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Good Morning. .
CreatingSmiles
IMPLANT
BIOMATERIALS
Presented By:
Dr.VAIBHAV BUDAKOTI
Dept. of Prosthodontics, Crown ,
Bridge & Implantology
vaibhavbudakoti831994@gmail.com
CreatingSmiles
• Replacement of missing
teeth has always posed
a challenge to the
dentist in terms of
esthetics and successful
functioning of
masticatory loading.
CreatingSmiles
• With fixed replacements,
the disadvantages of
reduction of abutment
teeth and resulting
sensitivity discourage the
patient the treatment
option.
CreatingSmiles
• Caries risk at the crown-
tooth margin, increased
patient effort to maintain
oral hygiene, and alveolar
bone loss in pontic area
are other disadvantages.
• Removable prostheses
are unesthetic and
functionally poor.
CreatingSmiles
• Dental implants has
revolutionized the replacement
of missing natural teeth.
• Concept of osseointegration
was introduced by Per-Ingvar
Brånemark in 1952.
CreatingSmiles
History
• In 1931, an excavated
mandible of a woman
belonging to the Mayan age
contained three tooth shaped
pieces of shell placed into
the sockets.
• Dr. Leonard Linkow, the
father of modern implant
dentistry, placed first dental
implant in 1952.
CreatingSmiles
Osseointegration
• Depends on the composition and
surface characteristics of the
implant.
• Also called functional ankylosis, is
a process by which an implant
unites with the surrounding bone.
• The blood clot formed after implant
placement is replaced by organized
granulation tissue and further by
woven bone which finally converts
into mature bone.
CreatingSmiles
Branemark stated that for osseointegration to
occur an implant should have the following
qualities:
• It should be made of a highly biocompatible
material such as titanium.
• It should be sterile.
• It should be inserted by an atraumatic surgical
technique.
• It should have primary stability (minimum
torque during initial placement 35Ncm).
CreatingSmiles
• It should have adequate loading
during the healing period.
• It should have surface
configurations that cause
osteophilic attraction.
• It should have two parts- one
which favors
bioadhesion(osseointegration)
and another which favors
nonadhesion (collar area above
bone) –for efficient plaque
control.
CreatingSmiles
Parts of an Implant
CreatingSmiles
Abutment
• It is that part of the implant which supports the
crown and provides retention to it.
• It resembles a prepared tooth and is attached to
the body of the implant.
CreatingSmiles
Implant body/fixture
• It is placed in the bone
during implant surgery and
provides anchor to the
restoration.
• It is fixed onto the bone
and the abutment is
screwed onto it.
CreatingSmiles
Cover screw
• It is placed over the
implant body after the first
stage of surgery to
facilitate suturing of the
tissues and prevent growth
of tissues over the edge of
the implant.
CreatingSmiles
Healing cap
• They are placed over the
implant body and protrude
outside the tissues into the oral
cavity.
• They maintain the tissue
contour around the implants
and also help in permanent
restoration of the implant.
CreatingSmiles
CreatingSmiles
Advantages
• Implants avoid cutting down of neighboring
natural teeth.
• They help preserve bone and reduce bone
resorption.
CreatingSmiles
• They reduce the load on
the remaining natural
teeth as they offer
individual support.
• Improved efficiency in
chewing and speaking
compared to complete
denture.
CreatingSmiles
Disadvantages
• Involve a surgical procedure.
• Waiting period of 3-4 months to enable healing
before prosthesis.
• Increased cost compared to conventional
treatment.
CreatingSmiles
Indications
• Loss of one or more natural teeth, especially
when most of the posterior teeth serving as
occlusal stops are missing.
• Presence of a good quality and quantity of
bone around the edentulous area.
• Patient unwilling to undergo a reduction of the
natural teeth.
• Providing support for overdentures.
• Implant-supported maxillofacial prosthesis.
CreatingSmiles
Contraindications
• Inferior quality of bone in edentulous area.
• Bruxism
• Steroid therapy
• Bleeding disorders
• Immunodeficient coditions
• Proximity to anatomical structures such as the
inferior alveolar nerve or maxillary sinus.
