Torsional stability of HA-coated and grit-blasted titanium dental implants.

Hydroxylapatite (HA)-coated and grit-blasted (non-HA-coated) titanium dental implants were inserted into healed extraction sites of canine mandibles. After six weeks, the animals were killed and the implants mechanically tested in torsion to failure. Interface attachment strength, implant/tissue compatibility, integrity of the HA coating, and the location of interface failure were evaluated. Mechanical testing demonstrated an interface torsional strength of 3.98 +/- 0.93 MPa for the HA-coated implants and 2.25 +/- 0.65 MPa for the grit-blasted implants. This represents a 76.9% improvement in the maximum torsional interface strength, and is statistically-significant (p = 0.0004). On qualitative histologic analysis, interface failure was seen to occur primarily at the HA/implant interface, although failure through the HA coating and regions of bone/HA interface failure were observed. The HA-coated implants had bone in direct apposition to their surface with no fibrous tissue interposition. The grit-blasted implants also had regions of direct bone-implant apposition, but these areas were limited to a smaller proportion of the total interface area. There was no evidence of breakdown or change in thickness of the HA coating.     

In vivo characterization of titanium implants coated with synthetic hydroxyapatite by electrophoresis

This study compared in vivo the performances of commercially pure titanium (cp Ti) screw dental implants either uncoated or coated with synthetic hydroxyapatite (HA) by electrophoresis. The HA coating was characterized by scanning electron microscopy, energy dispersive spectroscopy (EDS) and Fourier-transform infrared (FT-IR) spectroscopy. Well-adhered carbonated-hydroxyapatite layers (4- to-8-microm-thick) were obtained. In vivo tests were carried out by insertion of both uncoated and HA-coated implants into rabbit tibiae for 8 or 12 weeks. Histomorphometric analysis was performed by scanning electron microscopy with the aid of image-processing software. Results showed significantly greater bone-implant contact for HA-coated implants (p<0.05) than cp Ti implants. Comparison of bone content inside the screw implants showed no significant differences (p>0.05) between both types of implants, although cp Ti had numerically higher percentage of bone content than HA-coated implants. In conclusion, the HA-coated implants had better performance regarding the bone-implant contact area than the uncoated implants; coating by electrophoresis proved to be a valuable process to coat metallic implants with an osteoconductive material such as hydroxyapatite.     

Histological and clinical comparisons of guided tissue regeneration on dehisced hydroxylapatite-coated and titanium endosseous implant surfaces: a pilot study.

Fifty-six endosseous cylindrical implants were placed in dog mandibles 12 weeks after the extraction of all mandibular premolars and first molars. Eight implants, four coated with 50 microns of hydroxylapatite (HA) and four grit-blasted and titanium-surfaced, were placed in each dog. Ideal implant placement sites were modified by creating standardized 3 x 5-mm facial dehiscence defects. Half the dehiscences were treated with a modified expanded polytetrafluoroethylene (PTFE) membrane; the remainder served as controls. After 8 weeks of healing, the animals were sacrificed and measurements made to determine the percentage of dehiscence repair. The HA-coated implants had a mean defect fill of 95.17% and the grit-blasted implants had a percent fill of 82.8% in the guided tissue regeneration (GTR) test group; the control implants demonstrated a mean fill of 55% and 39% in the HA-coated and grit-blasted implants, respectively. Significant differences (P less than .05) were noted between both test groups and the titanium control group, and between the HA test and HA control groups. Histologic evaluation showed significantly greater repair associated with HA-coated implants, as well as significant bone loss associated with clinically exposed membranes. It was concluded that within the limitations of this study, guided tissue regeneration is a viable option in treating defects associated with dental implants.     

