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DR ROSELINE MESHRAMKAR
PROFESSOR & HEAD
DEPARTMENT OF PROSTHODONTICS
SDM COLLEGE OF DENTAL SCIENCES AND HOSPITAL
DHARWAD, INDIA
INTRODUCTION
 Dental implants have been accepted as a predictable and reliable
treatment modality for the rehabilitation of both partially and completely
edentulous patients.
 Titanium implants have so far been the material of choice in implant
dentistry. However the grey colour of titanium impairs esthetic results
particularly in presence of thin gingival type.
 Recently , Zirconia has been widely used as dental implant substrate due
to its excellent properties like high flexural strength and fracture
toughness , optimal esthetics and high biocompatablity.
 The success of endosseous implants are
directly related to principle of osseointegration,
a process of implant bone interaction that led to
Bone to implant anchorage.
 It is a biological fixation of implant relating to
direct bone to implant contact without an
intervening connective tissue layer.
 Surface properties of biomaterial play a
Fundamental role of osseointegration process.
 Different approaches are being used to effort
to improve surface properties of zirconia.They
are airborne particle abrasion , acid etching with
Hcl or hydrofluoric acid, plasma spraying,
Aggregation of bioactive material such as
Hydroxyappatite.
OBJECTIVES OF THE STUDY
 To evaluate the osteoblastic activity of zirconia
without surface treatment. (Group I).
 To evaluate the osteoblastic activity of zirconia
with surface treatment. (etching) (Group II).
 To evaluate the osteoblastic activity of zirconia
with surface treatment UV radiation (Group III).
 To compare and evaluate the surface roughness
and osteoblastic activity between all the groups.
MATERIAL AND METHODS
60 Machined Zirconia discs of 2mm diameter and
1.5mm thickness were processed -20 discs per
group
GROUP I - No surface treatment (control)
GROUP II - Surface treatment with
•sandblasting (Aluminium oxide)
•acid etching (Hydrofluoric acid)
GROUP III - Surface treatment with UV Radiation
CELL CULTURE –For osteoblastic activity HOS(Human
osteoblastic sarcoma) were seededon test material at density
of 1x104 cm/cm2 and incubated at 37 C under humidified
atmosphere containing 5% Co2 after 48 hours.Cell seeded
Test material is fixed with 2.5% glutaraldehyde
MATERIAL AND METHODS
SEM ANALYSIS- Dry specimen mounted on a stud
using adhesive and epoxy resin, splutter coated with
gold before examining it with microscope.It is done
before and after cell culture.
Magnification-500 x 5000
SEM ANALYSIS
GROUP I- Control
Without Surface treatment-We can see few
parallel
lines, pits and cracks
GROUP II-Surface treated with
etching and Sandblasting- Porous
surface with prominent surface
Changes with elevations and
depressions
GROUP III-Surface treated with
UV Radiation- surface had lines, pits and
cracks
RESULTS
RESULTS
GROUP I- Control
Without Surface treatment
Osteoblastic activity seen with very
Few colonies
GROUP II-Surface treated with
etching and Sandblasting
Osteoblastic activity with
More colonies seen
GROUP III-Surface treated with
UV Radiation
Osteoblastic activity with maximum
number of colonies seen
Scarano et al, in 2003 examined the bone-implant interface of machined
zirconia implants at 4 weeks of healing and reported BIC values of 68.4%.
Akagawa et al,observed a BIC ratio of 66% to 81% for zirconia implants inserted
into mandible of monkeys after 24 months of healing which was similar to that of
zirconia implants at the 12-month observation.In our study zirconia samples
without surface treatment had osteoblastic cell adherence.In our study,zirconia
samples without surface treatment had osteoblastic adherence.
Deprich in 2008 demonstrated increase osseointegration with acid etched
zirconia which is similar to our findings where we observed increased
oseoblastic activity with surface treated with both sand blasting and
etching shown
DISCUSSION
Hisbergus et al in 2009 demonstrated that acid etching of zirconia
Do not provide surface roughness,which is in contradiction with our study
Gahlert et all, 2007 reported that osseintegration capacity of machined
zirconia surface can be substantially increased after modification by Al2O3
sand blasting.Our findings were in accordance with this study.
