Search Results (942)

Growth factors are proteins that play an essential part in tissue regeneration and development. They attach surface receptors to mediate their actions on cells. Signaling systems within cells are activated when growth factors bind to their associated receptors. These signaling cascades control the transcription of genes involved in cellular functions like proliferation, differentiation, migration, protein synthesis, and metabolism. This narrative review provides a comprehensive update on the use of growth factors in implant dentistry with a special emphasis on human clinical trials. Since wound healing and osseointegration are pre-requisites of successful implantation and growth factors are important components of homeostasis and wound healing, this review first starts with the basic biology of wound healing. Then, it presents the specific role of growth factors in wound healing and tissue regeneration. Finally, the PubMed database was searched using relevant keywords with some filters related to the research question. Out of the initial 44 records, all the clinical human studies (n = 29) with the actual dental implant placement and its assessment were included. These results of the published and relevant literature over the last 25 years on different applications of growth factors in the field of implant dentistry are critically discussed. Full article

Titanium implants are widely used in biomedical applications due to their excellent mechanical properties and biocompatibility. However, implant-associated bacterial infections and suboptimal osseointegration remain significant challenges. Recent studies have demonstrated that the interplay between micro- and nanostructures can enhance both biocompatibility and antibacterial properties. This study explores the synergistic effects of hierarchical and dual surface topography on Ti surfaces with micro- and nanostructures to demonstrate their ability to promote cellular biocompatibility and osteoinduction while simultaneously inhibiting bacterial colonization. The combination of selective laser melting (SLM) to create micro-structured surfaces and hydrothermal processes is used to generate distinctive nanopillar structures. By integrating nanoscale features that mimic the extracellular matrix with microscale topographies that influence cellular responses, we achieve a balance between enhanced osseointegration and antimicrobial performance. The physicochemical properties of these dual-scale topographies are characterized through cellular assays using dental pulp stem cells (DPSCs), demonstrating sustained support for long-term cell viability (above 78% in MTT and NR assays (p < 0.05), low levels of LDH release, and high levels of cellular migration) and osteoinduction (statistically significant (p < 0.0001) ALP activity increase and higher levels of calcified matrix deposition, upregulation of ALP and OCN genes compared with smooth surface topographies). Their antibacterial properties against S. aureus and E. coli showed a significant reduction (p < 0.05) in bacterial attachment and biofilm formation. Our findings highlight the potential of multi-scale surface modifications as a promising strategy for next-generation titanium implants, paving the way for improved clinical outcomes in orthopedic and dental applications. Full article

Objectives: This retrospective study aimed to evaluate the increase in vertical bone height following sinus lift procedures using the CAS (Crestal Approach Sinus) kit technique in combination with tissue-level implants. Additionally, the quantity of bone between the implant apex and the Schneiderian membrane was assessed to determine the effectiveness and safety of this minimally invasive approach. Methods: The study included 15 patients (20 implants) who underwent sinus lift procedures with the CAS kit technique and tissue-level implants in the posterior maxilla between September 2021 and October 2024. Inclusion criteria required a minimum residual bone height (RBH) of 2 mm. Cone-beam computed tomography (CBCT) scans were used for initial screening, and panoramic radiography evaluated outcomes at implant placement and nine months postoperatively. Primary outcomes included implant and prosthetic survival rates, as well as biological and technical complications. Secondary outcomes were vertical bone height and the amount of bone above the implant tip. Statistical analyses were conducted using the Wilcoxon signed-rank test with a significance level of 0.05. Results: All implants achieved successful osseointegration, with no implant or prosthetic failures and no biological or technical complications reported. The mean RBH at implant placement was 4.2 ± 1.4 mm, which increased to an overall membrane elevation of 13.8 ± 1.8 mm. At the 9-month follow-up, the overall membrane elevation was slightly reduced to 13.0 ± 1.6 mm (p = 0.000), with a mean bone gain of 9.6 ± 2.4 mm. The amount of bone above the implant tip was 3.4 ± 1.7 mm at placement, decreasing to 3.0 ± 1.2 mm at follow-up (p = 0.007). Conclusions: The CAS kit technique combined with tissue-level implants demonstrated significant vertical bone gain and high implant survival rates without complications. This minimally invasive approach proved effective and safe for sinus augmentation in patients with limited residual bone height. The findings support the CAS kit’s potential as a preferred technique for maxillary sinus elevation. Further research with larger cohorts and long-term follow-up is needed to validate these results. Full article

