Osseointegration enhanced by chemical etching of the titanium surface. A torque removal study in the rabbit.

Roughened implant surfaces are thought to enhance osseointegration. Torque removal forces have been used as a biomechanical measure of anchorage or osseointegration in which the greater forces required to remove implants may be interpreted as an increase in the strength of osseointegration. The purpose of this study was to compare the torque resistance to removal of screw shaped titanium implants having an acid etched (HCl/H₂SO₄) surface (Osseotite®) with implants having a machined surface. Two custom screw shaped implants, 1 acid etched and the other machined, were placed into the distal femurs of 10 adult New Zealand White rabbits. These implants were 3.25 mm in diameter x 4.00 mm in length without holes, grooves or slots to resist rotation. Following a 2 month healing period, the implants were removed under reverse torque rotation with a digital torque measuring device. Two implants with the machined surface preparation failed to achieve osseointegration. All other implants were found to be anchored to bone. Resistance to torque removal was found to be 4 x greater for the implants with the acid etched surface as compared to the implants with the machined surface. The mean torque values were 20.50 ± 6.59 N cm and 4.95 ± 1.61 N cm for the acid etched and machined surfaces respectively. The results of this study suggest that chemical etching of the titanium implant surface significantly increases the strength of osseointegration as determined by resistance to reverse torque rotation.     

Evaluation of stability of titanium and hydroxyapatite-coated osseointegrated dental implants: a pilot study

An endosseous implant is described as osseointegrated when it is immobile in function. Objective measures of stability testing have been described. The Periotest is a commercially available device that is used for this purpose. This study was designed to measure stability of endosseous implants placed in the mandible. Implants were placed in the mandibular canine or first premolar area to support an overdenture prosthesis. Stability was evaluated through the use of a Periotest device at the time of implant placement and following one year of functional loading. Implant designs were either a screw-shaped titanium alloy or a hydroxyapatite-coated cylinder. A total of 54 implants were placed, 37 were titanium screw-shaped implants, while the remaining 17 were hydroxyapatite cylinders. Initial measurements of stability showed no difference due to implant type. Following one year of functional loading, titanium screw-shaped implants were more stable than hydroxyapatite implants (P < 0.05). The difference in implant rigidity following a period of functional loading may be an indication of a difference in osseointegration between the two implants used in this study.     

Harder and stiffer bone osseointegrated to roughened titanium

Mechanisms underlying the beneficial anchorage of roughened titanium implants have not been identified. We hypothesized that the implant surface roughness alters intrinsic biomechanical properties of bone integrated to titanium. Nano-indentation performed on two- and four-week post-implantation bone specimens of rats revealed that bone integrated to acid-etched titanium was approximately 3 times harder than that integrated to the machined titanium, both at the osseointegration interface and at the inner area of the peri-implant bone. The hardness of the acid-etched surface-associated bone was equivalent to that of untreated cortical bone at week 4, while the bone hardness around the machined surface was equivalent to that of the untreated trabecular bone. The elastic modulus of the integrated bone was 1.5 to 2.5 times greater around the acid-etched surface than around the machined surface. Analysis of the data suggests that the implant surface roughness affects the biomechanical quality of osseo-integrated bone, and that the bone integrated to the acid-etched surface is harder and stiffer than the bone integrated to the machined surface.     

Removal torque and histomorphometric investigation of 4 different titanium surfaces: an experimental study in the rabbit tibia

This study presents a histomorphometric and biomechanical comparison of bone response to commercially pure titanium screws with 4 different types of surface topographies placed in the tibial metaphysis of 12 rabbits. Each rabbit had 4 implants placed, 2 in each tibia. The 4 surface topographies were a machined surface, a grit-blasted surface, a plasma-sprayed surface, and an acid-etched (Osseotite) surface. After a healing period of 5 weeks, histomorphometric and removal torque data revealed a significantly higher percentage of bone-to-implant contact and removal torque for acid-etched implants compared to machined, blasted, and plasma-sprayed implants. Within the limits of this short-term experimental study, the results indicated that micro-rough titanium surfaces obtained with acid-etching procedures achieved a 33% greater bone-to-implant contact over machined titanium surfaces with an abutment-type roughness and provided enhanced mechanical interlocking.     

