Dental Implants: Biofilm Inhibition by Surface Modification

Dental Implants
Biofilm inhibition by surface modification
Ahmet F. Yazıcı
AMN 510 - Spring ‘18

Dental Implant Types
● ENDOSSEOUS - “within the bone”
● SUBPERIOSTEAL - “on top of the bone”
● TRANSOSTEAL - “through the bone”

ENDOSSEOUS - “within the bone”
These implants are usually shaped like a screw or
cylinder and are made either of metal, metal
covered with ceramic, or ceramic material. They
are placed within the jawbone. There are also
blade-shaped endosseous implants.
Image Ⓒ http://dentalimplants.uchc.edu/
SUBPERIOSTEAL - “on top of the bone”
These implants consist of a metal framework that

attaches on top of the jawbone but underneath the
gum tissue.
TRANSOSTEAL - “through the bone”
These implants consist of a metal framework that

attaches on top of the jawbone but underneath the
gum tissue.These implants are either a metal pin or
a U-shaped frame that passes through the jawbone
and the gum tissue, into the mouth.
Anatomy of Tooth vs Implant
Important parameters for implants
● Material and microstructure
● Surface composition and characteristics
● Design factors
Classification of Dental Implant Materials
● Biotolerant: Not rejected, but surrounded by fibrous layer (capsule)
○ Gold, Co-Cr alloys, SS, Zirconium, Nb, Ta
○ PE, PMMA, PTFE, PU
● Bioinert: Allow bone growth on the surface (Contact osteogenesis)

○ Titanium, Ti-6Al-4V, Aluminum oxide, Zirconium oxide
● Bioactive: Allow bone growth on the surface along with chemical bonding (Bonding osteogenesis)
○ Hydroxyapatite, Fluorapatite, Carbon-silicon, Bioglass
Osteoconductive materials
Titanium
● Gold, SS, Co-Cr alloys are obsolete
● Titanium and alloys became the gold standard
● Exceptional biocompatibility
● Interacts with biological fluids through self-forming, self-healing oxide layer (2-10 nm)
● Corrosion resistance
● Similar modulus of elasticity that of bone
Causes of Failure
● Mechanical problems
● Poor osseointegration
● Infection or rejection
Unfortunately failures end up with implant removal.

Peri-implantisis
● Leading cause of implant failure
● A site-specific infectious disease that causes an

inflammatory process in soft tissues, and bone
loss around an osseointegrated implant in
function
● They can successfully develop into biofilms,

which protects them from environmental
challenges and enhances their growth
Antibacterial Coatings
● Antibotics, chlorhexidine -- Short term solutions
● Metal ions
○ Zinc and Silver are intrinsic antibacterial metals
○ Inhibits enzyme activity on respiratory chain and on cell membrane
Motivation of the study
● Integrate an antibacterial coating as well as thin ceramic layer to enhance osseointegration
● TiO2 , Ag nanoparticles and hydroxyapatite are used to create a composite layer

○ Creates an antibacterial and biocompatible surface
● Examine the stability of the coatings in biological fluids

Test Samples
● Ti-6Al-4V discs
● 3 sub-groups
○ Uncoated
○ TiO2 coated(anodised)
○ Ag NPs coated (electroplating)
● 3 samples for each sub-group

○ As-is
○ Nano-hydroxyapatite coating (nHA) ~25 nm
○ Micro-hydroxyapatite coating (mHA) ~5 μm
● Exposed to Streptococcus sanguinis for 24 hours

Surface characterization
● In the oral cavity, the surface roughness is one of the most fundamental factors affecting bacterial
adhesion with rougher surfaces known to encourage biofilm formation
● Smooth surfaces are therefore desirable for preventing bacterial adhesion. An Ra value of 0.2 μm
is considered to be the threshold surface roughness below which bacterial adhesion cannot be
reduced further.
● Application of the nHA coatings resulted in a surface roughness up to three-fold higher compared
to the uncoated controls and the mHA coating resulted in even rougher surfaces. Rougher discs
were found to promote biofilm formation.
● However, there is a dilemma for medical implants; a moderate roughness of 1–2 μm is necessary
for good osseointegration and is a prerequisite for the long-term success of the implant.
Uncoated
TiO2 coated
Ag coated
Antibacterial effect | Viability
The silver plated discs exhibited the highest
antibacterial activity with anodised discs also
demonstrating some antibacterial effect. The
presence of the nHA and mHA coatings was found
to increase the antibacterial performance of the
specimens further.
Antibacterial effect | Lactate
Bacterial adhesion
● All the silver plated discs (Ag, Ag-nHA, Ag-mHA)

