Ann Wennerberg

Experimental study of turned and grit-blasted screw-shaped implants with special emphasis on effects of blasting material and surface topography

In the rabbit tibia, commercially pure titanium implants blasted with 25-microns Al2O3 and TiO2 particles respectively were inserted and studied with respect to removal torque and histomorphometry. In the rabbit femur, as-machined implants and implants blasted with 75-microns Al2O3 particles were histomorphometrically compared. Before implant insertion, the differently produced surface topographies were characterized numerically and visually. The tibial implants blasted with different materials and the same sized (25 microns) blasting particles demonstrated similar results. Comparing implants blasted with 75-microns Al2O3 particles to as-machined implants, the blasted specimens exhibited a statistically significant higher bone-to-metal contact after 12 weeks in the rabbit bone.

Torque and histomorphometric evaluation of c.p. titanium screws blasted with 25‐ and 75‐μm‐sized particles of Al2O3

A comparison was made between screw-shaped c.p. titanium implants blasted with either 25- or 75-microns particles of Al2O3. The implant surfaces were investigated with respect to topography and composition before implantation in rabbit bone. Grit blasting with 25- or 75-microns particles produced two different surface roughnesses, but no significant difference in the surface composition for the two surfaces. After 12 weeks insertion time in the rabbit tibia and femur, a higher removal torque and more bone-to-metal contact was found for the implants blasted with 75-microns particles compared with the 25-microns-blasted ones.

Surface characteristics and in vitro biofilm formation on glass ionomer and composite resin.

In the initial stages of dental plaque formation, early colonizing bacteria bind to receptor structures in the pellicle, a proteinaceous film formed instantly after cleaning of the tooth surface. Dental restorative materials with surface characteristics different from the tooth might affect pellicle formation and the ability of bacteria to colonize the oral cavity. In this study (i) roughness and chemical composition of glass ionomer and composite resin surfaces before and after polishing, and (ii) the adsorption of salivary proteins and bacterial adherence to the pellicle-coated surfaces were examined. Compared with unpolished composite resin, unpolished glass ionomer had higher surface roughness, contained more inorganic, positively charged components, collected more proteins, and promoted better bacterial adherence. Polishing had the most pronounced effect on the composite resin, giving an enlarged and a rougher surface with a more inorganic character. Polishing the composite resin also led to increased biofilm formation.

Nano hydroxyapatite structures influence early bone formation

In a study model that aims to evaluate the effect of nanotopography on bone formation, micrometer structures known to alter bone formation, should be removed. Electropolished titanium implants were prepared to obtain a surface topography in the absence of micro structures, thereafter the implants were divided in two groups. The test group was modified with nanosize hydroxyapatite particles; the other group was left uncoated and served as control for the experiment. Topographical evaluation demonstrated increased nanoroughness parameters for the nano-HA implant and higher surface porosity compared to the control implant. The detected features had increased size and diameter equivalent to the nano-HA crystals present in the solution and the relative frequency of the feature size and diameter was very similar. Furthermore, feature density per microm(2) showed a decrease of 13.5% on the nano-HA implant. Chemical characterization revealed calcium and phosphorous ions on the modified implants, whereas the control implants consisted of pure titanium oxide. Histological evaluation demonstrated significantly increased bone formation to the coated (p < 0.05) compared to uncoated implants after 4 weeks of healing. These findings indicate for the first time that early bone formation is dependent on the nanosize hydroxyapatite features, but we are unaware if we see an isolated effect of the chemistry or of the nanotopography or a combination of both.

Oxidized implants and their influence on the bone response

Surface oxide properties are regarded to be of great importance in establishing successful osseointegration of titanium implants. Despite a large number of theoretical questions on the precise role of oxide properties of titanium implants, current knowledge obtained from in vivo studies is lacking. The present study is designed to address two aspects. The first is to verify whether oxide properties of titanium implants indeed influence the in vivo bone tissue responses. The second, is to investigate what oxide properties underline such bone tissue responses. For these purposes, screw-shaped/turned implants have been prepared by electrochemical oxidation methods, resulting in a wide range of oxide properties in terms of: (i) oxide thickness ranging from 200 to 1000 nm, (ii) the surface morphology of barrier and porous oxide film structures, (iii) micro pore configuration – pore sizes<8 μm by length, about 1.27 μ2 to 2.1 μm2 by area and porosity of about 12.7–24.4%, (iv) the crystal structures of amorphous, anatase and mixtures of anatase and rutile type, (v) the chemical compositions of TiO2 and finally, (vi) surface roughness of 0.96–1.03 μm (Sa). These implant oxide properties were divided into test implant samples of Group II, III, IV and V. Control samples (Group I) were turned commercially pure titanium implants. Quantitative bone tissue responses were evaluated biomechanically by resonance frequency analysis (RFA) and removal torque (RT) test. Quantitative histomorphometric analyses and qualitative enzyme histochemical detection of alkaline (ALP) and acidic phosphatase (ACP) activities were investigated on cut and ground sections after six weeks of implant insertion in rabbit tibia. In essence, from the biomechanical and quantitative histomorphometric measurements we concluded that oxide properties of titanium implants, i.e. the oxide thickness, the microporous structure, and the crystallinity significantly influence the bone tissue response. At this stage, however, it is not clear whether oxide properties influence the bone tissue response separately or synergistically.© 2001 Kluwer Academic Publishers

An in vivo study of bone response to implants topographically modified by laser micromachining.