CreatingSmiles
Classification of
Dental Implants
CreatingSmiles
Based on material used
• Metals and alloys: titanium and its alloys,
stainless steel, cobalt chromium, and
molybdenum
• Ceramics and carbon implants: made of
carbon with stainless steel
• Polymers and composites:
Polymethylmethacrylate and
polytetrafluoroethylene
CreatingSmiles
Based on biological response
• Biotolerant: these materials are not easily
rejected when implanted into living tissue but
are surrounded by a fibrous layer. E.g.
• Metals like gold, Co-Cr alloy, stainless steel,
zirconium, nobium
• Polymers like polyethylene, polyamide,
polymethylmerthacrylate, polyurethane
CreatingSmiles
• Bioinert: these materials allow close
apposition of bone on their surface, leading to
contact osteogenesis. E.g.
• Metals like commercially pure titanium (Cp-
Ti) and titanium alloy
• Ceramics like aluminum oxide and zirconium
oxide
CreatingSmiles
• Bioactive: these materials allow the formation
of bone onto their surface, but ion exchange
with host tissue leads to the formation of a
chemical bond along along the interface. E.g.
• Ceramics like HA, tricalcium phosphate,
bioglass, fluorapatite, and carbon-silicon.
CreatingSmiles
Based on histology
• Osseointegrated
• Fibro-osseointegrated
CreatingSmiles
Based on implant design
A. Endosteal implants: are
placed into the alveolar
and/or basal bone and
transect only one cortical
plate.
• E.g. Blade implants and
ramus frame implants.
• All implants placed within
the bone are endosteal
implants.
CreatingSmiles
B. Subperiosteal implants:
consists of an implant
substructure that is
custom cast frame placed
directly over the bony
cortex just below the
periosteum.
CreatingSmiles
C. Transperiosteal
implants: penetrate
both cortical plates.
e.g. transmandibular
implant, staple bone
implant, and
mandibular staple
implant.
CreatingSmiles
Based on macroscopic design
A. Threaded or threadless
B. Cylindrical or conical
C. Hollow or solid
CreatingSmiles
Based on surface treatments
• Titanium plasma sprayed(TPS)
• Aluminum oxide coated
• Hydroxyapatite coated
• Machined
• Blasted or etched with other biomaterials
• Electropolished
CreatingSmiles
Materials Used for
Dental Implants
CreatingSmiles
Titanium and its alloys
A. Commercially pure titanium(Cp-Ti)
• Titamium is divided into four grades based on
iron content (0.2%-0.5%)
Grade 1: O2[0.8%], Fe[0.2%]
Grade 4: O2[0.4%], Fe[0.5%]
• Microstructure
 Hexagonal close-packed(alpha phase)
 Cubic body-centered(beta phase)
CreatingSmiles
• Properties: Titanium exhibits the properties of
passivation (rendering a substance inactive or
inert by chemical action) upon contact with air
or tissue fluids, which minimizes biocorrosion.
• Nearly always covered by titanium
oxide(TiO2) layer which is biologically inert
osseointegration.
• It has thickness of 2-10 nm.
CreatingSmiles
• Modulus of elasticity is 5 times
greater(104GPa) than compact bone.
• Titanium is lightweight and has a density of
4.51g/cm.
• It has a melting point of 1668°C
CreatingSmiles
B. Titanium-6 Aluminum-4 Vanadium(Ti-6Al-
4Va)
• Composition:
90% titanium
6% aluminum
4% vanadium
• Modulus of elasticity of this alloy is 5-6
times(113GPa) that of compact bone.
CreatingSmiles
Iron-Chromium-Nickel-Based Alloys:
Stainless Steel
• Composition
70% iron(main constituent)
18% chromium(corrosion resistance)
8% nickel(stabilizes the austenitic structure)
• High strength and ductility.
