Three-dimensional bone response to commercially pure titanium, hydroxyapatite, and calcium-ion-mixing titanium in rabbits

Three-dimensional bone response to 3 biomaterials--commercially pure titanium (Ti), hydroxyapatite (HA), and calcium-ion-mixing titanium (Ca-Ti)--embedded in the tibiae of rabbits was examined chronologically. The rabbits were sacrificed at 2, 4, and 8 weeks after implantation, and the percent bone volume around each implant was calculated from the implant surface to each of 4 measurements: 36 microns, 0.25 mm, 0.5 mm, and 1.0 mm in 2 regions (cortical bone and bone marrow regions). Percent bone volume in the cortical bone was consistent, whereas in the bone marrow region, the percent bone volume varied according to implant material, implantation period, and distance from the implant surface. With Ti implants the percent increased gradually up to 8 weeks at each distance, whereas in HA and Ca-Ti implants the percent was largest at 4 weeks and increased closer to the surface. The percent with Ti implants was largest at 36 microns to 0.25 mm. Aspect of bone response to Ca-Ti was its position intermediate between those of HA and Ti. The decrease of the percent at 8 weeks was smaller than HA.     

Effects of electromagnetic field on bone healing around commercially pure titanium surface: histologic and mechanical study in rabbits

PURPOSE: The purpose of this pilot study was to evaluate the histologic and mechanical healing process in dental implants under the action of pulsed electromagnetic field (PEMF). MATERIALS AND METHODS: Forty-eight commercially pure implant fixtures were implanted in tibiae metaphysis of 12 New Zealand white rabbits divided into experimental (PEMF) and control groups. A PEMF with pulse width of 85 microseconds and a pulse frequency of 20 Mc was applied for 30 minutes per day. The animals were killed 21 and 42 days after implantation. The mechanical tests were performed in all animals and bone biopsies were prepared for decalcified sections analysis. RESULTS: Mechanical tests did not show significant differences between the groups (P > 0.05); however, statistically significant differences were observed over time (P < 0.0001). Similar histologic features were achieved for both groups. CONCLUSIONS: These results suggest that PEMF stimulation does not improve the bone-healing process around commercially pure dental implants.     

Bacterial adhesion on commercially pure titanium and zirconium oxide disks: an in vivo human study

BACKGROUND: Little is known about the mechanisms of bacterial interaction with implant materials in the oral cavity. A correlation between plaque accumulation and progressive bone loss around implants has been reported. Bacterial adhesion shows a direct positive correlation with surface roughness. Other surface characteristics also seem to be extremely important with regard to plaque formation. Different adhesion affinities of bacteria have been reported for different materials. The aim of this study was to characterize the percentage of surface covered by bacteria on commercially pure titanium and zirconium oxide disks. METHODS: Ten patients participated in this study. A removable acrylic device was adapted to the molar-premolar region, and commercially pure titanium (control) and zirconium oxide (test) disks were glued to the buccal aspect of each device. The surface roughness of titanium and test specimens was similar. After 24 hours, all disks were removed and processed for scanning electron microscopy, for the evaluation of the portion of surface covered by bacteria. RESULTS: In control specimens, the area covered by bacteria was 19.3% +/- 2.9; in test specimens, the area was 12.1% +/- 1.96. The disk surface covered by bacteria on test specimens was significantly lower than that of control specimens (P = 0.0001). CONCLUSION: Our results demonstrate that zirconium oxide may be a suitable material for manufacturing implant abutments with a low colonization potential.     

