Zirconia (ZrO2) is one of the widely used metal oxides for potential bio-applications such as biosensors, cancer therapy, implants, and dentistry due to its high mechanical strength and less toxicity. Because of their widespread applications, the potential exposure to these nanoparticles (NPs) has increased, which has attracted extensive attention. Thus, it is urgent to investigate the toxicological profile of ZrO2 NPs. Titanium dioxide (TiO2) is another extensively used nanomaterials which are known to be weakly toxic. In this study, TiO2 NPs were served as control to evaluate the biocompatibility of ZrO2 NPs. We detected the cytotoxicity of TiO2 and ZrO2 NPs in osteoblast-like 3T3-E1 cells and found that reactive oxygen species (ROS) played a crucial role in the TiO2 and ZrO2 NP-induced cytotoxicity with concentration-dependent manner. We also showed TiO2 and ZrO2 NPs could induce apoptosis and morphology changes after culturing with 3T3-E1 cells at high concentrations. Moreover, TiO2 and ZrO2 NPs at high concentrations could inhibit cell osteogenic differentiation, compared to those at low concentrations. In conclusion, TiO2 and ZrO2 NPs could induce cytotoxic responses in vitro in a concentration-dependent manner, which may also affect osteogenesis; ZrO2 NPs showed more potent toxic effects than TiO2 NPs.

Objectives To compare the use of short implants (≤6 mm) in atrophic posterior maxilla versus longer implants (≥10 mm) with sinus floor elevation. Design A systematic review and meta-analysis based on randomised controlled trials (RCTs). Data sources Electronic searches were conducted in PubMed, Embase and the Cochrane CENTRAL. Retrospective and prospective hand searches were also performed. Eligibility criteria RCTs comparing short implants (≤6 mm) and longer implants (≥10 mm) with sinus floor elevation were included. Outcome measures included implant survival (primary outcome), marginal bone loss (MBL), complications and patient satisfaction. Data extraction and synthesis Risks of bias in and across studies were evaluated. Meta-analysis, subgroup analysis and sensitivity analysis were undertaken. Quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation. Results A total of seven RCTs involving 310 participants were included. No significant difference in survival rate was found for 1–3 years follow-up (RR 1.01, 95% CI 0.97 to 1.04, p=0.74, I²=0%, moderate-quality evidence) or for 3 years or longer follow-up (RR 1.00, 95% CI 0.97 to 1.04, p=0.79, I²=0%, moderate-quality evidence). However, short implants (≤6 mm) showed significantly less MBL in 1–3 years follow-up (MD=−0.13 mm, 95% CI −0.21 to 0.05; p=0.001, I²=87%, low-quality evidence) and in 3 years or longer follow-up (MD=−0.25 mm, 95% CI −0.40 to 0.10; p=0.001, I²=0%, moderate-quality evidence). In addition, short implant (≤6 mm) resulted in fewer postsurgery reaction (RR 0.11, 95% CI 0.14 to 0.31, p<0.001, I²=40%, moderate-quality evidence) and sinus perforation or infection (RR 0.11, 95% CI 0.02 to 0.63, p=0.01, I²=0%, moderate-quality evidence). Conclusions For atrophic posterior maxilla, short implants (≤6 mm) are a promising alternative to sinus floor elevation, with comparable survival rate, less MBL and postsurgery reactions. Additional high-quality studies are needed to evaluate the long-term effectiveness of short implants (≤6 mm). Trial registeration number The protocol has been registered at PROSPERO (CRD42018103531).