CreatingSmiles
Advantages
• Corrosion resistance
• Increased ductility
Disadvantages
• Vulnerable to crevice and pitting corrosion
• Contraindicated in patients allergic to nickel
CreatingSmiles
Cobalt-Chromium-Molybdenum alloy
• Composition
63% cobalt(four times as strong as compact bone)
50% chromium (corrosion resistance)
5% molybdenum
Traces of carbon, maganese, and nickel
CreatingSmiles
Ceramics
• Are inorganic, non metallic,
and non polymeric materials
that are either bioactive or
bioinert.
• Ceramic implants are
manufactured by compaction
and sintering at elevated
temperatures.
CreatingSmiles
Bioinert ceramics
• Used in root form,
endosteal, plate form,
and pin type dental
implants.
CreatingSmiles
• Advantages
Do not exhibit thermal and
electrical conductivity.
Undergo minimal
biodegradation.
Reactions with bone are
favorable.
CreatingSmiles
• Disadvantages
Cannot be autoclaved, since it results in decrease
in strength.
Scratches or notches present on the implant
surface may act as fracture initiation sites and
result in failure of the implant.
CreatingSmiles
Bioactive ceramics
• Are applied to titanium and cobalt alloy substrates
by plasma spraying.
• Plasma spraying provide a roughened,
biologically acceptable surface for bone growth
and ensure anchorage in jaw.
• The particles are small sized crystalline HA
ceramics.
• Average thickness between 50um and 70 um and
are mixtures of amorphous and crystalline phases.
CreatingSmiles
• Advantages
Minimal thermal and electrical conductivity
Minimal biodegradation
Minimal reactions with bone
• Disadvantages
Fractures can be initiated by scratches or notches
present on the implant surface.
A decrease in strength occurs when steam sterilized.
Residues of the chemical solutions used are found.
CreatingSmiles
Bioglass
Mechanism of action
• Change in pH near the bioglass
surface causes sodium, calcium,
and phosphorus ions to get
dissolved.
• Hydrogen ions in the local tissue
replace the lost sodium ions in
the bioglass.
• At the surface, a silica-rich gel
forms because of the selective
dissolution of elements.
CreatingSmiles
• Ca and P ions migrate to the silica gel surface,
from within both bioglass and tissue fluids,
when silica is lost.
• Osteoblasts proliferate, producing collagen
fibrils, as sufficient concentration of
phosphorus is present at the surface.
• Collagen fibrils develop and get incorporated
in the Ca and P gel.
CreatingSmiles
Advantages
• Similar to normal biological tissue
• Excellent biocompatibility
• Minimal thermal and electrical conductivity
• Modulus of elasticity similar to bone
Disadvantages
• Low mechanical, tensile, and shear strengths
under loading
• Low attachment between coating and substrate
• Variable solubility
CreatingSmiles
Polymers
• Used for manufacturing the superstructure
• They act as shock absorbers to load
bearing implants
Advantages
• Excellent biocompatibility
• Properties can be altered to suit clinical
implication
Disadvantages
• Inferior mechanical properties
• Lack of adhesion to living tissues
• Adverse immunological reactions
• Cannot be sterilized by steam or ethylene
oxide
CreatingSmiles
PEEK (poly-aryl-ether-ketone)
Dental Implants
• PEEK is a semi-crystalline linear
polycyclic thermoplastic
• applied as an implant material in
the implant body, abutment, and
superstructure.
• fewer hypersensitive and allergic
reactions.
• It does not have a metallic color;
it is beige with a touch of gray,
and has a more aesthetic
appearance than Ti
CreatingSmiles
Surface characteristics of an implant
• Dental implant surfaces should stimulate bone
growth around them upon placement
• The surface topography of an implant is
variably modified with surface treatment and
coatings in order to promote predictive
osseointegration
CreatingSmiles
Units of importance
• Sa: Value represents the mean height of peaks
and pits of the surface
• Sdr: is the developed surface area as compared
to a perfect flat area
CreatingSmiles
Surface characteristics of implants
are classified based on the following:
1. Roughness
a. Smooth: < 0.5 um
b. Rough: 0.5-3 um
i. Minimally rough: 0.5-1 um
ii. Intermediately rough: 1-2 um
iii. Rough: 2-3 um
2. Texture
a. Concave: By additive treatments like HA coating and
titanium plasma spraying
b. Convex: By substractive treatments like etching and
blasting
CreatingSmiles
Roughness
• Roughness increases the surface area
• Improves cell attachment and biochemical
interaction with the bone
Methods to increase surface roughness:
a) Machining:
• Implants with grooves on the thread are more
stable
• Surface oxides consists of a 2-10 um thick,
mostly amorphous layer of TiO2
CreatingSmiles
b) Acid etching:
• Implant surface is pitted.
