Abstract
Implant-associated infections (IAIs) are among the most intractable and costly complications in implant surgery. They can lead to surgery failure, a high economic burden, and a decrease in patient quality of life. This manuscript is devoted to introducing current antimicrobial strategies for additively manufactured (AM) titanium (Ti) implants and fostering a better understanding in order to pave the way for potential modern high-throughput technologies. Most bactericidal strategies rely on implant structure design and surface modification. By means of rational structural design, the performance of AM Ti implants can be improved by maintaining a favorable balance between the mechanical, osteogenic, and antibacterial properties. This subject becomes even more important when working with complex geometries; therefore, it is necessary to select appropriate surface modification techniques, including both topological and chemical modification. Antibacterial active metal and antibiotic coatings are among the most commonly used chemical modifications in AM Ti implants. These surface modifications can successfully inhibit bacterial adhesion and biofilm formation, and bacterial apoptosis, leading to improved antibacterial properties. As a result of certain issues such as drug resistance and cytotoxicity, the development of novel and alternative antimicrobial strategies is urgently required. In this regard, the present review paper provides insights into the enhancement of bactericidal properties in AM Ti implants.
Highlights
Bone infection is one the most serious and destructive risks associated with bone implant surgeries
A biofilm is a type of microbially derived fixation community that is characterized by cells that are irreversibly adhered to a substrate or interface between them, embedded in a matrix made up of their own extracellular polymeric substances [6]
This review summarizes the various recently proposed strategies that improve the antibacterial properties of additively manufactured (AM) Ti implants
Summary
Bone infection is one the most serious and destructive risks associated with bone implant surgeries. The following are various starting points from which to approach this: (1) Improving the AM processing parameters to obtain optimized surface physical properties and reduce bacterial adhesion [53]; (2) developing nano-AM technology to prepare nanoantibacterial structures on the implant surface [54]; (3) adding antimicrobial metal elements and exploring the appropriate proportion of elements to prepare the antimicrobial alloy using AM [55] From another point of view, a porous structure is more conducive to bacterial growth than implants with smooth surfaces, and the increased surface area may increase the number of bacteria that survive the disinfection process or cling to the surface before surgery [45]. The typical methods of antimicrobial functionalization of AM implants are listed, such as antibiotic coatings and antimicrobial active metal coatings
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