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Kassapidou M, Stenport VF, Johansson CB, Syverud M, Hammarström Johansson P, Börjesson J, Hjalmarsson L. Cobalt chromium alloys in fixed prosthodontics: Investigations of mechanical properties and microstructure. J Prosthet Dent 2023; 130:255.e1-255.e10. [PMID: 37355405 DOI: 10.1016/j.prosdent.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/26/2023]
Abstract
STATEMENT OF PROBLEM Cobalt chromium (Co-Cr) alloys possess beneficial mechanical properties because alloys, even in thin sections, can resist high mastication forces and exhibit an acceptable bond to the surface porcelain layer. Traditional manufacturing techniques of Co-Cr alloys such as casting have been replaced with newer fabrication techniques, such as milling, laser melting, and presintered milling. Despite scarce documentation, these new manufacturing techniques are being used to fabricate dental and implant constructions. PURPOSE This in vitro study investigates the hardness, yield strength, elastic modulus, and microstructure of the most commonly used Co-Cr alloys for fixed prosthodontics based on manufacturing technique. In addition, this study investigates the effect of heat treatment on the mechanical properties and microstructure of these materials. MATERIAL AND METHODS Five Co-Cr alloys were included (dumbbell and rectangular shaped) based on four manufacturing techniques: cast, milled, laser melted, and presintered milled. Commercially pure titanium grade 4 and titanium-6 aluminum-4 vanadium ELI (extra low interstitial) were included for comparison, and yield strength and elongation after fracture were evaluated. The specimens were tested for hardness using the Vickers test and for elastic modulus using a nondestructive impulse excitation technique. The microstructure of selected specimens was analyzed using focused ion beam-scanning electron microscopy (FIB-SEM) and energy dispersive X-ray spectroscopy (EDS). RESULTS The mechanical properties depend on the manufacturing technique used; the laser-melted and presintered Co-Cr specimens demonstrated the highest mechanical properties, followed by the milled and cast groups. Both the laser-melted and the presintered milled Co-Cr specimens showed smaller grain size compared with the cast and milled Co-Cr specimens. The titanium-6 aluminum-4 vanadium ELI demonstrated higher hardness and yield strength compared to commercially pure titanium grade 4. No major differences were observed for the selected materials regarding the mechanical properties and microstructural appearance after heat treatment. CONCLUSIONS The laser melting and presintered milling techniques produced higher mechanical properties compared with the cast and milled Co-Cr. These findings were confirmed through microstructural analysis with respect to the grain size, precipitation, and number of pores.
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Affiliation(s)
- Maria Kassapidou
- Researcher, Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Researcher, Department of Prosthetic Dentistry, Institute for Postgraduate Dental Education, Jönköping, Sweden.
| | - Victoria Franke Stenport
- Professor, Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Carina B Johansson
- Professor Emerita, Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Morten Syverud
- Researcher, NIOM, Nordic Institute of Dental Materials, Oslo, Norway
| | - Petra Hammarström Johansson
- Researcher, Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Johan Börjesson
- Researcher, Department of Materials and Manufacturing, School of Engineering, Jönköping University, Jönköping, Sweden
| | - Lars Hjalmarsson
- Lecturer, Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Researcher, Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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Kassapidou M, Stenport VF, Johansson CB, Östberg AK, Johansson PH, Hjalmarsson L. Inflammatory Response to Cobalt-Chromium Alloys Fabricated With Different Techniques. J Oral Maxillofac Res 2021; 12:e3. [PMID: 35222870 PMCID: PMC8807148 DOI: 10.5037/jomr.2021.12403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Maria Kassapidou
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE 405 30 GöteborgSweden.
- Department of Prosthetic Dentistry, Institute for Postgraduate Dental Education, Jönköping, and Department of Biomedical and Clinical Sciences, Linköping University, LinköpingSweden.
| | - Victoria Franke Stenport
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE 405 30 GöteborgSweden.
| | - Carina B. Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE 405 30 GöteborgSweden.
| | - Anna-Karin Östberg
- Department of Oral Microbiology and Immunology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, GöteborgSweden.
| | - Petra Hammarström Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE 405 30 GöteborgSweden.
| | - Lars Hjalmarsson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE 405 30 GöteborgSweden.
- Dental Clinic, Folktandvården Sörmland AB, The Mälar Hospital, SE-631 88 Eskilstuna, Sweden and Centre for Clinical Research Sörmland, Uppsala University, EskilstunaSweden.
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Kassapidou M, Hjalmarsson L, Johansson CB, Hammarström Johansson P, Morisbak E, Wennerberg A, Franke Stenport V. Cobalt-chromium alloys fabricated with four different techniques: Ion release, toxicity of released elements and surface roughness. Dent Mater 2020; 36:e352-e363. [PMID: 32943232 DOI: 10.1016/j.dental.2020.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/03/2020] [Accepted: 08/29/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the metal ion release, surface roughness and cytoxicity for Co-Cr alloys produced by different manufacturing techniques before and after heat treatment. In addition, to evaluate if the combination of materials affects the ion release. METHODS Five Co-Cr alloys were included, based on four manufacturing techniques. Commercially pure titanium, CpTi grade 4 and a titanium alloy were included for comparison. The ion release tests involved both Inductive Coupled Plasma Optical Emission Spectrometry and Inductive Coupled Plasma Mass Spectrometry analyses. The surface analysis was conducted with optical interferometry. Cells were indirectly exposed to the materials and cell viability was evaluated with the MTT (3-(4.5-dimethylthiazol-2-yl)-2.5-diphenyltetrazolium bromide) method. RESULTS All alloys showed a decrease of the total ion release when CpTi grade 4 was present. The total ion release decreased over time for all specimens and the highest ion release was observed from the cast and milled Co-Cr alloy in acidic conditions. The cast and laser-melted Co-Cr alloy and the titanium alloy became rougher after heat treatment. All materials were within the limits of cell viability according to standards. SIGNIFICANCE The ion release from Co-Cr alloys is influenced by the combination of materials, pH and time. Surface roughness is influenced by heat treatment. Furthermore, both ion release and surface roughness are influenced by the manufacturing technique and the alloy type. The clinical implication needs to be further investigated.
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Affiliation(s)
- Maria Kassapidou
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden; Department of Prosthetic Dentistry, Institute for Postgraduate Dental Education, Box 1030, SE-551 11 Jönköping, Sweden.
| | - Lars Hjalmarsson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden; Specialist Dental Clinic, Folktandvården Sörmland AB, The Mälar Hospital, SE-631 88 Eskilstuna, Sweden; Centre for Clinical Research Sörmland, Uppsala University, SE-631 88 Eskilstuna, Sweden.
| | - Carina B Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden.
| | - Petra Hammarström Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden.
| | - Else Morisbak
- NIOM, Nordic Institute of Dental Materials, Sognsveien 70 A, 0855 Oslo, Norway.
| | - Ann Wennerberg
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden.
| | - Victoria Franke Stenport
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden.
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Franco-Tabares S, Wardecki D, Nakamura K, Ardalani S, Hjalmarsson L, Franke Stenport V, Johansson CB. Effect of airborne-particle abrasion and polishing on novel translucent zirconias: Surface morphology, phase transformation and insights into bonding. J Prosthodont Res 2020; 65:97-105. [PMID: 32938876 DOI: 10.2186/jpr.jpor_2019_524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose this study was to investigate the effect of Kern´s air-borne particle abrasion protocol (KAPA) and polishing on two translucent zirconias (4Y, 5Y-zirconias) compared to a traditional zirconia (3Y-zirconia). METHODS Two different surface treatments were analysed by X-ray diffraction (XRD) and interferometry 1) KAPA (0.1 MPa, 50 μm alumina, 10-12 mm distance, 15 sec and 30 sec and cleaning in ultrasound using isopropyl alcohol 99%) and 2) Clinical-delivery polishing paste (Zircon Brite, Dental Ventures, USA). Shear-bond strength tests (SBS's) were performed with a highly polished and virtually flat surface in combination with a 10-MDP based cement and a surface modified by KAPA in combination with zinc phosphate cement. The SBS was expressed in terms of MPa. RESULTS The mean values for monoclinic content were 13 wt%, 7 wt% and 2 wt% for 3Y-, 4Y- and 5Y-zirconias respectively, no differences were found between 15 and 30 seconds. Polishing did not result in phase transformation to monoclinic phase in any of the zirconias. The rhombohedral phase was identified in all types of zirconias regardless of surface treatment. Shear-bond strength tests showed 5 MPa for polished/10-MDP based cement and 3 MPa for KAPA/ Zinc phosphate. Statistically significant differences were found between the two different surface treatments but not between the types of zirconias. CONCLUSIONS KAPA for 15 sec seems to be equal to 30 sec regarding morphology and phase transformation. Sole micro-retention appears not to be fully responsible for the bonding phenomena of 10-MDP and zirconia that underwent KAPA.