Kohal et al in 2008 and Andreotelli et al in2009 in their report suggested
that low thermal degradation will weaker the surface stability of zirconia
materials thus possibly leading to promotion failure of sand blasted
implant.
DISCUSSION
Liu et al in 2005 demonstrated that zirconia posess photo catalytic
activity when exposed to UV light by removal of hydrophobic layer
of hydrocarbons from the surface of the material..
In our study we found that there was increased osteoblastic activity after UV
Radiation which is in accordance with study conducted byAtt et al in 2009 , UV
light treatment transformed the zirconia surface from hydrophobic to hydrophilic
status.It has been Particularly challenging to enhance the osteoconductive
capacity of zirconia by its surface topographical modification.
Recently, ultraviolet (UV)-mediated photo functionalization of titanium
implants has been proposed to enhance the adhesive property of titanium
to the bone. Photofunctionalized implants showed a near 100% BIC
and three times the strength of osseointegration in animal models.
DISCUSSION
CONCLUSION
 The cell adhesion in Group I Samples
were having less spread of
Osteoblastic cells and had fewer
osteoblastic cell colonies
 Group II Samples were having more
distinct spread of osteoblastic cells
Than group I.However they had fewer
osteoblastic cell colonies
 The cell adhesion seen in group III
(UV Photofunctionalisation) were
showing more prominent osteoblast cells
that was scattered throughout the
Sample and showed better adhesion as
compared to Group I and Group II
SCOPE FOR THE STUDY
 Further research to be done to focus on
Material changes after surface treatment
 Effect of UV light on invivo on
osteoconductive potential of zirconia
should be the target of exploration
 Further animal studies should be carried
out
LIMITATIONS
 This being an invitro study cannot
fully translate into invivo conditions
 Invivo conditions tissue response has
to be evaluated
 Intraoral conditions will also be
different.
References
1. Borgonovo A E:Censi Vavasorrii: Ealuaion of the success criteria for zirconia
implants. A four year clinical and radiological study. Int.J.Dent.2013
2. Payer M:Heschl A:Arnetzl G:Lorenzoni All ceramic restoration of zirconia
two piece implants – a randomized controlled clinical trial. Clin. Oral
implants res 2014
3. Osman RB; Morgaine , K.C;Duncan W Patient’s perspective on zirconia and
titanium implants with a novel distribution supporting maxillary and
mandiular over dentures.
4. Park Y.S ;Chung,S.H ;Shon Peri implant bone formation and surface
characteristics of rough surface zirconia implants manufactured by
powder injection molding techniques in rabbit tibia Clin. Oral.Implant.res
2013
5. Manzano ,G,Herrero L.R;Montero Comparison of cinical performance
of zirconia and titanium implants in animal models. A systematic
reiew Int. Oral Maxillofacial. Implants 2014
6. Javed F; Al-Hezaimi,K Almas Is titanium sensitivity associated with
allergic reactions in patients with dental implants? A systematic
review . Clin. Implant. Dent Relat Res 2013
7. Chatravedi T.P Allergy related tp dental implant and its clinical
significance . Clin. Cosmet .investig. Dent 2013
8. Sanon C Chevalier J Donulliard T Cattani Lorente M Scherrer A new
testing protocol for zirconia
9. Alhazzavi TF Lemons J Liu PR Essig ME Bartoulucci AA Janowski G.M
Influence of low temperture environmental exposure on metallic
properties and structural stabilities of dental zirconia
10. Cottom BA Mayo M J fracture toughness of nanocrystalline ZrO2
3 mol % Y2O3 determined by vickers intendation Scr Mter 1996
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Roseline

  • 1. DR ROSELINE MESHRAMKAR PROFESSOR & HEAD DEPARTMENT OF PROSTHODONTICS SDM COLLEGE OF DENTAL SCIENCES AND HOSPITAL DHARWAD, INDIA
  • 2. INTRODUCTION  Dental implants have been accepted as a predictable and reliable treatment modality for the rehabilitation of both partially and completely edentulous patients.  Titanium implants have so far been the material of choice in implant dentistry. However the grey colour of titanium impairs esthetic results particularly in presence of thin gingival type.  Recently , Zirconia has been widely used as dental implant substrate due to its excellent properties like high flexural strength and fracture toughness , optimal esthetics and high biocompatablity.