Stress shielding remains a major concern in cementless total hip arthroplasty (THA) due to the stiffness mismatch between femoral stems and surrounding bone. This study investigated the biomechanical and clinical performance of a novel Ti-33.6Nb-4Sn (Ti-Nb-Sn) alloy stem with a graded Young’s modulus achieved through localized heat treatment. A finite element model (FEM) of the Ti-Nb-Sn stem, incorporating experimentally validated Young’s modulus gradients, was constructed and implanted into a patient-specific femoral model. Stress distribution and micromotion were assessed under physiological loading conditions. Clinical validation was performed by evaluating radiographic outcomes at 1 and 3 years postoperatively in 40 patients who underwent THA using the Ti-Nb-Sn stem. FEM analysis showed low micromotion at the proximal press-fit region (4.89 μm rotational and 11.74 μm longitudinal), well below the threshold for osseointegration and loosening. Stress distribution was concentrated in the proximal region, effectively reducing stress shielding distally. Clinical results demonstrated minimal stress shielding, with no cases exceeding Grade 3 according to Engh’s classification. The Ti-Nb-Sn stem with a gradient Young’s modulus provided biomechanical behavior closely resembling in vivo conditions and showed promising clinical results in minimizing stress shielding. These findings support the clinical potential of modulus-graded Ti-Nb-Sn stems for improving implant stability in THA. Full article

Guided bone regeneration (GBR) procedures have been indicated to enhance bone response, reliably regenerate lost tissue, and create an anatomically pleasing ridge contour for biomechanically favorable and prosthetically driven implant placement. The aim of the current study was to evaluate and compare the bone regenerative performance of deproteinized bovine bone (DBB) and deproteinized porcine bone (DPB) grafts in a beagle mandibular model for the purposes of GBR. Four bilateral defects of 10 mm × 10 mm were induced through the mandibular thickness in each of the 10 adult beagle dogs being studied. Two of the defects were filled with DPB, while the other two were filled with DBB, after which they were covered with collagen-based membranes to allow compartmentalized healing. Animals were euthanized after 6, 12, 24, or 48 weeks postoperatively. Bone regenerative capacity was evaluated by qualitative histological and quantitative microtomographic analyses. Microcomputed tomography data of the bone (%), graft (%), and space (%) were compared using a mixed model analysis. Qualitatively, no histomorphological differences in healing were observed between the DBB and DPB grafts at any time point. By 48 weeks, the xenografts (DBB and DPB) were observed to have osseointegrated with regenerating spongy bone and a close resemblance to native bone morphology. Quantitatively, a higher amount of bone (%) and a corresponding reduction in empty space (space (%)) were observed in defects treated by DBB and DPB grafts over time. However, no statistically significant differences in bone (%)were observed between DBB (71.04 ± 8.41 at 48 weeks) and DPB grafts (68.38 ± 10.30 at 48 weeks) (p > 0.05). GBR with DBB and DPB showed no signs of adverse immune response and led to similar trends in bone regeneration over 48 weeks of permitted healing. Full article

