Biomaterial engineering surface to control polymicrobial dental implant-related infections: focusing on disease modulating factors and coatings development

ABSTRACT

Introduction

Peri-implantitis is the leading cause of dental implant loss and is initiated by a polymicrobial dysbiotic biofilm formation on the implant surface. The destruction of peri-implant tissue by the host immune response and the low effectiveness of surgical or non-surgical treatments highlight the need for new strategies to prevent, modulate and/or eliminate biofilm formation on the implant surface. Currently, several surface modifications have been proposed using biomolecules, ions, antimicrobial agents, and topography alterations.

Areas covered

Initially, this review provides an overview of the etiopathogenesis and host- and material-dependent modulating factors of peri-implant disease. In addition, a critical discussion about the antimicrobial surface modification mechanisms and techniques employed to modify the titanium implant material is provided. Finally, we also considered the future perspectives on the development of antimicrobial surfaces to narrow the bridge between idea and product and favor the clinical application possibility.

Expert opinion

Antimicrobial surface modifications have demonstrated effective results; however, there is no consensus about the best modification strategy and in-depth information on the safety and longevity of the antimicrobial effect. Modified surfaces display recurring challenges such as short-term effectiveness, the burst release of drugs, cytotoxicity, and lack of reusability. Stimulus-responsive surfaces seem to be a promising strategy for a controlled and precise antimicrobial effect, and future research should focus on this technology and study it from models that better mimic clinical conditions.

KEYWORDS:

• antimicrobial agents
• biofilm
• dental implants
• peri-implantitis
• surface properties
• titanium

Article highlights

• Peri-implant diseases are pathological conditions mediated by the host immune system activated by the accumulation of complex polymicrobial biofilms.

• The host inflammatory response, biofilm structure and composition, and some implant surface properties are essential factors in disease progression.

• There is a promising approach to prevent and control biofilm accumulation by developing antimicrobial surfaces with antifouling, contact-killing, and/or drug-release mechanisms.

• Common setbacks faced in antimicrobial surface modification research are cytotoxicity, burst release of antimicrobials, short-term effectiveness, and its chemical and physical stability.

• Recent advanced biomedical research focuses on smart antimicrobial surfaces activated on demand under specific internal or external stimuli.

Declaration of interest

The authors have no other 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 apart from those disclosed.

Declaration of interest

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Author contributions

Samuel S. Malheiros: Conceptualization (equal); Investigation (equal); Methodology (equal); Visualization (equal); Writing-original draft (lead). Bruna E. Nagay: Conceptualization (equal); Investigation (equal); Methodology (equal); Visualization (equal); Writing-review & editing (equal). Martinna M. Bertolini: Visualization (equal); Writing-review & editing (equal). Erica D. de Avila: Visualization (equal); Writing-review & editing (equal). Jamil A. Shibli: Visualization (equal); Writing-review & editing (equal). João Gabriel S. Souza: Conceptualization (equal); Visualization (equal); Writing-review & editing (equal). Valentim Adelino Ricardo Barão: Conceptualization (equal); Project administration (equal); Resources (equal); Supervision (equal); Writing-review & editing (equal).

Additional information

Funding

This manuscript was partially supported by the São Paulo Research Foundation (FAPESP) (grant numbers 2022/15677-5 to S.S.M, 2019/17238-6 to B.E.N., 2018/20719-3 and 2021/09434-0 to E.D.A., and 2020/05231-4 to V.A.R.B.), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (grant number 307471/2021-7 to V.A.R.B.),Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) (Finance code 001 to S.S.M.).