Histologic Evaluation of Early Human Bone Response to Different Implant Surfaces

Improved Biocompatibility and Osseointegration of Nanostructured Calcium-Incorporated Titanium Implant Surface Treatment (XPEED®)

Surface treatment of implants facilitates osseointegration, with nanostructured surfaces exhibiting accelerated peri-implant bone regeneration. This study compared bone-to-implant contact (BIC) in implants with hydroxyapatite (HA), sand-blasted and acid-etched (SLA), and SLA with calcium (Ca)-coated (XPEED®) surfaces. Seventy-five disk-shaped grade 4 Ti specimens divided into three groups were prepared, with 16 implants per group tested in New Zealand white rabbits. Surface characterization was performed using X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM), digital microscopy, and a contact angle analyzer. Cell viability, proliferation, and adhesion were assessed using MC3T3-E1 cells. Apatite formation was evaluated using modified simulated body fluid (m-SBF) incubation. After 4 weeks of healing, the outcomes reviewed were BIC, bone area (BA), removal torque tests, and histomorphometric evaluation. A microstructure analysis revealed irregular pores across all groups, with the XPEED group exhibiting a nanostructured Ca-coated surface. Surface characterization showed a crystalline CaTiO3 layer on XPEED surfaces, with evenly distributed Ca penetrating the implants. All surfaces provided excellent environments for cell growth. The XPEED and SLA groups showed significantly higher cell density and viability with superior osseointegration than HA (p < 0.05); XPEED exhibited the highest absorbance values. Thus, XPEED surface treatment improved implant performance, biocompatibility, stability, and osseointegration.

Influence of surface coatings on the stress distribution by varying friction contact at implant-bone interface using finite element analysis

The present work aims to evaluate the effect of various surface coatings of titanium dental implants by varying the friction coefficient (µ) at the interface between the dental implant and jawbone using finite element analysis (FEA) methods and to provide a comparative analysis between the various surface coatings and implant designs. An accurate model of the dental implant prosthetics consisting of the hard (cortical) and the soft (cancellous) bone, with the various titanium dental implant designs was modelled using a 3D CAD software, and the FE mesh model was generated using HyperMesh 13.0. Three coatings having different coefficient of friction values were selected: Titanium Nitride (TiN) with a friction coefficient of 0.19, Titanium Oxide (TiO₂) with a friction coefficient of 0.30 and Zirconium Nitride (ZrN) with a coefficient of friction of 0.49. The non-linear static stress analysis was conducted under three different loading conditions (vertical, lateral and oblique loading) using a CAE solver. The present study showed that surface coatings with high friction coefficients generated lower stresses in the cancellous bone while generating higher stresses in the cortical bone. However, for dental implants having microthreads in their neck region, surface coatings with a high coefficient of friction generated lower stresses at the interface between the cortical bone and the implant. The FEA results indicate that selecting suitable surface coatings would significantly decrease the stresses developed at the bone-implant interface, and future studies should conduct in vivo trials to validate the FEA results obtained.

Biomimetic Implant Surfaces and Their Role in Biological Integration—A Concise Review

Background: The increased use of dental implants in oral rehabilitation has been followed by the development of new biomaterials as well as improvements in the performance of biomaterials already in use. This triggers the need for appropriate analytical approaches to assess the biological and, ultimately, clinical benefits of these approaches. Aims: To address the role of physical, chemical, mechanical, and biological characteristics in order to determine the critical parameters to improve biological responses and the long-term effectiveness of dental implant surfaces. Data sources and methods: Web of Science, MEDLINE and Lilacs databases were searched for the last 30 years in English, Spanish and Portuguese idioms. Results: Chemical composition, wettability, roughness, and topography of dental implant surfaces have all been linked to biological regulation in cell interactions, osseointegration, bone tissue and peri-implant mucosa preservation. Conclusion: Techniques involving subtractive and additive methods, especially those involving laser treatment or embedding of bioactive nanoparticles, have demonstrated promising results. However, the literature is heterogeneous regarding study design and methodology, which limits comparisons between studies and the definition of the critical determinants of optimal cell response.

Modification of polyetheretherketone (PEEK) physical features to improve osteointegration

Polyetheretherketone (PEEK) has been widely applied in orthopedics because of its excellent mechanical properties, radiolucency, and biocompatibility. However, the bioinertness and poor osteointegration of PEEK have greatly limited its further application. Growing evidence proves that physical factors of implants, including their architecture, surface morphology, stiffness, and mechanical stimulation, matter as much as the composition of their surface chemistry. This review focuses on the multiple strategies for the physical modification of PEEK implants through adjusting their architecture, surface morphology, and stiffness. Many research findings show that transforming the architecture and incorporating reinforcing fillers into PEEK can affect both its mechanical strength and cellular responses. Modified PEEK surfaces at the macro scale and micro/nano scale have positive effects on cell-substrate interactions. More investigations are necessary to reach consensus on the optimal design of PEEK implants and to explore the efficiency of various functional implant surfaces. Soft-tissue integration has been ignored, though evidence shows that physical modifications also improve the adhesion of soft tissue. In the future, ideal PEEK implants should have a desirable topological structure with better surface hydrophilicity and optimum surface chemistry.

Influence of cold atmospheric plasma on dental implant materials - an in vitro analysis

Background and objectives

Alterations in the microenvironment of implant surfaces could influence the cellular crosstalk and adhesion patterns of dental implant materials. Cold plasma has been described to have an influence on cells, tissues, and biomaterials. Hence, the mechanisms of osseointegration may be altered by non-thermal plasma treatment depending on different chemical compositions and surface coatings of the biomaterial. The aim of the present study is to investigate the influence of cold atmospheric plasma (CAP) treatment on implant surfaces and its biological and physicochemical side effects.

Materials and methods

Dental implant discs from titanium and zirconia with different surface modifications were treated with CAP at various durations. Cell behavior and adhesion patterns of human gingival fibroblast (HGF-1) and osteoblast-like cells (MG-63) were examined using scanning electron microscopy and fluorescence microscopy. Surface chemical characterization was analyzed using energy-dispersive X-ray spectroscopy (EDS). Quantitative analysis of cell adhesion, proliferation, and extracellular matrix formation was conducted including real-time PCR.

Results

CAP did not affect the elemental composition of different dental implant materials. Additionally, markers for cell proliferation, extracellular matrix formation, and cell adhesion were differently regulated depending on the application time of CAP treatment in MG-63 cells and gingival fibroblasts.

