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Histological and biomechanical effects of implant surfaces sandblasted with titanium dioxide microparticles: An experimental study using the rabbit tibia model

January 6, 2017 / Categories: Digital Dentistry, Implant Dentistry

Gehrke, Sérgio Alexandre

Maté Sánchez de Val, José Eduardo

Nieves de Aza, Piedad

Prados Frutos, Juan Carlos

Sardá Aramburú Júnior, Jaime

Orlando Rossetti, Paulo Henrique

Calvo Guirado, José Luis

The objective of this study was to investigate the effect of sandblasted, large-grit, acid-etched (SLA) implant surfaces treated with titanium dioxide (TiO2) microparticles on the implants’ stability and resistance to reverse torque.

Introduction

Per-Ingvar Brånemark, a Swedish professor, demonstrated that osseointegration of titanium implants is such that the bone remains in close contact with the implant surface without any intervention by the connective tissue, although the titanium dioxide (TiO2) layer interacts directly with the bone tissue.1Sullivan R. Implant dentistry and the concept of osseointegration: a historical perspective.
→ J Calif Dent Assoc. 2001 Nov;29(11):737–45.

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The physical and chemical features of titanium, particularly its intrinsic properties, such as biocompatibility, low specific weight, high strength–weight ratio, low modulus of elasticity, and excellent corrosion resistance, are favorable for the manufacture of dental implants.2Lemons JE, Venugopalan R, Lucas L. Corrosion and biodegradation.
→ In: AF von Recum, editor. Handbook of biomaterials evaluation: scientific, technical and clinical testing of implant materials. New York: Taylor Francis; 1999.
Furthermore, titanium surfaces can be modified in an attempt to enhance their biological properties.3Liu X, Chu PK, Ding C. Surface modification of titanium, titanium alloys, and related materials for biomedical applications.
→ Mater Sci Eng R Rep. 2004 Dec;47(3-4):49–121.
Such modifications are achieved by adding a coat consisting of different types of bioactive substances, by removing portions of the external layer with the use of blasting materials of different particle sizes, or by applying chemical treatments and/or physical ones, such as laser.4Wennerberg A, Albrektsson T. Effects of titanium surface topography on bone integration: a systematic review.
→ Clin Oral Implants Res. 2009 Sep;20 Suppl 4:172–84.
Among these, blasting and acid etching have been the most widely used. In addition, their combination has shown improved biological activity of titanium surfaces in terms of implant osseointegration relative to smooth (machined) surfaces.5Novaes AB Jr, Souza SL, Barros RR, Pereira KK, Iezzi G, Piattelli A. Influence of implant surfaces on osseointegration.
→ Braz Dent J. 2010;21(6):471–81.

The modification of the implant surface can thus have benefits regarding the response of the surrounding bone tissue, accelerating the healing process and/or improving the quality of the newly formed bone.6Novaes AB Jr, Souza SL, Barros RR, Pereira KK, Iezzi G, Piattelli A. Influence of implant surfaces on osseointegration.
→ Braz Dent J. 2010;21(6):471–81.
7Wennerberg A, Albrektsson T. On implant surfaces: a review of current knowledge and opinions.
→ Int J Oral Maxillofac Implants. 2010 Jan-Feb;25(1):63–74.
8Sul YT, Johansson C, Wennerberg A, Cho LR, Chang BS, Albrektsson T. Optimum surface properties of oxidized implants for reinforcement of osseointegration: surface chemistry, oxide thickness, porosity, roughness,and crystal structure.
→ Int J Oral Maxillofac Implants. 2005 May-Jun;20(3):349–59
Studies have shown that osseointegration is related to microgeometric features, such as the degree of surface roughness, and to factors such as the physical and chemical properties of surfaces.9Sul YT, Johansson C, Wennerberg A, Cho LR, Chang BS, Albrektsson T. Optimum surface properties of oxidized implants for reinforcement of osseointegration: surface chemistry, oxide thickness, porosity, roughness,and crystal structure.
→ Int J Oral Maxillofac Implants. 2005 May-Jun;20(3):349–59
10Le Guéhennec L, Soueidan A, Layrolle P, Amouriq Y. Surface treatments of titanium dental implants for rapid osseointegration.
→ Dent Mater. 2007 Jul;23(7):844–54.
Rough surfaces were found to stimulate osteoblastic gene expression and to enhance bone formation and bone implant fixation.11Ellingsen JE, Johansson CB, Wennerberg A, Holmén A. Improved retention and bone-to-implant contact with fluoride-modified titanium implants.
→ Int J Oral Maxillofac Implants. 2007 Jul;23(7):844–54.
12Abrahamsson I, Albouy JP, Berglundh T. Healing at fluoride-modified implants placed in wide marginal defects: an experimental study in dogs.
→ Clin Oral Implants Res. 2008 Feb;19(2):153–9.
While an associated inflammatory response was reported,13Stanford CM, Johnson GK, Fakhry A, Gratton D, Mellonig JT, Wanger W. Outcomes of a fluoride modified implant one year after loading in the posterior-maxilla when placed with the osteotome surgical technique.
→ Appl Osseointegr Res. 2006;5:50–55.
the overall success rate was satisfactory, with the majority of implants yielding good osseointegration and stability one year after surgery.14Variola F, Brunski JB, Orsini G, Tambasco de Oliveira P, Wazen R, Nanci A. Nanoscale surface modifications of medically-relevant metals: state of the art and perspectives.
→ Nanoscale. 2011 Feb;3(2):335–53.

