Year : 2016 | Volume
: 27 | Issue : 4 | Page : 341--342
What is an ideal implant surface?
Junho Lee, Young Ku
Department of Periodontology, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, 110-768, Republic of Korea
Department of Periodontology, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, 110-768
Republic of Korea
|How to cite this article:|
Lee J, Ku Y. What is an ideal implant surface?.Indian J Dent Res 2016;27:341-342
|How to cite this URL:|
Lee J, Ku Y. What is an ideal implant surface?. Indian J Dent Res [serial online] 2016 [cited 2022 May 22 ];27:341-342
Available from: https://www.ijdr.in/text.asp?2016/27/4/341/191863
Dr. Brånemark's findings on titanium implants brought huge development in clinical dentistry as well as dental research. For decades, many investigated specifically implant surface material, morphology, hydrophilicity, chemistry, and nanoroughness to hasten the early stages of the bone healing period.
The initial implant osseointegration has been considerably improved with the development of implant designs and surface treatments: Smooth to rough, oxidized to acid-etched, sand-blasting, and hydrophobic to hydrophilic. These novel and upgraded biological and chemical treatments on implant surface may have resulted in stronger bone responses than those prior.
Implant manufacturers evaluated the roughness of surfaces with the Sa (the average roughness over a surface in three-dimensional height) and Sdr (surface height and spatial roughness parameter) values. The original Brånemark implant was commercially pure titanium Grade 1 machined surface. It had Sa of 0.9 μm and Sdr of 34%. TiUnite of Nobel Biocare has anodized surface with Sa value of 1.1 μm and Sdr value of 37%. The sandblast with large grit and acid-etched (SLA) implant from Straumann has Sa of 1.5 μm and Sdr of 34%. Then, a novel hydrophilic Straumann implant with SLActive surface was introduced; its Sa was 1.75 μm and Sdr was significantly increased to 143%. OsseoSpeed of Astra Tech is known for its unique microthreads and surface treatment with fluoride ions. Its surface has Sa of 1.4 μm and Sdr of 37%.
The above Sa and Sdr values and types of implant surfaces from different but very well-known implant systems are not the same. However, we hardly worry about their osseointegration since numerous published long-term studies as well as our clinical experiences prove that they achieve direct bone-to-implant contact. Like what Albrektsson stated about the background factors needed for osseointegration, implant surface topography is crucial, but it is not the only factor in bone responses or osseointegration. It needs biocompatibility, design, surface conditions, status of host bed, surgical technique, and loading conditions for successful osseointegration. However, considering the long-term success, the micro- or nano-features of implant surface would be a more debatable topic in terms of peri-implantitis and plaque accumulations.
On peri-implantitis conditions, multiple anti-infective therapies have been applied and studied to reduce the number of pathogens expecting the re-osseointegration of implants. In spite of faster osseointegration rate and higher bone-to-implant contact, rough surface implants tend to show higher risk of peri-implantitis according to Esposito et al. Implant surface, on the other hand, is a critical factor in both osseointegration and re-osseointegration. Yet, the further determination of the newly formed bone quantity and quality on contaminated implant surfaces is still needed. So that, clinicians may feel more confident in providing a certain treatment modality in an evidence-based implant surface. Moreover, patients may be more comfortable and be benefited from the provided implant treatments.
Thus far, there is still no "optimum" implant surface characteristics per se, yet there could be a trend. Regarding the excellence of the current implant surface treatment technology with the evidence-based manufacturer's protocols, we, with our humble experience, believe that the judgment in choosing an implant system should be governed by each individual patient concerning their biological, psychological, and physiological conditions.
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