Publications

Objectives: Despite the high survival rates of dental implants, peri-implantitis is a prevalent complication. Periimplantitis is related to biofilm that adheres to the surface of implants and causes peri-implant chronic inflammation and bone destruction. Different surface treatments have been proposed to prevent biofilm formation. The objective of this systematic review was analyzing different types of antimicrobial coatings and identifying the most effective one(s) to control bacterial colonization over extended periods of analysis. Data, sources and study selection: We performed a bibliographic search in Pubmed and Cochrane base of articles published after 2010 to answer, according to the PICO system, the following question: What is the most effective antibacterial surface coating for dental implants? Only papers including a minimum follow-up bacteria growth analysis for at least 48 h were selected. After selection, the studies were classified using the PRISMA system. A total of 40 studies were included. Conclusions: Three main categories of coatings were identified: Antibacterial peptides, synthetic antimicrobial molecules (polymers, antibiotics, ...), and metallic nanoparticles (silver). Antibacterial peptide coatings to modify dental implant surfaces have been the most studied and effective surface modification to control bacterial colonization over extended periods of incubation as they are highly potent, durable and biocompatible. However, more in vitro and pre-clinical studies are needed to assess their true potential as a technology for preventing periimplant infections.

JTD Keywords: Anti-infective coating, Antibiotics, Antimicrobial peptide coatings, Antimicrobial peptides, Antimicrobial polymers, Bacterial colonizatio, Biofilm formatio, Cationic peptides, Chimeric peptides, Dental implants, Human gingival fibroblasts, Metal nanoparticles, Osseointegrated oral implants, Peri-implantitis, Silver nanoparticles, Surface treatment, Sustained-release device, Titanium surfaces

Summary form only given. Commercially pure titanium (cp Ti) dental implants have been widely and successfully used with high rates of clinical success in normal situations. However, there is still a lack of reliable synthetic materials to be used either a) when immediate loading of the implant is desired or b) when bone presents compromised conditions due to trauma, infection, systemic disease and/or lack of significant bone volume. Our group has aimed the development of biomimetic strategies of surface modification to obtain metallic implants with osteostimulative capabilities. These surface modifications will provide implants with a rapid rate of newly-formed bone growth and with ossecoalescence, i.e., direct chemical contact with the surrounding tissues. Consequently, the biomimetically-modified implants will be reliably used on those more demanding clinical situations, cp Ti surfaces treated to obtain a combination of an optimal random surface topography (in the micro and nanolevels) with a chemical modification of the naturally-formed titania layer have been proved bioactive. These rough and bioactive surfaces nucleate and grow a homogeneous hydroxyapatite layer both in vitro and in vivo. They stimulate the osteoblasts differentiation and trigger a rapid bone formation that mechanically fixes implants under immediate-loading conditions. A simple process using silane chemistry has been proved specific, rapid, and reliable to covalently immobilize biomolecules on cp Ti surfaces. This methodology can be used to develop biofunc- tionalized implant surfaces with different or combined bioactivities. The biofunctional molecules can be biopolymers, proteins, growth factors, and synthetic peptides specifically designed to be attached to the surface. The bioactive properties of the molecules designed and used can be mineral growing and nucleation, osteoblast differentiation (bone regeneration), fibroblasts differentiation (biological sealing), antibiotic,... Specifically, we have obtained mechanically and thermochemically stable coatings made of recombinant elastin-like biopolymers. The biopolymers bear either a) the RODS peptide, which is a highly-specific cell-adhesion motif present in proteins of the extracellular matrix for different tissues including bone, or b) an acidic peptide sequence derived from statherin, a protein present in saliva with high affinity for calcium-phosphates and with a leading role in the remineralization processes of the hard tissues forming our teeth. Two different biomimetic strategies have been successfully developed combining topographical modification, inorganic treatments and/or biofunctionalization for improving bioactive integrative properties of cp Ti implants.

JTD Keywords: Biomedical materials, Bone, Cellular biophysics, Dentistry, Molecular biophysics, Prosthetics, Proteins, Surface treatment, Titanium