Peri-implantitis, a biofilm-associated inflammatory disease, significantly threatens dental implant longevity. Current treatments face limitations due to biofilm robustness. This study evaluates the efficacy of antimicrobial-releasing titanium-silica (Ti/SiO2) composite implant systems against multispecies oral biofilms, aiming to advance innovative localized and targeted peri-implantitis prevention and management strategies.
Ti/SiO2 inserts were engineered with macroporous Ti6Al4V discs produced by additive manufacturing (AM) and a sol–gel-derived mesoporous SiO2 barrier for controlled antimicrobial release across the discs. Chlorhexidine (CHX), as the gold standard antimicrobial agent in dental practice, was tested for its release efficacy using either a laboratory-prepared chlorhexidine diacetate solution (CHX-DA) or the commercial formulation Corsodyl. Phosphate-buffered saline (PBS) and Brain Heart Infusion-2 (BHI-2) medium served as control solutions. After establishing the CHX-DA release profile, multispecies biofilms were grown on the inserts. The antimicrobial efficacy of the release systems was assessed via viability-qPCR, scanning electron microscopy (SEM), and metabolic acid profiling. All experiments were conducted four times.
A mean pore diameter of 5.6 nm was observed for the discs, resulting in a steady drug release rate (≈0.00077 mmol/L CHX-DA/day). The antimicrobial-fed inserts showed less biofilm formation, with ≥ 2 log10 reductions in viable bacteria compared to controls. CHX-DA and Corsodyl showed effective suppression of pathogenic bacteria and reductions in metabolic acid production. SEM analysis revealed morphological changes in bacterial cells on treated surfaces.
Antimicrobial-releasing Ti/SiO2 implant discs demonstrated sustained efficacy in biofilm prevention and treatment, indicating their feasibility as a future strategy for peri-implantitis management.
This study investigated the effects of controlled in vivo repetitive mechanical loading on peri-implant tissue quantity and quality in a bisphosphonate (BP)-treated osteoporosis-like rat model.
At 3 months post-ovariectomy, Wistar rats were randomly assigned to receive either alendronate (ALN) or saline. Bilateral maxillary first molars were extracted at 9 weeks old, and Grade IV titanium implants were placed in healed alveolar ridges 4 weeks after starting treatment. Four weeks postimplantation, sites were randomly assigned to test (Load) or control (Non-load) groups. The Load group received controlled mechanical loading (10 N, 3 Hz, 1800 cycles, 2 days/week) via implants for 2 weeks. Peri-implant bone quantity and quality parameters were assessed, including micro-computed tomography (microCT)-derived morphometry, bone-related cell distribution, collagen composition and alignment, and sclerostin expression.
BRONJ stage 0-like lesions, characterized by necrotic bone with epithelium coverage, were observed in all ALN-treated maxillae. Despite comparable epithelial and microCT morphometry (p > 0.05), the Load group demonstrated significantly improved bone quality around implants, with reduced necrotic bone, higher osteocyte density, fewer osteoclasts and TRAP-positive mononuclear cells at the crestal site (p < 0.05), and greater deposition of well-aligned type I collagen (p < 0.05). Conversely, the Non-load group exhibited substantially larger necrotic areas, increased empty lacunae, reduced osteocyte density, increased sclerostin expression, and more disorganized type III collagen (p < 0.05).
This study is the first to demonstrate that implant loading alleviates BRONJ stage 0-like lesions by enhancing peri-implant bone quality. Mechanical loading promotes peri-implant bone health through cellular adaptation and extracellular matrix remodeling, even under BP-treated osteoporotic-like conditions.
To compare the clinical performance of two sandblasted, large-grit, acid-etched implant surfaces regarding changes in radiographic marginal bone level (MBL) 12 months after loading.
In this randomized, split-mouth, dual-center clinical trial, each patient received one test (modified hydrophilic surface) implant and one control (conventional surface) implant. The primary endpoint was the change in MBL measured 12 months after loading. Secondary outcomes included the assessment of soft tissue wound healing index (WHI), adverse events, implant stability quotient (ISQ), peri-implant soft tissue parameters (probing pocket depth, bleeding on probing, keratinized mucosa width), and oral health–related quality of life (OHRQoL) measured with the Oral Health Impact Profile-14 (OHIP-14). Generalized linear models, paired Student's t-tests, and Wilcoxon tests were employed for data analysis.
