Literatura – Ossean

IMPLANT SURFACE

1 – Nanometer-scale features onmicrometer-scale surface texturing: A bone histological, gene expression, and nano mechanical study

Paulo G. Coelho, Tadahiro Takayama, Daniel Yoo, Ryo Jimbo, Sanjay Karunagaran, Nick Tovar, Malvin N. Janal, Seiichi Yamano.

Bone, Issue 65, Aug. 2014. Bone (2014), http://dx.doi.org/10.1016/j.bone.2014.05.004

ABSTRACT

Article History: Micro- and nanoscale surfacemodifications have been the focus ofmultiple studies in the pursuit of accelerating 24bone apposition or osseointegration at the implant surface. Here, we evaluated histological and nanomechanical 25properties, and gene expression, for a microblasted surface presenting nanometer-scale texture within a26micrometer-scale texture (MB) (Ossean™ Surface, Intra-Lock International, Boca Raton, FL) versus a dual-acid27etched surface presenting texture at the micrometer-scale only (AA), in a rodent femur model for1, 2, 4, and 288 weeks in vivo.

Following animal sacrifice, samples were evaluated in terms of histomorphometry, biomechanical29 properties through nanoindentation, and gene expression by real-time quantitative reverse transcription 30polymerase chain reaction analysis. Although the histomorphometric, and gene expression analysis results 31were not significantly different between MB and AA at 4 and 8 weeks, significant differences were seen at 1 32and 2 weeks.

The expression of the genes encoding collagen type I (COL-1), and osteopontin (OPN) was significantly33 higher for MB than for AA at 1 week, indicating up-regulated osteoprogenitor and osteoblast differentiation34. At 2 weeks, significantly up-regulated expression of the genes for COL-1, runt-related transcription factor 2 35(RUNX-2), osterix, and osteocalcin (OCN) indicated progressive mineralization in newly formed bone.

The nanomechanical36 properties tested by the nanoindentation presented significantly higher-rank hardness and elastic 37modulus for the MB compared to AA at all time points tested. In conclusion, the nanotopographical featured 38 surfaces presented an overall higher host-to-implant response compared to the microtextured only surfaces.

39 The statistical differences observed in some of the osteogenic gene expression between the two groups may40shed some insight into the role of surface texture and its extent in the observed bone healing mechanisms. 4142 © 2014 Published by Elsevier Inc.

2 – Identification card and codification of the chemical and morphological characteristics of 62 dental implant surfaces. Part 1: description of the Implant Surface Identification Standard (ISIS) codification system.

David M. Dohan Ehrenfest, Marco Del Corso, Byung-Soo Kang, Philippe Leclercq, Ziv Mazor, Robert A. Horowitz, Philippe Russe, Hee-Kyun Oh, De-Rong Zou, Jamil Awad Shibli, Hom-Lay Wang, Jean-Pierre Bernard, and Gilberto Sammartino.

POSEIDO. 2014;2(1):7-22.

ABSTRACT

Dental implants are commonly used in dental therapeutics, but dental practitioners only have limited information about the characteristics of the implant materials they take the responsibility to place in their patients. Manufacturers, scientists and administrations are also lacking of a consensual and clear method and terminology to characterize and control implant surfaces.

The objective of this series of 5 articles is to define and describe the Implant Surface Identification Standard (ISIS) system for the chemical and morphological characterization of dental implant surfaces, and to use it to characterize and establish the respective Identification (ID) Card and code of 62 implant surfaces available on the market. In this first part, the current version of the ISIS system and methodology is described and discussed.

Using standardized protocols of analysis and terminology, each osseointegrated implant surface can be defined using a standardized characterization code. First the ISIS codification system describes the surface chemical composition: the core material (titanium grades, zirconia, hydroxy-apatite) and the chemical modification (impregnation, coating, pollution). The system then defines the surface morphology (topography, structures) at the microscale (microroughness, micropores, microparticles) and nanoscale (nanoroughness, nanopatterning, nanotubes, nanoparticles, nanosmooth), and its global architecture (homogeneity, cracks, fractal architecture).

This standardized characterization, classification and codification system allows to clarify the identity of each surface and to easily sort out their differences, to control implant production and to facilitate communication. Therefore it offers a global solution for the manufacturers, scientists, implant users, administrative authorities and the interactions of these 4 actors, and it could be suggested as the basis of an ISO standard in the future.Keywords. Dental implant, nanostructure, osseointegration, surface properties, titanium.

3 – Identification card and codification of the chemical and morphological characteristics of 62 dental implant surfaces. Part 2: anodized and Titanium Plasma-Sprayed (TPS) surfaces (Group 1, metallurgy modification).

David M. Dohan Ehrenfest, Marco Del Corso, Byung-Soo Kang, Philippe Leclercq, Ziv Mazor, Robert A. Horowitz, Philippe Russe, Hee-Kyun Oh, De-Rong Zou, Jamil Awad Shibli, Hom-Lay Wang, Jean-Pierre Bernard, and Gilberto Sammartino.

POSEIDO. 2014;2(1):23-35.

ABSTRACT

Background and Objectives: Platelet concentrates for surgical use (Platelet-Rich Plasma PRP or Platelet-rich fibrin PRF) are surgical adjuvants to improve healing and promote tissue regeneration. L-PRF (Leukocyte- and Platelet-Rich Fibrin) is one of the 4 families of platelet concentrates for surgical use and is widely used in oral and maxillofacial regenerative therapies. The objective of this first article was to evaluate the mechanical vibrations appearing during centrifugation in 4 models of commercially available table centrifuges frequently used to produce L-PRF.

