种植牙治疗,近三十年前,随着微型钛表面的出现,被确立为护理标准,通过增强骨整合彻底改变了临床结果。然而,尽管取得了如此关键的进步,挑战依然存在,包括延长的愈合时间,限制性临床适应症,稳定的成功率,和种植体周围炎的显著发病率。这篇综述探讨了微表面的生物学优点和局限性,并评估了纳米特征牙种植体表面的现状,旨在阐明解决植入治疗中现有障碍的策略。目前可用的纳米特征牙科植入物将纳米结构结合到其前身的微粗糙表面上。虽然纳米特征整合到微粗糙表面显示出增强早期骨整合的潜力,在骨整合能力方面,它没有超过其前辈。这种差异可能是由于,在某种程度上,成骨细胞固有的“二分法动力学”,其中通过纳米特征增加的表面粗糙度增强成骨细胞分化,但同时阻碍细胞附着和增殖。我们还展示了一个可控的,混合微纳米钛模型表面,并将其与市售纳米特征表面进行对比。与商业纳米特征表面不同,可控微纳米杂化表面具有增强细胞分化和增殖的优势。因此,目前的纳米特征牙种植体代表了从传统的微型种植体进化的一步,然而,他们目前缺乏克服现有限制的变革能力。进一步的研究和开发努力必须设计根植于基础科学的优化表面,从而推动该领域的技术进步。
Dental implant therapy, established as standard-of-care nearly three decades ago with the advent of microrough titanium surfaces, revolutionized clinical outcomes through enhanced
osseointegration. However, despite this pivotal advancement, challenges persist, including prolonged healing times, restricted clinical indications, plateauing success rates, and a notable incidence of peri-implantitis. This review explores the biological merits and constraints of microrough surfaces and evaluates the current landscape of nanofeatured dental implant surfaces, aiming to illuminate strategies for addressing existing impediments in implant therapy. Currently available nanofeatured dental implants incorporated nano-structures onto their predecessor microrough surfaces. While nanofeature integration into microrough surfaces demonstrates potential for enhancing early-stage
osseointegration, it falls short of surpassing its predecessors in terms of
osseointegration capacity. This discrepancy may be attributed, in part, to the inherent \"dichotomy kinetics\" of osteoblasts, wherein increased surface roughness by nanofeatures enhances osteoblast differentiation but concomitantly impedes cell attachment and proliferation. We also showcase a controllable, hybrid micro-nano titanium model surface and contrast it with commercially-available nanofeatured surfaces. Unlike the commercial nanofeatured surfaces, the controllable micro-nano hybrid surface exhibits superior potential for enhancing both cell differentiation and proliferation. Hence, present nanofeatured dental implants represent an evolutionary step from conventional microrough implants, yet they presently lack transformative capacity to surmount existing limitations. Further research and development endeavors are imperative to devise optimized surfaces rooted in fundamental science, thereby propelling technological progress in the field.