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Importance of Titanium Implant’s Surface Modification

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The dentist needs a target implant surface for achieving successful implantation. Read the article to know the importance of surface-modified dental implants.

Medically reviewed by

Dr. Sowmiya D

Published At July 4, 2022
Reviewed AtAugust 4, 2023

Why Is Surface Modification Needed?

The recent advances in implant dentistry have prompted dentists to consider multiple non-surgical strategies and preventive modalities post-implant insertion to maintain successful and long-term outcomes. It is not only the dental implant anchorage that affects the long-term success rates, but it is also the quality and surface of the dental implant that plays a crucial role in determining peri-implant (around the implanted area) health.

Not only the aesthetic outcome but the prevention of connective tissue adhesion by promoting osseointegration (bone formation), anchorage (also called BIC - bone-implant contact), and preventing soft tissue inflammation; these biological and localized factors are responsible for both the success and failure of implants. But the technological advances in the current modern-day field of implant dentistry, like the modification of titanium implant surfaces, are a significant determinant of anchorage and stability.

What Is the Importance of Titanium Implant’s Surface Modification?

In the prosthetic implant system, the soft tissue seal is created by the abutment that connects a fixture and the gingival component of the oral cavity. This soft tissue seal protects the implanted area from bacterial contamination. The soft tissue seal, once formed, also restores the continuity in the anatomy and function of the tooth implanted that would have been disrupted while drilling the bone.

Research indicates that the titanium abutment geometry and its surface significantly influence fibroblasts' marginal bone resorption and adhesion. It involves the modification of titanium abutment by specific methods that increase the surface roughness and the wettability of the implant. As per traditional implant research, roughened implant surface promotes more epithelial adhesion and facilitates the creation of the soft tissue seal we discussed above. The findings are credible in recent advances in surface modification of dental implants through the contact guidance concept.

What Is Contact Guidance Concept?

The contact guidance concept states that compared to the two-dimensional nature of smooth implant surface, the roughened surfaces are bioactivated and remain three-dimensional, and are capable of inducing potent cell differentiation. In animal studies conducted by inserting implants according to the surface modification, four different kinds of methods have been compared as follows:

  • Machined.

  • Acid-etched.

  • Surfaces that have been mildly oxidized.

  • Machined with groove implants.

After six months of histologic study in detail in these animal studies, the machined implant surface possesses the smallest area of peri-implant tissue inflammation compared to the non-surface-modified areas or the grooved implants associated with larger inflammatory infiltrates in the peri-implant soft tissues.

What Are the Modification Methods?

Titanium material used for dental implants is known to have a stable form and good biologic response without any capacity to trigger foreign body response in the host. However, research indicates that surface biocompatibility can be enhanced through micro roughened modifications. The different methods of surface modifications are listed below-

A. Sand Blasted, Large Grit, Acid-Etched Surfaces (SLA) or Surface Roughened Implants: This method involves sandblasting the turned titanium surface of the implant with large grit particles ranging from 250 to 500 micrometer. Later, the surface is acid etched with hydrochloric, sulfuric, or nitric acids. This method has been clinically shown to induce good osteogenesis and is the most frequently used surface modification in current-day implant dentistry.

B. Anodic Oxidation: In the titanium layers of the dental implant, titanium oxide or TiO2 that is spontaneously formed when the implant surface is exposed to the atmosphere is what makes it biocompatible in the oral cavity. This titanium oxide layer is not only thickened but also stabilized, and histomorphometric analysis has shown that there are lower rates of implant failure when the titanium surface is anodized.

C.Hydroxyapatite Coated Implants: The main component of the bone is the hydroxyapatite; research deems such an HA-coated particle layer to be biocompatible with the alveolar bone so that there is direct contact between osteoblast and coated surface. However, the major issue with such implant surface is that these HA particles may wear off; instead of promoting bone healing, they can provoke ab Inflammatory host response leading to the failure phenomenon of the implant in the load-bearing or the stress-bearing areas.

D. Nano Level Modification Methods: Other methods have also been recently implemented in implant dentistry so that the osteogenic cells can be programmed at a nanoscale level to be biocompatible with the implant's titanium surface. These methods include titanium dioxide nanotube arrangements, fluoride treatments, ultraviolet photofunctionalization, and coatings with functional peptides. These research methods are a developing area in the field of implant dentistry.

Conclusion:

To conclude, the surface modification of dental implants is considered a significant advance to reduce any form of host inflammation or enhance connective tissue formation so that the dental implants are osseointegrated and biocompatible. However, as it is a developing arena of implant dentistry, the ongoing research in surface modification of implant surfaces holds promising future results.

Frequently Asked Questions

1.

What Methods Can Be Used to Modify the Surface of Implants?

Various methods can be used to modify the surface of implants, including physical, chemical, and biological approaches. Physical methods involve altering the surface topography, such as sandblasting or etching. Chemical methods involve modifying the surface chemistry, such as depositing a coating or creating a surface oxide layer. Biological methods involve modifying the surface to encourage tissue growth or prevent bacterial attachment.

2.

How Does the Roughness of the Surface Affect Medical Implants Made of Titanium?