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Affiliation(s)
- Sebastian Franco-Tabares
- Department of Prosthodontics / Dental Materials Science, Institute of Odontology, University of Gothenburg, The Sahlgrenska Academy
| | - Dariusz Wardecki
- Department of Chemistry and Chemical Engineering, Division of Environmental Inorganic Chemistry, Chalmers University of Technology
| | - Keisuke Nakamura
- Department of Advanced Free Radical Science, Tohoku University Graduate School of Dentistry, Sendai
| | - Sina Ardalani
- Institute of Odontology, University of Gothenburg, The Sahlgrenska Academy
| | - Lars Hjalmarsson
- Department of Prosthodontics / Dental Materials Science, Institute of Odontology, University of Gothenburg, The Sahlgrenska Academy.,Specialist Dental Clinic, Folktandvården Sörmland AB, The Mälar Hospital, Eskilstuna.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna
| | - Victoria Franke Stenport
- Department of Prosthodontics / Dental Materials Science, Institute of Odontology, University of Gothenburg, The Sahlgrenska Academy
| | - Carina B Johansson
- Department of Prosthodontics / Dental Materials Science, Institute of Odontology, University of Gothenburg, The Sahlgrenska Academy
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Thorkildsen RD, Johansson CB, Hogmalm J, Johansson PH, Røkkum M. Early Cup Loosening After Metal-on-Metal Total Joint Replacement of the Trapeziometacarpal Joint: A Retrieval Study. J Hand Surg Am 2020; 45:213-222. [PMID: 31537396 DOI: 10.1016/j.jhsa.2019.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/21/2019] [Accepted: 06/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the possible mechanisms behind early cup loosening in a metal-on-metal trapeziometacarpal joint replacement. METHODS The trapezia from 5 female patients were removed as part of a salvage procedure after a median of 22 months (range, 7-43 months) after implantation. Three osteoarthritic patients with symptomatic cup loosening and 2 with instability had a median age of 62 years (range, 59-65 years) at primary surgery. The trapezia with cups in situ were preserved and processed for histomorphometry. Studies with laser ablation inductively coupled plasma mass spectrometry and scanning electron microscopy with energy dispersive x-ray spectroscopy were also performed on 2 of the specimens. RESULTS In all 5 specimens, osteolytic lesions undermined the cups and were also seen at the cup edges, completely surrounding the loose cups. Large amounts of dark particular material were seen in the periprosthetic tissues, mostly internalized by macrophages. The presence of chrome and cobalt in these regions was confirmed. Four of the 5 cups showed marked or complete loss of hydroxyapatite. CONCLUSIONS We have found several possible explanations for the poor performance of this cup, including its cannulated design and metal-on-metal bearing. The changes seen are early and advanced, raising serious concerns about the implant and particularly the articulation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Rasmus D Thorkildsen
- Division of Orthopedic Surgery, Oslo University Hospital, Gothenburg, Sweden; Institute of Clinical Medicine, University of Oslo, Oslo, Norway, Gothenburg, Sweden.
| | - Carina B Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, Gothenburg, Sweden
| | - Johan Hogmalm
- Department of Earth Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Petra H Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, Gothenburg, Sweden
| | - Magne Røkkum
- Division of Orthopedic Surgery, Oslo University Hospital, Gothenburg, Sweden; Institute of Clinical Medicine, University of Oslo, Oslo, Norway, Gothenburg, Sweden
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Barkarmo S, Longhorn D, Leer K, Johansson CB, Stenport V, Franco‐Tabares S, Kuehne SA, Sammons R. Biofilm formation on polyetheretherketone and titanium surfaces. Clin Exp Dent Res 2019; 5:427-437. [PMID: 31452954 PMCID: PMC6704035 DOI: 10.1002/cre2.205] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 11/12/2022] Open
Abstract
Objective Polyetheretherketone (PEEK) is a polymer used in devices in orthopedic and dental rehabilitation. The aim of this in vitro study was to compare biofilm formation by a range of important oral bacterial species on PEEK, blasted PEEK, commercially pure titanium (cp-Ti), and titanium-6 aluminium-4 vanadium (Ti6Al4V). Material and methods Coin-shaped samples were manufactured, and the surfaces were characterized using optical interferometry, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and contact angle measurements. Bacterial species of Streptococcus sanguinis, Streptococcus oralis, Enterococcus faecalis, and Streptococcus gordonii were cultured on the four material surfaces for varying amounts of time. Biofilms were quantified following staining with crystal violet. Results Roughness and contact angle results showed blasted PEEK > PEEK > cp-Ti = Ti6Al4V. There was increased biofilm formation on blasted PEEK by S. sanguinis, S. oralis, and S. gordonii, whereas the bacterial adhesion was similar on PEEK, cp-Ti, and Ti6Al4V. The bacterial growth of E. faecalis was significantly higher on cp-Ti compared with the other three groups. Conclusion The results, taking into consideration the biofilm formation, suggest that PEEK should perform as well as cp-Ti or TiAl6V4 when used as a dental restorative material.
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Affiliation(s)
- Sargon Barkarmo
- Department of Prosthetic Dentistry/Dental Materials ScienceInstitute of Odontology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Daniel Longhorn
- School of Dentistry, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Kiran Leer
- School of Dentistry, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- Institute of Microbiology and InfectionUniversity of BirminghamBirminghamUK
| | - Carina B. Johansson
- Department of Prosthetic Dentistry/Dental Materials ScienceInstitute of Odontology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Victoria Stenport
- Department of Prosthetic Dentistry/Dental Materials ScienceInstitute of Odontology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Sebastian Franco‐Tabares
- Department of Prosthetic Dentistry/Dental Materials ScienceInstitute of Odontology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Sarah A. Kuehne
- School of Dentistry, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- Institute of Microbiology and InfectionUniversity of BirminghamBirminghamUK
| | - Rachel Sammons
- School of Dentistry, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
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Franco-Tabares S, Stenport VF, Hjalmarsson L, Tam PL, Johansson CB. Chemical Bonding to Novel Translucent Zirconias: A Mechanical and Molecular Investigation. J Adhes Dent 2019; 21:107-116. [PMID: 30949624 DOI: 10.3290/j.jad.a42361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate direct bonding of a 10-MDP-based cement to two novel translucent yttria-stabilized tetragonal zirconia polycrystal ceramics (4Y-TZP, 5Y-TZP) and observe the influence of thermocycling on this bonding. MATERIALS AND METHODS Powders of presintered and isostatically pressed 5Y-TZP, 4Y-TZP and 3Y-TZP were mixed with a 10-MDP-based cement (Panavia F 2.0), then stored in deionized water for 48 h at 37°C or thermocycled 10,000 times. Raman spectroscopy and Fourier-transform infrared spectroscopy were used to assess the presence of a functional group (PO32-) that could indicate bonding before and after thermocycling. X-ray photoelectron spectroscopy was used to identify the presence of the suspected Zr-O-P bond in the same specimens. A shear-bond strength (SBS) test was conducted based on ISO 29022:2013. RESULTS Marked peaks assigned to the asymmetric vibrations of the PO32- functional group were observed in both zirconias before and after thermocycling. The binding energy corresponding to Zr-O-P interactions (531.5 eV) was masked by the aluminosilicate in the filler of the cement. Shear bond strengths were approximately 20 MPa after water storage and approximately 6 MPa after thermocycling. No differences were found between the control group and the translucent zirconias. CONCLUSION Direct bonding of the 10-MDP-based cement to both 4Y-TZP and 5Y-TZP was highly plausible. Both 4Y-TZP and 5Y-TZP may be promising alternatives to glass-ceramic restorations.
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Trbakovic A, Hedenqvist P, Mellgren T, Ley C, Hilborn J, Ossipov D, Ekman S, Johansson CB, Jensen-Waern M, Thor A. A new synthetic granular calcium phosphate compound induces new bone in a sinus lift rabbit model. J Dent 2018; 70:31-39. [PMID: 29258851 DOI: 10.1016/j.jdent.2017.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 11/29/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate if a synthetic granular calcium phosphate compound (CPC) and a composite bisphosphonate-linked hyaluronic acid-calcium phosphate hydrogel (HABP·CaP) induced similar or more amount of bone as bovine mineral in a modified sinus lift rabbit model. MATERIAL AND METHODS Eighteen adult male New Zeeland White rabbits, received randomly one of the two test materials on a random side of the face, and bovine mineral as control on the contralateral side. In a sinus lift, the sinus mucosa was elevated and a titanium mini-implant was placed in the alveolar bone. Augmentation material (CPC, HABP·CaP or bovine bone) was applied in the space around the implant. The rabbits were euthanized three months after surgery and qualitative and histomorphometric evaluation were conducted. Histomorphometric evaluation included three different regions of interest (ROIs) and the bone to implant contact on each installed implant. RESULTS Qualitative assessment (p = <.05), histomorphometric evaluations (p = < .01), and implant incorporation (p = <.05) showed that CPC and bovine mineral induced similar amount of bone and more than the HABP·CaP hydrogel. CONCLUSION CPC induced similar amount of bone as bovine mineral and both materials induced more bone than HABP·CaP hydrogel. CLINICAL SIGNIFICANCE The CPC is suggested as a synthetic alternative for augmentations in the maxillofacial area.
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Affiliation(s)
- Amela Trbakovic
- Department of Surgical Sciences, Plastic & Oral and Maxillofacial Surgery, Uppsala University, 751 85 Uppsala, Sweden.
| | - Patricia Hedenqvist
- Swedish University of Agricultural Sciences, Department of Clinical Sciences, PO Box 7054, 750 07 Uppsala, Sweden.
| | - Torbjörn Mellgren
- Polymer Chemistry, Department of Chemistry, Ångströms Laboratory, Uppsala University, Box 538, 75121 Uppsala, Sweden.
| | - Cecilia Ley
- Swedish University of Agricultural Sciences, Department of Biomedical Sciences and Veterinary Public Health, Division of Pathology, PO Box 7028, 750 07 Uppsala, Sweden.
| | - Jöns Hilborn
- Polymer Chemistry, Department of Chemistry, Ångströms Laboratory, Uppsala University, Box 538, 75121 Uppsala, Sweden.
| | - Dmitri Ossipov
- Polymer Chemistry, Department of Chemistry, Ångströms Laboratory, Uppsala University, Box 538, 75121 Uppsala, Sweden
| | - Stina Ekman
- Swedish University of Agricultural Sciences, Department of Biomedical Sciences and Veterinary Public Health, Division of Pathology, PO Box 7028, 750 07 Uppsala, Sweden.
| | - Carina B Johansson
- University of Gothenburg, The Sahlgrenska Academy, Institute of Odontology, Department of Prosthodontics, Dental Materials Science, P.O. Box 450, 405 30 Gothenburg, Sweden.
| | - Marianne Jensen-Waern
- Swedish University of Agricultural Sciences, Department of Clinical Sciences, PO Box 7054, 750 07 Uppsala, Sweden.
| | - Andreas Thor
- Department of Surgical Sciences, Plastic & Oral and Maxillofacial Surgery, Uppsala University, 751 85 Uppsala, Sweden.
