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Understanding Surface Topography
Dr. Andy asks:
There are many different surface coatings for dental implant fixtures: hydroxyapatite (HA), acid etch, sand blast, TiUnite, Osseotite, and so on.
Each manufacturer makes claims that the particular surface coating on his dental implant fixtures produces the best osseointegration and the greatest chance for success. Are there any studies that compare these surface coatings? Is one coating better than the other? What is the driving rationale behind these different coatings? Where is this headed? Comments would be appreciated. Thanks.
October 30, 2006 in Surface Treatments | Permalink
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Comments
The International Journal of Oral & Maxillofacial Implants Vol. 13 Number 5 from 1998 has an article titled " Removal Torque Values of Titanium Implants in the Maxilla of Miniature Pigs." By Daniel Buser DDS etal. The study compares an 8mm SLA implant to a 10mm Osseotite. Torque removals for SLA which has both a Macro and Micro Morphology to its roughened surface required substantially more torque to remove them implant from bone at all time points. Despite having 2mm less of roughed surface.
Journal of Biomed Mater Res. 1995 Mar;29(3):389-401. SLA compared to other rough surface methods and the Old Straumann TPS surface
Clinical Oral Implants Res. 2005 Dec; 16(6): 657-66 Sand blasted (Macro) + Acid Etching (Micro) "...showed significantly enhanced rates of cell spreading in comparison with the others."
A Macro roughened surface that is enhanced by a micro topography appears to have the best bone to implant contact and torque removal values in the literature. The time line for osseointegration is improved allowing for patients to be restored at ealier time points when compared to Implant surfaces that do not have this dual characteristic. Hopefully their will be no further off topic discussion about immediate load which is a function of primary stability not the rate at which the body can shift from primary to secondary stability.
You can go to Pubmed to find articles about the morphology of dental implants and the effect on osseointegration.
You will hear 3i say that sand blasting is bad and Lifecore will say that acid etching may leave a residue of dangerous acid. But independent research is much better than marketing claims in my view.
Posted by: | Oct 30, 2006 4:06:48 PM
has anyone compared to these two surfaces to Astra Tech flouride modified surface
Posted by: | Oct 31, 2006 5:26:40 PM
In a methodical review of promotional material of some 80 implant manufacturers and of the dental research literature, Jokstad et al found no clear evidence of biologic advantages of any particular implant system over another regardless of the type of surface. (Jokstad A, Braegger U, Brunski JB, Carr AB, Naert I, Wennerberg A. Quality of dental implants. Int Dent J. 2003;53(6 Suppl 2):409-43.)
That being the case, practical considerations become uppermost. We can disregard implant surface types.
There are no major differences in the surgical phase of various systems. In the prosthetic phase, however, the differences are marked. For instance, screw retention -- a legacy of the research origins of many of today’s implants, is common among the established implant designs. The literature has over a hundred papers dealing with screw retention in implantology and the associated problems of screw loosening and screw fracture. Manufacturers of the newer, simpler systems use designs which approximate conventional crown and bridge work including cement retention of abutments and prostheses. To date, there are no papers in the literature on the subject of cement failure in implantology.
We can disregard marketing department claims of surface superiority. We simply need to look for systems which approximate conventional prostheitcs and have few steps and few parts.
Posted by: Dr. Tenax | Oct 31, 2006 5:53:11 PM
Yes, because the roughtness of a surface is not enough to bring a material an ability to be biologically linked to a bony structure.
Depending on the type of coating some surfaces are more prone to enhance bone growth than others.
It is important to distinguish two concepts:
1- biological link between any material and bone cells
2- bone enhancement inside some porous material with a somewhat link that could be very weak.
There is not a straightforward link between a porous surface and its ability to make a strong biological link with tissues.
Depending on the ability for a material to share some "bridges" with a bony structure the results may differ a lot whatever the kind of coating the material had been subdued to...
Posted by: | Nov 1, 2006 4:42:48 AM
Nice to hear many coments on the surface. As a student in the Implant dentistry I was taught by many teachers (Dr.Linkow, Dr.Hilttatum,e.t.c.) That the surface roughness of an implant and osseointegration are directly related but there is a limiting value of roughness after which the osseointegration does not change.
Posted by: M.Sridhar Reddy | Nov 1, 2006 9:20:11 AM
Surface technology should not be dismissed. The 2003 study measured outcomes. Meaning most companies report a survival rate of between 93-99 percent for the approved treatment protocols. Although it should be noted that the quality of bone is a key factor and few companies stretch their product offering to see what kind of result they get in class III and IV bone. In addition, the various articles reveiwed have different restorative time points, so a positive outcome at 6 months from one company is viewed as equivalent to a similar case restored at 8 weeks. 4 months of time seems to be a pretty big benefit to a patient in a flipper. Just as an immediate temporary would be a benefit if it doesn't compromise the stability of the implant.
Posted by: | Nov 1, 2006 2:44:11 PM
The title should not be Surface coatings, but more appropriately, Surface topography as not all surfaces are coatings. Some are raw titanium without any additives and some are subtractive. Please do your homework.
Posted by: RS | Nov 1, 2006 5:25:11 PM
We can disregards marketing department claims.
How does one spin surface topography into a discussion on cemented abutments and is an implant system that has the worst surface topograhy?
You are selling/marketing a porous coated surface implant-Tenax.
Few steps fewest parts is part of you website! I did a google search. The hypocracy is at an time high.
By the way, Tenax looks to be a limited sytem. No custome abutments, No screw retained prostheses as you can only cement abutments.
Please go and pump your system in the right blog or forum.
Posted by: | Nov 18, 2006 5:51:41 AM
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