• Hydrochloric acid(HCL), sulfuric
acid(H2SO4), and nitric
acid(HNO3) are used
• Results in a minimally rough
surface with sa values 0.3-1 um
• Advantages: Increased attraction of
osteoblasts to the implant surface
occurs due to a microscopic
increase in the surface area
CreatingSmiles
c) Sandblasting/grit blasting
• Particles of aluminum trioxide and titanium
dioxide are used
• Allows adhesion, proliferation, and
differentiation of osteoblasts.
• Sa values are 0.5-2 um
d) Sandblasted and acid-etched(SLA) surface
• Dental implants are first sandblasted and then
etched.
• Sa values 1-2 um
• Advantages: Healing, osseointegration, and
stability of implants are achieved in 6 weeks
with SLActive as against the usual 12 weeks.
CreatingSmiles
e) Anodized surfaces
• Anodic oxidation of a titanium
implant surface results in a partial
crystalline and phosphate-enriched
microstructured surface.
• Results in improved bone ingrowth
due to mechanical interlocking
• Advantages: Higher clinical
success rate.
Bone-implant contact ratio is high.
CreatingSmiles
f) Titanium spraying
• Titanium plasma-sprayed(TPS) screw implant
is a self-tapping titanium screw with a
titanium plasma-flame-sprayed surface.
• There is a six-fold increase in the surface area
of the implant-bone interface improve
retention.
CreatingSmiles
g) Porous sintering
• Refers to incorporation of porosity on the
implant by sintering of the metal powder.
• Pores give an increased retention due to
increased ingrowth of surrounding bone into
the pores.
• Laser-sintered metals have been developed to
improve long-term performance.
CreatingSmiles
h) Hydroxyapatite plasma
spraying
• Most frequently used method
for deposition of calcium
phosphate coatings on
implant surface.
• Improve the bioactivity.
• Surface area of the implant
increases upto aprox. 6 times
the original surface area.
• Ra value 5.0±1um
CreatingSmiles
Recent advances in surface coatings
• ZiUnite: metal free ceramic; it has porous
surface based on zirconia
• Bioactive glass coated: bioactive silicate glass
particles are sprayed over the implants by
enameling procedure.
• Protein coated: recombinant human bone
morphogenic protein(rhBMP) is coated over
dental implants.
CreatingSmiles
Latest developments
• Corundum blasting: it creates deep pits in the
implant surface that can act as retentive
pockets for new bone.
• PVD coating: physical vapor deposition
coatings such as titanium nitride or zirconium
nitride are applied for cosmetic reasons on
dental implant collars and abutments for wear
protection.
CreatingSmiles
CreatingSmiles
Nanotechnology in implants
• Addition of nanoscale calcium
phosphate crystals to the implant
surface increases the complexity
of the surface and improves
healing by causing a surface
change.
• Nanostructured surfaces control
the differentiation pathways into
specific cell lineages and
ultimately direct the nature of
peri-implant tissues.
CreatingSmiles
Conclusion
Various implant materials alter the response of
the surrounding tissue to its placement,
namely, osseointegration. More importantly,
the surface characteristics of an implant
determine the predictibility and success of
osseointegration. With recent advances in
implant biomaterials and surface
characteristics, the cellular and tissue response
to the implants can be altered to improve
osseointegration.
CreatingSmiles
References
• Philips’ Science of Dental Materials, 11th ed.
• S. Mahalaxmi Materials Used in Dentistry, 1st
ed.
