1
|
Walter N, Stich T, Docheva D, Alt V, Rupp M. Evolution of implants and advancements for osseointegration: A narrative review. Injury 2022; 53 Suppl 3:S69-S73. [PMID: 35948509 DOI: 10.1016/j.injury.2022.05.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 02/02/2023]
Abstract
Since ancient times, reduction and internal fixation has been applied to restore skeletal integrity. Despite advances in the understanding of fracture healing, the risk of complication such as implant loosening or implant-related infection still depicts a challenging complication. Nowadays, a great deal of research is devoted to unreveal the impact of implant surface modifications on osteogenic processes to enhance bone consolidation and osseointegration. This narrative review is aimed to (1) show the evolution and already achieved milestones of implant optimization, and (2) to outline the key factors that contribute to an enhanced osseointegration. Different physical and chemical roughening techniques are currently applied in various studies. Surface patterning on the nanoscale has been found to be an essential factor for the biological response, achievable by e.g. anodisation or laser texturing. Besides surface roughening, also different coating methods are vastly investigated. Next to metal or inorganic compounds as coating material, a variety of biomolecules is currently studied for their osteosupportive capacities. Osseointegration can be improved by surface modification on the micro and nanoscale. Bioactive agents can further improve the osseointegration potential. Used agents at the moment are e.g. inorganic compounds, growth factors (BMPs and non-BMPs) and antiresorptive drugs. The advancement in research on new implant generations therefore aims at actively supporting osseointegration processing.
Collapse
Affiliation(s)
- Nike Walter
- Department of Trauma Surgery, University Medical Centre, Regensburg, Germany
| | - Theresia Stich
- Department of Trauma Surgery, University Medical Centre, Regensburg, Germany
| | - Denitsa Docheva
- Department of Musculoskeletal Tissue Regeneration, Orthopaedic Hospital König-Ludwig-Haus, University of Wuerzburg, Wuerzburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Centre, Regensburg, Germany.
| |
Collapse
|
2
|
Zirconia versus Titanium Implants: 8-Year Follow-Up in a Patient Cohort Contrasted with Histological Evidence from a Preclinical Animal Model. MATERIALS 2022; 15:ma15155322. [PMID: 35955254 PMCID: PMC9369473 DOI: 10.3390/ma15155322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
Zirconia ceramic (ZC) implants are becoming more common, but comparisons between preclinical histology and long-term clinical trials are rare. This investigation comprised (1) 8-year clinical follow-up of one-piece ZC or titanium (Ti) implants supporting full overdentures and (2) histomorphometric analysis of the same implants in an animal model, comparing implants with various surface treatments. Methods: (1) Clinical trial: 24 completely edentulous participants (2 groups of N = 12) received 7 implants (one-piece ball-abutment ZC or Ti; maxilla N = 4, mandible N = 3) restored with implant overdentures. Outcomes after 8-years included survival, peri-implant bone levels, soft-tissue responses, and prosthodontic issues. (2) Preclinical trial: 10 New Zealand sheep received 4 implants bilaterally in the femoral condyle: Southern Implants ZC or Ti one-piece implants, identical to the clinical trial, and controls: Southern ITC® two-piece implants with the same surface or Nobel (NBC) anodised (TiUnite™) surface. %Bone-implant contact (%BIC) was measured after 12 weeks of unloaded healing. Results: 8 of 24 participants (33%) of an average age of 75 ± 8 years were recalled; 21% of original participants had died, and 46% could not be contacted. 80.4% of implants survived; excluding palatal sites, 87.5% of Ti and 79% of ZC implants survived. All failed implants were in the maxilla. Three ZC implants had fractured. Bone loss was similar for Ti vs. ZC; pocket depths (p = 0.04) and attachment levels (p = 0.02) were greater for Ti than ZC implants. (1.7 ± 1.6 mm vs. 1.6 ± 1.3 mm). All implants in sheep femurs survived. %BIC was not statistically different for one-piece blasted surface Ti (80 ± 19%) versus ZC (76 ± 20%) or ITC® (75 ± 16 mm); NBC had significantly higher %BIC than ITC (84 ± 17%, p = 0.4). Conclusion: Short-term preclinical results for ZC and Ti one-piece implants showed excellent bone-implant contact in unloaded femoral sites. This differed from the long-term clinical results in older-aged, edentulous participants. While ZC and Ti implants showed equivalent performance, the risks of peri-implantitis and implant loss in older, completely edentulous patients remain a significant factor.
