|Year : 2010 | Volume
| Issue : 3 | Page : 433-438
|Status of surface treatment in endosseous implant: A literary overview
Ankur Gupta, M Dhanraj, G Sivagami
Department of Prosthodontics and Oral Implantology, Saveetha Dental College, Saveetha University, Chennai - 600 077, India
Click here for correspondence address and email
|Date of Submission||03-Sep-2009|
|Date of Decision||09-Oct-2009|
|Date of Acceptance||04-Mar-2010|
|Date of Web Publication||29-Sep-2010|
| Abstract|| |
The attachment of cells to titanium surfaces is an important phenomenon in the area of clinical implant dentistry. A major consideration in designing implants has been to produce surfaces that promote desirable responses in the cells and tissues. To achieve these requirements, the titanium implant surface can be modified in various ways. This review mainly focuses on the surface topography of dental implants currently in use, emphasizing the association of reported variables with biological outcome.
Keywords: Bone implant interface, surface topography, surface chemistry, adhesion molecules, hydroxyapatite coating, sputtering
|How to cite this article:|
Gupta A, Dhanraj M, Sivagami G. Status of surface treatment in endosseous implant: A literary overview. Indian J Dent Res 2010;21:433-8
Over the past three decades, significant advances have occurred in the clinical use of oral and maxillofacial implants. Statistics on the use of dental implant reveal that about 100,000-300,000 dental implants are placed per year,  which approximates the numbers of artificial hip and knee joints placed per year.  Implants are currently used to replace missing teeth, rebuild the craniofacial skeleton, provide anchorage during orthodontic treatments and even to help new bone formation in the process of distraction osteogenesis.
|How to cite this URL:|
Gupta A, Dhanraj M, Sivagami G. Status of surface treatment in endosseous implant: A literary overview. Indian J Dent Res [serial online] 2010 [cited 2019 Sep 15];21:433-8. Available from: http://www.ijdr.in/text.asp?2010/21/3/433/70805
Despite the impressive clinical accomplishments with oral and maxillofacial implants-and the undisputed fact that implants have improved the lives of millions of patients-it is nevertheless disquieting that key information is still missing about fundamental principles underlying their design and clinical use. With some important exceptions, the design and use of oral and maxillofacial implants has often been driven by an aggressive marketing environment rather than by basic advances in biomaterials, biomechanics or bone biology. Hence, it is important to comprehensively navigate the various factors controlling the success of dental implants.
Among the several parameters influencing the success of the implants, implant bone interface plays a crucial role in prolonging the longevity and effective function of the implant-supported prosthesis. There are several modalities to improve bone implant interface to promote faster and more effective osseointegration.
| Controlling the Bone Implant Interface by Biomaterial Selection and Modification|| |
Different approaches are employed to obtain desired outcomes at the bone-implant interface. As a general rule, an ideal implant biomaterial should present a surface that will not disrupt, and that may even enhance, the general processes of bone healing, regardless of implantation site, bone quantity and bone quality.  As described by Ito et al.,  the approaches to alter implant surfaces can be classified as physicochemical, morphologic or biochemical.
| Physicochemical Method|| |
It mainly 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 method, which increases the cell adhesion properties. The role of electrostatic interaction in biological events is mainly proposed to be conducive to tissue integration. , But, on the contralateral side, it has been found that it does not help in adhering selective cells/tissues and it has not been shown to increase the bone implant interfacial strength. 
| Morphological Methods|| |
It mainly deals with alteration of surface morphology and roughness to influence cell and tissue response to implants. Many animal studies support that bone ingrowth into macro rough surfaces enhances the interfacial and shear strengths. 
In addition, surfaces with specially contoured grooves can induce contact guidance,  whereby direction of cell movement is affected by morphology of substrate. The added advantage is that this method prevents the epithelial downgrowth on dental implants. 
The two categories of surface characteristics commonly cited for determining tissue response are:
- Surface topography/morphological characteristics.
- Chemical properties.
Surface topography can produce orientation and guide locomotion of special cells, and has the ability to directly affect their shape and function.
Implant surfaces have been classified on different criteria, such as roughness, texture and orientation of irregularities.
There are several advantages of increasing surface roughness:
- Wennerberg and coworkers  have classified implant surfaces based on the surface roughness as:
- Minimally rough (0.5-1 μm)
- Intermediately rough (1-2 μm)
- Rough (2-3 μm)
- Based on texture obtained, the implant surface can be divided as:
- Concave texture (mainly by additive treatments like hydroxyapatite (HA) coating and titanium plasma spraying)
- Convex texture (mainly by subtractive treatment like etching and blasting)
- Based on the orientation of surface irregularities, implant surfaces are divided as:
- Isotropic surfaces: have the same topography independent of measuring direction.
- Anisotropic surfaces: have clear directionality and differ considerably in roughness.
Advantages of increased roughness:
Different methods have been described in the literature that increase the surface roughness, such as:
- Increased surface area of implant adjacent to bone.
- Improved cell attachment to bone.
