In an attempt to regain function and aesthetics in the craniofacial region, different biomaterials, including titanium, hydroxyapatite, biodegradable polymers and composites, have been widely used as a result of the loss of craniofacial bone. Although these materials presented favorable success rates, osseointegration and antibacterial properties are often hard to achieve. Although bone-implant interactions are highly dependent on the implant's surface characteristics, infections following traumatic craniofacial injuries are common. As such, poor osseointegration and infections are two of the many causes of implant failure. Further, as increasingly complex dental repairs are attempted, the likelihood of infection in these implants has also been on the rise. For these reasons, the treatment of craniofacial bone defects and dental repairs for long-term success remains a challenge. Various approaches to reduce the rate of infection and improve osseointegration have been investigated. Furthermore, recent and planned tissue engineering developments are aimed at improving the implants' physical and biological properties by improving their surfaces in order to develop craniofacial bone substitutes that will restore, maintain and improve tissue function. In this review, the commonly used biomaterials for craniofacial bone restoration and dental repair, as well as surface modification techniques, antibacterial surfaces and coatings are discussed.

Orthopedic implant failure as a result of bacterial infection affects approximately 0.5-5% of patients. These infections are often caused by Staphylococcus aureus which is capable of attaching and subsequently forming a biofilm on the implant surface, making it difficult to eradicate with systemic antibiotics. Further, with the emergence of antibiotic-resistant bacteria, alternative treatments are necessary. Silver nanoparticles have received much attention for their broad spectrum antibacterial activity which has been reported to be both size and shape dependent. The purpose of this study was therefore to evaluate the effect of three different geometries on their effect on microbial susceptibility as well as evaluate their effect on bone cell viability. Silver nanoparticles of spherical, triangular and cuboid shapes were synthesized by chemical reduction methods. The susceptibility of S. aureus and methicillin-resistant S. aureus was evaluated a 24 h period and determined using a colorimetric assay. Further, the viability of human fetal osteoblast (hFOB) cells in the presence of the silver nanoparticles was evaluated over a period of 7 days by AlmarBlue fluorescence assay. hFOB morphology was also evaluated by light microscopy imaging. Results indicated that silver nanoparticle geometry did not have an effect on microbiota susceptibility or hFOB viability. However, high concentrations of silver nanoparticles (0.5 nM) conferred significant susceptibility towards the bacteria and significantly reduced hFOB viability. It was also found that the hFOBs exhibited an increasingly reduced viability to lower silver nanoparticle concentrations with an increase in exposure time.

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