Surface treatments of titanium dental implants for rapid osseointegration

Root canal irrigants.

European Association for Osseointegration; 19-22 February 2009, Pfaffikon, Switzerland; 2nd Consensus Conference

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

https://www.endoexperience.com/documents/PetersetalRotaryArticle.pdf

Current Challenges and Concepts in the Preparation of Root Canal Systems: A Review

Increased surface roughness of dental implants has demonstrated greater bone apposition; however, the effect of modifying surface chemistry remains unknown. In the present study, we evaluated bone apposition to a modified sandblasted/acid-etched (modSLA) titanium surface, as compared with a standard SLA surface, during early stages of bone regeneration. Experimental implants were placed in miniature pigs, creating 2 circular bone defects. Test and control implants had the same topography, but differed in surface chemistry. We created the test surface by submerging the implant in an isotonic NaCl solution following acid-etching to avoid contamination with molecules from the atmosphere. Test implants demonstrated a significantly greater mean percentage of bone-implant contact as compared with controls at 2 (49.30 vs. 29.42%; p = 0.017) and 4 wks (81.91 vs. 66.57%; p = 0.011) of healing. At 8 wks, similar results were observed. It is concluded that the modSLA surface promoted enhanced bone apposition during early stages of bone regeneration.

Enhanced Bone Apposition to a Chemically Modified SLA Titanium Surface

Many dental clinical implant studies have fo- cused on the success of endosseous implants with a variety of surface characteristics. Most of the surface alterations have been aimed at achieving greater bone-to-implant con- tact as determined histometrically at the light microscopic level. A previous investigation in non-oral bone under short- term healing periods (3 and 6 weeks) indicated that a sand- blasted and acid-etched titanium (SLA) implant had a greater bone-to-implant contact than did a comparably- shaped implant with a titanium plasma-sprayed (TPS) sur- face. In this canine mandible study, nonsubmerged implants with a SLA surface were compared to TPS-coated implants under loaded and nonloaded conditions for up to 15 months. Six foxhound dogs had 69 implants placed in an alternating pattern with six implants placed bilaterally in each dog. Gold crowns that mimicked the natural occlusion were fabricated for four dogs. Histometric analysis of bone contact with the implants was made for two dogs after 3 months of healing (unloaded group), 6 months of healing (3 months loaded), and after 15 months of healing (12 months loaded). The SLA implants had a significantly higher (p < 0.001) percentage of bone-to-implant contact than did the TPS implants after 3 months of healing (72.33 ± 7.16 versus 52.15 ± 9.19; mean ± SD). After 3 months of loading (6 months of healing) no significant difference was found be- tween the SLA and TPS surfaced implants (68.21 ± 10.44 and 78.18 ± 6.81, respectively). After 12 months of loading (15 months of healing) the SLA implants had a significantly greater percentage (p < 0.001) of bone-to-implant contact than did the TPS implants (71.68 ± 6.64 and 58.88 ± 4.62, respectively). No qualitative differences in bone tissue were observed between the two groups of implants nor was there any difference between the implants at the clinical level. These results are consistent with earlier studies on SLA im- plants and suggest that this surface promotes greater osse- ous contact at earlier time points compared to TPS-coated implants. © 1998 John Wiley & Sons, Inc. J Biomed Mater Res, 40, 1-11, 1998.

http://www.ibmc.up.pt/projectos/FJMonteiro/Bonamidi%20Project/References%20Bonamidi/Cochran%20-%20Bone%20response%20unloaded%20sandblasted%20surface.pdf

Bone response to unloaded and loaded titanium implants with a sandblasted and acid-etched surface : A histometric study in the canine mandible

Acids of intrinsic and extrinsic origin are thought to be the main etiologic factors for dental erosion. There is evidence that acidic foodstuffs and beverages play a role in the development of erosion. However, the pH of a dietary substance alone is not predictive of its potential to cause erosion as other factors modify the erosive process. These factors are chemical (pKa values, adhesion and chelating properties, calcium, phosphate and fluoride content), behavioural (eating and drinking habits, life style, excessive consumption of acids) and biological (flow rate, buffering capacity, composition of saliva, pellicle formation, tooth composition, dental and soft tissue anatomy). The interplay between erosion and abrasion (specially oral hygiene practices) may be the main driver leading to the clinical manifestation of this disorder. Recommendations for patients at risk for dental erosion such as reducing acid exposure by reducing the frequency and contact of acids will be discussed.

The Role of Diet in the Aetiology of Dental Erosion

The diagnosis of occlusal caries at non-cavitated sites remains problematic, especially since clinical visual detection has limited sensitivity. Electrical methods of detection show considerable promise, but specificity is reduced. The aims of this in vitro study were: (1) to assess the validity of a new laser fluorescence device--the DIAGNOdent--(and compare the values with those of a fixed-frequency electrical device); (2) to determine the optimum cut-off points of the new device for different stages of the caries process, and (3) to assess the reproducibility of the new laser device. For validity and determination of optimum cut-off points, 105 extracted teeth with macroscopically intact occlusal surfaces were measured by a single examiner, using both the laser fluorescence device (on both moist and dried teeth) and an Electronic Caries Monitor. The teeth were subsequently examined histologically to determine the specificity, sensitivity and likelihood ratio at the D2 (caries extending through more than half of the enamel thickness) and D3 (caries involving dentin) levels. The values obtained for the laser device ranged from 0.72 to 0.87 (specificity), 0.76 to 0.87 (sensitivity) and 3.0 to 5.6 (likelihood ratio). Those for the ECM ranged from 0.64 to 0.78 (specificity), 0. 87 to 0.92 (sensitivity) and 2.4 to 4.1 (likelihood ratio). To determine intra- and interexaminer reproducibility of the DIAGNOdent, 11 dentists recorded two different measurements at the same site on a separate set of 83 extracted molar teeth, and these were compared using Cohen's kappa (at D2 and D3 levels) and Spearman's correlation coefficient. The average intra-examiner kappa scores were 0.88 (D2) and 0.90 (D3), with a Spearman correlation of 0.97. For interexaminer reproducibility, the average kappa values were 0.65 (D2) and 0.73 (D3), with a Spearman correlation of 0.84. It is concluded that for occlusal caries (1) the new laser device has a higher diagnostic validity than the ECM, and (2) in vitro, measurements using the device are highly reproducible. Thus, the laser device could be a valuable tool for the longitudinal monitoring of caries and for assessing the outcome of preventive interventions.

Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro.

A new scoring system, the Basic Erosive Wear Examination (BEWE), has been designed to provide a simple tool for use in general practice and to allow comparison to other more discriminative indices. The most severely affected surface in each sextant is recorded with a four level score and the cumulative score classified and matched to risk levels which guide the management of the condition. The BEWE allows re-analysis and integration of results from existing studies and, in time, should initiate a consensus within the scientific community and so avoid continued proliferation of indices. Finally, this process should lead to the development of an internationally accepted, standardised and validated index. The BEWE further aims to increase the awareness of tooth erosion amongst clinicians and general dental practitioners and to provide a guide as to its management.

/pdf/basic-erosive-wear-examination-bewe-a-new-scoring-system-for-1qprgo715p.pdf

Adrian Lussi

Papers

Enhanced Bone Apposition to a Chemically Modified SLA Titanium Surface

Bone response to unloaded and loaded titanium implants with a sandblasted and acid-etched surface : A histometric study in the canine mandible

The Role of Diet in the Aetiology of Dental Erosion

Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro.

Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs