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Advanced Biomaterials for Bone and Soft Tissue Regeneration, Perimplantitis Treatment, Implant Prosthetics

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A special issue of Materials (ISSN 1996-1944). This special issue belongs to the section "Biomaterials".

Deadline for manuscript submissions: 20 December 2024 | Viewed by 18717

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Prof. Dr. Tiziano Testori

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1. IRCCS Orthopedic Institute Galeazzi, Dental Clinic (Dean: Luca Francetti MD, DDS), Section of Implant Dentistry and Oral Rehabilitation (Head: Tiziano Testori MD, DDS, FICD), Milan, Italy
2. Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
3. Adjunct Clinical Associate Professor, Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry
Interests: implant dentistry; biomaterials; bone grafts
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Prof. Dr. Massimo Del Fabbro

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1. Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20122 Milan, Italy
2. Dental and Maxillo-Facial Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
Interests: oral and maxillofacial surgery; MRONJ management; temporomandibular joint disorders; bone regeneration; head and neck cancer; dental implants; zygomatic implants; guided surgery; biomaterials; tissue engineering; CAD/CAM methods; virtual surgical planning
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The development of biomaterials for restoring hard and soft tissue lost for different reasons includes several aspects of basic sciences, such as physiology, stem cell biology, chemistry, biomolecules, and physical sciences. The knowledge of such aspects allows us to understand how biomaterials interact with living tissues, which may improve clinical procedures and optimize treatment protocols.

In recent years, there has been an increased interest in applying advanced biotechnologies to tissue engineering in dentistry. Three-dimensional nano-scaffolds combined with growth factors, signaling molecules and cell therapies, innovative implant surfaces, and prosthetic solutions have proved to be promising approaches in oral surgery protocols aiming to improve wound healing, prevent bone resorption, and preserve the alveolar ridge in order to provide sufficient bone support for oral rehabilitation.

The aim of this Special Issue is to evaluate original research papers, reviews, and technical reports, encouraging manuscripts concerning the state of the art in the fields of bioinspired approaches and materials for the treatment of periimplantitis, the management of soft tissue around implants, and the development of innovative implant prosthetic solutions.

Potential topics include but are not limited to the following:

Dental implants, biomaterials, and surface properties;
Novel approaches for periimplantitis;
Predictable soft tissue management around implants;
Novel biomaterials for regenerative medicine;
Applications of biomolecules for bone regeneration;
Dental pulp stem cells for bone regeneration;
Bioprinted enriched scaffolds for tissue engineering;
Stem cells and blood-derived growth factors for hard and soft tissue healing;
Antioxidant protection against oxidative stress for improving tissue healing and regeneration procedures.

Prof. Dr. Tiziano Testori
Prof. Dr. Massimo Del Fabbro
Guest Editors

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Keywords

biomaterials
tissue regeneration
tissue engineering
regenerative medicine
implant surfaces
bone regeneration
osseointegration
wound healing
periimplantitis
soft tissue management
implant prosthetic solutions

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Published Papers (9 papers)

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Research

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9 pages, 1132 KiB

Open AccessArticle

Preload and Removal Torque of Two Different Prosthetic Screw Coatings—A Laboratory Study

by Lara Coelho, José Manuel Mendes, Joana Mendes, Carlos Aroso, António Sérgio Silva and Maria-Cristina Manzanares-Céspedes