Materials and Methods: The 4 different tested centrifuges were the original L-PRF centrifuge (Intra-Spin, Intra-Lock, the only CE and FDA cleared system for the preparation of L-PRF) and 3 other laboratory centrifuges (not CE nor FDA cleared for L-PRF): A-PRF 12 (Advanced PRF, Process), LW – UPD8 (LW Scientific) and Salvin 1310 (Salvin Dental). Each centrifuge was opened for inspection, two accelerometers were installed (one radial, one vertical), and data were collected with a spectrum analyzer. Each centrifuge was tested in 2 configurations (full-load or half load with 9ml blood collection tubes filled with water) and at the following rotational speeds: 1500, 1800, 2100, 2400, 2700, 3000 and 3300 rpm. Extra rotational speeds were used on some centrifuges. One centrifuge (Salvin) had only one available rotational speed (3400 rpm). For each test, the software documented both radial and vertical vibration.

Results: Very significant differences in the level of vibrations at each rotational speed were observed between the 4 tested machines. The original L-PRF centrifuge (Intra-Spin) was by far the most stable machine in all configurations. At the classical speed of production of L- PRF, the level of undesirable vibration on this centrifuge is between 4.5 and 6 times lower than with other centrifuges. Moreover, Intra-Spin always remains under the threshold of resonance, unlike the 3 other tested machines.

Discussion and Conclusion: Each centrifuge has its clear own profile of vibrations depending on the rotational speed, and this may impact significantly the characteristics of the PRP or PRF produced with these devices. This result may reveal a considerable flaw in all the PRP/PRF literature, as this parameter was never considered. It is now necessary to evaluate the impact of the vibration parameter on the architecture and cell content of the L- PRF clots produced with these 4 different machines.

Keywords: Blood platelets, growth factors, leukocytes, platelet-rich plasma, regenerative medicine, wound healing

4 – Identification card and codification of the chemical and morphological characteristics of 62 dental implant surfaces. Part 3: sand-blasted/acid-etched (SLA type) and related surfaces (Group 2A, main subtractive process).

David M. Dohan Ehrenfest, Marco Del Corso, Byung-Soo Kang, Philippe Leclercq, Ziv Mazor, Robert A. Horowitz, Philippe Russe, Hee-Kyun Oh, De-Rong Zou, Jamil Awad Shibli, Hom-Lay Wang, Jean-Pierre Bernard, and Gilberto Sammartino.

POSEIDO. 2014;2(1):37-55.

ABSTRACT

Background and objectives: Dental implants are commonly used in dental therapeutics, but dental practitioners only have limited information about the characteristics of the implant materials they take the responsibility to place in their patients. The objective of this work is to describe the chemical and morphological characteristics of 62 implant surfaces available on the market and establish their respective Identification (ID) Card, following the Implant Surface Identification Standard (ISIS). In this third part, surfaces produced through the main subtractive process (sand-blasting/acid-etching, SLA-type and related) were investigated.

Materials and Methods: Eighteen different implant surfaces were characterized: Straumann SLA (ITI Straumann, Basel, Switzerland), Ankylos (Dentsply Friadent, Mannheim, Germany), Xive S (Dentsply Friadent, Mannheim, Germany), Frialit (Dentsply Friadent, Mannheim, Germany), Promote (Camlog, Basel, Switzerland), Dentium Superline (Dentium Co., Seoul, Korea), Osstem SA (Osstem implant Co., Busan, Korea), Genesio (GC Corporation, Tokyo, Japan), Aadva (GC Corporation, Tokyo, Japan), MIS Seven (MIS Implants Technologies, Bar Lev, Israel), ActivFluor (Blue Sky Bio, Grayslake, IL, USA), Tekka SA2 (Tekka, Brignais, France), Twinkon Ref (Tekka, Brignais, France), Bredent OCS blueSKY (Bredent Medical, Senden, Germany), Magitech MS2010 (Magitech M2I, Levallois-Perret, France), EVL Plus (SERF, Decines, France), Alpha Bio (Alpha Bio Tec Ltd, Petach Tikva, Israel), Neoporos (Neodent, Curitiba, Brazil). Three samples of each implant were analyzed. Superficial chemical composition was analyzed using XPS/ESCA (X-Ray Photoelectron Spectroscopy/Electron Spectroscopy for Chemical Analysis) and the 100nm in-depth profile was established using Auger Electron Spectroscopy (AES). The microtopography was quantified using optical profilometry (OP). The general morphology and the nanotopography were evaluated using a Field Emission-Scanning Electron Microscope (FE-SEM). Finally, the characterization code of each surface was established using the ISIS, and the main characteristics of each surface were summarized in a reader-friendly ID card.

Results: From a chemical standpoint, in the 18 different surfaces of this group, 11 were based on a commercially pure titanium (grade 2 or 4) and 7 on a titanium-aluminium alloy (grade 5 or grade 23 ELI titanium). 4 surfaces presented some chemical impregnation of the titanium core, and 5 surfaces were covered with residual alumina blasting particles. 15 surfaces presented different degrees of inorganic pollutions, and 2 presented a severe organic pollution overcoat. Only 3 surfaces presented no pollution (and also no chemical modification at all): GC Aadva, Genesio, MIS Seven. From a morphological standpoint, all surfaces were microrough, with different microtopographical aspects and values. All surfaces were nanosmooth, and therefore presented no significant and repetitive nanostructures. 14 surfaces were homogeneous and 4 heterogeneous. None of them was fractal.

Discussion and Conclusion: The ISIS systematic approach allowed to gather the main characteristics of these commercially available products in a clear and accurate ID card. The SLA-type surfaces have specific morphological characteristics (microrough, nanosmooth, with rare and in general accidental chemical modification) and are the most frequent surfaces used in the industry. However they present different designs, and pollutions are often detected (with blasting/etching residues particularly). Users should be aware of these specificities if they decide to use these products.

