种植体表面处理技术对骨结合影响研究进展

种植修复在临床的推广应用，引发了种植骨结合领域的研究热潮。种植体表面经过处理，可改变其表面性能，从而促进骨结合的形成，提高种植的成功率。本文对近年来应用于临床的多种种植体表面处理技术做一综述。     

The influence of recombinant human BMP-2 on bone-implant osseointegration: biomechanical testing and histomorphometric analysis

The healing period for bone-implant osseointegration lasts 3-6 months or even longer. The aim of this study was to investigate whether osseointegration can be enhanced by the use of bone morphogenetic protein-2 (BMP-2). In the femurs of 8 Japanese white rabbits, 16 implants were applied with 1.0 mg recombinant human BMP-2 (rhBMP-2) as group A, and the other 16 implants without rhBMP-2 as group B. Calcein green 20 mg/kg and alizarin red 20 mg/kg were injected 4 and 8 weeks after implantation, respectively. At 12 weeks, the animals were killed. In 16 implant-bone blocks, binding strength was measured by pull-out test, and the extracted implants were observed under a scanning electronic microscope. The other blocks were analysed for percentage of marked bone adjacent to the implant surface by confocal laser scanning microscope. The pull-out strengths of group A were greater than that of group B (P<0.05). Scanning electronic microscopy (SEM) showed more calcified substances on the surface of the implants of group A than B. There was more marked bone around group A than B implants at 4 weeks (P<0.05) and 8 weeks (P<0.05). rhBMP-2 improves the quantity and quality of implant-bone osseointegration. Biomechanical testing and histomorphometric analysis are reliable methods to use in researching the implant-bone interface.     

Effect of various surface treatment methods on the bond strength of the heat-pressed ceramic samples

This in vitro study was conducted to evaluate the interaction between the shear bond strength and the surface treatment method for a commercial dental ceramic. Ninety bonded ceramic units were manufactured for this study. Each unit was made by luting two cylinder-shaped ceramic samples to each other with a resin-composite luting agent. The units were then divided into nine groups, containing 10 units in each group. Samples from each group were treated with one of the following: etching with 4.9% hydrofluoric acid for 10, 20 and 40 s, 9.5% hydrofluoric acid for 10, 20 and 40 s, 40% orthophosphoric acid for 40 s, air abrasion with alumina in 50-microm particles, and grinding with a high-speed diamond bur. The treated samples were then silanated and luted with a resin-composite luting agent. The luted units were then loaded to failure. Two samples from each group were neither silanated nor luted after the surface treatment procedure, and morphological changes obtained by various surface treatment regimens were investigated by scanning electron microscopy. A statistically significant difference was observed among the mean shear bond strengths of the groups prepared with different surface treatment techniques (P = 0.00). Hydrofluoric acid appeared to be the most suitable chemical medium to produce a reliable ceramic bond. Etching time and concentration of the acidic medium were also observed as important prognostic variates. Orthophosphoric acid treatment was observed to be the least effective surface treatment method on the heat-pressed ceramic samples. Physical applications such as bur grinding and air blasting maintained stronger bonds than the orthophosphoric acid, while producing weaker bonds than surfaces treated with hydrofluoric acid in all concentrations and etching periods. The effect of the silane priming agent was not considered in this study.     

A histomorphometric analysis of the effects of fluoride on experimental ectopic bone formation in the rat

Ectopic bone formation was induced in 14 rats receiving 100 ppm fluoride in drinking water and in 14 control animals. Sections from ossicles removed after 14 and 20 days were sampled for stereological analysis. Bone volume density and bone volume were reduced in experimental animals on day 14 (p less than 0.05). This difference was no longer present after 20 days. On day 20, surface density and areas of formative surfaces were increased in the fluoride group (p less than 0.05). Osteoid seam thickness was higher in the fluoride group on both days (p less than 0.01). In conclusion, fluoride induced quantitative alterations in ectopic bone formation, and the presented model may prove a useful addendum to previous methods for investigation of fluoride effects on mineralization processes in vivo.     

种植体掺离子表面改性技术及其促进骨结合的研究进展

种植牙因其在解决牙列缺损方面巨大的优势,已成为许多缺牙患者首选的治疗方式。在临床应用中,如何促进种植体与骨组织界面的骨结合是种植治疗成功的关键,因此种植体表面改性一直是研究的热点。骨组织中含有钙、磷、锌、镁、锶等大量微量元素,这些微量元素对于骨组织的生长发育必不可少。因此可以通过将微量元素掺入种植体表面来促进种植体骨结合。本文着重介绍了种植体表面改性的相关技术以及微量元素促进骨结合的具体机制。     

Influence of implant positioning in extraction sockets on osseointegration: histomorphometric analyses in dogs