Tissue regeneration in bone defects adjacent to endosseous implants: an experimental pilot study

Extraction socket defects or alveolar ridge defects may limit or restrict placement of implants. The present study assessed the efficacy of inducing bone formation with demineralized freeze-dried bone (DFDB), osteoinduction with hydroxyapatite (HA), and guided bone regeneration with expanded polytetrafluoroethylene (e-PTFE) in bone defects adjacent to endosseous implants in an animal model. Twenty-four implants were placed in the long bones of 3 pigs. After preparation of 24 cylindric acute defects adjacent to the coronal 5 mm of each implant, 18 of the defects were treated by DFDB, HA, or e-PTFE. The 6 remaining defects healed spontaneously with no treatment (controls). In each pig, one tibia received 4 commercially pure titanium screw implants (3.75 mm x 15 mm), while the contralateral tibia received 4 HA-coated cylindric implants (3.25 mm x 15 mm). Bone formation in response to the 3 treatments and control cases was evaluated using computer-assisted densitometric image analysis. The results showed that a higher density of tissue formed under e-PTFE membranes. A significantly greater increase in bone density was noticed in bone defects treated with an e-PTFE membrane vs DFDB (P = 0.04), in e-PTFE vs control sites (P = 0.04), and in defects treated with HA vs DFDB (P = 0.04) in HA-coated implants. In titanium implants the differences observed were not significant. It was also observed that bone regeneration in defects treated with HA differs with the type of implant used (titanium vs HA-coated implants), but such differences were not significant.     

Bone response to plasma-sprayed hydroxyapatite and radiofrequency-sputtered calcium phosphate implants in vivo

PURPOSE: The objective of this study was to evaluate the effect of radiofrequency- (RF) sputtered calcium phosphate (CaP) coating of titanium implants on bond strength at the bone-implant interface and percent bone contact length. MATERIALS AND METHODS: Cylindric sputtered CaP-coated and plasma-sprayed hydroxyapatite- (HA) coated implants (4.0 mm diameter and 8 mm length) were implanted in dog mandibles. Half the sputtered CaP-coated implants were heat-treated. RESULTS: Twelve weeks after implant placement, no statistical differences in the mean ultimate interfacial strengths were observed between as-sputtered CaP-coated, sputtered CaP-coated heat-treated, and control plasma-sprayed HA-coated implants. Histomorphometric evaluation indicated that the percent bone contact lengths for the plasma-sprayed HA-coated implants and the as-sputtered CaP-coated implants were similar and significantly greater than that for the sputtered CaP-coated heat-treated implants. Differences in the ultimate interfacial strength and percent bone contact length between different implant sites in the mandible were not observed. DISCUSSION: The results of this study, considered together with the results of previous studies, suggest that once early osseointegration is achieved, biodegradation of the thin CaP coatings is not detrimental to bone-coating-implant fixation, and does not compromise bone responses to the coated implant surfaces. CONCLUSION: The interfacial strength and histomorphometric data suggest that the CaP coatings applied using the sputtering process produce bone responses similar to those of HA coatings applied using plasma spraying.     

Bone formation in transforming growth factor beta-I-loaded titanium fiber mesh implants

The osteoconductive properties of porous titanium (Ti) fiber mesh with or without a calcium phosphate (Ca-P) coating and osteoinductive properties of noncoated Ti fiber mesh loaded with recombinant human Transforming Growth Factor beta-1 (rhTGF-beta1) were investigated in a rabbit non-critical size cranial defect model. Nine Ca-P-coated and 18 non-coated porous titanium implants, half of them loaded with rhTGF-beta1, were bilaterally placed in the cranium of 18 New Zealand White rabbits. At 8 weeks postoperative, the rabbits were sacrificed and the skulls with the implants were retrieved. Histological analysis demonstrated that in the TGF-beta1-loaded implants, bone had been formed throughout the implant, up to its center, whereas in the non-loaded implants only partial ingrowth of bone was observed. Bone formation had a trabecular appearance together with bone marrow-like tissue. No difference in ingrowth could be observed between the non-TGF-beta1-loaded non-coated implants and the Ca-P-coated ones. All histological findings were confirmed by image analysis: 97% ingrowth was seen in the rhTGF-beta1-loaded implants, while only 57% and 54% ingrowth was observed in the non-loaded Ca-P-coated and non-coated implants, respectively. Bone surface area and bone fill were significantly higher in the rhTGF-beta1-loaded implants (1.37 mm2 and 36%, respectively) than in the non-loaded implants (0.57 mm2 and 26%). No statistical difference was found for any parameter between the Ca-P-coated and noncoated implants. Quadruple fluorochrome labeling showed that in the Ti and Ti-CaP implants mainly bone guidance had occurred from the former defect edge, while in the Ti-TGF-beta1 implants bone formation had mainly started in the center of a pore and proceeded in a centrifugal manner. Our results show that: (1) the combination of Timesh with TGF-beta1 can induce orthotopic bone formation; (2) Ti-fiber mesh has good osteoconductive properties; (3) a thin Ca-P coating, as applied in this study, does not seem to further enhance the bone-conducting properties of a titanium scaffold material.     

