Effect of modifications of dual acid-etched implant surfaces on peri-implant bone formation. Part I: organic coatings

Objective: The aim of the present study was to test the hypothesis that peri-implant bone formation can be improved by modifying dual acid-etched (DAE) implant surfaces using organic coatings that enhance cell adhesion and osteogenic differentiation.
Material and methods: Ten adult female foxhounds received experimental titanium implants in the mandible 3 months after removal of all premolar teeth. Six types of implants were evaluated in each animal: (i) implants with a machined surface (MS), (ii) implants with a DAE surface topography, (iii) implants with an acid-etched surface coated with RGD peptides, (iv) implants with an acid-etched surface coated with collagen I, (v) implants with an acid-etched surface coated with collagen I and chondroitin sulphate (CS), (vi) implants with an acid-etched surface coated with collagen I and CS and recombinant human bone morphogenetic protein-2. Peri-implant bone regeneration was assessed by histomorphometry after 1 and 3 months in five dogs each by measuring bone implant contact (BIC) and the bone volume density (BVD) of the newly formed peri-implant bone.
Results: After 1 month, mean BIC was significantly higher in the coated implants group than in the MS group. There was no significant difference when mean BIC in the DAE group was compared with implants with any of the organic coatings, but the difference was significant when compared with the MS implants. Differences in mean BVD value did not reach significance between any of the surfaces. After 3 months, the same held true for the mean BIC of all the groups except for Coll I. Mean volume density of the newly formed bone was higher in all the surface modifications, albeit without statistical significance.
Conclusions: It is concluded that with the exception of Coll I, the tested organic surface coatings on DAE surfaces did not improve peri-implant bone formation when compared with the DAE surfaces but enhanced BIC when compared with the MSs.     

Mechanical insertion properties of calcium‐phosphate implant coatings

Objectives: To investigate the influence of protein incorporation on the resistance of biomimetic calcium‐phosphate coatings to the shear forces that are generated during implant insertion. Materials and Methods: Thirty‐eight standard (5 × 13 mm) Osseotite^® implants were coated biomimetically with a layer of calcium phosphate, which either lacked or bore a co‐precipitated (incorporated) depot of the model protein bovine serum albumin (BSA). The coated implants were inserted into either artificial bone (n=18) or the explanted mandibles of adult pigs (n=12). The former set‐up was established for the measurement of torque and of coating losses during the insertion process. The latter set‐up was established for the histological and histomorphometric analysis of the fate of the coatings after implantation. Results: BSA‐bearing coatings had higher mean torque values than did those that bore no protein depot. During the insertion process, less material was lost from the former than from the latter type of coating. The histological and histomorphometric analysis revealed fragments of material to be sheared off from both types of coating at vulnerable points, namely, at the tips of the threads. The sheared‐off fragments were retained within the peri‐implant space. Conclusion: The incorporation of a protein into a biomimetically prepared calcium‐phosphate coating increases its resistance to the shear forces that are generated during implant insertion. In a clinical setting, the incorporated protein would be an osteogenic agent, whose osteoinductive potential would not be compromised by the shearing off of coating material, and the osteoconductivity of an exposed implant surface would not be less than that of a coated one. To cite this article:
Hägi TT, Enggist L, Michel D, Ferguson SJ, Liu Y, Hunziker EB. Mechanical insertion properties of calcium‐phosphate implant coatings.
Clin. Oral Impl. Res. 21 , 2010; 1214–1222.
doi: 10.1111/j.1600‐0501.2010.01916.x     

Histomorphometric analysis of the osseointegration of four different implant surfaces in the femoral epiphyses of rabbits

