosthesis. The hypothesis of this study was that the load-bearing capacity of extensive mandibular prostheses is significantly underestimated when assuming mandibular support at the temporomandibular joint on the occlusal side compared to the assumption of perfect osseointegration between the implant and bone. Finite Element Method (FEM) simulation studies were conducted to analyze occlusal load transfer, considering two joint support conditions: support in both temporo-mandibular joints and support in only one joint, opposite the bite side. Additionally, two variants of the implant-bone connection were examined: an optimistic scenario assuming complete osseointegration and a pessimistic scenario assuming no osseointegration, with fixation achieved solely through bone fixation plates. The findings indicated a significant underestimation of the loads transferred by the implant and bone tissue when symmetrical joint support and osseointegration were assumed. Although there is currently no conclusive evidence supporting the complete exclusion of the joint, the computational results demonstrated that, in the absence of precise data regarding the percentage contribution of the joint on the occlusal side, it is preferable to employ more stringent criteria for assessing the load-bearing capacity of mandibular prostheses. This assessment should include the exclusion of joint support on the occlusal side to ensure a more conservative and reliable evaluation of the prosthesis’s mechanical performance. Full article

Nowadays, custom-made subperiosteal implants are emerging as a solution in all those cases where there is lack of healthy bone tissue to support endosseous implants. The development of innovative techniques has allowed the production of grids that precisely match the patient’s anatomy. Elucidating the impact of laser-melted Ti6Al4V grids on both hard and soft tissues with which they come into contact is, therefore, mandatory. In this study, we analyzed the effects of five different surface treatments on a human osteoblast-like cell line (MG-63). In particular, the cell proliferation and osteogenic response were evaluated. Taken together, our data demonstrate that in our in vitro setting, the new surface treatment developed by Al Ti color could enhance osteogenesis and improve the stabilization of the implant to the residual bone by stimulating the best osteogenic response in MG-63 cells. Although further studies are required to validate our data in an in vivo model, our results provide the basis for future advances in implantology for the long-term maintenance of osseointegration. Full article

Autografts, allografts, and synthetic bone substitutes are essential in reconstructive orthopedic surgery. Although autografts and allografts provide excellent skeletal integration, their use is limited by host morbidity and graft acquisition challenges. Synthetic materials like β-tricalcium phosphate (β-TCP) offer promising osseoconductive properties as a potential substitute. This study evaluated the osseointegration of β-TCP ceramic cylinder implants in bone defects in rabbits. Eighteen New Zealand rabbits underwent radial diaphysis ostectomy to create a critical segmental defect and were divided into three groups: Group A received β-TCP blocks, Group B received allogenous cortical bone grafts, and Group C underwent ostectomy without defect filling. Postoperative assessments included clinical evaluations, radiographs, micro-computed tomography, and histology at various time points to assess osseointegration and implant resorption. At the 120th postoperative day, Group B showed successful bone integration without infection. In contrast, Group A showed no osseointegration or resorption of the β-TCP implants, and Group C exhibited bone non-union. While β-TCP demonstrated biocompatibility, it lacked osseoconductivity, likely due to low porosity. β-TCP implants did not promote bone consolidation, suggesting that further research on porosity and shape is needed to improve their suitability for veterinary orthopedic reconstructive surgery. Full article

Advancements in implant design, surface characteristics, and surgical protocols have made implant restorations safe and highly predictable procedures. Bone metabolism plays a central role in the success of implant therapy. Diabetes mellitus is a significant disease impacting bone metabolism, particularly during the initial stages of osseointegration and in long-term survival. Moreover, aging is linked to various systemic conditions, such as diabetes, which increase the susceptibility of the periodontium and teeth to disease, often resulting in tooth loss. Studies on the impact of glycemic control on the success and longevity of implant–prosthetic rehabilitation in diabetic patients highlight a significant association between hyperglycemia and complications in implant therapy. This review identified 18 relevant publications through Medline, and studies were screened against the aim and objectives of the review. A total of five articles were excluded because of lack of focus on the effect of glycemic control on dental implants. Diabetic patients with poorly controlled blood glucose levels may face a heightened risk of developing implant complications. Effective glycemic control plays a critical role in the long-term success of dental implants in these individuals. Marginal bone loss (MBL) is a critical indicator of implant health and success. Clinical studies generally show greater MBL in diabetic patients compared to non-diabetic individuals. Furthermore, controlled type 2 diabetes mellitus (T2DM) has been associated with significantly better maintenance. Full article

