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Biomaterials and Implants in Development Osteointegration

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: closed (31 December 2019) | Viewed by 40304

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Prof. Dr. José Luis Calvo Guirado

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Full Professor of Oral Surgery and Implant Dentistry. International Dentistry Research Cathedra, Faculty of Health Sciences, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
Interests: dental implants; biomedical engineering; orthopedic materials; synthesis and testing of biomaterials; bioceramics
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Dear Colleagues,

This issue will focus on the various conventional features of dental implants made in titanium, zirconia or titanium-zirconia implants. This clinical issue considered to describe new treatments in Trauma, Orthopedics and also in Dentistry considered and the influence of their physical properties on treatment outcomes in different kinds of patients.

Dental implant and new development of biomaterials can beneficial in some cases treatment possibilities are limited as a result of individual patients’ physical characteristics – bone density, bone quality or bone height.

Investigations comparing trauma implants and dental implants with new surfaces will occupy cortical bone, reduce crestal bone resorption and reduce micromotion compared with regular implants placed in trabecular and cortical bone and also in fractured patients.

This issue will assess how certain implant features (biomaterials, cells, surfaces,implants design, etc.) can influence in the treatment outcomes among completely edentulous patients rehabilitated with implant-supported fixed prostheses and orthopedic patients with complicated fractures. In this context, the research published in this issue will consider the impact of surgical and prosthetic type on patients’ quality of life and satisfaction with their oral health and orthopedic status.

It is my pleasure to invite you to submit a manuscript for this Special Issue. Full papers, communications, and reviews are all welcome.

Prof. Dr. José Luis Calvo Guirado
Guest Editor

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 Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

Biomaterials
Dental implants and surfaces
Implant design
Orthopedic materials
Orthopedic screws

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Published Papers (9 papers)

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Research

14 pages, 4602 KiB

Open AccessArticle

Osteo-Compatibility of 3D Titanium Porous Coating Applied by Direct Energy Deposition (DED) for a Cementless Total Knee Arthroplasty Implant: In Vitro and In Vivo Study

by Dong Jin Ryu, Hun Yeong Ban, Eui Yub Jung, Chung-Hee Sonn, Da Hee Hong, Shakra Ahmad, Bomi Gweon, Dohyung Lim and Joon Ho Wang

J. Clin. Med. 2020, 9(2), 478; https://doi.org/10.3390/jcm9020478 - 9 Feb 2020

Cited by 13 | Viewed by 4183

Abstract

Direct energy deposition (DED) technology has gained increasing attention as a new implant surface technology that replicates the porous structure of natural bones facilitating osteoblast colonization and bone ingrowth. However, concerns have arisen over osteolysis or chronic inflammation that could be caused by Cobalt-chrome (CoCr) alloy and Titanium (Ti) nanoparticles produced during the fabrication process. Here, we evaluated whether a DED Ti-coated on CoCr alloy could improve osteoblast colonization and osseointegration in vitro and in vivo without causing any significant side effects. Three types of implant CoCr surfaces (smooth, sand-blasted and DED Ti-coated) were tested and compared. Three cell proliferation markers and six inflammatory cytokine markers were measured using SaOS2 osteoblast cells. Subsequently, X-ray and bone histomorphometric analyses were performed after implantation into rabbit femur. There were no differences between the DED group and positive control in cytokine assays. However, in the 5-bromo-2′-deoxyuridine (BrdU) assay the DED group exhibited even higher values than the positive control. For bone histomorphometry, DED was significantly superior within the 1000 µm bone area. The results suggest that DED Ti-coated metal printing does not affect the osteoblast viability or impair osseointegration in vitro and in vivo. Thus, this technology is biocompatible for coating the surfaces of cementless total knee arthroplasty (TKA) implants. Full article

(This article belongs to the Special Issue Biomaterials and Implants in Development Osteointegration)