• John J Manappallil Basic Dental Materials, 4th
ed.
• Andreas Schwitalla, Wolf-Dieter Müller,
PEEK Dental Implants: A Review of the
Literature, Journal of Oral Implantology.
2013;39(6):743-749.
Thank You. .CreatingSmiles

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Implant Biomaterials

  • 2. IMPLANT BIOMATERIALS Presented By: Dr.VAIBHAV BUDAKOTI Dept. of Prosthodontics, Crown , Bridge & Implantology vaibhavbudakoti831994@gmail.com
  • 4. • Replacement of missing teeth has always posed a challenge to the dentist in terms of esthetics and successful functioning of masticatory loading. CreatingSmiles
  • 5. • With fixed replacements, the disadvantages of reduction of abutment teeth and resulting sensitivity discourage the patient the treatment option. CreatingSmiles
  • 6. • Caries risk at the crown- tooth margin, increased patient effort to maintain oral hygiene, and alveolar bone loss in pontic area are other disadvantages. • Removable prostheses are unesthetic and functionally poor. CreatingSmiles
  • 7. • Dental implants has revolutionized the replacement of missing natural teeth. • Concept of osseointegration was introduced by Per-Ingvar Brånemark in 1952. CreatingSmiles
  • 8. History • In 1931, an excavated mandible of a woman belonging to the Mayan age contained three tooth shaped pieces of shell placed into the sockets. • Dr. Leonard Linkow, the father of modern implant dentistry, placed first dental implant in 1952. CreatingSmiles
  • 9. Osseointegration • Depends on the composition and surface characteristics of the implant. • Also called functional ankylosis, is a process by which an implant unites with the surrounding bone. • The blood clot formed after implant placement is replaced by organized granulation tissue and further by woven bone which finally converts into mature bone. CreatingSmiles
  • 10. Branemark stated that for osseointegration to occur an implant should have the following qualities: • It should be made of a highly biocompatible material such as titanium. • It should be sterile. • It should be inserted by an atraumatic surgical technique. • It should have primary stability (minimum torque during initial placement 35Ncm). CreatingSmiles
  • 11. • It should have adequate loading during the healing period. • It should have surface configurations that cause osteophilic attraction. • It should have two parts- one which favors bioadhesion(osseointegration) and another which favors nonadhesion (collar area above bone) –for efficient plaque control. CreatingSmiles
  • 12. Parts of an Implant CreatingSmiles
  • 13. Abutment • It is that part of the implant which supports the crown and provides retention to it. • It resembles a prepared tooth and is attached to the body of the implant. CreatingSmiles
  • 14. Implant body/fixture • It is placed in the bone during implant surgery and provides anchor to the restoration. • It is fixed onto the bone and the abutment is screwed onto it. CreatingSmiles
  • 15. Cover screw • It is placed over the implant body after the first stage of surgery to facilitate suturing of the tissues and prevent growth of tissues over the edge of the implant. CreatingSmiles
  • 16. Healing cap • They are placed over the implant body and protrude outside the tissues into the oral cavity. • They maintain the tissue contour around the implants and also help in permanent restoration of the implant. CreatingSmiles
  • 18. Advantages • Implants avoid cutting down of neighboring natural teeth. • They help preserve bone and reduce bone resorption. CreatingSmiles
  • 19. • They reduce the load on the remaining natural teeth as they offer individual support. • Improved efficiency in chewing and speaking compared to complete denture. CreatingSmiles
  • 20. Disadvantages • Involve a surgical procedure. • Waiting period of 3-4 months to enable healing before prosthesis. • Increased cost compared to conventional treatment. CreatingSmiles
  • 21. Indications • Loss of one or more natural teeth, especially when most of the posterior teeth serving as occlusal stops are missing. • Presence of a good quality and quantity of bone around the edentulous area. • Patient unwilling to undergo a reduction of the natural teeth. • Providing support for overdentures. • Implant-supported maxillofacial prosthesis. CreatingSmiles
