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Purpose The present study was conducted to evaluate the effect of using ozone gel with transcrestal sinus elevation using osteotomes, on the bone width and the buccal plate of bone thickness around the implants placed simultaneously. Materials and methods A total of 30 sinuses with an average residual alveolar bone height ranging from 4–7 mm participated in this randomized controlled clinical trial. Following a closed sinus lift procedure, patients were randomized into two groups: one for the ozone gel recipient group and the other for control group. Cone beam computed tomography was carried out both immediately and four months postoperatively. Radiographic evaluations were performed to assess bone width and labial plate thickness at both crestal and midcrestal levels. Results Radiographic analysis revealed that the mean bone width of the control group after four months postoperative was (8.54 ± 1.46 mm) compared to (8.96 ± 1.66 mm) in the study group, which was statistically insignificant ( P  ≤ .0.05). The mean labial plate of bone thickness value of the control group after four months postoperative was (1.86 ± 0.63 mm) compared to (1.89 ± 0.51 mm) in the study group. Although the bone dimensions in the study group was higher than the control group, it was statistically insignificant ( P  ≤ .0.05). Conclusion When compared to the graftless group, the ozone gel recipient group showed non-significant difference in the results in terms of bone width and thickness. Both methods, nevertheless, produced outcomes that were acceptable. Trial registration This study protocol was retrospectively registered on the trial registry “Clinical trials.gov PRS”. ClinicalTrials.gov ID is: NCT06604819 and the registration date is 20/9/2024.

Objectives Nonsteroidal anti‐inflammatory drugs (NSAIDs) are often prescribed following the placement of dental implants, but the effects of these drugs on the osseointegration process are poorly understood. We designed a randomized, placebo‐controlled pilot study to quantitatively assess the effect of NSAIDs during early implant osseointegration. Materials and Methods Subjects receiving a maxillary dental implant were randomized to take naproxen or placebo for 7 days after the surgery. Implant osseointegration was quantified using Resonance Frequency Analysis device. Implant‐Stability‐Quotient (ISQ) measurement was performed at the time of surgery and at follow‐up visits 1, 4, and 16 weeks after surgery. Periapical radiographs were taken to measure the marginal bone level. Separately, a questionnaire of NSAIDs usage was provided to subjects presenting with early implant failure. Results After 4 weeks, ISQ values increased modestly ( + 1%) in subjects receiving naproxen whereas subjects receiving placebo had a much larger increase in ISQ value (+41%). We observed 55% more marginal bone loss at 4 weeks, and 52% at 16 weeks in the naproxen group compared to the placebo group. These results were not found to have statistically significant between groups (p ≥ 0.05). These effect sizes and variance were used to conduct a power analysis to determine the necessary sample size for future studies. Furthermore, our separate questionnaire study revealed that 68% of our patients with early failed dental implants reported a history of NSAIDs usage after the surgery. Conclusion In conclusion, this pilot study provides effect sizes and sample size estimates for future studies to definitively determine recommendations regarding NSAID usage following dental implant surgery. Nonetheless, our study did not observe any statistically significant differences in ISQ value or marginal bone loss after up to 16 weeks of follow‐up between subjects from naproxen and placebo groups.

Limited information exists regarding soft tissue and hard tissue responses to abutments with different material composition. The aim of this study is to evaluate soft and hard tissue responses to titanium and polymer healing abutments over a 3-month period. Sixteen patients were included in this prospective trial. Implants were provisionalized with either titanium or polymer healing abutments. Changes of marginal bone level and soft tissue dimensions were recorded at implant installation and at 3 months.

The choice of augmentation material is a crucial factor in sinus augmentation surgery. Bovine-derived hydroxyapatite (BHA) and beta-tricalcium phosphate (β-TCP) have been used successfully in sinus augmentation procedures. Choosing one of these materials for sinus augmentation is still controversial. The aim of this clinical study was to compare the biological performance of the new BHA graft material and the well-known synthetic β-TCP material in the sinus augmentation procedure. The study consisted of 23 patients (12 male and 11 female) who were either edentulous or partially edentulous in the posterior maxilla and required implant placement. A total of 23 two-step sinus-grafting procedures were performed. BHA was used in 13 patients, and β-TCP was used in 10 patients. After an average of 6.5 months of healing, bone biopsies were taken from the grafted areas. Undecalcified sections were prepared for histomorphometric analysis. The mean new bone formation was 30.13% ± 3.45% in the BHA group and 21.09% ± 2.86% in the β-TCP group ( P = .001). The mean percentage of residual graft particle area was 31.88% ± 6.05% and 34.05% ± 3.01% for the BHA group and β-TCP group, respectively ( P = .047). The mean percentage of soft-tissue area was 37.99% ± 5.92% in the BHA group and 44.86% ± 4.28% in the β-TCP group ( P = .011). Both graft materials demonstrated successful biocompatibility and osteoconductivity in the sinus augmentation procedure. However, BHA appears to be more efficient in osteoconduction when compared with β-TCP.

