Sandblasted and acid-etched dental implants: a histologic study in rats

PURPOSE: Current literature has revealed that surface etching of endosseous implants can improve bone-implant contact. The aim of this study was to evaluate the differences in bone-implant contact (BIC) between sandblasted/acid-etched and machined-surface implants. MATERIALS AND METHODS: Thirty-two Sprague-Dawley rats were used in this study. Two implant surfaces, Ecotek (sandblasted/ acid-etched) and machined, were used with 1 implant placed in each tibia of the animals. A total of 64 implants were placed. BIC was evaluated at 5, 15, 30, and 60 days. Histomorphometry of the BIC was evaluated statistically. RESULTS: The sandblasted/acid-etched surface demonstrated a greater BIC percentage than the machined surface. This difference was statistically significant only at 30 and 60 days after healing. DISCUSSION AND CONCLUSION: The sandblasted/acid-etched surface demonstrated a stronger bone response than the machined one at a later period of healing.     

Effects of decontamination and implant surface characteristics on re-osseointegration following treatment of peri-implantitis

Background: Although considerable bone fill may occur following treatment of peri-implantitis, re-osseointegration appears to be limited and unpredictable.
Objectives: To evaluate the effects of various decontamination techniques and implant surface configurations on re-osseointegration of contaminated dental implants.
Material and methods: Three months after tooth extraction, implants consisting of a basal part and an exchangeable intraosseous implant cylinder (EIIC) were placed in the mandibles of dogs. The EIIC was machined (M), sandblasted and acid-etched (SLA), or titanium plasma sprayed (TPS). Ligature-induced peri-implantitis was initiated 8 weeks post-implantation and lasted until bone loss reached the junction of the two implant parts. Three treatment modalities were applied: (T1) the EIIC was exchanged for a pristine EIIC; (T2) the EIIC was sprayed in situ with saline; and (T3) the EIIC was removed, cleansed outside the mouth by spraying with saline, steam-sterilized, and remounted. A collagen barrier was placed over each fixture, and 3 months later, samples were processed for histology and histomorphometry.
Results: T2 revealed the highest bone-to-implant contact (BIC) level (significantly better than T1 and T3). T2 also yielded the highest bone crest level (significantly better than T1), followed by T3 (significantly better than T1). SLA showed the highest BIC level (significantly better than M), followed by TPS. There were no statistically significant differences in bone crest height between implant types.
Conclusions: Both SLA implants and in situ cleansing resulted in the best re-osseointegration and bone fill of previously contaminated implants.     

Increased bone formation around coated implants

Aim: We hypothesized that coating threaded, sandblasted acid-etched titanium implants with collagen and chondroitin sulphate (CS) increases bone formation and implant stability, compared with uncoated controls.
Materials and Methods: Three different implant surface conditions were applied: (1) sandblasted acid-etched (control), (2) collagen/chondroitin sulphate (low-dose – CS1), (3) collagen/chondroitin sulphate (high-dose – CS2). Sixty 9.5 mm experimental implants were placed in the mandible of 20 minipigs. Bone–implant contact (BIC) and relative peri-implant bone-volume density (rBVD – relation to bone-volume density of the host bone) were assessed after 1 and 2 months of submerged healing. Implant stability was measured by resonance frequency analysis (RFA).
Results: After 1 month, coated implants had significantly more BIC compared with controls (CS1: 68%, p <0.0001, CS2: 63%, p =0.009, control: 52%). The rBVD was lower for all surface conditions, compared with the hostbone. After 2 months, BIC increased for all surfaces. No significant differences were measured (CS1: 71%, p =0.016, CS2: 68%, p =0.67, control: 63%). The rBVD was increased for coated implants. RFA values were 71–77 at implantation, 67–73 after 1 month and 74–75 after 2 months. Differences in rBVD and RFA were not statistically significant.
Conclusions: Data analysis suggests that collagen/CS has a positive influence on bone formation after 1 month of endosseous healing.     

