Implant Materials,

Designs, and
Surface
Topographies
Dr. Abdullah Alkeraidis
BDS, Prostho (cert), Msc, Dental Implant (Cert), FICOI
Consultant in prosthodontics, RDC

Implant materials

Biotolerant
not

necessarily rejected when implanted into living tissue,

but are surrounded by a fibrous layer in the form of a capsule

Bioinert
close

apposition of bone on their surface,

leading to contact osteogenesis

Bioactive
the

formation of new bone onto their surface,but ion exchange

with host tissue leads to the formation of a chemical bond along
the interface (bonding osteogenesis)

The best defention of biochemical bonding

mode of implant anchorage is:
bioactivity is the characteristic of an implant
material which allows it to form abond with living
tissue

Osteoconductive

(Bioinert & Bioactive )

scaffolds allowing bone growth on their surfaces

Osteoinductive

recombinant human bone morphogenetic protein 2

(rhBMP-2)
the capacity to induce bone formation de novo
Biotolerant,

bioinert, and bioactive materials are all

biocompatible by definition and result in a

predictable host response in specific application.

Ti is the material of choice for

intraosseous applications
- high passivity
- controlled thickness
- rapid formation
- ability to repair
- resistance to chemical attack
- catalytic activity
- modulus of elasticity
Parr GR,Gardner LK,Toth RW. Titanium:The mystery metal of implant
dentistry.Dental materials aspects. J Prosthet Dent 1985;54(3):410414

Titanium toxicity
Although titanium ions have been shown to enter

the peri-implant bone and the regional lymph

nodes, kidneys, lungs, and liver, titanium and it is
alloys have proven to be extremely biocompatible.
Titanium-aluminum-vanadium alloy (Ti6Al-4V) is

used commonly for orthopedic and oral implants

with very few report of titanium sensitivity.

 The high corrosion resistant and biocompatibility of

titanium are the result of a thin surface film of

titanium dioxide (TiO2)
TiO2 have shown no toxic or carcinogenic effects.
High fatigue strength (>600 MPa)

Implant design

Shape
Cylinder: press-pit
straight cylinder
trapezoid cylinder with step or thread
straight wall
finned taper design
Thread : self tap
V shape
Reverse buttress thread
microthread
round thread

Implant surfaces

manufacture

procedure

shape

material

surface

Branemark

Nobelbiocare (sweden)

screw

Pure Ti

machined

ITI

Strauman
(swiss)

1
2

Screw
cylinder

Pure Ti

TPS, SLA

Steri-Oss

Nobel
biocare

1
2

Screw
cylinder

Ti6Al4V

TPS
HAP coat

Sulzer

Sulzer(USA)

1
2

screw

Pure Ti

HAP coat
blast

Astra

Astra
(Sweden)

1
2

screw

Pure Ti

Tioblast

Endopore

Innova(Canada)

cylinder

Ti6Al4V

Porous coat

Bicon

Bicon(USA)

pine

Ti6Al4V

Machined
TPS

3i

Implant
innovation(USA)

Screw
cylinder

Pure Ti

Machined
Acid etching

Success
Branemark

92%(5y Mx), 99%(5y Mn), full eden Adell 1990

96.6%(5y) partial eden, Van steenberghe 1990
97.2%(5y) Mx & Mn post, Jemt, 1993
98.9%(10y, 15y) Mn eden, Linquist 1996
100% (5y) Mn, Henry 1996

ITI

88.0%(8y)Mx &Mn Babbush 1986

96.2%(3y) Mx &Mn Buser 1992
96.7%(8y) Mx &Mn Buser 1997

3i

97.3%(4y Mx), 98.2%(4yMn) Faehn 1995

93.3(5y Mx), 97%(5y Mn) Lazzara 1996
96.6%(3y Mx & Mn) Sullivan 1997

Astra

97.8%(8y) Mn full eden , Arvidson 1990

100% (2y) single missing,karlsson 1997
100%(3y) partial eden, Palmer 1997
100%(3y) Mx post ,Ellegard 1997

Sulzer(calcitek)

97.3%(8y ), Mx & Mn Kent 1990

97.0%(Mx 5y), 98.0%(Mn 5y) Stulz 1997
81.4%(8y) Mx & Mn, Wheeler 1996

Types of implant Surfaces

Scope
Implant-tissue interface
Effect of surface properties on cell response
Surface properties and composition
Surface modifications
Mechanical,chemical, combination, laser
Surface coatings and properties
Hydroxyapatite, Titanium
Coating Methods
Plasma-sprayed, electrodeposition,
precipitation

Implant
Surfaces
Machined
Surface

Commercially Pure Titanium

Ti-Al-Vanadium
Coated=Added

Rough
Surface

HA

TPS

Uncoated=Subtracted
Acid Etched

Sandblast

TiO2-blast

SLA

Why a

Rough surface ?

