Mechanical loading of bone-anchored implants during functional performance tests in service members with transfemoral limb loss.

Introduction: For individuals with limb loss, bone-anchored implants create a direct structural and functional connection to a terminal prosthesis. Here, we characterized the mechanical loads distal to the abutment during several functional performance tests in Service members with transfemoral (TF) limb loss, to expand on prior work evaluating more steady-state ambulation on level ground or slopes/stairs. Methods: Two males with unilateral TF limb loss and two males with bilateral TF limb loss participated after two-stage osseointegration (24 and 12 months, respectively). Tri-directional forces and moments were wirelessly recorded through a sensor, fit distal to the abutment, during six functional tests: Timed Up and Go (TUG), Four Square Step Test (FSST), Six Minute Walk Test (6MWT), Edgren Side-Step Test (SST), T-Test (TTEST), and Illinois Agility Test (IAT). Additionally, participants performed a straight-line gait evaluation on a 15 m level walkway at a self-selected speed (0.93-1.24 m/s). Peak values for each component of force and moment were extracted from all six functional tests; percent differences compared each peak with respect to the corresponding mean peak in straight-line walking. Results: Peak mechanical loads were largest during non-steady state components of the functional tests (e.g., side-stepping during SST or TTEST, standing up from the ground during IAT). Relative to walking, peak forces during functional tests were larger by up to 143% (anterior-posterior), 181% (medial-lateral), and 110% (axial); peak moments were larger by up to 108% (flexion-extension), 50% (ab/adduction), and 211% (internal/external rotation). Conclusions: A more comprehensive understanding of the mechanical loads applied to bone-anchored implants during a variety of activities is critical to maximize implant survivability and long-term outcomes, particularly for Service members who are generally young at time of injury and return to active lifestyles.

Evaluation of Failure in Single-Piece Implant Systems: A One-Year Follow-Up Study.

Objective: This study's goal was to assess the failure rate and peri-implant complications of single-piece implant systems over the course of a one-year follow-up. Materials and Methods: Patient records were examined retrospectively. 150 single-piece dental implants were analyzed. Clinical results, implant features, and demographic information were gathered. Implant failure, which is characterized as the total loss of osseointegration, served as the key outcome indicator. Patient satisfaction and peri-implant problems were secondary outcomes. Data analysis employed descriptive statistics. Results: During the one-year follow-up period, the failure rate for single-piece implant systems was 6.7%. The two main factors leading to implant failure were found to be poor osseointegration (60%) and biomechanical overload (40%). 20% of the cases had peri-implant problems, such as peri-implantitis. 85% of the panelists felt that single-piece implants had satisfied their patients. Conclusion: A 6.7% failure rate in single-piece implant systems was seen in this one-year follow-up investigation. The major causes of implant failure were found to be poor osseointegration and biomechanical loading. In 20% of the cases, peri-implant problems such as peri-implantitis, were noted. There was great patient satisfaction. These results highlight the significance of regulating occlusal forces, optimizing osseointegration, and applying preventive measures to ensure the long-term viability of single-piece implant systems.

Evaluating the Role of Nanoparticles in Enhancing Bone Regeneration in Dental Implantology.

Background: Dental implantology has witnessed substantial progress in recent years, driven by a growing emphasis on optimizing bone regeneration around dental implants. Nanoparticles have emerged as a potential tool for enhancing osseointegration and bone tissue regeneration. Materials and Methods: This human clinical trial enrolled 60 adult participants requiring dental implants. Patients were randomly assigned to one of two groups: a control group receiving conventional dental implants, and an experimental group receiving dental implants with nanoparticle-coated surfaces. Radiographic imaging, histological analysis of bone biopsies, and implant stability assessments were conducted at three and six months post-implantation. Results: Histological examination of bone biopsies revealed a statistically significant increase in new bone formation in the experimental group compared to the control group at both three and six months (P < 0.05). Radiographic assessment demonstrated a 25% higher bone density around nanoparticle-coated implants (P < 0.01) at the six-month mark. Implant stability quotient (ISQ) measurements indicated a 20% greater stability in the experimental group (P < 0.05) at the same time point. Conclusion: This human clinical trial provides strong evidence that the incorporation of nanoparticles on dental implant surfaces enhances bone regeneration and osseointegration in a human population.