Background: The aim of this review was to evaluate the antibacterial properties of functionalized bioceramics for dental applications. Methods: The electronic databases PubMed, Medline, ProQuest, and Google Scholar were used to search for peer-reviewed scientific publications published between 2020 and 2025 that provide insights to answer research questions related to the role of antibacterial-functionalized bioceramics in combating pathogens in dentistry without triggering immune reactions and inflammation, as well as on their efficacy against various pathogens and whether understanding the antibacterial mechanism can promote the development of glass-ceramic and bioceramic with long-term antibacterial activity. The keywords used to answer the research questions were: bioglass, bioceramic, biocompatible, antibacterial, osseointegration, implant, and bioactive materials. Results: Bacterial infections play a key role in the longevity of medical devices. A crucial problem is drug-resistant bacteria. Antibacterial ceramics have received great attention recently because of their long-term antibacterial activity, good mechanical properties, good biocompatibility, and bioactivity. This review provides a detailed examination of the complex interactions between bacteria, immune cells, and bioceramics from a clinical perspective. The focus of the researchers is on developing new-generation bioceramics with multifunctionality, in particular with antibacterial properties that are independent of conventional antibiotics. The highlight of this review is the exploration of bioceramics with dual functions such as antibacterial and bioactive properties, promoting bone regeneration and antibacterial activity, which have the potential to revolutionize implant technology. Another research focus is modifying the implant surface from hydrophilic to hydrophobic in order to increase the antibacterial activity of bioceramics. Conclusions: The aim of this review is to help researchers understand the current state-of-the-art antibacterial activities of bioceramics, which could promote the development of antibacterial ceramics and their clinical application. Full article

Background/Objectives: This literature review aims to systematically analyze the efficacy of electrolytic cleaning for treating peri-implantitis, including its impact on disease resolution, re-osseointegration of treated implants, and peri-implantitis recurrence. It also compares various study and treatment protocols used in the selected papers. Methods: A comprehensive search was conducted in MEDLINE (via PubMed) and the Cochrane Central Register of Controlled Trials using the keywords “electrolytic cleaning implant” or “GalvoSurge”. Studies published until 31 December 2024 were considered for inclusion. Results: Out of 141 articles retrieved, four publications were selected for the review. These studies were analyzed for implant type, number, evaluation methods, observation periods, surgical procedures, and additional treatments. Disease resolution was reported in one study, while peri-implantitis recurred in the remaining studies. However, re-osseointegration of treated implants was observed in all selected papers. Conclusions: Due to the limited and heterogeneous nature of the studies, it is difficult to draw definitive conclusions about the effectiveness of electrolytic cleaning as a treatment for peri-implantitis. To ensure consistent trial outcomes and improve predictability, clear clinical guidelines and surgical protocols for electrolytic decontamination are essential. Full article

In the design of mandibular implants, the application of previous research findings, which highlight the significance of asymmetric occlusal load transfer schemes, is often lacking. The generated identical oblique occlusal force for maximum muscle efficiency may not be the sole criterion for assessing the load-bearing capacity of a mandibular prosthesis. The hypothesis of this study was that the load-bearing capacity of extensive mandibular prostheses is significantly underestimated when assuming mandibular support at the temporomandibular joint on the occlusal side compared to the assumption of perfect osseointegration between the implant and bone. Finite Element Method (FEM) simulation studies were conducted to analyze occlusal load transfer, considering two joint support conditions: support in both temporo-mandibular joints and support in only one joint, opposite the bite side. Additionally, two variants of the implant-bone connection were examined: an optimistic scenario assuming complete osseointegration and a pessimistic scenario assuming no osseointegration, with fixation achieved solely through bone fixation plates. The findings indicated a significant underestimation of the loads transferred by the implant and bone tissue when symmetrical joint support and osseointegration were assumed. Although there is currently no conclusive evidence supporting the complete exclusion of the joint, the computational results demonstrated that, in the absence of precise data regarding the percentage contribution of the joint on the occlusal side, it is preferable to employ more stringent criteria for assessing the load-bearing capacity of mandibular prostheses. This assessment should include the exclusion of joint support on the occlusal side to ensure a more conservative and reliable evaluation of the prosthesis’s mechanical performance. Full article

Trabecular titanium implants are widely used in orthopedic surgery and are known to promote osseointegration. In this study, we investigated whether primary human osteoblast-like cells grown inside a 3D trabecular titanium scaffold undergo changes in migration capacity, transcriptomic profile, and cellular phenotype as compared to the same osteoblasts not grown inside the scaffold. Scratch tests have shown that primary human osteoblast-like cells grown inside the 3D trabecular titanium scaffold promote the migration of cells from the external environment into the scaffold. Next generation sequencing analysis demonstrated that primary human osteoblast-like cells grown inside the 3D trabecular titanium scaffold modified the expression of genes involved in cell cycle and extracellular matrix remodeling, while maintaining a normal expression of the specific osteoblast markers, such as osteocalcin and osterix, as well as a comparable mineralization capacity. These data demonstrate that primary human osteoblast-like cells grown inside the titanium scaffold in a 3D environment acquire specific features favoring osseointegration. Full article

