Hamdan S. Alghamdi

Self-healing hybrid nanocomposites consisting of bisphosphonated hyaluronan and calcium phosphate nanoparticles

Non-covalent interactions are often regarded as insufficient to construct macroscopic materials of substantial integrity and cohesion. However, the low binding energy of such reversible interactions can be compensated by increasing their number to work in concert to create strong materials. Here we present the successful development of an injectable, cohesive nanocomposite hydrogel based on reversible bonds between calcium phosphate nanoparticles and bisphosphonate-functionalized hyaluronic acid. These nanocomposites display a capacity for self-healing as well as adhesiveness to mineral surfaces such as enamel and hydroxyapatite. Most importantly, these non-covalently cross-linked composites are surprisingly robust yet biodegradable upon extensive in vitro and in vivo testing and show bone interactive capacity evidenced by bone ingrowth into material remnants. The herein presented method provides a new methodology for constructing nanoscale composites for biomedical applications, which owe their integrity to reversible bonds.

Calcium-phosphate-coated Oral Implants Promote Osseointegration in Osteoporosis

Osteoporotic conditions are anticipated to affect the osseointegration of dental implants. This study aimed to evaluate the effect of a radiofrequent magnetron-sputtered calcium phosphate (CaP) coating on dental implant integration upon installment in the femoral condyles of both healthy and osteoporotic rats. At 8 weeks post-implantation, bone volume and histomorphometric bone area were lower around non-coated implants in osteoporotic rats compared with healthy rats. Interestingly, push-out tests revealed significantly enhanced implant fixation for CaP-coated compared with non-coated implants in both osteoporotic (i.e., 2.9-fold) and healthy rats (i.e., 1.5-fold), with similar implant fixation for CaP-coated implants in osteoporotic conditions compared with that of non-coated implants in healthy conditions. Further, the presence of a CaP coating significantly increased bone-to-implant contact compared with that in non-coated implants in both osteoporotic (i.e., 1.3-fold) and healthy rats (i.e., 1.4-fold). Sequential administration of fluorochrome labels showed significantly increased bone dynamics close to CaP-coated implants at 3 weeks of implantation in osteoporotic conditions and significantly decreased bone dynamics in osteoporotic compared with healthy conditions. In conclusion, analysis of the data obtained demonstrated that dental implant modification with a thin CaP coating effectively improves osseointegration in both healthy and osteoporotic conditions.

Undersized Implant Site Preparation to Enhance Primary Implant Stability in Poor Bone Density: A Prospective Clinical Study

PURPOSE Achieving primary implant stability in areas with poor bone density is often challenging to the clinician. Previous research has suggested that modified surgical protocols might be beneficial in such situations. The objective of the present clinical study was to evaluate the survival rate of implants placed using undersized implant site preparation in areas with poor bone density. MATERIALS AND METHODS A total of 52 implants were placed in 29 patients. Of the 52 implants, 26 were surgically placed according to the standard drilling protocol (control group) and 26 were placed in low-density bone using an adapted bone drilling method (test group). The maximum insertion torque values and resonance frequency analysis measurements were also recorded. All implants were examined clinically and radiographically at follow-up visits during the study period. Oral hygiene status, bleeding on probing, peri-implant probing depth, and implant survival rate were assessed. RESULTS According to the survival criteria used in the present study, no failure was recorded, and the overall survival rate was 100% for both groups after 12 months. The mean probing depth was 2.75 ± 0.75 mm in the test group and 2.87 ± 0.79 mm in the control group. The mean insertion torque value was 35.19 ± 4.79 Ncm in the test group and 34.62 ± 5.82 Ncm in the control group. The resonance frequency analysis value was 68.58 ± 4.81 implant stability quotient and 66.69 ± 5.41 implant stability quotient in the test and control groups, respectively. The observed differences were not statistically significant (P > .05). CONCLUSIONS The results of the present study suggest that placement of implants by an adapted drilling technique in sites with poor bone density is beneficial in enhancing primary implant stability and improving the implant survival rate.