The Outcome of Smoking on Healing of Bone Around Dental Implants.

Objectives: To assess the outcome of cigarette smoking and non-smoking on the healing of bone around dental implants. Materials and Method: A retrospective analysis was made over 6 years of the clinical and radiographic findings corresponding to 60 consecutive patients (25 women and 35 men) who had received a total of 100 implants. Patients were divided into two groups: smokers, 32 patients (received 50 implants); and non-smokers (NSs), 28 patients (received 50 implants). Smokers were identified as people smoking >15 cigarettes per day. The success and failure cases were evaluated and studied. The data were analyzed using descriptive statistics. Result: Smokers and NSs received 50 implants in each group with 5 (10%) and 2 (4%) failures and 90% and 96% of success in smokers and NSs, respectively. Smokers had a higher failure rate than NSs. The difference was statistically significant. Conclusion: The results indicated a higher success of implants in NSs compared to smokers.

Complete Removal of Residual Particles and Realization of Mechanical Properties to Improve Osseointegration in Additively Manufactured Ti6Al4 V Scaffolds through Flowing Acid Etching.

Massive unmelted Ti6Al4 V (Ti64) particles presented across all surfaces of additively manufactured Ti64 scaffolds significantly impacted the designed surface topography, mechanical properties, and permeability, reducing the osseointegration of the scaffolds. In this study, the proposed flowing acid etching (FAE) method presented high efficiency in eliminating Ti64 particles and enhancing the surface modification capacity across all surfaces of Ti64 scaffolds. The Ti64 particles across all surfaces of the scaffolds were completely removed effectively and evenly. The surface topography of the scaffolds closely resembled the design after the 75 s FAE treatment. The actual elastic modulus of the treated scaffolds (3.206 ± 0.040 GPa) was closer to the designed value (3.110 GPa), and a micrometer-scale structure was constructed on the inner and outer surfaces of the scaffolds after the 90 s FAE treatment. However, the yield strength of scaffolds was reduced to 89.743 ± 0.893 MPa from 118.251 ± 0.982 MPa after the 90 s FAE treatment. The FAE method also showed higher efficiency in decreasing the roughness and enhancing the hydrophilicity and surface energy of all of the surfaces. The FAE treatment improved the permeability of scaffolds efficiently, and the permeability of scaffolds increased to 11.93 ± 0.21 × 10-10 mm2 from 8.57 ± 0.021 × 10-10 mm2 after the 90 s FAE treatment. The treated Ti64 scaffolds after the 90 s FAE treatment exhibited optimized osseointegration effects in vitro and in vivo. In conclusion, the FAE method was an efficient way to eliminate unmelted Ti64 particles and obtain ideal surface topography, mechanical properties, and permeability to promote osseointegration in additively manufactured Ti64 scaffolds.

Sustained Release of Salicylic Acid for Halting Peri-Implantitis Progression in Healthy and Hyperglycemic Systemic Conditions: A Gottingen Minipig Model.