Materials 2024, 17(6), 1414; https://doi.org/10.3390/ma17061414 - 20 Mar 2024

Viewed by 1102

Abstract

This study aimed to evaluate the effect of two coating materials, a silicone sealing gel and a polytetrafluoroethylene (PTFE) tape, on the screw preload and removal torque value (RTV) to develop strategies to prevent prosthetic screw loosening. We examined 45 complexes comprising an implant, abutment, and prosthetic screw, of which 15 samples were uncoated, 15 were coated with GapSeal^® (Hager & Werken GmbH & Co., Duisburg, Germany), and 15 were coated with PTFE tape (MIARCO^®, Valencia, Spain). The screws were tightened to register the preload and then untightened to register the RTV. The preload values showed a statistically significant difference only in the PTFE group, suggesting that this lubricant negatively affects the preload. The RTVs showed statistically significant differences among all groups, with the GapSeal^® group and PTFE group showing the highest and lowest values, respectively. It can be concluded that the application of the PTFE tape on the screw significantly reduced the preload and RTV. The silicone sealing gel did not affect the preload but increased the RTV. Therefore, the use of GapSeal^® should be considered to prevent prosthetic screw loosening, while the use of PTFE tape should be avoided. Full article

(This article belongs to the Special Issue Advanced Biomaterials for Bone and Soft Tissue Regeneration, Perimplantitis Treatment, Implant Prosthetics)

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12 pages, 1172 KiB

Open AccessArticle

Tissue-Level Laser-Lok Implants Placed with a Flapless Technique: A 4-Year Clinical Study

by Andrea Spinelli, Fausto Zamparini, Georgios Romanos, Maria Giovanna Gandolfi and Carlo Prati

Materials 2023, 16(3), 1293; https://doi.org/10.3390/ma16031293 - 2 Feb 2023

Cited by 4 | Viewed by 1880

Abstract

Background: The present study aims to analyze the use of Laser-Lok microtextured neck implants placed with a transmucosal surgical approach. The marginal bone level (MBL) and periodontal parameters were evaluated in a cohort prospective 4-year clinical study. Methods: A total of 41 implants were placed in 36 healthy consecutive patients (16 males, 20 females, mean age 60 ± 9 years). Tapered tissue level implants, characterized by a 2.0 mm laser-microtextured neck, were used with a flapless approach. Customized abutments and provisional resin crowns were positioned. Definitive metal–ceramic crowns were cemented approximately 4 months after insertion. Periapical radiographs were taken after 1, 3, 6, 12, 36 and 48 months from implant placement to evaluate MBL. Gingival thickness (thin/thick), plaque score (PS) and bleeding on probing (BoP) were evaluated. Results: After 48 months, all implants were safe from complications. No complications, peri-implantitis, early implant failures or mucositis occurred. The survival rate was 100%. Mean MBL during the follow-up was −0.15 ± 0.18 at T1, −0.29 ± 0.29 at T3, −0.45 ± 0.37 at T6, −0.53 ± 0.45 at T12, −1.06 ± 1.13 at T 36 and −1.10 ± 0.89 at T 48. Implants placed 2–3 months after tooth extraction revealed lower MBL variation when compared to those placed immediately (in fresh extraction sockets) or in completely healed ridges (delayed group). Narrower diameter implants (3.8 mm) showed significantly higher MBL variation when compared to 4.6 diameter implants. Multilevel analysis at T48 revealed that among all the evaluated variables, implant diameter was the factor mostly associated with MBL modifications (p = 0.027). Conclusion: This 4-year clinical study supports the use of Laser-Lok implants placed at tissue level with a flapless approach. A limited bone loss during the 48-month follow-up was observed. Periodontal parameters were stable with no sign of inflammation or soft tissue alteration. The use of Laser-Lok implants with transmucosal surgery represents a suitable technique with a minimally invasive approach. Full article

(This article belongs to the Special Issue Advanced Biomaterials for Bone and Soft Tissue Regeneration, Perimplantitis Treatment, Implant Prosthetics)

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18 pages, 4837 KiB

Open AccessArticle

Concurrence of High Corrosion Resistance and Strength with Excellent Ductility in Ultrafine-Grained Mg-3Y Alloy

by Mária Zemková, Peter Minárik, Eva Jablonská, Jozef Veselý, Jan Bohlen, Jiří Kubásek, Jan Lipov, Tomáš Ruml, Vojtěch Havlas and Robert Král

