Titanium Implant and Its Cleaning/Decontamination Techniques

A special issue of Bioengineering (ISSN 2306-5354). This special issue belongs to the section "Biomedical Engineering and Biomaterials".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 6225

Special Issue Editor


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Guest Editor
West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
Interests: peri-implantitis; decontamination; re-osseointegration; photo-responsive materials; electrochemical treatment; inflammation; surface analysis

Special Issue Information

Dear Colleagues,

Titanium implants have revolutionized the treatment of diseases such as tooth loss, osteoarthropathy, and bone fracture, improving the quality of life for millions of patients worldwide. However, the occurrence of implant-associated infections, including dental peri-implantitis, prosthetic joint infection (PJI), infection after fracture fixation (IFF), and similar complications remains a formidable clinical challenge, potentially leading to implant failure despite extensive treatment efforts and associated costs. Most studies have mainly focused on implant disinfection, but deep cleaning of bacterial contaminants, including bacteria and extracellular polymeric substances (EPS), is also critical to halt the disease progression and achieve successful treatment. For example, dental peri-implantitis, a typical bacteria plaque-mediated inflammatory disease, can lead to substantial loss of supporting bone, implant loosening, and ultimately implant failure. Current clinical cleaning treatments (also called decontamination) for infected titanium implants are facing significant challenges in achieving deep decontamination results and satisfactory therapy outcomes, due to the irregular shape and threaded type of implants, in situ operation limitations, strong adhesion of biofilm EPS on implants, etc. Therefore, efficient and mild cleaning techniques for the complete removal of decontaminants from titanium implants are still lacking and also challenging. Excitingly, recent emerging methods such as bubble burst, electrochemical treatment, photocatalysis, and enzymatic treatment have been reported, which have great promise but also have a long way to go to achieve clinical application.  

Therefore, this Special Issue was developed to present newly emerging approaches for the deep cleaning of titanium implants and related studies in order to enable the better management of peri-implant infection diseases. We welcome contributions including original research articles, reviews, and short communications.

Dr. Li Xie
Guest Editor

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Keywords

  • titanium implants
  • peri-implantitis
  • decontamination
  • physical methods
  • chemical methods
  • laser, biofilm
  • EPS

Published Papers (6 papers)