Surface analysis of machined versus sandblasted and acid-etched titanium implants

Initially, implant surface analyses were performed on 10 machined implants and on 10 sandblasted and acid-etched implants. Subsequently, sandblasted and acid-etched implant cytotoxicity (using L929 mouse fibroblasts), morphologic differences between cells (osteoblast-like cells MG63) adhering to the machined implant surfaces, and cell anchorage to sandblasted and acid-etched implant surfaces were evaluated. Results indicated that acid etching with 1% hydrofluoric acid/30% nitric acid after sandblasting eliminated residual alumina particles. The average roughness (Ra) of sandblasted and acid-etched surfaces was about 2.15 microns. Cytotoxicity tests showed that sandblasted and acid-etched implants had non-cytotoxic cellular effects and appeared to be biocompatible. Scanning electron microscopic examination showed that the surface roughness produced by sandblasting and acid etching could affect cell adhesion mechanisms. Osteoblast-like cells adhering to the machined implants presented a very flat configuration, while the same cells adhering to the sandblasted and acid-etched surfaces showed an irregular morphology and many pseudopodi. These morphologic irregularities could improve initial cell anchorage, providing better osseointegration for sandblasted and acid-etched implants.     

Histologic evaluation of human bone integration on machined and sandblasted acid-etched titanium surfaces in type IV bone

The aim of this preliminary study was to evaluate the influence of a sandblasted acid-etched surface on bone-implant contact percentage (BIC%) as well as the bone density in the threads area (BD%) in type 4 bone after 2 months of unloaded healing. Five subjects (mean age = 42.6 years) received 2 microimplants each during conventional implant surgery in the posterior maxilla. The microimplants with commercially pure titanium surface (machined) and sandblasted acid-etched surface served as the control and test surfaces, respectively. After a healing period of 2 months, the microimplants and the surrounding tissue were removed and prepared for ground sectioning and histomorphometric analysis. One microimplant with a machined surface was found to be clinically unstable at the time of retrieval. Histometric evaluation indicated mean BIC% was 20.66+/-14.54% and 40.08+/- 9.89% for machined and sandblasted acid-etched surfaces, respectively (P=.03). The BD% was 26.33 +/-19.92% for machined surface and 54.84+/-22.77% for sandblasted acid-etched surface (P=.015). Within the limits of this study, the data suggest that the sandblasted acid-etched implant surface presented a higher percentage of bone-implant contact compared with machined surfaces, under unloaded conditions in posterior maxilla after a healing period of 2 months.     

Nano-crystalline diamond-coated titanium dental implants – A histomorphometric study in adult domestic pigs

Promising biomaterial characteristics of diamond-coatings in biomedicine have been described in the literature. However, there is a lack of knowledge about implant osseointegration of this surface modification compared to the currently used sandblasted acid-etched Ti-Al6-V4 implants. The aim of this study was to investigate the osseointegration of microwave plasma-chemical-vapour deposition (MWP-CVD) diamond-coated Ti-Al6-V4 dental implants after healing periods of 2 and 5 months.Twenty-four MWP-CVD diamond-coated and 24 un-coated dental titanium-alloy implants (Ankylos^®) were placed in the frontal skull of eight adult domestic pigs. To evaluate the effects of the nano-structured surfaces on bone formation, a histomorphometric analysis was performed after 2 and 5 months of implant healing. Histomorphometry analysed the bone-to-implant contact (BIC). No significant difference in BIC for the diamond-coated implants in comparison to reference implants could be observed for both healing periods. Scanning electron microscopy revealed an adequate interface between the bone and the diamond surface. No delamination or particle-dissociation due to shearing forces could be detected. In this study, diamond-coated dental titanium-alloy implants and sandblasted acid-etched implants showed a comparable degree of osseointegration.     

