Hans Jacob Rønold

Effect of micro-roughness produced by TiO2 blasting--tensile testing of bone attachment by using coin-shaped implants.

The aim of the present study was to examine bone response to micro-rough titanium implants. Forty coin-shaped implants were divided into eight groups according to their surface roughness. The first group had electropolished surfaces. The surfaces of implant groups 2-8 were blasted with TiO2 particles with incremental grain sizes ranging from 7.5-12.5 to 270-330 microns. Five implants from each group were placed into the cortical bone of the proximal tibia in New Zealand Black rabbits. To avoid bone overgrowth during the retention phase the implants were fitted into tight polytetrafluoroethylene (PTFE) caps leaving only the flat test surface exposed to bone. The healing period was set to 10 weeks, and implants with attached bone were evaluated using a tensile testing machine. In groups 1-7 a significant correlation between the micro-roughness of the implant surfaces and retention strength was observed. Maximum bone bonding was observed with implants blasted with 180-220 microns grain size (group 7). Blasting with larger TiO2 particles appeared to decrease the effect. The findings suggest that the best grain size of TiO2 particles for optimising retention of titanium implants in cortical bone should be in the 180-220 microns range.

Analysing the optimal value for titanium implant roughness in bone attachment using a tensile test

This study aims at studying the effect of surface roughness on bone attachment of coin-shaped titanium implants. All implants in this study were blasted with TiO(2) particles of 180-220 microm, and then divided into three groups. One group had no further surface treatment whereas the other two groups were subsequently etched with hot hydrochloric acid (0.01M or 1M). The surface topography of the implant specimens was examined by SEM and by a confocal laser scanner for a numeric evaluation of S(a), S(t) and S(dr). The ranging implants in the three groups differed significantly in surface structure. The implants with modified surfaces were then placed into the tibias of 12 rabbits (n=16). After 8 weeks healing, the attachment of bone to implants were examined using a standardised tensile test analysis. The implants that were only blasted (positive control) showed significantly better functional attachment (p<0.001) than the acid etched. Implant surfaces etched with 1M HCl solution had the lowest retention in bone. There was a negative correlation between the increasing roughness and mechanical retention in bone of the implants in this study. The results support observations from earlier studies that suggested an optimal surface roughness for bone attachment, identified by in situ tensile tests and expressed as the arithmetic mean deviation (S(a)), to be in the range between 3.62 and 3.90 microm and that a further attachment depended on mechanical interlocking between bone and implant.

The use of a coin shaped implant for direct in situ measurement of attachment strength for osseointegrating biomaterial surfaces

Most animal models currently used to study the retention of implants in bone are influenced by shear forces introduced during the retention test. This is mainly due to the implant design, which most often are cylindrical, conical or threaded. In these models interlocking between bone and implant surface will increase the effect of genuine bone bonding and thus give a false positive outcome. The purpose of the present study was to establish a model for testing functional attachment of implants in situ, with minimal influence of interlocking and shear forces. The model involves the use of flat coin shaped implant placed onto the cortical bone of rabbit tibia without mechanical fixation to the bone. The implant is passively retained on the cortical bone by a titanium band retainer. During the healing period, the contact between the coin shaped implants and the bone is restricted to the flat test surfaces. To prevent interlocking effects from lateral bone attachments a polytetrafluoroethylene (PTFE) cap covering the vertical and the upper faces of the implants were used. The tensile test was performed with a gradual, calibrated pull, perpendicular to the bone-implant interface. This pullout model makes it possible to study the kinetics and strength of bone bonding with negligible influence of shear forces or mechanical interlocking.

In vivo performance of absorbable collagen sponges with rosuvastatin in critical-size cortical bone defects.

Rosuvastatin (RSV) is a synthetic statin with favourable pharmacologic properties, but its local effect in bone has yet to be investigated. The aim of this study was to evaluate the potential of absorbable collagen sponge (ACS) as a carrier for RSV to enhance bone formation in critical-size cortical bone defects adjacent to titanium implants. ACS, treated with different concentrations of RSV (R1 = 8.7 + or - 1.8 microg; R2 = 52.0 + or - 4.4 microg; R3 = 259.1 + or - 8.8 microg) or phosphate-buffered saline alone, were placed into the bone marrow through a defect made in the proximal tibial cortical bone of New Zealand White rabbits. One empty defect (SHAM) served as an internal control in each animal. After a healing time of 4 weeks, a concentration-dependent increase of alkaline phosphatase activity in ACS treated with RSV was detected in the bone fluid after removing the implants. In addition, a significant concentration-dependent increase in BMP-2 mRNA levels was found in the cortical bone tissue adjacent to the RSV-treated ACS. The cortical architecture of bone defects analysed by micro-computed tomography showed a trend towards higher bone volume in the ACS+R1 group compared with SHAM, which was accompanied by an increase in the bone mineral density. Evaluation of histological sections showed new bone formation in ACS treated with RSV but not in untreated ACS. These results indicate that RSV, when administered locally in bone, may have a potential effect in stimulating bone formation.