Collapse
|
3
|
KUROSAKA M, KATAOKA Y, MIYAZAKI T. <i>In vitro</i> characterization of primary osteoblasts on titanium surfaces processed with wire-type electric discharge machining. Dent Mater J 2022; 41:655-659. [DOI: 10.4012/dmj.2021-231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Masao KUROSAKA
- Department of Conservative Dentistry, Division of Biomaterials and Engineering, Showa University School of Dentistry
| | - Yu KATAOKA
- Department of Conservative Dentistry, Division of Biomaterials and Engineering, Showa University School of Dentistry
| | - Takashi MIYAZAKI
- Department of Conservative Dentistry, Division of Biomaterials and Engineering, Showa University School of Dentistry
| |
Collapse
|
4
|
Stich T, Alagboso F, Křenek T, Kovářík T, Alt V, Docheva D. Implant-bone-interface: Reviewing the impact of titanium surface modifications on osteogenic processes in vitro and in vivo. Bioeng Transl Med 2022; 7:e10239. [PMID: 35079626 PMCID: PMC8780039 DOI: 10.1002/btm2.10239] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 12/12/2022] Open
Abstract
Titanium is commonly and successfully used in dental and orthopedic implants. However, patients still have to face the risk of implant failure due to various reasons, such as implant loosening or infection. The risk of implant loosening can be countered by optimizing the osteointegration capacity of implant materials. Implant surface modifications for structuring, roughening and biological activation in favor for osteogenic differentiation have been vastly studied. A key factor for a successful stable long-term integration is the initial cellular response to the implant material. Hence, cell-material interactions, which are dependent on the surface parameters, need to be considered in the implant design. Therefore, this review starts with an introduction to the basics of cell-material interactions as well as common surface modification techniques. Afterwards, recent research on the impact of osteogenic processes in vitro and vivo provoked by various surface modifications is reviewed and discussed, in order to give an update on currently applied and developing implant modification techniques for enhancing osteointegration.
Collapse
Affiliation(s)
- Theresia Stich
- Experimental Trauma Surgery, Department of Trauma SurgeryUniversity Regensburg Medical CentreRegensburgGermany
| | - Francisca Alagboso
- Experimental Trauma Surgery, Department of Trauma SurgeryUniversity Regensburg Medical CentreRegensburgGermany
| | - Tomáš Křenek
- New Technologies Research CentreUniversity of West BohemiaPilsenCzech Republic
| | - Tomáš Kovářík
- New Technologies Research CentreUniversity of West BohemiaPilsenCzech Republic
| | - Volker Alt
- Experimental Trauma Surgery, Department of Trauma SurgeryUniversity Regensburg Medical CentreRegensburgGermany
- Clinic and Polyclinic for Trauma Surgery, University Regensburg Medical CentreRegensburgGermany
| | - Denitsa Docheva
- Experimental Trauma Surgery, Department of Trauma SurgeryUniversity Regensburg Medical CentreRegensburgGermany
| |
Collapse
|
5
|
Sharma A, Waddell JN, Li KC, A Sharma L, Prior DJ, Duncan WJ. Is titanium-zirconium alloy a better alternative to pure titanium for oral implant? Composition, mechanical properties, and microstructure analysis. Saudi Dent J 2021; 33:546-553. [PMID: 34803299 PMCID: PMC8589587 DOI: 10.1016/j.sdentj.2020.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/18/2020] [Accepted: 08/23/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Titanium (Ti) is widely accepted as a biomaterial for orthopaedic and dental implants, primarily due to its capacity to integrate directly into the bone and its superior corrosion resistance. It has been suggested that titanium–zirconium alloy (TiZr), with 13–17% of zirconium, has better mechanical properties than pure Ti, but there are very few published studies assessing the suitability of TiZr for high-load- bearing implants. This study aimed to compare the mechanical properties and microstructures of TiZr and commercially pure titanium (Ti). Methodology Pure Ti and TiZr alloy discs were prepared and subjected to characterisation by nanoindentation, electron dispersive spectroscopy (EDS), X-ray diffraction (XRD), and electron backscatter diffraction (EBSD). Results The TiZr alloy was found to have significantly lower elastic modulus value (p < 0.0001) and greater hardness than Ti (p < 0.05). The EDS results confirmed the presence of Zr (13–17%) in the TiZr alloy, with XRD and EBSD images showing microstructure with the alpha phase similar to commercially available Ti. Conclusion The lower elastic modulus, higher hardness, presence of alpha phase, and the finer grain size of the TiZr alloy make it more suitable for high-load-bearing implants compared to commercially available Ti and is likely to encourage a positive biological response.
