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248 SURFACE MICROSTRUCTURE OF DENTAL IMPLANTS BEFORE AND AFTER INSERTION  SALERNO ET AL

Surface Microstructure of Dental


Implants Before and After Insertion: An In
Vitro Study by Means of Scanning
Probe Microscopy
Marco Salerno, PhD,* Angelo Itri, MD, DDS,† Marco Frezzato, MSc,‡ and Alberto Rebaudi, MD, DDS§

ral implantology allows for Introduction: The surface micro- implants whose amplitude parame-

O rehabilitation of the odontosto-


matognathic system by surgical
and prosthetic techniques suitable for
structure of dental implants affects
osseointegration, which makes their
accurate topographic characteriza-
ters increased. The surface area
underwent minor changes even
when the texture changed (Tri-Vent,
the insertion of dental implants. To tion important. We defined a proce- Pitt Easy PURETEX, Exp #1). The
restore the lost elements, a prosthetic
dure for evaluation of implant implants that ranked the lowest in
device is designed, manufactured, and
connected with an abutment mounted topography before (pre-) and after all parameters before implantation
onto a dental implant. The long-term (post-) in vitro implantation test in were DT4013TI, Tri-Vent, OT-F1,
success of the implant is determined by bovine bone. and Exp #2. On testing, DT4013TI
several factors1–3 among which os- Materials and Methods: The showed the highest decrease in val-
seointegration4–6 plays a dominant role apical morphology of ten implants ues, whereas Tri-Vent showed the
as pointed out early in the 1970s by was analyzed in pre- and post- highest increase in surface area.
Brånemark.7–9 In addition to biocom- conditions using atomic force All the experimental implants
patible chemistry of the material, the microscopy or 3D profilometry. showed similar topographic prop-
surface morphology of the implant is We extracted four topographical erties both pre- and post-test.
important for both primary stability parameters (two amplitude, 1 spa- Conclusion: For most implants,
and long-term bone integration.10–15 tial, and 1 hybrid) and assessed the no major changes occurred in sur-
Implant designs and surface treatments
differences by analysis of variance. face topography on implantation.
that allow for the best coupling to
bone tissue are required in particular Results and Discussion: The The procedure applied seems prom-
to reduce bone trauma and prosthetic implant with coating (Spline Twist ising to evaluate the degradation of
fractures especially when an immedi- MP-1 HA) was damaged. The two implant surface on insertion.
ate load is applied.4,16,17 implants with highest pre-amplitude (Implant Dent 2015;24:248–255)
We tested seven commercial and parameters (Pitt Easy VTPS, Key Words: dental implants,
three experimental implants and char- TLR3815) maintained their character atomic force microscopy, surface
acterized them morphologically before on testing. Pitt Easy PURETEX and morphology, 3D profilometry,
OT-F1 were the only nondamaged imaging, surface roughness
*Research Technologist, Department of Nanophysics, Istituto
Italiano di Tecnologia, Genova, Italy.
†Private Practice, via Cesarea 2, Genova, Italy.
‡Technologist, Piezosurgery Inc., Columbus, OH.
§Private Practice, piazza della Vittoria 8, Genova, Italy.
(pre-) and after (post-) implantation by test applicability of our procedure for
Reprint requests and correspondence to: Marco Salerno, 3D topographic techniques of profilom- morphological characterization in view
PhD, Department of Nanophysics, Istituto Italiano di
Tecnologia, via Morego 30, I-16163 Genova, Italy,
etry and atomic force microscopy of systematic application.
Phone: +39-(0)10-71781444, Fax: +39-(0)10-7203,
E-mail: marco.salerno@iit.it
(AFM). Our goal was not to identify MATERIALS AND METHODS
the best implant because no clinical
ISSN 1056-6163/15/02403-248 experiments have been carried out, but Samples
Implant Dentistry
Volume 24  Number 3 rather (1) to inspect the amount of Ten implant samples were investi-
Copyright © 2015 Wolters Kluwer Health, Inc. All rights
reserved. change in surface morphology of the gated in a single specimen each (N ¼ 1).
DOI: 10.1097/ID.0000000000000244 implant soon after insertion and (2) to Seven implants were commercial from

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IMPLANT DENTISTRY / VOLUME 24, NUMBER 3 2015 249

