Clinical takeaway
- Peri-implantitis remains difficult to treat once it is established. Early detection, routine debridement, and follow-up remain key to prevent irreversible bone loss. NIH-funded research into laser biofilm removal, as well as other innovative materials and methods that are being developed, shows promise.
University of Kentucky (UK) researchers have been awarded a five-year $1.9 million grant to investigate how biofilms grow on 3D-printed titanium so implants can be designed to better resist bacteria, according to a UK news article.
For the nearly 3 million adults in the U.S. who have dental implants, this research, which is being funded by the U.S. National Institutes of Health, has the potential to make a major impact.
“The number of implants placed each year is growing by 500,000 or so every year,” Martha Grady, PhD, an associate department chair in UK’s engineering college, said in the story. “And implants are especially important in Kentucky, which has one of the highest rates of tooth loss in the country.”
Dental biofilm, a colorless, “fuzzy” layer of bacteria that adheres to the teeth, gums, tongue, and oral mucosa, can also “stick” to dental implants. Implants are particularly vulnerable because there’s a lack of connective tissue that provides protection, and, in some cases, bone, both of which can make it very easy for bacteria to gain a foothold.
Additionally, the implant’s surface itself can enable bacteria to thrive. Biofilm’s protective outer membrane, coupled with the known limitations of implants, shields bacteria from toothbrushing and flossing, leading to infection. When peri-implantitis takes hold, it can be hard to treat with antibiotics or debridement, ultimately leading to implant failure and bone loss.
Using lasers to strip away biofilm
To tackle this problem, Grady will lead a multidisciplinary team using lasers to remove biofilm from 3D-printed titanium implants. They will use laser-induced spallation, which involves high-energy pulsed laser beams that create compressive stress waves that in turn create tensile waves on the opposite side of the object.
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To put it in a more understandable context, like Newton’s cradle, which are metal balls suspended by wires, when an exterior ball on one side is dropped, the opposite exterior ball lifts through the force applied that travels through the set of balls. Laser-induced spallation, in this case, is the ball that is lifted and biofilm is the reactive ball -- the ball that is lifted up -- that is ejected by the laser’s waves.
Using laser-induced spallation, researchers can also create an adhesion index to determine how much force is required to eject biofilm from a titanium implant and the maximum amount of stress a bond between two materials can withstand before failing.
Besides engineering innovations to make titanium implants more resistant to bacteria, the research offers promising results to other prosthetics, such as hip implants, artificial knees, and other joints that are at risk for infection, as well as food production, the article states.
What does it mean for dentists now?
While there’s no immediate application for dentists and their patients with peri-implantitis now, it represents an advancement -- among infection-resistant materials and ultrasound -- into combating biofilm and its destructive effects, combined with other strategies, like diagnostic tests, that can catch peri-implantitis early before tooth or bone loss occurs.
For an overview of tools and approaches to biofilm management, DrBicuspid.com has published a useful roundup of emerging biofilm-blasting technologies.