Keywords: Dental implant, nanostructure, osseointegration, surface properties, titanium.

5 – Identification card and codification of the chemical and morphological characteristics of 62 dental implant surfaces. Part 4: Resorbable Blasting Media (RBM), Dual Acid-Etched (DAE), Subtractive Impregnated Micro/Nanotextured (SIMN) and related surfaces (Group 2B, other subtractive process).

David M. Dohan Ehrenfest, Marco Del Corso, Byung-Soo Kang, Philippe Leclercq, Ziv Mazor, Robert A. Horowitz, Philippe Russe, Hee-Kyun Oh, De-Rong Zou, Jamil Awad Shibli, Hom-Lay Wang, Jean-Pierre Bernard, and Gilberto Sammartino.

POSEIDO. 2014;2(1):57-79.

ABSTRACT

Background and objectives: Dental implants are commonly used in dental therapeutics, but dental practitioners only have limited information about the characteristics of the implant materials they take the responsibility to place in their patients. The objective of this work is to describe the chemical and morphological characteristics of 62 implant surfaces available on the market and establish their respective Identification (ID) Card, following the Implant Surface Identification Standard (ISIS). In this fourth part, surfaces produced through other subtractive processes (resorbable blasting media RBM, dual acid-etching DAE, subtractive impregnation micro/nanotexturization SIMN and others) were investigated.

Materials and Methods: Twenty different implant surfaces were characterized: MTX (Zimmer, Carlsbad, CA, USA), Biohorizons RBT (Biohorizons, Birmingham, AL, USA), OsseoFix (ADIN, Afula, Israel), Ossean (Intra-Lock, Boca Raton, Florida, USA), Blossom Ossean (Intra-Lock, Boca Raton, Florida, USA), Osstem RBM (Osstem implant Co., Busan, Korea), Ossean G23 ELI (Intra-Lock, Boca Raton, Florida, USA), SBM body (Implant Direct LLC, Calabasas, CA, USA), MegaGen RBM (MegaGen Co., Seoul, Korea), DIO BioTite-M (DIO Corporation, Busan, Korea), Blue Sky Bio RBM (Blue Sky Bio, Grayslake, IL, USA), Anthogyr BCP (Anthogyr, Sallanches, France), Shinhung RBM+ (Shinhung Co., Seoul, Korea), Neobiotech CMI (Neobiotech Co., Seoul, Korea), Osseospeed (AstraTech, Mölndal, Sweden), 3I OsseoTite (Biomet 3I, Palm Beach Gardens, FL, USA), 3I OsseoTite 2 (Biomet 3I, Palm Beach Gardens, FL, USA), Neoss ProActive (Neoss Ltd, Harrogate, UK), BTI Interna (Biotechnology Institute, Vitoria, Spain), Winsix WMRS (BioSAF IN, Ancona, Italy). Three samples of each implant were analyzed. Superficial chemical composition was analyzed using XPS/ESCA (X-Ray Photoelectron Spectroscopy/Electron Spectroscopy for Chemical Analysis) and the 100nm in-depth profile was established using Auger Electron Spectroscopy (AES). The microtopography was quantified using optical profilometry (OP). The general morphology and the nanotopography were evaluated using a Field Emission-Scanning Electron Microscope (FE-SEM). Finally, the characterization code of each surface was established using the ISIS, and the main characteristics of each surface were summarized in a reader-friendly ID card.

Results: From a chemical standpoint, in the 20 different surfaces of this group, 12 were based on a commercially pure titanium (grade 4) and 8 on a titanium-aluminium alloy (grade 5 or grade 23 ELI titanium). 16 surfaces presented different forms of chemical impregnation (most frequently with calcium phosphate CaP) and one surface presented a CaP particles discontinuous coating of the titanium core. 15 surfaces presented different degrees of inorganic pollutions, and 4 presented a significant organic pollution overcoat. Only 5 surfaces presented no pollution (Osseospeed, Ossean, Blossom Osseans and Blue Sky Bio). From a morphological standpoint, all surfaces were microrough, with different microtopographical aspects and values. 16 surfaces were smooth on the nanoscale, and therefore presented no significant and repetitive nanostructures. Four implants only were nanorough (Osseospeed, Ossean, Blossom Osseans), following a SIMN production process. One surface (ProActive) was covered with extended cracks all over the surface. 17 surfaces were homogeneous and 3 heterogeneous. Only 3 surfaces were fractal.

Discussion and Conclusion: The ISIS systematic approach allowed to gather the main characteristics of these commercially available products in a clear and accurate ID card. The RBM surfaces have specific morphological characteristics (microrough, CaP impregnation) and are frequently used in the industry, and many other technologies exist. All these surfaces presented different designs, and pollutions were often detected. Users should be aware of these specificities if they decide to use these products. Finally, the SIMN surfaces appeared as an interesting evolution for the various subtractive technologies, to develop specific chemical modification, microtexture and nano texture.

Keywords: Dental implant, nanostructure, osseointegration, surface properties, titanium.

6 – Identification card and codification of the chemical and morphological characteristics of 62 dental implant surfaces. Part 5: chemically coated surfaces (Group 3, coating) and implant collar surfaces (Group 4, collar).

David M. Dohan Ehrenfest, Marco Del Corso, Byung-Soo Kang, Philippe Leclercq, Ziv Mazor, Robert A. Horowitz, Philippe Russe, Hee-Kyun Oh, De-Rong Zou, Jamil Awad Shibli, Hom-Lay Wang, Jean-Pierre Bernard, and Gilberto Sammartino.

POSEIDO. 2014;2(1):81- 104.

