Surface Of Implants Research Articles

Correlation between Implant Surface Roughness and Implant Stability: A Systematic Review.

The aim of this study was to find in the literature data on the relationship between implant surface roughness and implant stability achieved, from the time of placement to three months afterward, to help us to know what type of surface roughness is more favorable to guarantee implant stability and osseointegration. A systematic review was conducted in accordance with the PRISMA 2020 (Preferred Reporting Items for Systematic Review and Meta-analysis) statement, and the protocol was registered on the Open Science Framework. The specific inclusion and exclusion criteria were selected using the PICOS framework. The databases Medline (PubMed), Scopus, the Web of Science and The Cochrane Library were searched up to October 2023. The selection of studies and data extraction were conducted by two independent reviewers. The review included a total of 11 studies. A total of 1331 dental implant placements were identified. Two of the eleven selected studies were on humans in vivo, eight were on animals in vivo, and one was on animals in vitro. A statistically significant correlation between surface roughness and implant stability as measured by resonance frequency analysis (RFA) was not identified in ten of the eleven selected studies. It appears that there is no correlation between primary stability and the degree of implant roughness. However, there appears to be a correlation between the roughness of the implant and the degree of osseointegration, as indicated by bone-implant contact values. This correlation is more closely related to secondary stability. The great methodological variability makes it difficult to compare data and draw conclusions, so it would be desirable to agree on a common methodology to help draw appropriate conclusions from published studies.

Near-Infrared Responsive Biomimetic Titanate/TiO2-X Heterostructure: A Therapeutic Strategy for Combating Implant-Associated Infection and Enhancing Osseointegration.

Implant-associated infections and delayed osseointegration are major challenges for the clinical success of titanium implants. To enhance antibacterial effects and promote early osseointegration, we developed a synergistic photothermal (PTT)/photodynamic (PDT) therapy strategy based on near-infrared (NIR) responsive biomimetic micro/nano titanate/TiO2-X heterostructure coatings (KMNW and NaMNS) in situ constructed on the surface of titanium implants. Specifically, KMNW and NaMNS significantly enhanced photothermal conversion capabilities, achieving localized high temperatures of 48-51 °C and promoting substantial amounts of reactive oxygen species production under 808 nm irradiation. In vitro antibacterial experiments demonstrated that KMNW achieved the highest antibacterial rates against Staphylococcus aureus and Escherichia coli, at 98.78 and 98.33% respectively. Moreover, by mimicking the three-dimensional fibrous network of the extracellular matrix during bone healing, both KMNW and NaMNS markedly promoted the proliferation and osteogenic differentiation of osteoblasts. In vivo implantation studies further confirmed these findings, with KMNW and NaMNS exhibiting superior antibacterial performance under NIR irradiation─94.45% for KMNW and 92.66% for NaMNS. Moreover, KMNW and NaMNS also significantly promoted new bone formation and improved osseointegration in vivo. This study presents a promising PTT/PDT therapeutic strategy for dentistry and orthopedics by employing NIR-responsive biomimetic coatings to combat implant-associated infection and accelerate osseointegration.

Emerging Strategies to Prevent Bacterial Infections on Titanium-Based Implants.

Titanium and titanium alloys remain the gold standard for dental and orthopedic implants. These materials are heavily used because of their bioinert nature, robust mechanical properties, and seamless integration with bone. However, implant-associated infections (IAIs) remain one of the leading causes of implant failure. Eradicating an IAI can be difficult since bacteria can form biofilms on the medical implant, protecting the bacterial cells against systemic antibiotics and the host's immune system. If the infection is not treated promptly and aggressively, device failure is inevitable, leading to costly multi-step revision surgeries. To circumvent this dire situation, scientists and engineers continue to develop novel strategies to protect the surface of medical implants from bacteria. In this review, details on emerging strategies to prevent infection in titanium implants are reported. These strategies include anti-adhesion properties provided by polymers, superhydrophobic, superhydrophilic, and liquid-infused surface coatings, as well as strategies and coatings employed to lyse the bacteria. Additionally, commercially available technologies and those under preclinical trials are examined while discussing current and future trends.

MICROSTRUCTURE, CHEMICAL COMPOSITION, AND NANOMECHANICAL PROPERTIES OF ARC-PVD ZrTa/ZrTaO2 BILAYER COATINGS

The results of vacuum-arc deposition of thin bilayer ZrTa/ZrTaO2 coatings on the surface of titanium dental implants, AISI-316L stainless steel are presented. The structure, phase and chemical composition of deposited coatings have been investigated by means of scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS) and X-ray diffraction analysis XRD. Nanomechanical properties have been investigated by nanoindentation method. The obtained results can be useful for optimization of implant surfaces to prevent corrosion and mechanical failure, thereby improving osseointegration.

