•Critical review of bone healing related to implant hardware.•Bone healing is remarkably affected by implant macrodesign and surgical drilling.•Multiple healing modes are described depending on ...hardware interplay with bone.
Osseointegration of metallic devices has been one of the most successful treatments in rehabilitative dentistry and medicine over the past five decades. While highly successful, the quest for designing surgical instrumentation and associated implantable devices that hastens osseointegration has been perpetual and has often been approached as single variable preclinical investigations. The present manuscript presents how the interplay between surgical instrumentation and device macrogeometry not only plays a key role on both early and delayed stages of osseointegration, but may also be key in how efficient smaller length scale designing (at the micrometer and nanometer scale levels) may be in hastening early stages of osseointegration.
Highlights • Atemporal osseointegration would improve patient's function and quality of life. • Accelerating/improving osseointegration demands combined and multiple engineering domains. • ...Hierarchical designing shall provide an informed design rationale for development. • Implant macrogeometry and surgical technique define the osseointegration pathway. • Despite the several years after its introduction, osseointegration is yet unresolved.
Since the founding of the osseointegration concept, the characteristics of the interface between bone and implant, and possible ways to improve it, have been of particular interest in dental and ...orthopaedic implant research. Making use of standardized tools of analysis and terminology, we present here a standardized characterization code for osseointegrated implant surfaces. This code describes the chemical composition of the surface, that is, the core material, such as titanium, and its chemical or biochemical modification through impregnation or coating. This code also defines the physical surface features, at the micro- and nanoscale, such as microroughness, microporosity, nanoroughness, nanotubes, nanoparticles, nanopatterning and fractal architecture. This standardized classification system will allow to clarify unambiguously the identity of any given osseointegrated surface and help to identify the biological outcomes of each surface characteristic.
This paper is aimed to present a biomaterials perspective in implant therapy that fosters improved bone response and long‐term biomechanical competence from surgical instrumentation to final ...prosthetic rehabilitation. Strategies to develop implant surface texturing will be presented and their role as an ad hoc treatment discussed in light of the interplay between surgical instrumentation and implant macrogeometric configuration. Evidence from human retrieved implants in service for several years and from in vivo studies will be used to show how the interplay between surgical instrumentation and implant macrogeometry design affect osseointegration healing pathways, and bone morphologic and long‐term mechanical properties. Also, the planning of implant‐supported prosthetic rehabilitations targeted at long‐term performance will be appraised from a standpoint where personal preferences (eg, cementing or screwing a prosthesis) can very often fail to deliver the best patient care. Lastly, the acknowledgement that every rehabilitation will have its strength degraded over time once in function will be highlighted, since the potential occurrence of even minor failures is rarely presented to patients prior to treatment.
To compile the current evidence on biomechanical, biologic, and clinical outcomes of undersized surgical preparation protocols in dental implant surgery.
An electronic search using three different ...databases (PubMed, Web of Science, and Cochrane Library) and a manual hand search were performed including in vitro, animal, and clinical studies published prior to October 2015. Studies in which an undersized drilling protocol was compared with a nonundersized drilling protocol were included.
From an initial selection of 1,655 titles, 29 studies met the inclusion criteria, including 14 biomechanical, 7 biologic, 6 biologic and biomechanical, and 2 clinical. Due to methodologic variation, meta-analysis was not performed. Several studies showed that implants inserted with an undersized drilling approach reached a significantly higher insertion torque value than conventional drilling in low-density substrates, while this effect is less evident if a thick cortical layer is present. Similar results in terms of boneto-implant contact (BIC) were achieved in the longer term between implants inserted with undersized and nonundersized protocols. Results in the short term were inconclusive. Clinical studies did not show negative outcomes for undersized drilling, although clinical evidence was sparse. No data are available on marginal bone loss.
From the biomechanical standpoint, an undersized drilling protocol is effective in increasing insertion torque in low-density bone. Biologic response in long-term healing after undersized implant placement is comparable to that in the nonundersized surgical drilling protocol. Clinical studies indicate that performing an undersized drilling protocol on low-density bone is a safe procedure; however, more extensive studies are needed to confirm these data.
The field of additive manufacturing, 3D printing (3DP), has experienced an exponential growth over the past four decades, in part due to increased accessibility. Developments including computer‐aided ...design and manufacturing, incorporation of more versatile materials, and improved printing techniques/equipment have stimulated growth of 3DP technologies within various industries, but most specifically the medical field. Alternatives to metals including ceramics and polymers have been garnering popularity due to their resorbable properties and physiologic similarity to extracellular matrix. 3DP has the capacity to utilize an assortment of materials and printing techniques for a multitude of indications, each with their own associated benefits. Within the field of medicine, advances in medical imaging have facilitated the integration of 3DP. In particular, the field of orthopedics has been one of the earliest medical specialties to implement 3DP. Current indications include education for patients, providers, and trainees, in addition to surgical planning. Moreover, further possibilities within orthopedic surgery continue to be explored, including the development of patient‐specific implants. This review aims to highlight the use of current 3DP technology and materials by the orthopedic community, and includes comments on current trends and future direction(s) within the field.