Objectives: The surface properties of titanium dental implants are key parameters for rapid and intimate bone–implant contact. The osseointegration of four implant surfaces was studied in the femoral epiphyses of rabbits. Material and methods: Titanium implants were either grit‐blasted with alumina or biphasic calcium phosphate (BCP) ceramic particles, coated with a thin octacalcium phosphate (OCP) layer, or prepared by large‐grit sand blasting and acid‐etched (SLA). After 2 and 8 weeks of implantation, the bone‐implant contact and bone growth inside the chambers were compared. Scanning electron microscopy (SEM) and profilometry showed distinct microtopographies. Results: The alumina‐Ti, BCP‐Ti and OCP‐Ti groups had similar average surface roughness in the 1–2 μm range whereas the SLA surface was significantly higher with a roughness averaging 4.5 μm. Concerning the osseointegration, the study demonstrated a significantly greater bone‐to‐implant contact for both the SLA and OCP‐Ti surfaces as compared with the grit‐blasted surfaces, alumina‐ and BCP‐Ti at both 2 and 8 weeks of healing. Conclusion: In this animal model, a biomimetic calcium phosphate coating gave similar osseointegration to the SLA surface. This biomimetic coating method may enhance the apposition of bone onto titanium dental implants.     

The effect of three different calcium phosphate implant coatings on bone deposition and coating resorption: a long-term histological study in sheep

The present study investigated the hypothesis that hydroxyapatite (HA), tricalcium phosphate (TCP), and a HA-gel coated on endosseous titanium (Ti) implants by spark discharging (SD) and dip coating would achieve predictable osseointegration without evident bioresorption of the coatings on the long term. A costal sheep model was used for the implantation of the HA/SD, HA/TCP/SD, and HA-gel/SD specimens, which were retrieved 6 and 12 months following implantation. HA and Ti coatings on implants obtained by conventional plasma spraying (HA/PS, Ti/PS) were used as controls. Microscopy showed that osseointegration was achieved from all types of implants. No evidence for bioresorption of the HA/SD, HA/TCP/SD, and HA-gel/SD coatings was present but cohesive failure with disruption of the coating/implant interface was seen. A statistical analysis of the histomorphometrical data showed no time-dependent effect, however. HA/PS coatings achieved significantly higher bone-implant contact (BIC) percentages of the total implant surface (toBIC) than the other types of coatings (P=0.01). If the BIC percentages were traced separately for implant portions placed into cortical and cancellous bone (coBIC and caBIC, respectively), detailed analysis showed that the caBIC values of HA-gel/SD and HA/PS coatings were significantly higher than that of the other types of coatings (P=0.01). CaBIC values were highly correlated with toBIC values (P<0.001). The present study showed that the preparation techniques used produced thin, dense, and unresorbable coatings that achieved osseointegration. Compared with the control coatings, however, only HA-gel/SD coating can be recommended from the investigated preparation techniques for a future clinical use if a better coating cohesion is achieved.     

Long-term effects of magnetron-sputtered calcium phosphate coating on osseointegration of dental implants in non-human primates

Objectives: To determine the effect of magnetron-sputtered calcium phosphate coating of implants on the later stages of osseointegration in a non-human primate model.
Material and methods: Eighteen and 20 implants with a 0.1 μm amorphous calcium phosphate coating and a turned surface, respectively, were inserted in the anterior upper and lower jaw of adult non-human primates. Following a 7.5 months healing period, one part of the implants remained in the submerged position. The other part of implants was connected to healing abutments to allow peri-implant inflammation to occur. After another 20 months, histologic and histomorphometric analysis of the peri-implant area was performed.
Results: Submerged implants with a calcium phosphate coating and a turned surface showed no signs of an inflammatory reaction. The histomorphometric parameters 'bone volume per tissue volume' (BV/TV) and 'bone-to-implant contacts' (BIC) were not affected by calcium phosphate coating. Non-submerged implants of both groups showed occasionally signs of inflammation at the implant–abutment junction. Histomorphometric analysis revealed that the distance between the implant–abutment junction and the most coronal level (where bone was attached to the implant) as well as BV/TV and BIC were independent from the surface modification.
Conclusion: Our results show that dental implants with calcium phosphate coating behave similar to turned implants independently whether they are connected to healing abutments or remain submerged. Ultra-thin calcium phosphate coating can combine the positive effects of calcium phosphate during the early stage of osseointegration without causing impairment of the later stages.     

