Infected Implants Research Articles

Daily sonic toothbrush triggered biocompatible BaTiO3/chitosan multiporous coating with enhanced piezocatalysis for intraoral antibacterial activity

Pure titanium and its alloys are widely used in dental implants because of their excellent physical chemistry and biocompatibility properties, but their negligible antibacterial activity may lead to bacterial infection and implants failure. Inspired by the piezoelectricity and porous structure of living bone, a multiporous piezo-coating with barium titanate (BaTiO3, BTO) nanoparticles embedded in chitosan film is modified on acid-etched pure titanium. The surface of coating shows antibacterial effects and can be further improved under daily sonic toothbrush stimulation with an antibacterial rate of 90.41%. Interestingly, the planktonic bacteria around this coating also have low proliferation. The antibacterial mechanism may be BTO-mediated intracellular and extracellular reactive oxygen species (ROS). On the one hand, the contact potential difference (CPD) caused by the spontaneous polarization of BTO nanoparticles may destroy the intracellular electron transfer and lead to ROS burst. On the other hand, BTO could transfer mechanical energy to electrical energy under the stimulation of sonic toothbrushing (ST), then driving piezocatalytic effect to generate extracellular ROS. In addition, the piezo-coating also exhibits excellent biocompatibility to MC3T3-E1 cells, and promotes more hydroxyapatite deposition and plasma albumin adhesion. In summary, during the stimulation of daily sonic toothbrush, the bioinspired piezo-coating can effectively inhibit the formation of bacterial biofilm, which is a promising strategy to prevent dental implants infection in daily life.

Synergistic coating strategy combining photodynamic and photothermal properties along with reinforcing corrosion protection fabricated on magnesium alloys

Postoperative infections of bone implants and loss of mechanical strength due to the corrosion are two major obstacles in the pathway for the magnesium alloys applications in biomedical region. To resolve above issues, a novel hybrid coating, MAO/EPR/Gel, is prepared on AZ31B magnesium alloys, in which the photodynamic therapy (PDT) and photothermal therapy (PTT) agents are combined together to form Er@PDA-RB and they are inserted in the micropores of micro-arc oxidation (MAO) coating rather than doping in it. The gelatin is utilized to prevent the leaking of Er@PDA-RB and it would be decomposed spontaneously in the human body. The |Z|0.01Hz of MAO/EPR and MAO/EPR/Gel are 4.35 × 104 Ω cm2 and 6.99 × 104 Ω cm2, which is much larger than that of MAO coating and bare AZ31B Mg alloy with the values of 3.70 × 104 Ω cm2 and 1.50 × 103 Ω cm2, respectively. The antibacterial ratio for E. coli reaches 93.9% under 980nm near-infrared (NIR) irradiation within 60min. Moreover, the MAO/EPR/Gel coating displays the excellent cytocompatibility with the HL-7702 cell viability > 75% with or without 980nm NIR irradiation. This multifunctional integrated coating accomplishes both PDT and PTT functions with only one NIR irradiation without sacrificing the anti-corrosion feature, which exhibits a promising application for magnesium alloys in biomedical applications.

Synergistic effect of chlorhexidine and azoles on candida biofilm on titanium surface.

Candida infections of orthopedic implants are one of the most detrimental orthopedic implant-related complications with unsuccessful treatment and a poor prognosis. Most orthopedic Candida infections form biofilms and have resistance to the commonly used antifungal agents. This study aimed to develop a novel combination of normally prescribed drugs against Candida biofilm on orthopedic implants. We cultured 26 clinical isolates of Candida strains to form biofilm without titanium sheets or on titanium sheets, which are the most commonly used materials for permanent or orthopedic implants. The checkerboard method was used to evaluate the synergistic effects of chlorhexidine (CHL) and azoles on these Candida biofilms. For the evaluation of synergistic effects, we constructed the cell viability assay by fluorescence staining and CFU reduction hot map of Candida. Twenty-six clinical isolates of Candida strains formed biofilm in 96-well plates without titanium sheets, and we selected 9 of them to form biofilm on titanium sheets in 24-well plates. In Candida biofilm formed in 96-wells, the synergistic rates of CHL with fluconazole, itraconazole, and voriconazole were 61% (16/26), 65% (17/26), and 23% (6/26), respectively. When compared to the blank control group, CHL monotherapy significantly inhibited biofilm formation on titanium sheets (P < 0.05). We demonstrated 100% synergistic rates of the CHL and fluconazole combination against Candida biofilm formation on titanium sheets, and the minimum inhibitory concentration of CHL and FLU decreased four- to eight-fold. We concluded that CHL combined with azoles inhibited the Candida biofilm formation 96-wells or on titanium sheets and has the potential to control the infections of orthopedic implants.

