| Month :
| Volume :
| Issue :
| Page :
319 - 324
Implant Surface Modifications:
Correspondence Address :
Dr. Hemlata Garg, C-5/1, Krishna Nagar, Delhi -51.
The aim of the present review was to elaborate on the surface modifications of biomaterials which are used in implant dentistry. The ongoing studies on the clinical and laboratory phases and on the biomaterial sciences have largely aimed at invoking a stronger bone response and an earlier and longer functional loading. Surgical grafting procedures to improve the bone bed are used to create an ideal environment for the implant functioning. The implant selection which is based on the available bone, is also an important determiner of the long term clinical success. The interfacial zone between the implant and the bone is composed of a relatively thin layer (<100um) which consists of heterogenous metallic oxide, proteins and connective tissue. The integrity of the implant â€“ tissue interface is dependent on the material and on mechanical, chemical, surface, biological and local environmental factors, all of which change as a function of time in vivo. Because a stable interface must be developed before the loading, it is desirable that the tissue apposition may be accelerated to the implant surface. The material developments that have been implemented in the clinical practice include the use of surface roughened implants and bioactive ceramic coatings. Osseointegration occurs around the screw threaded implants through the tissue ongrowth or through a direct apposition between the tissue and the implant surface. The alternative methods of the implant-tissue attachments, based on the tissue ingrowth into roughened or three dimensional surface layers, yield a higher bone metal shear strength and decreased implant loosening. A positive effect of various surface modifications which are illustrated in this review, has been observed and suggested by many groups.
Hydrophilic surface Laser etching Nanotitania Osseointegration Aniodized implants Biotolerant
An implant is a medical device which is made from one or more biomaterials, that is intentionally placed in the body either totally or that is partially buried beneath an epithelial surface (1). Osseointegration is the foundation of implant sciences and infinite articles have been published on the various aspects of manufacturing the implants and on the clinical and laboratory phases of implants. The implant machining, surface, designing, surgical techniques and the peri-implant considerations have all progressed from infancy to the state of art and science and continue to evolve with each passing year. The surface characteristics at the micro or nanometre level, hydrophilicity, biochemical bonding and other features are few of the determiners which are responsible for the implantâ€™s success (2).
Osseointegration per se is not linked to certain defined surface characteristics, since a great number of different surfaces achieve osseointegration. However, the stronger or weaker bone responses may be related to the surface phenomenon (2). The bone implant interface can be controlled by the selection and modification of the biomaterial from which is made. These include morphological, physiochemical and biochemical methods. The morphological methods involve alterations in the surface morphology and roughness, such as hydroxyapatite coating or blasting and etching. The physiochemical methods involve modification of the surface energy, the surface charge and the surface composition. The biochemical surface modification endeavours to utilize the current understanding of the biology and the biochemistry of the cellular function and differentiation (3). The biomaterials which are used most commonly for the dental implants are metals and their alloys, namely commercially pure titanium (1-4grades) and titanium alloys like Ti-6Al-4V, which are used most commonly as endosseous implants. The metallic implants undergo modifications such as passivation, anodization, ion implantation and texturing (4). Our aim was to review the surface modifications of the titanium based implants, some of the techniques of the modifications and the newer formulations.
Some studies (41) support the hypothesis that in case of a favourable bone quality implant, the surface roughness plays a minor role. A positive influence of the moderate rough surfaces on the early loading concepts has been suggested by many groups. A positive effect of the surface roughness has been observed in poor quality bone, but the pivotal proof of this effect is still lacking, according to some studies. Some indications which support the selection of HA coated implants over metallic implants include, the need for a greater bone implant interface contact and the ability to be placed in type IV bone, fresh extraction sites and newly grafted sites (4).
Jayaswal GP, Dange SP, Khalikar AN. Bioceramics in dental implants: A review. J Indian Prosthodont Soc. 2010; 10:8-12.
Wennerberg A, Albrektsson T. On implant surfaces: A review of the current knowledge and opinions. Int J Oral Maxillofac Implants 2010;25(1):63-74.
Muddugangadhar BC, Amarnath GS, Tripathi S, Dikshit S, Divya MS. Biomaterials for dental implants: An overview. Int J Oral Implantology Clin Res 2011;2(1):13-24.