To develop a peri-implantitis model in a Gottingen minipig and evaluate the effect of local application of salicylic acid poly(anhydride-ester) (SAPAE) on peri-implantitis progression in healthy, metabolic syndrome (MS), and type-2 diabetes mellitus (T2DM) subjects. Eighteen animals were allocated to three groups: (i) control, (ii) MS (diet for obesity induction), and (iii) T2DM (diet plus streptozotocin for T2DM induction). Maxillary and mandible premolars and first molar were extracted. After 3 months of healing, four implants per side were placed in both jaws of each animal. After 2 months, peri-implantitis was induced by plaque formation using silk ligatures. SAPAE polymer was mixed with mineral oil (3.75 mg/µL) and topically applied biweekly for up to 60 days to halt peri-implantitis progression. Periodontal probing was used to assess pocket depth over time, followed by histomorphologic analysis of harvested samples. The adopted protocol resulted in the onset of peri-implantitis, with healthy minipigs taking twice as long to reach the same level of probing depth relative to MS and T2DM subjects (∼3.0 mm), irrespective of jaw. In a qualitative analysis, SAPAE therapy revealed decreased levels of inflammation in the normoglycemic, MS, and T2DM groups. SAPAE application around implants significantly reduced the progression of peri-implantitis after ∼15 days of therapy, with ∼30% lower probing depth for all systemic conditions and similar rates of probing depth increase per week between the control and SAPAE groups. MS and T2DM conditions presented a faster progression of the peri-implant pocket depth. SAPAE treatment reduced peri-implantitis progression in healthy, MS, and T2DM groups.

Active osseointegration in an ex vivo porcine bone model.

Achieving osseointegration is a fundamental requirement for many orthopaedic, oral, and craniofacial implants. Osseointegration typically takes three to 6 months, during which time implants are at risk of loosening. The aim of this study was to investigate whether osseointegration could be actively enhanced by delivering controllable electromechanical stimuli to the periprosthetic bone. First, the osteoconductivity of the implant surface was confirmed using an in vitro culture with murine preosteoblasts. The effects of active treatment on osseointegration were then investigated in a 21-day ex vivo model with freshly harvested cancellous bone cylinders (n = 24; Ø10 mm × 5 mm) from distal porcine femora, with comparisons to specimens treated by a distant ultrasound source and static controls. Cell viability, proliferation and distribution was evident throughout culture. Superior ongrowth of tissue onto the titanium discs during culture was observed in the actively stimulated specimens, with evidence of ten-times increased mineralisation after 7 and 14 days of culture (p < 0.05) and 2.5 times increased expression of osteopontin (p < 0.005), an adhesive protein, at 21 days. Moreover, histological analyses revealed increased bone remodelling at the implant-bone interface in the actively stimulated specimens compared to the passive controls. Active osseointegration is an exciting new approach for accelerating bone growth into and around implants.

Reduced osseointegration in disuse and denervation rat models results from impaired cellular responses to multiscale microstructured titanium surfaces.

Immobilization-induced skeletal unloading results in muscle atrophy and rapid bone loss, thereby increasing the risk of falling and the need for implant therapy in patients with extended bed rest or neuromuscular injuries. Skeletal unloading causes bone loss by altering bone growth and resorption, suggesting that implant performance might be affected. To test this, we focused on early events in implant osseointegration. We used the rat sciatic neurectomy-induced disuse model under two different settings. In Study 1, 16 Sprague Dawley rats (SD) were separated into control, sham operated+cast immobilization, and sciatic neurectomy+casting groups; titanium implants with multiscale microtextured topography and hydrophilic chemistry (modSLA) were inserted in the distal femoral metaphysis. Neurectomy surgeries and casting were performed at the same surgical setting as implant placement; rats were euthanized 4 weeks post-implantation. In Study 2, we established the unloaded condition before implantation. A total of 12 SD rats were divided into control and sciatic+femoral neurectomy groups. A total of 24 days after sciatic and femoral neurectomy surgery, rats received implants. Study 2 rats were euthanized at 4 weeks post-implantation. MicroCT and histomorphometry showed that trabecular bone and osseointegration were reduced when disuse was established before implantation. Osteoblasts isolated from Study 1 sciatic neurectomy tibial bones exhibited impaired differentiation on modSLA culture disks, revealing a possible mechanism responsible for the decreased osseointegration observed in the Study 2 rats. This study addressed the importance of considering the mechanical unloading and muscle function history before implant insertion and suggests that implant performance was reduced due to poor cellular ability to regenerate.