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Kwon DH, Lee SJ, Wikesjö UME, Johansson PH, Johansson CB, Sul YT. Cover Image. J Clin Periodontol 2017. [DOI: 10.1111/jcpe.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kwon DH, Lee SJ, Wikesjö UME, Johansson PH, Johansson CB, Sul YT. Bone tissue response following local drug delivery of bisphosphonate through titanium oxide nanotube implants in a rabbit model. J Clin Periodontol 2017; 44:941-949. [PMID: 28703333 DOI: 10.1111/jcpe.12776] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate whether surface chemistry-controlled TiO2 nanotube structures may serve as a local drug delivery system for zoledronic acid improving implant-bone support. METHODS Twenty-four screw-shaped Ti implants with surface chemistry-controlled TiO2 nanotube structures were prepared and divided into a zoledronic acid-formatted test and a native control group. The implants were inserted into contra-lateral femoral condyles in 12 New Zealand White rabbits. Bone support was evaluated using resonance frequency analysis (RFA) and removal torque (RTQ), as well as histometric analysis following a 3-weeks healing interval. RESULTS Zoledronic acid-formatted TiO2 nanotube test implants showed significantly improved implant stability and osseointegration measured using RFA and RTQ compared with control (p < 0.05), and showed significantly enhanced new bone formation within the root of the threads compared with control (p < 0.05). CONCLUSIONS TiO2 nanotube implants may prove to be a significant delivery system for drugs or biologic agents aimed at supporting local bone formation. Additional study of candidate drugs/agents, optimized dosage and release kinetics is needed prior to evaluation in clinical settings.
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Affiliation(s)
- David H Kwon
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Periodontics, 618th Dental Company, Camp Humphreys, Pyeongtaek, Korea
| | - Sang J Lee
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA
| | - Ulf M E Wikesjö
- Laboratory for Applied Periodontal & Craniofacial Regeneration, Departments of Periodontics and Oral Biology, Augusta University
- Dental College of Georgia, Augusta, GA, USA
| | - Petra H Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carina B Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Young-Taeg Sul
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kassapidou M, Franke Stenport V, Hjalmarsson L, Johansson CB. Cobalt-chromium alloys in fixed prosthodontics in Sweden. Acta Biomater Odontol Scand 2017; 3:53-62. [PMID: 29242813 PMCID: PMC5724798 DOI: 10.1080/23337931.2017.1360776] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/25/2017] [Indexed: 11/05/2022]
Abstract
Aim: The aim of this study was to compile the usage of Co-Cr alloys in fixed prosthodontics (FP) among dental laboratories in Sweden. Methods: From March to October 2015, questionnaires were sent to 542 registered dental laboratories in Sweden. The questionnaires were divided in two parts, one for fixed dental-supported prosthodontics (FDP) and one for fixed implant-supported prosthodontics (FIP). Reminders were sent three times. Results: In total of 542 dental laboratories, 55% answered the questionnaires. Most dental laboratories use Co-Cr in FP, 134 (74%) in FDP and 89(66%) in FIP. The laboratories used Co-Cr alloys of various compositions in the prostheses, 35 for FDP and 30 for FIP. The most commonly used Co-Cr alloys for tooth-supported FDPs were (a) Wirobond® 280, (b) Cara SLM and (c) Wirobond® C. For implant-supported frameworks the frequently used alloys were: (a) Cara SLM, (b) Cara Milled and (c) Wirobond® 280. Except for the difference in composition of these alloys, they were also manufactured with various techniques. In tooth-supported prostheses the dominating technique was the cast technique while newer techniques as laser-sintering and milling were more commonly reported for implant-supported constructions. A fourth technique; the ‘pre-state’ milling was reported in FDP. Conclusion: More than 30 different Co-Cr alloys were reported as being used in FP. Thus, there is a need for studies exploring the mechanical and physical behavior and the biological response to the most commonly used Co-Cr alloys.
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Affiliation(s)
- Maria Kassapidou
- Department of Prosthetic Dentistry, Institute for Postgraduate Dental EducationJönköpingSweden.,Department of Prosthodontics/Dental Materials Science, Institute of Odontology, Sahlgrenska Academy, University of GothenburgGöteborgSweden
| | - Victoria Franke Stenport
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, Sahlgrenska Academy, University of GothenburgGöteborgSweden
| | - Lars Hjalmarsson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, Sahlgrenska Academy, University of GothenburgGöteborgSweden.,Specialist Dental Clinic, Folktandvården Sörmland AB, The Mälar HospitalEskilstunaSweden.,Centre for Clinical Research Sörmland, Uppsala UniversityEskilstunaSweden
| | - Carina B Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, Sahlgrenska Academy, University of GothenburgGöteborgSweden
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12
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Abstract
OBJECTIVE Several older studies report a low risk for parenchymal access to the CNS by surgical techniques. In more recent studies, including those with post-puncture CT scans, there are indications that the risk of bleeding might approach 8%. New therapies, such as those that use viral vectors, modified mRNA, or cell transplantation, will probably warrant more parenchymal access to the CNS. Other minimally invasive routes might then be tempting to explore. This study was designed in 2 parts to address the possibility of using the endovascular route. The first aim was to test the ability to create a parenchymal micro-working channel to the CNS in macaque monkeys through the vessel wall. Second, the biocompatibility of a device-associated, detached, distal securing plug that was made of nitinol was investigated in swine for 1 year. METHODS Trans-vessel wall intervention in the middle cerebral artery and associated cerebral parenchyma was performed in 4 rhesus macaque monkeys using a full clinical angiography suite. A contrast agent and methylene blue were injected to test the working channel and then detached at the distal end to act as a securing plug through the vessel wall. One-year follow-ups were also performed using angiography and histological analysis in 10 swine with 24 implants that were distributed in the external carotid artery tree. RESULTS The cerebral interventions were performed without acute bleeding. Both the contrast agent and methylene blue were infused into the brain parenchyma and subarachnoidal space via the endovascular micro-working channel (7 injections in 4 animals). In the 1-year follow-up period, the implant that was left in the external carotid vessel wall in the swine was covered by the endothelium, which was followed by dislodgement just outside the blood vessel with thin capsule formation. No stenosis in the artery was detected on 1-year angiography. The animals showed normal behavior and blood sample results during the follow-up period. This is the first histological demonstration of nitinol biocompatibility when the implant is positioned through an arterial wall and indicates that the trans-vessel wall technique is not comparable with stent placement and its ability to induce intimal hyperplasia and restenosis. CONCLUSIONS This study demonstrates that the trans-vessel wall technique is applicable to brain intervention in macaque monkeys, providing a micro-working channel for delivery or sampling. The long-term follow-up study of the detached device in swine showed no clinical or biochemical complications and a normal angiography appearance.
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Affiliation(s)
- Johan Lundberg
- Department of Clinical Neuroscience, Karolinska Institutet.,Department of Neuroradiology, Karolinska University Hospital, Stockholm
| | - Carina B Johansson
- Department of Prosthodontics/Dental Materials, Science, Sahlgrenska Academy, Institute of Odontology, University of Gothenburg, Sweden; and
| | - Stefan Jonsson
- Department of Materials Science and Engineering, Royal Institute of Technology, Stockholm, Sweden
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet.,Department of Neuroradiology, Karolinska University Hospital, Stockholm
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13
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Wang A, Williams RL, Jumbu N, Paxton JZ, Davis ET, Snow MA, Campbell Ritchie A, Johansson CB, Sammons RL, Grover LM. Development of tissue engineered ligaments with titanium spring reinforcement. RSC Adv 2016. [DOI: 10.1039/c6ra18005a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Titanium spring reinforced tissue-engineered ligament replacement: enhancing construct stiffness, load propagation and robustness under cyclic loading.
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Affiliation(s)
- Anqi Wang
- The School of Dentistry
- University of Birmingham
- Birmingham
- UK
| | | | - Neeraj Jumbu
- The Institute of Immunology and Immunotherapy
- College of Medical and Dental Sciences
- University of Birmingham
- Birmingham
- UK
| | | | - Edward T. Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust
- Birmingham
- UK
| | - Martyn A. Snow
- The Royal Orthopaedic Hospital NHS Foundation Trust
- Birmingham
- UK
| | | | - Carina B. Johansson
- Department of Prosthodontics/Dental Materials Science
- Institute of Odontology
- The Sahlgrenska Academy
- University of Gothenburg
- Gothenburg
| | | | - Liam M. Grover
- School of Chemical Engineering
- University of Birmingham
- Birmingham
- UK
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14
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Östberg AK, Dahlgren U, Sul YT, Johansson CB. Inflammatory cytokine release is affected by surface morphology and chemistry of titanium implants. J Mater Sci Mater Med 2015; 26:155. [PMID: 25779512 DOI: 10.1007/s10856-015-5486-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 02/24/2015] [Indexed: 06/04/2023]
Abstract
To investigate in vitro cellular cytokine expression in relation to commercially pure titanium discs, comparing a native surface to a fluorinated oxide nanotube surface. Control samples pure titanium discs with a homogenous wave of the margins and grooves and an often smeared-out surface structure. Test samples pure titanium discs with a fluorinated titanium oxide chemistry and surface morphology with nanopore/tube geometry characterized by ordered structures of nanotubes with a diameter of ≈ 120 nm, a spacing of ≈ 30 nm, and a wall thickness of ≈ 10 nm. Cross-section view showed vertically aligned nanotubes with similar lengths of ≈ 700 nm. Peripheral blood mononuclear leucocytes were cultured for 1, 3, and 6 days according to standard procedures. BioPlex Pro™ assays were used for analysis and detection of cytokines. Selected inflammatory cytokines are reported. A pronounced difference in production of the inflammatogenic cytokines was observed. Leucocytes exposed to control coins produced significantly more TNF-α, IL-1ß, and IL-6 than the test nanotube coins. The effect on the TH2 cytokine IL-4 was less pronounced at day 6 compared to days 1 and 3, and slightly higher expressed on the control coins. The morphology and surface chemistry of the titanium surface have a profound impact on basic cytokine production in vitro. Within the limitations of the present study, it seems that the fluorinated oxide nanotube surface results in a lower inflammatory response compared to a rather flat surface that seems to favour inflammation.