The roughness of the surface of medical implants made of titanium can affect their integration with the surrounding tissue. Rougher surfaces have been shown to promote osseointegration, the process by which bone grows around and integrates with the implant. However, excessively rough surfaces can cause increased wear and tear on the implant and surrounding tissue, leading to inflammation and implant failure. Therefore, finding an optimal level of roughness is crucial for successful implant integration.

3.

Why Are Implants Modified on Their Surface?

Implants are modified on their surface to improve their biocompatibility, reduce the risk of implant failure, and promote osseointegration. Surface modifications can also enhance the mechanical stability of the implant and provide a better platform for drug delivery. By modifying the surface of implants, it is possible to address some key challenges associated with implantation, such as implant rejection and bacterial infection.

4.

What Are the Factors That Can Cause Damage to Titanium?

Several factors can cause damage to titanium, including chemical corrosion, mechanical wear, and high temperatures. Corrosion can occur due to exposure to acidic or alkaline environments or the presence of other metals. Mechanical wear can be caused by friction and stress, releasing debris that can cause inflammation and tissue damage. High temperatures can cause titanium to lose its strength and mechanical properties, making it more susceptible to wear and tear.

5.

What Are the Disadvantages of Using Titanium as an Implant Material?

While titanium is a commonly used material for implants due to its biocompatibility and corrosion resistance, it does have some disadvantages. Titanium is relatively expensive and can be difficult to shape and work with compared to other materials. Additionally, titanium implants can cause imaging artifacts in certain medical imaging techniques, making diagnosing potential complications or issues more challenging.

6.

What Are the Three Categories That Surface Modifications for Implants Fall Under?

Surface modifications for implants generally fall under three categories: physical, chemical, and biological. Physical modifications involve altering the surface topography, such as sandblasting or etching. Chemical modifications involve modifying the surface chemistry, such as depositing a coating or creating a surface oxide layer. Biological modifications involve modifying the surface to encourage tissue growth or prevent bacterial attachment.

7.

Which Coatings Can Be Applied to Titanium Alloys Used for Implants?

Several coatings can be applied to titanium alloys used for implants, including hydroxyapatite, calcium phosphate, and diamond-like carbon. These coatings can improve the biocompatibility of the implant, enhance osseointegration, and reduce the risk of bacterial attachment. Additionally, some coatings can provide a better platform for drug delivery, making it possible to administer therapeutic agents to the implant site locally.

8.

What Are the Different Types of Surface Treatments Available for Implants?

Several surface treatments are available for implants, including sandblasting, acid etching, plasma spraying, and laser treatments. Sandblasting and acid etching involve altering the surface topography of the implant, while plasma spraying and laser treatments can create a surface coating. Each treatment has unique benefits and drawbacks, and the appropriate treatment will depend on the implant's and the patient's specific requirements.

9.

What Is Considered to Be the Ideal Surface for Implants?

The ideal surface for implants depends on the intended application of the implant. Ideally, an ideal surface should be biocompatible, promote osseointegration, resist corrosion and wear, and minimize bacterial attachment. Achieving an optimal level of roughness is also critical for successful implant integration. To ensure the best possible outcome, surface modifications can be tailored to specific implant types and patient needs.

10.

Which Type of Toothpaste Is Recommended for Cleaning Titanium Implants?

For cleaning titanium implants, it is recommended to use a non-abrasive toothpaste or a neutral pH solution. Abrasive toothpaste or acidic solutions can damage the implant's surface and increase the risk of bacterial attachment. Additionally, it is important to avoid using metal objects or brushes to clean the implant, as these can scratch the surface and create areas for bacterial growth.

11.

Is It Possible for Bacteria to Grow on Titanium Implants?

While titanium is generally resistant to bacterial attachment, it is still possible for bacteria to grow on the surface of implants. Bacterial attachment can cause inflammation and lead to implant failure. Therefore, it is important to maintain proper hygiene and regularly clean the implant to minimize the risk of bacterial attachment. Additionally, surface modifications can further reduce the risk of bacterial attachment.

12.

What Is the Process of Passivation for Titanium Implants?

Passivation is a process used to enhance the corrosion resistance of titanium implants. It involves the creation of a thin oxide layer on the implant's surface, which protects it from corrosion and wear. The passivation process typically involves exposing the implant to an oxidizing agent or a high-temperature treatment. Passivation can improve the longevity and performance of the implant, reducing the risk of complications and implant failure.

13.

What Is the Recommended Roughness for Implant Surfaces?

The recommended roughness for implant surfaces varies depending on the type of implant and its intended application. Generally, a surface roughness between 0.2 and 2 microns is optimal for promoting osseointegration and reducing bacterial attachment. An appropriate level of roughness can be achieved through various surface treatments, including sandblasting, acid etching, and plasma spraying.

14.

What Is the Purpose of Surface Modification for Implants?

The purpose of surface modification for implants is to enhance their biocompatibility and promote successful integration with the surrounding tissue. Surface modifications can also improve the mechanical properties of the implant, reduce the risk of bacterial attachment, and enhance the delivery of therapeutic agents to the implant site. By modifying the surface of implants, it is possible to improve their performance and longevity, reducing the risk of complications and improving patient outcomes.
Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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