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Research

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12 pages, 2539 KiB  
Article
Evaluation of Different Procedures for Titanium Dental Implant Surface Decontamination—In Vitro Study
by Ante Jordan, Igor Smojver, Ana Budimir, Dragana Gabrić and Marko Vuletić
Bioengineering 2024, 11(4), 326; https://doi.org/10.3390/bioengineering11040326 - 28 Mar 2024
Viewed by 700
Abstract
Polymicrobial biofilm removal and decontamination of the implant surface is the most important goal in the treatment of periimplantitis. The aim of this study is to evaluate the efficacy of four different decontamination methods for removing Acinetobacter baumannii and Staphylococcus aureus biofilms in [...] Read more.
Polymicrobial biofilm removal and decontamination of the implant surface is the most important goal in the treatment of periimplantitis. The aim of this study is to evaluate the efficacy of four different decontamination methods for removing Acinetobacter baumannii and Staphylococcus aureus biofilms in vitro. Seventy-five dental implants were contaminated with a bacterial suspension and randomly divided into five groups (n = 15): the negative control group, which received no treatment; the positive control group, treated with 0.2% chlorhexidine; group 1, treated with a chitosan brush (Labrida BioCleanTM, Labrida AS, Oslo, Norway); group 2, treated with a chitosan brush and 0.2% chlorhexidine; and group 3, treated with a device based on the electrolytic cleaning method (GalvoSurge, GalvoSurge Dental AG, Widnau, Switzerland). The colony-forming unit (CFU) count was used to assess the number of viable bacteria in each sample, and statistical analyses were performed. When compared to the negative control group, all the decontamination methods reduced the CFU count. The electrolytic cleaning method decontaminated the implant surface more effectively than the other three procedures, while the chitosan brush was the least effective. Further research in more realistic settings is required to assess the efficacy of the decontamination procedures described in this study. Full article
(This article belongs to the Special Issue Titanium Implant and Its Cleaning/Decontamination Techniques)
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13 pages, 4900 KiB  
Article
Extreme Serum Titanium Concentration Induced by Acetabular Cup Failure: Unveiling a Unique Scenario of Titanium Alloy Debris Accumulation
by Samo K. Fokter, Živa Ledinek, Milka Kljaić Dujić and Igor Novak
Bioengineering 2024, 11(3), 235; https://doi.org/10.3390/bioengineering11030235 - 28 Feb 2024
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Abstract
The majority of contemporary total hip arthroplasty (THA) implants are constructed from Ti alloys, which are generally believed to generate fewer adverse local tissue reactions (ALTRs) compared to CoCr alloys. This study presents a case of unusual primary THA failure where a substantial [...] Read more.
The majority of contemporary total hip arthroplasty (THA) implants are constructed from Ti alloys, which are generally believed to generate fewer adverse local tissue reactions (ALTRs) compared to CoCr alloys. This study presents a case of unusual primary THA failure where a substantial release of Ti alloy debris was observed. A 52-year-old active male underwent THA after post-traumatic aseptic necrosis of the femoral head in 2006. Seventeen years after the procedure, the patient presented with groin pain and a restricted range of motion. X-rays revealed the protrusion of the alumina ceramic head through the Ti6Al4V acetabular cup. Trace element analysis indicated significantly elevated levels of serum Ti, Al, and V. CT and MRI confirmed Ti alloy cup failure and a severe ALTR. During revision surgery, it was found that the worn-out ceramic head was in direct contact with the acetabular cup, having protruded through a central hole it had created over time. No acetabular liner was found. Histological analysis of his tissue samples showed wear-induced synovitis with areas of multinucleated foreign body giant cells and the accumulation of numerous metal particles but no acute inflammatory response. Six months after the revision THA, the patient has experienced favourable outcomes. This case provides an instructive illustration for studying the consequences of the substantial release of Ti alloy debris from orthopedic implants. Full article
(This article belongs to the Special Issue Titanium Implant and Its Cleaning/Decontamination Techniques)
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14 pages, 5164 KiB  
Article
Osteoblast Attachment on Bioactive Glass Air Particle Abrasion-Induced Calcium Phosphate Coating
by Faleh Abushahba, Elina Kylmäoja, Nagat Areid, Leena Hupa, Pekka K. Vallittu, Juha Tuukkanen and Timo Närhi
Bioengineering 2024, 11(1), 74; https://doi.org/10.3390/bioengineering11010074 - 12 Jan 2024
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Abstract
Air particle abrasion (APA) using bioactive glass (BG) effectively decontaminates titanium (Ti) surface biofilms and the retained glass particles on the abraded surfaces impart potent antibacterial properties against various clinically significant pathogens. The objective of this study was to investigate the effect of [...] Read more.
Air particle abrasion (APA) using bioactive glass (BG) effectively decontaminates titanium (Ti) surface biofilms and the retained glass particles on the abraded surfaces impart potent antibacterial properties against various clinically significant pathogens. The objective of this study was to investigate the effect of BG APA and simulated body fluid (SBF) immersion of sandblasted and acid-etched (SA) Ti surfaces on osteoblast cell viability. Another goal was to study the antibacterial effect against Streptococcus mutans. Square-shaped 10 mm diameter Ti substrates (n = 136) were SA by grit blasting with aluminum oxide particles, then acid-etching in an HCl-H2SO4 mixture. The SA substrates (n = 68) were used as non-coated controls (NC-SA). The test group (n = 68) was further subjected to APA using experimental zinc-containing BG (Zn4) and then mineralized in SBF for 14 d (Zn4-CaP). Surface roughness, contact angle, and surface free energy (SFE) were calculated on test and control surfaces. In addition, the topography and chemistry of substrate surfaces were also characterized. Osteoblastic cell viability and focal adhesion were also evaluated and compared to glass slides as an additional control. The antibacterial effect of Zn4-CaP was also assessed against S. mutans. After immersion in SBF, a mineralized zinc-containing Ca-P coating was formed on the SA substrates. The Zn4-CaP coating resulted in a significantly lower Ra surface roughness value (2.565 μm; p < 0.001), higher wettability (13.35°; p < 0.001), and higher total SFE (71.13; p < 0.001) compared to 3.695 μm, 77.19° and 40.43 for the NC-SA, respectively. APA using Zn4 can produce a zinc-containing calcium phosphate coating that demonstrates osteoblast cell viability and focal adhesion comparable to that on NC-SA or glass slides. Nevertheless, the coating had no antibacterial effect against S. mutans. Full article
