Prefabricating Implant-supported Interim Prosthesis from CBCT Scans: a Case Report of Digital Immediate Implant Restoration.

This clinical report describes the immediate implant placement and restoration for a 47-yearold woman with a protruded and loose maxillary right central incisor. The treatment included minimally invasive extraction, flapless immediate implant placement using a fully guided surgical template, and immediate implant-supported provisionalisation. The interim anatomical prosthesis was fabricated in advance based on preoperative CBCT scans, and the digital technique made it possible to integrate data precisely from different sources. After 6 months of provisionalisation, satisfactory gingival aesthetic and functional improvements were achieved, followed by a definitive screw-retained zirconia restoration. Thus, application of a complete digital workflow could reduce chairside time and create an optimal emergence profile that matches the residual bone architecture of the extraction sites with minimal interference.

Hollow mesoporous zirconia delivery system for biomineralization precursors.

Strategies based on the combination of nanocarrier delivery systems and scaffolds provide bone tissue engineering scaffolds with multifunctional capability. Zirconia, a biocompatible ceramic commonly used in orthopedic and dental implants, was used to synthesize hollow mesoporous nanocapsules for loading, storage and sustained release of a novel polyamine-stabilized liquid precursor phase of amorphous calcium phosphate (PAH-ACP) for collagen biomineralization and bone marrow stromal cells osteoinduction. Hollow mesoporous zirconia (hmZrO2) nanocapsules loaded with biomimetic precursors exhibited pH-sensitive release capability and good biocompatibility. The PAH-ACP released from loaded hmZrO2 still retained the ability to infiltrate and mineralize collagen fibrils as well as exhibited osteoinductivity. A collagen scaffold blended with PAH-ACP@hmZrO2 supplement and stem cells may be a promising tool for bone tissue engineering. STATEMENT OF SIGNIFICANCE: The advent of nanotechnology has catalyzed the development of bone tissue engineering strategies based on the combination of nanocarrier delivery systems and scaffolds, which provide distinct advantages, including the possibilities of sustained release and protection of the bioactive agents, site-specific pharmacological effects and reduction of side effects. Herein, hollow mesoporous zirconia (hmZrO2) nanocapsules with pH-sensitive capacity were synthesized for loading, storage and sustained release of a novel polyamine-stabilized liquid precursor phase of ACP (PAH-ACP). The loaded nanocapsules show good biocompatibility and demonstrate bioactivities for collagen biomineralization and bone marrow stromal cells osteoinduction. Our results may offer a promising tool for designing bone tissue engineering "cocktail therapy" involving seeding scaffolds with biomineralization precursors loaded hmZrO2 supplement and stem cells.

Biodegradable mesoporous delivery system for biomineralization precursors.

Scaffold supplements such as nanoparticles, components of the extracellular matrix, or growth factors have been incorporated in conventional scaffold materials to produce smart scaffolds for tissue engineering of damaged hard tissues. Due to increasing concerns on the clinical side effects of using large doses of recombinant bone-morphogenetic protein-2 in bone surgery, it is desirable to develop an alternative nanoscale scaffold supplement that is not only osteoinductive, but is also multifunctional in that it can perform other significant bone regenerative roles apart from stimulation of osteogenic differentiation. Because both amorphous calcium phosphate (ACP) and silica are osteoinductive, a biodegradable, nonfunctionalized, expanded-pore mesoporous silica nanoparticle carrier was developed for loading, storage, and sustained release of a novel, biosilicification-inspired, polyamine-stabilized liquid precursor phase of ACP for collagen biomineralization and for release of orthosilicic acid, both of which are conducive to bone growth. Positively charged poly(allylamine)-stabilized ACP (PAH-ACP) could be effectively loaded and released from nonfunctionalized expanded-pore mesoporous silica nanoparticles (pMSN). The PAH-ACP released from loaded pMSN still retained its ability to infiltrate and mineralize collagen fibrils. Complete degradation of pMSN occurred following unloading of their PAH-ACP cargo. Because PAH-ACP loaded pMSN possesses relatively low cytotoxicity to human bone marrow-derived mesenchymal stem cells, these nanoparticles may be blended with any osteoconductive scaffold with macro- and microporosities as a versatile scaffold supplement to enhance bone regeneration.

Translation of a solution-based biomineralization concept into a carrier-based delivery system via the use of expanded-pore mesoporous silica.

Mineralization of collagen fibrils using solution-based systems containing biomimetic analogs of matrix proteins to stabilize supersaturated calcium phosphate solutions have been predictably achieved in vitro. Solution-based systems have limitations when used for in-situ remineralization of human hypomineralized tissues because periodic replenishment of the mineralizing solution is infeasible. A carrier-based platform designed for delivering mineral precursors would be highly desirable. In the present work, mesoporous silica nanoparticles with expanded pores (eMSN; 14.8nm) were synthesized. Polyacrylic acid-stabilized amorphous calcium phosphate (PA-ACP) was generated from a supersaturated calcium and phosphate ion-containing solution, and chosen as the model mineralizing phase. After amine functionalization (AF) of the eMSN through a post-grafting method, the positively-charged AF-eMSN enabled loading of PA-ACP by electrostatic interaction. In-vitro cytotoxicity testing indicated that PA-ACP@AF-eMSN was highly biocompatible. The release kinetics of mineralization precursors from PA-ACP@AF-eMSN was characterized by an initial period of rapid calcium and phosphate release that reached a plateau after 120h. Intrafibrillar mineralization was examined using a 2-D fibrillar collagen model; successful mineralization was confirmed using transmission electron microscopy. To date, this is the first endeavor that employs expanded-pore mesoporous silica to deliver polymer-stabilized intermediate precursors of calcium phosphate for intrafibrillar mineralization of collagen. The carrier-based delivery system bridges the gap between contemporary solution-based biomineralization concepts and clinical practice, and is useful for in-situ remineralization of bone and teeth. STATEMENT OF SIGNIFICANCE: Concepts of collagen biomineralization have been reasonably well established in the past few years and intrafibrillar mineralization of collagen fibrils can be predictably achieved with analogs of matrix proteins using solution-based systems. However, solution-based systems have their limitations in clinical applications that require direct application of mineralization precursors in-situ because periodic replenishment of the mineralizing solution is impossible. The present work presents for the first time, the use of amine-functionalized mesoporous silica with expanded pores for loading and release of polyacid-stabilized amorphous calcium phosphate mineralization precursors, and for intrafibrillar mineralization of type I collagen fibrils. This strategy represents an important step in the translational application of contemporary biomineralization concepts for in-situ remineralization of bone and teeth.

Biomimetic Intrafibrillar Mineralization of Type I Collagen with Intermediate Precursors-loaded Mesoporous Carriers.

Limited continuous replenishment of the mineralization medium is a restriction for in-situ solution-based remineralization of hypomineralized body tissues. Here, we report a process that generated amine-functionalized mesoporous silica nanoparticles for sustained release of biomimetic analog-stabilized amorphous calcium phosphate precursors. Both two-dimensional and three-dimensional collagen models can be intrafibrillarly mineralized with these released fluidic intermediate precursors. This represents an important advance in the translation of biomineralization concepts into regimes for in-situ remineralization of bone and teeth.