Surveying coating strategies for peri-implantitis management: Clinical implications and classificatory approaches

Abstract

Background: Peri-implantitis, an inflammatory condition occurring in the supportive tissues, is triggered by a dysbiotic biofilm that grows on implant and/or abutment surfaces. Consequently, the entire surface becomes a notorious culprit, fostering bacterial adhesion that might lead to progressive loss of supporting bone. To combat peri-implantitis, research groups worldwide have diligently pursued the development of new antimicrobial coatings. However, for the successful development of coating materials, it is crucial to clarify their intended function. In this review, we propose a clear classification of coating strategies aimed at either preventing or treating peri-implantitis. Methods: We first delve deep within the concepts of prevention and treatment, as well as the physicochemical properties and biological requirements of each dental implant component for interacting with host tissue cells, to unravel and guide materials and technique complexity according to each purpose. Results: From a preventive standpoint, the goal is to impede disease initiation. This requires coating materials that can withstand the hostile oral environment indefinitely. In the treatment category, where the disease is already established, the coating material should act directly at the infected site. Furthermore, the physicochemical properties of the new antimicrobial coating must respect the properties required by each part of the implant to not compromise the interaction of the bone-biomaterial and soft tissue-biomaterial interfaces. Conclusion: Despite considerable efforts in designing antimicrobial coatings, commercial success has remained elusive thus far. This underscores the need to consider essential components to facilitate the construction, validation, and eventual clinical potential of antimicrobial coatings for future marketing. Plain Language Summary: In this review, we have raised an essential point about the importance of considering both biological and chemical challenges in the development of antimicrobial coatings for preventing and treating peri-implantitis. From a preventive perspective, these coatings need to be designed to withstand the complex environment of the oral cavity while maintaining their integrity and functionality. This requires coatings that can resist changes in environmental factors. Conversely, in the treatment category, material coatings need to be responsive to either internal or external stimuli to activate the release of therapeutic agents. These coatings must be capable of switching on or off depending on the intensity of stimuli, allowing for targeted drug delivery to combat infection or inflammation.