Inter and intra-operator reliability of Lekholm and Zarb classification and proposal of a novel radiomic data-driven clustering for qualitative assessment of edentulous alveolar ridges.

OBJECTIVES: The present study was conducted to evaluate the reproducibility of Lekholm and Zarb classification system (L&Z) for bone quality assessment of edentulous alveolar ridges and to investigate the potential of a data-driven approach for bone quality classification. MATERIALS AND METHODS: Twenty-six expert clinicians were asked to classify 110 CBCT cross-sections according to L&Z classification (T0). The same evaluation was repeated after one month with the images put in a different order (T1). Intra- and inter-examiner agreement analyses were performed using Cohen's kappa coefficient (CK) and Fleiss' kappa coefficient (FK), respectively. Additionally, radiomic features extraction was performed from 3D edentulous ridge blocks derived from the same 110 CBCTs, and unsupervised clustering using 3 different clustering methods was used to identify patterns in the obtained data. RESULTS: Intra-examiner agreement between T0 and T1 was weak (CK 0.515). Inter-examiner agreement at both time points was minimal (FK at T0: 0.273; FK at T1: 0.243). The three different unsupervised clustering methods based on radiomic features aggregated the 110 CBCTs in three groups in the same way. CONCLUSIONS: The results showed low agreement among clinicians when using L&Z classification, indicating that the system may not be as reliable as previously thought. The present study suggests the possible application of a reproducible data-driven approach based on radiomics for the classification of edentulous alveolar ridges, with potential implications for improving clinical outcomes. Further research is needed to determine the clinical significance of these findings and to develop more standardized and accurate methods for assessing bone quality of edentulous alveolar ridges.

Current developments and future perspectives of nanotechnology in orthopedic implants: an updated review.

Orthopedic implants are the most commonly used fracture fixation devices for facilitating the growth and development of incipient bone and treating bone diseases and defects. However, most orthopedic implants suffer from various drawbacks and complications, including bacterial adhesion, poor cell proliferation, and limited resistance to corrosion. One of the major drawbacks of currently available orthopedic implants is their inadequate osseointegration at the tissue-implant interface. This leads to loosening as a result of immunological rejection, wear debris formation, low mechanical fixation, and implant-related infections. Nanotechnology holds the promise to offer a wide range of innovative technologies for use in translational orthopedic research. Nanomaterials have great potential for use in orthopedic applications due to their exceptional tribological qualities, high resistance to wear and tear, ability to maintain drug release, capacity for osseointegration, and capability to regenerate tissue. Furthermore, nanostructured materials possess the ability to mimic the features and hierarchical structure of native bones. They facilitate cell proliferation, decrease the rate of infection, and prevent biofilm formation, among other diverse functions. The emergence of nanostructured polymers, metals, ceramics, and carbon materials has enabled novel approaches in orthopaedic research. This review provides a concise overview of nanotechnology-based biomaterials utilized in orthopedics, encompassing metallic and nonmetallic nanomaterials. A further overview is provided regarding the biomedical applications of nanotechnology-based biomaterials, including their application in orthopedics for drug delivery systems and bone tissue engineering to facilitate scaffold preparation, surface modification of implantable materials to improve their osteointegration properties, and treatment of musculoskeletal infections. Hence, this review article offers a contemporary overview of the current applications of nanotechnology in orthopedic implants and bone tissue engineering, as well as its prospective future applications.

Correlation Between Acquisition of Dental Implant Stability and Hounsfield Units at Dental Implant Placement.