  • 3.  The success of endosseous implants are directly related to principle of osseointegration, a process of implant bone interaction that led to Bone to implant anchorage.  It is a biological fixation of implant relating to direct bone to implant contact without an intervening connective tissue layer.  Surface properties of biomaterial play a Fundamental role of osseointegration process.  Different approaches are being used to effort to improve surface properties of zirconia.They are airborne particle abrasion , acid etching with Hcl or hydrofluoric acid, plasma spraying, Aggregation of bioactive material such as Hydroxyappatite.
  • 4. OBJECTIVES OF THE STUDY  To evaluate the osteoblastic activity of zirconia without surface treatment. (Group I).  To evaluate the osteoblastic activity of zirconia with surface treatment. (etching) (Group II).  To evaluate the osteoblastic activity of zirconia with surface treatment UV radiation (Group III).  To compare and evaluate the surface roughness and osteoblastic activity between all the groups.
  • 5. MATERIAL AND METHODS 60 Machined Zirconia discs of 2mm diameter and 1.5mm thickness were processed -20 discs per group GROUP I - No surface treatment (control) GROUP II - Surface treatment with •sandblasting (Aluminium oxide) •acid etching (Hydrofluoric acid) GROUP III - Surface treatment with UV Radiation
  • 6. CELL CULTURE –For osteoblastic activity HOS(Human osteoblastic sarcoma) were seededon test material at density of 1x104 cm/cm2 and incubated at 37 C under humidified atmosphere containing 5% Co2 after 48 hours.Cell seeded Test material is fixed with 2.5% glutaraldehyde MATERIAL AND METHODS SEM ANALYSIS- Dry specimen mounted on a stud using adhesive and epoxy resin, splutter coated with gold before examining it with microscope.It is done before and after cell culture. Magnification-500 x 5000 SEM ANALYSIS
  • 7. GROUP I- Control Without Surface treatment-We can see few parallel lines, pits and cracks GROUP II-Surface treated with etching and Sandblasting- Porous surface with prominent surface Changes with elevations and depressions GROUP III-Surface treated with UV Radiation- surface had lines, pits and cracks RESULTS
  • 8. RESULTS GROUP I- Control Without Surface treatment Osteoblastic activity seen with very Few colonies GROUP II-Surface treated with etching and Sandblasting Osteoblastic activity with More colonies seen GROUP III-Surface treated with UV Radiation Osteoblastic activity with maximum number of colonies seen
  • 9. Scarano et al, in 2003 examined the bone-implant interface of machined zirconia implants at 4 weeks of healing and reported BIC values of 68.4%. Akagawa et al,observed a BIC ratio of 66% to 81% for zirconia implants inserted into mandible of monkeys after 24 months of healing which was similar to that of zirconia implants at the 12-month observation.In our study zirconia samples without surface treatment had osteoblastic cell adherence.In our study,zirconia samples without surface treatment had osteoblastic adherence. Deprich in 2008 demonstrated increase osseointegration with acid etched zirconia which is similar to our findings where we observed increased oseoblastic activity with surface treated with both sand blasting and etching shown DISCUSSION
  • 10. Hisbergus et al in 2009 demonstrated that acid etching of zirconia Do not provide surface roughness,which is in contradiction with our study Gahlert et all, 2007 reported that osseintegration capacity of machined zirconia surface can be substantially increased after modification by Al2O3 sand blasting.Our findings were in accordance with this study. Kohal et al in 2008 and Andreotelli et al in2009 in their report suggested that low thermal degradation will weaker the surface stability of zirconia materials thus possibly leading to promotion failure of sand blasted implant. DISCUSSION