An oxidized implant surface may improve bone-to-implant contact in pristine bone and bone defects treated with guided bone regeneration: an experimental study in dogs

BACKGROUND: The aim of the present study was to histometrically evaluate bone healing in the absence of bone defects and in the presence of surgically created bone defects treated by guided bone regeneration at oxidized and turned implant surfaces. METHODS: Three months after dental extractions, standardized buccal dehiscence defects (height: 5 mm; width: 4 mm) were surgically created following implant site preparation in the mandible of 10 dogs. Oxidized-surface implants (OSI) and turned-surface implants (TSI) were inserted bilaterally, and the bone defects were treated by guided bone regeneration. After 3 months of healing, the animals were sacrificed, blocks were dissected, and undecalcified sections were obtained and processed for histometric analysis. The percentage of bone-to-implant contact (BIC) and bone density (BD) was evaluated inside the threads on the buccal (regenerated bone) and lingual sides (pristine bone) of the implants. Data were evaluated using two-way analysis of variance (P <0.05). RESULTS: New bone formation could be observed in OSI and TSI in the region of the defect creation. The BIC values observed in OSI for pristine and regenerated bone were 57.03% +/- 21.86% and 40.86% +/- 22.73%, respectively. TSI showed lower values of BIC in pristine bone (37.39% +/- 23.33%) and regenerated bone (3.52% +/- 4.87%). The differences between OSI and TSI were statistically significant. BD evaluation showed no statistically significant differences between OSI and TSI in pristine and regenerated bone. CONCLUSION: The oxidized implant surface promoted a higher level of BIC than the turned implant surface at pristine and regenerated bone.     

Response of rat bone marrow cells to commercially pure titanium submitted to different surface treatments

OBJECTIVES: Alterations in the commercially pure titanium (cpTi) surface may be undertaken to improve its biological properties. The aim of this study is to investigate the biocompatibility of cpTi submitted to different surface treatments. METHODS: The cpTi surfaces were prepared so that machined and blasted surfaces, either acid etched or not, were compared using rat bone marrow cells cultured to differentiated into osteoblast. For attachment evaluation, cells were cultured for 4 and 24h. Cell morphology was evaluated after 3 days. After 7, 14, and 21 days cell proliferation was evaluated. Total protein content and alkaline phosphatase (ALP) activity were evaluated after 14 and 21 days. For bone-like nodule formation, cells were cultured for 21 days. Data were compared by analysis of variance. RESULTS: Cell attachment, cell morphology, cell proliferation, and ALP activity were not affected by surface treatments. Total protein content was reduced by blasted and acid etched surface. Bone-like nodule formation was significantly reduced by blasted, acid etched, and a combination of both blasted and acid etched surfaces. CONCLUSIONS: Based on these results, it can be suggested that cpTi surfaces that were submitted only to machining treatment favor the final event of osteoblastic differentiation of the rat bone marrow cells, evidenced by increased bone-like nodule formation.     

A removal torque and histomorphometric study of commercially pure niobium and titanium implants in rabbit bone

Screw-shaped commercially pure (c.p.) niobium and c.p. titanium implants were inserted in rabbit bone. After a healing period of 3 months, a significantly higher removal torque was demonstrated to unscrew the niobium implants (average 32.9 Ncm) compared to the c.p. titanium implants (average 25.3 Ncm). In the histomorphometric part of the study, there were no significant differences in bone-to-metal contact between the 2 implant materials. An average of 41.1% bony contact was demonstrated for the niobium screws compared to an average of 37.2% for the c.p. titanium ones. Our removal torque findings could be related to the differences that we observed between the 2 implant surfaces as indicated by SEM. Since niobium implants showed a more irregular surface topography and niobium is a softer metal than c.p. titanium, this seems the most probable reason for the differences observed in removal torque between the 2 metals. Hypothetically, a more "positive biocompatibility" of the c.p. niobium in comparison to the c.p. titanium remains as another possible reason for the observed differences. However, against such a difference in biocompatibility between c.p. niobium and c.p. titanium, there is the very similar amount of bony contact registered in the histomorphometric analysis.     

A removal torque and histomorphometric study of bone tissue reactions to commercially pure titanium and Vitallium implants.

Screw-shaped commercially pure (CP) titanium and Vitallium implants were inserted in the rabbit tibial metaphysis. After a healing period of 3 months, it was demonstrated that a higher torque was needed to remove the CP titanium implants (average 24.9 Ncm) compared to Vitallium implants (average 11.7 Ncm). The histomorphometric part of the study revealed more bone-to-metal contact for the CP titanium implants (average 34.7%) compared to the Vitallium implants (average 21.7%). The results obtained in this study could be explained by differences in the topography or in biocompatibility of the metals, or a combination of these two factors.     