二氧化钛纳米管对兔胫骨内种植体旋转扭力的影响

目的　通过兔子动物模型评估种植体表面不同管径的TIO2纳米管对成骨细胞黏附、种植体扭力和成骨基因表达的影响。方法　将24个订做的螺旋状的长为6 mm,外径为2.5 mm的纯钛种植体分为3组。A组：对照组平滑面种植体;B组：表面为30 nm管径TiO2纳米管的种植体;C组：表面为70 nm管径TiO2纳米管的种植体。分别将种植体植入兔子胫骨,手术后四周,处死兔子,采用数字扭力仪通过反向旋转取下腿部种植体,测量种植体扭力,通过扫描电子显微镜分析种植体表面成骨细胞的粘附,通过实时PCR检测核心结合因子（Runx2）、胰岛素样生长因子（IGF）、I型胶原（col 1）和骨钙素（OCN）的基因表达水平。结果　表面为70 nm管径TiO2纳米管的种植体可以增强兔胫骨内种植体的扭力（P＜0.05）,并显著性的提高Runx2、IGF、col 1和 OCN等成骨基因的表达水平（P＜0.05）。结论　相对于30 nm管径纳米管,表面为70 nm管径纳米管的种植体可以获得良好的成骨反应,并且在早期植入期具有较高的界面强度。     

A multi-center study comparing dual acid-etched and machined-surfaced implants in various bone qualities

BACKGROUND: A major reason for the success of modern dental implant systems has been the development of implant designs that enhance direct bone-implant interface. Surface roughness has been a factor in this success and different systems have utilized very different implant surface roughness. The major purpose of this study was to evaluate 2 similar implants with different surface roughness characteristics. METHODS: Two similarly designed, screw-type, commercially pure titanium implants, one dual acid-etched (DAE) and the other machined-surfaced (MS), were compared in this prospective, randomized-controlled, multi-center study, in which a total of 97 patients were enrolled at a private dental practice or a university dental clinic. Both implant types were placed in each patient using a 2-stage approach with a conventional 4- to 6-month healing period. Implants supported fixed prostheses, hybrid prostheses, and overdentures as dictated by the individual patient's need. All of the cases were followed using clinical and radiographic examinations. Criteria of success were the absence of peri-implant radiolucency, mobility, and persistent signs or symptoms of pain or infection. RESULTS: Of the 432 implants (247 dual acid-etched, 185 machined-surfaced), 36 implants (12 dual acid-etched and 24 machined-surfaced) have failed. The pre-loading integration success rate of the dual acid-etched implants (95.0%) was statistically higher (P < 0.01) than the success rate of the machined-surfaced implants (86.7%). At 36 months, the cumulative success rates (CSR) are 95.0% for the dual acid-etched implants and 86.7% for the machined-surfaced implants. CONCLUSIONS: The difference in success rates is most likely attributed to the acid-etched surface characteristics. The greatest performance difference is observed in the conditions of poor quality or soft bone where the 3-year post-loading CSR are 96.8% (dual acid-etched) and 84.8% (machined-surfaced).     

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.     

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.     

Influence of nicotine administration on different implant surfaces: a histometric study in rabbits