- Increased bone present at implant interface.
- Increased biochemical interaction of implant with bone.
They are explained briefly as follows:
- Blasting :
- Chemical etching
- Porous surfaces
- Plasma-sprayed surfaces
- Ion-sputtering coating
- Anodized surface
- HA coating
- Blasting:Blasting implant surface with particles of various diameters is one of the frequently used methods of surface alteration. 
It is mainly performed by Al2 O3  and TiO2, with particle size ranging from small, medium to large (150-350 μm) grit. Roughness depends on particle size, time of blasting, pressure and distance from the source of particle to the implant surface.
Advantages of blasting
Studies have inferred that it allows adhesion, proliferation and differentiation of osteoblasts,  and it has also been noticed that fibroblasts adhere to the surface with difficulty and hence could limit soft tissue proliferation  and increase bone formation.
Although blasting is the most commonly used modality for increasing the surface roughness, its use has been limited due to the following reasons.
Al2 O3 particles are left after blasting. Studies have presented mixed results regarding its presence. It was reported in catalyzing osseointegration  by few authors and others have shown that the aluminum ion particles could impair bone formation by a possible competitive action with calcium ions.
- Chemical etching: The metallic implant is immersed into an acidic solution, which erodes its surface, creating pits of a specific diameter and shape. Acid-etching produces micropits on the titanium surfaces, with sizes ranging from 0.5 to 2 μm in diameter.
Immersion of titanium implants for several minutes in a mixture of concentrated HCl and H2SO4 heated above 100°C (dual acid etching) is employed to produce a microrough surface. This type of surface promotes rapid osseointegration while maintaining long-term success over 3 years.
The concentration of the acidic solution, time and temperature are factors determining the result of a chemical attack and microstructure of the surface.
Various modifications on the technique have been employed, such as
- Dual acid-etched technique:  Proposed to produce a microtexture rather than a macrotexture. It has been found that dual acid-etched surfaces enhance the osteoconductive process through the attachment of fibrin and osteogenic cells, resulting in bone formation directly on the surface of the implant.
Advantage of the dual acid-etched technique is in higher adhesion and expression of platelet and extracellular genes, which help in colonization of osteoblasts at the site and promote osseointegration.
- Sandblasted and acid-etched (SLA) method: The abbreviation SLA, as introduced by Buser et al. in a histomorphometric study in 1991, stands for sand-blasted, large grit, acid etched.
- The surface is produced by a large grit 250-500-μm blasting process followed by etching with hydrochloric/sulfuric acid. Sandblasting results in surface roughness and acid etching leads to microtexture and cleaning. ,, These surfaces are known to have better bone integration as compared to the above-stated methods.
- Porous surfaces: 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. Advantages of this method are as follows:
- A secure 3D interlocking interface with bone is observed.
- Predictable and minimal crestal bone remodeling.
- Short healing time.
- Provide space, volume for cell migration and attachment and thus support contact osteogenesis.
- Plasma-sprayed surfaces: This process involves the heating of HA by a plasma flame at a temperature of approximately 15,000-20,000 K and HA is propelled onto the implant in an inert environment like argon to a thickness of about 50-100 μm. Advantages are:
- Reported to increase the surface area of bone implant interface and act similar to the 3D surface, which may stimulate adhesion osteogenesis. ,
- Surface area to increase by 600%.
- Increases tensile strength of the bone implant interface. 
- Improves primary stability.
- Ion-sputtering coating: It is the process by which a thin layer of HA 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. ,
- Anodized surface: 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. 
- HA coating: ,,,, HA coating was brought to the dental profession by De Groot. 
Advantages of HA coating are
- For type 4 bone (based on Misch and Judy classification).
- Fresh extraction sites.
- Newly grafted sites.
Disadvantages of HA coating are:
- HA coating can lower the corrosion rates of the same substrate alloys.
- HA coating can be credited with enabling to obtain improved bone implant attachment. ,
- Have higher success rates in the maxilla.
- Being osteoconductive in nature, more bone deposition is noted.
- Delamination of coating leads to failure of implant. 
- Dissolution/fracture of HA coating results in failure.
- Predisposes to plaque retention.
Various methods of HA coating have been described, which are as follows
Various techniques of sputtering have been elicited in the literature, the important ones being described below:
- Functionally graded coating:  The main disadvantage of plasma spraying coating is delamination. But, this disadvantage is overcome by the use of HA along with Ti6Al4V.  The coating becomes mechanically strong, bioinert and biocompatible.
- Antibiotic coating: Gentamycin along with the layer of HA can be coated onto the implant surface. Gentamycin acts as a local prophylactic agent along with systemic antibiotics in dental implant surgery.
- Laser ablation technique: ,, To control the morphology of coating of HA, i.e. either crystalline or amorphous, this technique is best suited.
- Pulsed laser deposition (PLD): , PLD is a unique physical vapor deposition process that uses a pulsed laser such as KrF to ablate the target material, forming a highly energetic plume that deposits the film onto the substrate.
