IMPLANT SURFACE TREATMEMT

Presented by
Nehal Abdelrahim Amin Elsherif
 ?Why to do implant surface treatment

Implant failure may result from titanium’s reduced ability to*

induce osseointegration, which causes poor or delayed
.osseointegration

Furthermore, early titanium implants had a mechanically*

polished surface that was smooth, and research in recent years
revealed that this surface is less stable over time than those with a
.rough surface

In order to achieve a larger contact surface, treatment of the*

implant surface was performed in order to increase the
.osseointegration between the bone and the implant
 ?Why to do implant surface treatment
To achieve an appropriate modification of titanium surface,*
which increases the percentage of BIC (bone implant contact),
.to favor osseointegration
to achieve appropriate modification which has antibacterial*
.properties to prevent peri-implant diseases
Also to resists the stresses it will undergo with*
functionalization, such as chewing, thus guaranteeing healthy
.peri-implant tissue over time
 titanium and titanium alloys

are widely used to create implants due to its excellent

:mechanical properties
biocompatibility
corrosion resistance
non-magnetism
non-toxicity
very reactive and forms an oxide layer of about
.5nm in thickness, which protects it from corrosion
 Titanium
.However, it lacks anti-bacterial properties
As a result, bacteria tend to adhere to the collars of implants and
. failure can be linked to peri-implant infection

consequently, it is crucial that titanium implants

have long-term anti-bacterial properties
. and improved early osseointegration capability

So, it is necessary to apply a treatment

to change the surface of pure titanium, optimizing
the surface’s morphology
. and chemical composition
Objectives: This study aims to evaluate the efficacy and safety of
two types of sandblasted with large-grit and acid-etched (SLA)
.surface implants with different surface roughness
 Surface characteristics of the implant affects the
.speed and strength of osseointegration

implant-bone interface plays an important role in prolonging the

longevity and improving the function of the implant-supported
.prosthesis

The nanotechnology develops a biomimetic

.implant surface topography with nanoscale molecules and features
 Biomimetics and Nanotechnology

The imitation of natural cellular environments is called

.biomimicry
Nanoscale modification of an implant surface could mimic the
cellular environments thus accelerate the process of rapid bone
.growth
Nanotopography alters cellular response
 Nanotechnology alters surface reactivity

Nanoscale modification of the implant surface may alter the

.endosseous implants surface reactivity

Existing reports suggest that little bone bonding occurs at endosseous

.titanium implants,particularly during the early phases of bone formation

Nanoscale modifications of topography appear to change the

.chemical reactivity of bulk materials

the calcium phosphate precipitation on grit blasted titanium was

dramatically altered by HF surface treatment that creates nanoscale
.topographic surface features
The topographical implant features

Implant surface roughness

:is divided into

. Macro-roughness

.Micro-roughness

.Nano-roughness
Macro-roughness in the range of millimeters to tens of microns. It
improves The mechanical stability. Responsible for stronger
but delayed Osseo integration
i.e. primary stability of the Implant (anchorage)

Micro-roughness in the range of 1-10 μm. maximizes

the interlocking between mineralized bone and implant
surface.Also Responsible for minimizing pressure on the
cortical bone during insertion.

Nano-roughness
Nano level is in the range of 1-100 nm. Responsible
for protein adsorption, cellular response and
consequently Affects the rate ofosseointegration
Surface nano-roughness alters cellular and tissue response and
behaviour towards implant surface compared to conventional
sized topography
:Nano-textured implant surface enhances

Proteins adsorption-1

Osteoblast adhesion, proliferation, extra cellular -2

.matrix formation and mineralization
.Increase rate of osseointegration-3
The implant surface shape and structure affect the osseointegration
process, which is necessary to provide
.implant stability

The stability of the implant, both primary and secondary, is a factor

.that affects how well the implant itself will osseointegrate

While the primary stability is a mechanical phenomenon that

depends on both the implant’s macroscopic and microscopic design
and the surgical technique used to position it, numerous studies have
found that the implant’s surface is the key factor in achieving a high
.level of secondary stability

The most significant advancement in implant dentistry has been the

observation of direct bone-to-implant contact (BIC) which was
verified with electron microscopy
Electron microscopy detail of a smooth (hydrophobe)
and a rough (hydrophile) implant surface, with
re-wetting percentages. The hydrophilic surface has a
higher Bone to implant contact percentage than the
.hydrophobic surface
 Biointegration
Biointegration is the bonding of living tissue to the
surface of a biomaterial or implant, independent of any
.mechanical interlocking mechanism
It is often used to describe the bond to hydroxyapatite-
.coated dental implants
Biointegration is essential to the success and longevity
.of the implant
Nanoparticles used in the coating of dental
:implants can be
Osteo integrative properties (Al2O3, lO3 hydroxyapatite,
calcium phosphate)

Antimicrobial (silver, zinc, cooper, quercitrin,

chlorhexidine)

Osteo integrative and antimicrobial activities (TiO2,

.nano-crystalline diamond)
Physicochemical treatments of major implant surfaces give
:rise to different types of implants

Machined polished treated hybrid

A significant advantage of treated and hybridized surfaces is

the increased degree of hydrophilicity and wettability
compared with untreated, machined, smooth surfaces, which
.are considered hydrophobic
The only way to modify something on the surface is to add or
reduce materials on a micro- or
.nanometric scale
Dental implants with moderately rough surfaces
osseointegrate faster and their use has significantly
decreased early failures and enabled application of
.immediate loading protocols
Different dental implant manufacturers have developed
different techniques to achieve moderate roughness,
,including: titanium plasma spraying
,coating with hydroxyapatite
,sandblasting
,acid-etching
,laser ablation
sandblasting combined with acid-etching (SA)
.anodization
 Surface Modifications