Influence of implant diameter on surrounding bone

OBJECTIVES: Implant osseointegration is dependent upon various factors, such as bone quality and type of implant surface. It is also subject to adaptation in response to changes in bone metabolism or transmission of masticatory forces. Understanding of long-term physiologic adjustment is critical to prevention of potential loss of osseointegration, especially because excessive occlusal forces lead to failure. To address this issue, wide-diameter implants were introduced in part with the hope that greater total implant surface would offer mechanical resistance. Yet, there is little evidence that variation in diameter translates into a different bone response in the implant vicinity. Therefore, this study aimed at comparing the impact of implant diameter on surrounding bone. MATERIAL AND METHODS: Twenty standard (3.75 mm) and 20 wide (5 mm) implants were placed using an animal model. Histomorphometry was performed to establish initial bone density (IBD), bone to implant contact (BIC) and adjacent bone density (ABD). RESULTS: BIC was 71% and 73%, whereas ABD was 65% and 52%, for standard and wide implants, respectively. These differences were not statistically different (P>0.05). Correlation with IBD was then investigated. BIC was not correlated with IBD. ABD was not correlated to IBD for standard implants (r2=0.126), but it was correlated with wide implants (r2=0.82). In addition, a 1 : 1 ratio between IBD and ABD was found for wide implants. It can be concluded, within the limits of this study, that ABD may be influenced by implant diameter, perhaps due to differences in force dissipation.     

Effect of surface roughness and calcium phosphate coating on the implant/bone response

The influence of surface roughness and calcium phosphate (Ca-P) coating on the bone response of titanium implants was investigated. Four types of titanium implants, i.e. as-machined, grit blasted, as-machined with Ca-P sputter coating, and grit blasted with Ca-P sputter coating, were prepared. The Ca-P sputter-coating, produced by using the RF magnetron sputter technique, was rapid heat-treated with infrared radiation at 600 degrees C. These implants were inserted into the left and right femoral condyles and the left and right tibial diaphyses of the rabbits. After implantation periods of 2 and 12 weeks, the bone-implant interface was evaluated histologically and histomorphometrically. Histological evaluation revealed no new bone formation around different implant materials after 2 weeks of implantation. After 12 weeks, bone healing was almost completed. For both tibial and femoral implants, Ca-P coated implants always showed a higher amount of bone contact than either of the non-coated implants. On the other hand, surface roughness improved only the response to implants inserted into the tibial diaphysis. On the basis of these findings, we concluded that 1) deposition of a sputtered Ca-P coating on an implant has a beneficial effect on the bone response to this implant during the healing phase, and 2) besides implant surface conditions the bone response is also determined by local implant site conditions.     

Importance of Ca(2+) modifications for osseointegration of smooth and moderately rough anodized titanium implants - a removal torque and histological evaluation in rabbit

Background: Incorporation of Ca²⁺ into the titania of anodized titanium surfaces has been found to enhance osseointegration. It provides a stable surface when the ions are incorporated into the oxide layer during the anodizing process. The Ca²⁺ may suggestively be prominent sites for mineral induction, attract proteins, and catalyze intracellular cascades. Purpose: The aim of the present study was to evaluate the osseointegration of smooth (S_a < 0.5 µm) and moderately rough (S_a 1.0–2.0 µm) commercially pure titanium implants, with and without Ca²⁺, in order to reflect on the importance of surface chemistry in relation to topography. Materials and Methods: Anodized implants with (OxCa) or without Ca²⁺ (Ox), blasted implants (Bl), and blasted anodized implants, with (BlOxCa) or without Ca²⁺ (BlOx), were inserted in rabbit femur and tibia. The implant surfaces were characterized using interferometry, scanning electron microscopy, and X‐ray photoelectron spectroscopy prior to implant installation. Removal torque (RTQ) measurements were executed on all implants after a healing period of 12 weeks. The implants were, thereafter, removed en bloc with surrounding tissues and prepared for histological evaluations. Results: RTQ measurements of tibial implants revealed significantly higher values for BlOxCa implants (90.7 ± 23.3 Ncm) compared to OxCa (64.6 ± 18.2 Ncm) and BlOx implants (69.7 ± 17.5 Ncm) (p = 0.029). Ca²⁺ modification of smooth implants placed in the femur did not reveal any differences. Conclusion: Ca²⁺ modification of smooth implants resulted in similar interfacial shear strength as moderately rough implants and Ca²⁺ modification of moderately rough implants demonstrated the significantly strongest interfacial shear strength when placed in rabbit tibia. This possibly demonstrated surface chemistry compensating for lesser roughness.     

