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.
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.