Implant surface vs osseointegration

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1. Dr. Firas Kassab 2. ã Introduction ã Classification of implant surfaces ã Methods to alter implant surfaces ã Evaluation of the interface ã Conclusion ã…

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  • 1. Dr. Firas Kassab
  • 2. • Introduction • Classification of implant surfaces • Methods to alter implant surfaces • Evaluation of the interface • Conclusion • References Dr. Firas Kassab 2
  • 3. Definition: Osseointegration: The apparent direct attachment or connection of osseous tissue to an inert, alloplastic material without intervening connective tissue. - GPT 8 Dr. Firas Kassab 3
  • 4. • The concept of Osseointegration was discovered by • Per- Ingvar Branemark and his co-worker and, has had a dramatic influence on clinical treatment of oral implants. Dr. Firas Kassab 4
  • 5. • The First generation titanium implants which were machined with a smooth surface texture. • Implant surfaces have been recognized to play an important role in molecular interactions, cellular response and Osseo integration. Dr. Firas Kassab 5
  • 6. • The Second generation implants with surface modification can accelerate and improve implant osseointegration. • Implants underwent mechanical blasting, acid etching, bioactive coatings, more recently , laser modified surfaces. Dr. Firas Kassab 6
  • 7. • The main objective for the development of implant surface modifications is to promote Osseo integration, with faster and stronger bone formation. • Furthermore, it accelerates the bone healing and thereby allowing immediate or early loading . Dr. Firas Kassab 7
  • 8. 1. Implant materials 2. Based on chemical composition 3. Based on Biocompatibility 4. Based on implant surface texture 5. Based on implant surface irregularities Dr. Firas Kassab 8
  • 9. 6. Based on the orientation of surface irregularities on implant surface 7. Based on surface roughness on implant surfaces Dr. Firas Kassab 9
  • 10. Metals Ceramics Polymers Chemical composition Biological compatibility Bio inertBio tolerant Bio active Dr. Firas Kassab 10
  • 11. 1.Biotolerant Ex:Gold,CobaltChromium,Stainless steel,Zirconium,Niobium 2.Bioinert Ex:zirconium, alumina, ceramics, titanium,stainless steel,gold etc 3. Bioactive Ex: Hydroxyapatite, glassceramic, bioglass etc.., Bioinert and Bioactive materials are osteoconductive in nature. Dr. Firas Kassab 11
  • 12. Based on texture obtained, the implant surface can be divided as: 1. Concave texture ( Additive treatments like hydroxyapatite (HA)coating and titanium plasma spraying) 2. Convex texture (Subtractive treatment like etching and blasting) Dr. Firas Kassab 12
  • 13. Based on the orientation of surface irregularities, implant surfaces are divided as: 1. Isotropic surfaces: have the same topography independent of measuring direction. 2. Anisotropic surfaces: have clear directionality and differ considerably in roughness. Dr. Firas Kassab 13
  • 14. Wennerberg and coworkers have classified implant surfaces based on the surface roughness as: 1. Minimally rough (0.5-1 mm) 2. Intermediately rough (1-2mm) 3. Rough (2-3 mm) Dr. Firas Kassab 14
  • 15. Methods to increase the surface roughness 1. Blasting 2. Chemical etching 3. Porous surfaces 4. Plasma-sprayed surfaces 5. Ion-sputtering coating 6. Anodized surface Dr. Firas Kassab 15
  • 16. 1.Blasting : • Blasting implant surface with particles of various diameters is one of the most frequently used methods of surface alteration. • Various ceramic particles have been used such as Alumina, Titanium oxide and Calcium phosphate particles. Dr. Firas Kassab 16
  • 17. • Etching with strong acids such as HCl, H2SO4,HNO3 and HF is used for roughening dental implants. • Acid-etching produces micropits on implant surfaces with sizes ranging from 0.5 to 2 μm in diameter. Acid- etching has been shown to greatly enhance Osseointegration. Dr. Firas Kassab 17
  • 18. • Recently a new surface was introduced that was sandblasted with large grit and acid-etched (SLA). • This surface is produced with large grit (250-500 micro- metres) blasting process and followed by Hydrochloric and sulfuric acid. Dr. Firas Kassab 18