Segmental bone tissue engineering by seeding osteoblast precursor cells into titanium mesh-coral composite scaffolds

The size and specific shape of bone grafts are important for jaw reconstruction. In this experiment, segmental bone grafts were engineered in a predetermined shape via seeding osteoblast precursor cells into titanium mesh-coral composite scaffolds. Titanium meshes were moulded into the shape of a column with length 12 mm and diameter 8mm. The column was filled with natural coral granules and the complex acted as a cell-seeding scaffold. About 4 x 10(7) osteoblast precursor cells in 200 microl cell-culture medium were seeded into each of six scaffolds and incubated in vitro for 2 days. Then, the composites were implanted subcutaneously into the backs of nude mice and incubated in vivo. Two months after implantation, the animals were killed and new bone formed in the scaffolds was investigated by gross inspection, X-ray examination, histological observation and mechanical testing. The results showed that newly formed tissue was red and presented the gross appearance of bone, and kept the original shape of the column. Titanium mesh was situated on the surface of the bone graft. An X-ray blocking shadow was observed in and around the titanium scaffolds; most of the coral granules had been absorbed. Histological observation demonstrated a large amount of new bone formed and integrated well with titanium mesh. Mechanical testing showed that new bone improved the mechanical property of the graft significantly. In conclusion, a titanium mesh-coral composite scaffold with osteoblast precursor cells is an efficient means to engineer segmental bone, possessing the desired shape and mechanical strength.     

Human histologic and histomorphometric analyses of hydroxyapatite-coated implants after 10 years of function: a case report

PURPOSE: No consensus exists on the long-term performance of hydroxyapatite (HA) coatings on dental implants. The aim of this study was to evaluate the long-term stability of the HA coating in a human autopsy specimen. MATERIALS AND METHODS: Two mandibular HA-coated implants were retrieved postmortem from a woman after 10 years of functional loading with an implant/tooth-supported fixed partial denture. After ground sectioning, the specimens were histomorphometrically analyzed. RESULTS: Direct bone-implant contact was found at 78.48% of the implant surface. HA coating disappearance had occurred in a few areas (22.75%), but bone was in direct apposition to the titanium surface. Bone volume measured 27.66%, and expected bone-implant contact was 37.55%. No inflammatory reaction was seen in the supracrestal soft tissues or the bone compartment. DISCUSSION: Most of the HA coating was maintained on the implants, and areas lacking HA were directly apposed by bone. This observation suggests that the underlying titanium surface should have a macro-texture to promote the adaptation of bone to the titanium surface in case of HA disappearance, as well as to decrease failure at the HA-titanium interface. CONCLUSIONS: In a patient in whom prosthetic treatment was appropriately performed and proper plaque control was maintained, the HA coating was not damaged and contributed to the success of the implant over 10 years of clinical functioning.     

Histologic and histomorphometric comparison of immediately placed hydroxyapatite-coated and titanium plasma-sprayed implants: a pilot study in dogs.