Mechanical properties and biocompatibility of multilayer systems based on amorphous SiN:H/SiCN:H layers on Ti6Al7Nb titanium alloy

Surfaces of metallic implants that replace diseased joints are bound to degrade over time under constant mechanical wear and corrosion, caused by the presence of biological fluids. Production of wear particles and toxic metal ions that follows can undermine both implant stability and patient’s health. To counteract this process multiple surface modifications have been proposed in scientific literature, ranging from simple nitriding to protective layers (e.g.: DLC, CN:H) and multilayer systems. This work presents a combined approach to outlined issue, using multi-staged plasma deposition with SiCN:H layer as a key component, realized using the MW CVD (Microwave Chemical Vapour Deposition) system. The study covers chemical characterization by EDS and FTIR analysis and measurements of relevant functional parameters, such as hardness, Young’s modulus, coefficient of friction, specific wear rate and wettability. Additionally, biocompatibility of modified surfaces are tested on MG-63 cells using Alamar Blue assay, flow cytometry and alkaline phosphatase (ALP) assay. Chemical and microscopic studies revealed amorphous cauliflower-like microstructures that have proven to be hydrogenated SiCN/SiN structures. The obtained layers are turned out to be biocompatible (>70 % of cell survival rate), additionally layers based on amorphous SiCN:H boost ALP activity due to combination of their chemistry and mechanical properties.

Relationship between Roughness and Wettability of Nine Types of Implant Surfaces and Potential Interference of Surface Oxygen and Carbon: In Vitro Evaluation.

Aim: To assess the roughness and hydrophilicity of nine types of dental implant surfaces, while also examining the presence of contaminants carbon and oxygen on these surfaces. Furthermore, the study investigated potential correlations between these characteristics across the analyzed surfaces. Materials and Methods: The surfaces analyzed were as follows: MI: machined (turned), Implacil implant; TOI: blasted with titanium oxide, Implacil implant; TOAEI: blasted with titanium oxide and acid-etched, Implacil implant; ZAED: blasted with zirconia and acid-etched, DSP implant; CPD: coated with calcium phosphate, DSP implant; XD: subjected to an experimental treatment (patent pending), DSP implant; DAEHAS: double acid-etched and activated with hydroxyapatite nano-crystals, SIN implant; DAES: double acid-etched, SIN implant; and AMP: untreated surface of the Plenum implant, produced by additive manufacturing. Four and five disc-shaped specimens were used in the hydrophilicity and roughness assessments, respectively. Roughness was evaluated by optical profilometry and scanning electron microscopy; hydrophilicity was determined using the sessile-drop technique; and the chemical analysis was performed using X-ray photoelectron spectroscopy. The Kruskal- Wallis, Mann-Whitney, and Spearman correlation tests were employed to analyze the data (p < 0.10). Results: Significant differences were observed among the analyzed surfaces in terms of both roughness and hydrophilicity (p < 0.001). The surface exhibiting the highest roughness was AMP, whereas the greatest hydrophilicity was exhibited by CPD. Correlations between roughness and hydrophobicity were observed for MI (r = 0.936, p = 0.009), ZAED (r = 0.957, p = 0.004), and DAES (r = 0.964, p = 0.005). The carbon concentration observed on the CPD surface was lower than that observed on the other surfaces, whereas the oxygen concentrations were similar. No correlations were observed between the presence of contaminants and the roughness or hydrophilicity characteristics. Conclusion: Roughness and hydrophilicity values exhibited considerable variation among the tested surfaces. Aside from the CPD surface, comparable concentrations of carbon and oxygen were detected. Although correlations between roughness and hydrophilicity were observed only for the ZAED, DAES, and MI surfaces, these correlations were inadequate to establish a causal relationship between the two surface characteristics.