BACKGROUND: This study investigated the influence of implant surface on osseointegration around titanium implants inserted in the tibiae of rabbits administered with nicotine. METHODS: Thirty-two (32) New Zealand rabbits were included in the study. After anesthesia, the tibia surface was exposed and 2 screw-shaped commercially available pure titanium implants 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 1 of 4 treatment subgroups, and daily subcutaneous injections of nicotine were administered: A) saline solution; B) 0.37 mg/kg; C) 0.57 mg/kg; and D) 0.93 mg/kg. In order to label regenerated bone, a 2% calcein green solution was administered by intramuscular injection at 0, 7, and 15 days after implant insertion. After 42 days, the animals were sacrificed and undecalcified sections were prepared. The degree of bone contact with the implant surface, the bone area, and the intensity of bone labeling were measured into the limits of the implant threads. RESULTS: Statistical analysis (2-way ANOVA) revealed no significant difference regarding the effect of nicotine on bone healing around the implants (P>0.05). However, a significant influence of the implant surface on the degree of bone-to-implant contact was detected in groups C (30.13 +/- 4.97 and 37.85 +/- 8.85, for machined and Al2O3-blasted surfaces, respectively) and D (27.79 +/- 3.93 and 33.13 +/- 8.87, for machined and Al2O3-blasted surfaces, respectively) (P<0.05). CONCLUSIONS: Although nicotine administration may not statistically influence bone healing around titanium implants, implant surface design may enhance osseointegration after nicotine administration.     

Bone reactions adjacent to titanium implants with different surface characteristics subjected to static load. A study in the dog (II)

The purpose of the present study was to compare bone reactions adjacent to titanium implants with either a titanium plasma-sprayed (TPS) or a machined surface subjected to lateral static loading induced by an expansion force. In 3 labrador dogs, the 2nd, 3rd and 4th mandibular premolars were extracted bilaterally. 12 weeks later, 2 implants with a TPS surface were placed in one side and 2 implants with a machined surface were placed in the contralateral side. Twelve weeks after implant installation, crowns, connected in pairs with orthodontic expansion screws, were fitted to the implants and a 0.6 mm wide expansion was initiated. Clinical registrations, standardized radiographs and fluorochrome labeling were carried out during a 24-week period of loading. Biopsies with the implants in situ were harvested and processed for ground sectioning. The sections were subjected to histologic and histometric examination. A higher marginal bone level was observed around implants with a TPS surface compared to machined implants. Furthermore, the values describing the amount of bone-to-implant contact at the bone/implant interface as well as the density of the peri-implant bone were lower at the machined than at the TPS implants.     

The anchorage of Brånemark and ITI implants of different lengths. I. An experimental study in the canine mandible

Abstract: The anchorage of machined Brånemark and ITI TPS‐coated implants of various lengths was investigated in an animal model. Brånemark fixtures 7 and 10 mm long and ITI implants 6 and 10 mm long were inserted in the mandible of dogs and were reverse‐torqued after 3 months of healing. The failing mode was different for the two implant systems. For the ITI implants, loosening coincided with the peak reverse‐torque values. For the Brånemark fixtures, two reverse‐torque values were identified and recorded, a ‘start to rotate’ and a peak value. The ‘start to rotate’ values for the 7 and 10 mm Brånemark fixtures were 36.67 and 38.57 Ncm, respectively, the peak values were 61.88 and 69.13 Ncm. The increase in implant length from 7 to 10 mm did not significantly improve the anchorage. The mean reverse‐torque values for the 6‐ and 10‐mm ITI implants were 104.66 and 192.25 Ncm, respectively; the difference was statistically significant. The mean removal torque of the 6‐mm ITI implant was higher than the 7‐ and 10‐mm Brånemark implants. It is suggested that the distinct anchorage magnitude and the distinct loosening patterns registered for both implant systems might be related to the various surface states. The latter might account for the different failure tendencies mentioned in the literature for short Brånemark and ITI implants.     

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.     

The effects of implant surface roughness and surgical technique on implant fixation in an in vitro model

OBJECTIVES: The aim of the present study was to determine the relationship between implant surface parameters, surgical approach and initial implant fixation. MATERIAL AND METHODS: Sixty tapered, conical, screw-shaped implants with machined or etched surface topography were implanted into the explanted femoral condyle of goats. The implant sites were prepared either by a conventional technique, by undersized preparation, or by the osteotome technique. Peak insertion & removal torque, bone-to-implant contacts (BIC) and morphological bone appearance were assessed by scanning electron microscope (SEM) and micro-computer tomography. (micro-CT). RESULTS: Insertion and removal torque values were significantly higher for etched implants inserted with the undersized technique (115.2 +/- 31.1, 102.9 +/- 36.4 N cm) respectively. Also, the average BIC value was higher for the etched implants placed with the undersized technique (87.5 +/- 5.6), which was statistically significant compared with machined and etched implants inserted by conventional technique. CONCLUSION: In conclusion, this study shows that the surgical technique has a decisive effect on implant fixation (represented in this study by installation torque value/removal torque value and histomorphometric evaluation) in trabecular bone. Nevertheless, additional in vivo studies have to be done to prove the importance of surgical protocol for the final implant-bone response.     