Aim: To evaluate the influence of implant positioning into extraction sockets on osseointegration. Material and methods: Implants were installed immediately into extraction sockets in the mandibles of six Labrador dogs. In the control sites, the implants were positioned in the center of the alveolus, while in the test sites, the implants were positioned 0.8 mm deeper and more lingually. After 4 months of healing, the resorptive patterns of the alveolar crest were evaluated histomorphometrically. Results: All implants were integrated in mineralized bone, mainly composed of mature lamellar bone. The alveolar crest underwent resorption at the control as well as at the test sites. After 4 months of healing, at the buccal aspects of the control and test sites, the location of the implant rough/smooth limit to the alveolar crest was 2±0.9 mm and 0.6±0.9 mm, respectively (P<0.05). At the lingual aspect, the bony crest was located 0.4 mm apically and 0.2 mm coronally to the implant rough/smooth limit at the control and test sites, respectively (NS). Conclusions: From a clinical point of view, implants installed into extraction sockets should be positioned approximately 1 mm deeper than the level of the buccal alveolar crest and in a lingual position in relation to the center of the alveolus in order to reduce or eliminate the exposure above the alveolar crest of the endosseous (rough) portion of the implant. To cite this article:
Caneva M, Salata LA, de Souza SS, Baffone G, Lang NP, Botticelli D. Influence of implant positioning in extraction sockets on osseointegration: histomorphometric analyses in dogs.
Clin. Oral Impl. Res. 21 , 2010; 43–49.     

钛表面3种不同处理方法对钛-瓷结合影响的对比研究

目的对比钛表面分别经微弧氧化和Nd:YAG激光处理、喷砂处理后的表面形貌、理化性能的差异,比较其对钛瓷结合强度的影响。方法将60个规格为25.0 mm×5.0 mm×0.5 mm的标准钛片试件,随机均分为3组,每组20片(A组为微弧氧化组,B组为激光轰击组,C组为喷砂组),运用扫描电镜、X射线衍射仪、EDS等分析其形貌和物相;三点弯曲实验测试钛瓷结合强度并进行统计学分析比较。结果 A、B、C 3组试件的钛瓷结合强度均高于ISO9693要求的25 MPa,Nd:YAG激光处理试件钛瓷结合强度较微弧氧化处理高,且两者均高于喷砂组。结论 3种处理方式都能提高钛表面的钛瓷结合强度,Nd:YAG激光处理后效果优于微弧氧化和喷砂处理。     

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.     

改良喷砂表面处理提高钛牙种植体骨结合的界面生物力学研究

目的：研究改良喷砂表面处理对钛牙种植体骨界面剪切强度的影响。从界面生物力学角度证实改良喷砂表面处理在钛牙种植体中应用的可行性和应用价值。方法：将光滑表面钛种植体与改良喷砂表面种植体随机植入狗股骨内侧髁,分别于植入后2、4、12周取材,Instron电子拉伸试验机检测种植体骨界面的剪切强度。扫描电镜与X－射线能谱分析仪观察植入12周拔出的种植体表面,并进行元素分析。结果：改良喷砂表面组骨界面剪切强度明显高于光滑表面组,约高出4倍,且植入2周即已获得超出光滑表面组12周所能达到的最大强度。植入12周后拔出的改良喷砂表面种植体表面经扫描电镜观察与X－射线谱分析,提示种植体表面大部分被覆骨组织,粗糙表面的二级窝洞内充满骨样组织。结论：改良喷砂表面处理所获得的粗糙表面可以大大地提高牙种植体骨界面的结合强度。此类粗糙表面所特有的二级窝洞在这里起着重要作用。     

Finite element analysis of bone-implant biomechanics: refinement through featuring various osseointegration conditions

A refinement technique is proposed for developing finite element models capable of simulating peri-implant bone conditions for bone types II, III, and IV at various degrees of osseointegration. The refined models feature a transition region between bone (cortical and cancellous) and implant and designate it partially to fully osseointegrated by assigning corresponding fractions of the bulk bone's elastic properties to this region. Bone is assumed to be transversely isotropic. The refined technique is implemented in a case study, in which osseointegrated (25-100%) peri-implant bone, type II, III, or IV with an implant attached, is loaded with a 100 MPa occlusal load. The biomechanics of this peri-implant bone was simulated and analysed. Results showed that the less dense bone must support higher stress and strain, especially at the cortical region. Higher degree of osseointegration induced higher stress but lower strain. Both the bone type and the osseointegration condition significantly affected the stress-strain relation. For minimum stress and strain, denser and more osseointegrated peri-implant bone is desirable. When bone failure criteria were set, based on the yield strength and strain of the bone, a higher degree of osseointegration was needed for the less dense peri-implant bone to be considered safe.     