ABSTRACT

Background and objectives: Dental implants are commonly used in dental therapeutics, but dental practitioners only have limited information about the characteristics of the implant materials they take the responsibility to place in their patients. The objective of this work is to describe the chemical and morphological characteristics of 62 implant surfaces available on the market and establish their respective Identification (ID) Card, following the Implant Surface Identification Standard (ISIS). In this fifth part, coated surfaces and some collar surfaces were investigated.

Materials and Methods: Sixteen different implant surfaces were characterized: NanoTite (Biomet 3I, Palm Beach Gardens, FL, USA), SLActive (ITI Straumann, Basel, Switzerland), Roxolid SLActive (ITI Straumann, Basel, Switzerland), Xpeed (MegaGen Co., Seoul, Korea), Xpeed Plus (MegaGen Co., Seoul, Korea), Inicell (Thommen, Waldenburg, Switzerland), Integra-CP/NanoTite (Bicon, Boston, MA, USA), Dentis Haptite (Dentis, Daegu, Korea), Legacy 2 HA (Implant Direct LLC, Calabasas, CA, USA), Biohorizons HA (Biohorizons, Birmingham, AL, USA), Osstem HA (Osstem implant Co., Busan, Korea), DIO BioTite-H (DIO Co., Busan, Korea), Laser-Lok collar (Biohorizons, Birmingham, AL, USA), SBM collar (Implant Direct, Calabasas, CA, USA), Ossean collar (Intra-Lock, Boca Raton, Florida, USA), Kohno DES ZirTi (Sweden & Martina, Due Carrare, Italy). Three samples of each implant were analyzed. Superficial chemical composition was analyzed using XPS/ESCA (X-RayPhotoelectron Spectroscopy/Electron Spectroscopy for Chemical Analysis) and the 100nm in-depth profile was established using Auger Electron Spectroscopy (AES). The microtopography was quantified using optical profilometry (OP). The general morphology and the nanotopography were evaluated using a Field Emission-Scanning Electron Microscope (FE-SEM). Finally, the characterization code of each surface was established using the ISIS, and the main characteristics of each surface were summarized in a reader- friendly ID card.

Results: From a chemical standpoint, in the 16 different surfaces of this group, 5 were based on a commercially pure titanium (grade 4), 4 on a titanium-aluminium alloy (grade 5 or 23), 1 on a titanium-zirconium alloy, 3 on hydroxyapatite, 1 on brushite and 2 on a calcium phosphate core. 13 surfaces presented different forms of chemical impregnation or discontinuous coating of the core material. 15 surfaces presented different degrees of inorganic pollutions, and 1 presented also some organic pollution overcoat. Only 1 surface presented no pollution (Ossean collar). From a morphological standpoint, 1 surface was micropatterned (laser patterning) and 15 microrough, with different microtopographical aspects and values. 8 surfaces were smooth on the nanoscale, and therefore presented no significant and repetitive nanostructures. Eight surfaces were nanomodified: 2 implants were nanorough (Haptite and Ossean collar) and 6 were covered with nanoparticles (CaP, NaCl or Ca nanocrystals deposition: NanoTite, SLActive and Xpeed). Hydroxyapatite and brushite coated surfaces were heterogeneous and covered with extended cracks all over the surface. Only 6 surfaces were homogeneous and 10 were heterogeneous. Only one surface (Ossean collar) was fractal.

Discussion and Conclusion: The ISIS systematic approach allowed to gather the main characteristics of these commercially available products in a clear and accurate ID card. Coated surfaces had very specific morphological characteristics depending on the type of coating (nanocrystals heterogeneous deposition, or heterogeneous maximal microroughness with extended cracks for example). All these surfaces presented different designs, and pollutions were often detected. Users should be aware of these specificities if they decide to use these products. The development of new surfaces for the implant cervical area is also an important clinical paradigm users should be aware about. Finally, the diversity of the surfaces analyzed in this study illustrated that the ISIS system could be an interesting basis for the development of a clear and simple ISO standard for dental implant surfaces and other implantable devices.

Keywords: Dental implant, nanostructure, osseointegration, surface properties, titanium.

7 – Fractal patterns applied to implant surface: definitions and perspectives

David Marcel Dohan Ehrenfest, DDS, MS, PhD1
University of Gothenburg, Department of Biomaterials, University of Gothenburg

J Oral Implantol. 2011 Oct;37(5):506-9. Epub 2011 Jun 13.

ABSTRACT

Fractal patterns are frequently found in the Nature, but they are difficult to reproduce in artificial objects such as implantable materials. In this article, a definition of the concept of fractals for osseointegrated surfaces is suggested, based on the search for quasi self-similarity on at least 3 scales of investigation: microscale, nanoscale and atomic/crystal scale. Following this definition, the fractal dimension of some surfaces may be defined (illustrated here with Intra-Lock Ossean surface). However the biological effects of this architecture are still unknown and should be examined carefully in the future.

8 – Identification card and codification of the chemical and morphological characteristics of 14 dental implant surfaces.

David Marcel Dohan Ehrenfest, DDS, MS, PhD1, Lydia Vazquez, Yeong-Joon Park, Gilberto Sammartino,
and Jean-Pierre Bernard Chonnam National University School of Dentistry, LoB5 unit, School of Dentistry, Gwangju, South Korea.

Journal of Oral Implantology: October 2011, Vol. 37, No. 5, pp. 525-542. doi: http://dx.doi.org/10.1563/AAID-JOI-D-11-00080

ABSTRACT

Dental implants are commonly used in daily practice, however most surgeons do not really know the characteristics of these biomedical devices they are placing in their patients. The objective of this work is to describe the chemical and morphological characteristics of 14 implant surfaces available on the market, and to establish a simple and clear identification (ID) card for all of them, following the classification procedure developed in the Dohan Ehrenfest et al. (2010) Codification (DEC) system.