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16 pages, 4889 KiB

Open AccessArticle

Prospective, Clinical Pilot Study with Eleven 4-Mm Extra-Short Implants Splinted to Longer Implants for Posterior Maxilla Rehabilitation

by Daniel Torassa, Pablo Naldini, José Luis Calvo-Guirado and Enrique Fernández-Bodereau

J. Clin. Med. 2020, 9(2), 357; https://doi.org/10.3390/jcm9020357 - 28 Jan 2020

Cited by 14 | Viewed by 3228

Abstract

In many clinical situations, rehabilitation with implants in the posterior maxillary region is complicated by limited bone availability. In this context, the use of 4 mm long implants (known as extra-short implants) may be used thanks to the concept of osseointegration enhancement. It has been demonstrated that short implants offer an alternative to the regeneration procedures involved in placing longer implants in areas where bone height is compromised. This prospective pilot study tested a treatment protocol in which 11 extra-short (4 mm) implants were splinted to 11 mesially placed longer (8 mm) implants in the posterior maxillary regions of partially edentulous patients, without using supplementary bone regeneration procedures. Eleven patients were included in this single cohort study. The clinical performance of the extra-short implants was assessed during a two-year follow-up period, obtaining a 100% survival rate and mean bone loss of 0.3 mm. Implant stability measured by resonance frequency analysis (RFA) at the time of placement was 54.9 ± 4.9, increasing to 77.0 ± 2.6 at 24 months. The study demonstrated the gradual consolidation of osseointegration in bone of less-than-ideal quality in the posterior maxillary region. The results obtained show that a partially edentulous maxilla with reduced bone height may be rehabilitated by using an extra-short implant splinted to a mesial implant of 8mm length or longer. Despite the small sample size, this pilot study observed that extra-short implants achieved adequate bone stability and clinical performance after a 24-month follow-up. Full article

(This article belongs to the Special Issue Biomaterials and Implants in Development Osteointegration)

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16 pages, 3837 KiB

Open AccessArticle

Porphyromonas Gingivalis Load is Balanced by 0.20% Chlorhexidine Gel. A Randomized, Double-Blind, Controlled, Microbiological and Immunohistochemical Human Study

by Simonetta D’Ercole, Gianmaria D’Addazio, Silvia Di Lodovico, Tonino Traini, Mara Di Giulio and Bruna Sinjari

J. Clin. Med. 2020, 9(1), 284; https://doi.org/10.3390/jcm9010284 - 20 Jan 2020

Cited by 32 | Viewed by 3970

Abstract

Microbial contamination could compromise the stability of dental implants increasing the risk of inflammatory reactions in the surrounding soft tissues. In this human, randomized, double-blind, clinical study, the presence of Porphyromonas gingivalis on the healing abutment and the inflammatory infiltrate surrounding peri-implant soft tissues were investigated. Experiments were done in order to clarify the effect of 0.20% chlorhexidine (CHX) versus placebo, applied during each rehabilitation stage. Thirty patients (15 per group) were included. The load of adhering P. gingivalis on the healing screw were quantified by quantitative Polymerase Chain Reaction (qPCR) Taq-Man. Immunohistochemical analysis was carried out on the gingival biopsy. Moreover, clinical data were recorded. Analysis of variance and the Holm–Sidak test was used to evaluate differences between groups. The results showed a significant low presence of P. gingivalis load in healing abutments belonging to the 0.20% CHX group. Overall, the differences in terms of P. gingivalis DNA copy number between two groups were statistically significant (p < 0.01). All implants showed very low plaque and bleeding scores, but the placebo group appeared to have the highest expression of inflammation markers for T Lymphocytes, B Lymphocytes and macrophages Cluster definitions (CD3, CD20 and CD68). The use of 0.20% CHX could be recommended in all clinical procedures as it reduces significantly P. gingivalis load and host inflammatory response around implants. Full article

(This article belongs to the Special Issue Biomaterials and Implants in Development Osteointegration)

