surface configuration of implant -...

2009-09-18

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Surface configuration of ImplantSurface configuration of Implant

Department of Periodontology, SNU

Chung, Jae-eun

Challenges in Challenges in ImplantologyImplantology

Improve Techniques Improve Tools

Implants in marketImplants in market

Revolutionary implantNano-technology

Accelerate osseointegrationPromote osseointegrationgSpeed up osseointegrarion

OsteoconductiveThe latest advancement in implant dentistry

Quality of dental implantsQuality of dental implants

Quality of dental implants

• Substantial number of claims made by different manufacturers on alleged superiority due to design and characteristics are not based on sound and long-term clinical scientific research

Jokstad et al. Int Dent J 2003;53:409-443

Race for the surfaceRace for the surface

IONS

POLYSACCARIDES

IMMUNOGLOBULIN

S f Ch t i tiPROTEINS

FIBROBLASTS

CHONDROBLASTS

OSTEOBLASTS

Surface Characteristics

Topography+Chemistry

Endosseous Surface Surface Ch i

BiomimeticA hHealing Topography Chemistry Approach

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Surface Surface Ch i

BiomimeticA h

EndosseousEndosseousTopography Chemistry ApproachHealingHealing

Distance osteogenesisContact osteogenesis

Mechanism of Mechanism of EndosseousEndosseous healinghealing

Osborn & Newesely, Biomaterials 1980;1:108-111

Distance Distance OsteogenesisOsteogenesis

Bone approximating the implant surface• Cortical bone• Osseointegration of “Machined” implant

Contact Contact OsteogenesisOsteogenesis

Bone apposition to the implant surface• In poor quality bone, Surface• Osteoconduction• De novo bone formation (Cement line matrix)

Blood cells

OsteoconductionOsteoconduction in in Contact Contact OsteogenesisOsteogenesis

GP IIb/IIIa Rc

Park & Davies. COIR 2000;11:530-539Nygren et al. J Lab Clin Med 1997;129:35-46

Broberg et al. J Lab Clin Med 2002;139:163-172Bromberek et al. Exp Cell Res 2002;275:230-242

Fibrin : The transitory matrix

OsteoconductionOsteoconduction in in Contact Contact OsteogenesisOsteogenesis

Graves et al. Connective Tissue Res 1989;23:209-218Daives. Anat Rec 1996;245:426-45

DAE Machined

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Bone implant interface• Interfacial matrix

De novo De novo Bone Formation in Bone Formation in Contact Contact OsteogenesisOsteogenesis

Steflik et al. J Biomed Mater Res 1998;39:611-620Davies. J Dent Edu 2003;67:932-949

Albrektsson & Hansson. Biomateirals 1986;7:201-205

Thickness of Interfacial tissueSS > Mobile Ti > Stable Ti

De novo De novo Bone Formation in Bone Formation in Contact Contact OsteogenesisOsteogenesis

Bone/Implant interface• In vitro modeling

Davies. Anat Rec 1996;245:526-445

Endosseous Surface Ch i

BiomimeticA h

Surface Surface T hT hHealing Chemistry ApproachTopographyTopography

Macrostructure Macrostructure

Thread implant

• Maximize initial contact

• Improve initial stability

• Enlarge implant surface area

• Favor dissipation of interfacial stress

Microthread

Abrahamsson & Berglundh. Clin Implant Dent Relat Res 2006;8:107-113

Microthread

Microstructure Microstructure –– Evaluation Evaluation

Methods of evaluation

Rough ?

Smooth?

Quantitative Evlaluation

Mechanical Contact Profilometer

Optical Profiling(Confocal Laser Scanning

Microscopy)

Scanning Probe Microscope

Wennerberg & Albrektsson. Int J Oral Maxillofac Imp 2000;15:331-344

Resolution level of surface roughness

Kasemo et al. Adv Dent Res 1999;13:11-19


FormForm WavinessWaviness RoughnessRoughness

Where to evaluate?

Wennerberg & Albrektsson. Int J Oral Maxillofac Imp 2000;15:331-344

FlankValley

Top

9 points : 3Flanks 3Tops 3Valleys

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Isotropic? Anisotropic?

2-D vs 3-D

Dong et al. Instrument and measurement techniques of 3d surface topography. Penton Press, 1994:3-63

MicrosturctureMicrosturcture –– Surface ParameterSurface Parameter

Space

Hybird

Height Rq Sa Sq

Sm Scx Str

Δq SΔq Sdr

Ra

Surf. Smooth V10d30p V3d30p H22d30p H10d30p H10d39p H3d30p H3d7p

EpiAtt(㎛)

248 304 319 121 152 159 2-8 195

Direc-tion

y q Δq dr

Chehroudi et al. I Biomed Mater Res 1990;24:1203-1219

Effect of Surface RoughnessEffect of Surface Roughness

4 weeks healing

Abrahamsson et al. Clin Oral Imp Res 2004;15:381-392

4 weeks healing

Effect of Surface CharacteristicsEffect of Surface Characteristics

Platelet Activation

Protein Adsorption

Surface Surface

Surface Roughness

Surface Surface EnergyEnergy

Surface Chemistry

Matrix Production

Cell AdhesionCell Proliferation

Cell Differentiation

Protein adsorption


MachinedMachined

Sela et al. Clin Oral Impl Res 2007;18:630-638

Acid EtchingAcid Etching

Acid Etching Acid Etching + Blasting+ Blasting


Platelet activation

DAEDAE 320 Grit320 Grit MachinedMachined PolishedPolished

Park et al. Biomaterials 2001;22:2671-2682

DAEDAE

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ALP : early marker of OB diffOsteocalcin : late marker of OB diffType I collagen : indicator of synthetic capacityRunx-2(Cbfα-1), Osterix