Background: Mandibular reconstruction poses challenges in achieving functional and aesthetic outcomes. Effective oral rehabilitation is crucial for restoring function and improving quality of life; however, the altered neomandibular anatomy complicates oral hygiene, increasing the risk of peri-implant complications and making successful rehabilitation more difficult. This study introduces a novel approach combining vestibuloplasty with patient-specific implant-retained splints to enhance oral health and improve rehabilitation outcomes. Methods: Three patients underwent mandibular reconstruction with a free vascularized fibula flap (FFF). After 6 months of osseointegration, vestibuloplasty and soft tissue refinement were performed, with a split-thickness skin graft placed on the FFF periosteum. An implant-retained splint was secured to the abutments for two weeks to support soft tissue healing. Implant survival, bone loss, and peri-implant health were evaluated over a 2-year follow-up. Results: A total of 12 implants were placed, primarily in the neomandible (83.3%), with a 100% survival rate. Implant survival was assessed. Implant survival was assessed based on established criteria for clinical success, including stability, presence of pain, bleeding on probing (BOP), pocketdepth, bone loss and lack of peri-implant radiolucency. Functional outcomes included normal mouth opening, laterotrusion, and protrusion. Pocket depths ranged from 3 to 4 mm, except for one implant in cases 1 and 2. The mean BOP was 51.7%. Conclusions: This case series introduces a surgical technique that combines CAD/CAM and vestibuloplasty to optimize dental rehabilitation in mandibular FFF reconstructions, demonstrating safe thinning of soft tissues for improved oral hygiene and survival. Full article

Background: To prevent excessive compression of the cortical layer, which can lead to marginal bone loss, various companies have introduced specialized drills. However, these drills often lack the necessary precision, as the operator’s hand may neither be stable enough to prevent ovalization and over-widening nor precise enough to maintain coaxial alignment. Therefore, the aim of this study was to develop a device capable of achieving calibrated cortical preparation in terms of both dimension and coaxiality. Methods: A machining technology based on drilling principles was employed to create the device. Results: Nine blades were incorporated between the transmucosal neck and the implant threads, enabling the blades to cut the cortical bone coaxially during the implant insertion process. Conclusions: The primary goal of this study was to develop an implant capable of achieving calibrated cortical bone preparation, ensuring both precise dimensional control and coaxial alignment. This design incorporates integrated blades that allow for controlled cortical decompression, helping to manage radial compressive stresses during implant placement. Although the experimental studies cited were conducted independently of this research, they validate the functional efficacy of this implant design, demonstrating its ability to promote osseointegration and preserve marginal bone. The results suggest that this implant configuration holds the potential for improving clinical outcomes, particularly in cases where bone quality or density poses challenges to implant stability. Full article

Preventing or treating infections at implantation sites where the risk of bacterial contamination is high requires the development of intelligent drug delivery systems. The objective of this work was to develop a production method and characterization of fourth-generation oxide nanotubes on titanium grade 4 surface as a potential drug carrier. This study focused on the anodizing process; physico-chemical characterization using FE-SEM, EDS, and FTIR; in vitro corrosion resistance in an artificial saliva solution; and determining the drug release kinetics of gentamicin sulfate using UV-VIS. The anodizing process was optimized to produce fourth-generation oxide nanotubes in a fluoride-free electrolyte, ensuring rapid growth and lack of order. Results showed that the length of the oxide nanotubes was inversely proportional to the anodizing voltage, with longer nanotubes formed at lower voltages. The nanotubes were shown to have a honeycomb structure with silver particles co-deposited on the surface for antibacterial properties and were capable of carrying and releasing the antibiotic gentamicin sulfate in a controlled manner, following Fick’s first law of diffusion. The corrosion resistance study demonstrates that the oxide nanotubes enhance the corrosion resistance of the titanium surface. The oxide nanotubes show promise in enhancing osseointegration and reducing post-implantation complications. Full article