Fourteen different implant surfaces were characterized:

  1. TiUnite,
  2. Ospol,
  3. Kohno,
  4. Osseospeed,
  5. Ankylos,
  6. MTX,
  7. Promote,
  8. BTI Interna,
  9. EVL,
  10. Twinkon,
  11. Ossean,
  12. NanoTite,
  13. SLActive,
  14. Integra-CP.

Superficial chemical composition was analyzed using XPS/ESCA and the 100nm in-depth profile was established using AES. The microtopography was quantified using light interferometry (IFM). The general morphology and the nanotopography were evaluated using a FESEM. Finally, the characterization code of each surface was established using the DEC, and the main characteristics of each surface were summarized in a reader-friendly ID card. Results: FROM A CHEMICAL STANDPOINT, in the 14 different surfaces, 10 were based on a commercially pure titanium (grade 2 or 4), 3 on a titanium-aluminium alloy (grade 5 titanium), and the last one on a calcium phosphate core.

9 surfaces presented different forms of chemical impregnation or discontinuous coating of the titanium core, and 3 surfaces were covered with residual alumina blasting particles. 12 surfaces presented different degrees of inorganic pollutions, and 2 presented a severe organic pollution overcoat. Only 2 surfaces presented no pollution (Osseospeed and Ossean). FROM A MORPHOLOGICAL STANDPOINT, 2 surfaces were microporous (anodization) and 12 microrough, with different microtopographical aspects and values.

10 surfaces were smooth on the nanoscale, and therefore presented no significant and repetitive nanostructures. 4 implants were nanomodified: 2 implants were nanorough (Osseospeed and Ossean), and 2 were covered with nanoparticles (NanoTite and SLActive). TiUnite and Kohno HRPS were covered with extended cracks all over the surface. Only 8 surfaces could be considered as homogeneous.This systematic approach allowed to gather the main characteristics of these commercially available products in a single ID card.

9 – Histomorphometric Evaluation of Bioceramic Molecular Impregnated and Dual Acid Etched Implant Surfaces in the Human Posterior Maxilla

Jamil Awad Shibli, DDS, MS, PhD; Sauro Grassi, DDS, MS; Adriano Piattelli, MD, DDS; Gabriele E. Pecora, MD, DDS; Daniel S. Ferrari, DDS, MS; Tatiana Onuma, DDS; Susana d’Avila, DDS, MS, PhD; Paulo G. Coelho, DDS, PhD; Raquel Barros, DDS, MS; Giovanna Iezzi, DDS, PhD

Clinical Implant Dentistry and Related Research.
Published Online: 28 Apr 2009 in Wiley InterScience
© 2010 Wiley Periodicals, Inc.”

ABSTRACT

Background: Physical and bioceramic incorporation surface treatments at the nanometer scale showed higher means of bone-to-implant contact (BIC) and torque values compared with surface topography at the micrometer scale; however, the literature concerning the effect of nanometer scale parameters is sparse.

Purpose: The aim of this study was to evaluate the influence of two different implant surfaces on the percentage bone-toimplant contact (BIC%) and bone osteocyte density in the human posterior maxilla after 2 months of unloaded healing.

Materials and Methods: The implants utilized presented dual acid-etched (DAE) surface and a bioceramic molecular impregnated treatment (Ossean®, Intra-Lock International, Boca Raton, FL, USA) serving as control and test, respectively. Ten subjects (59 1 9 years of age) received two implants (one of each surface) during conventional implant surgery in the posterior maxilla. After the non-loaded period of 2 months, the implants and the surrounding tissue were removed by means of a trephine and were non-decalcified processed for ground sectioning and analysis of BIC%, bone density in threaded area (BA%), and osteocyte index (Oi).

Results: Two DAE implants were found to be clinically unstable at time of retrieval. Histometric evaluation showed significantly higher BIC% and Oi for the test compared to the control surface (p < .05), and that BA% was not significantly different between groups.Wilcoxon matched pairs test was used to compare the differences of histomorphometric variables between implant surfaces. The significance test was conducted at a 5% level of significance.

Conclusion: The histological data suggest that the bioceramic molecular impregnated surface-treated implants positively modulated bone healing at early implantation times compared to the DAE surface.

10 – Comparative Analysis of Early Bone Bonding Using Various Surface Treatments

R.J. Miller, P. Coelho, C. Marin, R. Granato, M. Suzuki, J. Gil Delray Beach, FL.
2010, Academy of Osseointegration, Annual Meeting, P202

ABSTRACT

It is well established that, for several weeks following implant placement, the bone to implant bond is weaker as a result of the catabolic phase of bone. Strategies ranging from roughening the implant surface to applying osteoinductive materials have been employed in an attempt to re-engineer the bone response. A study was proposed to compare three different surface treatments. Implants of similar architecture from three manufacturers were evaluated to test early bone bonding.

Tested were 36 endosseous implants with variations in surface treatment from three different manufacturers (12 of each type). One implant of each design was placed in each of 6 animals (beagle dogs), 3 per side in the mandible. The same protocol was used in the contralateral side two weeks later following the same distribution of the previous implant placement procedure. The animals were sacrificed 3 weeks after the initial implant surgery.

For biomechanical testing, the bone blocks with implants were adapted to an electronic torque machine equipped with a 200 Ncm torque load cell. The implants were torque to interfacial fracture at a rate of ~ 0.19618 radians/sec, and the maximum torque value was recorded for each specimen. When compared to an acid-etched and particulate calcium phosphate coating (Nanotite? – Group 1) and a TiO blasted + HF etched surface (Osseospeed? – Group 2), at one week the Ossean? surface implants (acid etched and calcium phosphate impregnated – Group 3) had a 500% greater bone-bonding shear strength as demonstrated in a reverse torque pullout study.