An evaluation of biocompatibility of indigenously produced pure titanium: an experimental study in rabbits

The indigenously produced pure titanium dental implants are economical and useful for common human use in India. The aim of this study is to test the biocompatibility of the indigenously produced pure titanium dental implant material obtained from the Defense Metallurgical Research Laboratory, Hyderabad, India, and the Institute of Nuclear Medicine and Allied Science, Delhi, India. An experimental study in rabbits was done to study the amount of ordered bone formation around the screw and cylinder type of indigenously produced pure titanium metal implant specimens. The experimental animals were killed at 4, 6, 8, 12, and 16 weeks from the date of implantation. The histopathological examination of the animals killed at 16 weeks demonstrates the presence of osteoblastic cell proliferation and early ordered bone formation toward the implant site, indicating signs of osseointegration of both screw- and cylinder-type indigenously produced pure titanium specimens.     

Evaluation of bone ingrowth into porous titanium implant: histomorphometric analysis in rabbits

A porous material for bone ingrowth with adequate pore structure and appropriate mechanical properties has long been sought as the ideal bone-implant interface. This study aimed to assess in vivo the influence of three types of porous titanium implant on the new bone ingrowth. The implants were produced by means of a powder metallurgy technique with different porosities and pore sizes: Group 1 = 30 % and 180 μm; Group 2 = 30% and 300 μm; and Group 3 = 40% and 180 μm;. Six rabbits received one implant of each type in the right and left tibiae and were sacrificed 8 weeks after surgery for histological and histomorphometric analyses. Histological analysis confirmed new bone in contact with the implant, formed in direction of pores. Histomorphometric evaluation demonstrated that the new bone formation was statistically significantly lower in the group G1 than in group G3, (P = 0.023). Based on these results, increased porosity and pore size were concluded to have a positive effect on the amount of bone ingrowth.     

纯钛膜在种植外科中应用效果的初步研究

目的 评价无孔纯钛膜治疗种植体周围骨缺损的临床效果，并探讨其应用技巧。方法 81例患者的92颗种植体周围骨缺损均采取自体碎骨及Bio-Oss人工骨移植充填后，国产无孔纯钛膜覆盖治疗，术后6～10个月行种植Ⅱ期手术，同时取出钛膜。结果 5例(6颗种植体)发生种植术后软组织瓣早期裂开或穿孔，钛膜外露且早期取出；其余76例软组织瓣愈合良好，原骨缺损完全骨性修复。结论 钛膜有良好的生物相容性，有效地防止移植的骨代用品移位、纤维结缔组织长入，其塑形性好，能维持较大的骨再生修复空间，骨生成量大。     

The integration of chitosan-coated titanium in bone: an in vivo study in rabbits

PROCEDURE: Much research is directed at surface modifications to enhance osseointegration of implants. A new potential coating is the biopolymer, chitosan, the deacetylated derivative of the natural polysaccharide, chitin. Chitosan is biocompatible, degradable, nontoxic, and exhibits osteogenic properties. The aim of this research was to investigate the hypothesis that chitosan-coated titanium supports bone formation and osseointegration. MATERIALS AND METHODS: Chitosan (1 wt% of 92.3% deacetylated chitosan in 1% acetic acid) was solution cast and bonded to rough ground titanium pins (2-mm diameterx4-mm long) via silane reactions. Calcium phosphate sputter-coated titanium and uncoated titanium pins were used as controls. Two chitosan-coated pins, and 1 each of calcium phosphate coated and uncoated pins were implanted unilaterally in the tibia of 16 adult male New Zealand white rabbits. At 2, 4, 8, and 12 weeks, undecalcified sections were histologically evaluated for healing and bone formation. RESULTS: Histological evaluations of tissues in contact with the chitosan-coated pins indicated minimal inflammatory response and a typical healing sequence of fibrous, woven bone formation, followed by development of lamellar bone. These observations were similar to those for tissues interfacing the control calcium phosphate-coated and uncoated titanium implants. Quantitative comparisons of the bone-implant interface were not possible since 31% of the implants migrated into the tibial marrow space after implantation due to insufficient cortical bone thickness to hold pins in place during healing. CONCLUSION: These data support the hypothesis that chitosan-coatings are able to develop a close bony apposition or the osseointegration of dental/craniofacial and orthopedic implants.     