Histologic and histomorphometric analysis of three types of dental implants following 18 months of occlusal loading: a preliminary study in baboons

The purpose of this study was to determine the percentage of 'bone area' (BA) and 'bone-to-implant contact' (BIC) of dental implants with different designs and surface modifications after functional loading. Three types of dental implants with fixed partial dentures were placed in the posterior jaws of adult baboons (commercially pure titanium (CpTi) screws, grit-blasted acid-etched (GBAE) screws, and titanium plasma-sprayed (TPS) cylinders), three of the same design per quadrant. After 18 months of functional loading, all implants investigated were successfully integrated in the jawbone and histologic and histomorphometric analyses were carried out. Statistical evaluation was performed with a mixed model with data given as least-square means and standard errors of the mean (SEM). Histologically, direct BIC without connective tissue interposed between implant surfaces and peri-implant bone was seen. Analysis of BA within 1 mm around implants showed significant differences between CpTi (50.5%) and TPS (39.7%) (+/-2.72 SEM; P<0.01) in the maxilla. To account for the different implant designs, absolute BIC was calculated. Significant differences were found between CpTi (23.9 mm) and TPS (15.1 mm) and between GBAE (27.2 mm) and TPS (15.1 mm) (+/-1.05 SEM; P<0.01) in the maxilla and between GBAE (26.5 mm) and TPS (19.6 mm) (+/-1.42 SEM; P<0.01) in the mandible. Overall, the data indicate that, in the maxilla, screw-shaped implants showed more absolute BIC than cylindrical implants, which had less maxillary than mandibular absolute BIC after 18 months of functional loading.     

Bone apposition around two different sandblasted and acid-etched titanium implant surfaces: a histomorphometric study in canine mandibles

PURPOSE: The aim of this study was to evaluate bone apposition to a modified sandblasted and acid-etched (SLA) implant surface (modSLA) in the canine mandible as compared with the standard SLA surface. MATERIAL AND METHODS: In this experimental study, all mandibular premolars and first molars were extracted bilaterally in five foxhounds. After a healing period of 6 months, each side of the mandible received six randomly assigned dental implants alternating between the standard SLA and modSLA surface. The dogs were sacrificed at 2 weeks (n=2) or 4 weeks (n=3) after implant placement. Histologic and histomorphometric analyses were then performed for each implant. RESULTS: The microscopic healing patterns at weeks 2 and 4 for the two implant types with the standard SLA and modSLA surfaces showed similar qualitative findings. New bone tissue had already established direct contact with implant surfaces after 2 weeks of healing. The mean percentage of newly formed bone in contact with the implant (BIC) was significantly greater for modSLA (28.2+/-7.9%) than for SLA (22.2+/-7.3%) (P<0.05). This difference was no longer evident after 4 weeks. An increase in BIC for both implant surface types occurred from weeks 2 to 4. This increase was statistically significant when compared with SLA at 2 weeks (P<0.05), but not when compared with modSLA at 2 weeks. CONCLUSION: The data from the present study demonstrate significantly more bone apposition for the modSLA surface than the standard SLA surface after 2 weeks of healing. This increased bone apposition may allow a further reduction of the healing period following implant placement for patients undergoing early loading procedures.     

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.     

Lethal photosensitization and guided bone regeneration in treatment of peri-implantitis: an experimental study in dogs