Dental implant manufacturers have developed and marketed implants with several types of chemical and physical surface treatments. 15Binon PP. Implants and components: entering the new millennium.
→ Int J Oral Maxillofac Implants. 2000 Jan-Feb;15(1):76–94.
However, there is still no consensus on what the optimal conditions for periimplant bone growth are. It is known that bone response can be influenced by implant surface topography at the micrometer level, and it has been hypothesized that a nanometric surface can also have an effect.16 Bressan E, Sbricoli L, Guazzo R, Tocco I, Roman M, Vindigni V, Stellini E, Gardin C, Ferroni L, Sivolella S, Zavan B. Nanostructured surfaces of dental implants.
→ Int J Mol Sci. 2013 Jan 17;14(1):1918–31.
Notwithstanding, the mechanisms behind an optimal bone response to a given type of surface still remain largely unknown.

Surfaces known as SLA (sandblasted, largegrit, acid-etched) are produced by blasting with microparticles of some materials followed by acid etching. Alumina is one of the most widely used materials, but some authors have highlighted some features of alumina blasting that could compromise osseointegration (e.g., particle detachment during the healing process and absorption by the surrounding tissues).17Aparicio C, Gil FJ, Fonseca C, Barbosa M, Planell JA. Corrosion behavior of commercially pure titanium shot blasted with different materials and size of shot particles for dental implant applications.
→ Biomaterials. 2003 Jan;24(2):263–73.
The presence of alumina residues on implant surfaces due to the manufacturing process has been regarded as a potential risk, compromising long-term osseointegration. 18Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (II). Etiopathogenesis.
→ Eur J Oral Sci. 1998 Jun;106(3):721–64.
19Johansson C, Albrektsson T, Thomsen P, Sennerby L, Lodding A, Odelius H. Tissue reactions to titanium-6 aluminum-4 vanadium alloy.
→ Eur J Exp Musculoskel Res. 1992;1:161–9.
Alternatively, TiO2 is used as a blasting material and has shown interesting results in experimental studies. Particularly, TiO2-blasted implants were associated in humans with a significant enhancement of bone to implant contact (BIC) when compared with machined surfaces.20Ivanoff CJ, Hallgren C, Widmark G, Sennerby L, Wennerberg A. Histologic evaluation of the bone integration of TiO2 blasted and turned titanium microimplants in humans.
→ Clin Oral Implants Res. 2001 Apr;12(2):128–34.
21Rasmusson L, Kahnberg KE, Tan A. Effects of implant design and surface on bone regeneration and implant stability: an experimental study in the dog mandible.
→ Clin Implant Dent Relat Res. 2001 Jan;3(1):2–8.
22Gehrke SA, Taschieri S, Del Fabbro M, Coelho PG. Positive biomechanical effects of titanium oxide for sandblasting implant surface as an alternative to aluminium oxide.
→ J Oral Implantol. 2015 Oct;41(5):515–22.
Under unfavorable clinical conditions, such as in the presence of poor-quality bone, fast and predictable osseointegration would be beneficial, allowing prosthetic rehabilitation. In the case of insufficient bone quantity or anatomical limitations, or in the presence of local and systemic conditions that could compromise longterm osseointegration, implants with a rough surface show better bone apposition and BIC than do those with smooth surfaces.23Piattelli A, Degidi M, Paolantonio M, Mangano C, Scarano A. Residual aluminum oxide on the surface of titanium implants has no effect on osseointegration.
→ Biomaterials. 2003 Oct;24(22):4081–9.
24Cochran DL, Buser D, ten Bruggenkate CM, Weingart D, Taylor TM, Bernard JP, Peters F, Simpson JP. The use of reduced healing times on ITI implants with a sandblasted and acid-etched (SLA) surface: early results from clinical trials on ITI SLA implants.
→ Clin Oral Implants Res. 2002 Apr;13(2):144–53.
There fore, the aim of the present in vivo study was to evaluate the behavior of surfaces shortly after implantation by measuring removal torque and analyzing histological parameters.