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16 pages, 5386 KiB

Open AccessArticle

Presence of ROS in Inflammatory Environment of Peri-Implantitis Tissue: In Vitro and In Vivo Human Evidence

by Eitan Mijiritsky, Letizia Ferroni, Chiara Gardin, Oren Peleg, Alper Gultekin, Alper Saglanmak, Lucia Gemma Delogu, Dinko Mitrecic, Adriano Piattelli, Marco Tatullo and Barbara Zavan

J. Clin. Med. 2020, 9(1), 38; https://doi.org/10.3390/jcm9010038 - 23 Dec 2019

Cited by 31 | Viewed by 3474

Abstract

Analyses of composition, distribution of cellular and extracellular matrix components, and molecular analysis of mitochondria related genes of bone loss in the presence of inflammatory environment in humans was the aim of the present project. As a human model we chose peri-implantitis. Morphological analyses were performed by means classical histological, immunohistochemical, and SEM (scanning electron miscroscopy) test. Gene expression analysis was performed to evaluate epithelium maturation, collagen fiber production, and genes related to mitochondrial activity. It was found that a well-defined keratinocyte epithelium was present on the top of all specimens; a distinct basal lamina was present, as well as desmosomes and autophagic processes related to the maturation of keratinocytes. Under this epithelium, a full inflammatory cell infiltrate was present for about 60% of the represented by plasma cells. Collagen type I fibers were present mainly in the form of fragmented cord tissue without cells. A different distribution of blood vessels was also present from the apical to the most coronal portion of the specimens. High levels of genes related to oxidative stress were present, as well as the activation of genes related to the loss of ability of osteogenic commitment of Mesenchymal stem cells into osteoblasts. Our study suggests that peri-implantitis lesions exhibit a well defined biological organization not only in terms of inflammatory cells but also on vessel and extracellular matrix components even if no difference in the epithelium is evident, and that the presence of reactive oxygen species (ROS) related to the inflammatory environment influences the correct commitment of Mesenchymal stem cells. Full article

(This article belongs to the Special Issue Biomaterials and Implants in Development Osteointegration)

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0 pages, 13890 KiB

Open AccessArticle

RETRACTED: Nurse’s A-Phase–Silicocarnotite Ceramic–Bone Tissue Interaction in a Rabbit Tibia Defect Model

by Belén Ñíguez Sevilla, Ruben Rabadan-Ros, Miguel Alcaraz-Baños, Francisco Martínez Díaz, José E. Mate Sánchez de Val, Iván López-Gónzalez, Jose Luis Calvo-Guirado, Piedad N. De Aza and Luis Meseguer-Olmo

J. Clin. Med. 2019, 8(10), 1714; https://doi.org/10.3390/jcm8101714 - 17 Oct 2019

Cited by 7 | Viewed by 3993 | Retraction

Abstract

Calcium phosphate materials are widely used as bone substitutes due to their bioactive and biodegradable properties. Also, the presence of silicon in their composition seems to improve the bioactivity of the implant and promote bone tissue repair. The aim of this study was to develop a novel ceramic scaffold by partial solid-state sintering method with a composition lying in the field of the Nurse’s A-phase–silicocarnotite, in the tricalcium phosphate–dicalcium silicate (TCP–C₂S) binary system. Also, we evaluated its osteogenic and osteoconductive properties after being implanted into tibia defects in New Zealand rabbits. X-ray, microcomputer tomography, and histomorphometry studies demonstrated that this porous ceramic is highly biocompatible and it has excellent osteointegration. The material was being progressively reabsorbed throughout the study and there was no unspecified local or systemic inflammatory response observed. These results suggest that ceramic imitates the physicochemical characteristics of bone substitutes used in bone reconstruction. Full article

(This article belongs to the Special Issue Biomaterials and Implants in Development Osteointegration)

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11 pages, 5814 KiB

Open AccessArticle

A Finite Element Analysis to Compare Stress Distribution on Extra-Short Implants with Two Different Internal Connections

by Silvia Helena García-Braz, María Prados-Privado, Luiz Carlos Silveira Zanatta, José Luis Calvo-Guirado, Juan Carlos Prados-Frutos and Sérgio Alexandre Gehrke

