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Summary. Achieving good clinical outcomes with implanted biomaterials depends upon achieving optimal function, both mechanical and biological, which in.
Table of contents

Gingiva, as a soft tissue covering the jaw bone, is attached to a tooth by junctional epithelium seal. A similar permeable seal can also be formed between a gingiva and an abutment. Thus, as small a gap as possible is desired to reduce the probability of bacterial penetration [ 70,71 ]. Gingival properties are difficult to quantify due to its heterogeneous composite structure. Differences between individuals can stem from different parameters such as age, sex, life style choices and inflammations such as gingivitis.

For example, gingiva becomes less elastic when aging [ 71 ]. The orientation of collagen fibers in connective tissue is important for the structure of a gingiva. The collagen fiber structure of keratinized mucosa provides better attachment for teeth allowing it to endure more mastication frictions and forces. Thus, for a good quality of abutment-tissue interface, keratinized epithelia should be enhanced in gingiva [ 70 ]. The essential differences between periodontal i. Attachment mechanisms of periodontal and peri-implant soft tissues are rather similar, the biggest differences coming from different surfaces and wound healing processes caused by implantation.

Due to implantation, peri-implant tissue resembles a scar tissue. A hydrophilic surface can enhance vascularization and thus the stability of an abutment [ 72,73 ]. An abutment attachment is initialized within the first seconds after the implantation of an abutment. First a water layer is placed on an abutment in nanoseconds followed by the second layer attached to it by hydration and steric forces [ 74 ]. Acellular salivary biofilm of three layers phosphoproteins and low- and high-molecular-weight glycoproteins forms in this layer, depending on pH, flow rate and composition of saliva. It helps to minimize bacterial attachment by reducing interfacial free energy and increasing strains for some bacteria [ 74 ].

After the initial biological responses a delayed response follows: cell attachment and proliferation, tissue reactions, which can enhance or prevent healing. Enhancing reactions include contact, connection, growth and differentiation of cells. Peri-implant tissue healing is a long process [ 75 ], but it should be allowed to proceed undisturbed. If an attachment between an abutment and soft tissue is ruptured repeatedly, the height of a gingiva is reduced.

This reduction affects mainly the height of the connective tissue, while the height of the epithelial tissue stays the same [ 76 ]. Dental implant and abutment faces many mechanical and biological factors in an oral environment, and they all affect the attachment to the tissues. Mechanical loads during mastication, grinding and parafunctional clenching directly create mechanical stress in the implants and respectively cause micromotions on the tissue interface [ 77 ].

Mastication stresses depend on individual characteristics such as age, sex, bone quality, soft tissue characteristics and used food type [ 78 ].

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Force and stresses are non-uniform, causing additional wear due to some parafunctional chewing habits, neuromuscular forces and abrasion of food and antagonists [ 72,79 ]. Such forces are difficult to predict and control, but they have a great impact on the new tissue formation and also tissue-implant interface development. The third important contribution associated with macro- and microscopic forces is various biological and biochemical factors. These include, for example, pumping effect of fluid, which affect local pH, salinity, delivery of species and removal of metabolic products, etc.

For any biomaterial of the dental implant, bacteria are exploiting all three cases to attach to the surfaces: 1 an immediate, earliest competitive attachment after implantation, 2 accumulation in to a biofilm during use, and 3 follow-up penetration infiltration of bacteria through the permeable epithelial junction seal. The most critical one is the first, as in the case that bacteria would occupy the surface there would be no space for cells and mucosal tissue to attach well.

This creates a continuous source of infection and will lead to implant failure. From the above analysis, one may conclude that one of the options for carrying out such tests, and assessing whether or not one implant or material would be better than another one, would be mimicking the conditions of the implant location. A prerequisite in the evaluation of any biomaterial is the creation of a suitable and relevant testing environment, whether or not the material specimen contains live cells.

In the case of added cells, most testing conditions temperature, time, atmosphere, media are being dictated or fixed due to cell culture requirements and may not be too much varied. In a wider analysis, one may also be interested in the behavior of a biomaterial beyond the limits of its application to assess critical factors such as variations of humidity, temperature or sterilization method on materials property [ 80 ]. For example, if a material is steam-sterilized, does it change porosity or elastic modulus, and, if yes, how much? For the dental implant case shown above, the most important practical endpoints are the improvement of the 1 tissue-biomaterial adherence, 2 resistance to potential bacterial contamination and biofilm formation, and 3 absence of potentially hazardous earlier adverse effects.