Conclusions

CAP application is beneficial for dental implant materials to allow for faster proliferation and adhesion of cells from the surrounding tissue on both titanium and zirconia implant surfaces with different surface properties.

Clinical relevance

The healing capacity provided through CAP treatment could enhance osseointegration of dental implants and has the potential to serve as an effective treatment option in periimplantitis therapy.

Innovative Surface Modification Procedures to Achieve Micro/Nano-Graded Ti-Based Biomedical Alloys and Implants

Due to the growing aging population of the world, and as a result of the increasing need for dental implants and prostheses, the use of titanium and its alloys as implant materials has spread rapidly. Although titanium and its alloys are considered the best metallic materials for biomedical applications, the need for innovative technologies is necessary due to the sensitivity of medical applications and to eliminate any potentially harmful reactions, enhancing the implant-to-bone integration and preventing infection. In this regard, the implant’s surface as the substrate for any reaction is of crucial importance, and it is accurately addressed in this review paper. For constructing this review paper, an internet search was performed on the web of science with these keywords: surface modification techniques, titanium implant, biomedical applications, surface functionalization, etc. Numerous recent papers about titanium and its alloys were selected and reviewed, except for the section on forthcoming modern implants, in which extended research was performed. This review paper aimed to briefly introduce the necessary surface characteristics for biomedical applications and the numerous surface treatment techniques. Specific emphasis was given to micro/nano-structured topographies, biocompatibility, osteogenesis, and bactericidal effects. Additionally, gradient, multi-scale, and hierarchical surfaces with multifunctional properties were discussed. Finally, special attention was paid to modern implants and forthcoming surface modification strategies such as four-dimensional printing, metamaterials, and metasurfaces. This review paper, including traditional and novel surface modification strategies, will pave the way toward designing the next generation of more efficient implants.

Evaluating protein binding specificity of titanium surfaces through mass spectrometry-based proteomics

OBJECTIVES

To evaluate whether surface characteristics of different titanium modifications may influence the composition of the salivary pellicle on each surface by analyzing the salivary proteome through mass spectrometry-based proteomics.

MATERIALS AND METHODS

Titanium discs with three surfaces modifications (PT (machined titanium), SLA (sandblasted/large-grit/acid-etched), and SLActive (modified SLA)) were characterized (topography, chemistry, and energy) prior to being exposed to saliva for 2 h to form a protein pellicle. The resultant protein layer was retrieved and analyzed through mass spectrometry (nLC-ESI-MS/MS) to examine the surface specificity for protein binding, while the proteome profile of each surface was classified.

RESULTS

The proteome analysis showed that the salivary pellicle composition was more complex on rough surfaces (SLA and SLActive). Although variability in protein composition was observed between surfaces, most proteins were detected on more than one surface, indicating a limited surface specificity for protein binding. Additionally, the salivary pellicle formed on the SLActive presented a larger number of proteins associated with immune response, biological adhesion, and biomineralization.

CONCLUSIONS

Although topography, chemistry, and energy differed between the surfaces, they were not determinant to produce a salivary pellicle with high surface specificity. Also, we showed that several salivary proteins adsorbed on Ti surfaces are involved in biological functions important to the biointegration.

CLINICAL RELEVANCE

This study sheds light on the necessity for the development of bioactive surfaces that favors the formation of a specific protein layer that can enhance tissue response to assist the biointegration of dental implants.

Biological Cell Investigation of Structured Nitinol Surfaces for the Functionalization of Implants

Expandable implants including shape memory alloy (SMA) elements have great potential to minimize the risk of implant loosening and to increase the primary stability of bone anchoring. Surface structuring of such elements may further improve these properties and support osteointegration and bone healing. In this given study, SMA sheets were processed by deploying additive and removal manufacturing technologies for 3D-printed surgical implants. The additive technology was realized by applying a new laser beam melting technology to print titanium structures on the SMA sheets. The removal step was realized as a standard process with an ultrashort-pulse laser. The morphology, metabolic activity, and mineralization patterns of human bone marrow stromal cells were examined to evaluate the biocompatibility of the new surface structures. It was shown that both surface structures support cell adhesion and the formation of a cytoskeleton. The examination of the metabolic activity of the marrow stromal cells on the samples showed that the number of cells on the laser-structured samples was lower when compared to the 3D-printed ones. The calcium phosphate accumulation, which was used to examine the mineralization of marrow stromal cells, was higher in the laser-structured samples than in the 3D-printed ones. These results indicate that the additive- and laser-structured SAM sheets seem biocompatible and that the macrostructure surface and manufacturing technology may have positive influences on the behavior of the bone formation. The use of the new additive technique and the resulting macrostructures seems to be a promising approach to combine increased anchorage stability with simultaneously enhanced osteointegration.

Gingival fibroblasts behavior on bioactive zirconia and titanium dental implant surfaces produced by a functionally graded technique

Adding a biological apatite layer to the implant surface enhances bone healing around the implant.

Enhanced osteogenic differentiation of human mesenchymal stromal cells as response to periodical microstructured Ti6Al4V surfaces

Titanium-based alloys, for example, Ti6Al4V, are frequently employed for load-bearing orthopedic and dental implants. Growth of new bone tissue and therefore osseointegration can be promoted by the implant's microtopography, which can lead to improved long-term stability of the implant. This study investigates the effect that an organized, periodical microstructure produced by an electron beam (EB) technique has on the viability, morphology, and osteogenic differentiation capacity of human mesenchymal stromal cells (hMSC) in vitro. The technique generates topographical features of 20 μm in height with varying distances of 80-240 μm. Applied alterations of the surface roughness and local alloy composition do not impair hMSC viability (>94%) or proliferation. A favorable growth of hMSC onto the structure peaks and well-defined focal adhesions of the analyzed cells to the electron beam microstructured surfaces is verified. The morphological adaptation of hMSC to the underlying topography is detected using a three-dimensional (3D) visualization. In addition to the morphological changes, an increase in the expression of osteogenic markers such as osteocalcin (up to 17-fold) and osteoprotegerin (up to sixfold) is observed. Taken together, these results imply that the proposed periodical microstucturing method could potentially accelerate and enhance osseointegration of titanium-based bone implants.

