Research Methods for Implementing Infection Quality Control for Dental Implants (IQ-ReMDI).

Dental implants are set to become increasingly popular as the population ages.
Implant failures are relatively uncommon but can be challenging to replace. Those
that mandate immediate surgical removal are typically caused by peri-implantitis,
an inflammatory disease caused by microbial infection. A replacement implant has
relatively lower success rates and often requires additional soft and/or hard tissue
grafts, new abutments and longer healing times. Microbial infection of the tissues
around the implant is a major challenge which may jeopardise the success of
osseointegrated implants. Therefore, an understanding of the predictive potential
of infection-resistant implants is essential to reduce such complications. There is
limitation in the current methods of investigating anti-microbial biomaterials, in that
few bacterial species models have been used so far, which are arguably not
reflective of the rich microbial populations observed in the oral environment.
Methodological development based on complex microbial biofilms in various
dysbiotic states could be more suited to predict progression to peri-implantitis.
The group at University of Leeds (UoL) Dental School has previously successfully
developed a robust periodontitis biofilm model which will be adapted to replicate
microbiological conditions associated with peri-implantitis. This unique and
complex system will be used as a tool to conduct rigorous tests on dental implants'
anti-microbial properties.
Through this secondment scheme, we propose an innovation partnership between
the UoL and the Nottingham-based dental implant manufacturer Attenborough
Dental Laboratory (ATT). Building on our previous successful research in both
microbiome and biomaterials development at UoL, the project will offer the
opportunity to form a highly efficient multi-disciplinary team with the aim to design
and implement a new biological system of health and quality control of implant
materials at ATT. ATT and UoL's knowledge of biomechanics modelling of porous implants
combined with 3D-printing of additive material coatings will provide the project with
novel infection-resistant, customisable implants. The cytotoxicity, bactericidal
activities, vascularisation and osseointegration properties will be carried out using
co-culturing with human osteoblasts and endothelial cells in the presence or
absence of peri-implantitis-associated microbes. Our biological system approach
will cumulate in being tested for implementation into ATT's in-line manufacturing
process as an efficient method for ensuring the reduction of the risk of implant
failure.
The work is expected to have high translational impact and value for both UoL and
ATT through knowledge transfer and will provide training and enhanced career
prospects for the secondee.

Aim: To develop and implement a peri-implantitis model to evaluate implants. Methods for Implementation: The lead applicant has previous success in developing a robust periodontitis biofilm model (doi: 10.1038/s41598-019-41882-y), where dental plaque samples from healthy volunteers were cultured on inert surfaces under nutritional conditions that reflected periodontal inflammation and which consequently shifted the microbial population to that found typically in periodontitis. This approach can easily be adapted to modelling conditions leading to peri-implantitis, and can be used as a tool to test the anti-microbial properties of implant materials. This approach is unique in that no complex microbial system has yet been used for implant applications. Our approach will be to develop an efficient microbiological system for implant characterisation that is suitable for use in a commercial environment, paving the way for further collaboration post-secondment. We will certify implants that achieve a clear reduction of peri-implantitis-associated microbiota over time ontheir surfaces, so they can be brought further towards commercialisation. We will undertake investigations in parallel for achieving our aim.