1. Wettability ;

increased
2. Surface & Bone-to-implant contact ; increased
3. Mechanical interlocking of bone into implant ; promote
4. Resistance to compression;
increased
5. Tension & Shear strength;
increased

6. Cellular adhesion ;

increased

A) Effect of Surface on Osteoblasts

The surface chemical composition ; almost
identical
Surface roughness effect on Osteoblast
; Proliferation / Differentiation
/ Protein Synthesis of osteoblasts

Alkaline phosphatase matrix activity

; Machined < TPS< SLA
Alkaline phosphatase ; enzyme indicative of
differentiated Osteoblasts

Surface affects the production of osteoblasts

by local factors

B) Effect of Surface on Growth factors

Prostagladin (PGE) & TGF-B production
; Machined < TPS < SLA
The Mechanism is not fully understood.
The surface modulates cell behavior.
= the differences in bone formation
adjacent to surface

Surface topography that effect on

Osseointegration
1. Surface roughness
size
pattern
distribution of peaks & valley

2. Intimacy of bone contact with implant

higher percentage of bone-implant contact

Soft tissue & Surface

Smooth surface ; favor Fibroblasts attachment &

Soft tissue growth

Rough surface ; favor Osteoblasts & ingrowth of
bone
Carlsson ( 1988): Bowers (1992) : Gotfredsen ( 1992)

Titanium oxide layer

Titanium interacts with biologic fluids through its
stable oxide layer,which forms the basis for its
exceptional biocompatibility. When exposed to air,Ti
forms an oxide layer-9 immediately (10 sec) that
reaches a thickness of 2 to 10 nm by 1 sec and
provides corrosion resistance.

Surface modification:
Chemical
Acids
HNO3 (Passivation)
HCl/H2SO4
HF/HNO3
Alkali and heat treatment
NaOH

Surface Modifications:
Mechanical
Grit-blasting with abrasives
Glass bead
Silica (SiO2)
Alumina (Al2O3)
Apatitic abrasive (Principally HA, Ca10
(PO4)6 (OH)2)
Laser texturing

Surface modifications:
Coating
Plasma-sprayed HA
Coating composition: HA+Amorphous
Calcium Phosphate (ACP)
Plasma-sprayed Ti
Hybrid: coated and uncoated

Surface modifications:
Combination of mechanical &
chemical
Sandblasting with medium grit (0.12-

0.25 m) and acid treated with

HF/HNO3
Sandblasting with large grit (0.250.50 m) and acid treated with
HCl/H2SO4
Sandblasting and plasma-spraying
with HA or Ti

Particle size effect on roughness and

pull-out strength: Alumina
Ti surfaces grit-blasted with 25- and 75-

m particles resulted in higher pull out

strength and bone contact in the 75- m
blasted surface
Ti surfaces grit-blasted with 25- and
250- m particles resulted in higher
pull-out strength and bone contact in the
250- m surface
Wenneberg et al. 1996

Objectives of surface modifications

and coatings
Improve osseointegration
Optimize bone cell response
Accelerate bone attachment
Greater bone contact
Provide bioactive surface

6 different surfaces of commercially

pure Ti dental implants
Type E: Electro-polished
Type SMP: Sandblasted with medium grit

(0.12-0.25 m) and acid treated

with HF/HNO3
Type SL: Sandblasted with large grit (0.250.50 m)
Type SLA: Sandblasted with large grit and
acid treated with HCl/H2SO4
Type TPS: Sandblasted then Ti plasma sprayed
Type HA: Sandblasted then HA plasma sprayed

Surface roughness vs. bone

attachment (%)
70

Electro-polished

60
50
40

Medium grit &acid

pickle
SL

30

TPS (coat)

20

SLA

10

HA(coat)

Increasing surface roughness results in increased bone attachment

Surface roughness vs.