Tribological behaviour of laser textured Ti3AlV 2.5V alloy under simulated body fluid

The use of lasers to fabricate micro-textures on the surface of medical implants is an effective method to improve their bio-tribological properties. In the present study, three distinct configurations of micro-textures, namely, co-axial circles, hexagon, and line with varying spacing of 300 µm, 400 µm, and 500 µm, were fabricated on Ti3Al2.5V alloy using Nd:YAG fibre lasers. The influence of micro-textured geometries on microhardness, coefficient of friction (COF), and wear rate was estimated. The tribological properties of the polished and textured samples were investigated using a linear reciprocating tribometer against silicon nitride (Si3N4) balls under simulated body fluid (SBF) lubricant. Orthogonal results indicate that the co-axial circles with a spacing of 305 µm prove to be the most efficient in enhancing the tribological performance of textured surfaces. This configuration demonstrates a significant improvement, with a 33.62 % reduction in friction coefficient and a 61.81 % reduction in wear rate compared to polished samples. The decrease in spacing appears to enhance the anti-friction and anti-wear properties of the textured surfaces. The working mechanism behind the reduction in the friction coefficient and wear rate lies in the capacity of the textures to trap particles.

Zirconia Implants: A Brief Review and Surface Analysis of a Lost Implant

Zirconia implants have emerged as a valuable alternative for clinical scenarios where aesthetic demands are high, as well as in cases of hypersensitivity to titanium or for patients who refuse metallic objects in their bodies due to personal reasons. However, these implants have undergone various changes in geometry, manufacturing techniques, and surface modifications since the introduction of the first zirconia implants. The present study aims to review the current evidence on zirconia implants, considering the changes they have undergone in recent years. Additionally, it aims to analyze the three-dimensional surface characteristics of a failed zirconia implant using scanning electron microscopy and elemental analysis with energy-dispersive X-ray spectrometry (EDX). A zirconia implant lost three weeks after placement was immediately assessed using VP-SEM equipment and chemically analyzed by EDX using a 410-M detector connected to the microscope. Sparse material depositions were found on all parts of the implant, with a notable concentration in the thread grooves. The elements identified in the sample included zirconium, oxygen, carbon, calcium, and phosphorus. This report demonstrates that the surface of zirconia implants can accumulate elements early in the process of bone matrix neoformation, which is consistent with the initial stage of osseointegration.

Preventing bacterial adhesion on scaffolds for bone tissue engineering

Bone implant infection constitutes a major sanitary concern which is associated to high morbidity and health costs. This manuscript focused on overviewing the main research efforts committed up to date to develop innovative alternatives to conventional treatments, such as those with antibiotics. These strategies mainly rely on chemical modifications of the surface of biomaterials, such as providing it of zwitterionic nature, and tailoring the nanostructure surface of metal implants. These surface modifications have successfully allowed inhibition of bacterial adhesion, which is the first step to implant infection, and preventing long-term biofilm formation compared to pristine materials. These strategies could be easily applied to provide three-dimensional (3D) scaffolds based on bioceramics and metals, of which its manufacture using rapid prototyping techniques was reviewed. This opens the gates for the design and development of advanced 3D scaffolds for bone tissue engineering to prevent bone implant infections.

Nanotechnology applications in breast implant manufacturing for improved durability and functionality

Breast implants are often used in restorative and cosmetic surgeries. However, the materials used for implants today could be better regarding biocompatibility and mechanical strength. It is possible to make composite biomaterials out of nanomaterials with better mechanical qualities than common implant materials like silicone elastomers and saline-filled shells. Researchers have found that adding carbon nanotubes, graphene, and hydroxyapatite nanoparticles to the shells of metal and silicone implants makes them much stronger, more flexible, and less likely to break. Researchers are also looking into polymer nanocomposites made of polycaprolactone and polylactic acid to see if they can break down better and integrate better with tissues. Changing the surface of implants at the nanoscale level can make them more biocompatible by controlling how proteins stick to the material and how cells interact with it. Animal tests with nanocoatings of polyacrylate, chitosan, and hyaluronic acid showed that they lowered the formation of capsules and inflammation. Antimicrobial nanoparticles, such as silver, zinc oxide, and antibiotics, are attached to the surfaces of implants to protect against infections and release drugs locally. Nanocontrast agents are used in high-resolution MRI and ultrasound images of implant shell integrity to get new imaging and diagnosis tools. By tracking biomarkers, nanostructured sensors could be used to find seromas, ruptures, and device failures with little to no damage. Much work has been done to show that different nanotechnologies can help breast implants in a pre-clinical setting. However, problems with regulation and standardization still need to be fixed before the implants can be used in people and made in large quantities. The process needs to be improved even more to make a lot of nanocomposite and etched surfaces. To make sure patients are safe, it is also important to do long-term biocompatibility and nanotoxicology tests. Nanotechnology has a lot of promise to change the way breast implants are made so that they look better and improve people's quality of life. This review examines nanotechnology's emerging applications for enhancing breast implants' durability and performance.