J. Clin. Med. 2019, 8(8), 1103; https://doi.org/10.3390/jcm8081103 - 25 Jul 2019

Cited by 17 | Viewed by 4863

Abstract

Background: The goal of this study was to analyze the stress distribution on two types of extra-short dental implants with 5 mm of length: An internal hexagon (IH) and morse taper connection (MT). Methods: The three-dimensional model was composed of trabecular and cortical bone, a crown, an extra-short dental implant and their components. An axial load of 150 N was applied and another inclined 30° with the same magnitude. Results: Stress concentrations on the IH implant are observed in the region of the first threads for the screw. However, in the MT implant the highest stress occurs at the edges of the upper implant platform. Conclusions: In view of the results obtained in this study the two types of prosthetic fittings present a good stress distribution. The Morse taper connections presented better behavior than the internal in both loading configurations. Full article

(This article belongs to the Special Issue Biomaterials and Implants in Development Osteointegration)

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12 pages, 1459 KiB

Open AccessArticle

Development of a Novel Nanotextured Titanium Implant. An Experimental Study in Rats

by André Antonio Pelegrine, Peter Karyen Moy, Alireza Moshaverinia, Ana Lúcia do Amaral Escada, José Luis Calvo-Guirado and Ana Paula Rosifini Alves Claro

J. Clin. Med. 2019, 8(7), 954; https://doi.org/10.3390/jcm8070954 - 30 Jun 2019

Cited by 9 | Viewed by 3031

Abstract

This animal study evaluated the osseointegration level of a new nanotextured titanium surface produced by anodization. Ti-cp micro-implants (1.5 mm diameter by 2.5 mm in length) divided into two groups: titanium nanotextured surface treatment (Test Group) and acid etched surface treatment (Control Group). Surface characterization included morphology analysis using scanning electron microscopy and wettability by measuring contact angle. Sixteen Wistar rats were submitted to two micro implants surgical placement procedures. In each rat, one type of micro implant placed in each tibia. The animals sacrificed after two (T1) and six weeks (T2) post-implantation. After the euthanasia, tibias processed for histomorphometric analysis, which allowed the evaluation of bone to implant contact (BIC) and the bone area fraction occupancy between the threads (BAFO). Our surface analysis data showed that the Control Group exhibited an irregular and non-homogenous topography while the Test Group showed a nanotextured surface. The Test Group showed higher wettability (contact angle = 5.1 ± 0.7°) than the Control Group (contact angle = 75.5 ± 4.6°). Concerning the histomorphometric analysis results for T1, Control and Test groups showed BIC percentages of 41.3 ± 15.2% and 63.1 ± 8.7% (p < 0.05), respectively, and for BAFO, 28.7 ± 13.7% and 54.8 ± 7.5%, respectively (p < 0.05). For T2, the histomorphometric analysis for Control and Test groups showed BIC percentages of 51.2 ± 11.4% and 64.8 ± 7.4% (p < 0.05), respectively and for BAFO, 36.4 ± 10.3% and 57.9 ± 9.3% (p < 0.05), respectively. The findings of the current study confirmed that the novel nanotextured surface exhibited superior wettability, improved peri-implant bone formation, and expedited osseointegration. Full article

(This article belongs to the Special Issue Biomaterials and Implants in Development Osteointegration)

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12 pages, 19739 KiB

Open AccessArticle

Impact of Different Titanium Implant Thread Designs on Bone Healing: A Biomechanical and Histometric Study with an Animal Model

by Sergio Alexandre Gehrke, Tiago Luis Eliers Treichel, Letícia Pérez-Díaz, Jose Luis Calvo-Guirado, Jaime Aramburú Júnior, Patricia Mazón and Piedad N. de Aza