Materials and methods

Twenty-four cylindrical self-tapping implants with internal hexagon packaged and ready for sale were used for in vivo testing. Twelve implants with a machined surface (Fig. 1) were used in the control group (C group). Twelve implants with surfaces sandblasted with 50–150 μm TiO2 micro particles at a 5 atm pressure for 1 min, ultrasonically cleaned with an alkaline solution, rinsed in distilled water and then conditioned with maleic acid (Fig. 2) were used in the test group (T group). The implants (Implacil De Bortoli, São Paulo, Brazil) were 4 mm in diameter and 8 mm in length.

Fig. 1a-c
(a) Image of the implant used as control (C group), with smooth surface.
(b & c) SEM images of the surface at 1,000× and 5,000× magnification.
Fig. 2a-c
(a) Image of the implant used as test (T group), with SLA surface.
(b & c) SEM images of the surface at 1,000× and 5,000×magnification.

Six mature New Zealand white rabbits were used in this study. This study was approved by the Ethics Committee (#004-09-2015) of the Itapiranga Faculty of Veterinary Medicine, Itapiranga, Brazil. The rabbits were anesthetized by intramuscular ketamine (35 mg/kg; Agener Pharma ceutica, Brazil). Thereafter, a muscle relaxant (Rompum 5 mg/kg, Bayer, Brazil) and a tranquilizer (Acepran 0.75 mg/kg, Univet, Brazil) were injected intramuscularly. Additionally, 1 mL of local anesthetic (3% prilocaine-felypressin, Astra, Mexico) was injected subcutaneously at the site of surgery to improve analgesia and control bleeding. A skin incision with a periosteal flap was used to expose the bone in the proximal tibia. The preparation of the bone site was done with burs under copious saline irrigation. Two implants were inserted into the tibial metaphysis of each rabbit (Fig. 3), one most proximal at 5 mm from the articulation and the other 10 mm to the distal, thus avoiding differences in bone typology in this area. The implant position was randomized for each animal at www.randomization.com. The tibia was chosen as the implant site because it provides easier surgical access. The implant insertion was performed by hand with a torque of < 20 N until locking of the implant in the opposite cortical portion of the osteotomy, as part of the implant shoulder just out in relation to the top of the cortical bone crest, thereby avoiding excessive compression of the bone due to implant design. The periosteum and fascia were sutured with catgut and the skin with silk. Postoperatively, a single dose of 600,000 IU of benzathine penicillin (Benzetacil, Eurofarma Laboratórios, Rio de Janeiro, Brazil) was used. After surgery, the animals were placed in individual cages with 12-h cycles of light, controlled temperature (21 °C), and food and water ad libitum. No complications or deaths occurred in the postoperative period. All of the animals were euthanized after four weeks using an intravenous overdose of ketamine (2 mL) and xylazine (1 mL). A total of 24 implants were retrieved. The implants of all right tibiae were immediately analyzed using a torque-testing machine (CME, Técnica Industrial Oswaldo Filizola, Guarulhos, Brazil), which was fully controlled by DynaView Torque Standard/ Pro M software (Fig. 4).

Fig. 3
Image of the implants inserted into the tibia.
Fig. 4
Image of the computerized torque machine used in the removal torque test.

