The Impact of Dental Implant Surface Modifications on Osseointegration and Biofilm Formation



Stefanie Kligman
Zhi Ren
Chun-Hsi Chung
Michael Angelo Perillo
Yu-Cheng Chang
Hyun Koo
Zhong Zheng
Chenshuang Li

Kligman, Stefanie1, Ren, Zhi1, Chung, Chun-Hsi1, Perillo, Michael Angelo1, Chang, Yu-Cheng2, Koo, Hyun1, Zheng, Zhong3, Li, Chenshuang1
Faculty / Advisor: Li, Chenshuang1
1University of Pennsylvania School of Dental Medicine, Department of Orthodontics
2University of Pennsylvania School of Dental Medicine,Department of Periodontics
3University of California, Los Angeles, School of Dentistry; David Geffen School of Medicine, Division of Growth and Development, Section of Orthodontics; Department of Surgery

Introduction

To conquer the most common dental implant-related complications, peri-implantitis and subsequent implant loss, implant surfaces of titanium, zirconia and polyether ether ketone (PEEK) have been modified to introduce desired properties to a dental implant and thus increase the implant success rate and expand their indications. Ideal modifications enhance the interaction between the implant’s surface and its surrounding bone which will facilitate osseointegration while minimizing the bacterial colonization to reduce the risk of biofilm formation. Our objective was to review surface modifications commonly used in implantology and their impact on osseointegration and biofilm formation, which is crucial for clinicians to choose the most suitable materials to improve the success and survival of implantation.

Methods

A comprehensive review of the literature published between 2015 and 2021 was conducted by using the pubmed database with the keywords “dental implant” “surface modification,” “titanium,” “zirconia,” “PEEK,” “osseointegration”, and “biofilm formation.” After screening, 257 publications are included in the current review.

Results

Physical, chemical and biological implant surface modifications have notable effects on osseointegration and biofilm formation. Physical modifications are categorized at the macro, micro, and nano levels. At macro level, manufacturing a wide, taper-shaped, V-shape thread implant would most likely achieve more favorable clinical outcomes. The most common types of micro-level modifications include machining, grit-blasting, and sandblasting combined with acid etching, which not only favor osseointegration, but also impact bacterial attachment and biofilm formation. In addition, nano-level implant surface modifications, including laser ablation and nanocomposites, have a promising potential in promoting osseointegration and preventing biofilm formation. Chemical modifications improve osseointegration and mitigate biofilm formation by providing a hydrophilic surface. The most common chemical modifications used currently are discrete crystalline deposition, anodic oxidation, and photofunctionalization. Overall, a chemical-modified implant surface could significantly benefit bone healing. Biological modifications include plasma, extracellular matrix, peptides, growth factors, messenger molecules, drugs, and antibacterial agents. These modifications have shown a diversity of effects.

Conclusion

Surface roughness, which directly affects both osseointegration and biofilm formation, is the primary target for all kinds of surface modifications. A combination of modifications at different levels may provide advancing benefits, although the investigations in this area are still in infancy. In this constantly evolving field, future studies will continue to strive for a more evolved implant surface that achieves the precise combination between rapid and enhanced osseointegration and the limitation of biofilm formation.