Effects of implant thread geometry on percentage of osseointegration and resistance to reverse torque in the tibia of rabbits

BACKGROUND: Dental implant thread geometry has been proposed as a potential factor affecting implant stability and the percentage of osseointegration. Therefore, the aim of this prospective, randomized, parallel arm study was to evaluate the effects of dental implant thread design on the quality and percent of osseointegration and resistance to reverse torque in the tibia of rabbits. METHODS: Seventy-two custom-made, screw-shaped, commercially pure titanium implants (3.25 mm diameter x 7 mm length) were placed in the tibiae of 12 white New Zealand rabbits. Each tibia received three implants of varying thread shapes: one with a V-shaped, one with a reverse buttress, and one with a square thread design. The rabbits were sacrificed following an uneventful healing period of 12 weeks. Implants in the right tibiae underwent histologic and histomorphometric assessments of the bone-to-implant contact (BIC) and the radiographic density of surrounding bone, while implants in the left tibiae were used for reverse-torque testing. Differences between the three thread designs were examined using analysis of variance (ANOVA). RESULTS: Data showed that the square thread design implants had significantly more BIC and greater reverse-torque measurements compared to the V-shaped and reverse buttress thread designs, while no differences were found in radiographic bone density assessments. CONCLUSION: These results indicate that the square thread design may be more effective for use in endosseous dental implant systems.     

Effect of modifications of dual acid-etched implant surfaces on periimplant bone formation. Part II: calcium phosphate coatings

Abstract: The aim of the present study was to test the hypothesis that calcium phosphate coatings of dual acid-etched surfaces (DAEs) can improve periimplant bone regeneration. Ten adult female foxhounds received experimental titanium screw implants in the mandible 3 months after removal of all premolar teeth. Five types of surface states were evaluated in each animal: (i) implants with a machined surface (MS) (Control 1); (ii) implants with a DAE (Control 2); (iii) implants with a DAE coated with collagen I (Control 3); (iv) implants with a DAE with mineralized collagen I; and (v) implants with a DAE with a hydroxylapatite (HA) coating. Periimplant bone regeneration was assessed by histomorphometry after 1 and 3 months in five dogs each by measuring bone implant contact (BIC) and the volume density of the newly formed periimplant bone (BVD). After 1 month, mean BIC of experimental implants did not differ significantly from implants with DAE and collagen-coated surfaces, but was significantly higher than the MS implants. BVD was enhanced significantly only in implants with mineralized collagen coating compared with DAE and collagen-coated controls. After 3 months, the mean values of BIC had increased significantly in the group of implants with HA and mineralized collagen coating but were not significantly different from implants with DAE and collagen-coated surfaces. The same held true for the mean BVD values. In conclusion, the present study could not verify the hypothesis that calcium phosphate coatings of DAEs in the present form enhanced periimplant bone formation compared with the DAE surface alone.     

A histologic and histomorphometric evaluation of two types of retrieved human titanium implants

This study analyzed the interfacial human bone response to retrieved implants that had been functionally loaded in the human environment. A solid-screw titanium plasma-sprayed (TPS) implant was removed 5 years after implantation because of a fracture at the joint between the implant and the crown. A sand-blasted acid-etched titanium implant (SLA) was used as an anchorage for orthodontic treatment. At the end of the treatment, the SLA implant was removed. Both types were functionally loaded without any symptoms expressed by the patients. Histology showed bone contact between the TPS or the SLA implant and surrounding bone, but the SLA implant revealed much more interfacial bone contact. The contact microradiograms showed that the bone surrounding the TPS and SLA implants was highly calcified. The measured percentage of bone-implant contact around the SLA implant was significantly higher (P <.05) than that around the TPS implant.     