One of the key factors influencing osseointegration is the hydrophilicity of the surface of dental implants; high hydrophilicity is more advantageous than low hydrophilicity. This study aimed to compare the hydrophilic properties of titanium and zirconia implants from different manufacturers. An in vitro analysis was conducted on 15 implants—13 titanium and 2 zirconia—each featuring distinct compositions and surface treatments. Their hydrophilicity was assessed using the contact angle method, where a drop of saline solution was pipetted onto the apical part of the implant. For each implant, 30 contact angle measurements were taken at three different surface wetting time intervals. The contact angle is defined as the internal angle between the tangent to the surface of the liquid and the surface at the point of tangency; a smaller angle means a higher hydrophilicity. The results show that titanium implants from BTI UniCa, Nobel TiUltra, and Straumann Roxolid SLActive—which are classified as premium implants—exhibited the highest hydrophilicity. In contrast, zirconia implants demonstrated significantly lower hydrophilicity. Within this group, the Nobel Pearl implant exhibited smaller contact angles than the Bredent WhiteSKY implant. Our findings confirm that high-quality titanium implants show superior hydrophilicity, potentially improving clinical outcomes by accelerating healing and facilitating immediate loading protocols, but this could only be proven with an in vivo animal study. Conversely, the relatively lower hydrophilicity of zirconia implants highlights the need for continued advancements in zirconia composition and surface modification to optimize their osseointegration potential. Full article

The dust generated during the sandblasting process of the sandblasted and acid-etched (SLA) method, commonly used to treat the surface of Ti dental implants, poses significant challenges in maintaining a clean manufacturing environment and ensuring safe working conditions. Nevertheless, surface modification remains crucial for improved performance of Ti dental implants. To address this problem and propose a clean and simple surface modification process to potentially replace SLA modification, this study aimed to characterize the surfaces of commercially pure Ti (cp-Ti) samples treated by acid etching and compare them with SLA-treated samples in terms of surface roughness (R_q), wettability (assessed through contact angle measurements), mineralized matrix deposition (evaluated through simulated body fluid [SBF] soaking), cell viability, cell differentiation (assessed based on alkaline phosphatase activity), and mineralization (assessed using MTT assay). Acid-etched surfaces exhibited nano- and micro-roughness and higher hydrophilicity than SLA surfaces, which is conducive to forming a highly bioactive TiO₂ surface. Moreover, acid-etched samples exhibited earlier hydroxyapatite deposition after SBF soaking than SLA samples. Furthermore, the acid-etched surfaces were nontoxic and displayed significantly higher cell viability and differentiation after seven days than SLA surfaces. These findings suggest that acid etching is a viable alternative to the SLA method, likely offering superior surface bioactivity and biocompatibility. Full article

(1) Background: The challenges in Implantology involve the development of alternative methods to enhance bone repair in patients with systemic conditions, such as osteoporosis. This study aimed to evaluate the effect of a local anti-sclerostin monoclonal antibody (Scl-Ab) on the functionalization of titanium implant surfaces through a dip-coating technique in peri-implant bone repair. (2) Methods: A total of 32 female rats were separated into four groups (n = 8): SHAM NT (Sham surgery), OVX NT (ovariectomy), SHAM Scl-Ab (SHAM; implants functionalized with Scl-Ab), and OVX Scl-Ab (OVX; implants functionalized with Scl-Ab). Implant surgery was executed 30 days after ovariectomy, and the rats were euthanized 28 days postoperatively. The right tibia was used for removal torque and RT-PCR, while the left tibia was collected for micro-CT and laser confocal microscopy. (3) Results: Functionalization with Scl-Ab significantly increased the gene expression of bone markers, especially ALP, in the SHAM Scl-Ab group compared to the other groups (p < 0.05). (4) Conclusions: Some parameters of this study indicate that implants functionalized with anti-sclerostin bone anabolic drug enhance peri-implant bone repair, especially in healthy rats. However, more studies must be carried out to confirm the therapeutic benefits of this approach. Full article