A Newly Created Meso-, Micro-, and Nano-Scale Rough Titanium Surface Promotes Bone-Implant Integration

Titanium implants are the standard therapeutic option when restoring missing teeth and reconstructing fractured and/or diseased bone. However, in the 30 years since the advent of micro-rough surfaces, titanium’s ability to integrate with bone has not improved significantly. We developed a method to create a unique titanium surface with distinct roughness features at meso-, micro-, and nano-scales. We sought to determine the biological ability of the surface and optimize it for better osseointegration. Commercially pure titanium was acid-etched with sulfuric acid at different temperatures (120, 130, 140, and 150 °C). Although only the typical micro-scale compartmental structure was formed during acid-etching at 120 and 130 °C, meso-scale spikes (20–50 μm wide) and nano-scale polymorphic structures as well as micro-scale compartmental structures formed exclusively at 140 and 150 °C. The average surface roughness (Ra) of the three-scale rough surface was 6–12 times greater than that with micro-roughness only, and did not compromise the initial attachment and spreading of osteoblasts despite its considerably increased surface roughness. The new surface promoted osteoblast differentiation and in vivo osseointegration significantly; regression analysis between osteoconductivity and surface variables revealed these effects were highly correlated with the size and density of meso-scale spikes. The overall strength of osseointegration was the greatest when the acid-etching was performed at 140 °C. Thus, we demonstrated that our meso-, micro-, and nano-scale rough titanium surface generates substantially increased osteoconductive and osseointegrative ability over the well-established micro-rough titanium surface. This novel surface is expected to be utilized in dental and various types of orthopedic surgical implants, as well as titanium-based bone engineering scaffolds.

Proteome analysis of human serum proteins adsorbed onto different titanium surfaces used in dental implants

Titanium dental implants are commonly used due to their biocompatibility and biochemical properties; blasted acid-etched Ti is used more frequently than smooth Ti surfaces. In this study, physico-chemical characterisation revealed important differences in roughness, chemical composition and hydrophilicity, but no differences were found in cellular in vitro studies (proliferation and mineralization). However, the deposition of proteins onto the implant surface might affect in vivo osseointegration. To test that hypothesis, protein layers formed on discs of both surface type after incubation with human serum were analysed. Using mass spectrometry (LC/MS/MS), 218 proteins were identified, 30 of which were associated with bone metabolism. Interestingly, Apo E, antithrombin and protein C adsorbed mostly onto blasted and acid-etched Ti, whereas the proteins of the complement system (C3) were found predominantly on smooth Ti surfaces. These results suggest that physico-chemical characteristics could be responsible for the differences observed in the adsorbed protein layer.

Protein adsorption on a laser-modified titanium implant surface

PURPOSE

The aim of this study was to investigate the earlier phase of the osseointegration of a laser-treated implant surface in terms of human protein adsorption.

MATERIALS AND METHODS

Titanium surfaces were divided into machined (M), sandblasted (SB), and laser-treated (LT). The LT surfaces were created with an Nd diode-pumped laser in Q-switching, whereas the SB were treated with Al2O3. An x-ray photoelectron spectroscopy (XPS) analysis of titanium surface was performed. Titanium discs were used for albumin and fibronectin adsorption evaluation through fluorescence intensity. Fibronectin evaluation was also made with Western Blot analysis on experimental implants.

RESULTS

LT discs appeared to trigger a higher albumin and fibronectin adsorption with a regular pattern. The mean count of albumin adsorption was 0.29 and 3.8 for SB and LT, respectively (P = 0.016), whereas fibronectin values were 0.67 and 4.9 for (SB) and (LT) titanium (P = 0.02). XPS analysis showed that titanium, oxygen, carbon, and nitrogen were found on all 3 surfaces.

CONCLUSION

Laser-engineered porous titanium surface seems to promote, in vitro, the adsorption of albumin and fibronectin more than sandblasted (SB) or machined (M) implants.

The evaluation of prepared microgroove pattern by femtosecond laser on alumina-zirconia nano-composite for endosseous dental implant application

Ceramic dental materials, especially alumina (20 %vol)-yttrium stabilized tetragonal zirconia poly crystal (A-Y-TZP20), have been considered as alternatives to metals for endosseous dental implant application. For increasing the bone-to-implant contact as well as the speed of bone formation, a new surface modification can be effective. The aim of this study was to design microgroove patterns by femtosecond laser on A-Y-TZP20 nano-composite disks for endosseous dental implant application. The phase composition and the morphology of the A-Y-TZP20 nano-composite samples were characterized using X-ray diffraction and Scanning electron microscopy equipped with energy dispersive X-ray spectroscopy techniques. Statistical analysis was submitted to Kolmogorov-Smirnov test and Student's t test for independent variables, with a 5 % significance level. EDAX analysis revealed a significant decrease in the relative content of contaminants like carbon (p < 0.05) in laser surface-treated group as compared to non surface-treated group. X-ray diffraction did not show any change in the crystalline structure induced by laser processing. It was concluded that the femtosecond laser is a clean and safe method for surface modification of A-Y-TZP20.

Effect of locally applied bFGF on implant stability: biomechanical evaluation of 2 different implant surfaces in rabbits

OBJECTIVES

The aim of this study was to evaluate the implant stability with the addition of local application of basic fibroblast growth factor (bFGF) during the osseointegration of 2 different dental implant surfaces using rabbit tibia model.

MATERIALS AND METHODS

Fifty-six dental implants, 28 of hydrophilic surface (SLActive) and 28 of hydrophobic surface (OsseoSpeed), were placed in 14 mature New Zealand rabbits. The rabbits each received both SLActive and OsseoSpeed implants per tibia, and bFGF was applied locally on 1 randomly selected tibia. Half of the subjects were killed at the fourth week of healing period, and the other half were killed at the twelfth week. Stabilization was assessed using resonance frequency analysis (RFA) and removal torque value (RTV).

RESULTS

The local application of bFGF was found to enhance osseointegration, especially at the fourth week of healing period after application (P = 0.046). RFAs and RTVs were found to be higher in bFGF-treated implant with hydrophilic surfaces when compared with both bFGF-treated hydrophobic implants and nontreated hydrophilic controls.

CONCLUSION

Local application of bFGF seems to increase the stabilization values in implants with hydrophilic surfaces and those with hydrophobic surfaces.

Influence of Surface Topographical Cues on the Differentiation of Mesenchymal Stem Cells in Vitro

Adult stem cell research has been advanced in recent years because of the cells' attractive abilities of self-renewal and differentiation. Topography of materials is one of the key features that can be harnessed to regulate stem cell behaviors. Stem cells can interact with underlying material through nanosized integrin receptors. Therefore, the manipulation of topographical cues at a nanoscale level can be employed to modulate the cell fate. In this review, we focus our discussion on the different surface topographical cues, especially, with an emphasis on the viral nanoparticle-coated materials, and their effects on stem cell differentiation.

