Oral implant surfaces part 1 /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call

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Oral implant surfaces part 1 /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. ABSTRACT  This article reviews the topographic and chemical properties of different oral implant surfaces and in vivo responses to them  The article consider detailed mechanical,topographic,and physical characteristic of implant surfaces. anchorage mechanisms such as biomechanical and biochemical bonding are examined www.indiandentalacademy.com
  4. 4. INTRODUCTION   The surface quality will determine tissue reactions to an oral implant. Surface quality may be divided in to 3 categories 1.mechanical properties 2.topographic properties 3.physicochemical properties  SUL et al2002-anodizing an implant lead to change in surface roughness as well as alteration of oxide crystallinity and embedding of ions in the surface  MORRA et al2003-machined implants display a lower concentration of titanium on the surface and a higher concentration of carbon that’s in sandblasted, acid etched, or plasma sprayed www.indiandentalacademy.com
  5. 5. ASPECTS OF SURFACE QUALITY MECHANICAL PROPERTIES  Relates to potential stress on the surface that may result in increased corrosion rate and wear relating to hardness of material  KOHO 1990 related decreased fatigue strength of implant surfaces with porous coating  MCKELLOP1995described a technique to minimize wear is ion implantation  Wear is related to strength of material, but also surface roughness www.indiandentalacademy.com
  6. 6. TOPOGRAPHIC PROPERTIES  The surface topography relates to the degree of roughness of surface and orientation of surface irregularities  The original BRANEMARK implant was turned screw of minimal surface roughness between 0.5 and 1 in sa value-gold standard  In mid 1990s implant roughness of 1.5 shows stronger bone response than turned, smoother and rough plasma sprayed implants-WENNERBERG 1996 www.indiandentalacademy.com
  7. 7.    Potential drawback of roughening the implant surface include greater problem with peri-implantitis (BECKER 2000 AND ASTRAND 2000) and a greater risk of ion leakage.greater surface roughness greater tissue implant contact and hence ionic leakage. ALBEIT related to very rough (more than 2 sa) plasma sprayed implants Moderately roughened surfaces (Tioblast screw) shows no incidence of peri implantitis and maintained bone height. Majority of commercially availlable implants are moderatlyroughened. www.indiandentalacademy.com
  8. 8. CHARACTERISTIC OF IMPLANT SURFACES     O.o4-smooth-machined experimental abutments-no benefits 0.5-1-minimal roughness- turned,osseotite,before1995longest clinical document-not for untrained surgeons 1-2-moderatly rough-tio blast, SLA, TiUNITE,Fralit-2, most implants today-stronger bone response, better clinical results-only short clinical follow up more than 2- rough- plasma sprayed titanium, hydroxy apatite coated-positive 5yr documentation, increased incidence of peri implantitis in 2 studies www.indiandentalacademy.com
  9. 9.  Currently considerable interest is in nano structure.  WOJICIAK1998-study on nanotopographies.  Macrophage cell lines react to microgrooves at the nanometer level  RICE2003-no significant effects in cell adhesion  WENNERBERG2000- for clinical purpose the relevant way is to describe an oral implant surface by referring to its micro sized irregularities. www.indiandentalacademy.com
  10. 10. PHYSICAL CHARACTERISTICS      Physical characteristic refers to factors such as surface energy and charge. HENCH AND ETHRIDGE 1982-surface energy is a measure of extent to which bonds are unsatisfied at the surface. A surface with high energy has a high affinity for adsorption i.e. stronger osseointegration BAIER1982-glow discharge treatment result in high surface energy as well as implant sterilization BAIER1986-high surface energy influences protien to form an advantageous primary coat on implants www.indiandentalacademy.com
  11. 11.  HENCH1982- practical way to measure surface energy is contact angle measurements  Hydrophobic or hydrophillic  Wettability of surface(BAIER1986)  the hypothesis that implants with high surface energy results in stronger osseointegration was not verified. High surface energy changed immediately when implants are changed from glow discharge container to patient through air. www.indiandentalacademy.com
  12. 12. ANCHORAGE MECHANISM OF ORAL IMPLANTS  Many oral implants companies launch new products claiming unique bioactive surfaces. Hence the focus has shifted from surface roughness to surface chemistry.  Opinion on bone anchorage and emphasis on biochemical bonding www.indiandentalacademy.com
  13. 13. BIOMECHANICAL BONDING  A turned titanium implant,such as the original Branemark screw, is anchored to bone through in growth into small irregularities of the implant surface by biomechanical bonding.  Thus osseointegration depends on biomechanical bonding.  Blasted acid-etched and other moderately roughened implants show a stonger bone response than turned devices. www.indiandentalacademy.com
  14. 14.      The potentially negative aspect with biomechanical bonding is that it is time consuming . There are weeks of delay before bone has started to grow into surface irregularities of the implant. Before bone interlocking ,the implant is dependent on its macro design for retention. Bone needs a minimum of 50 to 100 micrometer pores for proper growth. Irregularities of atleast of 1micrometer may be invaded by bone ,although complete Haversian system need a large space.-WENNERBERG2000 www.indiandentalacademy.com