  • 11. Liu et al in 2005 demonstrated that zirconia posess photo catalytic activity when exposed to UV light by removal of hydrophobic layer of hydrocarbons from the surface of the material.. In our study we found that there was increased osteoblastic activity after UV Radiation which is in accordance with study conducted byAtt et al in 2009 , UV light treatment transformed the zirconia surface from hydrophobic to hydrophilic status.It has been Particularly challenging to enhance the osteoconductive capacity of zirconia by its surface topographical modification. Recently, ultraviolet (UV)-mediated photo functionalization of titanium implants has been proposed to enhance the adhesive property of titanium to the bone. Photofunctionalized implants showed a near 100% BIC and three times the strength of osseointegration in animal models. DISCUSSION
  • 12. CONCLUSION  The cell adhesion in Group I Samples were having less spread of Osteoblastic cells and had fewer osteoblastic cell colonies  Group II Samples were having more distinct spread of osteoblastic cells Than group I.However they had fewer osteoblastic cell colonies  The cell adhesion seen in group III (UV Photofunctionalisation) were showing more prominent osteoblast cells that was scattered throughout the Sample and showed better adhesion as compared to Group I and Group II SCOPE FOR THE STUDY  Further research to be done to focus on Material changes after surface treatment  Effect of UV light on invivo on osteoconductive potential of zirconia should be the target of exploration  Further animal studies should be carried out LIMITATIONS  This being an invitro study cannot fully translate into invivo conditions  Invivo conditions tissue response has to be evaluated  Intraoral conditions will also be different.
  • 13. References 1. Borgonovo A E:Censi Vavasorrii: Ealuaion of the success criteria for zirconia implants. A four year clinical and radiological study. Int.J.Dent.2013 2. Payer M:Heschl A:Arnetzl G:Lorenzoni All ceramic restoration of zirconia two piece implants – a randomized controlled clinical trial. Clin. Oral implants res 2014 3. Osman RB; Morgaine , K.C;Duncan W Patient’s perspective on zirconia and titanium implants with a novel distribution supporting maxillary and mandiular over dentures. 4. Park Y.S ;Chung,S.H ;Shon Peri implant bone formation and surface characteristics of rough surface zirconia implants manufactured by powder injection molding techniques in rabbit tibia Clin. Oral.Implant.res 2013
  • 14. 5. Manzano ,G,Herrero L.R;Montero Comparison of cinical performance of zirconia and titanium implants in animal models. A systematic reiew Int. Oral Maxillofacial. Implants 2014 6. Javed F; Al-Hezaimi,K Almas Is titanium sensitivity associated with allergic reactions in patients with dental implants? A systematic review . Clin. Implant. Dent Relat Res 2013 7. Chatravedi T.P Allergy related tp dental implant and its clinical significance . Clin. Cosmet .investig. Dent 2013 8. Sanon C Chevalier J Donulliard T Cattani Lorente M Scherrer A new testing protocol for zirconia 9. Alhazzavi TF Lemons J Liu PR Essig ME Bartoulucci AA Janowski G.M Influence of low temperture environmental exposure on metallic properties and structural stabilities of dental zirconia 10. Cottom BA Mayo M J fracture toughness of nanocrystalline ZrO2 3 mol % Y2O3 determined by vickers intendation Scr Mter 1996

Editor's Notes

  1. In 2009 Hisbergus et al20 demonstrated that acid etching of zirconia do not provide surface roughness. In a study done by Gahlert et al4, 2007 reported that osseintegration capacity ofmachined zirconia surface can be substantially increased after modification by Al2O3 sand blasting. However sand blasting may have a negative effect on the microstructure of zirconia leading to -initial transformation of zirconia surfacefrom the tetragonal to the monoclinic phase and thereby reducing the resistance to low thermal degradation