Titanium dental implants with various restorative options are popular for replacing missing teeth due to their comfortable fit, excellent stability, natural appearance, and impressive track record in clinical settings. However, challenges such as potential issues with osseointegration, peri-implant bone loss, and peri-implantitis might lead to implant failure, causing concern for patients and dental staff. Surface modification has the potential to significantly enhance the success rate of titanium implants and meet the needs of clinical applications. This involves the application of various physical, chemical, and bioactive coatings, as well as adjustments to implant surface topography, offering significant potential for enhancing implant outcomes in terms of osseointegration and antimicrobial properties. Many surface modification methods have been employed to improve titanium implants, showcasing the diversity of approaches in this field including sandblasting, acid etching, plasma spraying, plasma immersion ion implantation, physical vapor deposition, electrophoretic deposition, electrochemical deposition, anodization, microarc oxidation, laser treatments, sol-gel method, layer-by-layer self-assembly technology, and the adsorption of biomolecules. This article provides a comprehensive overview of the surface modification methods for titanium implants to address issues with insufficient osseointegration and implant-related infections. It encompasses the physical, chemical, and biological aspects of these methods to provide researchers and dental professionals with a robust resource to aid them in their study and practical use of dental implant materials, ensuring they are thoroughly knowledgeable and well-prepared for their endeavors.

OBJECTIVE: This study evaluated the implant stability, volumetric changes, and patient-reported outcome measures (PROMs) of hydroxyapatite (HA) nano-coated sandblasted/acid-etched (SLA) implants compared to uncoated SLA implants.
METHODS: Forty patients were recruited and randomly allocated to HA nano-coated SLA group (test, n = 20) and uncoated SLA group (control, n = 20) using single-blinded/block randomization. Implants were immediately placed in maxillary posterior region using a digital surgical guide. Insertion torque and implant stability quotient (ISQ) were measured at implant surgery and 1, 2, 3, and 4 months postoperatively. Intraoral scans, PROMs and soft tissue inflammation data were collected, and multivariable linear regression analysis of ISQ was performed.
RESULTS: In total, 48 implants (test; n = 24, control; n = 24) in 37 patients (test; n = 19, control; n = 18) were analyzed. Despite no significant between-group difference at surgery, the test group showed higher ISQ values than the control group at 2 (76.53 ± 4.17 vs. 71.32 ± 4.79, p < 0.01), 3 (77.45 ± 4.41 vs. 73.85 ± 4.69, p < 0.05), and 4 months (79.08 ± 2.96 vs. 73.43 ± 3.52, p < 0.0001) postoperatively. There were no significant differences in linear and volumetric changes, PROMs, and soft tissue inflammation analysis between two groups. The ISQ at implant surgery was influenced by age and diabetes mellitus (DM) at the implant level and DM and predicted total bone-to-implant contact area at the patient level.
CONCLUSIONS: HA nano-coated SLA implants promoted favorable immediate implants stability during early osseointegration phase compared to uncoated SLA implants, but displayed similar dimensional changes, PROMs, and soft tissue inflammation outcomes.
BACKGROUND: Clinical Research Information Service (CRIS), KCT0006364. Registered 21 July 2021, https://cris.nih.go.kr/cris/search/detailSearch.do?seq=24221&search_page=L .

Dental implants are one of the most important and successful advancements in modern dentistry. One aspect of dental implant design that influences the rate and degree of osseointegration is implant surface features. Nano-engineering techniques are anticipated to improve titanium dentistry implants\' surface characteristics, which in turn promote peri-implant osteogenesis. In this paper, we review the recent advances in nanosurface engineering techniques for enhancing the bioactivity of dental implants.