Preparation of a Zn/hydroxyapatite/chitosan composite coating with an antibacterial ability and cytocompatibility on a NiTi alloy

Zn has been extensively used to prevent microbial infections in orthopedic implants; however, high amounts of Zn inhibit cell proliferation. This study investigated the ability to decrease the cytotoxicity of Zn-doped coatings on NiTi shape memory alloys (NiTi SMAs) while maintaining their antibacterial activity. The Zn3(PO4)2 distributed in the chitosan coating, annotated as ZHAP, was obtained by electrophoretic deposition in a chitosan solution with Zn acetate acid and hydroxyapatite particles. The ZHAP inhibited bacterial growth and exhibited a good antibacterial activity (86 %) against Staphylococcus aureus. In addition, the MG63-cell adhesion and cytocompatibility with ZHAP were better than those with the Zn-doped coating due to the precipitation of Zn3(PO4)2 which decreased the release of Zn2+ ions from the chitosan matrix. The coatings did not affect neither the superelasticity (< 0.5 % residual strain) nor the shape memory ability (100 % recovery rate) of the NiTi SMAs.

Strontium-polydopamine hybrid coating to improve antibacterial ability and osseointegration of titanium implants

Poor osseointegration and implant-associated infection of titanium implants have prompted their urgent development. Strontium (Sr) is widely recognized to promote osteoblast differentiation and inhibit osteoclast growth. To this end, this study aimed to develop a Sr-containing polydopamine (PDA)-coated implant with practical antibacterial ability and excellent osseointegration ability to meet clinical applications. This hybrid coating used PDA as an adhesion layer and a carrier for Sr ions. The effects of Sr contents on shear bond strength, in vitro stability, antibacterial ability, and in vitro osteogenic activity of the implant were evaluated. The Sr-doped PDA surface was soaked in simulated body fluid (SBF) at pH 7.4 or 5.0 for a long time (up to 90 days) to evaluate the in vitro stability. The antimicrobial ability of the hybrid coating against E. coli and S. aureus was examined, while its cellular function was assessed using RAW 264.7 and MG63 cells. The current phase and chemical composition results indicated the presence of Sr ions on the surface of PDA. When Sr was added to PDA, the initial shear strength values were comparable to those of the PDA coating. Soaking time reduced the strength values of Sr-containing coatings, especially for 90 days. However, Sr coating significantly reduced the growth of the two bacteria in a dose-dependent manner. Likewise, Sr coating had a significant dose-dependent inhibitory effect on the development of RAW 264.7 cells but improved MG63 osteogenesis. In conclusion, 40 % Sr-containing PDA hybrid coating on titanium implants may be a potential implant in terms of in vitro stability, antibacterial ability, and osteogenic activity.

Management of Biofilm with Breast Implant Surgery.

After studying this article, the participant should be able to: 1. Understand how bacteria negatively impact aesthetic and reconstructive breast implants. 2. Understand how bacteria infect breast implants. 3. Understand the evidence associated with common implant infection-prevention strategies, and their limitations. 4. Understand why implementation of bacteria-mitigation strategies such as antibiotic administration or "no-touch" techniques may not indefinitely prevent breast implant infection. Bacterial infection of aesthetic and reconstructive breast implants is a common and expensive problem. Subacute infections or chronic capsular contractures leading to device explantation are the most commonly documented sequelae. Although bench and translational research underscores the complexities of implant-associated infection, high-quality studies with adequate power, control groups, and duration of follow-up are lacking. Common strategies to minimize infections use antibiotics-administered systemically, in the breast implant pocket, or by directly bathing the implant before insertion-to limit bacterial contamination. Limiting contact between the implant and skin or breast parenchyma represents an additional common strategy. The clinical prevention of breast implant infection is challenged by the clean-contaminated nature of breast parenchyma, and the variable behavior of not only specific bacterial species but also their strains. These factors impact bacterial virulence and antibiotic resistance.