Anusavice Kenneth J. Philips Science of Dental Materials. 11th ed. St Louis; Saunders Elsevier: 2005.
Wennerberg A, Ektessabi A, Albrektsson T, Johansson C, Andersson B. A 1-year follow up of implants of differing surface roughness which were placed in a rabbit bone. Int J Oral maxillofac Implants 1997; 12(4):486-94.
Wennerberg A, Albrektsson T. Suggested guidelines for the topographical evaluation of implant surfaces. Int J OralMaxillofac Implants 2000; 15:331-44.
Wennerberg A, Albrektsson T, Andersson B. The design and surface characteristics of 13 commercially available oral implant systems. Int J Oral Maxillofac Implants 1993; 8:622-33.
Chehroudi B, Gould TRL, Brunette DM. Titanium-coated micromachined grooves of different dimensions affect the epithelial and connective-tissue cells differently in vivo. J Biomed Mater Res 1990; 24:1203-19.
Orsini G, Assenza B, Scarano A, Piatteli M, Piatteli A. Surface analysis of machined versus sand blasted and acid etched Ti implants. Int J Oral Maxillofac Implants 2000; 15(6):779-84.
Coelho PG, Cardaropoli G, Suzuki M, Lemons JE. Histomorphometric evaluation of a nanothickness of bioceramic deposition on endosseous implants: A study in dogs. Clin Implant Dent Rel Res 2009; 11(4):292-302.
Ducheyne P, Willems G, Martens M, Helsen J. In vivo metal ion release from porous titanium-fibre material. J Biomed Mater Res 1984; 18:293-308.
Kummer FJ, Ricci JL, Bluementhal NC. RF plasma treatment of the metallic implant surfaces. J Applied Biomater 1992; 3:39-44.
Woodman JL, Jacobs JJ, Galante JO, Urban R. Metal ion release from titanium-based prosthetic segmental replacements of the long bones in baboons: A long term study. J Orthop Res 1984; 1:421-30.
Savarino L, Cenni E, Stea S, Donati ME, Paganetto G, Moroni A, et al. X-ray diffraction of newly formed bone which was close to the alumina or the hydroxyapatite-coated femoral stem. Biomaterials 1993; 14: 900-05.
Osborn JF, Willich P, Meenen N. The release of titanium into the human bone from a titanium implant which was coated with plasma sprayed titanium. In: Heimke G, Solteoz U, Lee AJC (eds). Clinical implant material. Advances in Biomaterials: Amsterdam: Elsevier Science, 1990;9-75-80.
Ducheyne P. Titanium and calcium phosphate ceramic dental implants, surfaces, coatings and interfaces. J Oral Implantol 1988; 14: 325-440.
Blumenthal NC, Cosma V. Inhibition of apatite formation by the titanium and the vanadium ions. J Biomed Mater Res Appl Biomater 1989; 23:13-22.
Memoli VA, Woodman JL, Urban RM, Galante JO. Long term biocompatibility of the porous titanium fibre metal composites [Abstract]. Presented at the 29th Annual Orthopaedic Research Society, Anaheim, California, 8-10 Mar 1983.
Lugowski SJ, Smith C, McHugh AD, Van Loon JC. Release of metal ions from dental implant materials in vivo: Determination of Al, Co, Cr, Mo, Ni, V and Ti in organ tissues. J Biomed Mater Res 1992; 25:1443-58.
Jimbo R, Sawase T, Baba K, Kurogi T, Shibata Y, Atsuta M. Enhanced initial cell responses to chemically modified anodized titanium. Clin Implant Dent Relat Res 2008; 10:55-61.
Ellingsen JE, Johansson CB, Wennerberg A, Holmen A. Improved retention and the bone to implant contact with fluoride modified titanium implants. Int J Oral Maxillofac Implants 2004; 19(5):659-66.
Occuzzo M, Wilson Jr, Thomas G. A prospective study of the 3 weeks loading of chemically modified titanium implants in the maxillary molar region: 1-year results. Int J oral Maxillofac Implants 2009; 24(1):65-72.
Jarmer T, Palmquist A, Branemark R, Hermansson L, Engqvist H, Thomsen P. Characterization of the surface properties of commercially available dental implants by using scanning electron microscopy, a focussed ion beam, and high resolution transmission electron microscopy. Clin Implant Dent Rel Res 2008; 10(1):11-22.