Peri-implant infection is one of the biggest threats to the success of dental implant. Existing coatings on titanium surfaces exhibit rapid decrease in antibacterial efficacy, which is difficult to promisingly prevent peri-implant infection. Herein, we report an N-halamine polymeric coating on titanium surface that simultaneously has long-lasting renewable antibacterial efficacy with good stability and biocompatibility. Our coating is powerfully biocidal against both main pathogenic bacteria of peri-implant infection and complex bacteria from peri-implantitis patients. More importantly, its antibacterial efficacy can persist for a long term (e.g., 12~16 weeks) in vitro, in animal model, and even in human oral cavity, which generally covers the whole formation process of osseointegrated interface. Furthermore, after consumption, it can regain its antibacterial ability by facile rechlorination, highlighting a valuable concept of renewable antibacterial coating in dental implant. These findings indicate an appealing application prospect for prevention and treatment of peri-implant infection. Infection is a major problem for dental implants with current antibacterial coatings losing efficacy quickly. Here, the authors report on the N-halamine polymeric coating of titanium implants to create a long-lasting renewable antibacterial layer and demonstrate application in vivo.

Purpose To evaluate granulocyte colony-stimulating factor (G-CSF) efficacy in accelerating bone regeneration following opening-wedge high tibial valgus osteotomy for genu varum. Methods A phase II trial was conducted for evaluating the preoperative administration of G-CSF given at 10 μg/kg/day for 3 consecutive days with an additional half-dose 4 h before the opening-wedge high tibial valgus osteotomy. Overall, 12 patients (Group A) received G-CSF treatment, and the subsequent 12 patients (Group B) underwent surgery without G-CSF. The osteotomy gap was filled by a bone graft substitute. Bone marrow cell (BMC) mobilization was monitored by CD34+ve cell and clonogenic progenitor cell analysis. All patients underwent a clinical (Lysholm Knee Scale and SF-36) and radiographic evaluation preoperatively, as well as at given intervals postsurgery. Results All patients completed the treatment program without major side effects; G-CSF was well tolerated. BMC mobilization occurred in all Group A patients, with median peak values of circulating CD34+ve cells of 110/μL (range 29–256). Circulating clonogenic progenitors paralleled CD34+ve cell levels. A significant improvement in Lysholm Knee Scale was recorded at follow-up in Group A compared to Group B. At the radiographic evaluation, there was a significant increase in osseointegration at the bone-graft junction in Group A at 1, 2, 3 and 6 months postsurgery compared to Group B. The computerized tomography scan of the grafted area at 2 months postsurgery showed no significant difference in the quality of the newly formed bone between the two Groups. Conclusions Although the limited number of patients does not allow firm conclusions, the study suggests that G-CSF can be safely administered preoperatively in subjects undergoing opening-wedge high tibial valgus osteotomy; in addition, the clinical, radiographic and CT monitoring indicate that G-CSF and/or mobilized BMCs may hasten bone graft substitute osseointegration. Level of evidence I.

Aseptic loosening is the primary cause of bone prosthesis failure, commonly attributed to inadequate osseointegration due to coatings misaligned with bone regeneration. Here, we modify the titanium surface with a mussel-inspired peptide to form a 3,4-dihydroxyphenylalanine (DOPA)-rich coating, then graft N 3 -K15-PVGLIG-K23 (P1) and N 3 -Y5-PVGLIG-K23 (P2), which are composed of anti-inflammatory (K23), angiogenic (K15), osteogenic (Y5), and inflammation-responsive (PVGLIG) sequences, onto the surface via click chemistry, forming the DOPA-P1@P2 coating. DOPA-P1@P2 promotes bone regeneration through sequential regulation. In the initial stage, the outermost K23 induces M2 macrophage polarization, establishing a pro-regenerative immune microenvironment. Subsequently, K15 and Y5, exposed by the release of K23, enhance angiogenesis and osteogenesis. In the final stage, DOPA-P1@P2 outperforms the TiO₂ control, showing a 161% increase in maximal push-out force, a 207% increase in bone volume fraction, and a 1409% increase in bone-to-implant contact. These findings show that DOPA-P1@P2 efficiently enhances interfacial osseointegration by sequentially regulating bone regeneration, providing viable insights into coating design. Aseptic loosening is the primary cause of bone prosthesis failure, commonly attributed to inadequate osseointegration. Here, researchers report an inflammation-responsive titanium coating (DOPA-P1@P2) to enhance implant osseointegration by sequentially regulating bone regeneration.