The history of metallic orthopedic materials spans a few centuries, from the use of carbon steel to the widespread adoption of titanium and its alloys. This paper explores the evolution of these materials, emphasizing their mechanical properties, biocompatibility, and the roles that they have played in improving orthopedic care. Key developments include the discovery of titanium’s osseointegration capability, the advent of porous coatings for osseointegration, surface modifications, and the rise of additive manufacturing for patient-specific implants. Beyond titanium, emerging materials such as biodegradable alloys, tantalum, zirconium, and amorphous metals are creating a completely new field of application for orthopedic metals. These innovations address longstanding challenges, including stress shielding, corrosion, and implant longevity, while leading the way for bioresorbable and 3D-printed patient-specific solutions. This paper concludes by examining future trends and their potential for industrial application. By understanding the historical developments in metallic orthopedic materials, this review highlights how past advancements have laid the foundation for both current and future innovations, guiding research towards solutions that better mimic the properties of biological tissues, offer higher reliability in vivo, and enable patient-specific treatments. Full article

Background/Objectives: The socket-shield technique (SST) was developed to preserve the facial/buccal portion of a tooth root to prevent post-extraction ridge resorption. It has gained attention for use in anterior implant sites, but its application in posterior sites remains unexplored. The aim of this case report was to report a proof-of-principle case using SST in a lower molar site and evaluate its effectiveness in preserving tissues. Methods: A 34-year-old non-smoking patient with a non-restorable mandibular first molar (tooth #36) underwent immediate implant placement with the SST. The tooth’s crown was removed, and the buccal segments of the roots were retained as “shields” while the implant was placed in the center of the socket. Preoperative and postoperative cone-beam CT (CBCT) scans and clinical exams were used to assess outcomes up to 12 months. Results: The SST procedure was completed uneventfully. CBCT after 4 months and 12 months showed minimal horizontal bone loss: ~0.2 mm at 4 months; ~0.1 mm additional loss by 12 months. The peri-implant soft tissue profile remained stable, and the implant achieved osseointegration with high primary and secondary stability. Conclusions: In this clinical case, the socket-shield technique effectively preserved alveolar bone and soft tissue contours in a molar extraction site, avoiding the ridge collapse often seen post-extraction. This suggests SST may be a viable tissue preservation approach in posterior sites; however, long-term follow-up and further studies are needed to confirm sustained outcomes and validate the technique’s predictability. Full article

This study introduces a novel titanium hollow structure for mandibular reconstruction designed to optimize mechanical stability and stress distribution. A comparative evaluation with a similar polyetheretherketone (PEEK) structure is performed to assess material-specific biomechanical behavior. Methods: Finite element analysis (FEA) simulations were conducted to evaluate stress distribution, displacement, and structural stability of the symmetrical titanium and PEEK hollow structures under physiological conditions. The reconstructions were designed based on Scherk minimal surfaces, integrating fixing plates to achieve optimal mechanical performance while maintaining symmetry. Results: The FEA simulations demonstrated that the titanium hollow structure exhibited higher mechanical stability, lower displacement, and more uniform stress distribution, ensuring structural integrity under applied forces. In contrast, the PEEK structure displayed greater flexibility, which reduced stress shielding but resulted in higher deformation and lower load-bearing capacity. While titanium inherently supports osseointegration, PEEK requires surface modifications to enhance bone integration and long-term stability. Conclusions: The titanium hollow structure presents a promising advancement in metal-based mandibular reconstruction, effectively balancing strength, durability, and biological integration. Future research should focus on using more structures, enhancing surface modifications and optimizing lattice structures to further improve the biological and biomechanical performance of PEEK-based and titanium-based implants in load-bearing conditions. Full article