The Effect of Flapless and Full-thickness Flap Techniques on Implant Stability During the Healing Period

Purpose : When soft tissue flaps are reflected for implant placement, the blood supply from the periosteum to the bone is disrupted. The aim of this study was to compare the effects of the flapless (FL) and full-thickness flap (FT) techniques on implant stability. Methods : Nine patients received 22 implants. The implants were placed using the FL technique on the contralateral side of the jaw; the FT technique was used as the control technique. Resonance frequency analysis (RFA) was performed at the time of implant placement and at 6 and 12 weeks after implant placement. RFA values were compared between the FL and FT groups and between time intervals in the same group. Results : The median (interquartile range [IQR]) RFA values at the time of implant placement were 75.00 (15.00) for the FL technique and 75.00 (9.00) for the FT technique. At 6 weeks, the median (IQR) values were 79 (3.30) for the FL technique and 80 (12.70) for the FT technique. At 12 weeks, the median (IQR) values were 82.3 (3.30) for the FL technique and 82.6 (8.00) for the FT technique. There were no significant differences between the 2 techniques at the time of implant placement, after 6 weeks or after 12 weeks, with p values of 0.994, 0.789, and 0.959, respectively. There were significant differences between the RFA values at the time of implant placement and after 6 weeks for the FL technique (p=0.028) but not for the FT technique (p=0.091). There were also significant differences between the RFA values at 6 weeks and the RFA values at 12 weeks for the FL technique (p=0.007) and for the FT technique (p=0.003). Conclusion : Periosteum preservation during the FL procedure will speed up bone remodeling and result in early secondary implant stability as well as early loading.

Efficacy of standard (SLA) and modified sandblasted and acid-etched (SLActive) dental implants in promoting immediate and/or early occlusal loading protocols: a systematic review of prospective studies

OBJECTIVE

To assess the survival percentage, clinical and radiographic outcomes of sandblasted and acid-etched (SLA) dental implants and its modified surface (SLActive) in protocols involving immediate and early occlusal loading.

METHODS

MEDLINE, EMBASE and the Cochrane Oral Health Group's Trials Register CENTRAL were searched in duplicate up to, and including, June 2013 to include randomised controlled trials (RCTs) and prospective observational studies of at least 6-month duration published in all languages. Studies limited to patients treated with SLA and/or SLActive implants involving a treatment protocol describing immediate and early loading of these implants were eligible for inclusion. Data on clinical and/or radiographic outcomes following implant placement were considered for inclusion.

RESULTS

Of the 447 potentially eligible publications identified by the search strategy, seven RCTs comprising a total of 853 implants (8% titanium plasma-sprayed, 41.5% SLA and 50.5% SLActive) and 12 prospective observational studies including 1394 SLA and 145 SLActive implants were included in this review. According to the Cochrane Collaboration's tool for assessing risk of bias, one of the studies was considered to be at a low risk of bias, whereas the remaining studies were considered to be at an unclear risk. Regarding the observational studies, all of them presented a medium methodological quality based on the Modified Newcastle-Ottawa scale. There were no significant differences reported in the studies in relation to implant loss or clinical parameters between the immediate/early loading and delayed loading protocols. Overall, 95% of SLA and 97% of SLActive implants still survive at the end of follow-up.

CONCLUSIONS

Despite of the positive findings achieved by the included studies, few RCTs were available for analysis for SLActive implants. Study heterogeneity, scarcity of data and the lack of pooled estimates represent a limitation between studies' comparisons and should be considered when interpreting the present findings.

Progressive immediate loading of a perforated maxillary sinus dental implant: a case report

The displacement of a dental implant into the maxillary sinus may lead to implant failure due to exposure of the apical third or the tip of the implant beyond the bone, resulting in soft tissue growth. This case report discusses dental implant placement in the upper first molar area with maxillary sinus involvement of approximately 2 mm. A new technique for progressive implant loading was used, involving immediately loaded implants with maxillary sinus perforation and low primary stability. Follow-up was performed with resonance frequency analysis and compared with an implant placed adjacent in the upper second premolar area using a conventional delayed loading protocol. Implants with maxillary sinus involvement showed increasing stability during the healing period. We found that progressive implant loading may be a safe technique for the placement of immediately loaded implants with maxillary sinus involvement.

Implant surface material, design, and osseointegration

The structural and functional union of the implant with living bone is greatly influenced by the surface properties of the implant. The success of a dental implant depends on the chemical, physical, mechanical, and topographic characteristics of its surface. The influence of surface topography on osseointegration has translated to shorter healing times from implant placement to restoration. This article presents a discussion of surface characteristics and design of implants, which should allow the clinician to better understand osseointegration and information coming from implant manufacturers, allowing for better implant selection.

Surface biocompatibility of differently textured titanium implants with mesenchymal stem cells

OBJECTIVE

The major challenge for contemporary dentistry is restoration of missing teeth; currently, dental implantation is the treatment of choice in this circumstance. In the present study, we assessed the interaction between implants and Dental Pulp Stem Cells (DPSCs) in vitro by means of 3D cell culture in order to better simulate physiological conditions.

METHODS

Sorted CD34+ DPSCs were seeded onto dental implants having either a rough surface (TriVent) or one coated with a ceramic layer mimicking native bone (TiUnite). We evaluated preservation of DPSC viability during osteogenic differentiation by an MTT assay and compared mineralized matrix deposition with SEM analysis and histological staining; temporal expression of osteogenic markers was evaluated by RT-PCR and ELISA.

RESULTS

Both surfaces are equally biocompatible, preserve DPSC viability, stimulate osteogenic differentiation, and increase the production of VEGF. A slight difference was observed between the two surfaces concerning the speed of DPSC differentiation.

SIGNIFICANCE

Our study of the two implant surfaces suggests that TriVent, with its roughness, is capable of promoting cell differentiation a bit earlier than the TiUnite surface, although the latter promotes greater cell proliferation.