The purpose of this study was to evaluate the effect of lethal photosensitization and guided bone regeneration (GBR) on the treatment of ligature-induced peri-implantitis in different implant surfaces. The treatment outcome was evaluated by clinical and histometric methods. A total of 40 dental implants with four different surface coatings (10 commercially pure titanium surface (cpTi); 10 titanium plasma-sprayed (TPS); 10 acid-etched surface; 10 surface-oxide sandblasted) were inserted into five mongrel dogs. After 3 months, the animals with ligature-induced peri-implantitis were subjected to surgical treatment using a split-mouth design. The controls were treated by debridment and GBR, while the test side received an additional therapy with photosensitization, using a GaAlAs diode laser, with a wavelength of 830 nm and a power output of 50 mW for 80 s (4 J/cm2), and sensitized toluidine blue O (100 microg/ml). The animals were sacrificed 5 months after therapy. The control sites presented an earlier exposition of the membranes on all coating surfaces, while the test group presented a higher bone height gain. Re-osseointegration ranged between 41.9% for the cpTi surface and 31.19% for the TPS surface in the test sites; however differences were not achieved between the surfaces. The lethal photosensitization associated with GBR allowed for better re-osseointegration at the area adjacent to the peri-implant defect regardless of the implant surface.     

Bactericidal effect of the Er:YAG laser on dental implant surfaces: an in vitro study

BACKGROUND: The aim of the in vitro study was to examine the bactericidal effect of an Er:YAG laser on common dental implant surfaces. METHODS: Seventy-two titanium platelets with 3 different surfaces--sandblasted and acid-etched (SA), titanium plasma-sprayed (TPS), and hydroxyapatite-coated (HA)--were incubated with a suspension of Streptococcus sanguinis (ATCC 10556). Irradiation at pulse energies of 60 and 120 mJ and a frequency of 10 pps was performed on a computer-controlled XY translation stage. After laser treatment the specimens were sonicated and the bacterial growth examined by counting colony forming units on blood agar plates. Temperature elevations during irradiation were investigated using K-type thermocouples. Laser treated implant surfaces were analyzed by means of electron microscopy. RESULTS: Compared to non-irradiated specimens, mean bacterial reductions of 99.51% (SA), 98.39% (HA), and 99.6% (TPS) at a pulse energy of 60 mJ and 99.92% (SA), 99.85% (HA), and 99.94% (TPS) at 120 mJ were calculated. At these laser parameters, no excessive temperature elevations or morphological implant surface alterations were detected. CONCLUSIONS: Even at low energy densities, the Er:YAG laser has a high bactericidal potential on common implant surfaces. Clinical studies are justified to evaluate the applicability and efficacy of the Er:YAG laser in the treatment of peri-implantitis.     

Guided bone regeneration around titanium plasma-sprayed,acid-etched,and hydroxyapatite-coated implants in the canine model

BACKGROUND: Endosseous dental implants with rough surfaces have been designed to improve early healing, especially in areas of poor bone or insufficient bone quantity. The aim of this study was to histomorphometrically assess the bone-to-implant contact on 3 different rough-surfaced implants following guided bone regeneration. METHODS: Mandibular premolars and first molars were extracted in 12 dogs, and healing was allowed for 6 months. Six implant osteotomy sites were prepared, 3 per side, followed by the creation of 7.3 mm wide by 5 mm deep surgical defects in the coronal section of the osteotomy sites. Ten-mm long titanium screw-type implants with titanium plasma-sprayed (TPS), hydroxyapatite-coated (HA), or acid-etched (AE) surfaces were placed; the surrounding defects were filled with canine demineralized freeze-dried bone allograft; implants/grafts were covered with expanded polytetrafluoroethylene membranes; and the tissue was closed. Following a healing period of 4 months, the animals were sacrificed and mandibular blocks were harvested for histomorphometric analysis. RESULTS: The mean percentage of bone-to-implant contact in the defect and non-defect areas for the different implant surfaces was: AE 16.24% defect, and 28.78% non-defect; TPS 25.08% defect, and 16.96% non-defect; and HA 48.25% defect and 26.60% non-defect. Within the defect, the mean difference in the bone-to-implant contact was significant for HA compared to TPS (P < 0.0001) and HA versus AE (P < 0.0001); TPS versus AE was not significant (P = 0.063). In the non-defect areas, the mean difference in the bone-to-implant contact was significant for AE versus TPS (P = 0.010); all other comparisons were not significant. There were 18 membrane exposures in the 72 implant sites. Data were analyzed again to assess the impact of membrane complications. Using a 1-way analysis of variance, the bone-to-implant contact was compared between the sites with and without membrane complications. No significant differences were seen in the defect areas or in the non-defect areas between the sites with and without membrane complications. CONCLUSION: In this study, the bone-to-implant contact in regenerated bone was greatest when an HA-coated implant was used.     