In vivo evaluation of bioactive glass-based coatings on dental implants in a dog implantation model

OBJECTIVES Although titanium is commonly used as a favorable bone implant material due to its mechanical properties, its bioactive and osteoconductive capacity is relatively low. Calcium phosphate ceramics, predominantly hydroxyapatite (HA), have been frequently used for coating purposes to improve the bioactive properties. In view of the suggested osteopromotive capacity of bioactive glasses (BGs), this study aimed to evaluate the effect of BG incorporation into HA coatings on implant performance in terms of bone contact and bone area. MATERIALS AND METHODS A total of 48 screw-type titanium implants with magnetron sputter coatings containing different ratios of HA and BG (HA, HABGLow, and HABGHigh; n = 8) were placed into the mandible of 16 Beagle dogs. After 4 and 12 weeks, their performance was evaluated histologically and histomorphometrically. Peri-implant bone area percentage (BA%) was determined in three zones (inner, 0-500 μm; middle, 500-1000 μm; and outer, 1000-1500 μm). Additionally, bone-to-implant contact (BIC%) and first bone-implant contact (1st BIC) were assessed for each sample. RESULTS After 4 weeks, bone-to-implant contact for the HA- and HABGLow-coated groups was significantly higher (P < 0.05) than for the HABGHigh coatings. Mean values for overall BA% showed comparable values for both the HABGLow (58.3%)- and HABGHigh (56.3%)-coated groups. Data suggest that the relative BA around the HA-coated implants (67.8%) was higher, although this was only significant compared to the HABGHigh group. After 12 weeks, all three groups showed similar bone-to-implant contact and no differences in BA were found. CONCLUSIONS The incorporation of BG into HA sputter coatings did not enhance the performance of a dental implant in implantations sites with good bone quality and quantity. On the contrary, coatings containing high concentrations of BG resulted in inferior performance during the early postimplantation healing phase.

Surgical management of gingival recession: A clinical update

Gingival recession is defined as the apical migration of the junctional epithelium with exposure of root surfaces. It is a common condition seen in both dentally aware populations and those with limited access to dental care. The etiology of the condition is multifactorial but is commonly associated with underlying alveolar morphology, tooth brushing, mechanical trauma and periodontal disease. Given the high rate of gingival recession defects among the general population, it is imperative that dental practitioners have an understanding of the etiology, complications and the management of the condition. The following review describes the surgical techniques to treat gingival recession.

Effect of surface alkali-based treatment of titanium implants on ability to promote in-vitro mineralization and in-vivo bone formation

This study investigated whether a novel alkali-based surface modification enhances in vitro mineralization as well as in vivo bone formation around titanium (Ti) implants in a femoral condyle model of 36 male Wister rats. All implant surfaces were grit-blasted and then received either acid-etching treatment, alkali-based treatment, or were left untreated (controls). Histological and histomorphometrical analyses were performed on retrieved specimens after 4 and 8weeks of healing to assess peri-implant bone formation. Results of implants surface characterisation showed notable differences in the topography and composition of alkali-treated surfaces, reflecting the formation of submicron-structured alkali-titanate layer. In the in vitro test, alkali-treated Ti surfaces showed the ability to stimulate mineralization upon soaking in simulated body fluid (SBF). In vivo histomorphometrical analyses showed similar values for bone area (BA%) and bone-to-implant contact (BIC%) for all experimental groups after both 4- and 8-week implantation periods. In conclusion, the surface topography and composition of the grit-blasted Ti implants was significantly modified using alkali-based treatment. With respect to the present in vivo model, the biological performance of alkali-treated Ti implants is comparable to the commercially available, grit-blasted, acid-etched Ti implants. STATEMENT OF SIGNIFICANCE Since success rate of dental implants might be challenged in bone of low density, an optimum implant surface characteristic is demanding. In this work, alkali treatment of Ti implants showed significant advantage of surface mineralization upon soaking in simulated body fluid. Using an in vivo rat model, Ti surfaces with either acid-etching treatment or alkali-based treatment evoked robust bone formation around Ti implants. Such information may be utilized for the advancement of biomaterials research for bone implants in future.