The effect of a machined collar on coronal hard tissue around titanium implants: a radiographic study in the canine mandible

PURPOSE: The purpose of this study was to radiographically evaluate the effect of a machined titanium coronal collar on the marginal bone around 1-part endosseous dental implants placed at different heights relative to the bone crest. MATERIALS AND METHODS: Sixty dental implants were placed in edentulous spaces bilaterally in 5 foxhounds. Thirty test implants had a sandblasted, large-grit, dual acid-etched surface (SLA) over the entire length of the implant. The other 30 implants (control) had a machined collar around the most coronal 1.8 mm of the implant; an SLA surface covered the remainder of the implant. Both control and test implants were placed at 3 distinct levels relative to the bone crest. Six implants (3 control and 3 test) were randomly placed side by side in each hemimandible. Radiographs were taken at placement (baseline) and monthly for 6 months postplacement using a standardized radiographic template. RESULTS: Fifty-eight of the implants integrated and were analyzed on each proximal surface. Bone loss occurred around all implants over the 6 months of the study. In general, implants placed with the top of the SLA surface above the bone crest had significantly less bone loss than implants with the top of the SLA surface placed flush with the bone level. Apically placed implants had greater bone loss than coronally placed implants. The magnitude of bone loss around paired control and test implants was approximately the same. DISCUSSION AND CONCLUSION: The least bone loss with each implant type was observed when the top of the implant was placed above the alveolar crest. When there was no machined collar, the least distance from the implant top to the bone crest (not, however, the least bone loss) was observed when the top of the implant was level with the bone crest.     

The role of surface roughness in promoting osteointegration

Scientific evidence that has been gathered in the past 20 years established that certain endosseous dental implants--primarily screw-type implants made of commercially pure titanium can be successfully utilized as anchorage for dental prostheses. In recent years, an effort has been made to simplify the surgical procedure, in order to modify clinical treatment modalities. One of the trends is to increasingly utilize microrough titanium implants. Roughened implant surfaces have a long history in implant dentistry, and the most prominent surface is titanium plasma-sprayed (TPS). In recent years new implant surfaces have emerged, so-called microrough titanium surfaces produced with reducing techniques such as grit-blasting with Al2O3 or TiO2 particles, sandblasting and acid-etching, or acid-etching alone. These different titanium surfaces have been tested in numerous in-vivo studies utilizing different animal models. Summarizing the results of these studies, it can be concluded that there is currently sufficient evidence that titanium implants with a microrough surfaces achieve a faster bone integration, a higher percentage of Bone implant Contact (BIC), and a higher resistance to shear documented with higher Removal Torque Values (RTV) when compared with titanium implants with a polished or machined surface. In order to understand the mechanism through which surface roughness modulates its effects mentioned above, recent studies used in-vitro experimental methods to study cell response to implant surface topography. These studies have shown that osteoblasts are sensitive to surface roughness, exhibiting decreased proliferation and a more differentiated phenotype on rougher surfaces. PGE2 production is enhanced on rough surfaces, as is the production of TGF beta 1, suggesting that surface roughness can mediate autocrine and paracrine regulation of osteogenesis. Moreover, surface roughness was found to modulate the effect of systemic hormones like 1,25-(OH)2D3 on osteoblasts. The clinical advantages of implants with rough surface were observed in recently conducted clinical trials. It was found, in humans, that roughened titanium implants need shorter healing period before loading, 6-8 (SLA and Osseotite respectively) weeks instead of 12 weeks. The clinical advantages of shorter healing periods are obvious. Moreover, it was found that certain roughened implants can be used in shorter sizes (6-8 mm) then accepted today. The utilization of shorter implants offers the avoidance of extensive surgical procedures such as nerve lateralization in the mandible or sinus grafting in the maxilla. However, sufficient long term documentation is still lacking, and the predictability of such modalities has yet to be examined in long term prospective clinical trials.     

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.