Clinical Evaluation of Hard and Soft Tissue Parameters around Implant Surfaces Bio –Modified with Alendronate

Clinical Evaluation of Hard and Soft Tissue Parameters around Implant Surfaces Bio –Modified with Alendronate

Therapeutic Efficacy of an Erythromycin-Loaded Coaxial Nanofiber Coating in a Rat Model of S. aureus-Induced Periprosthetic Joint Infection.

Implant surface nanofiber (NF) coatings represent an alternative way to prevent/treat periprosthetic joint infection (PJI) via local drug release. We developed and characterized a coaxial erythromycin (EM)-doped PLGA/PCL-PVA NF coating. The purpose of this study was to determine the efficacy of EM-NF coatings (EM0, no EM, EM100 (100 mg/mL), and EM1000 (1000 mg/mL) wt/wt) in a rat PJI model. A strong bond of the EM-NF coating to the surface of titanium (Ti) pins was confirmed by in vitro mechanical testing. Micro-computed tomography (mCT) analysis showed that both EM100 and EM1000 NF effectively reduced periprosthetic osteolysis compared to EM0 at 8 and 16 weeks after implantation. Histology showed that EM100 and EM1000 coatings effectively controlled infection and enhanced periprosthetic new bone formation. The bone implant contact (BIC) of EM100 (35.08%) was higher than negative controls and EM0 (3.43% and 0%, respectively). The bone area fraction occupancy (BAFO) of EM100 (0.63 mm2) was greater than controls and EM0 (0.390 mm2 and 0.0 mm2, respectively). The BAFO of EM100 was higher than that of EM1000 (0.3 mm2). These findings may provide a basis for a new implant surface fabrication strategy aimed at reducing the risks of defective osseointegration and PJI.

Synergistic Bactericidal Effect of Zn2+ Ions and Reactive Oxygen Species Generated in Response to Either UV or X-ray Irradiation of Zn-Doped Plasma Electrolytic Oxidation TiO2 Coatings.

Zn-containing TiO2-based coatings with Na, Ca, Si, and K additives were obtained by plasma electrolytic oxidation (PEO) of Ti in order to achieve an effective and broad bactericidal protection without compromising biocompatibility. A protocol has been developed for cleaning the coating surface from electrolyte residues, ensuring the preservation of the microstructure and composition of the surface layer. Using high-resolution transmission electron microscopy, three characteristic microstructural zones in the PEO-Zn coating are well documented: zone 1 with a TiO2-based nanocrystalline structure, zone 2 with an amorphous structure, and zone 3 around pores with an amorphous-nanocrystalline structure. The excellent cytocompatibility of PEO-Zn samples was confirmed by three different methods: monitoring the proliferation of MC3T3-E1 cells, assessing the viability of sheep osteoblast cells using calcein-AM staining and fluorescence microscopy, and incubation with spheroids based on primary osteoblast cells and mouse embryonic fibroblast NIH3T3 cells. The PEO-Zn coatings absorb >60% of the incident light over the UV and Vis-NIR spectral ranges. After 24 h, the PEO-Zn coatings completely inactivate four types of strains: Gram-positive Staphylococcus aureus CSA154 and ATCC29213 and Gram-negative Escherichia coli K261 and U20, and also prevent E. coli U20 and K261 biofilm formation. The superior antibacterial activity is associated with the synergistic effect of Zn2+ ions in safe concentration and reactive oxygen species (ROS) generated in response to either UV irradiation or soft short-term X-ray irradiation. The X-ray irradiation-induced ROS formation by a PEO coating is reported for the first time. The enhanced bactericidal activity after X-ray irradiation compared to UV illumination is attributed to the more intense ROS generation in the first few hours. The results obtained significantly expand the possibilities of using PEO coatings on the surfaces of titanium implants.

Synthesis of Heterostructured TiO2 Nanopores/Nanotubes by Anodizing at High Voltages.