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Affiliation(s)
- Anna-Karin Östberg
- Department of Oral Microbiology and Immunology, The Sahlgrenska Academy, Institute of Odontology, University of Gothenburg, P.O. Box 450, 405 30, Göteborg, Sweden
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15
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Eeg-Olofsson M, Lith A, Håkansson B, Reinfeldt S, Taghavi H, Fredén Jansson KJ, Johansson CB. Evaluation of Bone Tissue Formation in a Flat Surface Attachment of a Bone Conduction Implant: A Pilot Study in a Sheep Model. Audiol Neurotol Extra 2014. [DOI: 10.1159/000369918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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16
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Halldin A, Jimbo R, Johansson CB, Gretzer C, Jacobsson M. Improved osseointegration and interlocking capacity with dual acid-treated implants: a rabbit study. Clin Oral Implants Res 2014; 27:22-30. [PMID: 25349918 DOI: 10.1111/clr.12507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2014] [Indexed: 12/28/2022]
Abstract
AIM To investigate how osseointegration is affected by different nano- and microstructures. The hypothesis was that the surface structure created by dual acid treatment (AT-1), applied on a reduced topography, might achieve equivalent biomechanical performance as a rougher surface treated with hydrofluoric acid (HF). MATERIALS AND METHODS In a preclinical rabbit study, three groups (I, II, and III) comprised of test and control implants were inserted in 30 rabbits. The microstructures of the test implants were either produced by blasting with coarse (I) or fine (II) titanium particles or remained turned (III). All test implants were thereafter treated with AT-1 resulting in three different test surfaces. The microstructure of the control implants was produced by blasting with coarse titanium particles thereafter treated with HF. The surface topography was characterized by interferometry. Biomechanical (removal torque) and histomorphometric (bone-implant contact; bone area) performances were measured after 4 or 12 weeks of healing. RESULTS Removal torque measurement demonstrated that test implants in group I had an enhanced biomechanical performance compared to that of the control despite similar surface roughness value (Sa ). At 4 weeks of healing, group II test implants showed equivalent biomechanical performance to that of the control, despite a decreased Sa value. Group III test implants showed decreased biomechanical performance to that of the control. CONCLUSIONS The results of the present study suggest that nano- and microstructure alteration by AT-1 on a blasted implant might enhance the initial biomechanical performance, while for longer healing time, the surface interlocking capacity seems to be more important.
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Affiliation(s)
- Anders Halldin
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.,DENTSPLY Implants AB, Mölndal, Sweden
| | - Ryo Jimbo
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Carina B Johansson
- Dental Materials, Department of Prosthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Magnus Jacobsson
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.,DENTSPLY Implants AB, Mölndal, Sweden
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17
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Barkarmo S, Andersson M, Currie F, Kjellin P, Jimbo R, Johansson CB, Stenport V. Enhanced bone healing around nanohydroxyapatite-coated polyetheretherketone implants: An experimental study in rabbit bone. J Biomater Appl 2014; 29:737-47. [DOI: 10.1177/0885328214542854] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To investigate the bone response to threaded polyetheretherketone (PEEK) implants coated with nanohydroxyapatite. Materials and methods A total of 39 PEEK implants were coated with nanocrystalline hydroxyapatite and 39 uncoated implants were used as controls. The implant surface was characterized by optical interferometry and scanning electron microscope. The implants were inserted in the tibia and femur of 13 rabbits. After 6 weeks of healing, quantitative and qualitative analyses were performed. Results The test implants showed significantly higher removal torque test values compared with the control group. Histomorphometric evaluation demonstrated higher bone-to-implant contact for the test implants; however, there were no differences in bone area between the groups. Qualitative histological analyses demonstrated inflammatory cellular reactions in close vicinity of both implant surfaces. A two-cell layer of foreign body giant cells was observed irrespective of sample type. Conclusion Our findings demonstrate that implants with a threaded design render good stability to PEEK in both coated and uncoated implants. Nanohydroxyapatite-coated PEEK implants demonstrated improved bone formation compared with uncoated controls.
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Affiliation(s)
- S Barkarmo
- Department of Prosthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Andersson
- Department of Chemical and Biological Engineering, Applied Surface Chemistry, Chalmers University of Technology, Gothenburg, Sweden
| | - F Currie
- Promimic AB, Stena Center 1B, Gothenburg, Sweden
| | - P Kjellin
- Promimic AB, Stena Center 1B, Gothenburg, Sweden
| | - R Jimbo
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - CB Johansson
- Department of Prosthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - V Stenport
- Department of Prosthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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18
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Arvidsson A, Sarve H, Johansson CB. Comparing and visualizing titanium implant integration in rat bone using 2D and 3D techniques. J Biomed Mater Res B Appl Biomater 2014; 103:12-20. [DOI: 10.1002/jbm.b.33168] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/21/2014] [Accepted: 03/19/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Anna Arvidsson
- Dentsply IH AB; Box 14, SE 431 21 Mölndal Sweden
- University of Gothenburg, The Sahlgrenska Academy, Institute of Odontology; Department of Prosthodontics/Dental Materials Science.; P.O. Box 450, SE 405 30 Göteborg Sweden
| | - Hamid Sarve
- University of Gothenburg, The Sahlgrenska Academy, Institute of Odontology; Department of Prosthodontics/Dental Materials Science.; P.O. Box 450, SE 405 30 Göteborg Sweden
- Centre for Image Analysis, Uppsala University; Box 337, SE-751 05 Uppsala Sweden
| | - Carina B. Johansson
- University of Gothenburg, The Sahlgrenska Academy, Institute of Odontology; Department of Prosthodontics/Dental Materials Science.; P.O. Box 450, SE 405 30 Göteborg Sweden
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Mordenfeld A, Johansson CB, Albrektsson T, Hallman M. A randomized and controlled clinical trial of two different compositions of deproteinized bovine bone and autogenous bone used for lateral ridge augmentation. Clin Oral Implants Res 2013; 25:310-320. [DOI: 10.1111/clr.12143] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Arne Mordenfeld
- Department of Oral & Maxillofacial Surgery; Public Health Service; Gävle Sweden
- Centre for Research and Development; Uppsala University/Gävleborg County Council; Gävleborg Sweden
- Department of Materials Science & Technology; Malmö University; Malmö Sweden
| | - Carina B. Johansson
- Department of Prosthodontics / Dental Materials Science; the Sahlgrenska academy; University of Gothenburg; Gothenburg Sweden
| | - Tomas Albrektsson
- Department of Materials Science & Technology; Malmö University; Malmö Sweden
- Department of Biomaterials; Institute for Clinical Sciences; the Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Mats Hallman
- Department of Oral & Maxillofacial Surgery; Public Health Service; Gävle Sweden
- Centre for Research and Development; Uppsala University/Gävleborg County Council; Gävleborg Sweden
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20
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Nyberg J, Hertzman S, Svensson B, Johansson CB. Osseointegration of Implants in Irradiated Bone With and Without Hyperbaric Oxygen Treatment: An Experimental Study in Rat Tibiae. Int J Oral Maxillofac Implants 2013; 28:739-46. [DOI: 10.11607/jomi.3083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Halldin A, Jimbo R, Johansson CB, Wennerberg A, Jacobsson M, Albrektsson T, Hansson S. Implant stability and bone remodeling after 3 and 13 days of implantation with an initial static strain. Clin Implant Dent Relat Res 2012; 16:383-93. [PMID: 23061968 DOI: 10.1111/cid.12000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Bone is constantly exposed to dynamic and static loads, which induce both dynamic and static bone strains. Although numerous studies exist on the effect of dynamic strain on implant stability and bone remodeling, the effect of static strain needs further investigation. Therefore, the effect of two different static bone strain levels on implant stability and bone remodeling at two different implantation times was investigated in a rabbit model. METHODS Two different test implants with a diametrical expansion of 0.15 mm (group A) and 0.05 mm (group B) creating initial static bone strains of 0.045 and 0.015, respectively. The implants were inserted in the proximal tibial metaphysis of 24 rabbits to observe the biological response at implant removal. Both groups were compared to control implants (group C), with no diametrical increase. The insertion torque (ITQ) was measured to represent the initial stability and the removal torque (RTQ) was measured to analyze the effect that static strain had on implant stability and bone remodeling after 3 and 13 days of implantation time. RESULTS The ITQ and the RTQ values for test implants were significantly higher for both implantation times compared to control implants. A selection of histology samples was prepared to measure bone to implant contact (BIC). There was a tendency that the BIC values for test implants were higher compared to control implants. CONCLUSION These findings suggest that increased static bone strain creates higher implant stability at the time of insertion, and this increased stability is maintained throughout the observed period.
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Affiliation(s)
- Anders Halldin
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden; Astra Tech AB, Mölndal, Sweden
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22
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Lindgren C, Mordenfeld A, Johansson CB, Hallman M. A 3-year clinical follow-up of implants placed in two different biomaterials used for sinus augmentation. Int J Oral Maxillofac Implants 2012; 27:1151-1162. [PMID: 23057029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
PURPOSE The aims of the present study were to compare a novel biphasic calcium phosphate (BCP) with deproteinized bovine bone (DBB) for maxillary sinus floor augmentation in a split-mouth design and to perform a clinical follow-up of dental implants placed in the augmented sinuses. MATERIALS AND METHODS Partially or completely edentulous patients requiring bilateral sinus augmentation were included in the study. The patients were randomized for augmentation with BCP (test) and DBB (control) in the contralateral side. Eight months after grafting, dental implants were placed. After 3 years of graft healing, core biopsy specimens were obtained from the grafted areas for histologic and histomorphometric analyses. After 3 years of functional implant loading, implant survival/success rates and clinical indices were assessed and radiographic examination and resonance frequency analysis were performed. RESULTS Nine completely edentulous patients and two partially edentulous patients (mean age, 67 years) who required bilateral sinus augmentation were included in the study, and 62 implants were placed. The mean values for the area of newly formed bone in the retrieved specimens were 29% ± 14.3% and 32% ± 18.0% for BCP and DBB, respectively; the percentage of graft particles in contact with bone was 38% ± 10.9% in the BCP group and 44% ± 12.1% in the DBB group (no statistical significant differences between groups). The mean values for the area of BCP particles and DBB particles were 20% ± 7.5% and 24% ± 13.5%, respectively (difference not significant). One dental implant was lost from each group, resulting in an overall implant survival rate of 96.8% after 3 years of loading. CONCLUSION After 3 years, a similar amount of newly formed bone was present regardless of the biomaterial used. The choice of biomaterial did not seem to influence implant survival rates.