Chemical Modifications Physical Modifications

Anodic Oxidation-1 Plasma Spray-1

)Anodization(

Combinations of Acids-2 Blasting technique-2

 Chemical Modification

Anodic Oxidation (Anodization)-1

(Galvanic current) condense the oxide layer Tio2
.among the implant surface

The titanium substrates serves as the anode

.Inert platinum sheet provides the cathode

Anodization Enhances the growth of osteoblast and

Limits the proliferation of fibroblasts
Anodizing has emerged as a useful technique for
changing the surface morphology of titanium or
titanium alloys to enhance bone development because
:it is
,inexpensive
,simple to apply
. and easy to control
Anodizing can provide a surface morphology with a
pore structure on a micro Nano scale as well as
increase the wear and corrosion resistance of pure
.titanium implants
 Chemical Modification

Combinations of Acids-2
The titanium sample etched with a solution of strong
acids, e.g., H2SO4 Sulfuric acid and H2O2, acid
.Hydrogen peroxide

Effective in creating a thin grid of nanopits on a

titanium surface (diameter 20–100 nm)
 Physical Modifications

Plasma Spray-1
)most common method in research work(
.A vacuum is used to remove all contaminants
Kinetic energy guides the charged metallic ions or
.plasma to the device surface

A wide range of materials

).e.g., Ag, Au, Ti(
can be coated onto
.implant surface
The aim of the present systematic review was to
analyse studies using inorganic implant coatings and
the effect of tricalcium phosphate (TCP) and
hydroxyapatite (HA) implant surface coatings on bone
.formation
 technique 2-Blasting

Creation of a porous layer on the implant surface

achieved through the collision with microscopic

.particles
.
aluminia .TIO2((
Backscatter-SEM micrographs of the analyzed implant systems.
Note the various numbers and sizes of the Al2O3 particles
(black dots) remaining on the surface following etching. Scale
.bar: 200 μm
 Subtraction surface Treatments

A technique for creating moderately rough implant

.surfaces is sandblasting and acid mordantation (SA)

it needs to be properly planned and managed in order

to produce a final medical device that is clean and
reliable as particulates( which are remnants of the
sandblasting )causes a 15% reduction in tensile
strength, which could lead to the beginning of a
fracture process
the treatments of subtraction consist of removal of portions of the
implant surface. An example of subtraction treatment is
.irradiation of the implant surface with a LASER beam

This process results in an increase in resistance to corrosion and

biocompatibility of titanium, due to its oxidation and subsequent
.formation of oxides and nitrides

No contamination of the surface and a high degree of

reproducibility of this technique, which produces a complex and
homogeneous surface morphology, with a high degree of purity,
thus favoring osseointegration and increasing the removal torque
 Implant Surface Treatment recently can
:be also divided into

.Subtraction Treatments-1

.Addition Treatments -2

.CGF Coated Dental Implants -3

In this study, the effects of concentrated growth factor (CGF), an autologous
blood-derived biomaterial, in improving the process of osseointegration of dental
implants have been evaluated. Here, permeation of dental implants with CGF has
been obtained by using a Round up device. These CGF-coated dental implants
retained a complex internal structure capable of releasing growth factors (VEGF,
TGF-β1, and BMP-2) and matrix metalloproteinases (MMP-2 and MMP-9) over
.time
The CGF-permeated implants induced the osteogenic differentiation of human
bone marrow stem cells (hBMSC) as confirmed by matrix mineralization and the
.expression of osteogenic differentiation markers
Moreover, CGF provided dental implants with a biocompatible and biologically
active surface that significantly improved adhesion of endothelial cells on CGF-
coated implants compared to control implants (without CGF)
Figure 1 Scanning electron microscopy analysis of CGF-permeated implant.
(A) CGF was able to adhere to the implant surface almost completely. (B,C)
CGF fibrin forming a dense network conteining few corpuscular elements.
.(D) A corpuscular element entangled in the fibrin network
Sol-gel coatings a liquid with a specific composition (i.e. Sol) is
converted into a solid gel phase. Thin coatings can be
deposited onto a surface by dip or spin coating techniques.

Nano crystalline Hydroxyapatite coatings Nanoparticles of HA is

prepared by mixing H PO 3 3and Ca (NO ) to a Ca/P ratio of 1.67
in the presence of a 3liquid crystalline phase. The crystalline
phase limits particle growth upto 5nm. When HA particles
have formed, the liquid crystalline phase is dissolved and the
particles can be deposited onto a surface using
.dicyandiamide
Biologically Active Drugs Incorporated Dental ImplantsSome •
osteogenic drugs have been applied to implant surfaces

Incorporation of bone antiresorptive drugs, such as

bisphosphonate, might be very relevant in clinical cases lacking
bone support. Bisphosphonate incorporated on to Ti implants
increased bone density locally in the peri-implant region with
the effect of the antiresorptive drug limited 12to the vicinity of
.the implant
Other experimental studies
using PSHA (Plasma-Sprayed Hydroxyapatite) coated dental
implants immersed in pamidronate or zoledronate
.demonstrated a significant increase in bone contact area

The main problem lies in the grafting and sustained release of

antiresorptive drugs on the Ti implant surface. Increase in peri-
implant bone density is bisphosphonate concentration-
dependent