  15. 15.  Electropolished titanium surfaces of roughness similar to abutments do not become properly osseointegrated-CARLSSON1988, BURSER1991  The strongest biomechanical bonds are seen to surfaces of roughness of about 1.5 micrometer whereas rougher, plasma-sprayed implants shows weaker bone ingrowthWENNERBERG1996 www.indiandentalacademy.com
  16. 16. BIOCHEMICAL BONDING  Bioactivity is the charecteristic of an implant material which allows it to form a bond with living tissues.  OSBORN AND NEWESLY1980- titanium is bioinert material Potential chemical bonding between implant and host tissues was first suggested by HENCHet al 1970and referred then to a certain glass-ceramic composition and its reaction to the host tissues.   Instead ,calcium phosphate ceramics were launched as potentially bioactive surface coatings for titanium implants HULBERT et al 1990  Bioactive implants in addition to chemical bonding show biomechanical anchorage also. www.indiandentalacademy.com
  17. 17.  Commercially pure titanium (cp) in its native form is only capable of biomechanical bonding, chemical modifications of cp titanium may lead to a bioactive material.  Surface modifications have consisted of NaOH and heat treatment( KIM AND SKRIPITIS1998)or, ion implantation with calcium or anodizing with electrolytes containing phosphorus ,sulphur,calcium(HANAW1991) magnesium ions(SUL 2002) www.indiandentalacademy.com
  18. 18.      Two types of implant surfaces are potentially bioactive 1.surface represented by calcium phosphate coated implants 2.flouridated osseospeed implants (Ash tech) implants. oxidized surfaces are bioactive. whether there is any evidence of oxidised TiUnite implants being bioactive has been nvestigated- SUL 2002 Failed to explain any bioactivity on oxidised surface with embedded phosphorous ions www.indiandentalacademy.com
  19. 19. CALCIUM PHOSPHATE COATED IMPLANTS       LEGEROS2002 –Calcium phosphate has similarities to bone mineral. They form bone apaite like mineral or carbonate HA on their surfaces They are able to promote cellular function, leading to formation of strong calcium phosphate interface and they are osteoconductive and may bind to bone morphogenic protein to become osteoinductive JARCO et al1977- were the first to present indication of direct bone bonding to HA. NEO AND OGEOS 1992 believe that calcium phosphate has bioactive capacities It is hypothetised that inter facial bone mineral like carbonated apatite layer is formed by ion dissoltion from bio ceramic material (DUCHYENE 1999) (JANSEN 2003) other potential mechanism include direct effect from ca and phosphorus concentration and high affinity of growth factor www.indiandentalacademy.com
  20. 20. FLUORIDATED IMPLANTS        Introduced by FILLINGSEN 1995 Push out tests flouridated implants sustained Indication of bioactivity JOHANSSON et al 2002 – greater bone contact 1-3 months ELLINGSEN 2003- rabbit, blasted intermediate rough implants with and with out fluoridating of surfaces. Fluoridated, blasted implants show higher removal torque than blasted www.indiandentalacademy.com
  21. 21. EVIDENCE FOR A BIOACTIVE IMPLANT SURFACE       HENCH 1971- TISSUE COALESCENCE-this theory is based on high power trans electron micrography demonstrating that the tissue floats in to the surface of the biomaterial the distance is so small that biochemical bonding is possible DAVIESet al 1990- similar inter facial morphology between bioactive HA and cp titanium when implant is removed rupture occurs This occurs not at interface but in the bone tissue(ELLINGSEN1995) hence finding bone on the implant surface is conclusive of biomechanical inter locking. CHEMICAL EVIDENCE such as formation of calcium carbonate apatite layers on the calcium phosphate ceramic implants(DACULSI1990) www.indiandentalacademy.com
  22. 22. ORAL IMPLANT SURFACES SUGGESTED TO BE OSSEOATTRACTIVE      Do not use bio active 510k designation substantial equalization may be denied and then prospective , RCT must be performed before sale Lack proper 5 yr clinical trial OSSETITE ACID ETCHED IMPLANTS- give rise to a particular fibrin retention that allows osteogenic cell to migrate to implant surface,enabling what DAVIES1998 calls “De Novo bone formation”. Seen in novel cellpllus implant. www.indiandentalacademy.com
  23. 23.  SLA implant and DPS implant surface- blasted and etched, moderately roughened  TiUnite implant-anodised,oxide thickness of 1000nm, porous  Osteoattractive-moderatly roughened,more attractive to bone formation www.indiandentalacademy.com
  24. 24. DOPED SURFACES  Implant surfaces have been doped with potentially bone stimulating factors such as BMP or other bone growth factors  Hypothetical solution for future  FRANKE-STENPORT2002- external application of growth factors have effect in ordinarily placed oral implants.  WIKEJSO2002- observation does not contradict evidence of positive effect of BMP in cases with lack of bone support- resorbed ridges www.indiandentalacademy.com
  25. 25. www.indiandentalacademy.com
  26. 26. TO CONCLUDE…   . Moderately roughened surfaces have some clinical advantages compared to the turned smoother and rougher plasma sprayed surfaces bioactive implants may present some promise for future  Infact it seems probable that improvement in surgical technique will present good prospect for improving clinical results.  Some surgeons have fewer good clinical results than others working with the same implants this is an important observation to avoid being misled by the commercial side of oral implantologist; who things that osteoattrative surface modifications are claimed as the only way to improve clinical success  www.indiandentalacademy.com
  27. 27. THANK YOU www.indiandentalacademy.com