Effect of RGD peptide coating of titanium implants on periimplant bone formation in the alveolar crest. An experimental pilot study in dogs

The aim of the present study was to analyse the effect of organic coating of titanium implants on periimplant bone formation and bone/implant contact. Three types of implants were used: (i) Ti6Al4V implants with polished surface (control 1) (ii) Ti6Al4V implants with collagen coating (control 2) (iii) Ti6Al4V implants with collagen coating and covalently bound RGD peptides. All implants had square cross-sections with an oblique diameter of 4.6 mm and were inserted press fit into trephine burr holes of 4.6 mm in the mandibles of 10 beagle dogs. The implants of five animals each were evaluated after a healing period of 1 month and 3 months, during which sequential fluorochrome labelling of bone formation was performed. Bone formation was evaluated by morphometric measurement of the newly formed bone around the implant and the percentage of implant bone contact. After 1 month there was only little bone/implant contact, varying between 2.6 and 6.7% in the cortical bone and 4.4 and 5.7% in the cancellous bone, with no significant differences between the three types of implants. After 3 months, implants with polished surfaces exhibited 26.5 and 31.2% contact in the cortical and cancellous bone, respectively, while collagen-coated implants had 19.5 and 28.4% bone contact in these areas. Implants with RGD coating showed the highest values with 42.1% and 49.7%, respectively. Differences between the surface types as such were not significant, but the increase in bone/implant contact from 1 to 3 months postoperatively was significant only in the group of RGD-coated implants (P = 0.008 and P = 0.000). The results of this pilot study thus provide only weak evidence that coating of titanium implants with RGD peptides in the present form and dosage may increase periimplant bone formation in the alveolar process. The results therefore require further verification in a modified experimental setting.     

骨替代材料在口腔种植领域中的成骨效果

骨替代材料目前已成为拔牙位点保存术、牙槽嵴骨增量术和上颌窦底提升术的主要材料,而羟磷灰石、磷酸钙和生物活性玻璃以其良好的生物相容性、骨传导性、生物降解性、骨再生能力和骨结合率成为骨替代材料的代表.单一成分骨替代材料的诱导骨再生能力取决于材料本身的表面形貌、结构、成分、孔径和孔隙率.按不同比例复合的新型骨替代材料,可使原单一骨替代材料的性能得以互补.骨替代材料与血小板浓缩物的联合应用,可促进前成骨细胞的增殖与分化,激发成骨细胞的活动,促进血管新生,从而利于骨替代材料存活.骨替代材料与生长因子的联合应用,可获得不同程度骨结合和骨改建,增加材料的细胞黏附率,改善支架的力学性能,在骨愈合早期即能促进新骨形成.随着科技的进步,未来骨替代材料的成骨性能日臻完善,在口腔种植领域的应用前景将会更加广阔.     

In vivo evaluation of the trabecular bone behavior to porous electrostatic spray deposition-derived calcium phosphate coatings

OBJECTIVES: Electrostatic spray deposition (ESD) is a new technique to deposit calcium phosphate (CaP) coatings. The aim of the present study was to evaluate the bone behavior of ESD CaP-coated implants with various degrees of crystallinities in the trabecular bone of the femoral condyle of goats. MATERIAL AND METHODS: Using the ESD technique, thin porous CaP coatings were deposited on tapered, conical, screw-shaped titanium implants. Three different heat-treatments were applied, resulting in amorphous CaP (400 degrees C, ESD1), crystalline carbonate apatite (500 degrees C, ESD2), and crystalline carbonated hydroxyapatite (700 degrees C, ESD3). Implants were inserted into the trabecular bone of the femoral condyles of goats for 12 weeks, and titanium (Ti) implants served as controls. RESULTS: The results showed that ESD-derived coatings are osteocompatible. Histomorphometrical analysis showed that the application of a CaP coating resulted in more bone contact along the press-fit area of the implant compared with the Ti implants. Moreover, the percentage bone contact of the ESD3-coated implants was increased, compared with the Ti control group. Regarding the other coatings, no differences were found compared with the control group. CONCLUSION: Crystalline carbonated hydroxyapatite ESD-coated implants positively influenced the biological performance compared with Ti control implants.     