Estudo in vitro da influência do formato e do tratamento de superfície de implantes odontológicos no torque de inserção, resistência ao arrancamento e frequência de ressonância

OBJETIVO: A proposta do estudo foi avaliar a influência do formato e do tratamento de superfície na estabilidade primária de implantes odontológicos, inseridos em diferentes substratos, utilizando-se associação de métodos, como torque de inserção, resistência ao arrancamento e frequência de ressonância. MATERIAL E MÉTODO: Foram utilizados 32 implantes da marca Conexão® (Conexão Sistemas de Prótese Ltda, Arujá, São Paulo, Brasil), sendo: oito cilíndricos com tratamento Porous (CA), oito cilíndricos usinados (MS), oito cilíndricos tratamento duplo Porous (MP) e oito cônicos sem tratamento (CC). Os substratos utilizados para inserção foram: costela de porco; poliuretana Synbone©; poliuretana Nacional® (15, 20, 40 PCF), e madeira. O torque de inserção (TI) foi quantificado utilizando-se um torquímetro digital Kratos®; a força de arrancamento (RA) foi aferida por meio de tração axial, realizada em uma Máquina Universal de Ensaios (Emic® DL-10000), e utilizou-se também análise por meio de frequência de ressonância (RF). Para obtenção dos resultados estatísticos, utilizou-se análise de variância e teste de Tukey (significância de 5%). RESULTADO: Ao analisar o torque de inserção, verificou-se que os implantes com tratamento de superfície não foram diferentes estatisticamente dos usinados, assim como os implantes cilíndricos não tiveram diferença dos cônicos em todos os substratos (p>0,05), com exceção da poliuretana Synbone©. Em relação à resistência ao arrancamento, os implantes tratados e usinados, assim como cônicos e cilíndricos, não tiveram diferença estatística (p>0,05); a análise de frequência de ressonância mostrou que não houve diferença entre os implantes (p>0,05), com exceção da poliuretana Nacional® (20 PCF). CONCLUSÃO: Os formatos e o tratamento de superfície estudados não demonstraram valores significantes quando foram comparados os implantes entre si e, considerando os substratos avaliados, não houve diferença estatística entre os diferentes tipos de implantes.

The Influence of Low-Level Laser on Osseointegration Around Machined and Sandblasted Acid-Etched Implants: A Removal Torque and Histomorphometric Analyses

Evaluation of the influence of laser application on osseointegration around implants with different surface characteristics is limited. This study aims to evaluate the influence of low-level lasers on the early stages of osseointegration. Ninety-six external hex implants (3.75 mm × 5.0 mm) were placed in 24 rabbits-one machined and one sandblasted acid-etched per tibia. The rabbits were later divided into the laser group, which received a total dose of 24 J/cm(2) of gallium-aluminum-arsenide laser over 15 days, and a control group. At 16 and 30 days after surgery, removal torque and histomorphometric analyses were performed. No statistical differences in removal torque or histomorphometric analyses were verified between laser and control groups regardless of implant surface (P > .05). Time was the only variable presenting significant differences between measurements (P < .05). Low-level laser had no significant short-term effect on bone-to-implant contact and removal torque values regardless of implant surface characteristics.

The effect of surface topography on cell shape and early ERK1/2 signaling in macrophages; linkage with FAK and Src

Implant surface topography can modulate macrophage behavior during wound healing by the production of proinflammatory cytokines. This study investigated the activation of FAK, Src, and ERK1/2 signaling intermediates of the proinflammatory ERK1/2 pathway in RAW 264.7 macrophages in response to polished (P), coarse-grit-blasted (B), acid etched (E), and grit-blasted and etched (SLA) surface topographies. In addition, the effects of these topographies on cell spreading, vinculin organization, and viability were determined. Macrophages on the SLA surface changed from predominantly well-spread cells to ones with a more spherical morphology over time. In contrast, macrophages on the P surface changed from being predominantly spherical cells to well spread. The morphological changes were associated with changes in the distribution of vinculin. The overall patterns of the pFAK, pSrc, pERK1/2 levels as well as pERK1/2 nuclear translocation associated with cell shape with greater activation being seen with a more spread morphology. These results suggest that surface topography differentially activates signaling pathways that affect cell function and raise the possibility that topographies can be designed to optimize desired cell responses.

Bone healing with or without platelet-rich plasma around four different dental implant surfaces in beagle dogs

PURPOSE

Surface development is one of the major aims in dental implant engineering. Additive application of substances could possibly improve the new bone formation around dental implants. The present study evaluated the bone reaction on four different implant surfaces with or without platelet-rich plasma (PRP).

MATERIALS AND METHODS

Four self-tapping titanium screw implants (Brånemark MK III [Nobel Biocare, Göteborg, Sweden], Osseotite [3i, Miami, FL, USA], Xive [Densply Friadent, Mannheim, Germany], and Compress [IGfZ eG, Diez, Germany]) with different surfaces were inserted in each hemimandible of 12 female beagle dogs; the implant positions and the application of PRP were randomized. After intravital fluorochrome staining, sacrifices and biopsies harvesting were performed after 6 weeks (five dogs; one dog died before) and 12 weeks (six dogs) and the respective specimens were analyzed.

RESULTS

The only significant difference in bone remodeling was found for the Compress implants with increased bone formation compared with the Brånemark implants at 12 weeks (sign test, p = .03). Comparing the histological and histomorphometric specimens of all other implant surfaces with respect to peri-implant bone remodeling and the resulting bone-implant contact rates (BICRs), no statistically significant differences were seen in the PRP or non-PRP groups (sign test, all p values ≥ .063).

CONCLUSIONS

This study found no significant differences in the BICR for roughened implant surfaces compared with machined surfaces. In this animal model, the addition of PRP did not demonstrate evidence of faster bone formation or the resulting BICR.

Bone-to-implant contact around immediately loaded direct laser metal-forming transitional implants in human posterior maxilla

OBJECTIVE

Direct laser metal forming (DLMF) is a procedure in which a high-power laser beam is directed onto a metal powder bed and programmed to fuse particles according to a computer-aided design file, generating a thin metal layer. This histologic study evaluated the bone-to-implant contact (BIC%) around immediately loaded DLMF transitional implants retrieved after 2 months from posterior human maxillae.

METHODS

Twelve totally edentulous individuals (mean age, 66.14 ± 2.11 years) received DLMF transitional implants divided in twelve immediately loaded (IL) and twelve unloaded (UI) implants. These transitional implants were placed between conventional implants to support the interim complete maxillary denture during the healing period. After 8 weeks, the transitional implants and the surrounding tissue were removed and prepared for histomorphometric analysis.