New PMMA-Based Hydroxyapatite/ZnFe2O4/ZnO Composite with Antibacterial Performance and Low Toxicity.

Polymethylmethacrylate (PMMA) is the most commonly used bone void filler in orthopedic surgery. However, the biocompatibility and radiopacity of PMMA are insufficient for such applications. In addition to insufficient biocompatibility, the microbial infection of medical implants is one of the frequent causes of failure in bone reconstruction. In the present work, the preparation of a novel PMMA-based hydroxyapatite/ZnFe2O4/ZnO composite with heterophase ZnFe2O4/ZnO NPs as an antimicrobial agent was described. ZnFe2O4/ZnO nanoparticles were produced using the electrical explosion of zinc and iron twisted wires in an oxygen-containing atmosphere. This simple, highly productive, and inexpensive nanoparticle fabrication approach could be readily adapted to different applications. From the findings, the presented composite material showed significant antibacterial activity (more than 99% reduction) against P. aeruginosa, S. aureus, and MRSA, and 100% antifungal activity against C. albicans, as a result of the combined use of both ZnO and ZnFe2O4. The composite showed excellent biocompatibility against the sensitive fibroblast cell line 3T3. The more-than-70% cell viability was observed after 1-3 days incubation of the sample. The developed composite material could be a potential material for the fabrication of 3D-printed implants.

Are Absorbable Plates More Resistant to Infection Than Titanium Implants? An Experimental Pre-Clinical Trial in Rabbits.

Background: Infection of orthopaedic implants after internal fixation of bone fractures remains a major complication with occasionally devastating consequences. Recent studies have reported that the use of absorbable materials, instead of metallic ones, may lead to a lower incidence of postoperative infection. In this experimental pre-clinical animal study, we compared the infection rate between absorbable implants consisting of copolymers composed from trimethylene carbonate, L-polylactic acid, and D, L-polylactic acid monomers, and titanium implants after the inoculation of a pathogenic microorganism. Material and Methods: We used an experimental implant-related infection model in rabbits. Sixty animals were randomly and equally divided into two groups. In all animals, the right femur was exposed via a lateral approach and a 2.5 mm two-hole titanium plate with screws (Group A), or a two-hole absorbable plate and screws (Group B), were applied in the femoral shaft. Afterwards, the implant surface was inoculated with Pseudomonas Aeruginosa at a concentration of 2 × 108 CFU/mL. The primary outcome was the comparison of the incidence of developed infection between the two groups. The wound condition was monitored on a daily basis and radiographies were obtained at 12 weeks postoperatively. Infection-related laboratory markers (white blood cell count, erythrocyte sedimentation rate, and C-reactive protein values) were assessed at 3, 6, and 16 weeks postoperatively. Histologic analysis and cultures of tissue samples were also performed to evaluate the presence of infection. Results: Clinical and laboratory signs of infection were evident in 11 rabbits in Group A (36.7%), and 4 in Group B (13.3%). The difference between the groups was statistically significant (p = 0.04). Five animals in Group B (16.7%) had clinical and histologic signs of a foreign-body reaction with significantly elevated CRP and ESR values but no simultaneous presence of infection was identified (p = 0.04). Bone remodelling with thickening of the periosteum and surrounding sclerosis was demonstrated radiologically in animals developing infection or foreign-body reactions. Conclusions: Absorbable plates and screws show lower susceptibility to infection compared to titanium ones. However, their application is associated with foreign-body reaction and the potential need for a second surgical intervention.