UNASSIGNED: Titanium (Ti) and its alloys are widely utilized in endosseous implants. However, their clinical efficacy is marred by complications arising from bacterial infections owing to their inadequate antibacterial properties. Consequently, enhancing the antibacterial attributes of implant surfaces stands as a pivotal objective in the realm of implantable materials research.
UNASSIGNED: In this study, we employed sequential anodization and plasma immersion ion implantation (PIII) technology to fabricate a silver-embedded sparsely titania nanotube array (SNT) on the near-β titanium alloy Ti-5Zr-3Sn-5Mo-15Nb (TLM) implants. The surface characteristics, antimicrobial properties, biocompatibility, and osteogenic activity of the silver-nanomodified SNT implant (SNT Ag) surface, alongside peri-implant inflammatory responses, were meticulously assessed through a combination of in vitro and in vivo analyses.
UNASSIGNED: Compared with polished TLM and SNT, the silver-embedded SNT (SNT Ag) surface retained the basic shape of nanotubes and stably released Ag+ at the ppm level for a long time, which demonstrated an effective inhibition and bactericidal activity against Staphylococcus aureus (SA) while maintaining ideal cytocompatibility. Additionally, the subtle modifications in nanotubular topography induced by silver implantation endowed SNT Ag with enhanced osteogenic activity and mitigated inflammatory capsulation in soft tissue peri-implants in a rat model.
UNASSIGNED: Incorporating a silver-embedded SNT array onto the implant surface demonstrated robust antibacterial properties, impeccable cytocompatibility, exceptional osteogenic activity, and the potential to prevent inflammatory encapsulation around the implant site. The Silver-PIII modification strategy emerges as a highly promising approach for surface applications in endosseous implants and trans-gingival implant abutments.

In the present study, the antimicrobial peptide nisin was successfully conjugated onto the surface of sulfonated polyetheretherketone (SPEEK), which was decorated with graphene oxide (GO) to investigate its biofilm resistance and antibacterial properties. The PEEK was activated with sulfuric acid, resulting in a porous structure. The GO deposition fully covered the porous SPEEK specimen. The nisin conjugation was accomplished using the crosslinker 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) through a dip-coating method. The surface micrographs of the SPEEK-GO-nisin sample indicated that nisin formed discrete islets on the flat GO surface, allowing both the GO and nisin to perform a bactericidal effect. The developed materials were tested for bactericidal efficacy against Staphylococcus aureus (S. aureus). The SPEEK-GO-nisin sample had the highest antibacterial activity with an inhibition zone diameter of 27 mm, which was larger than those of the SPEEK-nisin (19 mm) and SPEEK-GO (10 mm) samples. Conversely, no inhibitory zone was observed for the PEEK and SPEEK samples. The surface micrographs of the bacteria-loaded SPEEK-GO-nisin sample demonstrated no bacterial adhesion and no biofilm formation. The SPEEK-nisin and SPEEK-GO samples showed some bacterial attachment, whereas the pure PEEK and SPEEK samples had abundant bacterial colonies and thick biofilm formation. These results confirmed the good biofilm resistance and antibacterial efficacy of the SPEEK-GO-nisin sample, which is promising for implantable orthopedic applications.

Tissue development deformity or tissue defect is a major clinical challenge. Tissue engineering technology provides a promising solution to these problems. Among them, functional biomaterials with regenerative abilities are one of the development trends. Polypeptide is a small molecule that can be used to modify tissue engineering materials. However, the function of a single polypeptide molecule is limited and insufficient to construct comprehensive microenvironment for tissue regeneration. Fusion peptides combining two or more polypeptide molecules with different functions were expected to achieve multiple efficaciesin vivo, providing a novel solution for clinical tissue regeneration engineering applications. This paper reviews the construction methods, degradation process, and biological activities of fusion peptides, and presents recent global research progress and prospects concerning fusion peptides. It provides a reference helping to guide the future exploration and development of fusion peptide-based functional biomaterials for tissue engineering.

Nanotechnology has become an emerging research field with numerous biomedical scientific applications. Silver possesses bactericidal activities that have been harnessed for centuries; however, there is a concern about the toxic effects of silver nanoparticles. This paper aims to provide an overview of silver-treated dental implants and discuss their potential to reduce the prevalence of peri-implant diseases. An electronic search was performed using PubMed. After screening, data extraction was performed on the 45 remaining articles using inclusion and exclusion criteria. Most of the articles demonstrated that silver nanoparticles embedded in a coating layer and/or on surface-treated titanium exhibit sound antibacterial effects and biocompatibility. Most of the reviewed studies revealed that silver nanoparticles on dental implant surfaces reduced cytotoxicity but provided a prolonged antibacterial effect. The cytotoxicity and antibacterial effect are closely linked to how the silver nanoparticles are released from the titanium surfaces, where a slower release increases cell viability and proliferation. However, to improve the clinical translation, there is still a need for more studies, especially evaluating the long-term systemic effects and studies recreating the conditions in the oral cavity.

