Abstract
Titanium (Ti) and its alloys offer favorable biocompatibility, mechanical properties and corrosion resistance, which makes them an ideal material choice for dental implants. However, the long-term success of Ti-based dental implants may be challenged due to implant-related infections and inadequate osseointegration. With the development of nanotechnology, nanoscale modifications and the application of nanomaterials have become key areas of focus for research on dental implants. Surface modifications and the use of various coatings, as well as the development of the controlled release of antibiotics or proteins, have improved the osseointegration and soft-tissue integration of dental implants, as well as their antibacterial and immunomodulatory functions. This review introduces recent nano-engineering technologies and materials used in topographical modifications and surface coatings of Ti-based dental implants. These advances are discussed and detailed, including an evaluation of the evidence of their biocompatibility, toxicity, antimicrobial activities and in-vivo performances. The comparison between these attempts at nano-engineering reveals that there are still research gaps that must be addressed towards their clinical translation. For instance, customized three-dimensional printing technology and stimuli-responsive, multi-functional and time-programmable implant surfaces holds great promise to advance this field. Furthermore, long-term in vivo studies under physiological conditions are required to ensure the clinical application of nanomaterial-modified dental implants.
Highlights
In the 1960s, the first preclinical and clinical studies revealed that implants made of commercially pure titanium (Ti) could achieve anchorage in bone, which shifted the paradigm in implant dentistry [1]
To ensure the successful establishment and maintenance of osseointegration, TNTs on Ti implants have loaded with various orthobiologics, including bone morphogenetic protein-2 (BMP-2) [47], platelet-derived growth factor-BB [48], alendronate [49], ibandronate [50], N-acetyl cysteine (NAC) [51], and parathyroid hormone (PTH) [52]
Ti-6Al-7Nb alloy dental implants were coated with Cu NPs and cultured with P. gingivalis in vitro, and the findings suggested that Cu NPs can aid in local infection control around implants [144]
Summary
In the 1960s, the first preclinical and clinical studies revealed that implants made of commercially pure titanium (Ti) could achieve anchorage in bone, which shifted the paradigm in implant dentistry [1]. In the 1990s, research findings reported that significantly stronger bone response and higher bone-to-implant contact were achieved in moderately rough or microrough implant surfaces [7]. In the past 10 years, zirconium dioxide implants showed comparable preclinical and clinical outcomes as those of moderately rough Ti implants [10]. According to 10-year clinical observations [11,12,13]. Despite the favorable clinical results, there are still implant-related mechanical, biological and functional complications [14,15]. One major complication is peri-implantitis, which can cause bone loss around the implant, eventually leading to implant failure. 20% of patients and 10% of implants will be affected by peri-implantitis 5–10 years after implantation [16,17]
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