removal torque (NCm)
250
200
150

HA
Ti alloy
CP Ti

100
50
0
Maxilla

Mandible

HA-coated implants showed 250%

higher removal torque than
commercially pure or alloyed
titanium

Potential disadvantages of HA
coated implants
Low adhesion strength of coating to

metal substrate
Coating-bone bond stronger than
coating-substrate bond

Disadvantages of plasma-spray
method for depositing apatite
coating
Variability in coating composition

(HA/ACP ratio) within the coating and

among the manufacturers
Line-of-sight method does not provide
uniform coating of surfaces, especially
implant of complex geometry
High temperature does not allow
incorporation of bioactive molecules

Alternatives to plasma-spray
coating method
Electrochemical deposition
Precipitation
Advantages:

Homogenous composition
ability to coat complex geometry
ability to incorporate bioactive
molecules

Effects of surface modification

Provide textured surface
Increase surface area
Improve adherence of coatings
Provide bioactive surface

Optimum surface properties for

maximum osseointegration?
Surface treatment to maximize
surface properties for optimum
osseointegration?

Machine surface
Milling
Mark III, IV. 3i, Restore(basic type)
Roughness of surface
0.53-0.96m
Titanium oxide layer
Increasing bone generation and

antiinflamation
Astra(sweden) machined surfce originally
change to blasted surface

TPS, HA coating
HA coating
Hydroxyapatite powder plasma spray
Initial osteointegration
1.59-2.49m
TPS coating
Coated titanium particle(0.05-0.1mm)with argon
plasma in 1500C, 600m/sec
1.82-2.5m
Irregular rougness
Separate titanium particle in dense bone

Acid etching
Acid etching
Steri-oss, Biohorizon, 3i
3i(double acid etching)

:1.3m

machined surface + rough surface

Frialit-2 synchro stepped screw

Uppermost part
polished collar area(0.4mm) :microgroove in SEM

acid etched(1mm)
Low part acid etched after grit blasting

Blasting
Astra TiO2 blasting
1.3m
Less bone resorption
0.48mm bone resorption in 5years
Makkonen et al, COIR, 1997

Al2O3, TiO2 particle blasting

Restore resorbable blasted media(HA)
1.16-2.20m (ITI)

Resorbable Blast Media (RBM) Surface

Treatment
Improved bone cell contact as compared to
a machine surface
Utilizes biocompatible blast media (calcium
phosphate) for surface roughening
Blast media resorbs during the passivation
process, resulting in an optimum
roughness profile of a pure TiO2 surface
with no surface contaminants
Other roughening processes leave a residue
of silica or ceramic embedded in the
titanium surface
RBM surface treatment is available on all
D1/D2 and D3 implants

Blasting
ITI SLA
acid etching after blasting
Small dimple in large dimple
Blood clot Easily attach
mesenchymal cells differentiate well
Early loading system(6wks)
Machined + SLA

Compare to Double AcidEtched implant

120

110

100

70

80
60

Bone to implant
contact

40
20
0
TiUnite

D-A-E

Removal torque(Ncm) 8weeks

after insertion in dog
mandible

60
50

Bone to implant contact

40
30

TiUnite

20

D-A-E

10
0

Coronal

Apical

Percentage(%) bone to
implant contact at
6weeks in rabbit
femoral bone

0.8

Early stability

0.6
0.3

0.4
0.2
0

TiUnite

D-A-E

Resonance
frequency(kHz)
change between 0 to 6
weeks in rabbit
femoral bone

PORE
Endopore (3 dimensional bone

growth)
150-300m
Sintering spherical particle(44-150m)in
1250C
Type III-IV and short bone height
Loading with short fixture
Mx posterior area. External connection
system

size

Estimated surface
area(mm2)

Endopore

4.1X12mm

781

Branemark

4.0X12mm

248

PORE
Ti-Unite
Electrochemical oxidation
Increasing pore size toward apex
Roughness: coronal: 1-2m
apical:7-8m
External connection

The MTX process does not weaken the titanium implant body,
ensuring that the strength of the implant is maintained.
Furthermore, implant threads are not rounded by the MTX process,
and cutting grooves remain intact for efficient self-tapping
Zimmer Dentals MTX surface allows for increased bone
apposition for long-term success
MTX is a non-coated, microtextured surface created by gritblasting the machined titanium implant surface with Calcium
Phosphate particles, followed by washing in non-etching acid
and distilled water baths to remove residual blasting material.