  • 19. • These are produced when spherical powder of the metallic/ceramic material becomes a coherent mass within the metallic core of the implant body. • These are characterized by pore size, shape, volume and depth, which are affected by the size of the spherical particles and the temperature and pressure of the sintering chamber. Dr. Firas Kassab 19
  • 20. 1. A three dimensional interlocking interface in bone is observed. 2. Shorter healing time. 3. Provide space ,volume for cell-migration and attachment and thus support contact osteogenesis. Dr. Firas Kassab 20
  • 21. • Plasma-spraying is a technique in which hydroxyapatite (HA) ceramic particles are injected into a plasma torch at high temperature approximately 15,000-20,000 K and projected on to the surface of the titanium where they condense and fuse together, forming a film. • Plasma-sprayed coatings can be deposited with a thickness of about 50–100 μm. Dr. Firas Kassab 21
  • 22. • It is the process by which a thin layer of Hydroxyapatite can be coated onto an implant substrate. • This is performed by directing a beam of ion onto an HA block that is vaporized to create plasma and then recondensing this plasma onto the implant. Dr. Firas Kassab 22
  • 23. • Oxidation process can be used to change the characteristic of the oxide layer and make it more biocompatible. • This is carried out by applying a voltage on the titanium implant immersed in the electrolyte. • This results in a surface with micropores of variable diameter and demonstrates lack of cytotoxicity and increased cell attachment and proliferation. Dr. Firas Kassab 23
  • 24. Advantages of increased roughness: 1. Increased surface area of implant adjacent to bone. 2. Improved cell attachment to bone. 3. Increased bone present at implant interface. 4. Increased biochemical interaction of implant with bone. Dr. Firas Kassab 24
  • 25. Methods to alter Implant surfaces 1. Physicochemical 2. Morphologic or Biochemical Dr. Firas Kassab 25
  • 26. • This method involves the alteration of surface energy, surface charge, and surface composition with the aim of improving the bone-implant interface. • The method employed is the Glow discharge treatment, in which materials are exposed to ionized inert gas, such as argon. Dr. Firas Kassab 26
  • 27. • This method involves in alteration of surface morphology and roughness to influence cell and tissue response to implants. • Advantage : This method prevents the epithelial growth on dental implants. Dr. Firas Kassab 27
  • 28. Most commonly used methods to assess the quality of Osseo integration. 1.Biomechanical test 2.Histomorphometric analysis Dr. Firas Kassab 28
  • 29. Biomechanical test 1.Pull-out test 2.Push-out test 3.Torque measurement Dr. Firas Kassab 29
  • 30. RADIOGRAPHS PERIOTEST & REVERSE TORQUE Dr. Firas Kassab 30
  • 31. 4.Resonance frequency analysis It consists of a post which is screwed into the implant and a transducer/receiver unit. It works by emmiting a radio frequency and then reads the amplitude which returns to the unit from the implant. Basically it reads and gives a number that is associated with the “solidness” of the implant. Dr. Firas Kassab 31
  • 32. • There are number of surfaces commercially available for dental implants.Various methods modifying the implant surface have greatly influenced the quality of clinical service in implant prosthodontics. • Implant surface characterization and working knowledge about how surface and bulk biomaterial properties inter relate to implant osseo integration represent an important area in implant based reconstructive surgery Dr. Firas Kassab 32
  • 33. REFERENCES: 1)INT J Oral Maxillofac Implants 2000;15:675-690 2)Indian Journal of Dental Sciences.(March 2012) 3) Wennerberg A, Albrektsson Suggested guidelines for the topographic evaluation of implant surfaces. 4)Int J Oral Maxillofac Implants 2000;15:331-44. 5) Brunette DM. The effects of implant surface topography on the behavior of cells. Int J Oral Maxillofac Implants1988;3:231 6) Puleo DA, Thomas MV. ImplantSurfaces. Dent Clin North Am 2006;50:323-338. Dr. Firas Kassab 33
  • 34. Thank you Dr. Firas Kassab 34
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