This paper reports on the coating of heterostructured TiO2 nanopores/nanotubes on Ti substrates by anodizing at high voltages to design surfaces for biomedical implants. As the anodized voltage from 50 V to 350 V was applied, the microstructure of the coating shifted from regular TiO2 nanotubes to heterostructured TiO2 nanopores/nanotubes. In addition, the dimension of the heterostructured TiO2 nanopores/nanotubes was a function of voltage. The electrochemical characteristics of TiO2 nanotubes and heterostructured TiO2 nanopores/nanotubes were evaluated in simulated body fluid (SBF) solution. The creation of heterostructured TiO2 nanopores/nanotubes on Ti substrates resulted in a significant increase in BHK cell attachment compared to that of the Ti substrates and the TiO2 nanotubes.

The Addition of Hydroxyapatite Nanoparticles on Implant Surfaces Modified by Zirconia Blasting and Acid Etching to Enhance Peri-Implant Bone Healing.

This study investigated the impact of adding hydroxyapatite nanoparticles to implant surfaces treated with zirconia blasting and acid etching (ZiHa), focusing on structural changes and bone healing parameters in low-density bone sites. The topographical characterization of titanium discs with a ZiHa surface and a commercially modified zirconia-blasted and acid-etched surface (Zi) was performed using scanning electron microscopy, profilometry, and surface-free energy. For the in vivo assessment, 22 female rats were ovariectomized and kept for 90 days, after which one implant from each group was randomly placed in each tibial metaphysis of the animals. Histological and immunohistochemical analyses were performed at 14 and 28 days postoperatively (decalcified lab processing), reverse torque testing was performed at 28 days, and histometry from calcified lab processing was performed at 60 days The group ZiHa promoted changes in surface morphology, forming evenly distributed pores. For bone healing, ZiHa showed a greater reverse torque, newly formed bone area, and bone/implant contact values compared to group Zi (p < 0.05; t-test). Qualitative histological and immunohistochemical analyses showed higher features of bone maturation for ZiHa on days 14 and 28. This preclinical study demonstrated that adding hydroxyapatite to zirconia-blasted and acid-etched surfaces enhanced peri-implant bone healing in ovariectomized rats. These findings support the potential for improving osseointegration of dental implants, especially in patients with compromised bone metabolism.

The treatment of bacterial biofilms cultivated on knee arthroplasty implants using the bioelectric effect.

Introduction: The formation of bacterial biofilms on knee arthroplasty implants can have catastrophic consequences. The aim of this study was to analyze the effectiveness of the bioelectric effect in the elimination of bacterial biofilms on cultivated knee arthroplasty implants. Methods: A novel device was designed to deliver a bioelectric effect on the surface of knee arthroplasty implants. 4-femoral prosthetic implants were cultivated with a staphylococcus aureus inoculum for 15days. The components were divided into four different groups: A (not treated), B (normal saline 20-minutes), C (bioelectric effect 10-minutes), D (bioelectric effect 20-minutes). The implants were sonicated, and the detached colonies were quantified as the number of colony-forming unit (CFUs). The implants were sterilised and the process was repeated in a standardized manner four more times, to obtain a total of five samples per group. Results: The number of the CFUs after a 10-minute exposure to the bioelectric effect was of 208.2 ± 240.4, compared with 6,041.6 ± 2010.7 CFUs in group A, representing a decrease of 96.5% ± 4.3 (p = 0.004). And a diminution of 91.8% ± 7.9 compared with 2,051.0 ± 1,364.0 CFUs in group B (p = 0.109). The number of bacterial colonies after a 20-minute exposure to the bioelectric effect was 70 ± 126.7 CFUs, representing a decrease of 98.9% ± 1.9 (p = 0.000) compared with group A. And a decrease of 97.8% ± 3.0 (p = 0.019) compared with group B. Conclusions: The bioelectric effect was effective in the elimination of bacterial biofilm from knee arthroplasty implants. This method could be used in the future as part of conventional surgical procedures.

Electrophoretic Deposition and Characterization of Curcumin/Chitosan Coatings

The purpose of the study was to investigate the electrophoretic deposition (EPD) route, microstructure and surface properties of composite curcumin/chitosan coatings on commercially pure titanium substrates for biomedical applications. Multiple routes of preparation of the dispersed systems for the EPD process and their electrokinetic properties have been investigated to obtain homogeneous coatings. The zeta potential of solutions with various curcumin content in ethanol or isopropanol proved their relatively low electrophoretic mobility. Thus, curcumin was co-deposited with chitosan molecules on the cathode. The surface morphology of the coatings consisted of submicrometric curcumin particles embedded in the chitosan matrix. The increase in the curcumin content in the ethanol caused large agglomerates and undissolved curcumin particles to appear on the coating surface. The coatings were characterized by high adhesion to the substrate and a water contact angle in the range of 85° to 95°. The coatings changed the zeta potential of the titanium surface from significantly negative (−46.7 ± 2.3 mV) to less negative values (−20.6 ± 2.6 mV). The developed coatings are promising for mitigating biofilm formation on the surface of titanium bone implants.