For example, a biomaterial loaded with antibiotics or silver would definitely minimize the risk of biofilm formation, but at the same time it might inhibit or even prevent cell growth and attachment. This nevertheless might be still acceptable in specific patients HIV carriers, the immunodepressed as other potential risks are much larger. The concept of the biomaterials enhanced simulation testing [ 80—82 ]. The essential difference of BEST vs.

Advanced biomaterials: elaboration, nanostructure, interfaces with tissues

These are the most common parameters dental abutment and the implant are facing in reality [ 82—84 ]. The abutment pins can be cultivated either separately and then tested, or cultivated under dynamic conditions if so required [ 72,85 ]. It might be assumed that dynamic loading in physiological conditions could be considered as the earliest marker of the biomaterial-tissue interaction in this case, and it could be the measure for HOS when several biomaterial options are to be compared quickly before more detailed evaluation.

For HOS purposes many other parameters for the interface quality assessment can be also measured directly or as a post-processing of the data just in one experiment: dynamic shear modulus, bending modulus, loss tangent, cyclic decay, etc. Variation of geometry e. Also mucosal tissue alone without underlying bone can be cultured and tested on artificial supports if bone-mucosa adhesion is not a subject of investigation.

When bacteria are added, or pH, temperature, media composition are changed, new data sets can be compared and the decision made for the selection of the best biomaterial solution [ 82 ]. The tissue-implant interface quality is a complex feature including a lot of contributions and is treated differently even for the same material-tissue combination used in different anatomic locations e. The dynamics of the interface development gives more challenges in its characterization and produces more scattered results.

This makes results comparison between different studies very challenging, if not impossible. This can be improved with combined mechanical, fluidic, biological tests and models with multi-purpose protocols to secure patient safety by certifying biomaterial in hostile-like conditions. In this review only parts of the big problem were considered, such as bacterial interaction with biomaterials and its effect on the interface quality.

An example for dental implant and abutment testing, using the BEST platform, was presented, and similar protocols can be tailored for rather complex clinical conditions, as shown e. Thus it is possible to mimic and control the most significant conditions in vitro aiming to provide high-output screening, to evaluate the effect of different parameters on tissue-implant interface quality and to select lead biomaterials candidates for further application.

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National Center for Biotechnology Information , U. Sci Technol Adv Mater. Published online Jul Michael Gasik. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract One of the greatest challenges in the development of new medical products and devices remains in providing maximal patient safety, efficacy and suitability for the purpose.

Keywords: Biomaterial, simulation, testing, in vitro , biomechanics, dynamics, implant. Open in a separate window. Introduction One of the greatest challenges in the development of new medical products and devices remains in providing maximal patient safety, efficacy and suitability for the purpose.

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Figure 1. Figure 2. The philosophy of pentataxis concept MHD, magnetohydrodynamics. Table 1.

Polymers & Biomaterials

Fundamental stimuli and pentataxis forces with the respective phenomena simplified. Biomaterials and bacteria interactions 3. Biofilm problem in modern implantology As any surgery or medical intervention, an implantation might have complications, of which those associated with acute and delayed prosthetic joint infections PJI remain a high concern.

Biofilm formation at the biomaterial-tissue interface Why and how is biofilm formed on any surface? Metallic biomaterials Several metallic alloys are being widely employed in orthopedic and dental areas, the major ones being titanium alloys, stainless steels, cobalt-chromium, noble metals and some shape memory alloys [ 39 ]. Polymeric biomaterials The types of polymers applied in orthopedic and dental load-bearing practice are usually limited to polyethylene PE with different density and molecular weight, polymethylmethacrylate PMMA as for bone cement, and fluorinated polymers such as PTFE and polyetheretherketone PEEK families [ 50—53 ].

Ceramic biomaterials As with all other materials, all bioceramics might be colonized by bacteria, and all are eventually capable of making biofilms [ 29 ].