Porous ceramic titanium dioxide scaffolds promote bone formation in rabbit peri-implant cortical defect model.

Titanium oxide (TiO₂) scaffolds have previously been reported to exhibit very low mechanical strength. However, we have been able to produce a scaffold that features a high interconnectivity, a porosity of 91% and a compressive strength above 1.2 MPa. This study analyzed the in vivo performance of the porous TiO₂ scaffolds in a peri-implant cortical defect model in the rabbit. After 8 weeks of healing, morphological microcomputed tomography analyses of the defects treated with the TiO₂ scaffolds had significantly higher bone volume, bone surface and bone surface-to-volume ratio when compared to sham, both in the cortical and bone marrow compartment. No adverse effects, i.e. tissue necrosis or inflammation as measured by lactate dehydrogenase activity and real-time reverse transcription polymerase chain reaction analysis, were observed. Moreover, the scaffold did not hinder bone growth onto the adjacent cortical titanium implant. Histology clearly demonstrated new bone formation in the cortical sections of the defects and the presence of newly formed bone in close proximity to the scaffold surface and the surface of the adjacent Ti implant. Bone-to-material contact between the newly formed bone and the scaffold was observed in the histological sections. Islets of new bone were also present in the marrow compartment albeit in small amounts. In conclusion, the present investigation demonstrates that TiO₂ scaffolds osseointegrate well and are a suitable scaffold for peri-implant bone healing and growth.

Clinical Evaluation of CAD/CAM Metal-Ceramic Posterior Crowns Fabricated from Intraoral Digital Impressions

PURPOSE The aim of this in vivo study was to evaluate the accuracy of metal-ceramic crowns fabricated using computer-aided design/computer-assisted manufacturing (CAD/CAM) in conjunction with intraoral digital impressions. MATERIALS AND METHODS Fifty patients in a general practice participated in the study. Patients were provided with crowns fabricated from digital impressions taken with an intraoral chairside scanner. Prior to crown insertion, the marginal integrity, esthetics, and occlusal and articulation contacts were evaluated using California Dental Association (CDA) criteria. The precementation space of the crowns was evaluated with the replica technique. RESULTS No adjustments were needed for any of the interproximal contact points. Adjustments of occlusion and articulation contacts were needed in 20% of the restorations. Clinical evaluation of the marginal integrity showed satisfactory results according to the CDA criteria. The 50 silicone replicas showed a median precementation space of 46 μm at the marginal measurement location, 94 μm at the midaxial location, and 185 μm at the centro-occlusal location. CONCLUSIONS The precementation spaces of the crowns were within the acceptable range for CAD/CAM restorations.

Porous titanium granules promote bone healing and growth in rabbit tibia peri-implant osseous defects

OBJECTIVES The aim of this study was to investigate the osteoconductive properties and biological performance of porous titanium granules used in osseous defects adjacent to titanium implants. MATERIAL AND METHODS In this animal experimental study, calibrated defects were prepared in the tibias of 24 New Zealand rabbits. The defects were randomized into two tests and one control group. The test defects were grafted with either metallic or oxidized porous titanium granules (PTG or WPTG, respectively), whereas control defects were left empty (sham). The defects were closed with a submerged coin shaped titanium implant. Defects were left for healing for 4 weeks. After healing, the implants were removed and the new bone tissue formed onto the implant surface was analyzed for run x 2, osteocalcin, collagen-I, tartrate-resistant acid phosphatase, H(+)-ATPase, tumor necrosis factor-alpha, interleukin (IL)-6 and IL-10 gene expression using reverse transcriptase polymerase chain reaction. Wound fluid from the healed defects was analyzed for lactate dehydrogenase and alkaline phosphatase activity. Finally osteoconductivity was analyzed by micro-computed tomography and histology. RESULTS Significantly more new bone formed in PTG and WPTG grafted defects compared with sham. The new bone grew both through the porosities of the granules and onto the implant surfaces. The WPTG group showed significantly less expression of key inflammation markers, but with no significant difference in a marker for necrosis. The WPTG also showed a significant increase in collagen-I mRNA expression compared with PTG. CONCLUSION The results suggest that PTG and WPTG are both osteoconductive materials that can be used to promote bone formation in osseous defects adjacent to titanium implants without hampering implant osseointegration.