  • 22. Contraindications • Inferior quality of bone in edentulous area. • Bruxism • Steroid therapy • Bleeding disorders • Immunodeficient coditions • Proximity to anatomical structures such as the inferior alveolar nerve or maxillary sinus. CreatingSmiles
  • 24. Based on material used • Metals and alloys: titanium and its alloys, stainless steel, cobalt chromium, and molybdenum • Ceramics and carbon implants: made of carbon with stainless steel • Polymers and composites: Polymethylmethacrylate and polytetrafluoroethylene CreatingSmiles
  • 25. Based on biological response • Biotolerant: these materials are not easily rejected when implanted into living tissue but are surrounded by a fibrous layer. E.g. • Metals like gold, Co-Cr alloy, stainless steel, zirconium, nobium • Polymers like polyethylene, polyamide, polymethylmerthacrylate, polyurethane CreatingSmiles
  • 26. • Bioinert: these materials allow close apposition of bone on their surface, leading to contact osteogenesis. E.g. • Metals like commercially pure titanium (Cp- Ti) and titanium alloy • Ceramics like aluminum oxide and zirconium oxide CreatingSmiles
  • 27. • Bioactive: these materials allow the formation of bone onto their surface, but ion exchange with host tissue leads to the formation of a chemical bond along along the interface. E.g. • Ceramics like HA, tricalcium phosphate, bioglass, fluorapatite, and carbon-silicon. CreatingSmiles
  • 28. Based on histology • Osseointegrated • Fibro-osseointegrated CreatingSmiles
  • 29. Based on implant design A. Endosteal implants: are placed into the alveolar and/or basal bone and transect only one cortical plate. • E.g. Blade implants and ramus frame implants. • All implants placed within the bone are endosteal implants. CreatingSmiles
  • 30. B. Subperiosteal implants: consists of an implant substructure that is custom cast frame placed directly over the bony cortex just below the periosteum. CreatingSmiles
  • 31. C. Transperiosteal implants: penetrate both cortical plates. e.g. transmandibular implant, staple bone implant, and mandibular staple implant. CreatingSmiles
  • 32. Based on macroscopic design A. Threaded or threadless B. Cylindrical or conical C. Hollow or solid CreatingSmiles
  • 33. Based on surface treatments • Titanium plasma sprayed(TPS) • Aluminum oxide coated • Hydroxyapatite coated • Machined • Blasted or etched with other biomaterials • Electropolished CreatingSmiles
  • 34. Materials Used for Dental Implants CreatingSmiles
  • 35. Titanium and its alloys A. Commercially pure titanium(Cp-Ti) • Titamium is divided into four grades based on iron content (0.2%-0.5%) Grade 1: O2[0.8%], Fe[0.2%] Grade 4: O2[0.4%], Fe[0.5%] • Microstructure  Hexagonal close-packed(alpha phase)  Cubic body-centered(beta phase) CreatingSmiles
  • 36. • Properties: Titanium exhibits the properties of passivation (rendering a substance inactive or inert by chemical action) upon contact with air or tissue fluids, which minimizes biocorrosion. • Nearly always covered by titanium oxide(TiO2) layer which is biologically inert osseointegration. • It has thickness of 2-10 nm. CreatingSmiles
  • 37. • Modulus of elasticity is 5 times greater(104GPa) than compact bone. • Titanium is lightweight and has a density of 4.51g/cm. • It has a melting point of 1668°C CreatingSmiles
  • 38. B. Titanium-6 Aluminum-4 Vanadium(Ti-6Al- 4Va) • Composition: 90% titanium 6% aluminum 4% vanadium • Modulus of elasticity of this alloy is 5-6 times(113GPa) that of compact bone. CreatingSmiles
  • 39. Iron-Chromium-Nickel-Based Alloys: Stainless Steel • Composition 70% iron(main constituent) 18% chromium(corrosion resistance) 8% nickel(stabilizes the austenitic structure) • High strength and ductility. CreatingSmiles
  • 40. Advantages • Corrosion resistance • Increased ductility Disadvantages • Vulnerable to crevice and pitting corrosion • Contraindicated in patients allergic to nickel CreatingSmiles