The conclusion reached is that there is a limitation of biologic activity on purely etched surfaces and there is also a qualitative difference in some nanotextured + calcium phosphate impregnated surfaces. The Ossean? surface appears to be biologically active in the sense that bone goes directly to the anabolic phase without intervening bone breakdown. This is relevant in immediate load cases and for extraction site defects where the percentage of initial bone-to-implant contact is compromised.

11 – Biomechanical Testing of Microblasted, Acid-Etched/Microblasted Surfaces,Anodized, and Discrete Crystalline Deposition in the Canine Radius Model.

R. Granato, C. Marin, M. Suzuki, E. Bonfante, P.G. Coelho New York, NY.

2010, Academy of Osseointegration, Annual Meeting, P221

ABSTRACT

The objective of this study was to evaluate the biomechanical fixation of four different implant surfaces at early implantation times in vivo in a canine radius model.

Methods: External hexagon Branemark type implants were utilized, and included the following surfaces: Microblasted (MI) (Ossean, Intra-Lock International), acid-etched and microblasted (AAM) (Nanoss, AMG), Anodized (A) (TiUnite, Nobel Biocare), and discrete crystalline deposition (DCD) (Nanotite, Biomet 3i) The implants were placed in the central region of the radii of 8 beagle dogs, remaining for 10 and 30 days in vivo. Following euthanisation, the implants were torqued to interface failure in a servoelectric system. Statistical analysis was performed at 95% confidence level by ANOVA considering Torque at dependent variables and implant surface and time in vivo as independent variables.

Results: No significant differences between surfaces were observed in torque at 2 weeks in vivo. At 4 weeks, the AAM presented significantly higher torque values compared to the DCD and A surfaces (p< 0.001). The MI surface presented an intermediate value between the AAM, and the DCD and A surfaces. Significantly higher torque values were observed at 30 days compared to 10 days (p> 0.22).

Conclusion: Significantly higher biomechanical fixation was observed for the AAM surface group when similar implant macrogeometries were utilized during mechanical testing.

12 – Physico/Chemical Characterization and Biomechanical Evaluation of Three Different Grit-Blasting and Acid-Etching Surface Treatments. An Experimental Study in Dogs.

G.S. Bernardes, R.Granato, M. Suzuki, J.N. Gil, C. Marin, P.G. Coelho New York, NY

2009, Academy of Osseointegration, Annual Meeting, P180

ABSTRACT

The objective of this study was to physico/chemically characterize and compare the biomechanical fixation of 3 different grit-blasting and acid-etching procedures in titanium alloy surfaces.

Methods: The surfaces were characterized by electron microscopy (SEM), atomic force microscopy (AFM), and x-ray photoelectron microscopy (XPS). Sand-blasted/acid-etched (SBAA), TCP-blasted/acid-etched (TBAA), and TCP-blasted (TB) screw type implants were placed along the proximal tibia of 6 beagle dogs (n = 12 per surface) remaining for 3 and 5 weeks. Following euthanization, the limbs were retrieved and the implants were biomechanically tested (torque to interface fracture) in an automated system until a 10% drop from the maximum torque was recorded. Statistical analysis was performed by one-way ANOVA at 95% level of significance and Tukey’s post-hoc test for multiple comparisons.

Results: Surface characterization showed that all surface treatments resulted in moderately rough surfaces. However, SBAA presented rougher profiles compared to the others. The biomechanical testing results showed significant differences between the implant surface groups (p<0.01; mean ?95%Cl in Ncm; 3 weeks – TBAA=99.66?9.81, TB=93.35?9.82, SBAA=88.76?9.81; 5 weeks – TBAA=117.41?9.81, TB=104.58?9.82, SBAA=96.01?9.81).

Conclusion: Despite the rougher profile observed for the SBAA surface, bioactive ceramic grit-blasting with or without subsequent acid etching resulted in higher biomechanical fixation after 5 weeks in vivo.

13 – The Effect of Implant Surface and Macrodesign on Initial Stability. A Study in Dogs.

R.J. Miller, C. Marin, R. Granato, J.N. Gil, M. Suzuki, P.G. Coelho New York, NY.
2009, Academy of Osseointegration, Annual Meeting, P195

ABSTRACT

The initial stability of dental implants is often times used as a predicament of its possible successful outcome. The purpose of this study was to evaluate the effect of different surface treatments and implant macrodesigns and on implant initial stability in a beagle model.

Methods: The third and fourth mandibular premolars of adult beagle dogs (~1.5 years of age) were extracted and the sites allowed to heal for 8 weeks. Subsequently, different combinations of macrodesign and implant surface treatment in screw root form implant designs (31- Nanotite, Astra Tech-Osseospeed, Intra-Lock – Ossean) with similar diameter and length were placed following the suggested manufacturer’s surgical protocol. The implants remained for 1 and 3 weeks in vivo (n=6 per system and implantation time). Following euthanization, the mandibles were retrieved and the implants were torque tested to interface failure with custom tooling adapted in an automated machine. Statistical analysis was performed by one-way ANOVA at 95% level of significance and Tukey’s post-hoc test for multiple comparisons.

Results: Significant differences were noted between groups following biomechanical testing (p<0.001; mean?95%Cl in Ncm; 1 week – 31 Nanotite= 19.43?8.39, Astra Osseospeed= 23.48?8.39, Intra-Lock Ossean= 107.6?8.39; 3 weeks – 31 Nanotite=25.17?10.27, Astra Osseospeed = 76.2?10.28, Intra-Lock Ossean = 94.82?10.27).