All of the implants of the left tibiae were used for histological analysis and were placed in 10% formalin after removal and taken to the Biotecnos Laboratory (Santa Maria, Brazil). After the fixation period, they were dehydrated in an ascending series of alcohols and embedded in glycol methacrylate resin (Technovit 9100 VLC, Kulzer, Hanau, Germany) to produce undecalcified sections. Undecalcified cut and ground sections that contained the central part of each implant and had a final thickness of 15 μm were produced using a macro-cutting and grinding system (Isomet 2000, Buehler, Braunschweig, Germany). The sections were stained with picro-siriushematoxylin, and histomorphometric analysis was then carried out. The specimens prepared for the analysis of the tissue around the implant were examined under a light microscope (EOS 200, Nikon, Tokyo, Japan). After digitizing the phase of each specimen under a light microscope, the percentage of bone-to-implant contact (BIC%) was measured using the Image Tool software for Microsoft Windows (Version 5.02). BIC% was calculated as the percentage of the total length of bone in direct contact with the implant surface, from the first crestal bone contact to the most apical contact.

The statistical analysis was performed using the t-test for comparison between groups. Two correlation measurements were used to assess the relationship between the groups: Pearson’s correlation coefficient (with -1 < R < 1; when R is close to ± 1 this indicates that the variables are
correlated; however, the relationship is linear) and Spearman’s rank correlation coefficient, simi lar to Pearson’s correlation coefficient, with -1 < R < 1. This measurement was more comprehensive because we assessed whether the relationship between the variables was nonlinear. All of the tests were performed using specific software (MedCalc, MedCalc Software, Belgium). The level of significance was set at ? = 0.05.

Results

The surgical procedures were uneventful and all of the animals presented appropriate healing within the first weeks after surgery. Inspections made during two postoperative weeks indicated no infection or inflammation. The biomechanical tests indicated osseointegration of all of the implants, but torque after four weeks was higher in the T group (71.0 ± 13.4 N cm; median of 73.5) than in the C group (54.5 ± 10.0 N cm; median of 56.5). The mean ± standard deviations and the statistical comparison are presented in Figure 5. The paired statistical tests showed that torque was significantly higher in the T group than in the C group at four weeks (p < 0.0001).

BIC% was higher in the T group (64.8 ± 7.4%; median of 66.0) after four weeks than in the C group (50.4 ± 7.9%; median of 49.5). These data and statistical significance (p = 0.0005) are shown in Figure 6. The new bone formed around the implants in the C group was not completely mineralized (Fig. 7). In the T group, however, better organization and mineralization were found after four weeks (Fig. 8) and there was better stimulation of the medullary bone portion (Fig. 9).

The Kolmogorov–Smirnov test identified that only the BIC% of the T group had nonparametric data. Thus, the correlation between reverse torque and BIC% (machined) was determined by Pearson’s correlation coefficient (R = -0.52; p = 0.08; 95% CI [-0.84–0.07]), whereas the correlation between reverse torque and BIC% (treated) was determined by Spearman’s correlation coefficient (R = 0.08; p = 0.79; 95% CI [-0.51–0.62]). The statistical data are summarized in Table 1.

table-1

Table 1

Fig. 5
Removal torque values (N cm) at four weeks in both groups.

Fig. 6
BIC values (%) at four weeks in both groups.

Fig. 7a & 7b
Histological images showing bone maturation and mineralization in the C group after four weeks, with new bone formation around the implants showing incomplete mineralization. (a) 200× and (b) 400× magnification.Staining with picro-siriushematoxylin.

Fig. 8a & 8b
Histological images showing bone maturation and mineralization in the T group after four weeks, with more advanced new bone formation around the implants in the new bone organization areas. (a) 100× and (b) 400× magnification. Staining with picro-sirius-hematoxylin.

Fig. 9
Histological images showing bone maturation and the BIC after four weeks. There was visibly better stimulation of the medullary bone portion in the T group in comparison to the C group (yellow arrows).

Table. 1
Mean ± SD and median (reverse torque and BIC%) values at baseline and at eight weeks.

