Marco Wieland

Potential of chemically modified hydrophilic surface characteristics to support tissue integration of titanium dental implants

In the past, several modifications of specific surface properties such as topography, structure, chemistry, surface charge, and wettability have been investigated to predictably improve the osseointegration of titanium implants. The aim of the present review was to evaluate, based on the currently available evidence, the impact of hydrophilic surface modifications of titanium for dental implants. A surface treatment was performed to produce hydroxylated/hydrated titanium surfaces with identical microstructure to either acid-etched, or sand-blasted, large grit and acid-etched substrates, but with hydrophilic character. Preliminary in vitro studies have indicated that the specific properties noted for hydrophilic titanium surfaces have a significant influence on cell differentiation and growth factor production. Animal experiments have pointed out that hydrophilic surfaces improve early stages of soft tissue and hard tissue integration of either nonsubmerged or submerged titanium implants. This data was also corroborated by the results from preliminary clinical studies. In conclusion, the present review has pointed to a potential of hydrophilic surface modifications to support tissue integration of titanium dental implants.

Bone Response to Loaded Implants With Non-Matching Implant-Abutment Diameters in the Canine Mandible

BACKGROUND One way to evaluate various implant restorations is to measure the amount of bone change that occurs at the crestal bone. The objective of this study was to histologically evaluate the alveolar bone change around a bone-level, non-matching implant-abutment diameter configuration that incorporated a horizontal offset and a Morse taper internal connection. METHODS The study design included extraction of all mandibular premolars and first molars in five canines. After 3 months, 12 dental implants were placed at three levels in each dog: even with the alveolar crest, 1 mm above the alveolar crest, and 1 mm below the alveolar crest. The implants were submerged on one side of the mandible. On the other side, healing abutments were exposed to the oral cavity (non-submerged). Gold crowns were attached 2 months after implant placement. The dogs were sacrificed 6 months postloading, and specimens were processed for histologic and histometric analyses. RESULTS Evaluation of the specimens indicated that the marginal bone remained near the top of the implants under submerged and non-submerged conditions. The amount of bone change for submerged implants placed even with, 1 mm below, and 1 mm above the alveolar crest was -0.34, -1.29, and 0.04 mm, respectively (negative values indicate bone loss). For non-submerged implants, the respective values were -0.38, -1.13, and 0.19 mm. For submerged and non-submerged implants, there were significant differences in the amount of bone change among the three groups (P <0.05). The percentage of bone-to-implant contact for submerged implants was 73.3%, 71.8%, and 71.5%. For non-submerged implants, the respective numbers were 73.2%, 74.5%, and 76%. No significant differences occurred with regard to the percentage of bone contact. CONCLUSIONS Minimal histologic bone loss occurred when dental implants with non-matching implant-abutment diameters were placed at the bone crest and were loaded for 6 months in the canine. The bone loss was significantly less (five- to six-fold) than that reported for bone-level implants with matching implant-abutment diameters (butt-joint connections).

Impact of guided bone regeneration and defect dimension on wound healing at chemically modified hydrophilic titanium implant surfaces: an experimental study in dogs

OBJECTIVES The aim of the present study was to evaluate the impact of guided bone regeneration and defect dimension on wound healing at chemically modified titanium implant surfaces (modSLA). MATERIALS AND METHODS ModSLA implants were placed at chronic-type lateral ridge defects of different heights (H1-H4: 2, 4, 6 and 8 mm) and randomly allocated to either (a) GBR (polyethylene glycol membrane + biphasic calcium phosphate) or (b) untreated control. At 2 and 8 weeks (n=6 dogs each), dissected blocks were processed for histomorphometrical analysis [e.g., percentage linear fill (PLF), regenerated area (RA)]. RESULTS At 8 weeks, both groups revealed comparable mean PLF (%) [ CONTROL H1 (26.1 +/- 5.8)-H4 (60.4 +/- 11.8); GBR: H1 (8.3 +/- 5.3)-H4 (50.7 +/- 23.1)] and RA (mm(2)) [ CONTROL H1 (2.5 +/- 0.4)-H4 (7.4 +/- 4.1); GBR: H1 (1.8 +/- 1.0)-H4 (10.8 +/- 5.9)] values. A significant difference was observed for the mean PLF values at H1 defects. CONCLUSION It was concluded that (i) modSLA titanium implants supported bone regeneration and osseointegration at H1-H4 defects and (ii) the present GBR procedure did not seem to improve the outcome of vertical bone regeneration, but tended to increase the mean RA values.