Alveolar bone quality at the implantation site affects the initial stability of dental implant treatment. However, the relationship between bone quality and osseointegration has yet to be evaluated. Herein, we aimed to investigate the effect of bone quality on dental implant stability in osseointegration formation changes. Patients underwent computed tomography imaging before dental implantation at the posterior. Hounsfield units were measured at the platform, middle, and tip sites. Implant stability was measured using resonance frequency analysis immediately and at 3 months postoperatively, in which the difference in implant stability quotients (ISQ) was defined as the change between primary and secondary fixation. In multiple regression analysis, the dependent variable was the change between the immediate and secondary fixations. We included 81 implants that conformed to the criteria. Primary fixation yielded the following results: R2 = 0.117, F = 2.529, and P = .047. The difference between the maxilla and mandible of the implantation site (P = .02) and the platform-site Hounsfield units (P = .019) were identified as significant factors. The following results were obtained regarding the change between the immediate and secondary fixation: R2 = 0.714, F = 40.964, and P < .001. The difference between diameter (P = .008) and the immediate ISQ (P < .001) were identified as significant factors. Overall, the bone quality of the implantation site affected initial fixation; however, it had limited effect on secondary fixation. Our findings clarified the period where bone quality affects dental implant treatment and is expected to advance dental implant treatment.

Early Implant Failure: A Meta-Analysis of 7 Years of Experience.

Background: The use of dental implant rehabilitation in the treatment of complete and partial edentulism has become an integral treatment today. This treatment is performed on healthy patients, but in some situations, also on those with associated general ailments. The presence of associated conditions increases the degree of difficulty of this type of treatment and tests the doctor's ability to manage the clinical case. The purpose of the study was to perform a meta-analysis of dental implants inserted over seven years and evaluate early implant failure in correspondence with age, sex, region of insertion, type of implant, and general state of health. Methods: A retrospective study was performed over 7 years of experience. For the study, 213 patients who fit the established inclusion criteria were selected. Patients were grouped taking into account age, sex, the type of implant used, and general associated conditions. The collected data were analyzed using IBM SPSS STATISTICS 25.0 for windows Results: There were no highlighted situations in which the rejection of the dental implant occurred 10 days postoperatively or later during the healing period. Conclusions: Our results confirm and strengthen the existing data in the specialized literature, especially those related to the loss of implants in patients with associated general diseases.

Effect of Antiresorptive Drugs on Osseointegrated Dental Implants: A Systematic Review.

Background: This systematic review aimed to evaluate the impact of antiresorptive drug therapy on osseointegrated dental implants and the association with medication-related osteonecrosis of the jaw (MRONJ). Methods: A systematic search, including a computer search of several databases with specific keywords, a reference search, and a manual search of four key maxillofacial journals were performed. Relevant articles were then evaluated and those that fulfilled the five predetermined criteria were chosen to enter the final review. A total of 445 implants in 135 subjects were included in the eight studies analyzed in the final review. Results: The failure rate of dental implants after antiresorptive medication in the included studies was 23%, with 83% of failures attributed to MRONJ. The average time from antiresorptive drug initiation to MRONJ development was approximately 34 months, ranging from 3 months to 16 years. The majority of MRONJ cases were classified as stage 2, and all sites showed either complete healing or substantial mucosal coverage after treatment. Conclusions: This review highlights the significant impact of antiresorptive drugs on osseo- integrated implants, with MRONJ identified as a leading cause of implant failure. The potential role of peri-implantitis as a trigger for MRONJ is emphasized. Regular monitoring and maintaining good periodontal health, especially within the first three years of antiresorptive drug therapy initiation, are crucial for implant success. Physicians and dentists should provide comprehensive information to patients prescribed with antiresorptive drugs, emphasizing the need for an awareness of the risks of MRONJ in the context of osseointegrated implants. A longer term of follow-up is recommended to identify and manage MRONJ around dental implants in an early manner.

Evaluation of effect on stability of implants with and without platelet rich fibrin using a resonance frequency analyzer - An in-vivo study.