  • 41. Cobalt-Chromium-Molybdenum alloy • Composition 63% cobalt(four times as strong as compact bone) 50% chromium (corrosion resistance) 5% molybdenum Traces of carbon, maganese, and nickel CreatingSmiles
  • 42. Ceramics • Are inorganic, non metallic, and non polymeric materials that are either bioactive or bioinert. • Ceramic implants are manufactured by compaction and sintering at elevated temperatures. CreatingSmiles
  • 43. Bioinert ceramics • Used in root form, endosteal, plate form, and pin type dental implants. CreatingSmiles
  • 44. • Advantages Do not exhibit thermal and electrical conductivity. Undergo minimal biodegradation. Reactions with bone are favorable. CreatingSmiles
  • 45. • Disadvantages Cannot be autoclaved, since it results in decrease in strength. Scratches or notches present on the implant surface may act as fracture initiation sites and result in failure of the implant. CreatingSmiles
  • 46. Bioactive ceramics • Are applied to titanium and cobalt alloy substrates by plasma spraying. • Plasma spraying provide a roughened, biologically acceptable surface for bone growth and ensure anchorage in jaw. • The particles are small sized crystalline HA ceramics. • Average thickness between 50um and 70 um and are mixtures of amorphous and crystalline phases. CreatingSmiles
  • 47. • Advantages Minimal thermal and electrical conductivity Minimal biodegradation Minimal reactions with bone • Disadvantages Fractures can be initiated by scratches or notches present on the implant surface. A decrease in strength occurs when steam sterilized. Residues of the chemical solutions used are found. CreatingSmiles
  • 48. Bioglass Mechanism of action • Change in pH near the bioglass surface causes sodium, calcium, and phosphorus ions to get dissolved. • Hydrogen ions in the local tissue replace the lost sodium ions in the bioglass. • At the surface, a silica-rich gel forms because of the selective dissolution of elements. CreatingSmiles
  • 49. • Ca and P ions migrate to the silica gel surface, from within both bioglass and tissue fluids, when silica is lost. • Osteoblasts proliferate, producing collagen fibrils, as sufficient concentration of phosphorus is present at the surface. • Collagen fibrils develop and get incorporated in the Ca and P gel. CreatingSmiles
  • 50. Advantages • Similar to normal biological tissue • Excellent biocompatibility • Minimal thermal and electrical conductivity • Modulus of elasticity similar to bone Disadvantages • Low mechanical, tensile, and shear strengths under loading • Low attachment between coating and substrate • Variable solubility CreatingSmiles
  • 51. Polymers • Used for manufacturing the superstructure • They act as shock absorbers to load bearing implants Advantages • Excellent biocompatibility • Properties can be altered to suit clinical implication Disadvantages • Inferior mechanical properties • Lack of adhesion to living tissues • Adverse immunological reactions • Cannot be sterilized by steam or ethylene oxide CreatingSmiles
  • 52. PEEK (poly-aryl-ether-ketone) Dental Implants • PEEK is a semi-crystalline linear polycyclic thermoplastic • applied as an implant material in the implant body, abutment, and superstructure. • fewer hypersensitive and allergic reactions. • It does not have a metallic color; it is beige with a touch of gray, and has a more aesthetic appearance than Ti CreatingSmiles
  • 53. Surface characteristics of an implant • Dental implant surfaces should stimulate bone growth around them upon placement • The surface topography of an implant is variably modified with surface treatment and coatings in order to promote predictive osseointegration CreatingSmiles
  • 54. Units of importance • Sa: Value represents the mean height of peaks and pits of the surface • Sdr: is the developed surface area as compared to a perfect flat area CreatingSmiles
  • 55. Surface characteristics of implants are classified based on the following: 1. Roughness a. Smooth: < 0.5 um b. Rough: 0.5-3 um i. Minimally rough: 0.5-1 um ii. Intermediately rough: 1-2 um iii. Rough: 2-3 um 2. Texture a. Concave: By additive treatments like HA coating and titanium plasma spraying b. Convex: By substractive treatments like etching and blasting CreatingSmiles
