Race for Applicable Antimicrobial Dental Implant Surfaces to Fight Biofilm-Related Disease: Advancing in Laboratorial Studies vs Stagnation in Clinical Application

Abstract

Across years, potential strategies to fight periimplantitis have been notoriously explored through the antimicrobial coating implant surfaces capable of interfering with the bacterial adhesion process. However, although experimental studies have significantly advanced, no product has been marketed so far. For science to reach the society, the commercialization of research outcomes is necessary to provide real advancement in the biomedical field. Therefore, the aim of this study was to investigate the challenges involved in the development of antimicrobial dental implant surfaces to fight peri-implantitis, through a systematic search. Research articles reporting antimicrobial dental implant surfaces were identified by searching PubMed, Scopus, Web of Science, The Cochrane Library, Embase, and System of Information on Grey Literature in Europe, between 2008 and 2020. A total of 1778 studies were included for quality assessment and the review. An impressive number of 1655 articles (93,1%) comprised in vitro studies, whereas 123 articles refer to in vivo investigations. From those 123, 102 refer to animal studies and only 21 articles were published on the clinical performance of antibacterial dental implant surfaces. The purpose of animal studies is to test how safe and effective new treatments are before they are tested in people. Therefore, the discrepancy between the number of published studies clearly reveals that preclinical investigations still come up against several challenges to overcome before moving forward to a clinical setting. Additionally, researchers need to recognize that the complex journey from lab to market requires more than a great idea and resources to develop a commercial invention; research teams must possess the skills necessary to commercialize an invention.

A review on antimicrobial strategies in mitigating biofilm-associated infections on medical implants

“…The application of phytochemicals and other non-antibiotic compounds to address biofilm formation on medical implants is currently limited by a lack of scientific evidence regarding their efficacy, potential side effects, optimal dosage, and long-term impacts ( Braem et al, 2023 ). Further research is necessary to understand important factors such as cytotoxicity, stability of compounds in biological fluids, and overall effectiveness in combating biofilm-related challenges ( De Avila et al, 2022 ). Additionally, targeting specific signaling molecules involved in the QS system of bacteria using QS blockers have shown promising results in biofilm control ( Brackman and Coenye, 2015 ).…”

Antibacterial Adhesion Strategy for Dental Titanium Implant Surfaces: From Mechanisms to Application

“…Although these strategies have been explored for many years, studies in vivo are few, studies about clinical performance are few, and not one has reached the commercial stage [ 192 ]. Tetsurou et al focused on the antibacterial effect of silver nanoparticles and studied them in vivo [ 193 ].…”

Translating the determinant aspects on the study design in the dental implant field

“…In other words, the impressive technological advancement within the dental implant field is supported by research of quality, and the clinical application of scientific knowledge depends on the most appropriate type of study. 6 …”

“…In general , in vitro , ex vivo , and in silico models are carried out at the beginning of the idea construction to validate the methodology and reflect the natural process of knowledge development. 6–9 However, the persistence at this stage might reflect a lack of financial support and/or unsolved preclinical issues. After that, researchers may move forward to the preclinical trials within animal subjects to visualize potential interactions, safety, toxicity, and efficacy of a product within a living organism.…”

“…After that, researchers may move forward to the preclinical trials within animal subjects to visualize potential interactions, safety, toxicity, and efficacy of a product within a living organism. 6–8 At the peak of the pyramid are clinical research, which act to conclude and validate the meaningful scientific results to be translated into the real setting.…”