Materials 2022, 15(21), 7571; https://doi.org/10.3390/ma15217571 - 28 Oct 2022

Cited by 5 | Viewed by 1899

Abstract

In the field of magnesium-based degradable implantable devices, the Mg-Y-RE-Zr alloying system (WE-type) has gained popularity due to its satisfying degradation rate together with mechanical strength. However, utilization of RE and Zr in the WE-type alloys was originally driven to improve Mg-based alloys for high-temperature applications in the industry, while for medical purposes, there is a question of whether the amount of alloying elements may be further optimized. For this reason, our paper presents the Mg-3Y (W3) magnesium alloy as an alternative to the WE43 alloy. This study shows that the omission of RE and Zr elements did not compromise the corrosion resistance and the degradation rate of the W3 alloy when compared with the WE43 alloy; appropriate biocompatibility was preserved as well. It was shown that the decrease in the mechanical strength caused by the omission of RE and Zr from the WE43 alloy could be compensated for by severe plastic deformation, as achieved in this study, by equal channel angular pressing. Ultrafine-grained W3 alloy exhibited compression yield strength of 362 ± 6 MPa and plastic deformation at maximum stress of 18 ± 1%. Overall, the early results of this study put forward the motion of avoiding RE elements and Zr in magnesium alloy as a suitable material for biodegradable applications and showed that solo alloying of yttrium is sufficient for maintaining desirable properties of the material at once. Full article

(This article belongs to the Special Issue Advanced Biomaterials for Bone and Soft Tissue Regeneration, Perimplantitis Treatment, Implant Prosthetics)

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10 pages, 1290 KiB

Open AccessArticle

Healing of Alveolar Sockets Treated with Concentrated Growth Factors: A Split-Mouth Study

by Marco Mozzati, Margherita Tumedei, Giorgia Gallesio, Giulio Menicucci, Carlo Manzella, Tiziano Testori and Massimo Del Fabbro

Materials 2022, 15(14), 4859; https://doi.org/10.3390/ma15144859 - 12 Jul 2022

Cited by 8 | Viewed by 1847

Abstract

Background: tooth extraction is a common procedure in oral surgery. The socket healing process involves hard and soft tissues and is characterized by intense remodeling, which may determine consistent dimension changes. Several autologous platelet concentrates (APCs) proved to be effective for enhancing alveolar socket healing after tooth extraction, accelerating socket closure and countering alveolar bone resorption. Concentrated growth factors (CGFs) are one of the most recently developed APCs, and their effect on the socket healing process still needs to be confirmed. Aim: The aim of the present split-mouth study was to evaluate the effectiveness of CGFs in enhancing the healing process in the postextraction alveolar socket and reducing postoperative pain. Methods: One hundred and fifty-four extractions were performed. One of the extraction sockets of each patient was treated with CGFs (test site), and the other socket was unfilled (control site). The main outcomes were: healing index, alveolar dimensions at the crestal level, socket closure, and pain perception. Descriptive statistics of the results were analyzed. Follow-up data were compared to baseline using paired tests. Results: The healing index on day 7 was significantly better (p < 0.001) in the test group (5.01 ± 1.30) as compared to the control group (6.65 ± 1.41). The mean visual analog scale for pain (VAS) was significantly higher for the control group when compared to the CGF group in the first 5 days postextraction. There was a trend toward greater socket closure in the CGF group, indicating faster healing, as compared to the control group at 7, 14, and 21 days. Conclusions: CGFs can represent a useful adjunctive tool, considering their mechanical and biological properties, for improving alveolar socket healing and reducing postoperative patient discomfort. Full article

(This article belongs to the Special Issue Advanced Biomaterials for Bone and Soft Tissue Regeneration, Perimplantitis Treatment, Implant Prosthetics)

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12 pages, 2256 KiB

Open AccessArticle

Disinfection and Biocompatibility of Titanium Surfaces Treated with Glycine Powder Airflow and Triple Antibiotic Mixture: An In Vitro Study

by Mario Alovisi, Massimo Carossa, Narcisa Mandras, Janira Roana, Massimo Costalonga, Lorenza Cavallo, Enrico Pira, Maria Grazia Putzu, Davide Bosio, Ilaria Roato, Federico Mussano and Nicola Scotti