Background: Although the conventional replacement for lost teeth has been partial or full dentures, the need for a fixed, esthetic, and functional restoration makes dental implants a reliable alternative. Aim: To evaluate the initial and final stability of platelet rich fibrin coated implants using resonance frequency analyzer. Method: ology: Thirteen patients with two or more missing teeth were informed about the procedure, and a consent form was obtained after cone beam computer tomography evaluation. Blood was drawn from the anticubital area of the patient, which was centrifuged to obtain platelet-rich fibrin. In all, 26 implants were placed, among which 13 were platelet-rich fibrin-coated (test group) and 13 were without platelet-rich fibrin (control group), and implant stability quotient values were recorded. Results: The mean age of the patients was 34.4 (SD = 4.28). Majority of the patients were males (9; 69.2%) whereas there were only four (30.8%) female patients. When comparison between overall primary implant stability with and without PRF was done, the mean difference was 5.12 and this difference was not statistically significant (p = 0.221) whereas a statistically significant difference (p = 0.019) was found when comparison between overall secondary implant stability was done with and without PRF. The primary and secondary stability values for the control group were 69.18 ± 7.45 and 73.84 ± 8.21 respectively, and the primary and secondary stability values for the test group were 64.06 ± 12.66 and 81.49 ± 7.61 respectively, which showed statistically significant differences among the groups. The difference in these values signify that primary stability is more in control group whereas secondary stability is more in case group. This signifies that PRF enhances the stability of implant. Conclusion: Implants coated with platelet-rich fibrin exhibited better osseointegration than implants without platelet-rich fibrin.

Pre-implantation teriparatide administration improves initial implant stability and accelerates the osseointegration process in osteoporotic rats.

PURPOSE: Osteoporotic individuals who have dental implants usually require a prolonged healing time for osseointegration due to the shortage of bone mass and the lack of initial stability. Although studies have shown that intermittent teriparatide administration can promote osseointegration, there is little data to support the idea that pre-implantation administration is necessary and beneficial. METHODS: Sixty-four titanium implants were placed in the bilateral proximal tibial metaphysis in 32 female SD rats. Bilateral ovariectomy (OVX) was used to induce osteoporosis. Four major groups (n = 8) were created: PRE (OVX + pre-implantation teriparatide administration), POST (OVX + post-implantation administration), OP (OVX + normal saline (NS)) and SHAM (sham rats + NS). Half of rats (n = 4) in each group were euthanized respectively at 4 weeks or 8 weeks after implantation surgery, and four major groups were divided into eight subgroups (PRE4 to SHAM8). Tibiae were collected for micro-CT morphometry, biomechanical test and undecalcified sections analysis. RESULTS: Compared to OP group, rats in PRE and SHAM groups had a higher value of insertion torque (p < 0.05). The micro-CT analysis, biomechanical test, and histological data showed that peri-implant trabecular growth, implants fixation and bone-implant contact (BIC) were increased after 4 or 8 weeks of teriparatide treatment (p < 0.05). There was no statistically difference in those parameters between PRE4 and POST8 subgroups (p > 0.05). CONCLUSIONS: In osteoporotic rats, post-implantation administration of teriparatide enhanced peri-implant bone formation and this effect was stronger as the medicine was taken longer. Pre-implantation teriparatide treatment improved primary implant stability and accelerated the osseointegration process.

Assessment of a novel electrochemically deposited smart bioactive trabecular coating (SBTC®): a randomized controlled clinical trial.