A near-infrared-activated heterostructure endowed nerve scaffold with electrical stimulation and antibacterial performance

The weak tissue inducibility and easy implantation infection are still challenges confronted to tissue scaffold. Bismuth sulfide (Bi2S3) possessed favorable photoelectric, photothermal, and photodynamic properties not only enabling to response near-infrared light to generate electrical signals to promote nerve growth but also simultaneously produces reactive oxygen species (ROS) and heat to kill bacteria, which emerges as a promising alternative. However, the easy recombination of electron-hole weakens its photocurrent and ROS generation. Herein, Bi2S3/Ag3PO4 heterostructures are prepared by in situ growing Ag3PO4 on Bi2S3 and then mixed with poly-L-lactic acid powder to fabricate scaffolds by selective laser sintering. Due to the different Fermi levels of Bi2S3 and Ag3PO4, the photogenerated electrons of Bi2S3 transferred to the conduction band of Ag3PO4. Meanwhile, the heterojunction impeded the backflow of electrons, which efficiently achieved electron-hole pair separation. Results indicate that the photocurrent and ROS generated by the scaffold was enhanced. The improved photocurrent effectively induces stem cells to differentiate into nerve cells through up-regulating Ca2+ concentration and neural-specific markers Nestin expression. The produced ROS, photothermal, and Ag+ can synergistically kill bacteria. Ultimately, the scaffold exhibited excellent antimicrobial efficiency with 90.59 % and 91.45 % against E. coli and S. aureus, respectively. This strategy provides a new perspective to realize the integrated preparation of nerve scaffolds with electrical stimulation and antibacterial performance.

Monoclonal Antibody Disrupts Biofilm Structure and Restores Antibiotic Susceptibility in an Orthopedic Implant Infection Model.

Bacterial biofilms on orthopedic implants are resistant to the host immune response and to traditional systemic antibiotics. Novel therapies are needed to improve patient outcomes. TRL1068 is a human monoclonal antibody (mAb) against a biofilm anchoring protein. For assessment of this agent in an orthopedic implant infection model, efficacy was measured by reduction in bacterial burden of Staphylococcus aureus, the most common pathogen for prosthetic joint infections (PJI). Systemic treatment with the biofilm disrupting mAb TRL1068 in conjunction with vancomycin eradicated S. aureus from steel pins implanted in the spine for 26 of 27 mice, significantly more than for vancomycin alone. The mechanism of action was elucidated by two microscopy studies. First, TRL1068 was localized to biofilm using a fluorescent antibody tag. Second, a qualitative effect on biofilm structure was observed using scanning electron microscopy (SEM) to examine steel pins that had been treated in vivo. SEM images of implants retrieved from control mice showed abundant three-dimensional biofilms, whereas those from mice treated with TRL1068 did not. Clinical Significance: TRL1068 binds at high affinity to S. aureus biofilms, thereby disrupting the three-dimensional structure and significantly reducing implant CFUs in a well-characterized orthopedic model for which prior tested agents have shown only partial efficacy. TRL1068 represents a promising systemic treatment for orthopedic implant infection.

The effect of Staphylococcus aureus on innate and adaptive immunity and potential immunotherapy for S. aureus-induced osteomyelitis.

Osteomyelitis is a chronic inflammatory bone disease caused by infection of open fractures or post-operative implants. Particularly in patients with open fractures, the risk of osteomyelitis is greatly increased as the soft tissue damage and bacterial infection are often more severe. Staphylococcus aureus, one of the most common pathogens of osteomyelitis, disrupts the immune response through multiple mechanisms, such as biofilm formation, virulence factor secretion, and metabolic pattern alteration, which attenuates the effectiveness of antibiotics and surgical debridement toward osteomyelitis. In osteomyelitis, immune cells such as neutrophils, macrophages and T cells are activated in response to pathogenic bacteria invasion with excessive inflammatory factor secretion, immune checkpoint overexpression, and downregulation of immune pathway transcription factors, which enhances osteoclastogenesis and results in bone destruction. Therefore, the study of the mechanisms of abnormal immunity will be a new breakthrough in the treatment of osteomyelitis.

Factors associated with dental implant loss/complications in the Veterans Health Administration, 2015-2019.