Effects of implant surface coatings and composition on bone integration: a systematic review

Objective: The aim of the present review was to evaluate the bone integration efficacy of recently developed and marketed oral implants as well as experimental surface alterations.
Materials and methods: A PubMed search was performed for animal studies, human reports and studies presenting bone-to-implant contact percentage or data regarding mechanical testing.
Results: For recently developed and marketed oral implants, 29 publications and for experimental surface alterations 51 publications fulfilled the inclusion criteria for this review.
Conclusions: As demonstrated in the available literature dealing with recently developed and marketed oral implants, surface-roughening procedures also affect the surface chemical composition of oral implants. There is sufficient proof that surface roughening induces a safe and predictable implant-to-bone response, but it is not clear whether this effect is due to the surface roughness or to the related change in the surface composition. The review of the experimental surface alterations revealed that thin calcium phosphate (CaP) coating technology can solve the problems associated with thick CaP coatings, while they still improve implant bone integration compared with non-coated titanium implants. Nevertheless, there is a lack of human studies in which the success rate of thin CaP-coated oral implants is compared with just roughened oral implants. No unequivocal evidence is available that suggests a positive effect on the implant bone integration of peptide sequences or growth factors coated on titanium oral implants. In contrast, the available literature suggests that bone morphogenetic protein-2 coatings might even impede the magnitude of implant-to-bone response.     

Effect of immobilized bone morphogenic protein 2 coating of titanium implants on peri-implant bone formation

The aim of the present study was to test the hypothesis that immobilization of bone morphogenic protein (BMP2) on the surface of titanium implants can enhance peri-implant bone formation. Ten adult female foxhounds received experimental titanium screw implants in the mandible 3 months after removal of all premolar teeth. Three types of implant surfaces were evaluated in each animal: (i) implants with machined titanium surface, (ii) implants coated with collagen I, (iii) implants coated with collagen I, chondroitin sulphate (CS) and BMP2. Peri-implant bone regeneration was assessed using histomorphometry after 1 and 3 months in five dogs each by measuring bone-implant contact (BIC) and the volume density of the newly formed peri-implant bone (BVD). After 1 month, there was no significant enhancement in BIC values but volume density of the newly formed peri-implant bone was significantly higher in the two groups of coated implants. No significant difference was found between collagen and BMP2 coating. After 3 months, BIC was significantly higher in both collagen and BMP2-coated implants compared with implants with machined surfaces. Peri-implant BVD was also significantly increased in coated implants in comparison with machined surfaces. It was concluded that collagen coating of dental screw implants can enhance BIC and peri-implant bone formation. Addition of BMP2 does not increase peri-implant bone formation in the present application.     

Surface-conditioned dental implants: an animal study on bone formation

Aim: The aim of this study was to determine whether bone formation around surface-conditioned implants is enhanced compared with non-surface-conditioned sandblasted acid-etched titanium implants.
Materials and Methods: One hundred and forty-four implants were placed in the mandible of 18 minipigs. Before placement, implants were either surface conditioned in a solution containing hydroxide ions (conSF) or assigned to controls. Animals were euthanized after 2, 4 and 8 weeks of submerged healing, the 8-week group receiving polyfluorochrome labelling at week 2, 4, 6 and 8. One jaw quadrant per animal was selected for histological and histomorphometrical evaluation of mineralized bone–implant contact (mBIC), osteoid–implant contact (OIC) and bone volume (BV) analysis.
Results: Polyfluorochrome labelling showed no general differences in bone dynamics. mBIC showed the most pronounced differences after 2 weeks, reaching 65.5% for conSF compared with 48.1% for controls, p =0.270. Differences levelled out after 4 weeks (67.4% control, 65.7% conSF) and 8 weeks (64.0% control, 70.2% conSF). OIC levels were initially comparable, showing a slower decline for conSF after 4 weeks. BV was higher for conSF at all times. No significant differences could be found.
Conclusion: A tendency towards increased mBIC was shown for surface-conditioned implants after short-term healing.     