OBJECTIVES: A randomized controlled clinical trial of dental implants was conducted to compare the clinical properties of a novel electrochemically deposited calcium phosphate coating to those of a common marketed surface treatment. MATERIAL AND METHODS: Forty implants of the same brand and type were placed in 20 fully edentulous participants requiring mandibular implantation. The two study groups were defined by the surface treatment of the implants. 20 implants in the control group were coated via a commercial electrochemical surface treatment that forms a mixture of brushite and hydroxyapatite, while the remaining 20 in the test group were coated with a novel electrochemical Smart Bioactive Trabecular Coating (SBTC®). A split-mouth design was employed, with each participants receiving one control implant in one mandibular side and a test implant in the other. To mitigate potential operator-handedness bias, control and test implants were randomly assigned to mandibular sides. All cases underwent digital planning, implant placement with a static surgical guide, and participants received locator-anchored full-arch dentures. The primary outcome was implant stability (measured using Osstell ISQ) assessed at insertion, loading, and then 3 months, 9 months, and 2 years post-insertion. The secondary outcome was bone level change (in millimeters) over the 2-year observation period. Oral health-related quality of life (OHRQL) was monitored using the OHIP-14 questionnaire. Complications and adverse events were recorded. RESULTS: Successful osseointegration and implant stability were achieved in all cases, allowing loading. ISQ values steadily increased throughout the observation period. While no significant differences were observed between the SBTC® and control coatings, the test group exhibited a higher ISQ gain. Bone resorption was somewhat lower in the SBTC® but not significantly so. Patients' OHRQL significantly improved after denture delivery and remained stable throughout the follow-up. No complications or adverse events were observed. CONCLUSIONS: Based on the study results, we conclude that the new surface treatment is a safe alternative to the widely used control surface, demonstrating similar osseointegrative properties and time-dependent bone level changes. Further research may explore the broader implications of these findings. TRIAL REGISTRATION: The study is registered on clinicaltrials.gov under the identifier ID: NCT06034171.

Bone-anchored prostheses for transfemoral amputation: a systematic review of outcomes, complications, patient experiences, and cost-effectiveness.

Introduction: Bone-anchored prostheses (BAP) are an advanced reconstructive surgical approach for individuals who had transfemoral amputation and are unable to use the conventional socket-suspension systems for their prostheses. Access to this technology has been limited in part due to the lag between the start of a new procedure and the availability of evidence that is required before making decisions about widespread provision. This systematic review presents as a single resource up-to-date information on aspects most relevant to decision makers, i.e., clinical efficacy, safety parameters, patient experiences, and health economic outcomes of this technology. Methods: A systematic search of the literature was conducted by an information specialist in PubMed, MEDLINE, Embase, CINAHL, Cochrane Library, the Core Collection of Web of Science, CADTH's Grey Matters, and Google Scholar up until May 31, 2023. Peer-reviewed original research articles on the outcomes of clinical effectiveness (health-related quality of life, mobility, and prosthesis usage), complications and adverse events, patient experiences, and health economic outcomes were included. The quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and ROBINS-I, as appropriate. Results: Fifty studies met the inclusion criteria, of which 12 were excluded. Thirty-eight studies were finally included in this review, of which 21 reported on clinical outcomes and complications, 9 case series and 1 cohort study focused specifically on complications and adverse events, and 2 and 5 qualitative studies reported on patient experience and health economic assessments, respectively. The most common study design is a single-arm trial (pre-/post-intervention design) with varying lengths of follow-up. Discussion: The clinical efficacy of this technology is evident in selected populations. Overall, patients reported increased health-related quality of life, mobility, and prosthesis usage post-intervention. The most common complication is a superficial or soft-tissue infection, and more serious complications are rare. Patient-reported experiences have generally been positive. Evidence indicates that bone-anchored implants for prosthesis fixation are cost-effective for those individuals who face significant challenges in using socket-suspension systems, although they may offer no additional advantage to those who are functioning well with their socket-suspended prostheses.

Do Implant Coatings Affect Healing of Placed Implants? An Umbrella Review.