RESULTS

Mature woven preexisting bone lined by newly formed bone in early stages of maturation were found around all retrieved implants. Histometric evaluation indicated that the mean BIC% was 45.20 ± 7.68% and 34.10 ± 7.85% for IL and UI, respectively (P <0.05).

CONCLUSION

The present data obtained in humans showed that, although both IL and UI presented good BIC%, IL DLMF implants had a higher BIC% in the posterior maxilla.

Er:YAG laser-roughened enamel promotes osteoblastic differentiation

OBJECTIVE

The aim of this study was to test whether Er:YAG laser-etched enamel of human teeth could act as a biologically active scaffold for tissue regeneration.

BACKGROUND DATA

Hydroxylapatite (HA) with rough surface created by acid etching treatment has been used as a scaffold for tissue engineering. However, whether tooth HA can be a scaffold for osteoblastic cell seeding is still unclear.

MATERIALS AND METHODS

Enamel samples from human teeth were pretreated with an Er:YAG laser to create a rough surface. Then the surface of the laser-treated enamel was examined using a surface roughness profilometer and a scanning electron microscope. In addition, static water contact angles of the Er:YAG laser-treated enamel samples were measured using goniometry. To observe the effects of cell behavior on an Er:YAG laser-roughened enamel surface, we cultured MG63 osteoblast-like cells on the surface-modified enamel samples. Alkaline phosphatase activity, a marker of cell proliferation and differentiation, was monitored and compared with that in untreated control and acid-etched enamel samples.

RESULTS

Er:YAG laser treatment significantly improved the surface roughness of the enamel samples. Furthermore, MG63 osteoblast-like cells cultured on the Er:YAG laser-roughened enamel surface expressed more alkaline phosphatase activity and exhibited greater degrees of cellular differentiation than did cells that had been cultured on untreated enamel samples.

CONCLUSIONS

These results demonstrate that Er:YAG laser-roughened enamel promotes osteoblastic differentiation. This finding suggests that Er:YAG laser-roughened enamel surfaces can potentially serve as a scaffold for tissue engineering.

Microstructural and topographical characterization of different surface treatments of a surgical titanium alloy for dental implants

OBJECTIVE

To perform a topographical characterization of a titanium alloy subjected to different surface treatments using roughness evaluation, scanning electron microscopy, and atomic force microscopy.

MATERIALS AND METHODS

For each group, 6 discs of a titanium alloy had their surfaces modified by 4 treatments. All surfaces were blasted with Al2O3, cleaned, and the specimens were divided into 4 groups: G1, immersion in a standardized acid solution (SAS) (control group); G2, immersion in acetone, followed by immersion in SAS; G3, immersion in acetone, followed by immersion in SAS, followed by immersion in nitric acid; G4, immersion in acetone, followed by immersion in SAS, followed by immersion in sulfuric acid. Roughness parameters were determined with a roughness tester, and data were statistically analyzed using analysis of variance and Tukey tests (α = 5%).

RESULTS

Regarding the roughness parameters, no significant differences were found. Scanning electron microscopy and atomic force microscopy showed irregular surfaces with the presence of particles uniformly deposited on the surfaces.

CONCLUSION

A similar roughness pattern was created for all the groups. The images and topographic profiles indicated that all the groups showed high levels of roughness.

The cytocompatibility and osseointegration of the Ti implants with XPEED® surfaces

OBJECTIVES

This study evaluated cytocompatibility and osseointegration of the titanium (Ti) implants with resorbable blast media (RBM) surfaces produced by grit-blasting or XPEED(®) surfaces by coating of the nanostructured calcium.

MATERIAL AND METHODS

Ti implants with XPEED(®) surfaces were hydrothermally prepared from Ti implants with RBM surfaces in a solution containing alkaline calcium. The surface characteristics were evaluated by using a scanning electron microscope (SEM) and surface roughness measuring system. Apatite formation was measured with SEM after immersion in modified-simulated body fluid and the amount of calcium released was measured by inductively coupled plasma optical emission. The cell proliferation was investigated by MTT assay and the cell attachment was evaluated by SEM in MC3T3-E1 pre-osteoblast cells. Thirty implants with RBM surfaces and 30 implants with XPEED(®) surfaces were placed in the proximal tibiae and in the femoral condyles of 10 New Zealand White rabbits. The osseointegration was evaluated by a removal torque test in the proximal tibiae and by histomorphometric analysis in the femoral condyles 4 weeks after implantation.

RESULTS

The Ti implants with XPEED(®) surfaces showed a similar surface morphology and surface roughness to those of the Ti implants with RBM surfaces. The amount of calcium ions released from the surface of the Ti implants with XPEED(®) surfaces was much more than the Ti implants with RBM surfaces (P < 0.05). The cell proliferation and cell attachment of the Ti implants showed a similar pattern to those of the Ti implants with RBM surfaces (P > 0.1). Apatite deposition significantly increased in all surfaces of the Ti implants with XPEED(®) surfaces. The removable torque value (P = 0.038) and percentage of bone-to-implant contact (BIC%) (P = 0.03) was enhanced in the Ti implants with XPEED(®) surfaces.

CONCLUSION

The Ti implants with XPEED(®) surfaces significantly enhanced apatite formation, removal torque value, and the BIC%. The Ti implants with XPEED(®) surfaces may induce strong bone integration by improving osseointegration of grit-blasted Ti implants in areas of poor quality bone.

Short-term teriparatide delivery and osseointegration: a clinical feasibility study

Teriparatide is an anabolic osteoporosis therapeutic agent that can improve healing after fractures and periodontal surgeries. Clinical studies investigating the effects of teriparatide on the osseointegration of titanium implants have not been performed. We conducted an open-label randomized controlled feasibility study and included 24 individuals with edentulous lower jaws. The participants received 2 study implants in the mandible during interforaminal dental implant surgery. They were randomly assigned to receive either 20 µg of teriparatide once daily for 28 days or no treatment. Study implants were retrieved from 23 participants after 9 weeks and were subjected to histomorphometric analyses. Endpoints were new bone-volume-per-tissue-volume (NBV/TV) and new bone-to-implant-contact (NBIC). We report here that median values of NBV/TV in the control and the teriparatide groups were 15.4% vs. 17.6% in the periosteal compartment, 11.3% vs. 16.5% in the cortical compartment, and 7.3% vs. 12.0% in the medullary compartment, respectively. NBIC median values in the control and the teriparatide groups were 3.3% vs. 4.1% in the periosteal compartment, 5.0% vs. 4.4% in the cortical compartment, and 0.3% vs. 1.4% in the medullary compartment, respectively. The results provide the first histological data on the osseointegration of titanium study implants in individuals treated with teriparatide. ClinicalTrials.gov number, NCT00089674.

