The biggest group under the bioceramics class is the calcium phosphates, which are the commonly used crystal-like ceramics in the process of regenerating bone tissues. Calcium phosphates are used due to their unique features. These include their structural resemblance and conformation of the chemicals in them, the similarity of the bones’ mineral phase, and the osteoconductivity of the bones (Khan & Syed, 2019). Osteoconductivity refers to being able to provide an interface that is biocompatible along with the bone migrates. The interface created helps allows binding to occur to the host tissue minus the need to form scar tissue. Calcium phosphates are used in ceramic pieces that are porous and pellets that can be applied to reconstruct all the defects in bones. The bone flaws that can be corrected include an increase in the alveolar ridge defects after a tooth has been extracted, reconstruct bones after an injury has occurred, and the correction of several deformities.
Hydroxyapatite
Hydroxyapatite is used in several medical applications, including its usage as a matrix for controlling the rate of drug release and materials for the engineering of bone tissues. Several differences exist between the natural and the synthetic hydroxyapatite. Some of the differences are in their physical microstructure, size of the crystals, and the porosity of the two. However, the chemical similarities that the two HAs have to help in determining the osteoconductive ability of the HAs. When HA is compared to TCP, it can be said that HA resorbs at a slower rate and goes through a small alteration to form a bone-like material after embedding. Many attempts have been made to create bioceramic materials infused with ions from Hydroxyapatite. Mg-Hydroxyapatite, Silicon-hydroxyapatite, and Strontium-HA have proved to improve the biological and mechanical features to enhance the process of engineering the bone tissues. HA is, in most cases, applied to repair bones, supplement bones, and coat implants (Khan & Syed, 2019). Since the traditional ceramic derived from HA has a low mechanical strength, its usage is restricted to low load uses. To eliminate the problems, nanocrystalline HA was established. Nanocrystalline HA has exhibited a great sinterability and improved densification because of its increased surface area.
TCP and BCP
The basic concept of Biphasic Calcium Phosphate is centered on optimal stability amongst the steady (Hydroxyapatite) phases and phases that are more solvable (TCP). TCP is quickly replaced by bone that the hard to degrade HA, which contributes to its great solubility. After TCP has been degraded by dissolution and absorption, the regenerated bone has a normal bone structure. Through the development of ceramics from BCP, such as HA and TCP, it has become possible to get materials whereby bioactivity and degradation are controlled according to their constituents’ ratios. A lot of studies that have been conducted show that BCP pellets are biological compatibility and have good biological activity. Bioactivity plus biocompatibility help form fresh bones and degrade biomaterial (Khan & Syed, 2019). To increase the degree of destruction of the Hydroxyapatite/ TCP ceramics, the amount of the soluble phase should be increased. Research has indicated that BCPs with a high TCP ratio usually leads to a higher replacement of biomaterials of a new bone. Ideal properties conducive for the regeneration of bones is usually achieved by 60% HA and 40% TCP. Optimum bone regeneration in bones that have been created surgically becomes defective if BCP that contains the ratio of 85/15 of HA/TCP is used. However, according to recent studies, BCP products that contain higher TCP ratios are applied to enhance the osteoconductive effects.
Bioactive glasses
These are applied to repair bones and other types of biological ceramics comprising calcium, phosphorous, and silicon ions. The ions contained in the bioactive glasses help give it excellent mechanical strength. Initially, the bioactive glasses contain 45% silica, 24 percent sodium oxide, and 24 percent calcium oxide. It also contains 6% phosphorous pentoxide in the total weight percentage (Canillas et al. 2017). Bio glasses are considered to be biocompatible and osteoconductive. Depending on the condition of processing they went through, they can offer a porous structure that can promote the resorption and bone ingrowth. Bio glasses are good since they do not bring about any inflammatory responses, and the ones made from silica degrade entirely after six months. Studies indicate that silicon promotes the differentiation of mesenchymal cells and also promotes the formation of bones. When silica combines with apatite, it helps inhibit the proliferation of fibroblasts and the surface where bioimplant occurs. Glasses made out of borate also show a high rate of biodegradation than those made out of silica. However, the dilapidation degree of these glasses can be controlled by regulating the composition of the materials—glasses made out of phosphate promise to be a milestone in soft tissue engineering. The glasses made of phosphates are good because their solubility can be controlled by altering their composition (Terzioğlu & Kalemtaş, 2018). Bio glasses are usually brittle, show a low level of mechanical strength, and have reduced resistance to fracture. Due to these features, their usage should always be selective and associate with other substitutes of bones. The future of bioglasses is directed towards finding measures to incorporate elements such as ZN and manganese in the glasses. The incorporation will be a good measure because they have good osteogenic features.
