Does the incorporation of zinc into TiO2 on titanium surfaces increase bactericidal activity? A systematic review and meta-analysis

Douglas Thainan Silva Lima Mendes; Gusttavo Reis Leite Matos; Sandra Andreia Stwart de Araújo Souza; Michelle Cardinale Souza Silva Macedo; Débora Dos Santos Tavares; Cristiane Xavier Resende

doi:10.1016/j.prosdent.2022.05.007

Does the incorporation of zinc into TiO₂ on titanium surfaces increase bactericidal activity? A systematic review and meta-analysis

J Prosthet Dent. 2022 Oct 18:S0022-3913(22)00328-6. doi: 10.1016/j.prosdent.2022.05.007. Online ahead of print.

Authors

Douglas Thainan Silva Lima Mendes¹, Gusttavo Reis Leite Matos¹, Sandra Andreia Stwart de Araújo Souza², Michelle Cardinale Souza Silva Macedo², Débora Dos Santos Tavares³, Cristiane Xavier Resende⁴

Affiliations

¹ Postgraduate student, Post-graduate Program in Materials Science and Engineering, Federal University of Sergipe (UFS), São Cristóvão, Sergipe, Brazil.
² Adjunct Professor, Department of Materials Science and Engineering, Federal University of Sergipe (UFS), São Cristóvão, Sergipe, Brazil.
³ Adjunct Professor, Department of Health Education, Federal University of Sergipe (UFS), Lagarto, Sergipe, Brazil.
⁴ Adjunct Professor, Department of Materials Science and Engineering, Federal University of Sergipe (UFS), São Cristóvão, Sergipe, Brazil. Electronic address: cristianexr@academico.ufs.br.

PMID: 36270807
DOI: 10.1016/j.prosdent.2022.05.007

Abstract

Statement of problem: Infections associated with bacterial biofilm formation are an important cause of early implant failure. With the growing number of antibiotic-resistant bacteria, the incorporation of zinc into TiO₂ coatings of titanium implants has emerged to promote osseointegration and inhibit bacterial proliferation. However, a systematic assessment of its efficacy is lacking.

Purpose: The purpose of this systematic review and meta-analysis was to assess the bactericidal effect of zinc-modified TiO₂ coatings on titanium or Ti-6Al-4V alloy.

Material and methods: The review was structured based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist and the peer review of electronic search strategies (PRESS) guidelines. The search was performed in Science Direct, SCOPUS, Web of Science, and PubMed databases, including experimental in vitro studies that used titanium or Ti-6Al-4V as a control group and performed bacterial assays. Meta-analysis was performed by using the standardized mean differences of antibacterial effects.

Results: A total of 2519 articles were collected after duplicate removal. Then, eligibility criteria and a manual search were applied to select 20 studies for qualitative analysis and 16 studies for statistical analysis. The risk of bias revealed low-quality evidence. The meta-analysis showed that zinc positively affected the bactericidal activity of TiO₂ coatings (-8.79, CI_95%=-11.01 to -6.57, P<.001), with a high degree of heterogeneity (I²=78%). Subgroup analysis with TiO₂ nanotubes produced by anodization and ZnO nanoparticles by hydrothermal synthesis reduced heterogeneity to 43%, with the removal of outliers (I²=46%), with a favorable antibacterial effect for zinc incorporation into TiO₂.

Conclusions: Bactericidal activity was identified for zinc incorporated into TiO₂ coatings, making it an interesting option for titanium dental implants.

Publication types

Review