Discussion

Over the past decades, several in vivo studies have examined the effect of implant surfaces on bone healing and apposition.25Misch CE. Density of bone: effect on treatment plans, surgical approach, healing, and progressive bone loading.
→ Int J Oral Implantol. 1990;6(2):23–31.
26Hsu SH, Liu BS, Lin WH, Chiang HC, Huang SC, Cheng SS. Characterization and biocompatibility of a titanium dental implant with a laser irradiated and dual-acid etched surface.
→ Biomed Mater Eng. 2007;17(1):53–68.
Modifications in implant surface morphology and roughness were initially attempted to hasten host response to implants and to increase the level of mechanical interlock between the bone and implant surface, thus improving initial stability and sub-sequent stress dissipation during functional loading.
27Albrektsson T, Brånemark PI, Hansson HA, Lindström J. Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to-implantanchorage in man.
→ Acta Orthop Scand. 1981;52(2):155–70.
28Textor M, Sittig C, Frauchiger V, Tosatti S, Brunette DM. Properties and biological significance of natural oxide films on titanium and its alloys.
→ In: Brunette DM, Tengvall P, Textor M, Thomsen P, editors. Titanium in medicine.Berlin: Springer; 2001. p. 171–230.

Histological investigations have shown that the surface texture created by blasting leads to greater BIC than that of machined surfaces,29Ivanoff CJ, Widmark G, Johansson C, Wennerberg A. Histologic evaluation of bone response to oxidized and turned titanium micro-implants in humanjawbone.
→ Int J Oral Maxillofac Implants. 2003 May-Jun;18(3):341–8.
which is a desirable response, as it allows improvement of the overall biomechanics of the system. Blasting the implant surface with gritting agents made of materials other than alumina may change the surface composition and implant biocompatibility. 28 Abrasive blasting increases surface roughness and metal surface reactivity.30Wennerberg A, Albrektsson T, Johansson C, Andersson B. Experimental study of turned and grit-blasted screw-shaped implants with special emphasis on effects of blasting material and surface topography.
→ Biomaterials. 1996 Jan;17(1):15–22.
With the use of a blasting material such as alumina, a potential risk of contamination by remnants of blasting particles, with dissolution of aluminum ions into the host tissue, cannot be excluded.31Wennerberg A, Albrektsson T, Johansson C, Andersson B. Experimental study of turned and grit-blasted screw-shaped implants with special emphasis on effects of blasting material and surface topography.
→ Biomaterials. 1996 Jan;17(1):15–22.
It has been reported that aluminum ions may inhibit normal differentiation of bone marrow stromal cells and normal bone deposition and mineralization,32Thomson GJ, Puleo DA. Ti-6Al-4V ion solution inhibition of osteogenic cell phenotype as a function of differentiation time course in vitro.
→ Biomaterials. 1996 Oct;17(20):1949–54.
33Stea S, Savarino L, Toni A, Sudanese A, Giunti A, Pizzoferrato A. Microradiographic and histochemical evaluation of mineralization inhibition at the bone–alumina interface.
→ Biomaterials. 1992;13(10):664–7.
34Capdevielle MC, Hart LE, Goff J, Scanes CG. Aluminum and acid effects on calcium and phosphorus metabolism in young growing chickens (Gallus gallus domesticus) and mallard ducks (Anas platyrhynchos).
→ Arch Environ Contam Toxicol. 1998 Jul;35(1):82–8.
and aluminum has been shown to induce net calcium efflux from the cultured bone.35 Bushinsky DA, Sprague SM, Hallegot P, Girod C, Chabala JM, Levi-Setti R. Effects of aluminum on bone surface ion composition.
→ J Bone Miner Res. 1995 Dec;10(12):1988–97.
Moreover, aluminum may compete with calcium during the healing of the implant bed. Aluminum has been shown to accumulate at the mineralization front and in the osteoid matrix itself.36 Nimb L, Jensen JS, Gotfredsen K. Interface mechanics and histomorphometric analysis of hydroxyapatite-coated and porous glass-ceramic implants in canine bone.
→ J Biomed Mater Res. 1995 Dec;29(12):1477–82.
Therefore, other alternative sandblasting methods were developed in order to roughen the implant surface, such as the use of resorbable particles based on calcium37Albrektsson T, Wennerberg A. Oral implant surfaces: Part 1—review focusing on topographic and chemical properties of different surfaces and in vivo responses to them.
→ Int J Prosthodont. 2004 Sep-Oct;17(5):536–43.
and TiO2,38Albrektsson T, Wennerberg A. Oral implant surfaces: Part 2—review focusing on clinical knowledge of different surfaces.
→ Int J Prosthodont. 2004 Sep-Oct;17(5):544–64.
39Buser D, Broggini N, Wieland M, Schenk RK, Denzer AJ, Cochran DL, Hoffmann B, Lussi A, Steinemann SG. Enhanced bone apposition to a chemically modified SLA titanium surface.
→ J Dent Res. 2004 Jul;83(7):529–33.
both of which are unproblematic if small residues remain after surface treatment procedures.