Collapse
Affiliation(s)
- Ajay Sharma
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
| | - John N Waddell
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Kai C Li
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Lavanya A Sharma
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
| | - David J Prior
- Department of Geology, University of Otago, Dunedin, New Zealand
| | - Warwick J Duncan
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| |
Collapse
|
6
|
Maiborodin IV, Shevela AA, Toder MS, Shevela AI. [Current trends of the choice and processing of materials for dental implantation]. STOMATOLOGII︠A︡ 2018; 97:68-76. [PMID: 30199073 DOI: 10.17116/stomat20189704168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For assessment of the modern situation about the choice of materials for manufacture of dental implants and the processing of their surface the scientific literature for the last 2 years was study. On the basis of a large number of contradictory results of the researches devoted to each of dental implantation problems it is possible to draw a conclusion that any of primal problems of implantology is finally not solved. There is no unique opinion at the choice of optimum material for manufacture of dental implants, at the way of processing and modification of their surface. The problem of improvement of quality of dental implantation and fight against complications of this procedure cannot be solved simple drawing other substances on the implanted material surface, this task more easily and more successfully is solved via changes of product structure and various modification of implant surface. Up to the present the researches of an opportunity to influence on characteristics of the implanted materials, changing their structure and character of a surface, continue. And the publications reporting about the considerable positive effect of artificially created roughnesses on product surfaces, and the articles claiming that there are no big differences between the rough and polished implants are confirmed by objective measurements with statistical processing of the obtained data. It should be noted that among articles there are very many works of the doubtful plan or with insufficiently valid conclusions. This review leads to the conclusion that further clinical and experimental studies and about the choice of materials for manufacture of implants and at the ways of processing of their surface are necessary.
Collapse
Affiliation(s)
- I V Maiborodin
- Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Science, Siberian Branch, Novosibirsk, Russia
| | - A A Shevela
- International Center of Implantology of iDent, Novosibirsk, Russia
| | - M S Toder
- International Center of Implantology of iDent, Novosibirsk, Russia
| | - A I Shevela
- Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Science, Siberian Branch, Novosibirsk, Russia
| |
Collapse
|
7
|
Cruz RS, Lemos CAA, Oliveira HFF, de Souza Batista VE, Pellizzer EP, Verri FR. Comparison of the Use of Titanium–Zirconium Alloy and Titanium Alloy in Dental Implants: A Systematic Review and Meta-Analysis. J ORAL IMPLANTOL 2018; 44:305-312. [DOI: 10.1563/aaid-joi-d-17-00233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to compare the values of bone-implant contact (BIC) and removal torque (RTQ) reported in different animal studies for titanium–zirconium (TiZr) and titanium (Ti) dental implants. This review has been registered at PROSPERO under number CRD42016047745. We undertook an electronic search for data published up until November 2017 using the PubMed/Medline, Embase, and The Cochrane Library databases. Eligibility criteria included in vivo studies, comparisons between Ti and TiZr implants in the same study, and studies published in English that evaluated BIC and RTQ. After inclusion criteria, 8 studies were assessed for eligibility. Of the 8 studies, 7 analyzed BIC outcome and 3 analyzed RTQ outcome. Among such studies, 6 studies were considered for meta-analysis of quantitative for BIC and 2 studies for RTQ. There was no significant difference for BIC analysis (P = .89; random ration [RR]: −0.21; 95% confidence interval [CI]: −3.14 to 2.72). The heterogeneity of the primary outcome studies was considered low (7.19; P = .21; I2: 30%). However, the RTQ analysis showed different results favoring the TiZr dental implants (P = .001; RR: 23.62; 95%CI: 9.15 to 38.10). Low heterogeneity was observed for RTQ (χ2: 1.25; P = .26; I2: 20%). Within the limitations of this study, there was no difference between TiZr and Ti alloys implants in terms of BIC. However, TiZr implants had higher RTQ than Ti alloys.