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Affiliation(s)
- Christer Lindgren
- Department of Oral and Maxillofacial Surgery, Gäve Country Hospital, Sweden.
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23
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Browaeys H, Vandeweghe S, Johansson CB, Jimbo R, Deschepper E, De Bruyn H. The histological evaluation of osseointegration of surface enhanced microimplants immediately loaded in conjunction with sinuslifting in humans. Clin Oral Implants Res 2012; 24:36-44. [DOI: 10.1111/j.1600-0501.2011.02398.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Hilde Browaeys
- Department of Oral and Maxillofacial Surgery; Dental School; Faculty of Medicine and Health Sciences; University of Ghent; University Hospital Ghent; Ghent; Belgium
| | | | - Carina B. Johansson
- Department of Prosthodontics/Dental Materials Science; Institute of Odontology; University of Gothenburg; The Sahlgrenska Academy; Göteborg; Sweden
| | - Ryo Jimbo
- Department of Prosthodontics; Faculty of Odontology; Malmö University; Malmö; Sweden
| | - Ellen Deschepper
- Biostatistics Unit; Faculty of Medicine and Health Sciences; University of Ghent; University Hospital Ghent; Ghent; Belgium
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Sarve H, Friberg B, Borgefors G, Johansson CB. Introducing a novel analysis technique for osseointegrated dental implants retrieved 29 years postsurgery. Clin Implant Dent Relat Res 2011; 15:538-49. [PMID: 22171623 DOI: 10.1111/j.1708-8208.2011.00413.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate osseointegration of oral implants, which were retrieved from a patient after 29 years in situ, we use novel three-dimensional analysis methods and visualization techniques that supplement conventional two-dimensional analysis. MATERIALS AND METHODS The sample processing involved nondecalcification and embedment in resin. Conventional two-dimensional histomorphometrical methods were conducted. Additionally, the quantification was extended to three-dimensional by using synchrotron radiation micro-computed tomography (SRµCT) technique and two relevant visualization methods for the three-dimensional data were introduced. RESULTS The three-dimensional results involved three-dimensional quantification and visualization of two implant samples with methods beyond state-of-the-art. Traditional two-dimensional histomorphometrical results revealed a mean bone-implant contact (BIC) of about 50%. In most samples, bone area (BA) was lower inside the treads compared with out-folded mirror images, which were confirmed by the three-dimensional quantification. The BIC along four selected regions showed highest percentages in the bottom/valley region and lowest in the thread-peak region. Qualitative observations revealed ongoing bone remodeling areas in all samples. The apical hole demonstrated high osseointegration. CONCLUSION The novel techniques including an animation and an out-folding of BIC and BA enabled a simultaneous visualization of the three-dimensional material obtained from SRµCT data. However, the two-dimensional histological sections were needed for qualitative and quantitative evaluation of osseointegration and, thus, both methods are considered equally important.
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Affiliation(s)
- Hamid Sarve
- Centre for Image Analysis, Swedish University of Agricultural Sciences, Uppsala, Sweden.
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Halldin A, Jimbo R, Johansson CB, Wennerberg A, Jacobsson M, Albrektsson T, Hansson S. The effect of static bone strain on implant stability and bone remodeling. Bone 2011; 49:783-9. [PMID: 21782050 DOI: 10.1016/j.bone.2011.07.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 06/15/2011] [Accepted: 07/04/2011] [Indexed: 10/18/2022]
Abstract
Bone remodeling is a process involving both dynamic and static bone strain. Although there exist numerous studies on the effect of dynamic strain on implant stability and bone remodeling, the effect of static strain has yet to be clarified. Hence, for this purpose, the effect of static bone strain on implant stability and bone remodeling was investigated in rabbits. Based on Finite Element (FE) simulation two different test implants, with a diametrical increase of 0.15 mm (group A) and 0.05 mm (group B) creating static strains in the bone of 0.045 and 0.015 respectively, were inserted in the femur (group A) and the proximal tibia metaphysis (groups A and B respectively) of 14 rabbits to observe the biological response. Both groups were compared to control implants, with no diametrical increase (group C), which were placed in the opposite leg. At the time of surgery, the insertion torque (ITQ) was measured to represent the initial stability. The rabbits were euthanized after 24 days and the removal torque (RTQ) was measured to analyze the effect on implant stability and bone remodeling. The mean ITQ value was significantly higher for both groups A and B compared to group C regardless of the bone type. The RTQ value was significantly higher in tibia for groups A and B compared to group C while group A placed in femur presented no significant difference compared to group C. The results suggest that increased static strain in the bone not only creates higher implant stability at the time of insertion, but also generates increased implant stability throughout the observation period.
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Affiliation(s)
- Anders Halldin
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
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Johansson CB, Gretzer C, Jimbo R, Mattisson I, Ahlberg E. Enhanced implant integration with hierarchically structured implants: a pilot study in rabbits. Clin Oral Implants Res 2011; 23:943-53. [DOI: 10.1111/j.1600-0501.2011.02233.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sarve H, Lindblad J, Borgefors G, Johansson CB. Extracting 3D information on bone remodeling in the proximity of titanium implants in SRμCT image volumes. Comput Methods Programs Biomed 2011; 102:25-34. [PMID: 21269725 DOI: 10.1016/j.cmpb.2010.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 12/13/2010] [Accepted: 12/16/2010] [Indexed: 05/30/2023]
Abstract
Bone-implant integration is measured in several ways. Traditionally and routinely, 2D histological sections of samples, containing bone and the biomaterial, are stained and analyzed using a light microscope. Such histological section provides detailed cellular information about the bone regeneration in the proximity of the implant. However, this information reflects the integration in only a very small fraction, a 10 μm thick slice, of the sample. In this study, we show that feature values quantified on 2D sections are highly dependent on the orientation and the placement of the section, suggesting that a 3D analysis of the whole sample is of importance for a more complete judgment of the bone structure in the proximity of the implant. We propose features describing the 3D data by extending the features traditionally used for 2D-analysis. We present a method for extracting these features from 3D image data and we measure them on five 3D SRμCT image volumes. We also simulate cuts through the image volume positioned at all possible section positions. These simulations show that the measurement variations due to the orientation of the section around the center line of the implant are about 30%.
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Affiliation(s)
- Hamid Sarve
- Centre for Image Analysis, Swedish University of Agricultural Sciences, Uppsala, Sweden.
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Kang BS, Sul YT, Johansson CB, Oh SJ, Lee HJ, Albrektsson T. The effect of calcium ion concentration on the bone response to oxidized titanium implants. Clin Oral Implants Res 2011; 23:690-697. [PMID: 21443613 DOI: 10.1111/j.1600-0501.2011.02177.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Byung-Soo Kang
- Department of Biomaterials/Handicap Research, Institute for Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenInstitute for Clinical Dental Research, Korea University, Seoul, South KoreaDepartment of Clinical Medicine, School of Health and Medical Sciences, University of Örebro, Örebro, SwedenDepartment of Physics and Astronomy, Seoul National University, Seoul, South KoreaNational Center for Inter-University Research Facility, Seoul National University, Seoul, South Korea
| | - Young-Taeg Sul
- Department of Biomaterials/Handicap Research, Institute for Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenInstitute for Clinical Dental Research, Korea University, Seoul, South KoreaDepartment of Clinical Medicine, School of Health and Medical Sciences, University of Örebro, Örebro, SwedenDepartment of Physics and Astronomy, Seoul National University, Seoul, South KoreaNational Center for Inter-University Research Facility, Seoul National University, Seoul, South Korea
| | - Carina B Johansson
- Department of Biomaterials/Handicap Research, Institute for Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenInstitute for Clinical Dental Research, Korea University, Seoul, South KoreaDepartment of Clinical Medicine, School of Health and Medical Sciences, University of Örebro, Örebro, SwedenDepartment of Physics and Astronomy, Seoul National University, Seoul, South KoreaNational Center for Inter-University Research Facility, Seoul National University, Seoul, South Korea
| | - Se-Jung Oh
- Department of Biomaterials/Handicap Research, Institute for Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenInstitute for Clinical Dental Research, Korea University, Seoul, South KoreaDepartment of Clinical Medicine, School of Health and Medical Sciences, University of Örebro, Örebro, SwedenDepartment of Physics and Astronomy, Seoul National University, Seoul, South KoreaNational Center for Inter-University Research Facility, Seoul National University, Seoul, South Korea
| | - Hyun-Ju Lee
- Department of Biomaterials/Handicap Research, Institute for Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenInstitute for Clinical Dental Research, Korea University, Seoul, South KoreaDepartment of Clinical Medicine, School of Health and Medical Sciences, University of Örebro, Örebro, SwedenDepartment of Physics and Astronomy, Seoul National University, Seoul, South KoreaNational Center for Inter-University Research Facility, Seoul National University, Seoul, South Korea
| | - Tomas Albrektsson
- Department of Biomaterials/Handicap Research, Institute for Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenInstitute for Clinical Dental Research, Korea University, Seoul, South KoreaDepartment of Clinical Medicine, School of Health and Medical Sciences, University of Örebro, Örebro, SwedenDepartment of Physics and Astronomy, Seoul National University, Seoul, South KoreaNational Center for Inter-University Research Facility, Seoul National University, Seoul, South Korea
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Jimbo R, Ivarsson M, Koskela A, Sul YT, Johansson CB. Protein adsorption to surface chemistry and crystal structure modification of titanium surfaces. J Oral Maxillofac Res 2010; 1:e3. [PMID: 24421973 PMCID: PMC3886052 DOI: 10.5037/jomr.2010.1303] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 05/18/2010] [Indexed: 11/22/2022]
Abstract
Objectives To observe the early adsorption of extracellular matrix and blood plasma
proteins to magnesium-incorporated titanium oxide surfaces, which has shown
superior bone response in animal models. Material and Methods Commercially pure titanium discs were blasted with titanium dioxide
(TiO2) particles (control), and for the test group,
TiO2 blasted discs were further processed with a micro-arc
oxidation method (test). Surface morphology was investigated by scanning
electron microscopy, surface topography by optic interferometry,
characterization by X-ray photoelectron spectroscopy (XPS), and by X-ray
diffraction (XRD) analysis. The adsorption of 3 different proteins
(fibronectin, albumin, and collagen type I) was investigated by an
immunoblotting technique. Results The test surface showed a porous structure, whereas the control surface
showed a typical TiO2 blasted structure. XPS data revealed
magnesium-incorporation to the anodic oxide film of the surface. There was
no difference in surface roughness between the control and test surfaces.