The purpose of this pilot study was to make a histologic and histomorphometric comparison of hydroxyapatite-(HA) coated and titanium plasma-sprayed (TPS) root-form implants that were placed in 2 mongrel dogs immediately after extraction of mandibular premolars. After 8 weeks of healing, the implant-containing segments of the mandible were removed en bloc and bone blocks including implants were sectioned. Histologic and histomorphometric analyses were performed by evaluating bone sections. The mean bone contact percentage of HA-coated implants was 61.84 +/- 7.84%, with a range of 52.09% to 75.7%, and the mean bone contact percentage of TPS implants was 51.35 +/- 12.1%, with a range of 30.1% to 70.6%. This pilot study suggests that HA-coated implants placed into fresh extraction sockets can achieve better bone contact than TPS implants, but there was evidence that the surface of the HA layer can be resorbed, so long-term stability of HA coatings in immediate implantation must be investigated.     

A comparison of 3 different endosseous nonsubmerged implants in edentulous mandibles: a clinical report.

The purpose of this prospective clinical study was to investigate the outcome of 3 different types of endosseous, nonsubmerged implants in the anterior part of the mandible. Fourteen older edentulous patients, 10 females and 4 males, were included. All participants received 3 different types of endosseous implants in the anterior mandible: 1 titanium plasma-sprayed cylindric implant (4 mm in diameter), 1 titanium cylindric implant with hydroxyapatite (HA) coating (4 mm in diameter), and 1 standard threaded titanium implant (3.75 mm in diameter). The 3 types of implants were originally designed to be placed in a 2-step surgical procedure. However, at this stage all implants were simultaneously provided with a temporary abutment that penetrated the mucosa. Three months later the temporary abutments were replaced by ball abutments, which were connected to an overdenture. At 12, 24, and 36 months after surgery, marginal bone resorption and Periotest values were recorded. Two patients died within the 2 first postoperative years. Five of 42 implants (11.9%) failed to osseointegrate. After 3 years, marginal bone resorption around titanium plasma-sprayed implants was significantly greater than that seen around both HA-coated and threaded titanium implants. Threaded titanium implants also had significantly better scores for marginal bone resorption than the HA-coated implants. Periotest values for HA-coated cylinders were significantly lower than test values for the other implants after 3 years (P < .05). The conclusion from this investigation is that nonsubmerged implants showed impaired prognoses compared to implants placed according to the 2-stage concept. Marginal bone resorption around titanium plasma-sprayed cylindric implants was clearly increased compared to the 2 other implant systems. Periotest values for HA-coated cylindric implants were superior to titanium plasma-sprayed and pure titanium implant surfaces.     

Highly crystalline MP‐1 hydroxylapatite coating Part II: In vivo performance on endosseous root implants in dogs

The in vivo integration strength and degree of bone apposition were compared for oral endosseous implants with different plasma-sprayed hydroxylapatite (HA) coatings. Pullout strength measurements and histological analysis were used to compare two different commercially available coating from the same manufacturer. One coating does not receive a post-plasma-spray treatment and contains about 75% crystalline HA. The other coating is treated with the MP-1 process, a pressurized hydrothermal post-plasma-spray process, which increases the coating composition to approximately 95% crystalline HA without changing the coating's adhesive or cohesive strength. Comparisons were made in dogs after healing times of 3 and 15 weeks in the mandible. No significant differences were found in either case between the two coatings. Two different methods were used to determine the degree of bone apposition at 15 weeks. Both methods confirmed that the MP-1 process does not affect the osseointegration rate of plasma-sprayed HA coatings. Qualitative histology data suggest that the treated coating is more stable than the control coating, especially in cases of direct soft tissue attachment to the implant. The present data suggest that extensive dissolution of calcium phosphate components into surrounding tissue is not a necessary precursor for direct apposition of bone to HA-coated implants.     

Bone formation over partially exposed implants using guided tissue generation.