Titanium hydride and hydrogen concentration in acid‐etched commercially pure titanium and titanium alloy implants: a comparative analysis of five implant systems

Objectives: Acid etching is a popular method to texture the surface of dental implants. During etching, the titanium oxide protective layer is dissolved and small native hydrogen ions diffuse into the unprotected implant surface. They enrich the implant surface with hydrogen and precipitate into titanium hydride (TiH). The aim of this study was to measure the concentration of TiH at the implant surface and the total concentration of Hydrogen at five commercially available implant systems, made of either commercially pure (cp) titanium or titanium alloy. Material and methods: X‐Ray diffraction (XRD) was conducted on each implant system to determine the compounds present at the implant surface. Following a TiH₂/Ti calibration curve, the concentration of TiH was determined. Concentration of hydrogen in the implants was measured by the inert gas fusion thermal conductivity/infrared detection method. Results: XRD data showed that TiH was present on all cp titanium implants but not on the alloyed implants. TiH concentration varied between 5% and 37%. Hydrogen concentration varied between 43 and 108 ppm, no difference in uptake was found between the cp titanium and alloyed implants. Low solubility of hydrogen in α‐titanium is responsible for precipitation into TiH. Stronger etching conditions led to higher concentration of TiH2‐x. Conclusion: High solubility of hydrogen in the β‐phase of the alloy is preventing hydrogen from precipitating into TiH. All implants, even those lacking TiH at the surface, were enriched with hydrogen. In all implants, hydrogen concentration was within the normative limit of 130 ppm. To cite this article:
Szmukler‐Moncler S, Bischof M, Nedir R, Ermrich M. Titanium hydride and hydrogen concentration in acid‐etched commercially pure titanium and titanium alloy implants: a comparative analysis of five implant systems.
Clin. Oral Impl. Res. 21 , 2010; 944–950.
doi: 10.1111/j.1600‐0501.2009.01938.x     

Histological comparison of bone to implant contact in two types of dental implant surfaces: a single case study

AIM: The purpose of this single case study was to evaluate the influence of different implant surfaces on human bone and osseointegration. METHODS AND MATERIALS: A 47-year-old partially edentulous woman received two experimental implants along with conventional implant therapy. Experimental implants placed in the mandibular ramus consisted of machined and anodized surfaces, respectively. After three months of healing, the experimental implants were removed and prepared for ground sectioning and histological analysis. RESULTS: The data demonstrate anodized implant surfaces present a higher percentage of osseointegration when compared to a machined surface in cortical human bone after a healing period of three months. CONCLUSION: This single case study suggests an anodized implant surface results in a higher percentage of bone to implant contact when compared to machined surfaced implants when placed in dense bone tissue. However, further investigations should be conducted.     

Effect of bone to implant contact percentage on bone remodelling surrounding a dental implant

Dental implants are an effective, safe and predictable solution for patients suffering from tooth loss, but implant placement changes the normal mechanical environment of the jawbone leading to bone density redistribution and ‘remodelling’, in order to adapt to the new environment. Many bone remodelling theories assume the presence of 100% contact between bone and implant, which is inconsistent with clinical reality. About 50–80% bone–implant contact is commonly seen with clinically successful implants. The influence of different percentages of bone–implant contact on bone remodelling has not been investigated adequately. This study aims to evaluate this influence using a newly proposed remodelling algorithm through a 2D finite element model. Four different degrees of bone–implant contact (25, 50, 75 and 100%) are considered and their influences on the density distribution of the jawbone are evaluated. The predicted results indicate that no matter what the initial percentage of bone–implant contact (25–100%), the final outcome is about 58–60% contact when an equilibrium state is reached by bone remodelling. The results are consistent with clinical observations and findings.     

Effect of calcitonin on bone formation around titanium implant. A histometric study in rabbits.