For the protein adsorption test, the amount of albumin was significantly
higher on the control surface whereas the amount of fibronectin was
significantly higher on the test surface. Although there was no significant
difference, the test surface had a tendency to adsorb more collagen type
I. Conclusions The magnesium-incorporated anodized surface showed significantly higher
fibronectin adsorption and lower albumin adsorption than the blasted
surface. These results may be one of the reasons for the excellent bone
response previously observed in animal studies.
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Affiliation(s)
- Ryo Jimbo
- Department of Prosthodontics, Faculty of Odontology, Malmö University Malmö Sweden. ; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, Göteborg University Göteborg Sweden
| | - Mikael Ivarsson
- Clinical Research Center, Örebro University Hosptial Örebro Sweden
| | - Anita Koskela
- Clinical Research Center, Örebro University Hosptial Örebro Sweden
| | - Young-Taeg Sul
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, Göteborg University Göteborg Sweden. ; Institute for Clinical Dental Research, Korea University Seoul South Korea
| | - Carina B Johansson
- Department of Clinical Medicine, School of Health and Medical Sciences, Örebro University Örebro Sweden
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Johansson CB, Jimbo R, Stefenson P. Ex vivo and in vivo biomechanical test of implant attachment to various materials: introduction of a new user-friendly removal torque equipment. Clin Implant Dent Relat Res 2010; 14:603-11. [PMID: 20662862 DOI: 10.1111/j.1708-8208.2010.00296.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The removal torque (RTQ) analysis is commonly used for biomechanical evaluation of osseointegration. The overall aim of this study was to verify results obtained with a newly developed equipment for biomechanical testing of osseointegration. METHODS Verification of the new equipment for biomechanical tests involved three experiments: Part I, comparison of RTQ between implants placed in four different types of dental synthetic plasters. Part II, comparison of RTQ between custom made, experimentally used implants to self-tapping, commercially available implants molded in the same type of dental plaster. Part III, comparison of RTQ between commercially pure titanium implants to Ti6Al4V implants placed in rabbit bone, 6 weeks after insertion. Briefly, for all experiments, the peak RTQ values and the removal process were recorded every 0.01 seconds up to 10 seconds. After the measurements, peak RTQ values were converted to shear strength. RESULTS The developed equipment sensitively responded to the changes of properties related to the molding plasters, implant topographies, and materials. The monitored graphs corresponded well to the expected properties of the different implants and tested materials. CONCLUSION The new RTQ equipment proved to be accurate and could add new knowledge in understanding the biomechanical aspects of osseointegration.
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Affiliation(s)
- Carina B Johansson
- School of Health and Medical Sciences, Department of Clinical Medicine, Örebro University, Örebro, Sweden.
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Mordenfeld A, Hallman M, Johansson CB, Albrektsson T. Histological and histomorphometrical analyses of biopsies harvested 11 years after maxillary sinus floor augmentation with deproteinized bovine and autogenous bone. Clin Oral Implants Res 2010; 21:961-70. [PMID: 20497443 DOI: 10.1111/j.1600-0501.2010.01939.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The purpose of the present study was to histologically and histomorphometrically evaluate the long-term tissue response to deproteinized bovine bone (DPBB) particles used in association with autogenous bone and to compare particle size after 6 months and 11 years, in the same patients, in order to determine possible resorption. MATERIAL AND METHODS Twenty consecutive patients (14 women and six men) with a mean age of 62 years (range 48-69 years) with severe atrophy of the posterior maxilla were included in this study. Thirty maxillary sinuses with <5 mm subantral alveolar bone were augmented with a mixture of 80% DPBB and 20% autogenous bone. Eleven years (mean 11.5 years) after augmentation, biopsies were taken from the grafted areas of the 11 patients who volunteered to participate in this new surgical intervention. The following histomorphometrical measurements were performed in these specimens: total bone area in percentage, total area of the DPBB, total area of marrow space, the degree of DPBB-bone contact (percentage of the total surface length for each particle), the length of all DPBB particles and the area of all DPBB particles. The length and the area of the particles were compared with samples harvested from the same patients at 6 months (nine samples) and pristine particles from the manufacturer. RESULTS The biopsies consisted of 44.7+/-16.9% lamellar bone, 38+/-16.9% marrow space and 17.3+/-13.2% DPBB. The degree of DPBB to bone contact was 61.5+/-34%. There were no statistically significant differences between the length and area of the particles after 11 years compared with those measured after 6 months in the same patients or to pristine particles from the manufacturer. CONCLUSION DPBB particles were found to be well integrated in lamellar bone, after sinus floor augmentation in humans, showing no significant changes in particle size after 11 years. To cite this article: Mordenfeld A, Hallman M, Johansson CB, Albrektsson T. Histological and histomorphometrical analyses of biopsies harvested 11 years after maxillary sinus floor augmentation with deproteinized bovine and autogenous bone.
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Affiliation(s)
- Arne Mordenfeld
- Department of Oral and Maxillofacial Surgery, Public Health Service, Gävle, Sweden.
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Romanos GE, Traini T, Johansson CB, Piattelli A. Biologic Width and Morphologic Characteristics of Soft Tissues Around Immediately Loaded Implants: Studies Performed on Human Autopsy Specimens. J Periodontol 2010; 81:70-8. [DOI: 10.1902/jop.2009.090364] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Telleman G, Albrektsson T, Hoffman M, Johansson CB, Vissink A, Meijer HJ, Raghoebar GM. Peri-Implant Endosseous Healing Properties of Dual Acid-Etched Mini-Implants with a Nanometer-Sized Deposition of CaP: A Histological and Histomorphometric Human Study. Clin Implant Dent Relat Res 2009; 12:153-60. [DOI: 10.1111/j.1708-8208.2009.00147.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ballerini L, Franke-Stenport V, Borgefors G, Johansson CB. Comparison of histomorphometrical data obtained with two different image analysis methods. J Mater Sci Mater Med 2007; 18:1471-9. [PMID: 17387585 DOI: 10.1007/s10856-007-0150-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Accepted: 04/06/2006] [Indexed: 05/14/2023]
Abstract
A common way to determine tissue acceptance of biomaterials is to perform histomorphometrical analysis on histologically stained sections from retrieved samples with surrounding tissue, using various methods. The "time and money consuming" methods and techniques used are often "in house standards". We address light microscopic investigations of bone tissue reactions on un-decalcified cut and ground sections of threaded implants. In order to screen sections and generate results faster, the aim of this pilot project was to compare results generated with the in-house standard visual image analysis tool (i.e., quantifications and judgements done by the naked eye) with a custom made automatic image analysis program. The histomorphometrical bone area measurements revealed no significant differences between the methods but the results of the bony contacts varied significantly. The raw results were in relative agreement, i.e., the values from the two methods were proportional to each other: low bony contact values in the visual method corresponded to low values with the automatic method. With similar resolution images and further improvements of the automatic method this difference should become insignificant. A great advantage using the new automatic image analysis method is that it is time saving--analysis time can be significantly reduced.
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Affiliation(s)
- Lucia Ballerini
- Department of Clinical Medicine/Medical Technology, Orebro University, SE 70182 Orebro, Sweden
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Reigstad O, Franke-Stenport V, Johansson CB, Wennerberg A, Røkkum M, Reigstad A. Improved bone ingrowth and fixation with a thin calcium phosphate coating intended for complete resorption. J Biomed Mater Res B Appl Biomater 2007; 83:9-15. [PMID: 17318821 DOI: 10.1002/jbm.b.30762] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Bonit is claimed to be a resorbable electrochemically deposited calcium phosphate coating consisting mainly of brushite, which is a hydroxyapatite precursor. This study involved a comparison of Ti6Al4V screw-shaped implants with and without a 15 +/- 5 microm Bonit coating in rabbit tibia and femur, after 6 and 12 weeks of insertion. The biomechanical removal torque test showed significantly increased values for the coated implants after 12 weeks (p < 0.05) but not after 6 weeks of integration. Higher bone-implant contact was found for the coated implants in the tibia after 6 weeks and for both tibial and femoral screws after 12 weeks (p < 0.05). There was no difference in the inflammatory reaction around the implants, and possible grains of the coating could be detected after 6 weeks, but not after 12 weeks of follow-up. This unloaded short-term study has shown promising results for the easily applicable and resorbable coat (Bonit) compared to uncoated titanium-alloy implants.
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Affiliation(s)
- O Reigstad
- Orthopaedic Department, Rikshospitalet/National Hospital, 0027 Oslo, Norway.
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Bolind P, Johansson CB, Johansson P, Granström G, Albrektsson T. Retrieved Implants from Irradiated Sites in Humans: A Histologic/Histomorphometric Investigation of Oral and Craniofacial Implants. Clin Implant Dent Relat Res 2006; 8:142-50. [PMID: 16919022 DOI: 10.1111/j.1708-8208.2006.00010.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this report was to quantitatively and qualitatively evaluate the tissue response to bone-anchored implants retrieved from irradiated sites in patients. MATERIALS AND METHODS The material consists of 23 consecutively received Brånemark implants (Nobel Biocare AB, Göteborg, Sweden) placed in pre- or postoperatively irradiated sites. Twenty-two of the 23 implants were suitable for histologic evaluation of undecalcified sections in the light microscope. RESULTS The oral implants with shorter time in situ demonstrated sparse bone to implant contact with mainly dense connective tissue in the interface. However, for implants with longer time in situ, high amounts of bone-implant contact and bone fill of threads were noted. The mean values of bone-implant contact and bone area within the thread were calculated to 40% (16-94) and 70% (13-96), respectively. The craniofacial implants, with the exception of two implants lined with a capsular formation, demonstrated mature and newly formed bone at the bone-implant interface. The mean value for bone-metal contact was calculated to 45 and 53% for two specimens. The mean value for bone area within the thread ranged from 65 to 88% for three specimens. CONCLUSION; The possibility to achieve bone anchorage of implants in irradiated tissue was supported by the findings in this study. However, due to limited material, conclusions with regard to radiation dose and bone tissue response to implants cannot be stated.
