Division of Dental Biomaterials, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Advanced Dental Sciences and Technology Research Center, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Int J Nanomedicine. 2024 May 27;19:4835-4856. doi: 10.2147/IJN.S461549. eCollection 2024.
Metallic dental implants have been extensively used in clinical practice due to their superior mechanical properties, biocompatibility, and aesthetic outcomes. However, their integration with the surrounding soft tissue at the mucosal region remains challenging and can cause implant failure due to the peri-implant immune microenvironment. The soft tissue integration of dental implants can be ameliorated through different surface modifications. This review discussed and summarized the current knowledge of topography-mediated immune response and topography-mediated antibacterial activity in Ti dental implants which enhance soft tissue integration and their clinical performance. For example, nanopillar-like topographies such as spinules, and spikes showed effective antibacterial activity in human salivary biofilm which was due to the lethal stretching of bacterial membrane between the nanopillars. The key findings of this review were (I) cross-talk between surface nanotopography and soft tissue integration in which the surface nanotopography can guide the perpendicular orientation of collagen fibers into connective tissue which leads to the stability of soft tissue, (II) nanotubular array could shift the macrophage phenotype from pro-inflammatory (M1) to anti-inflammatory (M2) and manipulate the balance of osteogenesis/osteoclasia, and (III) surface nanotopography can provide specific sites for the loading of antibacterial agents and metallic nanoparticles of clinical interest functionalizing the implant surface. Silver-containing nanotubular topography significantly decreased the formation of fibrous encapsulation in per-implant soft tissue and showed synergistic antifungal and antibacterial properties. Although the Ti implants with surface nanotopography have shown promising in targeting soft tissue healing in vitro and in vivo through their immunomodulatory and antibacterial properties, however, long-term in vivo studies need to be conducted particularly in osteoporotic, and diabetic patients to ensure their desired performance with immunomodulatory and antibacterial properties. The optimization of product development is another challenging issue for its clinical translation, as the dental implant with surface nanotopography must endure implantation and operation inside the dental microenvironment. Finally, the sustainable release of metallic nanoparticles could be challenging to reduce cytotoxicity while augmenting the therapeutic effects.
金属牙科种植体由于其优越的机械性能、生物相容性和美学效果，已在临床实践中得到广泛应用。然而，它们在黏膜区域与周围软组织的整合仍然具有挑战性，并可能由于种植体周围免疫微环境而导致种植体失败。通过不同的表面改性可以改善牙科种植体的软组织整合。本综述讨论并总结了目前关于钛牙科种植体的形貌介导免疫反应和形貌介导抗菌活性的知识，这些知识可以增强软组织整合及其临床性能。例如，棘刺状和刺状等纳米柱形貌在人唾液生物膜中表现出有效的抗菌活性，这是由于纳米柱之间细菌膜的致命拉伸。本综述的主要发现包括：（I）表面纳米形貌与软组织整合的交叉对话，其中表面纳米形貌可以引导胶原纤维垂直取向进入结缔组织，从而稳定软组织；（II）纳米管状阵列可以将巨噬细胞表型从促炎（M1）转变为抗炎（M2），并操纵成骨/破骨的平衡；（III）表面纳米形貌可以为加载抗菌剂和具有临床意义的金属纳米粒子提供特定的位点，从而功能化植入物表面。含银纳米管状形貌显著减少了种植体周围软组织中纤维性包膜的形成，并表现出协同的抗真菌和抗菌特性。尽管具有表面纳米形貌的钛植入物通过其免疫调节和抗菌特性在体外和体内显示出对软组织愈合的有希望的靶向作用，但需要进行长期的体内研究，特别是在骨质疏松症和糖尿病患者中，以确保其具有免疫调节和抗菌特性的理想性能。产品开发的优化是其临床转化的另一个挑战问题，因为具有表面纳米形貌的牙科植入物必须在牙科微环境中承受植入和操作。最后，金属纳米粒子的可持续释放可能具有挑战性，因为在增强治疗效果的同时减少细胞毒性。