had a strong antibiofilm activity as confirmed by
the lack of biofilm development on the disc
surfaces.
● Application of the nHA and mHA coatings to the

silver plated discs did not diminish their
antibiofilm performance. All the remaining discs
had no antibiofilm activity with their surfaces
covered by a continuous biofilm formed by S.
sanguinis, which in most cases was thicker than a
monolayer.
● The presence of the nHA and mHA coatings on the

Ti6Al4V discs was found to further encourage
bacterial adhesion by 30%
Stability of coatings
Silver : Minimal dissolution (less than 0.07% in 24h)
Titanium : Notably, the titanium ion release from the Ti-nHA and Ti-mHA specimens was significantly
lower compared to the uncoated controls, probably because the HA coatings acted as a physical barrier
to Ti dissolution.
Hydroxyapatite : The absence of elevated concentrations of P or Ca in the media is consistent with no

appreciable dissolution of the HA coatings.
Conclusion
❏ The application of a dual layered silver-nHA coating provides highly antibacterial medium towards
the oral pathogen, S. sanguinis; causing bacterial growth inhibition in the surrounding media and
also preventing biofilm formation on the implant surface.
❏ The nanocoatings were stable and maintained their integrity in the experimental conditions.
❏ Critically, the silver was effective in the presence of clinically relevant forms of HA.
❏ It has a lower infection risk without compromising the biocompatible HA surface required for
successful osseointegration and accelerated bone healing.
References
❖ Besinis, Alexander, et al. "Antibacterial activity and biofilm inhibition by surface modified titanium
alloy medical implants following application of silver, titanium dioxide and hydroxyapatite
nanocoatings." Nanotoxicology 11.3 (2017): 327-338.
❖ Sykaras, Nikitas, et al. "Implant materials, designs, and surface topographies: their effect on
osseointegration. A literature review." International Journal of Oral & Maxillofacial Implants 15.5
(2000).
❖ Albrektsson, Tomas, and Ann Wennerberg. "Oral implant surfaces: Part 1--review focusing on
topographic and chemical properties of different surfaces and in vivo responses to them."
International Journal of Prosthodontics 17.5 (2004).
❖ Bollenl, Curd ML, Paul Lambrechts, and Marc Quirynen. "Comparison of surface roughness of oral
hard materials to the threshold surface roughness for bacterial plaque retention: a review of the
literature." Dental materials 13.4 (1997): 258-269.

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Dental Implants

Biofilm inhibition by surface modification

AMN 510 - Spring ‘18

● ENDOSSEOUS - “within the bone”

● SUBPERIOSTEAL - “on top of the bone”

● TRANSOSTEAL - “through the bone”

These implants consist of a metal framework that

These implants consist of a metal framework that

● Surface composition and characteristics

● Bioinert: Allow bone growth on the surface (Contact osteogenesis)

Unfortunately failures end up with implant removal.

● Leading cause of implant failure

● A site-specific infectious disease that causes an

● They can successfully develop into biofilms,

● Integrate an antibacterial coating as well as thin ceramic layer to enhance osseointegration

● TiO2 , Ag nanoparticles and hydroxyapatite are used to create a composite layer

● Examine the stability of the coatings in biological fluids

● 3 samples for each sub-group

● Exposed to Streptococcus sanguinis for 24 hours

● All the silver plated discs (Ag, Ag-nHA, Ag-mHA)

● Application of the nHA and mHA coatings to the

● The presence of the nHA and mHA coatings on the

Hydroxyapatite : The absence of elevated concentrations of P or Ca in the media is consistent with no

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