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Affiliation(s)
- Pia Bolind
- Department of Biomaterials/Handicap Research, Göteborg University, Göteborg, Sweden.
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Bolind P, Johansson CB, Johansson P, van Steenberghe D, Albrektsson T. Histologic evaluation of Brånemark clinic oral implants retrieved from grafted sites. Clin Implant Dent Relat Res 2006; 8:44-53. [PMID: 16681493 DOI: 10.2310/j.6480.2005.00032.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this report is to quantitatively and qualitatively describe the bone tissue response to Brånemark implants retrieved from grafted sites in patients. MATERIALS AND METHOD The material consists of consecutively received Brånemark implants retrieved from grafted sites. Thirty-five of these implants, retrieved from 16 patients, were suitable for the histologic evaluation of undecalcified sections in the light microscope. RESULTS The unloaded implants were mainly lined with soft tissue, and sparse bone-implant contact was observed only in some sections. The loaded implants, with the exception of one implant removed due to mobility, had mature and new bone-implant contact. Resorption of graft through cutting cone structures was detected. Cement lines were found separating bone-like tissue albeit no cellular content and bone tissue with detectable osteocytes. CONCLUSION In this heterogeneous group of implants from grafted sites, the unloaded implants showed limited bone-implant contact. The autografts showed seemingly mixed viability as judged by the cell content in the osteocyte lacunae and cement lines separating areas with filled and empty lacunae.
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Affiliation(s)
- Pia Bolind
- Department of Biomaterials/Handicap Research, Institute for Surgical Sciences, The Sahlgrenska Academy at Göteborg University, SE 405 30 Göteborg, Sweden
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Abstract
Today, aseptic loosening is the most common cause of revision of major arthroplasties. Aseptic loosening accounts for more than two-thirds of hip revisions and almost one-half of knee revisions in Sweden. Several theories on the cause of aseptic loosening have been proposed. Most of these theories, however, are based on empiric observations, experimental animal models or anecdotal cases. In this review, we discuss the most common theories concerning aseptic loosening. It emerges from this review that aseptic loosening has a multifactorial etiology and cannot be explained by a single theory.
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Affiliation(s)
- Mikael Sundfeldt
- Department of Biomaterials/Handicap Research, Sahlgrenska University Hospital, University of Gothenburg, Sweden.
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Abstract
The aim of this study was to investigate whether the coating of titanium (Ti) implants with hydroxyapatite (HA) might create a better fixation when titanium implants are implanted into a gap. In each of 16 rats, the medullary cavity of both femurs was entered by an awl from the trochanteric area. With steel burrs it was successively reamed to a diameter of 1.5 mm. In a random manner the proximal part of the cavity in half of the bones was reamed once again to a diameter of 2.0 mm. Nails with a diameter of 1.5 mm and a length of 34 mm were then inserted into the medullary cavity of these bones with press fit at the distal half and a gap to the bone in the proximal half. In the remaining bones the whole medullary canal was reamed to a diameter of 2.0 mm, and nails with a diameter of 2.0 mm and a length of 34 mm were introduced. In all cases, either a pure Ti nail or a Ti nail entirely plasma sprayed with HA was used in a random manner. The surface roughness of the pure Ti was characterized by Ra 2.6 microm and Rt 22 microm. Ra of HA was 7.5 microm and Rt 52 microm. At sacrifice after 16 weeks, both femurs were dissected free from soft tissues and then immersed in fixative. A specimen slice of about 5 mm in thickness was prepared from the subtrochanteric region with a water-cooled band saw. Sample preparation for undecalcified tissue followed the internal guidelines at the laboratories of the Department of Biomaterials/Handicap Research. Generally, bone contact to the nails with HA coating was more predictable than was bone contact to the Ti nails. But due to rather large variations in bone contact between the samples, statistical analyses revealed non-significant differences between the 4 groups (p = 0.083). There were no significant differences between Ti and HA coated nails of 2.0 mm (p = 0.633), nor between Ti and HA coated nails of 1.5 mm (p = 0.924). The pooled values for the 2.0 mm nails showed significantly higher bone bonding contact than the pooled values of the 1.5 mm nails (p = 0.011). Our results, then, indicate that bone bonding contact to implants with a loose fit insertion is less predictable than in press fit insertion, and HA coating seemed to be more predictable than pure Ti. However, due to large variations between the samples, the differences did not reach significant levels.
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Affiliation(s)
- Olav Reikerås
- Institute of Clinical Medicine, Rikshospitalet University Clinic, University of Oslo, Oslo, Norway.
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Abstract
The aim of this study was to evaluate osseous integration of hydroxyapatite coated titanium implants over time as compared to pure titanium. In 20 rats the medullary cavity of both femoral bones was entered by an awl from the trochanteric area. With steel burrs it was successively reamed to a diameter of 2.0 mm. Nails with a diameter of 2.0 mm and with a length of 34 mm were inserted into the medullary cavity; a pure titanium nail on the left side and a titanium nail entirely plasma-sprayed with hydroxyapatite (HA) on the right side. The surface roughness of the pure titanium was characterized by Ra 2.6 microm and Rt 22 microm, and HA had a roughness of Ra 7.5 (arithmetical mean roughness) microm and Rt (maximum profile height) 52 microm. The rats were randomized to a follow-up of 6 and 12 months, respectively. At sacrifice the femoral bones were dissected free from soft tissues. The bones were radiographed and then immersed in fixative. A specimen-slice of about 5 mm thickness was prepared from the region under the trochanter minor with a water cooled band-saw. Sample preparation for undecalcified tissue followed the internal guidelines at the laboratories of Biomaterials/Handicap Research. At 6 months the median bone bonding contact of the implants was 40% (range 0-92) in the titanium group and 34% (0-86) in the HA group. At 12 months the median bone bonding contact was 51% (0-97) in the titanium group and 86% (72-98) in the HA group. In conclusion, we found a significant (p = 0.001) increase in bone bonding contact from 6 to 12 months of the HA coated nails and significantly (p = 0.043) enhanced bone bonding contact in HA coated nails at 12 months as compared to pure titanium nails.
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Affiliation(s)
- Olav Reikerås
- Institute of Clinical Medicine, Rikshospitalet University Clinic, University of Oslo, Norway.
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Bolind P, Johansson CB, Balshi TJ, Langer B, Albrektsson T. A study of 275 retrieved Brånemark oral implants. INT J PERIODONT REST 2005; 25:425-37. [PMID: 16250565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The aim of this report was to describe the bone tissue response to Brånemark oral implants retrieved from patients. The material consisted of consecutively received Brånemark threaded oral implants and related patient data provided by clinicians. The implant samples were processed into undecalcified sections for evaluation under the light microscope. The analysis demonstrated a lower percentage of bone-to-implant contact for the unloaded implants as compared to the loaded implants. When the threads were divided into four different regions, the loaded implants had a lower percentage of bone-contacting length at the thread top as compared to the other three regions.
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Affiliation(s)
- Pia Bolind
- Department of Biomaterials/Handicap Research, Institute for Surgical Sciences, Göteborg University, Sweden
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Bolind PK, Johansson CB, Becker W, Langer L, Sevetz EB, Albrektsson TO. A descriptive study on retrieved non-threaded and threaded implant designs. Clin Oral Implants Res 2005; 16:447-55. [PMID: 16117769 DOI: 10.1111/j.1600-0501.2005.01129.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In the light microscope compare the amount of bone saucerization for non-threaded cylindrical and threaded implant designs in retrieved samples from patients. MATERIAL AND METHOD Consecutively received retrieved oral implants from 117 patients, whereof 85 non-threaded cylindrical and 85 Brånemark implants, have been included in the study. For 75 non-threaded cylindrical and 46 Brånemark implants was the entire implant length available for calculation. Undecalcified ground sections were investigated in the light microscope with calculation of percentage of implant length coronal to the first bone-implant contact and percentage of bone to implant contact. RESULTS Mean value for implant length coronal to first bone-implant contact was 65%, standard error of the mean (SEM) 3 (range 0-100%), for non-threaded cylindrical implants and 43%, SEM 6 (range 0-100%) for Brånemark implants. Mean values of bone contact along the entire implant length was 23%, SEM 2 (range 0-65%), for the non-threaded cylindrical implants and 33%, SEM 5 (range 0-93%) for the Brånemark implants. CONCLUSION Within the limitations of this retrospective, retrieval study non-threaded cylindrical implants demonstrated a greater bone saucerization when evaluated in the light microscope.
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Affiliation(s)
- Pia K Bolind
- Department of Biomaterials/Handicap Research, Institute for Surgical Sciences, Gothenburg University, Gothenburg, Sweden.
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Romanos GE, Johansson CB. Immediate loading with complete implant-supported restorations in an edentulous heavy smoker: histologic and histomorphometric analyses. Int J Oral Maxillofac Implants 2005; 20:282-90. [PMID: 15839123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
The clinical case presented is that of an edentulous female patient, a heavy smoker, who received implant-supported complete restorations in the maxilla and mandible using the immediate loading concept according to the Ankylos implant system. The patient received 12 commercially pure titanium (grade 2) Ankylos implants, 6 in the maxilla and 6 in the mandible. The implants were loaded immediately after surgery with temporary acrylic resin prostheses fabricated chairside using a prefabricated customized splint. The definitive ceramometal restorations were seated 4 months after surgery. Clinical and radiologic evaluation at 7 months after implant placement indicated functional bone anchorage of all implants, despite the patient being a smoker and having poor bone quality. The patient died 7 months after implant placement because of lung cancer; however, there was no known disease at the time of implant placement. After her death, the implants with the surrounding tissues were removed en bloc and examined histologically and histomorphometrically using undecalcified cut and ground sections. All implants were osseointegrated to some extent and surrounded by lamellar bone. However, around the upper, nonthreaded parts of the implants, much of the bone had been resorbed. In this region, fibrous connective tissue was in close contact with the titanium surface. Epithelial proliferation with pocket formation could not be observed in any of the implants. The histomorphometric evaluation of bone-implant contact in threads demonstrated a mean of approximately 51% of the available surface and a mean bone volume of approximately 52%, with a tendency toward greater contact and volume around the implants in the maxilla. If the nonthreaded cylindric portions of the implants were included, mean bone-implant contact was 46% and mean bone volume was 47%.