Influence of frequent clinical probing during the healing phase on healthy peri-implant soft tissue formed at different titanium implant surfaces: a histomorphometrical study in dogs.

OBJECTIVES To investigate (i) the impact of different titanium implant surfaces on soft tissue integration over 6 months, and (ii) the influence of frequent clinical probing during the healing phase on the established mucosal seal. MATERIAL AND METHODS Standardized clinical probing was randomly performed (12 dogs, probing versus control) at different transmucosal surfaces [machined (M), sand-blasted/acid-etched (SLA), and chemically modified acid-etched (modA), modSLA] at 2, 4, 8, and 12 weeks (i.e. 1 x , 2 x , 3 x , and 4 x). Histomorphometrical analysis (e.g. mucosal margin (PM) - apical extension of the junctional epithelium (aJE), PM - coronal level of bone-to-implant contact (CBI) was performed at 4, 8, 12, and 24 weeks. RESULTS While M and SLA groups revealed a split formation, epithelial cells and connective tissue were in close contact to modA and modSLA surfaces. Frequent clinical probing (i.e. 3 x and 4 x) increased mean pocket depths, PM-aJE, and aJE-CBI values in all groups and markedly disrupted the epithelial and connective tissue attachment. CONCLUSIONS It was concluded that irrespective of the surface characteristics, a frequent clinical probing at short intervals during the healing phase was associated with dimensional and structural changes of the mucosal seal.

Biomechanical evaluation of a microstructured zirconia implant by a removal torque comparison with a standard Ti‐SLA implant

OBJECTIVES The purpose of this study was to evaluate the biomechanical bone tissue response to novel microstructured zirconia implants in comparison to sandblasted and acid-etched (SLA) titanium implants through the analysis of removal torque (RTQ) measurements. MATERIALS AND METHODS Ti-SLA implants with a sandblasted, large-grit and acid-etched surface were compared with zirconia implants with an acid-etched surface. All implants had the same shape, a diameter of 4.1 mm and a length of 10 mm. A total of 136 implants were placed in the maxillae of 17 miniature pigs. Six animals were sacrificed after both 4 and 8 weeks and five animals were sacrificed after 12 weeks, thus providing a total of 102 implants for RTQ testing (34 implants were reserved for future histological analysis). The RTQ analysis was successfully performed, using a mixed model regression with P-values calculated using the nonparametric Brunner-Langer method, on 100 of the 102 implants, two were excluded from the analysis. RESULTS The adjusted mean RTQ values for Ti-SLA implants were 131 Ncm (95% CI: 107-155) at 4 weeks, 128 Ncm (108-148) Ncm at 8 weeks, and 180 Ncm (153-207 Ncm) at 12 weeks of healing, whereas RTQ values for the zirconia implants were 110 Ncm (86-134), 97 Ncm (76-118) and 147 Ncm (121-174) at the corresponding time intervals. A comparison of the implant materials resulted in P-values of P = 0.114 at 4 weeks, P = 0.034 at 8 weeks and P = 0.105 at 12 weeks (significance set at P < 0.05). CONCLUSIONS Within the limits of the present study, it could be confirmed that the biomechanical bone-tissue response of the investigated zirconia implants is non-inferior to that of the well-documented, roughened titanium surface, at each time point, within the set tolerance. There were no statistically significant differences between the two materials after a healing period of 4 and 12 weeks. The RTQ values of both implant types increased significantly from the 8-week to the 12-week time point.