The effects of sandblasting the implant surface with titanium oxide as an alternative to aluminum oxide have been investigated previously. 40Rasmusson L, Kahnberg KE, Tan A. Effects of implant design and surface on bone regeneration and implant stability: an experimental study in the dog mandible.
→ Clin Implant Dent Relat Res. 2001 Jan;3(1):2–8.
41Gehrke SA, Taschieri S, Del Fabbro M, Coelho PG. Positive biomechanical effects of titanium oxide for sandblasting implant surface as an alternative to aluminium oxide.
→ J Oral Implantol. 2015 Oct;41(5):515–22.
42 Ivanoff CJ, Widmark G, Johansson C, Wennerberg A. Histologic evaluation of bone response to oxidized and turned titanium micro-implants in humanjawbone.
→ Int J Oral Maxillofac Implants. 2003 May-Jun;18(3):341–8.
43Wennerberg A, Albrektsson T, Johansson C, Andersson B. Experimental study of turned and grit-blasted screw-shaped implants with special emphasis on effects of blasting material and surface topography.
→ Biomaterials. 1996 Jan;17(1):15–22.
44Gotfredsen K, Nimb L, Hjörting-Hansen E, Jensen JS, Holmén A. Histomorphometric and removal torque analysis for TiO2-blasted titanium implants. An experimental study on dogs.
→ Clin Oral Implants Res. 1992 Jun;3(2):77–84.
45Darvell BW, Samman N, Luk WK, Clark RK, Tideman H. Contamination of titanium castings by aluminium oxide blasting.
→ J Dent. 1995 Oct;23(5):319–22.
46Wennerberg A, Albrektsson T, Andersson B. Bone tissue response to commercially pure titanium implants blasted with fine and coarse particles of aluminum oxide.
→ Int J Oral Maxillofac Implants. 1996 Jan-Feb;11(1):38–45.
47Sennerby L, Dasmah A, Larsson B, Iverhed M. Bone tissue responses to surface-modified zirconia implants: a histomorphometric and removal torque study in the rabbit.
→ Clin Implant Dent Relat Res. 2005;7 Suppl 1:S13–20.
The research protocols took into account biomechanical (removal torque), interfacial and histological analyses, as well as histomorphometric and microhardness measurements. Only one study observed and analyzed specimens using both scanning electron microscopy (SEM) and histomorphometry, as well as the removal torque test, in dogs.48Gotfredsen K, Nimb L, Hjörting-Hansen E, Jensen JS, Holmén A. Histomorphometric and removal torque analysis for TiO2-blasted titanium implants. An experimental study on dogs.
→ Clin Oral Implants Res. 1992 Jun;3(2):77–84.
This study demonstrated that implants blasted with TiO2 particles had a better anchorage than implants with a machine-produced surface, in spite of there being no difference in BIC.49Gotfredsen K, Nimb L, Hjörting-Hansen E, Jensen JS, Holmén A. Histomorphometric and removal torque analysis for TiO2-blasted titanium implants. An experimental study on dogs.
→ Clin Oral Implants Res. 1992 Jun;3(2):77–84.