Guo Z, Zhou L, Rong M, Zhu A, Geng H. Bone response to a pure titanium implant surface which was modified by laser etching and microarc oxidation. Int J oral Maxillofac Implants 2010; 25(1):130-36.
Li LH, Kong YM, Kim HW, et al. Improved biological performance of the Ti implants due to surface modifications by micro-arc oxidation. Biomaterials 2004; 25:2867-75.
Gaggl A, Shultes G, Muller WD, Karcher H. Scanning electron microscopical analysis of laser treated titanium implant surfaces-A comparative study. Biomaterials 2000; 21:1067-73.
Cho SA, Jung SK. A removal torque of the laser treated titanium implants in rabbit tibia. Biomaterials 2003; 24:4859-63.
Hallgren C, Reimers H, Chakarov D, Gold J, Wennerberg A. An in vivo study of the bone response to implants which were topographically modified by laser micromachining. Biomaterials 2003; 24:701-10.
Itala AL, Ylanen HO, Ekholm C, Karlsson KH, Aro HT. A pore diameter of more than 100mm is not a requisite for the bone ingrowth in rabbits. J Biomed Mater Res 2000; 58:679-83.
Sul YT, Johansson CB, Petronis S, et al. Characteristics of surface oxides on turned and electrochemically oxidized pure titanium implants upto the dielectric breakdown: The oxide thickness, micropore configurations, surface roughness, crystal structure and chemical composition. Biomaterials 2002; 23:491-501.
Han Y, Xu K. Photoexcited formation of bone apatite-like coatings on micro-arc oxidized titanium. J Biomed Mater Res A 2004; 71:608-14.
Zhu L, Ye X, Tang G, et al. The corrosion test, the cell behaviour test, and an in vivo study of the gradient TiO2 layers which were produced by compound electrochemical oxidation. J Biomed Mater Res A 2006; 78:515-22.
Nasatzky E, Gultchin A, Schwartz Z. The role of surface roughness in promoting osseointegration. Refuat Hapeh Vehashinayim 2003; 20(3):8-19.
Deppe H, Warmuths, Heinrich A, Kroner T. Laser assisted three dimensional surface modifications of the titanium implants: Preliminary data.Lasers Med Sci 2005; 19:229-33.
Song WH, Jun YK, Han Y, Hong SH. Biomimetic apatite coatings on micro-arc oxidized titania. Biomaterials 2004; 25:3341-49.
Sul YT, Johansson C, Albrektsson T. Which surface properties enhance the bone response to implants? A comparison of the oxidized magnesium, TiUnite and the Osseotite implant surfaces. Int J Prosthodont 2006; 19:319-28.
Mohammadi S, Esposito M, Hall J, Emanuelsson L, Krozer A, Thomsen P. Long term bone response to titanium implants which were coated with thin, radiofrequent, magnetron-sputtered hydroxyapatite in rabbits. Int J Oral Maxillofac Implants 2004; 19(4):498-509.
Meirelles L, Melin L, Peltola T, Kjellin P, Kangasniemi I, Currie F, et al. Effect of the hydroxyapatite and the titania nanostructures on the early in vivo bone response. Clin Implant Dent Rel Res 2008; 10(4): 245-54.
Sykaras N, Woody Ronald D, Lacopino Anthony M, Triplett Gilbert R, Nunn Martha E. Osseointegration of dental implants which were complexed with rhBMP-2: A comparative histomorphometric and radiographic evaluation. Int J Oral Maxillofac Implants 2004; 19(5): 667-78.
Maurya K, Dua JS, Chawla S, Sonoo PR, Aggarwal A, Singh V. Polyetheretetherketone (PEEK) dental implants: A case for immediate loading. Int J Oral Impl Clin Res 2011; 2(2):97-103.
Nawab Al B, Pangen U, Duschner H, Krummenauer F, Wagner W. Turned, machined vs double etched dental implants in vivo. Clin Implant dent Rel Res 2007; 9(2):71-78.
DOI and Others
Financial OR OTHER COMPETING INTERESTS:
Date Of Submission: Nov 17, 2011
Date Of Peer Review: Jan 23, 2012
Date Of Acceptance: Jan 24, 2012
Date Of Publishing: Apr 15, 2012
JCDR is now Monthly
and more widely Indexed
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)