system

Surface

Branemark MK III, IV

Machined surface

3i

Double acid etching

Restore RBM

Calcium phosphate blasted

ITI

TPS coating ,

Bicon

Uncoated titanium alloy

TPS coating , HA coating

Ankylosis

Blasting surface

Biohorizon

D1:RBM
D2:acid etching after RBM
D3:TPS coating
D4:HA coating

Paragon

SBM(soluble blasted media)

Blasted surface

Top1mm:machined

Astra

TiO2 powder blasted

1.5 m roughness

Steri-oss
Replace

Acid etching
HA coating

Frialit-2

TPS-coating
HA coating
DPS(deep profile surface) grit-blasted and
etched coating

Endopore

Porous surface

Sintering Titanium bead

Upper 1mm smooth surface

Branemark Ti-unite

Titanium oxide layer

Coronal ;small pore, Apical:large pore

SLA

Uppermost thread 2:machined

Acid etching after Sandblasting

Upper 2mm polished

Parameters affecting histologic/biomechanical

data

critical judgment must be exercised

when fair comparisons are attempted

Clinicians must have knowledge of the

cellular and molecular events that lead to
osseointegration, because such knowledge
is essential to relate clinical findings with
basic mechanisms. It is evident that
implants should be carefully
selected,balancing the research information
on their properties with the intended
treatment plan.

Treatment of Implant surface with

different instruments
Periimplant tissue ; more susceptible than the

periodontium to bacteria
High free-surface energy

Rough surface ; 25 times more bacterial adhering than

to smooth surface
Recommend;
Plastic cup and rubber cup; no change to the surface
Cavitron Jet airpolishing;

Restriction
Ti curettes / Gracey curette
Ultrasonic scaler
Reiner Mengel et al ;IJOMI 1998;13:91-96

IMPLANT COMPONENTS
SURGICAL &
RESTORATIVE

Implant Classification
Body geometry
Surface and coatings
Stage
Loading
Scalloped implant
The Abutment Connection

Categories of Restorations
Cement-retained: All-ceramic, PFM, cast gold

* Abutment=>screwed into implant,

* Restorations=> cemented to the abutment
@ cement-retained hybrid prosthesis
Screw-retained : All-ceramic, PFM, cast gold, Hybrid

(by screw to an abutment or directly to an implant)

Overdenture restorations:

with both bar/clip and ball/cap designs

Companies
Noble Biocare
3i
Straumann (ITI)
Innova (Endopore)
Astra

Nobel Biocare

FIXTURE : straight
NP, RP, WP : 10,11.5,13,15mm
RP (4.3mm) : + 18mm
Replace select straight 3mm collar: only

for one stage NP (3.5mm), RP (4.5mm)

3i
surgical

Fixture
Internal : TG, Certain
External : osseotite , oss xp, oss NT
Shape

Straight (Osseotite)
Tapered (NT)

Osseotite(-20mm)/ ICE Super

self tapping(-20mm)
Osseotite XP 3/4 (-20mm)/
miniplant ICE-SST(18,20mm)
Osseotite, ICE SST(+20mm)
Osseotite xp4/5 (-18,-20mm)
/osseote,ICE SST(-20mm)
Osseotite,ICE SST(-18,-20/20mm)

Supracrestal placement
of A two stage implant system
Protocol
Eliminating the countersink procedure
Then, placing the implant app. 1.5mm

longer than the osteotomy

Single stage treatment

with a two stage implant system
No need for 2nd surgery
Reduces trauma
Decreases treatment time
maintains restorative flexibility

3i
Restorative

 Anterior cement- retained :

UCLA wax up
Gingihu prepable
zireal prepable

Anterior Screw-retained :
UCLA
Posterior cement-retained:
UCLA
Gingihue
Posterior screw-retained :
Angled abutment
UCLA

Restorative option for internal sys

ITI

Surgical

ITI
Restorative

Abutment
Solid abutment
Octa abutment
Synocta abutment

Impression for Solid Abutment

3 options
No modification
Modification of abutment
Modification of shoulder

Option A: Impression of no
modification
35 Ncm
Solid abutment screw
Once abutment removed, take a new

impression

Option C: Modification of the

shoulder
Same with conventional method

Impression procedure
two options
Snap on version :standard version
Screw-retained version

ITI : TE
Collar : 1.5 mm H
Insertion depth: 8,10,12,14mm
NP : D 3.5 mm collar H 1.5 mm
RP : D 4.3 mm
WP : D 5.0 mm

Innova
Endopore
Entegra