Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, VA, USA.
Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
J Dent Res. 2024 May;103(5):467-476. doi: 10.1177/00220345241231777. Epub 2024 Apr 15.
Implant osseointegration is reduced in patients with systemic conditions that compromise bone quality, such as osteoporosis, disuse syndrome, and type 2 diabetes. Studies using rodent models designed to mimic these compromised conditions demonstrated reduced bone-to-implant contact (BIC) or a decline in bone mineral density. These adverse effects are a consequence of disrupted intercellular communication. A variety of approaches have been developed to compensate for the altered microenvironment inherent in compromised conditions, including the use of biologics and implant surface modification. Chemical and physical modification of surface properties at the microscale, mesoscale, and nanoscale levels to closely resemble the surface topography of osteoclast resorption pits found in bone has proven to be a highly effective strategy for improving implant osseointegration. The addition of hydrophilicity to the surface further enhances osteoblast response at the bone-implant interface. These surface modifications, applied either alone or in combination, improve osseointegration by increasing proliferation and osteoblastic differentiation of osteoprogenitor cells and enhancing angiogenesis while modulating osteoclast activity to achieve net new bone formation, although the specific effects vary with surface treatment. In addition to direct effects on surface-attached cells, the communication between bone marrow stromal cells and immunomodulatory cells is sensitive to these surface properties. This article reports on the advances in titanium surface modifications, alone and in combination with novel therapeutics in animal models of human disease affecting bone quality. It offers clinically translatable perspectives for clinicians to consider when using different surface modification strategies to improve long-term implant performance in compromised patients. This review supports the use of surface modifications, bioactive coatings, and localized therapeutics as pragmatic approaches to improve BIC and enhance osteogenic activity from both structural and molecular standpoints.
在影响骨质量的系统性疾病患者中，如骨质疏松症、废用综合征和 2 型糖尿病，种植体骨整合减少。使用模拟这些受损条件的啮齿动物模型进行的研究表明，骨与种植体的接触减少（BIC）或骨密度下降。这些不利影响是细胞间通讯中断的结果。已经开发了多种方法来补偿固有受损条件下的改变微环境，包括使用生物制剂和植入物表面改性。化学和物理改性表面特性在微观、中观和纳米尺度上，以紧密模仿在骨中发现的破骨细胞吸收陷窝的表面形貌，已被证明是提高种植体骨整合的非常有效的策略。表面亲水性的增加进一步增强了骨-植入物界面处成骨细胞的反应。这些表面改性，单独或组合使用，通过增加成骨前体细胞的增殖和成骨分化，增强血管生成，同时调节破骨细胞活性以实现净新骨形成，从而改善骨整合，尽管具体效果因表面处理而异。除了对表面附着细胞的直接影响外，骨髓基质细胞和免疫调节细胞之间的通讯对这些表面特性也很敏感。本文报告了钛表面改性的进展，单独使用或与影响骨质量的人类疾病的动物模型中的新型治疗方法联合使用。它为临床医生提供了可转化的观点，当使用不同的表面改性策略来改善受损患者的长期植入物性能时，临床医生可以考虑这些观点。这篇综述支持使用表面改性、生物活性涂层和局部治疗作为实用方法，从结构和分子角度提高 BIC 和增强成骨活性。