J. Clin. Med. 2019, 8(6), 777; https://doi.org/10.3390/jcm8060777 - 31 May 2019

Cited by 25 | Viewed by 9066

Abstract

Threads of dental implants with healing chamber configurations have become a target to improve osseointegration. This biomechanical and histometric study aimed to evaluate the influence of implant healing chamber configurations on the torque removal value (RTv), percentage of bone-to-implant contact (BIC%), bone fraction occupancy inside the thread area (BAFO%), and bone and osteocyte density (Ost) in the rabbit tibia after two months of healing. Titanium implants with three different thread configurations were evaluated: Group 1 (G1), with a conventional “v” thread-shaped implant design; Group 2 (G2), with square threads; and Group 3 (G3), the experimental group with longer threads (healing chamber). Ten rabbits (4.5 ± 0.5 kg) received three implants in each tibia (one per group), distributed in a randomized manner. After a period of two months, the tibia blocks (implants and the surrounding tissue) were removed and processed for ground sectioning to evaluate BIC%, BAFO%, and osteocyte density. The ANOVA one-way statistical test was used followed by the Bonferoni’s multiple comparison test to determine individual difference among groups, considering a statistical difference when p < 0.05. Histometric evaluation showed a higher BAFO% values and Ost density for G3 in comparison with the other two groups (G1 and G2), with p < 0.05. However, the RTv and BIC% parameters were not significantly different between groups (p > 0.05). The histological data suggest that the healing chambers in the implant macrogeometry can improve the bone reaction in comparison with the conventional thread design. Full article

(This article belongs to the Special Issue Biomaterials and Implants in Development Osteointegration)

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13 pages, 2290 KiB

Open AccessArticle

Can the Macrogeometry of Dental Implants Influence Guided Bone Regeneration in Buccal Bone Defects? Histomorphometric and Biomechanical Analysis in Beagle Dogs

by Manuel Fernández-Domínguez, Victor Ortega-Asensio, Elena Fuentes Numancia, Juan Manuel Aragoneses, Horia Mihail Barbu, María Piedad Ramírez-Fernández, Rafael Arcesio Delgado-Ruiz, José Luis Calvo-Guirado, Nahum Samet and Sergio Alexandre Gehrke

J. Clin. Med. 2019, 8(5), 618; https://doi.org/10.3390/jcm8050618 - 7 May 2019

Cited by 4 | Viewed by 3774

Abstract

The aim of this experimental animal study was to assess guided bone regeneration (GBR) and implant stability (ISQ) around two dental implants with different macrogeometries. Forty eight dental implants were placed within six Beagle dogs. The implants were divided into two groups (n = 24 per group): G1 group implants presented semi-conical macrogeometry, a low apical self-tapping portion, and an external hexagonal connection (whereby the cervical portion was bigger than the implant body). G2 group implants presented parallel walls macrogeometry, a strong apical self-tapping portion, and an external hexagonal connection (with the cervical portion parallel to the implant body). Buccal (mouth-related) defects of 2 mm (c2 condition) and 5 mm (c3 condition) were created. For the control condition with no defect (c1), implants were installed at crestal bone level. Eight implants in each group were installed under each condition. The implant stability quotient (ISQ) was measured immediately after implant placement, and on the day of sacrifice (3 months after the implant placement). Histological and histomorphometric procedures and analysis were performed to assess all samples, measuring crestal bone loss (CBL) and bone-to-implant contact (BIC). The data obtained were compared with statistical significance set at p < 0.05. The ISQ results showed a similar evolution between the groups at the two evaluation times, although higher values were found in the G1 group under all conditions. Within the limitations of this animal study, it may be concluded that implant macrogeometry is an important factor influencing guided bone regeneration in buccal defects. Group G1 showed better buccal bone regeneration (CBL) and BIC % at 3 months follow up, also parallel collar design can stimulate bone regeneration more than divergent collar design implants. The apical portion of the implant, with a stronger self-tapping feature, may provide better initial stability, even in the presence of a bone defect in the buccal area. Full article

(This article belongs to the Special Issue Biomaterials and Implants in Development Osteointegration)

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