Biomedical Ti-Mo alloys with surface machined and modified by laser beam: biomechanical, histological, and histometric analysis in rabbits

PURPOSE

In vivo bone response was assessed by removal torque, hystological and histometrical analysis on a recently developed biomedical Ti-15Mo alloy, after surface modification by laser beam irradiation, installed in the tibia of rabbits.

MATERIALS AND METHODS

A total of 32 wide cylindrical Ti-15Mo dental implants were obtained (10mm × 3.75mm). The implants were divided into two groups: 1) control samples (Machined surface - MS) and 2) implants with their surface modified by Laser beam-irradiation (Test samples - LS). Six implants of each surface were used for removal torque test and 10 of each surface for histological and histometrical analysis. The implants were placed in the tibial metaphyses of rabbits.

RESULTS

Average removal torque was 51.5Ncm to MS and >90Ncm to LS. Bone-to-implant-contact percentage was significantly higher for LS implants both in the cortical and marrow regions.

CONCLUSIONS

The present study demonstrated that laser treated Ti-15Mo alloys are promising materials for biomedical application.

Scanning electron microscopy (SEM) and X-ray dispersive spectrometry evaluation of direct laser metal sintering surface and human bone interface: a case series

Recent studies have shown that direct laser metal sintering (DLMS) produces structures with complex geometry and consequently that allow better osteoconductive properties. The aim of this patient report was to evaluate the early bone response to DLMS implant surface retrieved from human jaws. Four experimental DLMS implants were inserted in the posterior mandible of four patients during conventional dental implant surgery. After 8 weeks, the micro-implants and the surrounding tissue were removed and prepared for scanning electron microscopy (SEM) and histomorphometric analysis to evaluate the bone-implant interface. The SEM and EDX evaluations showed a newly formed tissue composed of calcium and phosphorus. The bone-to-implant contact presented a mean of 60.5 ± 11.6%. Within the limits of this patient report, data suggest that the DLMS surfaces presented a close contact with the human bone after a healing period of 8 weeks.

Influence of direct laser fabrication implant topography on type IV bone: a histomorphometric study in humans

The aim of this histologic study was to evaluate the influence of the direct laser fabrication (DFL) surface topography on bone-to-implant contact (BIC%), on bone density in the threaded area (BA%) as well as bone density outside the threaded area (BD%) in type IV bone after 8 weeks of unloaded healing. Thirty patients (mean age 51.34 +/- 3.06 years) received 1 micro-implant (2.5-mm diameter and 6-mm length) each during conventional implant surgery in the posterior maxilla. Thirty micro-implants with three topographies were evaluated: 10 machined (cpTi); 10 sandblasted and acid etched surface (SAE) and 10 DFL micro-implants. After 8 weeks, the micro-implants and the surrounding tissue were removed and prepared for histomorphometric analysis. Four micro-implants (2 cpTi, 1 SAE and 1DLF) showed no osseointegration after the healing period. Histometric evaluation indicated that the mean BIC% was higher for the DFL and SAE surfaces (p = 0.0002). The BA% was higher for the DFL surface, although there was no difference with the SAE surface. The BD% was similar for all topographies (p > 0.05). Data suggest that the DFL and SAE surfaces presented a higher bone-to-implant contact rate compared with cpTi surfaces under unloaded conditions, after a healing period of 8 weeks.

Early human bone response to laser metal sintering surface topography: a histologic report

This histologic report evaluated the early human bone response to a direct laser metal sintering implant surface retrieved after a short period of healing. A selective laser sintering procedure using a Ti-6Al-4V alloy powder with a particle size of 25-45 microm prepared this surface topography. One experimental microimplant was inserted into the anterior mandible of a patient during conventional implant surgery of the jaw. The microimplant and surrounding tissues were removed after 2 months of unloaded healing and were prepared for histomorphometric analysis. Histologically, the peri-implant bone appeared in close contact with the implant surface, whereas marrow spaces could be detected in other areas along with prominently stained cement lines. The mean of bone-to-implant contact was 69.51%. The results of this histologic report suggest that the laser metal sintering surface could be a promising alternative to conventional implant surface topographies.

Cardoso LA, Shibli JA. Impact of Smoking on Human Bone Apposition at Different Dental Implant Surfaces: A Histologic Study in Type IV Bone

Smoking has adverse effects on peri-implant bone healing and can cause bone loss around successfully integrated implants placed on type IV bone. This study evaluated the influence of implant surface topography of microimplants retrieved from posterior maxilla of smokers after 2 months of unloaded healing. Seven partially edentulous patients received 2 microimplants (machined and sandblasted acid-etched surface) each during conventional implant surgery. Histometric evaluation showed that the mean bone to implant contact was 10.40 ± 14.16% and 22.19 ± 14.68% to machined and sandblasted acid-etched surfaces, respectively (P &lt; .001). These data suggest that the sandblasted acid-etched surface presented better results than the machined surface after a short healing time in smokers.

Endosseous implant anchorage is critically dependent on mechanostructural determinants of peri-implant bone trabeculae

Low bone mass is highly prevalent among patients receiving endosseous implants. In turn, the implantation prognosis in low-density skeletal sites is poor. However, little is known about the mechanostructural determinants of implant anchorage. Using metabolic manipulations that lead to low bone density and to its rescue, we show here that anchorage is critically dependent on the peri-implant bone (PIB). Titanium implants were inserted horizontally into the proximal tibial metaphysis of adult rats 6 weeks after orchiectomy (ORX) or sham ORX. Systemic intermittent administration of human parathyroid hormone (1-34) [iahPTH(1-34)] or vehicle commenced immediately thereafter for 6 weeks. The bone-implant apparatus was then subjected to image-guided failure assessment, which assesses biomechanical properties and microstructural deformation concomitantly. Anchorage failure occurred mainly in PIB trabeculae, 0.5 to 1.0 mm away from the implant. Mechanically, the anchorage performed poorly in ORX-induced low-density bone, attributable mainly to decreased trabecular number. iahPTH(1-34) rescued the PIB density and implant mechanical function by augmenting trabecular thickness (Tb.Th). However, implant biomechanical properties in low-density bone were relatively insensitive to implant surface treatment that affected only the osseointegration (%bone-implant contact). These results support a model wherein anchorage failure involves buckling of the weakest trabecular struts followed by sequential failure of the stronger trabeculae. Treatment with iahPTH(1-34) induced thicker struts, which were able to delay and even prevent failure of individual elements, thus implicating trabecular thickness as a prime target for enhancing implant anchorage by systemic bone anabolic therapy.