Conclusion: The combination of macrodesign and surface treatment affected the initial stability of the implants.

14 – Human Osteoblast growth on a Novel Implant Surface Vs a classic Blasted and Acid Etched Surface.

V. Bucci-Sabattini, C. Cassinelli, M. Morra Magenta, Italy.
2009, Academy of Osseointegration, Annual Meeting, CI-7

ABSTRACT

Among the multiple factors that determine the achievement and the preservation of the osseointegration, physicochemical properties of the implant surface play a primary role Within milliseconds after exposure, an implant’s surface is covered with protein molecules absorbed from the surrounding environment.

The nature, thickness, stability, and other characteristics of this protein layer depend in large measure on the characteristics of the surface. The structural details of the cells’ body that determine the achievement and preservation of a successful implant are the result of the stimuli that come from the implant surface.

Keeping these considerations in mind, an evaluation of the adhesion and proliferation of the SaOs-2 Human Osteoblast on two comparative surfaces have been carried out over varying time periods.

Phase 1: Superficial topographical characterization through X-ray Spectroscopy (XPS)

Phase 2: Comparing Osteoblasts’ adhesion to the Ossean? surface Vs the Classic Blasted and acid etched surface.

Phase 3: Comparing Alkaline Phosphatase (ALP) activity on those two surfaces has been closely evaluated of a various time periods.

This enzyme is an early indicator of the osteoblastic differentiation. At the time the production of ALP on the part of human mesenchymal cells have been evaluated. These are capable of differentiating in at least three different phenotypes: the adipogenic, chondrogenic, and osteogenic line. It is however still not clear which factors determind the preferential differentiation towards a particular line. The objective of this research is try to understand if the surface per se’ and/or the presence of adequate chemical stimuli could induce the desired differentiation.

Conclusion: The results of the research have demonstrated an advanced avtivity of the Alkaline Phosphatise Enzyme (ALP) on the Ossean? surface during the first days. The Ossean? surface shows, with statistically significant differential, a higher enzymatic activity compared to the Classic surface in the first phase of healing.

15 – Removal Torque and Histomorphometric Evaluation of Bioceramic Grit-Blasted/Acid-Etched and Dual Acid-Etched Implant Surfaces: An Experimental Study in Dogs

Charles Marin*, Rodrigo Granato*, Marcelo Suzuki†, Jose N. Gil*, Adriano Piattelli‡, and Paulo G. Coelho§
* Department of Oral and Maxillofacial Surgery Federal University of Santa Catarina, Florianopolis, SC, Brazil.
† Department of Prosthodontics, Tufts University, Boston, MA.
‡ Department of Oral Sciences, University of Chieti–Pescara, Chieti, Italy.
§ Department of Biomaterials and Biomimetics, New York University, New York, NY.
J Periodontol 008;79:1942-1949. October 2008 Volume 79 • Number 10

ABSTRACT

Background: Surface modifications to dental implants have been used in an attempt to accelerate the osseointegration process. The objective of this study was to biomechanically/histomorphometrically evaluate a bioceramic grit-blasted and acid-etched surface (BGB/AA;test) versus a dual acid-etched implant surface (control) in a beagle dog model.

Methods: Control and BGB/AA implants were subjected to a series of physicochemical characterization tools, including scanning electron microscopy (SEM), atomic force microscopy (AFM), and auger photoelectron spectroscopy (APS). The animal model included the placement of 72 implants along the proximal tibiae of six beagle dogs, which remained in place for 2 or 4 weeks. After euthanization, half of the specimens were biomechanically tested (removal torque), and the other half was non-decalcified processed to slides of ;30 mm thickness for histomorphologic and histomorphometric (percentage of bone-to-implant contact [%BIC]) evaluation. Analysis of variance at the 95% confidence level and the Tukey post hoc test were used for multiple comparisons.

Results: SEMand AFM showed that surface microtextures were qualitatively and quantitatively different and that the BGB/AA surface presented higher submicrometer average roughness values (Ra) and root mean square (RMS) values compared to control surfaces. Ca and P were detected at theBGB/AA surface by APS. Higher degrees of bone organization were observed along the perimeter of the BGB/AA surface compared to control, despite the non-significant differences in %BIC between the surfaces (P >0.25). Significantly higher removal torque was observed for the BGB/AA implants at both time periods (P <0.0001).

Conclusion: According to the biomechanical and histomorphologic results, early biomechanical fixation was positively affected by the BGB/AA surface compared to the dual-acid etched surface.

16 – Classification of osseointegrated implant surfaces: materials, chemistry and topography

David M. Dohan Ehrenfest1, Paulo G. Coelho2, Byung-Soo Kang1, Young-Taeg Sul1 and Tomas Albrektsson1

1 Department of Biomaterials, Institute for Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Sweden
2 Department of Biomaterials and Biomimetics, New York University, New York, USA
Trends Biotechnol. 2010 Apr;28(4):198-206. Epub 2010 Jan 29.

ABSTRACT

Since the founding of the osseointegration concept, the characteristics of the interface between bone and implant, and possible ways to improve it, have been of particular interest in dental and orthopaedic implant research. Making use of standardized tools of analysis and terminology, we present here a standardized characterization code for osseointegrated implant surfaces.

This code describes the chemical composition of the surface, that is, the core material, such as titanium, and its chemical or biochemical modification through impregnation or coating. This code also defines the physical surface features, at the micro- and nanoscale, such as microroughness, microporosity, nanoroughness, nanotubes, nanoparticles, nanopatterning and fractal architecture. This standardized classification system will allow to clarify unambiguously the identity of any given osseointegrated surface and help to identify the biological outcomes of each surface characteristic.