Osteogenesis around CaP-coated titanium implants visualized using 3D histology and micro-computed tomography

Calcium phosphate (CaP) coatings can enhance the performance of bone implants in compromised conditions, such as osteoporosis. Therefore, this study compared non-coated vs. CaP-coated (n = 8) titanium implants in osteoporotic ovariectomized (OVX) rats. Bone volume (BV) was assessed using micro-computer tomography (micro-CT) and three-dimensional (3D) histology, in three zones from the implant surface. Bone remodeling was assessed using fluorochrome labels and osteoclast staining. Micro-CT and 3D histology showed a BV reduction in OVX animals, of respectively 22.4 and 10.5%. BV was significantly increased inside all zones around CaP coatings, especially in the inner zone of the OVX animals. Fluorochrome labels were predominantly seen when the coating was applied. Osteoclasts were mainly found in the area remote from the surface of non-coated implants in control animals. For the coated implants, osteoclasts were distributed evenly, and present in direct vicinity of the surface. In conclusion, 3D histology is a suitable technique to obtain data and insight into bone architecture around implants at relatively high resolution. Bone formation was significantly reduced in osteoporotic animals. CaP coatings resulted in a higher BV directly around implants installed in osteoporotic animals, enhanced turnover, and a shift of remodeling activity toward the implant surface.

A theranostic dental pulp capping agent with improved MRI and CT contrast and biological properties

Different materials have been used for vital dental pulp treatment. Preferably a pulp capping agent should show appropriate biological performance, excellent handling properties, and a good imaging contrast. These features can be delivered into a single material through the combination of therapeutic and diagnostic agents (i.e. theranostic). Calcium phosphate based composites (CPCs) are potentially ideal candidate for pulp treatment, although poor imaging contrast and poor dentino-inductive properties are limiting their clinical use. In this study, a theranostic dental pulp capping agent was developed. First, imaging properties of the CPC were improved by using a core-shell structured dual contrast agent (csDCA) consisting of superparamagnetic iron oxide (SPIO) and colloidal gold, as MRI and CT contrast agent respectively. Second, biological properties were implemented by using a dentinogenic factor (i.e. bone morphogenetic protein 2, BMP-2). The obtained CPC/csDCA/BMP-2 composite was tested in vivo, as direct pulp capping agent, in a male Habsi goat incisor model. Our outcomes showed no relevant alteration of the handling and mechanical properties (e.g. setting time, injectability, and compressive strength) by the incorporation of csDCA particles. In vivo results proved MRI contrast enhancement up to 7weeks. Incisors treated with BMP-2 showed improved tertiary dentin deposition as well as faster cement degradation as measured by µCT assessment. In conclusion, the presented theranostic agent matches the imaging and regenerative requirements for pulp capping applications. STATEMENT OF SIGNIFICANCE In this study, we combined diagnostic and therapeutic agents in order to developed a theranostic pulp capping agent with enhanced MRI and CT contrast and improved dentin regeneration ability. In our study we cover all the steps from material preparation, mechanical and in vitro characterization, to in vivo study in a goat dental model. To the best of our knowledge, this is the first time that a theranostic pulp capping material have been developed and tested in an in vivo animal model. Our promising results in term of imaging contrast enhancement and of induction of new dentin formation, open a new scenario in the development of innovative dental materials.

Visualization of calcium phosphate cement in teeth by zero echo time H-1 MRI at high field

1H magnetic resonance imaging (MRI) by a zero echo time (ZTE) sequence is an excellent method to image teeth. Calcium phosphate cement (CPC) materials are applied in the restoration of tooth lesions, but it has not yet been investigated whether they can be detected by computed tomography (CT) or MRI. The aim of this study was to optimize high‐field ZTE imaging to enable the visualization of a new CPC formulation implanted in teeth and to apply this in the assessment of its decomposition in vivo. CPC was implanted in three human and three goat teeth ex vivo and in three goat teeth in vivo. An ultrashort echo time (UTE) sequence with multiple flip angles and echo times was applied at 11.7 T to measure T1 and T2* values of CPC, enamel and dentin. Teeth with CPC were imaged with an optimized ZTE sequence. Goat teeth implanted with CPC in vivo were imaged after 7 weeks ex vivo. T2* relaxation of implanted CPC, dentin and enamel was better fitted by a model assuming a Gaussian rather than a Lorentzian distribution. For CPC and human enamel and dentin, the average T2* values were 273 ± 19, 562 ± 221 and 476 ± 147 μs, respectively, the average T2 values were 1234 ± 27, 963 ± 151 and 577 ± 41 μs, respectively, and the average T1 values were 1065 ± 45, 972 ± 40 and 903 ± 7 ms, respectively. In ZTE images, CPC had a higher signal‐to‐noise‐ratio than dentin and enamel because of the higher water content. Seven weeks after in vivo implantation, the CPC‐filled lesions showed less homogeneous structures, a lower T1 value and T2* separated into two components. MRI by ZTE provides excellent contrast for CPC in teeth and allows its decomposition to be followed.