Twelve percent of the U.S. population has a dental implant. Although rare, implant loss/complications can impact quality of life. This study evaluated indicators for implant loss/complications. Veterans with dental implants placed between 2015 and 2019 were included. Implant loss/complications were defined as implant removal or peri-implant defect treatment within 90 days. Binomial logistic regression identified factors associated with implant loss/complications. From 2015 to 2019, 48,811 dental implants were placed in 38,246 Veterans. Implant loss/complications was identified for 202 (0.4%) implants. In adjusted analyses, Veterans aged 50-64 years (OR = 1.92 (95% confidence interval (CI): 1.06, 3.46)) and ≥65 (OR = 2.01 (95% CI: 1.14, 3.53)) were more likely to have implant loss/complications. History of oral infection, tooth location, and number of implants placed all significantly increased the odds of loss/complications. Dental implant loss/complications are rare outcomes. Older age, location of implant, and the number of implants placed during a visit were significant predictors of loss/complication.

Minimally Invasive and Innovative Management of Prosthesis Infections in Endoscopic-Assisted Breast Reconstruction.

Implant infection continues to be the most common complication of breast reconstruction, and it can lead to serious consequences of implant loss. Recently, endoscopic-assisted nipple-sparing mastectomy with direct-to-implant breast reconstruction is being performed more frequently, with similar prostheticinfection incidence compared to conventional techniques. But there is little information published in the literature on the management of periprosthetic infection in endoscopic-assisted breast reconstruction. A retrospective review was performed of patients who underwent endoscope-assisted breast reconstruction and developed periprosthetic infection between January 2020 and December 2022. Prosthesis infection was defined as any case where antibiotics were given, beyond the surgeon's standard perioperative period, in response to clinical signs such as swelling, pain, erythema, increased temperature, fever, etc. We summarized our clinical approach and treatment protocol for periprosthetic infection patients. Collected data include preoperative basic information, surgical details, postoperative data, and outcomes. A total of 580 patients (713 reconstructions) underwent endoscopic-assisted immediate breast reconstruction. There were 58 patients developed periprosthetic infection, 14 of whom had bilateral prosthesis reconstruction with unilateral prosthesis infection. The incidence of infection was 10.0%. Average follow-up was 17.3 ± 8.9 months (range = 2-37 months). Of the 58 patients, 53 (91.4%) patients successful salvaged implant and 5(8.6%) patients removed prosthesis. During follow-up, Baker III capsular contracture occurred in 2 patients (3.8%) who had radiotherapy. Our management of prosthesis infections in endoscopic-assisted breast reconstruction is easy, minimally invasive, and inexpensive. This method can be repeated if the implant infection does not improve after the first drainage. What's more, our data suggest that our prosthesis salvage of periprosthetic infection is effective. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

In vitro Antibacterial Effects of Curcumin-loaded Mesoporous Silica Nanoparticles inside the Dental Implant Fixture

Background: Infection in implants is a critical problem in the assemblies of two-piece implants. Aim: The purpose of this study was to test in vitro antibacterial effects of curcumin-loaded silica nanoparticles inside the implant fixture. Methods: Forty-five implants in five groups were used for evaluation of the antibacterial effects against Escherichia coli, Staphylococcus aureus, and Enterococcus faecalis. The groups were curcumin-containing silica nanoparticles, curcumin-free silica nanoparticles, curcumin, distilled water (negative control), and chlorhexidine (positive control). The mentioned materials in each group were poured into the inner cavity of the implant and then the abutment was closed (torque of 35 Ncm). All implant-abutment sections were dipped in bacterial suspension and incubated for 24 hours at 37°C. The inside of each implant was cultured on the surface of the culture plates. Results: The results showed that curcumin-containing silica nanoparticles affected all three bacterial species and the number of colonies in all three bacteria was significantly reduced. The nanoparticles showed antibacterial effects on S. aureus, E. coli and E. faecalis, which was statistically significant (p-value &lt;0.05). Conclusion: The outcomes of this study showed that the curcumin-loaded mesoporous silica nanoparticles can be used inside the implant fixture for benefiting from their antimicrobial properties and further success of implant therapy.