This pilot study tested whether a semipermeable expanded polytetrafluoroethylene (e-PTFE) membrane could be used to induce new bone to cover the partially exposed surface of titanium and hydroxylapatite (HA)-coated endosseous implants. Twenty threaded titanium and 10 HA-coated implants were placed in the tibia of five mongrel dogs. The implants were placed in a manner that left the cervical 2 to 3 mm exposed. Fifteen implants were used as controls and the rest were covered with an e-PTFE membrane. Animals were killed at 6, 8, and 12 weeks. Those implants covered by the membrane showed a progressive formation of bone on the exposed portion. The threaded titanium control implants showed reactive periosteal bone formation in the adjacent area, but no new bone formation on the exposed threads. The HA-coated controls, however, showed progressive bone formation on the exposed portion. Membrane position appeared to have an effect on the quantity of bone that formed, as those test sites in which there was a collapse of the membrane against the implant showed less new bone than those in which a protected space was created. This study showed that guided tissue generation may be used to induce new bone to form over the exposed portion of an implant, that the amount of new bone is influenced by the width of the space between membrane and implant, and that new bone forms on an exposed HA-coated implant even in the absence of a guiding membrane.     

Postmortem histologic evaluation of mandibular titanium and maxillary hydroxyapatite-coated implants from 1 patient.

Postmortem examination of human specimens is an extremely important aspect of evaluating the relative compatibility and long-term success of endosseous implant surfaces. The bone-implant interface of 5 commercially pure titanium screw-type mandibular implants after 85 months of service and 2 hydroxyapatite- (HA) coated maxillary implants after 38 months of service were examined. All implants were stable at the time of the patient's death. The mandibular implants had an average of 65% contact with bone and the maxillary implants had an average of 47% contact. The HA coating had separated from the maxillary implants in some areas and was free within surrounding connective tissue or surrounded by invaginating sulcular epithelium. The arrangement and pattern of bone contact appeared different between HA-coated and titanium implant surfaces.     

水热合成法制备羟基磷灰石生物涂层的体内及体外实验研究

目的对水热合成法制备羟基磷灰石生物涂层材料的细胞相容性及动物体内植入体与骨界面的状况进行研究.方法水热合成法制备羟基磷灰石涂层,采用细胞培养和动物实验评估涂层材料的生物相容性.结果成骨细胞在涂层材料表面具有良好的细胞增殖率,碱性磷酸酶活性逐渐增加.植入动物体内1月后即有骨组织与涂层材料结合,3月后骨结合量增加.涂层材料在体内稳定,未见溶解脱落.结论水热合成法制备的羟基磷灰石生物涂层材料具有良好的生物效应.     

表面经喷砂和酸蚀及羟基磷灰石涂层的TA2纯钛种植体对富血小板血浆体外骨诱导能力的影响

目的以表面经喷砂和酸蚀(SLA)及羟基磷灰石(HA)涂层双重处理的TA2纯钛种植体(HA/SLA-TA2)为支架材料,探讨其对富血小板血浆(PRP)体外诱导骨髓基质细胞(BMSCs)向成骨细胞分化能力的影响。方法PRP分别作用于常规培养的BMSCs(对照组)和与HA/SLA-TA2联合培养的BMSCs(实验组),通过扫描电镜观察BMSCs在HA/SLA-TA2表面的生长情况,并对两组细胞的增殖指数、碱性磷酸酶活性、骨钙素含量进行比较。结果实验组细胞生长状态良好,具有成骨细胞特点,其细胞增殖指数于联合培养第5天起明显高于对照组(P<0.05),碱性磷酸酶活性以及骨钙素含量分别于联合培养第9、13天起明显高于对照组(P<0.01)。结论HA/SLA-TA2是种植体表面骨组织工程较理想的支架材料,BMSCs与HA/SLA-TA2联合培养后,可增强PRP诱导其向成骨细胞分化的能力。     

Orthotopic bone formation in titanium fiber mesh loaded with platelet-rich plasma and placed in segmental defects