Bone healing around titanium implants has already been evaluated; however, the effect of drugs such as calcitonin during the period of bone maturation around titanium implants has not yet been investigated. The purpose of this study was to evaluate the effects of calcitonin administration on the late period of bone healing following titanium implant insertion. Twenty-seven adult New Zealand rabbits received one implant in each femur. Thirteen animals were randomly selected as the test group (2 IU/kg--calcitonin) and fourteen animals served as control (saline). The animals were sacrificed 6, 8, 12 and 18 weeks after surgery. Endosteal/periosteal bone length (EB/PB), endosteal/periosteal bone area (EBA/PBA) and total cortical length (TCL) around the implants were analyzed. After 6, 8, 12 and 18 weeks, a positive time effect was strongly observed (P < 0.05). Considering the treatment factor, there was a positive effect of calcitonin on EBA and EB variables at 12 weeks and TCL at 18 weeks. In conclusion, the administration of salmon calcitonin to healthy animals may improve bone mass at the later stages of bone healing following titanium implant insertion.     

Generation of new bone around titanium implants using a membrane technique: an experimental study in rabbits

Insufficient bone volume may be a significant problem in connection with dental implants. In this study, a technique based on the principle of guided tissue regeneration was tested for its ability to generate bone tissue around titanium implants. Implants were inserted in tibiae of rabbits. To create a secluded space for osteogenesis and to prevent soft-tissue ingrowth, a porous Teflon membrane was placed around exposed parts of the implant. Where a membrane had been used, the threads of the implant were completely covered with significant amounts of new bone. This study indicates that the membrane technique is a reconstructive surgical method that may be applicable to create new bone around exposed parts of titanium implants in a clinical setting.     

Nicotine and bone density around titanium implants: a histometric study in rabbits

This study investigated the influence of nicotine on bone density around titanium implants inserted in rabbits. Thirty-two New Zealand rabbits were included. After anesthesia, the tibiae surfaces were exposed and two screw-shaped, commercially available, pure titanium implants of 7.0 mm in length and 3.75 mm in diameter were placed bilaterally. A total of 128 implants were inserted: 64 blasted with Al2O3 particles (group 1) and 64 with a machined surface finish (group 2). The animals were randomly assigned to one of four treatment subgroups, and daily subcutaneous injections of nicotine were administered. After 42 days, the animals were killed and undecalcified sections were prepared. The bone density was measured in the cortical passage of the implant. Statistical analysis (two-way analysis of variance) revealed no significant difference neither regarding the effect of nicotine nor the effect of surface design on bone density around the implants (P > 0.05). Within the limits of the present study, it can be assumed that daily nicotine administration may not statistically influence bone density around titanium implants.     

Early trabecular bone healing around titanium implants: a histologic study in rabbits

BACKGROUND: A detailed insight into the early healing response of trabecular bone to unloaded titanium implants is lacking. METHODS: Cylindrical implants were inserted in the tibial epiphysis of rabbits and left to heal for 1 to 42 days. Samples were processed into paraffin or methylmethacrylate sections and histomorphometrically analyzed. RESULTS: A hematoma was observed after 1 and 3 days of implant placement. In addition, small fragments of bone trabeculae were detected around the implant as a result of the implant installment procedure. Soon, osteoclasts were observed resorbing these fragments, whereas osteoblasts incorporated them in strands of new bone, thereby making them difficult to distinguish from day 7 onward. At that time, osteoblasts were detected at the edges of the preexisting bone, actively depositing new bone, resulting in maximal osteoid deposition around the implant after 28 days (58%). After 7 days of healing, the presence of basic remodeling units in the surrounding bone was already maximal (P <0.05 versus t = 1 and 3 days). This remodeling activity, together with the new bone formation, provided a firm anchoring of the implant in the trabecular bone. CONCLUSIONS: This study evaluated the early cellular events in trabecular bone surrounding titanium implants. The insertion of an implant into bone initiates a series of biologic processes, including the formation of a hematoma, shattered bone fragments adjacent to the implantation site, intensive bone remodeling, and the formation of new bone, eventually leading to the osseointegration of the implant.