Plasma-Sprayed Osseoconductive Hydroxylapatite Coatings for Endoprosthetic Hip Implants: Phase Composition, Microstructure, Properties, and Biomedical Functions

This contribution attempts to provide a state-of-the-art account of the physicochemical and biomedical properties of the plasma-sprayed hydroxylapatite (HAp) coatings that are routinely applied to the surfaces of metallic endoprosthetic and dental root implants designed to replace or restore the lost functions of diseased or damaged tissues of the human body. Even though the residence time of powder particles of HAp in the plasma jet is extremely short, the high temperature applied induces compositional and structural changes in the precursor HAp that severely affect its chemical and physical properties and in turn its biomedical performance. These changes are based on the incongruent melting behavior of HAp and can be traced, among many other analytical techniques, by high resolution synchrotron X-ray diffraction, vibrational (Raman) spectroscopy, and nuclear magnetic resonance (NMR) spectroscopy. In vivo reactions of the plasma-sprayed coatings to extracellular fluid (ECF) can be assessed and predicted by in vitro testing using simulated body fluids (SBFs) as proxy agents. Ways to safeguard the appropriate biological performance of HAp coatings in long-term service by controlling their phase content, porosity, surface roughness, residual stress distribution, and adhesion to the implant surface are being discussed.

A comparison of textured vs smooth surfaced implants in sub fascial breast augmentation.

Subfascial placement of breast implants has the advantages of subglandular and submuscular placement without the adverse outcomes. This study examined the differences in outcomes between textured and smooth implants. A total of 385 patients underwent subfascial breast augmentation in two cohorts. The initial series (n=209) employed textured implants and the second (n=176) employed smooth implants. In all other respects, patient management was identical. Adverse outcomes, changes in breast morphometry, and patient satisfaction were compared between the two groups. The follow-up period ranged from to 74-272 weeks for smooth implants (mean 164 weeks, STD 50.6) and 78-279 weeks for textured implants (mean= 186 weeks, STD=54). The incidence of capsular contracture was the same for smooth and textured implants (4.7% and 6.2%, P=.64). Changes in breast shape at the lower pole, patient satisfaction, and the incidence of other adverse outcomes were the same in both groups. Subfascial placement of smooth and textured breast implants yielded similar outcomes.

Impact of surface chemical treatment in surgical regenerative treatment of ligature-induced peri-implantitis: A canine study.

Implant surface decontamination is a critical step in peri-implantitis treatment. The aim of this study was to assess the effect chemotherapeutic agents have on reosseointegration after treatment on ligature-inducted peri-implantitis. Six male canines had 36 implants placed and ligatures were placed around them for 28 weeks to establish peri-implantitis. The peri-implant defects were randomly treated by 1 of 3 methods: 0.12% chlorhexidine (CHX test group), 1.5% sodium hypochlorite (NaOCl test group), or saline (Control group). Sites treated with NaOCl and CHX were grafted with autogenous bone, and all sites then either received a collagen membrane or not. Histology sections were obtained at 6 months postsurgery to assess percentage of reosseointegration. Thirty-five implants were analyzed (CHX: 13; NaOCl: 14; Control:8). NaOCl-treated sites demonstrated reosseointegration with direct bone-to-implant-contact on the previously contaminated surfaces (42% mean reosseointegration), which was significantly higher than Controls (p<0.05). Correspondingly, clinical improvement was noted with a significant reduction in probing depth from 5.50±1.24mm at baseline to 4.46±1.70mm at 6-months postsurgery (p=0.006). CHX-treated sites demonstrated a nonsignificant reosseointegration of 26% (p>0.05); however, in the majority of cases, the new bone growth was at a distance from the implant surface without contact. Probing depths did not improve in the CHX group. The use of membrane did not influence reosseointegration or probing depths (all p>0.05). Titanium implants with peri-implantitis have the capacity to reosseointegrate following regenerative surgery. However, treatment response is contingent upon the chemotherapeutic agent selection. Additional chemical treatment with 1.5% NaOCl lead to the most favorable results in terms of changes in defect depth and percentage of reosseointegration as compared to CHX, which may hinder reosseointegration.