Dental implants modified with drug releasing titania nanotubes: therapeutic potential and developmental challenges

ABSTRACT

Introduction: The transmucosal nature of dental implants presents a unique therapeutic challenge, requiring not only rapid establishment and subsequent maintenance of osseointegration, but also the formation of resilient soft tissue integration. Key challenges in achieving long-term success are sub-optimal bone integration in compromised bone conditions and impaired trans-mucosal tissue integration in the presence of a persistent oral microbial biofilm. These challenges can be targeted by employing a drug-releasing implant modification such as TiO₂ nanotubes (TNTs), engineered on titanium surfaces via electrochemical anodization.

Areas covered: This review focuses on applications of TNT-based dental implants towards achieving optimal therapeutic efficacy. Firstly, the functions of TNT implants will be explored in terms of their influence on osseointegration, soft tissue integration and immunomodulation. Secondly, the developmental challenges associated with such implants are reviewed including sterilization, stability and toxicity.

Expert opinion: The potential of TNTs is yet to be fully explored in the context of the complex oral environment, including appropriate modulation of alveolar bone healing, immune-inflammatory processes, and soft tissue responses. Besides long-term in vivo assessment under masticatory loading conditions, investigating drug-release profiles in vivo and addressing various technical challenges are required to bridge the gap between research and clinical dentistry.

KEYWORDS:

• Dental implants
• local drug delivery
• osseointegration
• titania nanotubes
• titanium

Article highlights

• Appropriate modulation of hard and soft tissues is required for the long term success of dental implants, ensuring that osseointegration is rapidly achieved and subsequently maintained in the long term.

• Titania nanotubes (TNTs) can be fabricated on the complex geometry of dental implants (composed of Ti or Ti  alloys) using the cost-effective electrochemical anodization technique.

• TNTs can facilitate enhanced osteogenic and soft tissue response, which can further be augmented by loading and releasing active therapeutics such as bone forming proteins, antibiotics, growth factors and other macromolecules.

• To bridge the gap between research and clinical dentistry, key developmental challenges must be addressed including appropriate sterilization, mechanical stability, corrosion resistance and toxicity.

• For success in the challenging oral micro-environment, TNT technology must be tested in long term in vivo studies under clinically-relevant conditions.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.