PURPOSE: To analyze the available evidence and assess the effect of different implant coatings on healing outcomes. MATERIALS AND METHODS: Using the PICOS strategy, a structured question was formed. A protocol was agreed upon and registered with PROSPERO (no. CRD42022321926). The MEDLINE, Embase, Cochrane Database of Systematic Reviews, Scopus, Web of Science, Pubmed, and ScienceDirect databases were searched using a structured strategy. Study selection was independently carried out in duplicate, first by title and abstract, then by full-text assessment. Quality and risk of bias were independently assessed in duplicate using AMSTAR 2 and ROBIS. Data extraction was independently undertaken in duplicate using a predefined extraction form. RESULTS: The search yielded 11 systematic reviews for inclusion. The most commonly assessed coatings were based on calcium phosphate-including hydroxyapatite (HA), brushite, and bioabsorbable nano-HA-followed by bisphosphonate, then bioactive glass coatings. Included reviews most frequently assessed marginal bone loss (MBL), bone-to-implant contact (BIC), and survival/success rates. There was considerable heterogeneity and small sample sizes. The quality assessment suggested low confidence in the reviews and high risk of bias. CONCLUSIONS: The included reviews provide weak evidence that implant coatings improve osseointegration and reduce MBL following implant placement. There was weak evidence for progressive complications for calcium phosphate coatings. Further research and long-term multicenter controlled clinical trials with improved standardization and control of bias are required to better understand the effects of coating implants.

Revolutionizing Dental Implant Research: A Systematic Review on Three-Dimensional In Vitro Models.

Dental implants have been clinically used for almost five decades with high success rates. In vitro research models used in implant dentistry are limited to two-dimensional experiments, which are reproducible and well adapted to evaluate a single parameter but do not reproduce the complexity of clinical settings. On the contrary, the in vivo research models using animals offer similar histological and anatomical features to humans, and tissue healing can be close to a clinical situation, but those models are usually accompanied with ethical concerns, and their outcomes could not be extrapolated to humans because of interspecies variabilities. This makes the development of novel in vitro models that recapitulate physiological events occurring during dental implant placement of particular interest for current research in dentistry. Also, such models could be challenged by setting a pathological environment (peri-implantitis) to better understand the disease and eventually serve as a platform to evaluate novel treatment modalities. The aim of this systematic literature review was to cover all the in vitro three-dimensional (3D) complex models available for research in implant dentistry. To accomplish this, a comprehensive search of the literature present on Scopus and PubMed databases was done using specific keywords, as well as inclusion/exclusion criteria. Out of 1334 articles found, we have finally included 27 articles in this review with publication dates between 2001 and 2022. In those articles, the 3D models were designed to study tissue-implant interface behavior in bone or gingival tissue. The articles focused on simulating implant integration, evaluating the effect of different conditions on implant integration, or developing an infection model for the implant integration process. The methods used involved implant material and cells organized in a specific 3D structure. The 3D models developed were able to simulate the process of dental implant osseo- and soft tissue integration and lead to results comparable with conventional in vitro and in vivo models. A relatively limited number of articles were obtained, which indicates that this is an emerging field, highly dependent on progresses made in biotechnologies and tissue engineering, and that further investigation is needed to enhance these 3D in vitro models.

Exploring tribology and material contact science in spine surgery: implications for implant design.

Tribology, an interdisciplinary field concerned with the science of interactions between surfaces in contact and their relative motion, plays a well-established role in the design of orthopedic implants, such as knee and hip replacements. However, its applications in spine surgery have received comparatively less attention in the literature. Understanding tribology is pivotal in elucidating the intricate interactions between metal, polymer, and ceramic components, as well as their interplay with the native human bone. Numerous studies have demonstrated that optimizing tribological factors is key to enhancing the longevity of joints and implants while simultaneously reducing complications and the need for revision surgeries in both arthroplasty and spinal fusion procedures. With an ever-growing and diverse array of spinal implant devices hitting the market for static and dynamic stabilization of the spine, it is important to consider how each of these devices optimizes these parameters and what factors may be inadequately addressed by currently available technology and methods. In this comprehensive review, the authors' objectives were twofold: 1) delineate the unique challenges encountered in spine surgery that could be addressed through optimization of tribological parameters; and 2) summarize current innovations and products within spine surgery that look to optimize tribological parameters and highlight new avenues for implant design and research.