Tensile force testing of optimized coin-shaped titanium implant attachment kinetics in the rabbit tibiae

In the present study, the bone response of titanium implants at early bone healing stages, was evaluated using a tensile test. Test surface of coin-shaped cp. titanium implants were standardized by grit blasting with TiO2, grain size 180–220 μm. The surface topography of the implant specimens was examined by SEM, and by a confocal laser scanner for evaluation of Sa, St and Sdr. The implants were placed onto the leveled site on the tibia of 12 New Zealand White rabbits, 4 implants in each animal. The rabbits were divided into three groups with different observation times i.e. 2, 4 and 6 weeks. The retention of 12 implants were tested by measuring the pull-out force needed to detach the implant from the bone. There was a significant increase in implant retention from 2 to 4 and to 6 weeks healing time (p<0.05). Four implants from each time point were randomly chosen for histological evaluation. The histological appearance of the implant–bone interface at the different healing times showed noticeable differences in the degree of bone healing and maturation, suggesting that, in rabbits, 6 weeks healing time is a suitable observation point for tensile testing of surface optimized osseointegrating implants.

Bioactive implant surface with electrochemically bound doxycycline promotes bone formation markers in vitro and in vivo

OBJECTIVES The objective of this study was to demonstrate a successful binding of Doxy hyclate onto a titanium zirconium alloy surface. METHODS The coating was done on titanium zirconium coins in a cathodic polarization setup. The surface binding was analyzed by SEM, SIMS, UV-vis, FTIR and XPS. The in vitro biological response was tested with MC3T3-E1 murine pre-osteoblast cells after 14 days of cultivation and analyzed in RT-PCR. A rabbit tibial model was also used to confirm its bioactivity in vivo after 4 and 8 weeks healing by means of microCT. RESULTS A mean of 141 μg/cm(2) of Doxy was found firmly attached and undamaged on the coin. Inclusion of Doxy was documented up to a depth of approximately 0.44 μm by tracing the (12)C carbon isotope. The bioactivity of the coating was documented by an in vitro study with murine osteoblasts, which showed significantly increased alkaline phosphatase and osteocalcin gene expression levels after 14 days of cell culture along with low cytotoxicity. Doxy coated surfaces showed increased bone formation markers at 8 weeks of healing in a rabbit tibial model. SIGNIFICANCE The present work demonstrates a method of binding the broad spectrum antibiotic doxycycline (Doxy) to an implant surface to improve bone formation and reduce the risk of infection around the implant. We have demonstrated that TiZr implants with electrochemically bound Doxy promote bone formation markers in vitro and in vivo.

Osseointegration of dental implants in extraction sockets preserved with porous titanium granules – an experimental study

OBJECTIVES This study investigated osseointegration of dental implants inserted in healed extraction sockets preserved with porous titanium granules (PTG). MATERIAL AND METHODS Three adult female minipigs (Gøttingen minipig; Ellegaard A/S, Dalmose, Denmark) had the mandibular teeth P2, P3 and P4 extracted. The extraction sockets were preserved with metallic PTG (Tigran PTG; Tigran Technologies AB, Malmö, Sweden) n = 12, heat oxidized white porous titanium granules (WPTG) (Tigran PTG White) n = 12 or left empty (sham) n = 6. All sites were covered with collagen membranes (Bio-Gide; Geistlich Pharma, Wolhausen, Switzerland) and allowed 11 weeks of healing before implants (Straumann Bone Level; Straumann, Basel, Switzerland) were inserted. The temperature was measured during preparation of the osteotomies. Resonance frequency analysis (RFA, Osstell; Osstell AB, Gothenburg, Sweden) was performed at implant insertion and at termination. After 6 weeks of submerged implant healing, the pigs were euthanized and jaw segments were excised for microCT and histological analyses. RESULTS In the temperature and RFA analyses no significant differences were recorded between the test groups. The microCT analysis demonstrated an average bone volume of 61.7% for the PTG group compared to 50.3% for the WPTG group (P = 0.03) and 57.1% for the sham group. Histomorphometry demonstrated an average bone-to-implant contact of 68.2% for the PTG group compared to 36.6% for the WPTG group and 60.9% for the sham group (n.s). Eight out of ten implants demonstrated apical osseous defects in the WPTG group, but similar defects were observed in all groups. CONCLUSIONS PTG preserved extraction sockets demonstrate a similar outcome as the sham control group for all analyses suggesting that this material potentially can be used for extraction socket preservation prior to implant installment. Apical osseous defects were however observed in all groups including the sham group, and a single cause could not be determined.