  • 56. Roughness • Roughness increases the surface area • Improves cell attachment and biochemical interaction with the bone Methods to increase surface roughness: a) Machining: • Implants with grooves on the thread are more stable • Surface oxides consists of a 2-10 um thick, mostly amorphous layer of TiO2 CreatingSmiles
  • 57. b) Acid etching: • Implant surface is pitted. • Hydrochloric acid(HCL), sulfuric acid(H2SO4), and nitric acid(HNO3) are used • Results in a minimally rough surface with sa values 0.3-1 um • Advantages: Increased attraction of osteoblasts to the implant surface occurs due to a microscopic increase in the surface area CreatingSmiles
  • 58. c) Sandblasting/grit blasting • Particles of aluminum trioxide and titanium dioxide are used • Allows adhesion, proliferation, and differentiation of osteoblasts. • Sa values are 0.5-2 um d) Sandblasted and acid-etched(SLA) surface • Dental implants are first sandblasted and then etched. • Sa values 1-2 um • Advantages: Healing, osseointegration, and stability of implants are achieved in 6 weeks with SLActive as against the usual 12 weeks. CreatingSmiles
  • 59. e) Anodized surfaces • Anodic oxidation of a titanium implant surface results in a partial crystalline and phosphate-enriched microstructured surface. • Results in improved bone ingrowth due to mechanical interlocking • Advantages: Higher clinical success rate. Bone-implant contact ratio is high. CreatingSmiles
  • 60. f) Titanium spraying • Titanium plasma-sprayed(TPS) screw implant is a self-tapping titanium screw with a titanium plasma-flame-sprayed surface. • There is a six-fold increase in the surface area of the implant-bone interface improve retention. CreatingSmiles
  • 61. g) Porous sintering • Refers to incorporation of porosity on the implant by sintering of the metal powder. • Pores give an increased retention due to increased ingrowth of surrounding bone into the pores. • Laser-sintered metals have been developed to improve long-term performance. CreatingSmiles
  • 62. h) Hydroxyapatite plasma spraying • Most frequently used method for deposition of calcium phosphate coatings on implant surface. • Improve the bioactivity. • Surface area of the implant increases upto aprox. 6 times the original surface area. • Ra value 5.0±1um CreatingSmiles
  • 63. Recent advances in surface coatings • ZiUnite: metal free ceramic; it has porous surface based on zirconia • Bioactive glass coated: bioactive silicate glass particles are sprayed over the implants by enameling procedure. • Protein coated: recombinant human bone morphogenic protein(rhBMP) is coated over dental implants. CreatingSmiles
  • 64. Latest developments • Corundum blasting: it creates deep pits in the implant surface that can act as retentive pockets for new bone. • PVD coating: physical vapor deposition coatings such as titanium nitride or zirconium nitride are applied for cosmetic reasons on dental implant collars and abutments for wear protection. CreatingSmiles
  • 66. Nanotechnology in implants • Addition of nanoscale calcium phosphate crystals to the implant surface increases the complexity of the surface and improves healing by causing a surface change. • Nanostructured surfaces control the differentiation pathways into specific cell lineages and ultimately direct the nature of peri-implant tissues. CreatingSmiles
  • 67. Conclusion Various implant materials alter the response of the surrounding tissue to its placement, namely, osseointegration. More importantly, the surface characteristics of an implant determine the predictibility and success of osseointegration. With recent advances in implant biomaterials and surface characteristics, the cellular and tissue response to the implants can be altered to improve osseointegration. CreatingSmiles
  • 68. References • Philips’ Science of Dental Materials, 11th ed. • S. Mahalaxmi Materials Used in Dentistry, 1st ed. • John J Manappallil Basic Dental Materials, 4th ed. • Andreas Schwitalla, Wolf-Dieter Müller, PEEK Dental Implants: A Review of the Literature, Journal of Oral Implantology. 2013;39(6):743-749.

Editor's Notes

  1. Institute Straumann AG, Waldenburg, Switzerland