Materials 2022, 15(14), 4850; https://doi.org/10.3390/ma15144850 - 12 Jul 2022

Cited by 20 | Viewed by 2353

Abstract

The aim of this in vitro study was to compare three disinfection protocols of biofilm-coated machined (MAC) and acid etched (SLA) commercial pure Grade 4 Titanium disks. Samples were infected with a vial of polymicrobial biofilm to simulate peri-implantitis in vitro. Seventeen MAC and twenty SLA titanium disks were randomly assigned to: (1) glycine powder air-flow (GYPAP) for 1 min; (2) a local delivered triple paste antibiotic composed by a gel mixture with ciprofloxacin, metronidazole, and clarithromycin (3MIX) for 1 h; and (3) a combination of both (GYPAP + 3MIX). Biocompatibility of the titanium disks after each treatment protocol was assessed by measurement of adhesion and growth of adipose-derived mesenchymal stem cells (ASCs) after 24 and 72 h. A confocal laser scanning microscope (CLSM) assessed the antibacterial effect of each treatment. Data of the antibacterial efficacy and cell viability were presented as mean with standard deviation and calculated by one-way ANOVA with multiple comparisons via Bonferroni tests. Results were considered significant with p < 0.05. The higher cell viability was achieved by the 3MIX and GYPAP combination on the SLA surfaces after 72 h. CLSM analysis showed a mean ratio of dead bacteria statistically higher in the 3MIX + GYPAP group compared with the GYPAP and 3MIX subgroups (p < 0.05). In conclusion, data showed that the combination of GYPAP and 3MIX could be preferred to the other protocols, especially in presence of SLA titanium surface. Full article

(This article belongs to the Special Issue Advanced Biomaterials for Bone and Soft Tissue Regeneration, Perimplantitis Treatment, Implant Prosthetics)

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12 pages, 1809 KiB

Open AccessArticle

Radiographic Analysis of Graft Dimensional Changes after Lateral Maxillary Sinus Augmentation with Heterologous Materials and Simultaneous Implant Placement: A Retrospective Study in 18 Patients

by Luca Comuzzi, Margherita Tumedei, Adriano Piattelli, Gianluca Tartaglia and Massimo Del Fabbro

Materials 2022, 15(9), 3056; https://doi.org/10.3390/ma15093056 - 22 Apr 2022

Cited by 5 | Viewed by 1646

Abstract

Background: This investigation aimed to radiographically assess the variations of graft dimension following maxillary sinus augmentation by the lateral approach. Methods: Eighteen patients (seven males), with a mean age at surgery of 66.5 ± 9.8 (range 52–82) years, were unilaterally treated. Thirty-five dental implants were positioned in the posterior maxilla simultaneously to grafting with heterologous biomaterials. Intraoral radiographs taken at the time of surgery, after six months, and at the longest follow-up (up to nine years after implant placement) were analyzed. The following distances were measured: mesio-distal width of the graft, vertical distance from implant apex to most coronal level of the graft, distance from the mesial aspect of the (mesial) implant to the mesial graft extension; distance from the distal aspect of the (distal) implant to the distal graft extension, and graft height along the implant axis. The dimensional changes with respect to baseline, after six months and at the longest follow-up were calculated. Results: The patient-based mean follow-up was 38.3 ± 30.1 months (range 12–108 months). The mean residual bone height at the mesial and distal aspect of the implants was 3.19 ± 2.05 mm and 2.65 ± 1.60 mm, respectively (p = 0.38). The mean graft width at baseline was 27.95 ± 5.23 mm, and the mean graft width reduction was 10.2 ± 12.7% (2.98 ± 3.62 mm) and 11.3 ± 14.4% (3.36 ± 4.08 mm) at six months and at the latest follow-up. The change was significant at six months (p = 0.005), but did not show significant further variation (p = 0.11). On the mesial and distal aspect, the mean graft extension decreased by 1.56 ± 2.67 mm and 0.84 ± 2.71 mm at the latest follow-up. No significant difference between mesial and distal changes was found (p = 0.24), suggesting that the biomaterial is resorbed homogeneously on both sides. The mean graft height was 11.92 ± 2.53 mm at baseline and decreased by 9.3 ± 9.05% (1.11 ± 1.09 mm) at six months (p < 0.001). Non-significant further changes were found at the latest follow-up (p = 0.10). Conclusions: after early remodeling, heterologous bone substitutes showed a good dimensional stability in the mid-term for maxillary sinus augmentation. Full article