Comparison of chemically and pharmaceutically modified titanium and zirconia implant surfaces in dentistry: a study in sheep

Advanced surface modifications and materials were tested on the same implant geometry. Six types of dental implants were tested for osseointegration after 2, 4 and 8 weeks in a sheep pelvis model. Four titanium implant types were treated with newly developed surface modifications, of which two were chemically and two were pharmacologically modified. One implant was made of zirconia. A sandblasted and acid-etched titanium surface was used as reference. The chemically modified implants were plasma-anodized or coated with calcium phosphate. The pharmacological coatings contained either bisphosphonate or collagen type I with chondroitin sulphate. The implants were evaluated using macroscopic, radiographic and histomorphometric methods. All implants were well osseointegrated at the time of death. All titanium implants had similar bone implant contact (BIC) at 2 weeks (57-61%); only zirconia was better (77%). The main BIC increase was between 2 and 4 weeks. The pharmacologically coated implants (78-79%) and the calcium phosphate coating (83%) showed similar results compared with the reference implant (80%) at 8 weeks. There were no significant differences in BIC. Compared with previous studies the results of all implants were comparatively good.     

Preliminary 3-dimensional surface texture measurement and early loading results with a microtextured implant surface

PURPOSE: This investigation was conducted to obtain preliminary roughness data on a microtextured implant surface and to determine its ability to sustain a 1-stage surgical procedure and early full occlusal loading of single-tooth restorations in humans. MATERIALS AND METHODS: Three-dimensional (3D) vertical scanning interferometry was conducted on samples of the test surface (MTX) and 2 control surfaces (Osseotite and sandblasted/acid-etched [SLA]). Test implants were also placed in vivo, restored with fully occluding single-tooth restorations (n = 27) after 2 months of nonsubmerged healing, and clinically monitored for 48 months of follow-up. RESULTS: Microtexture was relatively uniform on the test surface and more random and irregular on the control surfaces. MTX and Osseotite were similar in some roughness parameters, but the MTX surface had a greater number of micropits that were spaced closer together (Stylus Y lambda q) and with higher slope values (Stylus Y delta q). Cumulative life table results were 100% for all MTX implants placed in maxillary and mandibular jaw locations, and no discernible marginal bone changes were observed. Overall implant success was 100% after 4 years of clinical functioning. DISCUSSION: The findings of this study appear promising but should be considered preliminary, because of the limitations in the number of locations measured on each product sample and the small number of implants clinically studied. CONCLUSION: Within the scope of the present study, MTX implants exhibited a uniform micropitted surface, as well as 100% survival and 100% clinical success after nonsubmerged placement, early loading with single-tooth restorations at 2 months, and 48 months of clinical functioning. (More than 50 references.)     

Histologic evaluation of early human bone response to different implant surfaces

BACKGROUND: Studies have demonstrated that roughened dental implant surfaces show firmer bone fixation and an increased percentage of bone-to-implant contact (BIC%) compared to commercially pure titanium-surface (machined) implants. Therefore, the purpose of this study was to evaluate the influence of implant-surface topography on human bone tissue after 2 months of unloaded healing. METHODS: Fourteen subjects with a mean age of 46.87 +/- 9.45 years received two microimplants each (2.5 mm in diameter and 6 mm in length), one test (sandblasted acid-etched surface) and one control (machined surface), either in the mandible or in the maxilla. After a healing period of 2 months, the microimplants and surrounding tissues were removed with a trephine bur and prepared for histologic analysis. RESULTS: All microimplants, except for one of the controls, were clinically stable after the healing period. Histometric evaluation indicated that the mean BIC% was 23.08% +/- 11.95% and 42.83% +/- 9.80% for machined and rough microimplant surfaces, respectively (P = 0.0005). The bone area within the threads was also higher for sandblasted-surface implants (P = 0.0005). The mean percentage of bone density did not differ between the two groups (P = 0.578). CONCLUSION: Data from the present histological study suggest that the sandblasted acid-etched implant provides a better human bone tissue response than machined implants under unloaded conditions after a healing period of 2 months.     