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Affiliation(s)
- George E Romanos
- Department of Implant Dentistry, New York University College of Dentistry, New York, New York 10010, USA.
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Ellingsen JE, Johansson CB, Wennerberg A, Holmén A. Improved retention and bone-tolmplant contact with fluoride-modified titanium implants. Int J Oral Maxillofac Implants 2004; 19:659-66. [PMID: 15508981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
PURPOSE The purpose of the present study was to investigate whether a fluoride modification of the titanium surface would have an effect on bone response after implantation. MATERIALS AND METHODS Titanium-oxide-blasted titanium implants with and without fluoride modification were investigated in a rabbit tibia model. Quantitative analysis of surface roughness, biomechanical interlocking, and in vivo tissue reactions in rabbit bone at 1 and 3 months after placement were compared. RESULTS The fluoride-modified test implants had a slightly smoother surface (Sa: 0.91 +/- 0.14 microm) than the unmodified control implants (Sa: 1.12 +/- 0.24 microm). Significantly higher removal torque values (85 +/- 16 Ncm vs 54 +/- 12 Ncm) and shear strength between bone and implants (23 +/- 9 N/mm2 vs 15 +/- 5 N/mm2) were measured for the fluoride-modified implants after 3 months. The histomorphometric evaluations demonstrated higher bone-to-implant contact for test implants at 1 month (35% +/- 14% vs 26% +/- 8%) and 3 months (39% +/- 11% vs 31% +/- 6%) after placement. DISCUSSION Implant surface modification with fluoride may result in morphologic and physiochemical phenomena that are of significance for the bone response. Another possible explanation for the findings in the present study is that a surface modification changes the surface chemical structures to be more suitable for bone bonding. CONCLUSION Based on the biomechanical and histomorphometric data, the fluoride-modified titanium implants demonstrated a firmer bone anchorage than the unmodified titanium implants. These implants achieved greater bone integration than unmodified titanium implants after a shorter healing time.
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Affiliation(s)
- Jan Eirik Ellingsen
- Oral Research Laboratory and Department of Prosthetic Dentistry, Dental Faculty, University of Oslo, Norway.
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Abstract
The aim of this study was to investigate the interaction between bone and pure titanium, titanium coated with hydroxyapatite (HA), and titanium coated with carbon in a rat femur model. In 25 rats, the medullary cavity of both femurs was entered by an awl from the trochanteric area. With steel burrs it was successively reamed to a diameter of 2.0 mm. Nails with a diameter of 2.0 mm and with a length of 34 mm were inserted in a random manner; either a pure titanium nail, a titanium nail entirely plasma-sprayed with a 75-100-microm layer of HA or a titanium nail coated with 2-10-microm carbon. The surface roughness of the pure titanium was characterized by Ra 2.6 microm and Rt 22 microm. Ra of HA was 7.5 microm and Rt 52 microm, and of carbon Ra was 0.4 microm and Rt 4.0 microm. Twelve rats were randomized to a follow up of 8 weeks, and the remaining 13 rats were followed for 16 weeks. At sacrifice both femora were dissected free from soft tissues and then immersed in fixative. A specimen slice of about 5 mm thickness was prepared from the subtrochanteric region with a water-cooled band-saw. Sample preparation for un-decalcified tissue followed the internal guidelines at the laboratories of Biomaterials/Handicap Research. At 8 weeks the median bone bonding contact of the implants was 43% (range 0-74) in the titanium group, 39% (0-75) in the HA group, and 3% (0-59) in the carbon group. At 16 weeks the corresponding figures were 58% (0-78) in the titanium group, 51% (15-75) in the HA group, and 8% (0-79) in the carbon group. In conclusion, we found great variability in bone bonding contact. In general, carbon-coated nails had reduced bone bonding contact both at 8 and at 16 weeks as compared to pure titanium or titanium coated with hydroxyapatite.
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Affiliation(s)
- Olav Reikerås
- Institute of Clinical Medicine, Rikshospitalet University Clinic, University of Oslo, Oslo, Norway.
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Ramires PA, Wennerberg A, Johansson CB, Cosentino F, Tundo S, Milella E. Biological behavior of sol-gel coated dental implants. J Mater Sci Mater Med 2003; 14:539-545. [PMID: 15348438 DOI: 10.1023/a:1023412131314] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The biocompatibility of dental implants coated with titania/hydroxyapatite (HA) and titania/bioactive glass (BG) composites obtained via sol-gel process was investigated using an in vitro and in vivo model. A device for the in vitro testing of screw-shaped dental implants was developed, in order to well compare the two experimental models studying the behavior of human MG63 osteoblast-like cells seeded onto a particular geometry. The expression of some biochemical parameters of osteoblastic phenotype (alkaline phosphatase specific activity, collagen and osteocalcin production) and some indications on cells morphology obtained by scanning electron microscopy were evaluated. The in vitro and in vivo models were compared after implants insertion in rabbit tibia and femur. The removal torque and histomorphometric parameters (percentage of bone in contact with implant surface and the amount of bone inside the threaded area) were examined. A good agreement was found between the in vitro and in vivo models. These experiments showed better performances of HA and BG sol-gel coated dental implants with respect to uncoated titanium; in particular, it was found that in vitro the HA coating stimulates osteoblastic cells in producing higher level of ALP and collagen, whereas in vivo this surface modification resulted in a higher removal torque and a larger bone-implant contact area. This behavior could be ascribed to the morphology and the chemical composition of the implants with rough and bioactive surfaces.
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Affiliation(s)
- P A Ramires
- PASTIS-CNRSM, Biomaterials Unit, S.S. 7 Appia Km 714, 72100 Brindisi, Italy.
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Abstract
AIM To evaluate the effect of a local single injection of amino-terminally truncated recombinant human fibroblast growth factor-4 (rhFGF-4s) on titanium implant incorporation in a rabbit bone. MATERIAL AND METHODS Thirty-six threaded titanium implants were inserted into the femur and tibia of six rabbits. Three weeks prior to implant insertion 10 microg of FGF-4 in an altelocollagen carrier or the carrier alone was injected into the intended implant sites. Biomechanical evaluation by (i) resonance frequency analysis and (ii) peak removal torque measurements was performed after 6 weeks. The implants with surrounding tissue were processed to undecalcified ground sections followed by light-microscopic quantifications of the bone in threaded area and the apical parts of the implants. RESULTS A general trend, however not statistically significant, with higher mean values obtained in the above-mentioned tests was found. The FGF-4-treated implants revealed a significantly increased bone area in the apical part of the implants compared to the corresponding control implants. CONCLUSION A local single injection of rhFGF-4 may stimulate bone formation around titanium implants in bone. However, further research is required to confirm these results, understand the mechanisms of FGF, and establish optimal dose and delivery methods.
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Affiliation(s)
- Victoria Franke Stenport
- Department of Biomaterials/Handicap Research, Institute of Surgical Sciences, Göteborg University, Göteborg, Sweden.
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Røkkum M, Reigstad A, Johansson CB, Albrektsson T. Tissue reactions adjacent to well-fixed hydroxyapatite-coated acetabular cups. Histopathology of ten specimens retrieved at reoperation after 0.3 to 5.8 years. J Bone Joint Surg Br 2003; 85:440-7. [PMID: 12729126 DOI: 10.1302/0301-620x.85b3.12834] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ten acetabular cups coated with hydroxyapatite (HA) had originally been inserted in five primary and five revision total hip replacements. The thickness of the HA was 155 +/- 35 microm. The cups, which were well-fixed, were retrieved, with their adherent tissue, at reoperation after 0.3 to 5.8 years because of infection (five hips), wear of polyethylene (three hips), and instability (two hips). Undecalcified sections showed a direct contact between bone and osteoid-like tissue which had formed directly onto the HA coating. The area within the threads and their mirror images, as well as the implant-tissue interfaces consisted of similar amounts of bone and soft tissue. Degradation of HA was seen in all hips. The mean thickness of the remaining HA coating was 97 microm (95% CI 94 to 101). The metal interface comprised 66% HA. The HA-tissue interface contained more bone than soft tissue (p = 0.001), whereas the metal-tissue interface included more soft tissue than bone (p = 0.019). Soft tissue at the implant interface and poor replacement of HA by bone may interfere with long-term fixation.
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Affiliation(s)
- M Røkkum
- Orthopaedic Department, National Hospital, Oslo, Norway
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Abstract
AIM The aim of present study was to evaluate if an enamel matrix derivative (Emdogain) may enhance bone formation and osseointegration of titanium implants, using a well-documented rabbit model. MATERIAL AND METHODS Thirty-six threaded commercially pure titanium (cp.ti.) implants were inserted in six New Zealand white rabbits. One implant was placed in each femur and two in each tibia. Prior to implant insertion approximately 0.5 mL of Emdogain (EMD) (test) or the vehicle gel (PGA: propylene glycol alginate) (control) was injected into the surgically prepared implant site. The follow-up time was 6 weeks. Biomechanical evaluations by resonance frequency analysis (RFA) and removal torque measurements (RTQ) were performed. Histomorphometrical quantifications were made on ground sections by measurements of the percentage of bone-to-metal contact, bone area inside the threads as well as outside the threads (mirror image). Bone lengths along the implant surface were also measured and used for shear strength calculations. RESULTS The results demonstrated no beneficial effects from the EMD treatment on bone formation around titanium implants in any of the tested parameters. Significant differences were demonstrated with removal torque test and shear force calculations for the control implants. No other parameter demonstrated a statistically significant difference. CONCLUSION The results of the present study may indicate that EMD does not contribute to bone formation around titanium implants. This observation may indicate that the bone formation that occurs after EMD treatment in periodontal defects is the result of functional adaptation. However, further research is required to evaluate the effect of EMD treatment on bone formation.
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Affiliation(s)
- V Franke Stenport
- Department of Biomaterials/Handicap Research, Institute of Surgical Sciences, Göteborg University, Box 412, S-405 30 Göteborg, Sweden.
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