(This article belongs to the Special Issue Advanced Biomaterials for Bone and Soft Tissue Regeneration, Perimplantitis Treatment, Implant Prosthetics)

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13 pages, 1905 KiB

Open AccessArticle

Radiographic Analysis of Graft Dimensional Changes in Transcrestal Maxillary Sinus Augmentation: A Retrospective Study

by Luca Comuzzi, Margherita Tumedei, Adriano Piattelli, Gianluca Tartaglia and Massimo Del Fabbro

Materials 2022, 15(9), 2964; https://doi.org/10.3390/ma15092964 - 19 Apr 2022

Cited by 12 | Viewed by 2136

Abstract

Background. The maxillary sinus lift is a popular and predictable technique associated with implant-supported rehabilitation of the severely atrophic maxilla. The aim of the present retrospective study was to investigate the effectiveness of transcrestal maxillary sinus augmentation and the graft resorption pattern using different heterologous bone substitutes. Methods. A total of 75 sinus-grafting procedures were performed and 89 implants were placed in 66 patients, 24 males and 42 females, with mean age 67.9 ± 10.64 years (range 43–84 years). Nineteen subjects were smokers. The mean follow-up period was 93.33 ± 54.71 months (range 14–240 months). Clinical and radiographical evaluations were performed. Graft height and width were measured at baseline and at the latest follow-up. Results. Mesiodistal and vertical resorption averaged 9.3 ± 20.7% (standard deviation), and 5.04 ± 9.9% of the postoperative size, respectively, considering the graft as the unit. Linear regression analysis showed that graft resorption in both the vertical and the mesiodistal dimension is independent of the follow-up time. Conversely, there was a trend for greater resorption when increasing the postoperative graft size, in both vertical (p = 0.001) and horizontal (p = 0.007) dimensions. When grouping the dimensional changes by graft particle size (only small (<300 μm) particles, combination of small and medium (>500 μm)/large (>1000 μm) particles, and only medium/large particles), there was a trend for greater resorption associated with smaller particles, but it was not significant; neither in the mesiodistal nor in the vertical dimension (p = 0.17 and p = 0.25, respectively). No implant was lost during the observation period. In conclusion, the transcrestal technique for maxillary sinus augmentation documented a high level of predictability. The low clinical morbidity and the contextual dental implant positioning is clinically useful in relation to a significant reduction of the time required for implant restoration, a consistent decrease of the number of surgical phases, and a cost-effectiveness approach for the rehabilitation. The graft resorption pattern in all cases was compatible with persistent implant protection and support. Full article

(This article belongs to the Special Issue Advanced Biomaterials for Bone and Soft Tissue Regeneration, Perimplantitis Treatment, Implant Prosthetics)

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20 pages, 1982 KiB

Open AccessReview

Residual Bone Height and New Bone Formation after Maxillary Sinus Augmentation Procedure Using Biomaterials: A Network Meta-Analysis of Clinical Trials

by Shahnavaz Khijmatgar, Massimo Del Fabbro, Margherita Tumedei, Tiziano Testori, Niccolò Cenzato and Gianluca Martino Tartaglia