Treatment of ligature-induced peri-implantitis by lethal photosensitization and guided bone regeneration: a preliminary histologic study in dogs

BACKGROUND: The purpose of this pilot study was to evaluate the healing potential and reosseointegration in ligature-induced peri-implantitis defects adjacent to various dental implant surfaces following lethal photosensitization. METHODS: A total of 36 dental implants with 4 different surface coatings (9 commercially pure titanium surface [CPTi]; 9 titanium plasma-sprayed [TPS]; 9 hydroxyapatite [HA]; and 9 acid-etched [AE]) were inserted in 6 male mongrel dogs 3 months after extraction of mandibular premolars. After a 2-month period of ligature-induced peri-implantitis and 12 months of natural peri-implantitis progression, only 19 dental implants remained. The dogs underwent surgical debridement of the remaining dental implant sites and lethal photosensitization by combination of toluidine blue O (100 microg/ml) and irradiation with diode laser. All exposed dental implant surfaces and bone craters were meticulously cleaned by mechanical means, submitted to photodynamic therapy, and guided bone regeneration (GBR) using expanded polytetrafluoroethylene (ePTFE) membranes. Five months later, biopsies of the implant sites were dissected and prepared for ground sectioning and analysis. RESULTS: The percentage of bone fill was HA: 48.28 +/- 15.00; TPS: 39.54 +/- 12.34; AE: 26.88 +/- 22.16; and CPTi: 26.70 +/- 16.50. The percentage of reosseointegration was TPS: 25.25 +/- 11.96; CPTi: 24.91 +/- 17.78; AE: 17.30 +/- 15.41; and HA: 15.83 +/- 9.64. CONCLUSION: These data suggest that lethal photosensitization may have potential in the treatment of peri-implantitis.     

A macro- and nanostructure evaluation of a novel dental implant

Success in implant dentistry also comes from the implant macrodesign and nanostructure of its surface. Titanium implant surface treatments have been shown to enhance osseointegration, maximize bone healing, and bone-to-implant contact for predictable clinical results. The aim of the study, was to evaluate the geometric macrodesign and the surface nanostructure of a novel dental implant full contact covering (FCC) obtained by electrochemical procedures. FCC implants were analyzed by scanning electronic microscope, profilometer, and x-ray photoelectron spectroscopy and compared with commercial sandblasted and sandblasted, large-grit acid-etched dental implants. Sample analysis allowed to distinguish the different implant macrodesigns, the step and the profile of the coils that cover the fixture, and the surface characteristics. FCC implant showed novel macro-characteristic of crestal module, coils, and apical zone compared with sandblasted and sandblasted and acid-etched dental implants. Moreover, the FCC nanostructure surface showed roughness values statistically higher than the 2 other surfaces, with a more homogeneity in a peaks and valleys arrangement. Finally, the x-ray photoelectron spectroscopy analysis detected differences between the examined surfaces, with the presence of several contaminants according to the different treatment procedures. Research on new macrostructures and nano morphology should result in a better qualitative and quantitative osseointegration response, with a predictability of the clinical results and long-term success of the implants.     