Abstract Statement of problem Few studies have investigated the volumetric polymerization shrinkage and film thickness of the different cementation techniques used to cement veneers. Purpose The ...purpose of this in vitro study was to evaluate the volumetric polymerization shrinkage (VS) and film thickness (FT) of various cementation techniques through 3-dimensional (3D) microcomputed tomography (μCT). Material and methods Forty-eight artificial plastic maxillary central incisors with standard preparations for veneers were provided by a mannequin manufacturer (P-Oclusal) and used as testing models with the manufacturer’s plastic veneers. They were divided into 8 groups (n=6): RelyX Veneer + Scotchbond Universal (RV+SBU); Variolink Esthetic LC+Adhese Universal (VE+ADU); Filtek Supreme Ultra Flowable + Scotchbond Universal (FF+SBU); IPS Empress Direct Flow + Adhese Universal (IEF+ADU); Filtek Supreme Ultra Universal + Scotchbond Universal (FS+SBU); IPS Empress Direct + Adhese Universal (IED+ADU); Preheated Filtek Supreme Ultra Universal + Scotchbond Universal (PHF+SBU); and Preheated IPS Empress Direct + Adhese Universal (PHI+ADU). Specimens were scanned before and after polymerization using a μCT apparatus (mCT 40; Scanco Medical AG), and the resulting files were imported and analyzed with 3D rendering software to calculate the VS and FT. Collected data from both the VS and FT were submitted to 1-way ANOVA (α=.05). Results VE+ADU had the lowest volumetric shrinkage (1.03%), which was not significantly different from RV+SBU, FF+SBU or IEF+ADU ( P >.05). The highest volumetric shrinkage was observed for FS+SBU (2.44%), which was not significantly different from RV+SBU, IED+ADU, PHF+SBU, or PHI+ADU ( P >.05). Group RV+SBU did not differ statistically from the remaining groups ( P >.05). Film thickness evaluation revealed the lowest values for RV+SBU, VE+ADU, FF+SBU, and IEF+ADU, with an average between groups of 0.17 mm; these groups were significantly different from FS+SBU, IED+ADU, PHF+SBU, and PHI+ADU ( P >.05), with an average of 0.31 mm. Conclusions Both the VS and the FT of direct restorative composite resins were higher than those of veneer cements and flowable composite resins, whether preheated or not preheated.
Non-resorbable dental barrier membranes entail the risk of dehiscence due to their smooth and functionally inert surfaces. Non-thermal plasma (NTP) treatment has been shown to increase the ...hydrophilicity of a biomaterials and could thereby enhance cellular adhesion. This study aimed to elucidate the role of allyl alcohol NTP treatment of poly(tetrafluoroethylene) in its cellular adhesion. The materials (non-treated PTFE membranes (NTMem) and NTP-treated PTFE membranes (PTMem)) were subjected to characterization using scanning electron microscopy (SEM), contact angle measurements, X-ray photoelectron spectroscopy (XPS), and electron spectroscopy for chemical analysis (ESCA). Cells were seeded upon the different membranes, and cellular adhesion was analyzed qualitatively and quantitatively using fluorescence labeling and a hemocytometer, respectively. PTMem exhibited higher surface energies and the incorporation of reactive functional groups. NTP altered the surface topography and chemistry of PTFE membranes, as seen through SEM, XPS and ESCA, with partial defluorination and polymer chain breakage. Fluorescence labeling indicated significantly higher cell populations on PTMem relative to its untreated counterparts (NTMem). The results of this study support the potential applicability of allyl alcohol NTP treatment for polymeric biomaterials such as PTFE—to increase cellular adhesion for use as dental barrier membranes.
Organ development requires complex signaling by cells in different tissues. Epithelium and mesenchyme interactions are crucial for the development of skin, hair follicles, kidney, lungs, prostate, ...major glands, and teeth. Despite myriad literature on cell–cell interactions and ligand–receptor binding, the roles of extracellular vesicles in epithelium–mesenchyme interactions during organogenesis are poorly understood. Here, we discovered that ∼100 nm exosomes were secreted by the epithelium and mesenchyme of a developing tooth organ and diffused through the basement membrane. Exosomes were entocytosed by epithelium or mesenchyme cells with preference by reciprocal cells rather than self-uptake. Exosomes reciprocally evoked cell differentiation and matrix synthesis: epithelium exosomes induce mesenchyme cells to produce dentin sialoprotein and undergo mineralization, whereas mesenchyme exosomes induce epithelium cells to produce basement membrane components, ameloblastin and amelogenenin. Attenuated exosomal secretion by Rab27a/b knockdown or GW4869 disrupted the basement membrane and reduced enamel and dentin production in organ culture and reduced matrix synthesis and the size of the cervical loop, which harbors epithelium stem cells, in Rab27aash/ash mutant mice. We then profiled exosomal constituents including miRNAs and peptides and further crossed all epithelium exosomal miRNAs with literature-known miRNA Wnt regulators. Epithelium exosome-derived miR135a activated Wnt/β-catenin signaling and escalated mesenchymal production of dentin matrix proteins, partially reversible by Antago-miR135a attenuation. Our results suggest that exosomes may mediate epithelium–mesenchyme crosstalk in organ development, suggesting that these vesicles and/or the molecular contents they are transporting may be interventional targets for treatment of diseases or regeneration of tissues.
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