Collapse
Affiliation(s)
- Ronaldo Silva Cruz
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, UNESP – Univ Estadual Paulista, Aracatuba Dental School, Sao Paulo, Brazil
| | - Cleidiel Aparecido Araujo Lemos
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, UNESP – Univ Estadual Paulista, Aracatuba Dental School, Sao Paulo, Brazil
| | - Hiskell Francine Fernandes Oliveira
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, UNESP – Univ Estadual Paulista, Aracatuba Dental School, Sao Paulo, Brazil
| | - Victor Eduardo de Souza Batista
- Department of Prosthodontics, Presidente Prudente Dental School, University of Western São Paulo - UNOESTE, Presidente Prudente, Brazil
| | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, UNESP – Univ Estadual Paulista, Aracatuba Dental School, Sao Paulo, Brazil
| | - Fellippo Ramos Verri
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, UNESP – Univ Estadual Paulista, Aracatuba Dental School, Sao Paulo, Brazil
| |
Collapse
|
8
|
Duncan WJ, Greer PFC, Lee MH, Loch C, Gay JHA. Wool-derived keratin hydrogel enhances implant osseointegration in cancellous bone. J Biomed Mater Res B Appl Biomater 2017; 106:2447-2454. [PMID: 29226584 DOI: 10.1002/jbm.b.34047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/26/2017] [Accepted: 10/31/2017] [Indexed: 11/11/2022]
Abstract
AIM This study investigated whether a keratin hydrogel derived from wool enhances ossointegration of dental implants, using a cancellous bone model in sheep. METHOD Ten female sheep received one dental implant per hind leg in the distal femoral condyles. Test implants were coated with 1 mL of keratin hydrogel containing sulphonated keratin and hydroxyapatite; control implants remained uncoated; implants were not functionally loaded axially. Biomechanical stability was tested with resonance frequency analysis (RFA) at placement and euthanasia. Animals were sacrificed after 4 weeks and resin-embedded histomorphometry performed. FINDINGS Bone appeared denser and more mature around the keratin-treated test implants. Average % bone-implant contact was significantly increased for the test (58.1 ± 4.6 [SD]%) compared to control implants (34.4 ± 7.5%) (p = 0.01). RFA values were lower for control (76.5 ± 4.2 ISQ) than test implants (80.4 ± 1.4) after 4 weeks (p = 0.04). CONCLUSION the increase in osseointegration found in this model suggests that keratin hydrogel has the potential to enhance the successful osseointegration of dental implants placed into poor quality bone. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2447-2454, 2018.
Collapse
Affiliation(s)
- Warwick J Duncan
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, 9054, New Zealand
| | - Philippa F C Greer
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, 9054, New Zealand
| | - Min-Ho Lee
- School of Dentistry and Institute of Biodegradable Material, Chonbuk National University, Jeonju, South Korea
| | - Carolina Loch
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, 9054, New Zealand
| | - Jennifer H A Gay
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, 9054, New Zealand
| |
Collapse
|