Antifouling Behavior of Copper-Modified Titania Nanotube Surfaces.

Titanium and its alloys are commonly used to fabricate orthopedic implants due to their excellent mechanical properties, corrosion resistance, and biocompatibility. In recent years, orthopedic implant surgeries have considerably increased. This has also resulted in an increase in infection-associated revision surgeries for these implants. To combat this, various approaches are being investigated in the literature. One of the approaches is modifying the surface topography of implants and creating surfaces that are not only antifouling but also encourage osteointegration. Titania nanotube surfaces have demonstrated a moderate decrease in bacterial adhesion while encouraging mesenchymal stem cell adhesion, proliferation, and differentiation, and hence were used in this study. In this work, titania nanotube surfaces were fabricated using a simple anodization technique. These surfaces were further modified with copper using a physical vapor deposition technique, since copper is known to be potent against bacteria once in contact. In this study, scanning electron microscopy was used to evaluate surface topography; energy-dispersive X-ray spectroscopy and X-ray photoelectron spectroscopy were used to evaluate surface chemistry; contact angle goniometry was used to evaluate surface wettability; and X-ray diffraction was used to evaluate surface crystallinity. Antifouling behavior against a gram-positive and a gram-negative bacterium was also investigated. The results indicate that copper-modified titania nanotube surfaces display enhanced antifouling behavior when compared to other surfaces, and this may be a potential way to prevent infection in orthopedic implants.

Cardiac implantable electronic device implantation and device-related infection.

Cardiac implantable electronic devices (CIED) are important tools for managing arrhythmias, improving hemodynamics, and preventing sudden cardiac death. Device-related infections (DRI) remain a significant complication of CIED and are associated with major adverse outcomes. We aimed to assess the trend in CIED implantations, and the burden and morbidity associated with DRI. The 2011-2018 National Inpatient Sample database was searched for admissions for CIED implantation and DRI. A total of 1 604 173 admissions for CIED implantations and 71 007 (4.4%) admissions for DRI were reported. There was no significant change in annual admission rates for DRI (3.96-4.59%, P value for trend = 0.98). Those with DRI were more likely to be male (69.3 vs. 57%, P < 0.001) and have a Charlson comorbidity index score ≥3 (46.6 vs. 36.8%, P < 0.001). The prevalence of congestive heart failure (CHF) increased in those admitted with DRI over the observation period. Pulmonary embolism, deep vein thrombosis, and post-procedural hematoma were the most common complications in those with DRI (4.1, 3.6, and 2.90%, respectively). Annual in-hospital mortality for those with DRI ranged from 3.9 to 5.8% (mean 4.4%, P value for trend = 0.07). Multivariate analysis identified CHF [odds ratio (OR) = 1.67; 95% confidence interval (CI) = 1.35-2.07], end-stage renal disease (OR = 1.90; 95% CI = 1.46-2.48), coagulopathy (OR = 2.94; 95% CI = 2.40-3.61), and malnutrition (OR = 2.50; 95% CI = 1.99-3.15) as the predictors of in-hospital mortality for patients admitted with DRI. Device-related infection is relatively common and continues to be associated with high morbidity and mortality. The prevalence of DRI has not changed significantly despite technical and technological advances in cardiac devices and their implantation.

Defeating the Hidden Foe: Antibiotic Therapy and Clinical Outcomes of Cutibacterium acnes Spinal Implant Infections.