Materials 2023, 16(4), 1376; https://doi.org/10.3390/ma16041376 - 6 Feb 2023

Cited by 5 | Viewed by 2195

Abstract

Background. Different factors may affect new bone formation following maxillary sinus floor augmentation for the rehabilitation of posterior edentulous maxilla. The purpose of this study was to determine the influence of residual bone height (RBH) on new bone formation after lateral sinus augmentation utilizing different biomaterials, through a network meta-analysis (NMA). Methods. PUBMED, Scopus, and Web of Science electronic databases were searched until 31 December 2022 to obtain relevant articles. A hand search was also conducted. Randomised controlled studies on maxillary sinus augmentation comparing different grafting materials in patients with atrophic posterior maxilla, in need of prosthetic rehabilitation, were included. The risk of bias was assessed following the guidelines of the Cochrane Collaboration. The primary outcome was new bone formation (NBF), assessed histomorphometrically. The statistical analysis was performed by splitting the data according to RBH (<4 mm and ≥4 mm). Results. A total of 67 studies were eligible for conducting NMA. Overall, in the included studies, 1955 patients were treated and 2405 sinus augmentation procedures were performed. The biomaterials used were grouped into: autogenous bone (Auto), xenografts (XG), allografts (AG), alloplasts (AP), bioactive agents (Bio), hyaluronic acid (HA), and combinations of these. An inconsistency factor (IF) seen in the entire loop of the XG, AP, and Bio+AP was found to be statistically significant. The highest-ranked biomaterials for the <4 mm RBH outcome were XG+AG, XG+AP, and Auto. Similarly, the surface under the cumulative ranking curve (SUCRA) of biomaterials for ≥4 mm RBH was Auto, Bio+XG, and XG+Auto. Conclusion. There is no grafting biomaterial that is consistently performing better than others. The performance of the materials in terms of NBF may depend on the RBH. While choosing a biomaterial, practitioners should consider both patient-specific aspects and sinus clinical characteristics. Full article

(This article belongs to the Special Issue Advanced Biomaterials for Bone and Soft Tissue Regeneration, Perimplantitis Treatment, Implant Prosthetics)

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21 pages, 4241 KiB

Open AccessReview

Short versus Longer Implants in Sites without the Need for Bone Augmentation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Luigi Guida, Eriberto Bressan, Gennaro Cecoro, Armando Davide Volpe, Massimo Del Fabbro and Marco Annunziata

Materials 2022, 15(9), 3138; https://doi.org/10.3390/ma15093138 - 26 Apr 2022

Cited by 9 | Viewed by 2284

Abstract

Objectives: The present systematic review and meta-analysis aims to analyse the clinical performance of short compared to longer implants inserted in sites without the need for bone augmentation. Methods: The protocol of the present PRISMA-driven meta-analysis was registered on PROSPERO (CRD42021264781). Electronic and manual searches were performed up to January 2022. All Randomized Controlled Trials (RCTs) comparing short (≤6 mm) to longer (≥8.5 mm) implants placed in non-atrophic and non-augmented sites were included. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomized clinical trials (RoB 2) and the quality of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A meta-analysis was performed on implant survival rate, marginal bone level change (MBLc), and technical and biological complications at the available follow-up time points. The power of the meta-analytic findings was determined by trial sequential analysis (TSA). Results: From 1485 initial records, 13 articles were finally included. No significant difference was found in the survival rate between short and long implant at any follow-up (moderate quality of evidence). Significantly more bone loss for long implants at 1 and 5 years from implant placement and more technical complications with short implants at 10 years were found. No other significant inter-group differences in terms of MBLc and biological complications were detected. Conclusions: Moderate evidence exists suggesting that short implants perform as well as longer ones in the rehabilitation of edentulous sites without the need for bone augmentation. Further long-term, well-designed RCTs, however, are still needed to provide specific evidence-based clinical recommendations for an extended use of short implants in non-atrophic sites. Full article

(This article belongs to the Special Issue Advanced Biomaterials for Bone and Soft Tissue Regeneration, Perimplantitis Treatment, Implant Prosthetics)

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