Dental implants are used to replace missing teeth. Although the success rate of dental implants is high, complications such as lack of osseointegration and peri-implantitis can occur. In this study a new type of dental implant is designed that mimics the root shape of the to be extracted tooth. These types of implants can be placed directly after extraction. To create these type of implants, CBCT scan, 3DXpert software, and SLM printing techniques are used. The aim of this current study is to investigate the application possibilities of antimicrobial surfaces created with the PEO process on these new types of dental implants and compare them with standard screw-type implants. Both implant types were analysed in terms of surface morphology, chemical composition, phase composition, Ag ion release profile and in vitro antimicrobial activity. All surfaces of the implants were successfully treated using the PEO process. The titanium oxide layer was formed homogeneously on all implants and resulted in a microporous surface layer. Using the zone of inhibition test, it was identified that all implants showed antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA), however a larger growth inhibition zone was identified for porous patient-specific implants than screw-type implants. The ion release test indicated that a higher ion release was found on the porous patient-specific implants with a higher surface area than the screw-type dental implants, which is probably related to the surface area of the implants. This study indicates it is possible to create patient-specific dental implants that show antimicrobial properties against MRSA.

The goal of this graduation project, conducted for the master science communication at the Delft University of Technology (TU Delft), was to design a tool to help partners of diabetes type 1 patients to come closer to the patient, by conversations about diabetes, to gain more insights in how the patients feels and how to support. The project is part of the Integrated Care Program for Diabetes type 1 patients (INCAP) in which ultiple partners are involved (SERMAS, Medtronic, Universidad Politécnica Madrid, TU Delft).

Dental implants are used to replace missing teeth. Replacing teeth is required, since neighboring teeth can move and reposition in undesired positions if there is an empty space. A dental implant consists of three parts, a dental prosthetic (crown), an abutment and the implant which is fixated in the bone.

Dental implants are placed during a surgical procedure performed by an oral surgeon. For this project five surgeries are observed to gain more insights in this procedure. The total treatment takes long, because in between different steps of the procedure bone healing is required. The main concerns of patients are the long treatment time, anxiety and stress. Next to that, there is a failure rate of 3-5% which is mainly caused by loosening of the implant due to a lack of osseointegration and infection, also called peri-implantitis.

Developments to promote osseointegration and to prevent infection are taking place. Additive manufacturing techniques are used to promote osseointegration. Research into antimicrobial surfaces is aimed to lower the risk of infection.

Based on the analysis of the problem and the developments that are taking place a new type of dental implant is designed. The new implants are patient-specific and have a porous structure to promote osseointegration. The implants are made to be placed immediately after extraction.

The implant is designed based on the following design features: Shape, structure, abutment, stability and antimicrobial surface.

Shape
The patient-specific shape is retrieved from a CBCT scan of the jaw of a patient. The required data of the tooth that needs to be replaced is collected. Using image segmentation software, the particular root of the to be replaced tooth is isolated.

Structure
A porous structure is created to allow bone-ingrowth. A computational method can be used to create the desired porosity inside the implant.

Abutment and antimicrobial surface
The abutment, the connector between the implant and the crown, is in the new design connected to the implant itself. An antimicrobial surface is needed to prevent infection. The surface of the implants is biofunctionalized by plasma electrolytic oxidation with silver nanoparticles.

Treatment
With this new type of implant the surgical procedure will be shortened to 6 months, instead of 9/12months. The main advantage is that bone healing after extraction is not required, which saves 3-6 months.

The design and manufacturing process are changed as well. Current implants are mass produced, while the new implants will be designed for one specific case and will be produced one-by-one. This affects the planning of the total treatment, a good collaboration between all stakeholders is needed.

The design is validated with four oral surgeons. All of them see added values in the patient-specific design. Different opinions have been formed about the porous structure and the antimicrobial layer.

In conclusion, the design shows large potential to positively impact the dental implant surgical procedure. More research and testing is needed to further develop these new type of implants.