Dental implants topographically modified by laser ablation of periodic arrays of micron-sized craters, were studied in a two-part laboratory investigation. The patterned and control (turned) implants were inserted in rabbit femur and tibia. After 12 weeks the fixation in the bone was evaluated mechanically or by histomorphometry (all threads along the implant and the three best consecutive threads were analysed). In the pilot study no difference was found with respect to bone-to-implant contact and peak removal torque. Significantly more bone was found for the control implants when measuring the bone area inside the threads in the tibia. In the second part of the study, the pattern was improved and significantly more bone-to-implant contact was found for the laser-machined implants. The second part of the study also demonstrated significantly greater peak removal torque values in the tibia with the test implants than the control implants.

State of the art of oral implants.

Objectives: The aim of this prospective study was to evaluate the Nobel Direct® and Nobel Perfect® one-piece implants (OPIs) when used for immediate function. Material and methods: Forty-eight pati ...

Reasons for failures of oral implants.

This study reviews the literature regarding the factors contributing to failures of dental implants. An electronic search was undertaken including papers from 2004 onwards. The titles and abstracts from these results were read to identify studies within the selection criteria. All reference lists of the selected studies were then hand-searched, this time without time restrictions. A narrative review discussed some findings from the first two parts where separate data from non-comparative studies may have indicated conclusions different from those possible to draw in the systematic analysis. It may be suggested that the following situations are correlated to increase the implant failure rate: a low insertion torque of implants that are planned to be immediately or early loaded, inexperienced surgeons inserting the implants, implant insertion in the maxilla, implant insertion in the posterior region of the jaws, implants in heavy smokers, implant insertion in bone qualities type III and IV, implant insertion in places with small bone volumes, use of shorter length implants, greater number of implants placed per patient, lack of initial implant stability, use of cylindrical (non-threaded) implants and prosthetic rehabilitation with implant-supported overdentures. Moreover, it may be suggested that the following situations may be correlated with an increase in the implant failure rate: use of the non-submerged technique, immediate loading, implant insertion in fresh extraction sockets, smaller diameter implants. Some recently published studies suggest that modern, moderately rough implants may present with similar results irrespective if placed in maxillas, in smoking patients or using only short implants.

Is marginal bone loss around oral implants the result of a provoked foreign body reaction

BACKGROUND When a foreign body is placed in bone or soft tissue, an inflammatory reaction inevitably develops. Hence, osseointegration is but a foreign body response to the implant, which according to classic pathology is a chronic inflammatory response and characterized by bone embedding/separation of the implant from the body. PURPOSE The aim of this paper is to suggest an alternative way of looking at the reason for marginal bone loss as a complication to treatment rather than a disease process. MATERIALS AND METHODS The present paper is authored as a narrative review contribution. RESULTS The implant-enveloping bone has sparse blood circulation and is lacking proper innervation in clear contrast to natural teeth that are anchored in bone by a periodontal ligament rich in blood vessels and nerves. Fortunately, a balanced, steady state situation of the inevitable foreign body response will be established for the great majority of implants, seen as maintained osseointegration with no or only very little marginal bone loss. Marginal bone resorption around the implant is the result of different tissue reactions coupled to the foreign body response and is not primarily related to biofilm-mediated infectious processes as in the pathogenesis of periodontitis around teeth. This means that initial marginal bone resorption around implants represents a reaction to treatment and is not at all a disease process. There is clear evidence that the initial foreign body response to the implant can be sustained and aggravated by various factors related to implant hardware, patient characteristics, surgical and/or prosthodontic mishaps, which may lead to significant marginal bone loss and possibly to implant failure. Admittedly, once severe marginal bone loss has developed, a secondary biofilm-mediated infection may follow as a complication to the already established bone loss. CONCLUSIONS The present authors regard researchers seeing marginal bone loss as a periodontitis-like disease to be on the wrong track; the onset of marginal bone loss around oral implants depends in reality on a dis-balanced foreign body response.

An animal study of c.p. titanium screws with different surface topographies

Sixty screw-shaped commercially pure (c.p.) titanium implants were inserted in the tibial and the femoral metaphyses of adult rabbits. The implants were divided into four groups with different surface roughnesses. The surface roughness was characterized before and after implant insertion. One group was left as-machined, this group had an initial Ra value of 0.4 μm. Two groups were blasted with 25 μm sized particles of TiO2 and Al2O3, respectively; corresponding Ra values for these groups were 0.9 μm and 0.8 μm. One group was blasted with 250 μm sized particles of Al2O3. The Ra value for this last group was 2.1 μm. After a healing time of 12 weeks the torque necessary for implant removal and histomorphometric evaluations was evaluated. After removal of the implants the Ra values for the four above mentioned groups were 0.9, 1.3, 1.1 and 1.9 μm, respectively. We found a better bone response for implants blasted with 25 μm sized particles compared to an as-machined (turned) surface, but no differences between the implants blasted with 25 μm particles and the implants blasted with 250 μm sized particles.