Animal models are essential in providing phenomenological information on biological reaction to endosseous implants.50 Piattelli A, Manzon L, Scarano A, Paolantonio M, Piattelli M. Histologic and histomorphometric analysis of the bone response to machined and sandblasted titanium implants: an experimental study in rabbits.
→ Int J Oral Maxillofac Implants. 1998 Nov-Dec;13(6):805–10.
The removal torque test is among the in vivo mechanical tests commonly used to evaluate the strength of the interaction between the bone and implant surface. 51Meredith N, Shagaldi F, Alleyne D, Sennerby L, Cawley P. The application of resonance frequency measurements to study the stability of titanium implants during healing in the rabbit tibia.
→ Clin Oral Implants Res. 1997 Jun;8(3):234–43.
52Pearce AI, Richards RG, Milz S, Schneider E, Pearce SG. Animal models for implant biomaterial research in bone: a review.
→ Eur Cell Mater. 2007 Mar;13:1–10.
53Steigenga J, Al-Shammari K, Misch C, Nociti FH Jr, Wang HL. Effects of implant thread geometry on percentage of osseointegration and resistance to reverse torque in the tibia of rabbits.
→ J Periodontol. 2004 Sep;75(9):1233–41.
High resistance to implant removal encountered during these tests indicates good integration between the bone and implant surface, or in the case of porous materials, a high degree of bone ingrowth into the pores of the implant.54Steigenga J, Al-Shammari K, Misch C, Nociti FH Jr, Wang HL. Effects of implant thread geometry on percentage of osseointegration and resistance to reverse torque in the tibia of rabbits.
→ J Periodontol. 2004 Sep;75(9):1233–41.
The present study evaluated the extent of osseointegration and the characteristics of the bone around the surface within four weeks after implantation.

Previous research has shown that surface characteristics influenced BIC, with statistically significant differences on different implant surfaces. 55 Piattelli A, Manzon L, Scarano A, Paolantonio M, Piattelli M. Histologic and histomorphometric analysis of the bone response to machined and sandblasted titanium implants: an experimental study in rabbits.
→ Int J Oral Maxillofac Implants. 1998 Nov-Dec;13(6):805–10.
Histomorphometric and removal torque measurements are two representative tests used to assess the nature of the implant–tissue interface. 56 Meredith N. Assessment of implant stability as a prognostic determinant.
→ Int J Prosthodont. 1998 Sep-Oct;11(5):491–501.
In this study, both surface biocompatibility and osteoconductive properties were confirmed by the biomechanical tests. Such interaction was more pronounced for the textured surface compared with the machined one, indicating a possible synergistic interaction of the mechanical interlock between the bone and implant surface and higher bone formation compared with the machined surface. The reverse torque values may appear rather high even for implants with a machined surface. This has to do with the experimental model chosen. In fact, the cortical bone of rabbit tibia is very compact and may firmly interlock with the implants. However, the aim of the present study was not to estimate parameter values that could be directly transferred to patients, but to compare two different surfaces using both in vitro and in vivo approaches. The results confirm that TiO2-blasted surfaces allow for greater osteoconductivity and accelerated bone formation compared with machined surfaces and are therefore recommended for anticipated loading protocols.

Conclusion

Despite the limitations of this study, TiO2 blasting displayed a positive effect on osseointegration and on the biomechanical features of the implants. The histological results confirmed the hypothesis that the SLA surface using blasting with TiO2 microparticles positively affects the osseointegration of titanium dental implants.

Competing interests

The authors declare that they have no conflict of interests related to this study.

Sérgio Alexandre Gehrke

Interview

with Sérgio Alexandre Gehrke

Why did you conduct the research reported on in this paper?

Since some studies have shown that the medium used for blasting during surface treatment of implants may affect osseointegration of implants, new methodologies are being employed, such as the use of titanium dioxide microparticles. Thus, the present study aimed to demonstrate histologically the behavior of implants with surfaces treated using this methodology.

For what reasons could others cite your paper?

Because it provides histological information on the behavior of implants treated by blasting with titanium dioxide that can be used and compared with other treatments.

How could your study’s findings have an impact on dentistry?

This study provides evidence that a well-textured and contaminant-free implant surface can improve the osseointegration process of dental implants.

What is the relevance of your study’s findings to the daily practice of a dentist?

The results can help the dentist in understanding and differentiating the products (implants) available, and this will help in deciding on the most suitable materials for his or her patient.

What are your recommendations for further investigation of the topic of your article?

It would be the comparison of this type of surface with others on the market.

References   [ + ]

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→ Int J Oral Maxillofac Implants. 2010 Jan-Feb;25(1):63–74.
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