Deteriorated bone quality in osteoporosis challenges the success of implants, which are in urgent need for better early osseointegration as well as antibacterial property for long-term stability. As osteoporotic bone formation tangles with angiogenic clues, the relationship between osteogenesis and angiogenesis has been a novel therapy target for osteoporosis. However, few designs of implant coatings take the compromised osteoporotic angiogenic microenvironment into consideration. Here, we investigated the angiogenic effects of bioactive strontium ions of different doses in HUVECs only and in a co-culture system with BMSCs. A proper dose of strontium ions (0.2-1 mM) could enhance the secretion of VEGFA and Ang-1 in HUVECs as well as in the co-culture system with BMSCs, exhibiting potential to create an angiogenic microenvironment in the early stage that would be beneficial to osteogenesis. Based on the dose screening, we fabricated a bioactive titanium surface doped with zinc and different doses of strontium by plasma electrolytic oxidation (PEO), for the establishment of a microenvironment favoring osseointegration for osteoporosis. The dual bioactive elements augmented titanium surfaces induced robust osteogenic differentiation, and enhanced antimicrobial properties. Augmented titanium implant surfaces exhibited improved bone formation and bone-implant contact under comprehensive assessment of an in vivo bone-implant interface. In conclusion, zinc- and strontium-augmented titanium surface benefits the osseointegration in osteoporosis via promoting osteogenic differentiation, exerting antibacterial efficacy, and stimulating early angiogenesis.

BACKGROUND: Many efforts have been made recently to arrange a newer, more hydrophilic and more osteoconductive implant surface. One of the possible options in this matter is modification with hydroxyl ion.
METHODS: Forty implants with the diameters 3.5 and 4.0 mm were inserted as a single missing tooth restoration protocol in the frontal aspect of the maxilla. All implants were loaded early in a 4 week period. Prior to and during the surgery, the following indices were considered: height of keratinized tissue, the thickness of soft tissue, and the initial level of bone tissue. After 12 months, the implant and the tissues in its direct vicinity were evaluated once more with the following indices: marginal bone loss (MBL), height of keratinized tissue (HKT), probing pocket depth (PPD), pink and white aesthetics scores (PES, WES), as well as pain sensations combined with the procedure (VAS). All results were related to the diameter of the implant and thickness of periodontal biotype.
RESULTS: High aesthetic outcomes were reported regardless of soft tissue thickness and implant diameter. The VAS score was higher for the 4.0 implant group, and the thickness of soft tissue had no influence on VAS. In case of implantation in thin or soft tissue, higher MBL levels were reported (0.26 mm), while in case of a thick phenotype, MBL was 0.06 mm.
CONCLUSIONS: Hydrophilic surface implants can be used for a protocol of early functional occlusal loading. The initial thickness of soft tissue does not influence aesthetic outcomes and does not raise pain perception, although it may elevate crestal bone resorption.

Macromers, polymeric molecules with at least two functional groups for cross-polymerization, are interesting materials to tailor mechanical, biochemical and degradative bulk and surface properties of implants for tissue regeneration. In this review we focus on macromers with at least one biodegradable building block. Manifold design options, such as choice of polymeric block(s), optional core molecule and reactive groups, as well as cross-co-polymerization with suitable anchor or linker molecules, allow the adaptation of macromer-based biomaterials towards specific application requirements in both hard and soft tissue regeneration. Implants can be manufactured from macromers using additive manufacturing as well as molding and templating approaches. This review summarizes and discusses the overall concept of biodegradable macromers and recent approaches for macromer processing into implants as well as techniques for surface modification directed towards bone regeneration. These aspects are reviewed including a focus on the authors\' contributions to the field through research within the collaborative research project Transregio 67.