低钙对微种植体骨结合影响的实验研究

目的 通过建立低钙动物模型来研究低钙状态对微种植体骨结合的影响.方法 将24只实验用健康哈白兔随机分为实验组和对照组,每组12只.实验组定量低钙饲料饲养,对照组正常饲料饲养,定期测量血清钙、镁、磷含量及骨密度值,当实验组骨密度值低于对照组后,进行统计学分析,差异有显著性,有统计学意义,即为低钙模型建立成功,即可进行微种植体的植入.植入后再分别将实验组和对照组随机分为A组：即刻加力组、B组：6周后加力组、C组：8周后加力组及D组：10周后加力组,以镍钛弹簧施力1.47N,于施力当天拍摄X线片,力值持续4周后进行标本制备、扫描电镜下观察.结果 实验组A组6枚种植体全部松动、脱落,种植失败;其余各组种植体在植入和施力后稳定性均良好,扫描电镜显示,对照组4组、实验组B、C、D三组均形成骨结合,且结合程度随时间的延长逐渐增强.结论 低钙实验组在微种植体植入后不可进行即刻加力,需等待＂二期负载＂,且随着＂无负载愈合期＂的延长,其骨结合程度增强,稳定性增强.     

Effect of bisphosphonates on anodized and heat-treated titanium surfaces: an animal experimental study

Background: Recent investigations reported that osseointegration of titanium implants can be significantly reinforced with a nanostructure treated with anodic oxidation and heat treatment. This experimental study investigates the effect of bisphosphonates on the nanotubular implant surface in rats. Methods: Thirty‐six titanium implants were divided into three groups: 1) machine‐turned (MT), 2) anodized and heat‐treated (AH), and 3) anodized and heat‐ and bisphosphonate‐treated (AHB) groups. The 36 implants were randomly placed in both tibias of 18 male Wistar rats. After 2 and 4 weeks, the levels of osseointegration of the implants were evaluated by a removal torque test and microcomputerized tomography (μCT). Peri‐implant bone tissue on the extracted region was examined for the expression of type I collagen and osteocalcin. Results: The AHB group showed the highest removal torque at 2 and 4 weeks (13.92 ± 1.51 Ncm and 18.10 ± 2.15 Ncm, respectively) followed, in order, by the AH group (11.63 ± 1.58 Ncm at 2 weeks and 14.80 ± 2.34 Ncm at 4 weeks) and MT group (4.30 ± 0.76 Ncm at 2 weeks and 6.20 ± 1.33 Ncm at 4 weeks) with statistically significant differences between the MT and other two groups at both time points. μCT images also revealed a denser appearance around implants in the AHB group than in the other groups. Levels of type I collagen and osteocalcin expression were similar between the MT and AH groups; however, the values were significantly higher in the AHB group compared to the other groups, which were 220.85% ± 71.09% and 363.04% ± 100.21%, respectively (P <0.05). Conclusion: Within the limits of this experiment, it was concluded that surface loading with bisphosphonates significantly improved the degree of osseointegration of titanium implants with a nanostructure.     

Bone apposition around two different sandblasted, large-grit and acid-etched implant surfaces at sites with coronal circumferential defects: an experimental study in dogs

Objective: The study was designed to evaluate bone apposition around SLA (sandblasted, large-grit and acid-etched) implants compared with modified SLA (modSLA) ones at sites with different sizes of circumferential gaps.
Material and methods: All mandibular premolars and first molars of six beagle dogs were extracted. After a healing period of 3 months, three 10-mm-long implants were inserted in each side of the mandible. One implant was inserted with a 0.5-mm and one with a 1-mm gap between the implants and bone around the coronal 5 mm of the implants. The third implant was inserted without a gap as a control. The dogs were sacrificed respectively at weeks 2, 4 and 8 after implant placement for histological and histomorphometric analyses.
Results: The histomorphometric results showed similar pattern of bone apposition for the two surfaces. At 2 and 4 weeks of healing, the percentage of newly formed bone-to-implant contact (BIC%), new bone fill (NBF%) and the distance between the most coronal position of BIC and the defect bottom (B–D) were significantly higher for modSLA ( P <0.05). At 8 weeks of healing, this difference was not significant ( P >0.05). With regard to the defect size, the histological analyses showed no significant differences between the two defect sizes at all time points ( P >0.05).
Conclusion: Significantly more bone apposition was found for the modSLA surface than for the SLA surface at early stage of healing, indicating that modSLA surface may enhance bone apposition in coronal circumferential defects at non-submerged implants. Gap size within 1 mm may not need any kind of regenerative procedures.