ReviewSurface treatments of titanium dental implants for rapid osseointegration
Introduction
In the past 20 years, the number of dental implant procedures has increased steadily worldwide, reaching about one million dental implantations per year. The clinical success of oral implants is related to their early osseointegration. Geometry and surface topography are crucial for the short- and long-term success of dental implants. These parameters are associated with delicate surgical techniques, a prerequisite for a successful early clinical outcome [1]. After implantation, titanium implants interact with biological fluids and tissues. Direct bone apposition onto the surface of the titanium is critical for the rapid loading of dental implants. After the initial stages of osseointegration, both prosthetic biomechanical factors and patient hygiene are crucial for the long-term success of the implants. There are two types of response after implantation. The first type involves the formation of a fibrous soft tissue capsule around the implant. This fibrous tissue capsule does not ensure proper biomechanical fixation and leads to clinical failure of the dental implant. The second type of bone response is related to direct bone–implant contact without an intervening connective tissue layer. This is what is known as osseointegration. This biological fixation is considered to be a prerequisite for implant-supported prostheses and their long-term success. The rate and quality of osseointegration in titanium implants are related to their surface properties. Surface composition, hydrophilicity and roughness are parameters that may play a role in implant–tissue interaction and osseointegration.
This review focuses on the different surfaces and methods that aim to accelerate the osseointegration of dental implants. The physical and chemical properties of implant surfaces are discussed in relation to their biological and clinical behavior. Manufacturers of dental implants have developed a variety of surfaces with different compositions and degrees of roughness. However, there is controversy as to the optimal features for implant surfaces regarding osseointegration kinetics.
Section snippets
Chemical composition of the surface of dental implants
The chemical composition or charges on the surface of titanium implants differ, depending on their bulk composition and surface treatments. The composition and charges are critical for protein adsorption and cell attachment. Dental implants are usually made from commercially pure titanium or titanium alloys. Commercially pure titanium (cpTi) has various degrees of purity (graded from 1 to 4). This purity is characterized by oxygen, carbon and iron content. Most dental implants are made from
Surface roughness of dental implants
There are numerous reports that demonstrate that the surface roughness of titanium implants affects the rate of osseointegration and biomechanical fixation [9], [10]. Surface roughness can be divided into three levels depending on the scale of the features: macro-, micro- and nano-sized topologies.
The macro level is defined for topographical features as being in the range of millimetres to tens of microns. This scale is directly related to implant geometry, with threaded screw and macroporous
Osteoconductive calcium phosphate coatings on dental implants
Metal implants have been coated with layers of calcium phosphates mainly composed of hydroxyapatite. Following implantation, the release of calcium phosphate into the peri-implant region increases the saturation of body fluids and precipitates a biological apatite onto the surface of the implant [65], [66]. This layer of biological apatite might contain endogenous proteins and serve as a matrix for osteogenic cell attachment and growth [67]. The bone healing process around the implant is
Future trends in dental implant surfaces
A few strategies should be considered in order to improve both the short and long-term osseointegration of titanium dental implants. These future trends concern the modifications of surface roughness at the nanoscale level for promoting protein adsorption and cell adhesion, biomimetic calcium phosphate coatings for enhancing osteoconduction and the incorporation of biological drugs for accelerating the bone healing process in the peri-implant area.
Conclusion
There are a number of surfaces commercially available for dental implants. Most of these surfaces have proven clinical efficacy (>95% over 5 years). However, the development of these surfaces has been empirical, requiring numerous in vitro and in vivo tests. Most of these tests were not standardized, using different surfaces, cell populations or animal models. The exact role of surface chemistry and topography on the early events of the osseointegration of dental implants remain poorly
Acknowledgements
The authors acknowledge Straumann AG (Bern, Switzerland) for providing the SLA samples, Astra Tech (Astra Zeneca, Rueil-Malmaison, France) for providing the TiOblast™ and OsseoSpeed™ samples. Cam Implants BV (Leiden, The Netherlands) is also acknowledged for providing the TPS and HA plasma-sprayed samples. We also thank Paul Pilet from the Miscoscopy Centre for SEM pictures and Kirsty Snaith for grammar corrections of the manuscript.
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