Implant surface vs osseointegration

1. Dr. Firas Kassab

2. • Introduction
• Classification of implant surfaces
• Methods to alter implant surfaces
• Evaluation of the interface
• Conclusion
• References
Dr. Firas Kassab 2

3. Definition:
Osseointegration:
The apparent direct attachment or connection of osseous
tissue to an inert, alloplastic material without intervening
connective tissue.
- GPT 8
Dr. Firas Kassab 3

4. • The concept of Osseointegration was discovered by
• Per- Ingvar Branemark and his co-worker and,
has had a dramatic influence on clinical treatment of
oral implants.
Dr. Firas Kassab 4

5. • The First generation titanium implants which were
machined with a smooth surface texture.
• Implant surfaces have been recognized to play an
important role in molecular interactions, cellular
response and Osseo integration.
Dr. Firas Kassab 5

6. • The Second generation implants with surface
modification
can accelerate and improve implant osseointegration.
• Implants underwent mechanical blasting, acid etching,
bioactive coatings, more recently , laser modified
surfaces.
Dr. Firas Kassab 6

7. • The main objective for the development of implant
surface modifications is to promote Osseo
integration, with faster and stronger bone
formation.
• Furthermore, it accelerates the bone healing and
thereby allowing immediate or early loading .
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8. 1. Implant materials
2. Based on chemical composition
3. Based on Biocompatibility
4. Based on implant surface texture
5. Based on implant surface irregularities
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9. 6. Based on the orientation of surface irregularities
on
implant surface
7. Based on surface roughness on implant surfaces
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10. Metals Ceramics Polymers
Chemical composition
Biological
compatibility
Bio inertBio tolerant Bio active
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11. 1.Biotolerant Ex:Gold,CobaltChromium,Stainless steel,Zirconium,Niobium
2.Bioinert Ex:zirconium, alumina, ceramics, titanium,stainless steel,gold etc
3. Bioactive Ex: Hydroxyapatite, glassceramic, bioglass etc..,
Bioinert and Bioactive
materials are
osteoconductive in nature.
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12. Based on texture obtained, the implant surface can be
divided as:
1. Concave texture ( Additive treatments like
hydroxyapatite (HA)coating and titanium plasma
spraying)
2. Convex texture (Subtractive treatment like
etching and blasting)
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13. Based on the orientation of surface irregularities, implant
surfaces are divided as:
1. Isotropic surfaces: have the same topography
independent
of measuring direction.
2. Anisotropic surfaces: have clear directionality and differ
considerably in roughness.
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14. Wennerberg and coworkers have classified
implant
surfaces based on the surface roughness as:
1. Minimally rough (0.5-1 mm)
2. Intermediately rough (1-2mm)
3. Rough (2-3 mm)
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15. Methods to increase the surface roughness
1. Blasting
2. Chemical etching
3. Porous surfaces
4. Plasma-sprayed surfaces
5. Ion-sputtering coating
6. Anodized surface
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16. 1.Blasting :
• Blasting implant surface with particles of various
diameters is one of the most frequently used methods of
surface alteration.
• Various ceramic particles have been used such as Alumina,
Titanium oxide and Calcium phosphate particles.
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17. • Etching with strong acids such as HCl, H2SO4,HNO3
and HF is used for roughening dental implants.
• Acid-etching produces micropits on implant surfaces
with sizes ranging from 0.5 to 2 μm in diameter. Acid-
etching has been shown to greatly enhance
Osseointegration.
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18. • Recently a new surface was introduced that was
sandblasted with large grit and acid-etched (SLA).
• This surface is produced with large grit (250-500
micro- metres) blasting process and followed by
Hydrochloric and sulfuric acid.
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19. • These are produced when spherical powder of the
metallic/ceramic material becomes a coherent mass
within the metallic core of the implant body.
• These are characterized by pore size, shape, volume and
depth, which are affected by the size of the spherical
particles and the temperature and pressure of the
sintering chamber.
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20. 1. A three dimensional interlocking interface in
bone is observed.
2. Shorter healing time.
3. Provide space ,volume for cell-migration and
attachment and thus support contact osteogenesis.
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21. • Plasma-spraying is a technique in which hydroxyapatite
(HA) ceramic particles are injected into a plasma torch at
high temperature approximately 15,000-20,000 K and
projected on to the surface of the titanium where they
condense and fuse together, forming a film.
• Plasma-sprayed coatings can be deposited
with a thickness of about 50–100 μm.
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22. • It is the process by which a thin layer of
Hydroxyapatite can be coated onto an implant
substrate.
• This is performed by directing a beam of ion onto an
HA block that is vaporized to create plasma and then
recondensing this plasma onto the implant.
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23. • Oxidation process can be used to change the characteristic of the oxide
layer and make it more biocompatible.
• This is carried out by applying a voltage on the titanium implant
immersed in the electrolyte.
• This results in a surface with micropores of
variable diameter and demonstrates lack of cytotoxicity
and increased cell attachment and proliferation.
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24. Advantages of increased roughness:
1. Increased surface area of implant adjacent to bone.
2. Improved cell attachment to bone.
3. Increased bone present at implant interface.
4. Increased biochemical interaction of implant with
bone.
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25. Methods to alter Implant surfaces
1. Physicochemical
2. Morphologic or Biochemical
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26. • This method involves the alteration of surface energy,
surface charge, and surface composition with the aim of
improving the bone-implant interface.
• The method employed is the Glow discharge treatment,
in which materials are exposed to ionized inert gas,
such as argon.
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27. • This method involves in alteration of surface
morphology and roughness to influence cell and tissue
response to implants.
• Advantage : This method prevents the epithelial
growth on dental implants.
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28. Most commonly used methods to assess the quality
of Osseo integration.
1.Biomechanical test
2.Histomorphometric analysis
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29. Biomechanical test
1.Pull-out test
2.Push-out test
3.Torque measurement
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30. RADIOGRAPHS PERIOTEST & REVERSE TORQUE
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31. 4.Resonance frequency analysis
It consists of a post which is screwed into the implant and a transducer/receiver unit. It works by
emmiting a radio frequency and then reads the amplitude which returns to the unit from the implant.
Basically it reads and gives a number that is associated with the “solidness” of the implant.
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32. • There are number of surfaces commercially available for
dental implants.Various methods modifying the implant
surface have greatly influenced the quality of clinical
service in implant prosthodontics.
• Implant surface characterization and working knowledge
about how surface and bulk biomaterial properties inter
relate to implant osseo integration represent an important
area in implant based reconstructive surgery
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33. REFERENCES:
1)INT J Oral Maxillofac Implants 2000;15:675-690
2)Indian Journal of Dental Sciences.(March 2012)
3) Wennerberg A, Albrektsson Suggested guidelines for the
topographic evaluation of implant surfaces.
4)Int J Oral Maxillofac Implants 2000;15:331-44.
5) Brunette DM. The effects of implant surface topography on
the behavior of cells. Int J Oral Maxillofac
Implants1988;3:231
6) Puleo DA, Thomas MV. ImplantSurfaces. Dent Clin North
Am 2006;50:323-338.
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34. Thank you
Dr. Firas Kassab 34