The study included 68 subjects (136 implants). No statistically significant differences were found between groups for any of the clinical outcomes measured. The mean change in MBL from loading to 12 months was 0.04 mm (SD = 0.39) for the modified hydrophilic implants and 0.07 mm (SD = 0.22) for the conventional implants (p = 0.658), with no significant differences between the groups.
Over a 12-month period of functional loading, both implant surfaces demonstrated comparable performance regarding peri-implant bone stability, safety, and clinical outcomes. Although a small but statistically significant difference between groups was observed in MBL changes from baseline to 12 months (MD = 0.15 mm), no significant differences were found in MBL changes from loading to 12 months (primary outcome), ISQ, soft tissue healing, or peri-implant health.
The study aims to investigate the effect of using the collagen membrane with symphyseal onlay blocks for horizontal augmentation of atrophic maxillary alveolar ridges versus uncovered symphyseal onlay blocks.
30 patients were randomly and equally allocated into test and control groups. The cortical block was fixed, and an equal mixture of xenograft and autograft particulates was placed to obliterate the gaps. Collagen membranes were used to cover the augmented sites in the test group, whereas they were not used in the control group. Bone thickness was measured at 2 and 5 mm from the crest at 6 months postoperative; bone biopsies were harvested for histomorphometric analysis.
The mean horizontal bone gain for the test group at 2 and 5 mm (5.18 ± 0.87 and 5.51 ± 0.83 mm, respectively) was significantly higher than the control group (4.05 ± 0.50 and 4.60 ± 0.69 mm, respectively). The mean graft resorption in the control group was (2.06 ± 0.43 and 1.03 ± 0.50) at 2 and 5 mm, respectively, and both were significantly higher than the test group (1.23 ± 0.46 and 0.74 ± 0.33). The mean bone area percent and the residual graft percent were higher in the test group (58.94% and 14.18%, respectively) than in the control group (43.18% and 3.97%, respectively), p < 0.001. Also, the mature bone percent in the test group (70.85%) was higher than the control group (48.37%), p < 0.001; both differences were statistically significant.
Collagen membranes' coverage of symphyseal onlay bone blocks resulted in superior bone quality and quantity for the augmented sites.
ClinicalTrials.gov identifier: NCT04462575
To compare the clinical and radiographic outcomes of crestal sinus floor elevation (SFE) using a digital surgical guide (DSG) and hydraulic sinus lift technique versus the conventional osteotome technique.
Patients requiring crestal SFE and single-implant placement in the posterior maxilla with a minimum of 5 mm of residual bone height were included and randomly assigned to two groups of crestal SFE with (i) the conventional technique (elevation of a mucoperiosteal flap and SFE by the osteotome technique, control group) and (ii) by using a DSG (without flap elevation, by using the sinus lift hydraulic system in the presence of a DSG, test group). Frequency of intraoperative membrane perforation, surgical time, and patient-reported outcomes were collected. Crestal bone loss at 6 months, new bone formation in the sinus, and implant position were assessed.
Twenty-three patients (24 implants, 12 in each group) were included. The DSG group experienced significantly lower postoperative pain (measured by the number of analgesics taken, 1.67 ± 0.77 vs. 2.75 ± 1.21, p = 0.028), shorter surgical time (22.3 ± 2.4 vs. 33.1 ± 4.1 min, p < 0.001), and smaller deviation of implant angulation from the ideal position (2.9° ± 0.6° vs. 8.6° ± 1.3°, p < 0.001) compared to the conventional group. The difference in other parameters was not significant.
Considering the study limitations, using a DSG with a hydraulic system for crestal SFE was superior to the conventional technique regarding pain score, surgical time, and implant angulation. Due to the relatively small sample size and lack of statistically significant differences in some parameters, these findings should be interpreted with caution.
Iranian Registry of Clinical Trials: IRCT20230529058333N1
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