Healing and osseointegration of submerged microtextured oral implants

The success of dental implants is primarily dependent upon the degree of osseointegration or bone-to-implant contact (BIC), possibly facilitated by a roughened implant surface. This study was performed to histologically evaluate the nature of osseointegration and bone healing of submerged microtextured implants in eight dogs. Three months following tooth extraction in the posterior mandibulae, three microtextured submerged implants were placed in each quadrant. Block biopsies were harvested at 4 and 16 weeks (four dogs each) following surgery, and histologic preparation was performed. Histomorphometric analysis demonstrated that % BIC value increased marginally from 40% at 4 weeks to 48% at 16 weeks, without a statistically significant difference. The first bone-to-implant contact (f-BIC) at 16 weeks was significantly lower than the 4-week f-BIC (0.81 mm vs. 0.56 mm). In conclusion, this study found minimal change in BIC over time (from 4 to 16 weeks) in unloaded microtextured implants, while the mean f-BIC value significantly increased during this same observation period.     

Long-term evaluation of implant survival in augmented sinuses: a case series

This study compared bone grafting regimens and different implant surfaces used for sinus augmentation and presented long-term implant success rates in augmented sinuses. Two hundred fifty-seven consecutive patients with 625 implants were evaluated retrospectively. In phase 1, 188 sinuses were grafted with (1) autograft alone; (2) autograft + demineralized freeze-dried bone allograft (DFDBA) + absorbable hydroxyapatite (AHA) in a ratio of approximately 1:3:3; or (3) DFDBA + AHA + nonabsorbable HA (NHA) in a ratio of approximately 1:1:1. In phase 2, grafting regimen 3 (combination of DFDBA + AHA + NHA) was used in another 69 patients. Data were analyzed based on bone grafting regimen, implant surface texture, and time of implant placement (immediate or delayed). In phase 1, graft type 3 had the lowest implant failure rate (2.7%), followed by type 2 (14.3%) and type 1 (44.4%). The overall implant failure rate was 3.6%. Smooth implants showed the highest failure rate (21.8%), followed by titanium plasma-sprayed (2.9%) and HA-coated (0.7%) implants. In phase 2, the overall implant survival rate was 92.5% after 3 years. Smooth implants showed the highest failure rate (41.7%), followed by sand-blasted, large-grit, acid-etched (6.8%) and HA-coated (3.4%) implants. All failures occurred when implants were placed simultaneously with sinus grafts. This study suggests that long-term implant success can be obtained when maxillary sinuses are augmented with a combination of DFDBA + AHA + NHA. Rough surfaces and delayed implant placement seem to increase implant success in these areas.     

Influence of implant microstructure on the osseointegration of immediate implants placed in periodontally infected sites. A histomorphometric study in dogs

The aim of this study was to evaluate the influence of implant microstructure on the osseointegration of immediate implants placed into infected sites. During 12 weeks, periodontitis was induced in six dogs in the areas of the first to fourth mandibular premolars of both sides. The teeth were extracted and the implants were placed immediately. Implant placement was randomly assigned so that for each side in the mandible a different implant surface, a new grit-blasted/acid-etched group 1 or titanium plasma spray surface group 2 was used, totaling 36 implants in the experiment. The animals were killed 12 weeks after implant placement. Two histomorphometric analyses were performed: percentage of bone/implant contact (BIC) and analyses of the bone density in adjacent and distant areas from the implant surface. The results showed that the percentages of BIC were 52.7% and 42.7% for groups 1 and 2, respectively. The bone density analysis revealed that the percentages of bone in the adjacent areas were 66.6% and 58.8%, and in the distant areas from the implants were 58.7% and 55.8% for groups 1 and 2, respectively. The mean differences of BIC were verified through the Mann-Whitney test and differences in bone density through the Kruskal-Wallis test. The differences were not statistically significant (P>0.05). In conclusion, osseointegration of implants placed into a more challenging healing situation such as immediate implants into periodontally compromised sites was successful for both surfaces; however, the grit-blasted/acid-etched surface, although not statistically significant, had a slightly better performance when compared to the titanium plasma spray surface for all the parameters studied.