Managing peri-implant mucositis and implants
These diseases are usually characterized by the presence of inflammation in a site with an implant. In Peri-implant, there is usually inflammation, especially in the soft muscles neighboring the dental implant. In most cases, there are no symptoms of loss of the bones supporting the teeth (Terzioğlu & Kalemtaş, 2018). On the other hand, peri-implantitis is usually shown by an irritation in the area around an implant, especially the soft muscle. Still, there is a loss of the bone supporting the teeth in this type of disease, which exceeds the biological remodeling process. The major symptom that determines the occurrence of this disease includes bleeding after probing. The probing lengths that cause bleeding are usually 4mm in depth. In most cases, no evidence shows any radiographic loss of bones beyond biological remodeling.
Risk Factors
Several risk factors have been identified that increase the chances of getting the disease. One of the major risk factors is if one had previous periodontal problems. Although an implant’s survival is not usually affected by a history of periodontal problems, it was found that peri-implantitis was a common problem in people who previously had dental problems (Renvert et al. 2018). Another risk factor is the inability to clean the implants correctly. How implants are designed and put can make it hard for the patient to clean the site with brushes and even interdental brushes. This is usually brought out by how the implants were positioned to meet the patients’ expectations and function properly. These aspects of the implant should be considered before implantation to improve daily dental hygiene. The dental providers should teach the patients on the right way to clean the implants and encourage them to have a regular dental checkup. This will help make it easy for the implants to be removed if the need arises, or detect any problem at an early stage.
Another risk factor that can increase the chances of developing the two diseases is smoking. Smoking has been linked to higher chances of failure of implants. According to medical reports, it was found out that 78 percent of smokers with implants developed peri-implantitis, while only 64 percent of non-smokers developed the disease. Another risk factor is genetic conditions. Studies showed that the IL-1RN gene was associated with a high chance of developing peri-implantitis (Lin et al. 2018). Diabetes has also been found to be a major risk factor that increases implantitis. The high amounts of glucose impact the rate at which tissues repair themselves and affect the host’s defense mechanisms. The defense mechanisms of the host are usually impaired because the ways used to control diabetes affects neutrophils. Due to that, diabetes can affect the rate of collagen formation in the extracellular matrix, and this causes impairment in the function of neutrophils and imbalance in the immune system. Therefore the ability for tissues to be repaired is affected, and the defense mechanism of the patients with diabetes is affected hence affected dental healing properties. Occlusal overload has also been a significant risk factor in peri-implantitis (Renvert et al. 2018). When people put on implants, they should be aware that the implants cannot handle the same weight as healthy teeth. When excess load and weight are applied to the implant, bones can fracture and later lead to bone loss. Poor oral hygiene can also cause per-implantitis. People are advised to clean the implants’ region well using the dental brushes to avoid any complications.
Clinical suggestions
Until recently, it has been concluded the two dental diseases can be effectively treated if detected early. Effective non-surgical methods can also be applied to treat the disease. However, non-surgical methods have not been proved to help treat peri-implantitis. To effectively manage the disease, it has been suggested that patients be taught how to identify the risk factors associated with increasing the chances of contracting the disease (Renvert et al. 2018). Patients are also advised to create a radiographic baseline at the time of placing the implants. The dental doctors are also encouraged to develop methods that can be used to monitor the health of the implants and determine the inflammation complications as part of dental maintenance attempts.
Since early detection is an essential aspect of managing the two diseases, it is vital to know the early signs associated with the diseases. The first symptom is breeding and probing. The implant’s first probing should be done after the restoration of the implant has been completed (Renvert et al. 2018). Since the peri-implant mucosa is usually very delicate, probing can be done using a periodontal probe. Radiographs can also be used for the early detection of diseases. Mobility can also be applied for the detection of peri-impantitis. However, mobility should not be used in detection because it implies that the implant is helpless and should instead be removed. However, normally, mobility can be considered to be loosening of the teeth’ components, which may sometimes lead to loss of crystal bones