Orthodontic miniscrews (MSs) are used for enhancing orthodontic anchorage either by supporting the teeth of the reactive unit or by obviating the need for the reactive unit altogether. Despite MSs’ popularity, their clinical application is not lacking in complications. The limited space of the insertion site (inter-radicular space), temporary use (limiting osseointegration) and the necessity to minimize the biological cost of insertion (bone incision) required the size of this auxiliary to be reduced, making it susceptible to mechanical failure. This review aimed to investigate factors influencing MS plastic deformation and fracture. The search applied five engines: PubMed, PMC, Web of Science, Scopus, Embase, and Ebsco. Quality assessment was performed according to the QUIN tool. After a thorough search process, 22 articles were included in this review. The most important factor influencing miniscrews’ plastic deformation and fracture was the screw diameter. The MS length and metal alloy did not influence its plastic deformation or fracture. The cylindrical design of the screw is preferable. If the cortical bone thickness in the insertion site exceeds 3 mm, pre-drilling upon insertion is recommended. Orthodontic MSs should not be reused. There is a need for high-quality clinical studies on the subject of MS deformation and fracture. The PROSPERO number is CRD42024509895. Full article

Background: With the growing use of dental implants, there is an urgent need to determine a prosthetic placement protocol by assessing implant stability and monitoring healing. Implant Stability Quotient (ISQ) values are produced using dental non-invasive devices through resonance frequency analysis, considered as indicators for measuring primary stability (i.e., at implant placement), monitoring biological stability (osseointegration), and prosthetic loading. A systematic and detailed comparison of ISQ measurement devices, for a given patient population, is lacking in the literature. This aspect is the subject of the present work, with the devices being two that are widely used in clinical practice (Osstell^® and Osseo^®100). The aim of this study was to evaluate the reliability of ISQ measurement using two standard devices most commonly used in clinical practice and to highlight any differences when comparing measurements at undefined time intervals. Methods: We enrolled 50 patients (16 males and 34 females) with a mean age of 55.4 years, who indicated dental implant placement and met the inclusion criteria. The sample was divided into two equal groups based on bone density: A (D1–D2 bone density) and B (D3–D4 bone density); each had 25 patients with 40 implants. ISQ was measured using two devices: Osstell^® and Osseo 100^®, at different time points (A: three and B: four follow-ups). Results: All enrolled patients completed the study without adverse events; all implants placed were successful, with no implant failure. In each of the study groups, ISQ values increased gradually with increasing follow-up time, and there was no significant difference between Osstell and Osseo 100 values at follow-up times except for the T1 follow-up in group A. Temporal comparisons for the two devices revealed significant differences in T0 vs. T2 in group A, whereas significant differences existed in T0 vs. T1, T2, and T3 in group B. Our findings indicated that the overall effect significantly depended on bone density rather than on the device used to measure ISQ. Conclusion: Regardless of the devices used, the ISQ measurement effectively monitors healing after implant insertion and allows prosthetic load to be modulated according to the ISQ value, especially when prosthetizing implants placed in fine trabecular bone (D4 or regenerated bone). Full article

The occurrence of bone diseases has been increasing rapidly, in line with the aging population. A representative spinal fusion material, polyetheretherketone (PEEK), is advantageous in this regard as it can work in close proximity to the elastic modulus of cancellous bone. However, if it is used without surface modification, the initial osseointegration will be low due to lack of bioactivity, resulting in limitations in surgical treatment. In this study, we aimed to modify the surface of PEEK cages to a hydrophilic surface by coating with polyethylene glycol (PEG), hyaluronic acid (HA), and polydopamine (PDA), and to analyze whether the coated surface exhibits improved bioactivity and changes in mechanical properties for orthopedic applications. Material properties of coated samples were characterized and compared with various PEEK groups, including PEEK, PEEK-PEG, PEEK-HA, and PEEK-PDA. In an in vitro study, cell proliferation was found to be enhanced on PDA-coated PEEK; it was approximately twice as high compared to the control group. In addition, mechanical properties, including static and torsion, were not affected by the presence of the coating. Thus, the results suggest that PEEK-PDA may have the potential for clinical application in fusion surgery for spinal diseases, as it may improve the rate of osseointegration. Full article