The effects of loading time on osseointegration and new bone formation around dental implants: a histologic and histomorphometric study in dogs

BACKGROUND: Immediate loading of dental implants has been introduced as a method of reducing implant treatment time without compromising its prognosis. In this research, the effects of loading time on the amount of bone-to-implant contact and bone formation around dental implants were evaluated histologically. METHODS: Three months prior to implantation, the lower premolar teeth of 15 dogs were extracted. Three or four dental implants were placed in the healed extraction sites for each dog (N = 48). Dividing the dogs into three groups, the implants were either loaded 48 hours or 1 week later with metallic or prefabricated acrylic crowns or were left unloaded until the time of sacrifice. Three months after implant insertion, the animals were sacrificed and samples were investigated to define the amount of bone-to-implant contact, lamellar and woven bone percentage, and local inflammation of the newly formed bone. RESULTS: No significant difference in the observed criteria was reported among the three groups (P >0.05); however, the unloaded group had the highest degree of bone-to-implant contact and the group loaded 48 hours after the primary implant insertion had the least. The prosthesis type had no significant effect on the implant success rate (P >0.05). The lamellar and woven bone percentage of newly formed bone also did not differ in the three groups (P >0.05). One implant from each group failed in this study. CONCLUSION: Loading time does not seem to significantly affect the degree of osseointegration and bone-to-implant contact and the composition of newly formed bone around dental implants.     

A histomorphometric study of dental implants with different surface characteristics

PURPOSE

One of the major keys to achieve successful osseointegration of the implant is its surface properties. The aim of this study was to investigate the bone response to dental implants with different surface characteristics using the rabbit tibia model. Tricalcium phosphate (TCP) coated, anodic oxidized and turned (control) surfaces were compared.

MATERIALS AND METHODS

Seventy two implants were placed in the tibia of eighteen rabbits. Nine rabbits were sacrificed at 3 weeks of healing and the remaining nine were sacrificed at 6 weeks of healing. The bone-to-implant contact (BIC) and the bone volume density (BVD) were assessed by light microscope after 3 and 6 weeks of healing.

RESULTS

Statistical analysis showed that no significant differences in the BIC and BVD were observed between the different implant surfaces and the control group at 3 weeks and 6 weeks of healing. Data also suggested that the BVD of all the surfaces showed significant difference at 3 and 6 weeks.

CONCLUSION

The present study has showed that osseointegration occurred in all investigated types of surface-treated implants. In the current study all of the threads of the implants were observed to calculate BIC and BVD values (instead of choosing some of the threads from the bone cortex for example), which didn''t make BIC or BVD percentage values better than in the control group, therefore the clinical relevance of these results remains to be shown.     

骨整合与种植材料表面修饰研究进展

本文介绍了种植体植入体内后发生骨整合的过程、细胞黏附于材料表面的相关蛋白以及种植材料所采用的表面修饰方法新进展,并指出了材料表面修饰特别是表面纳米修饰能提高种植材料的生物学性能.     

Comparison of the effects of various periodontal rotary instruments on surface characteristics of root surface

The efficacy of scaling and root planing using various periodontal rotary instruments was examined. Eighty extracted human teeth with a history of periodontal disease were divided into four groups of 20 and subjected to one of the following procedures: Use of 1) a Root Burnisher, 2) a Perio Planing Bur (both rotating instruments for contra angle handpieces), 3) a Tooth Planing Bur (rotating instrument for use with an air turbine), or 4) a Gracey Scaler. In each case, the time required for cleaning was measured. Twenty healthy extracted human teeth were used as untreated controls. After treatment, the surface roughness of 10 specimens out of each group were measured using a profilometer and observed by scanning electron microscopy (SEM). Half of the samples were then incubated in dishes with a suspension of fibroblasts. After counting the number of attached cells, the attachment of fibroblasts was observed by SEM. The root surfaces treated with the rotary instruments appeared smooth and there were no significant differences between groups. From the SEM observations, smooth root surfaces with different surface textures were evident and a tight attachment of fibroblasts was observed. The results of this study suggest that use of rotary instruments is superior for periodontal scaling and root planing.     

Evaluation of a predictive model for implant surface topography effects on early osseointegration in the rat tibia model

STATEMENT OF PROBLEM: Alterations in commercially pure titanium (cp Ti) implant surface topography can be made to increase bone formation or the interfacial shear strength of bone at the functioning implant. It is not known whether these 2 goals are congruent or mutually exclusive. PURPOSE: The aim of this study was to determine the effect of implant surface topography parameters of calculated biomechanical significance on the process of bone formation in a rat tibia model of osseointegration. MATERIAL AND METHODS: Implants (cp Ti grade IV) were machined and subsequently treated by grit blasting or grit blasting and 6.4 mol/L HCl. Measurements of surface roughness were made by atomic force microscopic analysis of similarly treated titanium disks. Cleaned and sterilized implants (12 machined, 12 with nonideal pit morphology, 12 with ideal pit morphology) were placed into the tibiae of 400-g male Wistar rats by using a series of drills, irrigation, and a self-tapping procedure. After 3 weeks, tibiae were harvested and processed and embedded in methyl methacrylate resin. Polished sections were examined by backscatter electron microscopy, and the percentage implant surface contacting bone was measured with the Scionics PC image analysis program. RESULTS. The implants possessing a proposed ideal pit morphology supported significantly greater bone formation at the implant surface (54% +/- 7% bone-to-implant contact [P<.003]) than the nonideal pit morphology (40% +/- 15%) or machined surfaces (34% +/- 6%). CONCLUSION: Implant surfaces with a proposed ideal pit morphology (which possess a calculated biomechanical significance) enhanced bone formation at early periods after placement in the rat tibia model.