17 – Basic Research Methods and Current Trends of Dental Implant Surfaces

Paulo G. Coelho1, Jose´ M. Granjeiro2, George E. Romanos3, Marcelo Suzuki4, Nelson R. F. Silva1, Giuseppe Cardaropoli1, Van P. Thompson1, Jack E. Lemons5

1 Department of Biomaterials and Biomimetics, New York University, New York, New York 10010

2 Department of Cellular and Molecular Biology, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil

3 Department of Periodontology, Rochester University, Rochester, New York 14620

4 Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts

5 Department of Prosthodontics and Biomaterials, University of Alabama at Birmingham, Birmingham, Alabama 35294

Published online 30 October 2008 in Wiley InterScience.
DOI: 10.1002/jbm.b.31264 ©2008 Wiley Periodicals, Inc. COELHO ET AL.

ABSTRACT

Among dental implant design alterations, surface modifications have been by far the most investigated topic. Regarding implant surface research, the lack of hierarchical approaches relating in vitro, in vivo, clinical trials, and ex vivo analyses has hindered biomaterials scientists with clear informed rationale guidelines for implant surface design.

This manuscript provides a critical hierarchical overview of the in vitro, laboratory in vivo, clinical, and ex vivo methodologies used to investigate the performance of novel biomaterials aiming to allow dental professionals to better evaluate the past, present, and future dental implant surface research. This manuscript also contains an overview of the commercially available surface texture and chemistry modifications including novel nanotechnology-based fabrication processes.

Over the last decade, surface texturing has been the most utilized parameter for increasing the host-to-implant response. Recently, dental implant surfaces utilizing reduced length scale physico/chemical features (atomic and nanometric) have shown the potential to synergistically use both texture and the inclusion of bioactive ceramic components on the surface.

Although surface modifications have been shown to enhance osseointegration at early implantation times, information concerning its long-term benefit to peri-implant tissues is lacking due to the reduced number of controlled clinical trials. Given the various implants/surfaces under study, the clinician should ask, founded on the basic hierarchical approach described for the in vitro, laboratory in vivo data, as well as the results of clinical studies to effectiveness before use of any dental implant. ‘ 2008 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 88B: 579–596, 2009

18 – Surface treatment at the cervical region and its effect on bone maintenance after immediate implantation: An experimental study in dogs.

Paulo G. Coelho, DDS, MS, BS, MSMtE, PhDa, Charles Marin, DDS, MSb, Rodrigo Granato, DDS, MSb, Estevam A. Bonfante, DDS, MS, PhDc, Cirilo P. Lima, DVM, PhDd, and Marcelo Suzuki, DDSe, New York, New York; Florianopolis, Santa Catarina; Bauru, São Paulo; Uberlândia, Minas Gerais; and Boston, Massachusetts

NEW YORK UNIVERSITY, UNIVERSIDADE FEDERAL DE SANTA CATARINA, UNIVERSIDADE FEDERAL DE UBERLÂNDIA, AND TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE

a Assistant Professor, Department of Biomaterials and Biomimetics, New York University.

b PhD candidate, Department of Dentistry, Universidade Federal de Santa Catarina.

c Private Practice, Bauru, Brazil.

d Associate Professor, Department of Veterinary Medicine, Universidade Federal de Uberlândia.

e Assistant Professor, Dept. of Prosthodontics, Tufts University School of Dental Medicine.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Aug;110(2):182-7. Epub 2010 Apr 24.

ABSTRACT

Objective: The aim of this study was to evaluate the effect of surface treatment at the cervical region of endosseous dental implants on the alveolar bone remodeling after implantation immediately after tooth extraction in a dog model.

Study design: The third and fourth premolars of 6 dogs were bilaterally extracted with a full-thickness flap, and threaded implants presenting a textured or a polished surface at the cervical regions were placed on the distal root extraction sockets. Submerged healing was allowed for 4 weeks, and bone-to-implant contact (BIC) and buccal and lingual bone loss were morphometrically measured.

Results: The BIC and lingual bone loss were not significantly different between textured and polished groups. Significantly lower buccal bone loss (P _ .01) was observed for the textured surface at 4 weeks in vivo.

Conclusion: Textured surface implants placed immediately after tooth extraction resulted in less bone loss only at the buccal cervical region compared with smooth surface implants. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;xx:xxx)

19 – Osseointegration: Hierarchical designing encompassing the macrometer, micrometer, and nanometer length scales

Paulo G. Coelhoa, Ryo Jimbod, Nick Tovar, Estevam A. Bonfantee

http://dx.doi.org/10.1016/j.dental.2014.10.007
0109-5641/© 2014 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

ABSTRACT

Objective: Osseointegration has been a proven concept in implant dentistry and orthopedics for decades. Substantial efforts for engineering implants for reduced treatment time frames have focused on micrometer and most recently on nanometer length scale alterations with negligible attention devoted to the effect of both macrometer design alterations and surgical instrumentation on osseointegration. This manuscript revisits osseointegration addressing the individual and combined role of alterations on the macrometer, micrometer, and nanometer length scales on the basis of cell culture, preclinical in vivo studies, and clinical evidence.

Methods: A critical appraisal of the literature was performed regarding the impact of dental implant designing on osseointegration. Results from studies with different methodological approaches and the commonly observed inconsistencies are discussed.

Results: It is a consensus that implant surface topographical and chemical alterations can hasten osseointegration. However, the tailored combination between multiple length scale design parameters that provides maximal host response is yet to be determined.

Significance: In spite of the overabundant literature on osseointegration, a proportional inconsistency in findings hitherto encountered warrants a call for appropriate multivariable study designing to ensure that adequate data collection will enable osseointegration maximization and/or optimization, which will possibly lead to the engineering of endosteal implant designs that can be immediately placed/loaded regardless of patient dependent conditions.