Macrophages play a pivotal role in the immunological cascade activated in response to biomedical implants, which predetermine acceptance or rejection of implants by the host via pro‐ and anti‐inflammatory polarisation states. The role of chemical signals in macrophage polarisation is well‐established, but how physical cues regulate macrophage function that may play a fundamental role in implant‐bone interface, remains poorly understood. Here we find that bone marrow‐derived macrophages (BMDM) cultured on polyacrylamide gels of varying stiffness exhibit different polarisation states. BMDM are ‘primed’ to a pro‐inflammatory M1 phenotype on stiff substrates, while to an anti‐inflammatory M2 phenotype on soft and medium stiffness substrates. It is further observed that matrix stiffening increases Piezo1 expression, as well as leads to subsequent activation of the mechanotransduction signalling effector YAP, thus favouring M1 polarisation whilst suppressing M2 polarisation. Moreover, upon treatment with YAP inhibitor, we successfully induce macrophage re‐polarisation to the M2 state within the implant site microenvironment, which in turn promotes implant osseointegration. Collectively, our present study thus characterises the critical role of the Piezo1‐YAP signalling axis in macrophage mechanosensing and stiffness‐mediated macrophage polarisation and provides cues for the design of immuno‐modulatory biomaterials that can regulate the macrophage phenotype. Matrix stiffening promotes M1 macrophage polarisation via the Piezo1‐YAP signalling axis. The application of YAP inhibitor successfully reverses the polarisation of macrophages towards anti‐inflammatory M2 phenotype and improves implant osseointegration.

Dental implants are commonly used to repair missing teeth. The implant surface plays a critical role in promoting osseointegration and implant success. However, little information is available about which implant surface treatment technology best promotes osseointegration and implant stability. The aim of this network meta-analysis was to evaluate the osseointegration and stability of four commonly used dental implants (SLA, SLActive, TiUnite, and Osseotite). The protocol of the current meta-analysis is registered in PROSPERO (International Prospective Register of Systematic Reviews) under the code CRD42020190907 ( https://www.crd.york.ac.uk ). We conducted a systematic review following PRISMA and Cochrane Recommendations. Medline (PubMed), Cochrane Library, Embase, and the Web of Science databases were searched. Only randomized controlled trials were considered. Twelve studies were included in the current network meta-analysis, eleven studies were included concerning the osseointegration effect and five studies were included for stability analysis (four studies were used to assess both stability and osseointegration). Rank possibility shows that the SLActive surface best promoted bone formation at an early healing stage and TiUnite seemed to be the best surface for overall osseointegration. For stability, TiUnite seemed to be the best surface. The present network meta-analysis showed that the SLActive surface has the potential to promote osseointegration at an early stage. The TiUnite surface had the best effect on osseointegration regarding the overall healing period. The TiUnite surface also had the best effect in stability.

Titanium implants are widely used in dental and orthopedic medicine. Nevertheless, there is limited osteoinductive capability of titanium leading to a poor or delayed osseointegration, which might cause the failure of the implant therapy. Therefore, appropriate modification on the titanium surface for promoting osseointegration of existing implants is still pursued. Graphene oxide (GO) is a promising candidate to perform implant surface biofunctionalization for modulating the interactions between implant surface and cells. So the objective of this study was to fabricate a bioactive GO-modified titanium implant surface with excellent osteoinductive potential and further investigate the underlying biological mechanisms. The large particle sandblasting and acid etching (SLA, commonly used in clinical practice) surface as a control group was first developed and then the nano-GO was deposited on the SLA surface via an ultrasonic atomization spraying technique to create the SLA/GO group. Their effects on rat bone marrow mesenchymal stem cells (BMSCs) responsive behaviors were assessed in vitro, and the underlying biological mechanisms were further systematically investigated. Moreover, the osteogenesis performance in vivo was also evaluated. The results showed that GO coating was fabricated on the titanium substrates successfully, which endowed SLA surface with the improved hydrophilicity and protein adsorption capacity. Compared with the SLA surface, the GO-modified surface favored cell adhesion and spreading, and significantly improved cell proliferation and osteogenic differentiation of BMSCs in vitro. Furthermore, the FAK/P38 signaling pathways were proven to be involved in the enhanced osteogenic differentiation of BMSCs, accompanied by the upregulated expression of focal adhesion (vinculin) on the GO coated surface. The enhanced bone regeneration ability of GO-modified implants when inserted into rat femurs was also observed and confirmed that the GO coating induced accelerated osseointegration and osteogenesis in vivo. GO modification on titanium implant surface has potential applications for achieving rapid bone-implant integration through the mediation of FAK/P38 signaling pathways.