Cutibacterium acnes can cause spinal implant infections. However, little is known about the optimal medical management and outcomes of C. acnes spinal implant infections (CSII). Our study aims to describe the management of patients with CSII and evaluate the clinical outcomes. We performed a retrospective cohort study of patients aged 18 years or older who underwent spinal fusion surgery with instrumentation between January 1, 2011, and December 31, 2020, and whose intraoperative cultures were positive for C. acnes. The primary outcome was treatment failure based on subsequent recurrence, infection with another organism, or unplanned surgery secondary to infection. There were 55 patients with a median follow-up (interquartile range) of 2 (1.2-2.0) years. Overall, there were 6 treatment failures over 85.8 total person-years, for an annual rate of 7.0% (95% CI, 2.6%-15.2%). Systemic antibiotic treatment was given to 74.5% (n = 41) of patients for a median duration of 352 days. In the subgroup treated with systemic antibiotics, there were 4 treatment failures (annual rate, 6.3%; 95% CI, 1.7%-16.2%), all of which occurred while on antibiotic therapy. Two failures occurred in the subgroup without antibiotic treatment (annual rate, 8.8%; 95% CI, 1.1%-31.8%). Our study found that the estimated annual treatment failure rate was slightly higher among patients who did not receive antibiotics. Of the 6 failures observed, 4 had recurrence of C. acnes either on initial or subsequent treatment failures. More studies are warranted to determine the optimal duration of therapy for CSII.

The Era of Biomaterials: Smart Implants?

Conditions, accidents, and aging processes have brought with them the need to develop implants with higher technology that allow not only the replacement of missing tissue but also the formation of tissue and the recovery of its function. The development of implants is due to advances in different areas such as molecular-biochemistry (which allows the understanding of the molecular/cellular processes during tissue repair), materials engineering, tissue regeneration (which has contributed advances in the knowledge of the properties of the materials used for their manufacture), and the so-called intelligent biomaterials (which promote tissue regeneration through inductive effects of cell signaling in response to stimuli from the microenvironment to generate adhesion, migration, and cell differentiation processes). The implants currently used are combinations of biopolymers with properties that allow the formation of scaffolds with the capacity to mimic the characteristics of the tissue to be repaired. This review describes the advances of intelligent biomaterials in implants applied in different dental and orthopedic problems; by means of these advances, it is expected to overcome limitations such as additional surgeries, rejections and infections in implants, implant duration, pain mitigation, and mainly, tissue regeneration.

Diagnostic performances and therapeutic impact of the Unyvero Implant and Tissue Infection multiplex PCR in periprosthetic joint infections.

Aim: We evaluated the diagnostic performances of UnyveroImplant and Tissue Infectionmultiplex PCR (mPCR) (Curetis) and the clinical impact of this PCR on therapeutic decisions. Materials &methods: AmPCR was performed on 33 joint fluids in addition to standard culture. A group of experts analyzed a posteriori the impact of the mPCR in the patient management. Results: The rate of concordance with culture was 74% (20/27). The sensitivity of the PCR was 59% and the specificity 90%. Clinicians would have started an appropriate treatment sooner for six patients (from 2 to 22days earlier). Conclusion: The PCR would improve the management of 22% of the patients. For other patients, mPCR results have to be completed with the culture.

Comparing the efficacy of antimicrobial pocket-irrigation protocols in an in vivo breast implant infection model

Breast implant infection and biofilm formation are major concerns in reconstructive and esthetic breast surgery, with significant medical and economic consequences. Staphylococcus is the common pathogen, with rapidly increasing rates of methicillin-resistant Staphylococcus aureus (MRSA). There is no consensus on prevention practices. This study compares the effect of several pocket irrigation and antibiotic prophylaxis regimens on implant colonization and biofilm formation in an established rat model of MRSA-infected silicone breast implants. Silicone discs were inserted in a sub-pectoral pocket in 57 rats (114 implants). Implant infection was induced by injection of free planktonic MRSA into the surgical pocket. Rats were allocated to study groups treated by different antimicrobial protocols: pocket irrigation with vancomycin, povidone-iodine, or saline. Each group was divided into subgroups treated with or without additional peri-operative systemic vancomycin. Implant colonization or overt infection was assessed at post-operative day 14 both clinically and by cultures. Pocket irrigation with vancomycin prevented contamination in 87% of implants. Irrigation and systemic vancomycin prevented contamination in 100% of implants with no difference between a single preoperative dose and a 48-h regimen. Systemic vancomycin alone or irrigation with povidone-iodine alone resulted in 100% contamination rates. In this in vivo model, combination of systemic vancomycin with vancomycin pocket irrigation was the most effective regimen, preventing contamination in 100% of implants. Continuation of post-operative antibiotic treatment showed no added advantage.