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Nanomaterials 2018, 8, 681 7 of 25 antimicrobial filling agents within multifunctional biomaterials, another attractive and challenging dental application of AgNPs relies on their potential use as biostatic or biocide coatings for conventional titanium-based dental implants [163,164]. Though AgNPs proved to be efficient and effective agents in dental practice, they remain controversial candidates for this specific area of research, due to their variable toxicity in biological systems. Therefore, any potential application of AgNPs in dentistry must include thorough studies regarding the optimal compromise between physicochemical features and biofunctional performance [165]. 6. Silver Nanoparticles for Wound Healing Wound infections represent an important clinical challenge, with major impact on patient morbidity and mortality and notable economic implications [166]. Preventing wound dehiscence and surgical-site infection are challenging and essential aspects in current clinical practice [167]. The skin is the most extensive and one of the most complex organs in the human body, but it can be easily affected by different harmful external factors [168]. Physically or chemically induced cutaneous wounds may significantly disturb skin structural and functional integrity at different stages, leading to permanent disability or even death, depending on the severity of the injury [169]. In the past few years, wound infections caused by opportunistic pathogenic microorganism became an important issue during current healthcare practice [170]. The ultimate tendency and ideal desideratum for infected-wound management is represented by fast tissue-recovery processes, accompanied by maximal functionality restoration and minimal scar-tissue formation [171]. The wound-healing process, as any complex pathophysiological mechanism, includes different stages, such as coagulation, inflammation, cellular proliferation, and matrix and tissue remodeling [171]. Since ancient times, silver-based compounds and materials were used for the unconventional and effective control of distinctive infections [172]. Given its intrinsic physicochemical features and biological peculiarities, nanosilver provides a wide range of efficient biocide activities against an impressive diversity of anaerobic and aerobic, Gram-negative and Gram-positive bacterial strains. It is well known that bacterial and mammalian cells poorly absorb metallic or elemental silver, due to its chemical inactivation. Therefore, in order to provide specific antibacterial effects under physiological conditions (including the presence of body fluids or secretions), the ionization of silver is required. After their penetration inside cells, silver ions merge with enzymatic and structural proteins [173]. AgNPs or silver ions used in absorbent wound dressings can interact with and destroy the bacteria found in exudate [174]. Briefly, recent data provide the following information regarding AgNP skin absorption: (i) there is plenty experimental evidence with respect to the in vitro skin permeation by nanoparticles, and (ii) there is an important increase in permeation in the case of damaged skin [175]. When naturally available biopolymers (e.g., chitosan [176] or collagen [177]) are implied in novel nanotechnology approaches, they possess tremendous potential regarding the obtaining of novel and functionally improved platforms for effective wound-healing applications [178]. ActicoatTM and BactigrasTM (Smith & Nephew), AquacelTM (ConvaTec), PolyMem SilverTM (Aspen), and TegadermTM (3M) are representative biocomposites modified with ionic silver and approved by the United States (US) Food and Drug Administration (FDA) for wound-dressing applications. In addition to these commercial products, promising results were reported with respect to the incorporation of AgNPs within novel and naturally derived biomaterials for enhanced wound-healing management, such as (but not limited to) modified cotton fabrics [179,180], bacterial cellulose [181,182], chitosan [176,183], and sodium alginate [184,185]. The use of AgNPs and Ag+ carriers also represents a valuable strategy for delayed diabetic wound-healing processes, since diabetic wounds may be accompanied by numerous secondary infections. AgNPs can help diabetic patients in early wound-healing stages, additionally providing minor scars [186]. Taking into account the efficient and enhanced antibacterial effects exhibitedPDF Image | Biomedical Applications of Silver Nanoparticles
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