Osteoblast response

Sandblasting (Al2O3)

Orsini et al. Int J Oral Maxillofac Impl 2000;15:779-784

Acid etching (1%HF+30%NitricAcid)


Osteoblast response

TurnedSa = 0.20 ㎛

Blasted with63-90㎛ particlesSa = 0.72 ㎛

Mustafa et al. Clin Oral Impl Res 2001;12:515-525

Sa 0.72 ㎛




Osteoblast response

Cbfa1 UMR Cbfa1 RCOB

Schneider et al. J Dent Res 2003;82:372-376

BSPⅡ UMR BSPⅡ RCOB


OB/FB response

Rat Calvaria OB Human Gingival FB

Kunzler et al. Biomaterials 2007;29:2175-2182


OB/FB response

Sb, Ra=5.70㎛ 09㎜, Ra=1.12㎛ SLA, Ra=3.00㎛ Thermanox, Ra=0.04㎛

Osteoblast

Kunzler et al. Biomaterials 2007;29:2175-2182

Fibroblast

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Surface Surface Ch iCh i

Endosseous Surface T h

BiomimeticA hChemistryChemistryHealing Topography Approach

Titanium Oxide LayerTitanium Oxide Layer

OX

IDE

OX

IDE

Corrosion ResistancePassivation abilityIONS

POLYSACCARIDES

IMMUNOGLOBULIN

AmorphousHomogenous

2-17㎚Thickness ∝ Crystalline

Tengval et al. Clin Mater 1992;9:115-134

E LA

YE

R

E LA

YE

RPROTEINS

FIBROBLASTS

CHONDROBLASTS

OSTEOBLASTS

Thickness Crystalline

Chemically modified titanium oxides Chemically modified titanium oxides FluorideFluoride

FluorideFluoride

TiO2 grit blasting Grit blasting + HF Grit blasting + EtchingGrit blasting + Etching + Rinsing(N2) + NaCl

Masaki et al. Clin Oral Impl Res 2005;16:650-656

FluorideFluoride

Control Fluoride-mod

1mo3mo

Ellingsen et al. Int J Oral Maxillofac Impl 2004;19:659-666

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FluorideFluoride

Non-modifiedBIC % = 34.21%

Actin

Collagen

Osteopontin

Cooper et al. Biomaterials 2006;27:926-936

Fluoride-modifiedBIC % = 55.45%

Osteocalcin

BSP

BMP

BiomimeticBiomimeticEndosseous Surface Ch i

SurfaceT h ApproachApproachHealing ChemistryTopography

Agents for Agents for BiomimeticBiomimetic ApproachApproach

BMP , RGDType 1 Collagen

HA, Calcium phosphate phases

Chitosan : glucosamine + N-acetyl glucosamin

Fluoride

Avila et al. Implant Dent 2009;18:17-26

BioceramicsBioceramics

HOW to coat implant surface with Ca-P ?

Plasma Spraying

Biomimetic Coating (Simulated Body Fluid)

Janet et al. Perio 2000 2006;41:157-176

Ca10PO4(OH)2

Bio –ACTIVE Implant for chemical BONDING

BiomimeticBiomimetic Coating of CaCoating of Ca--PP

Barrère et al. Bone 1999;25Supp:107s-111s

SBF0SBF0 SBF1SBF1 SBF2SBF2 SBF3SBF3

Closer structure to bone mineral than plasma sprayed HA coating

BiomimeticBiomimetic Coating of CaCoating of Ca--PP

OCPOCP BCABCA BCABCA

BCABCAOCPOCP

Wang et al. Biomaterials 2004;25:583-592

Modification of SBF Different mineral phaseSolubility & Attachment of bone marrow stromal cell

BCABCAOCPOCP

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Bioactive Protein Bioactive Protein -- BMPBMP

HOW to immobilize BMPs on titanium surface ?

Use AllyamineIncorporation BMP into biomimetic Ca-P

Thin amorphous layer of Ca-P Subsequent growth of thick crystalline lattice work

Ti6Al4V plateTi6Al4V plate SBF with MgSBF with Mg2+2+ Supersaturated CaSupersaturated Ca--P P + BMP+ BMP

Liu et al. Tissue eng 2004;10:101-108

Rh-BMP2

+ BMP+ BMP

Alkaline phophatase activity

SYPRO Ruby protein blot staining

Bioactive Protein Bioactive Protein -- RGDRGD

8wks, 8wks, Ti_RGDTi_RGD

Arg-Gly-Asp (RGD)

In ECM proteinsHigh affinity for integrinAdhesion of OB-like cell

Ti disk coated with 100M RGD in PBSImplanted in Rat calvaria

Kroese-Deutman et al. Tissue Eng 2005;11:186

8wks, Ti 8wks, Ti

2,4,8 weeks, evaluaion

CommentComment

Implant in Suboptimal condition

Faster osseointegration

Stronger bone-implant interface

Surface roughnessSurface roughness

Surface chemistry

Biomimetic approach

경청해경청해 주셔서주셔서 감사합니다감사합니다

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Effect of Surface ??Effect of Surface ??

Ivanoff et al. COIR 2001;12:128-134

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surface configuration of implant -...

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