(This article belongs to the Special Issue Titanium Implant and Its Cleaning/Decontamination Techniques)
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13 pages, 2671 KiB  
Article
Simultaneous Dual-Wavelength Laser Irradiation against Implant-Adherent Biofilms of Staphylococcus aureus, Escherichia coli, and Candida albicans for Improved Antimicrobial Photodynamic Therapy
by Shima Afrasiabi, Stefano Benedicenti, Antonio Signore, Mahnaz Arshad and Nasim Chiniforush
Bioengineering 2024, 11(1), 48; https://doi.org/10.3390/bioengineering11010048 - 2 Jan 2024
Cited by 1 | Viewed by 1161
Abstract
The efficiency of antimicrobial photodynamic therapy (PDT) might be improved by using multiple wavelengths. This study investigates the sensitivity of implant-adherent biofilms of Staphylococcus aureus, Escherichia coli, and Candida albicans to indocyanine green (ICG)-808 nm diode laser, toluidine blue O (TBO)-635 [...] Read more.
The efficiency of antimicrobial photodynamic therapy (PDT) might be improved by using multiple wavelengths. This study investigates the sensitivity of implant-adherent biofilms of Staphylococcus aureus, Escherichia coli, and Candida albicans to indocyanine green (ICG)-808 nm diode laser, toluidine blue O (TBO)-635 nm diode laser, and hydrogen peroxide (HP)-980 nm diode laser and their combination when irradiated with dual-wavelength laser irradiation (simultaneously 980–635 nm or 980–808 nm). After an incubation period of 72 h, the infected implants were randomly divided into seven different treatment modalities: Control, HP, HP-PDT, TBO-PDT, HP-TBO-PDT, ICG-PDT, and HP-ICG-PDT. After the treatments, the colony-forming units (CFUs)/mL and reactive oxygen species (ROS) generation were determined. All evaluated disinfection methods were significantly effective against the three investigated bacteria compared to the control. The combined treatment of HP-ICG-PDT or HP-TBO-PDT had the greatest antibacterial effect compared to each treatment alone. There were statistical differences between HP-ICG-PDT and ICG-PDT or HP-TBO-PDT and TBO-PDT for all three bacteria studied. PDT with simultaneous dual-wavelength laser irradiation is an efficient strategy to improve the therapeutic effect of PDT. Full article
(This article belongs to the Special Issue Titanium Implant and Its Cleaning/Decontamination Techniques)
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14 pages, 3578 KiB  
Article
Effect of Electrocautery and Laser Treatment on the Composition and Morphology of Surface-Modified Titanium Implants
by Jin-Seok Lee, Keunbada Son, Sung-Min Hwang, Young-Tak Son, Yong-Gun Kim, Jo-Young Suh, Jun Ho Hwang, Sung-Min Kwon, Jong Hoon Lee, Hyun Deok Kim, Kyu-Bok Lee and Jae-Mok Lee
Bioengineering 2023, 10(11), 1251; https://doi.org/10.3390/bioengineering10111251 - 26 Oct 2023
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Abstract
The purpose of this study was to investigate the effects of different peri-implantitis treatment methods (Er,Cr:YSGG laser, diode laser, and electrocautery) on various titanium implant surfaces: machined; sandblasted, large-grit, and acid-etched; and femtosecond laser-treated surfaces. Grade 4 titanium (Ti) disks, with a diameter [...] Read more.
The purpose of this study was to investigate the effects of different peri-implantitis treatment methods (Er,Cr:YSGG laser, diode laser, and electrocautery) on various titanium implant surfaces: machined; sandblasted, large-grit, and acid-etched; and femtosecond laser-treated surfaces. Grade 4 titanium (Ti) disks, with a diameter of 10 mm and a thickness of 1 mm, were fabricated and treated using the aforementioned techniques. Subsequently, each treated group of disks underwent different peri-implantitis treatment methods: Er,Cr:YSGG laser (Biolase, Inc., Foothill Ranch, CA, USA), diode laser (Biolase, Inc., Foothill Ranch, CA, USA), and electrocautery (Ellman, Hicksville, NY, USA). Scanning electron microscopy, energy-dispersive X-ray spectroscopy, and wettability were used to characterize the chemical compositions and surfaces of the treated titanium surfaces. Significant changes in surface roughness were observed in both the electrocautery (Sa value of machined surface = 0.469, SLA surface = 1.569, femtosecond laser surface = 1.741, and p = 0.025) and Er,Cr:YSGG laser (Ra value of machined surface = 1.034, SLA surface = 1.380, femtosecond laser surface = 1.437, and p = 0.025) groups. On femtosecond laser-treated titanium implant surfaces, all three treatment methods significantly reduced the surface contact angle (control = 82.2°, diode laser = 74.3°, Er,Cr:YSGG laser = 73.8°, electrocautery = 76.2°, and p = 0.039). Overall, Er,Cr:YSGG laser and electrocautery treatments significantly altered the surface roughness of titanium implant surfaces. As a result of surface composition after different peri-implantitis treatment methods, relative to the diode laser and electrocautery, the Er,Cr:YSGG laser increased oxygen concentration. The most dramatic change was observed after Er:Cr;YSGG laser treatment, urging caution for clinical applications. Changes in surface composition and wettability were observed but were not statistically significant. Further research is needed to understand the biological implications of these peri-implantitis treatment methods. Full article
(This article belongs to the Special Issue Titanium Implant and Its Cleaning/Decontamination Techniques)
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Review