The PLD technique involves three main steps: ablation of the target material, formation of a highly energetic plume and the growth of the film on the substrate. A high-power laser is used as an energy source to vaporize a target containing components of the desired film. When the laser radiation is absorbed by a solid surface, electromagnetic energy is converted into electronic excitation as well as chemical, mechanical and thermal energy to cause evaporation and plasma formation.
The ablation of the target forms a plume of energetic atoms, electrons, ions and molecules. Inside the dense plume, the collisional mean free path is exceptionally small. Immediately after ablation, the plume expands from the target with in vacuum toward the substrate surface. This is the latest method of coating HA onto an implant surface. HA is deposited onto pure Ti substrates at 400 o C in a water vapor and oxygen atmosphere, the pressure valve being in the range of 3.5 .10 -1 -10 -1 torr.
- Sputtering: ,, It is a process whereby, in a vacuum chamber, atoms or molecules of a material are ejected from a target by bombardment of high-energy ions. The dislodged particles are deposited on a substrate also placed in a vacuum chamber. There are various sputtering techniques, like diode sputtering, ion sputtering, radiofrequent/direct current sputtering, magnetron sputtering and reactive sputtering. All these techniques are variants of the above-mentioned physical phenomenon. However, an inherent disadvantage is that the deposition rate is very slow. The key advantages are:
- High deposition rates.
- Ease of sputtering of most of the materials.
- High-purity films.
- Extremely high adhesion of the films.
- Excellent coverage of highly difficult surface geometry.
- Ability to coat heat-sensitive substrates.
- Ease of automation and excellent uniform layers.
This technique shows strong HA titanium bonding associated with outward diffusion of Ti into the HA layer, forming TiO2 at the interface.
- Ratio frequency sputtering (RF) technique: This technique involves the deposition of HA in thin films. , Studies have shown that these coatings were more retentive, with the chemical structure being precisely controlled. The other major advantage of this technique is that the design of the implant, particularly threaded implant, is maintained.
- Magnetron sputtering: , Magnetron sputtering is a viable thin-film technique as it allows the mechanical properties of Ti to be preserved while maintaining the bioactivity of the coated HA. Films were deposited in a custom-built sputter deposition chamber at room temperature. The chamber was evacuated to a base pressure lower than 10_7 Torr. High-purity argon (Ar) gas was then back-filled into the chamber, bringing the working pressure to 5*10_3 Torr. A constant flow of Ar was supplied into the chamber during the deposition process.
Surface chemistry/chemical properties: Commercially pure titanium and Ti-6Al-4V are commonly used dental implant materials, although new alloys containing niobium, iron, molybdenum, manganese and zirconia have been developed.
The biomaterial surface interacts with water, ions and numerous biomolecules after implantation. The nature of these interactions, such as hydroxylation of the oxide surface by dissociative adsorption of water, formation of an electrical double layer and protein adsorption and denaturation, determine how cells and tissues respond to the implant. ,,
Biochemical methods: These methods offer an alternative/adjunct to physiochemical and morphological methods. This method mainly endeavors to utilize current understanding of biology and biochemistry of cellular function and differentiation. ,,,,,,
The goal of biochemical surface modification is to immobilize proteins, enzymes/peptides on the biomaterial for the purpose of inducing specific cell and tissue response or, in other words, to control the tissue implant interface with molecules delivered directly to the interface. 
Two main approaches have been suggested to achieve the above-stated goal:
- The first approach is mainly directed to control cell-biomaterial interaction utilizing cell adhesion molecules. A particular sequence, i.e. Arg-Gly-Asp(RGD) has been known to act as a mediator of attachment of cells to several plasma and extracellular matrix proteins, including osteopontin, bone sialoprotein, fibronectin, etc., and researchers are trying to deposit this particular sequence onto an implant to modulate the interface.
- The second approach mainly deals with the biomolecules with demonstrated osteotropic effects, and molecules like interleukin, growth factor 1 and 2, platelet growth factor, BMP, etc. are known to have this effect.
| Drug-Coated Implants|| |
As one of the chemical treatments, tetracycline-HCl functions as an antimicrobial agent capable of killing microorganisms that may be present on the contaminated implant surface. It also effectively removes the smear layer as well as endotoxins from the implant surface. Further, it inhibits collagenase activity, increases cell proliferation as well as attachment and bone healing. 
Finally, it enhances blood clot attachment and retention on the implant surface during the initial phase of the healing process and thus promotes re-osseointegration.
| Conclusion|| |
Dental implants are valuable devices for restoring lost teeth. Implants are available in many shapes, sizes and length, using a variety of materials with different surface properties. Among the most desired characteristics of an implant are those that ensure that the implant-tissue interface will be established quickly and can be maintained. The various methods of modifying the implant surface have been listed, and these techniques have greatly influenced the quality of clinical service in implant prosthodontics.
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Department of Prosthodontics and Oral Implantology, Saveetha Dental College, Saveetha University, Chennai - 600 077
Source of Support: None, Conflict of Interest: None
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