Implant devices have = proven a successful treatment modality in reconstructive surgeries. However, increasing rates of peri-implant diseases demand further examination of their pathogenesis. Polymicrobial biofilm formation on titanium surfaces has been considered the main risk factor for inflammatory processes on tissues surrounding implant devices, which often lead to implant failure. To overcome microbial accumulation on titanium surfaces biofilm targeting strategies have been developed to modify the surface and incorporate antimicrobial coatings. Because antibiotics are widely used to treat polymicrobial infections, these agents have recently started to be incorporated on titanium surface. This review discusses the biofilm formation on titanium dental implants and key factors to be considered in therapeutic and preventative strategies. Moreover, a systematic review was conducted on coatings developed for titanium surfaces using different antibiotics. This review will also shed light on potential alternative strategies aiming to reduce microbial loads and control polymicrobial infection on implanted devices.

The oral cavity presents a highly diverse community of microorganisms due to the unique environmental conditions for microbial adhesion and growth

Oral rehabilitation devices are susceptible to bio-tribocorrosion phenomena in the oral environment due to the synergism of wear, chemical, biochemical, and microbiological processes. This review summarizes the clinical problems and advances obtained based on current scientific evidence as well as the influence of tribological fundamentals, testing methodologies, and protocols in tribocorrosion analyses. The main clinical question related to oral rehabilitation with dental implants is the treatment failure, which is influenced by material degradation. Titanium-based implants are exposed to wear and corrosion challenges in the oral environment since the implantation and along the lifetime service. The titanium (Ti) properties such as structural material, connection design, surface treatments, alloying elements are influencing factors for material behavior. In addition, wear-corrosion factors such as cyclic loads, micromovements, oral biofilm, decontamination methods are also associated with dental implants degradation. These environmental conditions to which dental implants are submitted leads to the release of Ti particles and ions with cytotoxic and harmful effects on peri-implant surrounding tissues. In this context, the current state of the art of bio-tribocorrosion over the last decade has been steadily increasing to understand material degradation. The basic test system used to translate the tribocorrosion phenomena in the oral environment to the bench consists of electrochemical and tribological synergic analysis. The mechanical (applied load, frequency, stroke distance, and number of cycles) and electrochemical (solution composition, concentration of anions, and pH) test conditions are determinants for materials tribocorrosion performance. To overcome the tribocorrosion phenomena some strategies have been used such as alloying elements for Ti-alloys manufacture, surface treatments, and biomolecules immobilization. Further studies need to have the tribocorrosion analyses as the basis for new smart materials development considering the importance of such aspects for the biomaterial clinical behavior. Finally, tribological tests are relevant strategies for understanding the mechanisms of degradation in the oral environment and for providing a way to improve the clinical outcomes of dental implants.

Dental implants made of titanium (Ti) material is recognized as the leading treatment option for edentulous patients’ rehabilitation, showing a high success rate and clinical longevity. However, dental implant surface acts as a platform for microbial adhesion and accumulation once exposed to the oral cavity. Biofilm formation on implant surfaces has been considered the main etiologic factor to induce inflammatory diseases, known as peri-implant mucositis and peri-implantitis; the latter being recognized as the key reason for late dental implant failure. Different factors, such as biofilm matrix production, source of carbohydrate exposure, and cross-kingdom interactions, have encouraged increased microbial accumulation on dental implants, leading to a microbiological community shift from a healthy to a pathogenic state, increasing inflammation and favoring tissue damage. These factors combined with the spatial organization of biofilms, reduced antimicrobial susceptibility, complex microbiological composition, and the irregular topography of implants hamper biofilm control and microbial killing. In spite of the well-known etiology, there is still no consensus regarding the best clinical protocol to control microbial accumulation on dental implant surfaces and treat peri-implant disease. In this sense, different coatings and Ti surface treatments have been proposed in order to reduce microbial loads and control polymicrobial infections on implantable devices. Therefore, this critical review aims to discuss the current evidence on biofilm accumulation on dental implants and central factors related to the pathogenesis process of implant-related infections. Moreover, the potential surface modifications with anti-biofilm properties for dental implant devices is discussed to shed light on further promising strategies to control peri-implantitis.