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15 pages, 1166 KiB  
Review
Nonthermal Atmospheric Pressure Plasma Treatment of Endosteal Implants for Osseointegration and Antimicrobial Efficacy: A Comprehensive Review
by Sogand Schafer, Tina Swain, Marcelo Parra, Blaire V. Slavin, Nicholas A. Mirsky, Vasudev Vivekanand Nayak, Lukasz Witek and Paulo G. Coelho
Bioengineering 2024, 11(4), 320; https://doi.org/10.3390/bioengineering11040320 - 27 Mar 2024
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Abstract
The energy state of endosteal implants is dependent on the material, manufacturing technique, cleaning procedure, sterilization method, and surgical manipulation. An implant surface carrying a positive charge renders hydrophilic properties, thereby facilitating the absorption of vital plasma proteins crucial for osteogenic interactions. Techniques [...] Read more.
The energy state of endosteal implants is dependent on the material, manufacturing technique, cleaning procedure, sterilization method, and surgical manipulation. An implant surface carrying a positive charge renders hydrophilic properties, thereby facilitating the absorption of vital plasma proteins crucial for osteogenic interactions. Techniques to control the surface charge involve processes like oxidation, chemical and topographical adjustments as well as the application of nonthermal plasma (NTP) treatment. NTP at atmospheric pressure and at room temperature can induce chemical and/or physical reactions that enhance wettability through surface energy changes. NTP has thus been used to modify the oxide layer of endosteal implants that interface with adjacent tissue cells and proteins. Results have indicated that if applied prior to implantation, NTP strengthens the interaction with surrounding hard tissue structures during the critical phases of early healing, thereby promoting rapid bone formation. Also, during this time period, NTP has been found to result in enhanced biomechanical fixation. As such, the application of NTP may serve as a practical and reliable method to improve healing outcomes. This review aims to provide an in-depth exploration of the parameters to be considered in the application of NTP on endosteal implants. In addition, the short- and long-term effects of NTP on osseointegration are addressed, as well as recent advances in the utilization of NTP in the treatment of periodontal disease. Full article
(This article belongs to the Special Issue Titanium Implant and Its Cleaning/Decontamination Techniques)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Evaluation of different procedures for titanium dental implant surface decontamination
Author: Jordan
Highlights: Chlorhexidine-based solutions and cotton pellets, chitosan brushes, or electrolytic devices reduce the number of bacteria on the implant surface. The electrolytic cleaning procedure is more effective than the other three procedures at decontaminating the implant surface.

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