Abstract
In biomaterials science, it is nowadays well accepted that improving the biointegration of dental and orthopedic implants with surrounding tissues is a major goal. However, implant surfaces that support osteointegration may also favor colonization of bacterial cells. Infection of biomaterials and subsequent biofilm formation can have devastating effects and reduce patient quality of life, representing an emerging concern in healthcare. Conversely, efforts toward inhibiting bacterial colonization may impair biomaterial-tissue integration. Therefore, to improve the long-term success of medical implants, biomaterial surfaces should ideally discourage the attachment of bacteria without affecting eukaryotic cell functions. However, most current strategies seldom investigate a combined goal. This work reviews recent strategies of surface modification to simultaneously address implant biointegration while mitigating bacterial infections. To this end, two emerging solutions are considered, multifunctional chemical coatings and nanotopographical features.
Highlights
The replacement and healing of non-functional tissues has become a major challenge worldwide, due to the increase in life expectancy and the prevalence of age-related diseases
In the case of osteoarticular conditions, > 1 million total knee and hip replacement surgeries were performed in 2010 in the United States,[1,2] and projections indicate that the number of primary and revision joint arthroplasties will grow significantly in coming years;[3] similar statistics are found in Europe.[4,5]
Successful implant fixation and full recovery of lost function depend on many factors, which include patient characteristics, factors associated with the implantation site and those related to the surgical procedure and implant properties.[ 9 ] it is increasingly accepted that the two major causes of implant failure are aseptic loosening and infection.[10]
Summary
The replacement and healing of non-functional tissues has become a major challenge worldwide, due to the increase in life expectancy and the prevalence of age-related diseases. The aim of this review is to provide an overview of the existing strategies of surface modification that simultaneously combine cell adhesive/osteoinductive and antibacterial properties Implants with such multifunctional potential would accelerate implant osteointegration and healing but minimize the risk of early/late infections – improving their clinical outcome and reducing the number of revision surgeries. These coatings are highly osteoconductive and have shown osteointegrative potential in vivo.[9,13] According to some authors, CaP materials are osteoinductive as well, which may be attributed to their capacity to adsorb proteins such as growth factors (GFs) The highest levels of cell adhesion were obtained on the rougher surfaces functionalized with the peptide, compared to peptide-coated smooth surfaces or non-functionalized controls (smooth and rough).[99]
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