Emerging Antibacterial Biomaterial Strategies for the Prevention of Peri-implant Inflammatory Diseases

Purpose: Peri-implantitis is an inflammatory disease due to bacteria and plaque formation on implant surfaces which can lead to bone resorption and loss of osseointegration. Biomaterial strategies to prevent or eliminate initial bacterial attachment, in favor of host tissue attachment may have a positive effect on decreasing peri-implantitis, particularly for at risk patient goups. This study provides a brief overview of some of the experimental biomaterial strategies aimed at suppressing or inhibiting bacterial colonization of implant surfaces in favor or host cells and tissues. Materials and Methods: These biomaterial strategies have different mechanisms of action from interfering with bacterial adhesion by modifying surface energies, immobilizing antimicrobials on implant surfaces, creating photocatalytic surfaces, as well as modifying surfaces to deliver antimicrobial agents either prophylactically or in response to bacterial challenge. This is not a comprehensive review, rather a review of studies that serve to illustrate many of the different approaches being investigated. Results: While many of these strategies have demonstrated the potential to significantly reduce bacterial attachment on implant surfaces in vitro, it is unclear if these same reductions will be adequate clinically since even a few adhering bacteria may over time develop into inflammatory inducing biofilms or plaque. Also, data on the ability of the antibacterial modified biomaterials to support osseointegration and permuosal seal formation is still needed. Conclusion: Given the complex and multivariate causes of peri-implant disease, it is likely that combinations of these strategies (eg, antimicrobial surfaces and or delivery mechanisms coupled with methods to favor stable osseointegration and permucosal seal) will be most effective in developing implants resistant to peri-implant disease. Keywords: antimicrobial, biomaterials, dental implants, peri-implantitis, peri-mucositis, surfaces