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The long-term success of an implant depends on the stability of bone support around an osseointegrated implant. The dental implant surfaces provide an ideal substrate for bacterial adhesion forming a biofilm. Biofilm performs vast functions ranging from physical defensive barrier against phagocytic predation to working as a selective permeable barrier. Once crestal bone loss starts, it can result in increased bacterial accumulation resulting in further peri-implant tissue destruction. These rapidly growing bacteria give rise to a chronic infection which is difficult to eradicate by conventional mechanical as well as antibiotic therapy. Biofilm matrix limits the diffusion of systemic antimicrobial agents that are capable of damaging the microbial complexes. Shortcomings of systemic antibiotics also include relatively low drug concentration at the target site and potential toxicity. Evidence based reviews show that surface modifications can significantly affect initial adhesion and biofilm formation on the implant surface. The various functional modifications on the implant surfaces which have been suggested include coatings on the titanium implant which are incorporated with disinfectants, antibiotics as well as antimicrobial peptides for which different methods of physical adsorption have been reported. The ultimate antimicrobial surface should be responsive to even the lowest bacterial load. Nano- related concepts are also an emerging area of research in controlled drug delivery through the use of nanostructures (nanotubes, nanospheres) as therapeutic surface modification of dental implants. Henceforth this review throws light on coated dental implants which exhibit therapeutic properties as a strategy to combat peri implant infections, thereby aid in bridging the gap between research and clinical implant dentistry. KEYWORDS: Dental implants, Biofilm, Antibiotics, Antimicrobial peptides (AMPs). |