The osteoblastic differentiation of dental pulp stem cells and bone formation on different titanium surface textures

Bone Tissue Engineering (BTE) and Dental Implantology (DI) require the integration of implanted structures, with well characterized surfaces, in bone. In this work we have challenged acid-etched titanium (AET) and Laser Sintered Titanium (LST) surfaces with either human osteoblasts or stem cells from human dental pulps (DPSCs), to understand their osteointegration and clinical use capability of derived implants. DPSCs and human osteoblasts were challenged with the two titanium surfaces, either in plane cultures or in a roller apparatus within a culture chamber, for hours up to a month. During the cultures cells on the titanium surfaces were examined for histology, protein secretion and gene expression. Results show that a complete osteointegration using human DPSCs has been obtained: these cells were capable to quickly differentiate into osteoblasts and endotheliocytes and, then, able to produce bone tissue along the implant surfaces. Osteoblast differentiation of DPSCs and bone morphogenetic protein production was obtained in a better and quicker way, when challenging stem cells with the LST surfaces. This successful BTE in a comparatively short time gives interesting data suggesting that LST is a promising alternative for clinical use in DI.

Effects of titanium surface topography on bone integration: a systematic review

AIM

To analyse possible effects of titanium surface topography on bone integration.

MATERIALS AND METHODS

Our analyses were centred on a PubMed search that identified 1184 publications of assumed relevance; of those, 1064 had to be disregarded because they did not accurately present in vivo data on bone response to surface topography. The remaining 120 papers were read and analysed, after removal of an additional 20 papers that mainly dealt with CaP-coated and Zr implants; 100 papers remained and formed the basis for this paper. The bone response to differently configurated surfaces was mainly evaluated by histomorphometry (bone-to-implant contact), removal torque and pushout/pullout tests.

RESULTS AND DISCUSSION

A huge number of the experimental investigations have demonstrated that the bone response was influenced by the implant surface topography; smooth (S(a)<0.5 microm) and minimally rough (S(a) 0.5-1 mum) surfaces showed less strong bone responses than rougher surfaces. Moderately rough (S(a)>1-2 microm) surfaces showed stronger bone responses than rough (S(a)>2 microm) in some studies. One limitation was that it was difficult to compare many studies because of the varying quality of surface evaluations; a surface termed 'rough' in one study was not uncommonly referred to as 'smooth' in another; many investigators falsely assumed that surface preparation per se identified the roughness of the implant; and many other studies used only qualitative techniques such as SEM. Furthermore, filtering techniques differed or only height parameters (S(a), R(a)) were reported.

CONCLUSIONS

* Surface topography influences bone response at the micrometre level. * Some indications exist that surface topography influences bone response at the nanometre level. * The majority of published papers present an inadequate surface characterization. * Measurement and evaluation techniques need to be standardized. * Not only height descriptive parameters but also spatial and hybrid ones should be used.

Immediate and early loading of Straumann implants with a chemically modified surface (SLActive) in the posterior mandible and maxilla: 1-year results from a prospective multicenter study

OBJECTIVE

Immediate and early loading of implants can simplify treatment and increase patient satisfaction. This 3-year randomized-controlled trial will therefore evaluate survival rates and bone-level changes with immediately and early loaded Straumann implants with the SLActive surface.

MATERIAL AND METHODS

Partially edentulous patients >or=18 years of age were enrolled. Patients received a temporary restoration (single crown or two to four unit fixed partial denture) out of occlusal contact either immediately (immediate loading) or 28-34 days later (early loading group), with permanent restorations placed 20-23 weeks after surgery. The primary endpoint was change in crestal bone level from baseline (implant placement) to 12 months; the secondary variables were implant survival and success rates.

RESULTS

A total of 383 implants (197 immediate and 186 early) were placed in 266 patients; 41.8% were placed in type III and IV bone. The mean patient age was 46.3+/-12.8 years. Four implants failed in the immediate loading group and six in the early loading group, giving implant survival rates of 98% and 97%, respectively (P=NS). There were no implant failures in type IV bone. The overall mean bone level change from baseline to 12 months was 0.77+/-0.93 mm (0.90+/-0.90 and 0.63+/-0.95 mm in the immediate and early groups, respectively; P<0.001). However, a significant difference in implantation depth between the two groups (P<0.0001) was found. After adjusting for this slight difference in initial surgical placement depth, time to loading no longer had a significant influence on bone-level change. Significant influence was found for: center (P<0.0001), implant length (P<0.05) and implant position (P<0.0001). Bone gain was observed in approximately 16% of implants.

CONCLUSIONS

The results demonstrated that Straumann implants with the SLActive surface are safe and predictable when used in immediate and early loading procedures. Even in poor-quality bone, survival rates were comparable with those from conventional or delayed loading. The mean bone-level change was not deemed to be clinically significant and compared well with the typical bone resorption observed in conventional implant loading.

A macro- and nanostructure evaluation of a novel dental implant

Success in implant dentistry also comes from the implant macrodesign and nanostructure of its surface. Titanium implant surface treatments have been shown to enhance osseointegration, maximize bone healing, and bone-to-implant contact for predictable clinical results. The aim of the study, was to evaluate the geometric macrodesign and the surface nanostructure of a novel dental implant full contact covering (FCC) obtained by electrochemical procedures. FCC implants were analyzed by scanning electronic microscope, profilometer, and x-ray photoelectron spectroscopy and compared with commercial sandblasted and sandblasted, large-grit acid-etched dental implants. Sample analysis allowed to distinguish the different implant macrodesigns, the step and the profile of the coils that cover the fixture, and the surface characteristics. FCC implant showed novel macro-characteristic of crestal module, coils, and apical zone compared with sandblasted and sandblasted and acid-etched dental implants. Moreover, the FCC nanostructure surface showed roughness values statistically higher than the 2 other surfaces, with a more homogeneity in a peaks and valleys arrangement. Finally, the x-ray photoelectron spectroscopy analysis detected differences between the examined surfaces, with the presence of several contaminants according to the different treatment procedures. Research on new macrostructures and nano morphology should result in a better qualitative and quantitative osseointegration response, with a predictability of the clinical results and long-term success of the implants.