The effect of platelet-rich plasma (PRP) on bone formation was investigated in a rabbit segmental radial defect model. The purpose of the study was to evaluate the bone inductive properties of PRP with titanium fiber mesh and autologous bone chips in a 15-mm rabbit radial defect model. Eighteen New Zealand white rabbits were divided into three groups: I, PRP with autologous bone (PRP-Ti-Bone); II, autologous bone (Ti-Bone); III, control group (Ti). The implants were placed in the radial defect for 12 weeks. After sacrifice, all specimens were harvested for histological, histomorphometrical and radiographic analysis. Histomorphometrical analysis showed that bone formation was higher in the implants with PRP (PRP-Ti-Bone: 37+/-8%) than in those without PRP (Ti-bone: 25+/-6% and Ti: 25+/-5%) after 12 weeks of implantation. It was concluded that PRP has a stimulatory effect on bone formation in titanium fiber mesh filled with autologous bone graft in segmental bone defects. Titanium fiber mesh was also shown to be an excellent scaffold material for the application of autologous bone grafts with or without PRP.     

羟基磷灰石涂层的氧化锆陶瓷骨内种植实验初步研究

将烧结涂层的羟磷灰石-氧化锆复合生物陶瓷种植体及纯钛种植体按低创伤手术原则植入犬股骨。三个月后取标本进行骨一种植体结合强度试验，作含复合陶瓷种植体的不脱钙组织切片光镜观察，扫描电镜观察及Ca、P、Zr元素探针检测分析．结果表明，复合陶瓷—骨给合强度，显著高于钛—骨结合强度；复合陶瓷与骨组织结合紧密，界面无纤维结缔组织间隔，说明该材料具有极好的生物相容性。考虑到氧化锆陶瓷有着优良的机械性能，预计该复合生物陶瓷材料可能具有良好的发展前景。     

In vivo evaluation of hydroxyapatite coatings of different crystallinities

PURPOSE: The influence of calcium phosphate (CaP) and hydroxyapatite (HA) crystallinity on bone-implant osseointegration is not well established. In this study, the effect of HA crystallinity and coating method on bone-implant osseointegration was investigated using a rat tibia model. MATERIALS AND METHODS: HA coatings 1 to 5 microm thick were produced using a supersonic particle acceleration (SPA) technology. The HA crystallinities used for this study were weight ratios of 30%, 50%, 70%, and 90%. A total of 128 HA-coated implants were placed into the tibiae of 64 male Sprague-Dawley rats. Bone-implant interfaces were evaluated using histology and push-out strength testing at 3 and 9 weeks after implantation. RESULTS: The 70% crystalline coatings exhibited significantly greater interfacial strength (5 implants/time point/treatment) than the 30%, 50%, and 90% crystalline coatings at 3 and 9 weeks following implantation. The implants with coatings of 70% crystallinity also had the greatest bone contact length. In addition, the HA coatings produced with SPA demonstrated greater interfacial strength and bone contact length than plasma-sprayed HA coatings (except for the HA coating with 30% crystallinity). DISCUSSION: HA coatings of different crystallinities exhibited different dissolution and re-precipitation properties which may enhance early bone formation and bone bonding. CONCLUSIONS: This study suggested that coating crystallinity and coating methods can influence the bone-implant interface.     

Comparative study of hydroxyapatite and titanium dental implants in dogs

This study compares the clinical performances and histologic response in dogs to a cylindrical implant with a surface consisting of dense hydroxyapatite (HA) and a threaded titanium implant in functionally loaded and unloaded conditions. Implantation was performed in five dogs, which were killed at 2 or 4 months postfunctional condition (4 or 6 months after implantation). Clinical evaluation showed that neither implant demonstrated significant movement, and assessment of gingival inflammation and sulcus depth showed no significant differences between them. After axial sectioning, the titanium implants were easily removed from the bone, whereas the HA-coated implants were adherent to the bone. Histologically, both implants showed osteogenic ingrowth to the surface in functional and nonfunctional conditions. High-magnification scanning electron micrographs of plastic sections showed that a portion of the interface between the HA-coated implant and the bone showed no gap, whereas gaps were observed at all interfaces with the titanium implant. Histomorphometric analysis by light microscopy indicated that there was no significant difference in the percent bone contact length. Clinically, the two implants behaved similarly.