Quaternized chitosan/glycyrrhizic acid co-decorated titanium with enhanced antimicrobial, immunomodulatory, and osteogenic properties for dental implant applications.

Sandblasted and acid-etched titanium (SLA-Ti) implants encounter significant challenges in dental implant applications owing to their susceptibility to bacterial infections, inflammatory responses, and insufficient osseointegration. Herein, we developed a novel SLA-Ti co-decorated with phloretic acid-modified quaternized chitosan (PQCS) and oxidized glycyrrhizic acid (OGA), referred to as the SLA/PQCS/OGA. The SLA/PQCS/OGA demonstrated exceptional biocompatibility, with low hemolytic toxicity, negligible cytotoxicity, and systemic biosafety in rat models. In vitro and in vivo assays confirmed its superior antimicrobial efficacy against methicillin-resistant Staphylococcus aureus and Escherichia coli. Furthermore, the SLA/PQCS/OGA polarized macrophages toward the pro-healing M2 phenotype by inhibiting the nuclear factor-kappa B pathway and activating the Janus kinase 2/signal transducer and activator transcription 3 axis. With a high reactive oxygen species scavenging rate, the SLA/PQCS/OGA also significantly enhanced the osteogenic differentiation of MC3T3-E1 cells and promoted mineralization in vitro. Our study developed a highly efficient strategy for engineering functional polysaccharide-decorated SLA-Ti. This approach highlights the potential of chitosan derivatives and glycyrrhizic acid in dental implant applications, thereby advancing research and development in polysaccharide science and technology.