Table 1. List of Investigated Implants With Available Information


Bulk
Implant Model Manufacturer Material Surface Treatment Shape
18
Spline twist Zimmer Ti-Al6-V4 Coating with hydroxyapatite type MP-1 Spiral body, with 3-tips
MP-1 HA star flat apex
Tri-vent TRI19 Ti-Al6-V4 Sandblasting with differently sized Zirconia abrading Conical body, with dome
particles at body and apex apex
TLR3815 BioHorizons20 Ti-Al6-V4 Sandblasting with Tricalcium Phosphate Conical body, with dome
apex
DT4013TI Intra-Lock Ti-Al6-V4 (Ossean), sandblasting with Ca Phosphate and acid Cylindrical body, with
System etching dome apex
Europa21
Pitt easy VTPS Sympla22 Grade 4 Ti Ti plasma spray (TPS) carried out in vacuum (VTPS) Cylindrical body, with
dome apex
Pitt easy Sympla22 Grade 4 Ti Nanostructured biomimetic surface, by subtractive Cylindrical body, with
PURETEX means followed by decontamination dome apex
OT-F1 OT medical23 Grade 4 Ti Nanostructured surface by VTPS followed by etching Cylindrical body, with
(NANOPLAST) dome apex
Experimental #1 Eurocoating24 Grade 4 Ti Sandblasting Cylindrical body, with
conical apex
Experimental #2 Eurocoating24 Grade 4 Ti Sandblasting Cylindrical body, with
elliptical flat apex
Experimental #3 Eurocoating24 Grade 4 Ti Sandblasting Flat body with pyramidal
(blade) apex

six different companies, whereas three


were experimental ones from the same
company. The information available on
the investigated implants is reported in
Table 1. Before measurements, the
samples were inspected optically to
check their integrity with a stereomicro-
scope EZD4 (Leica Microsystems,
Wetzlar, Germany).

Implantation
Each implant was inserted into fresh
bovine bone of D1 quality (Misch classi-
fication,25 ;3 cm height and ;8 mm
radial thickness). For insertion of the
screw implants, a hole was first drilled
into the bone at 1300 rpm under continu-
ous cooling jet of physiological solution
with sequential use of different tips up to 3
mm diameter and ;13 mm depth (Fig. 1,
Fig. 1. A, Bovine bone specimen used during site preparation, selected to be D1 type ac- A). The implant fixture was inserted using
cording to Misch classification. B, Typical x-rays micrograph used in some cases to verify that a dynamometric driver set to maximum
the screw head had reached the site base upon implantation. C, Surface damage occurring in 100 N$cm torque. To better comply
the implant Spline Twist MP-1 HA, where the hydroxyapatite coating on apex (white layer) has with the geometrical constraints of
been partly removed upon implantation. D, This micrograph shows the spatial limitation for the analysis by contact probes, the
AFM measurements because of the risk of physical contact between the sample (head of the implant site was undercut of ;0.3
dental implant screw, in the bottom right) and AFM head with glass prisms and probe chip-
holder (top of the picture). In fact, in this case the head touches the sample surface instead of
mm by color bands set on the drill tips.
the probe tip (ie, the free-end of the cantilever pointing from left to right out of the silicon chip A periodontal probe was used to obtain
on the middle left). Similar limitations also apply for the profilometer, even though less critical the best possible contact between
(given the length of the tip, ;4 mm instead of ;15 mm). implant apex and site base. In unclear
cases, we used x-ray micrographs to

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250 SURFACE MICROSTRUCTURE OF DENTAL IMPLANTS BEFORE AND AFTER INSERTION  SALERNO ET AL

verify that the screw head had reached Topographical Measurements with 90 mm scan size collected with scan
the bottom of the hole (Fig. 1, B). For Both pre- and post-samples were rate of 0.3 Hz.
the blade implant (Exp.#3), insertion observed by either AFM or profilometry, After AFM probe landing, single
was obtained by press fit. with a MFP-3D (Asylum Research, test profiles were acquired at the oppo-
Soon after insertion, the implant Santa Barbara, CA) or a XP-2 (Ambios, site limits of the scan area. If during
was removed using the same screw- Santa Cruz, CA) instrument, respec- these line scans the piezo actuator did
driver with inverted torque and with tively. Where possible, we used AFM, not reach either the range limit, the
removal pliers and lateral cutting of which provides better resolution and measurement was started. The implants
bone when required taking care not to sensitivity. The implants were loaded that were not accessible by AFM due to
affect the sample surface. on a sample holder such that the surface Z-size saturation in either direction
The implants were cleaned from of the tip was horizontal by embedding were measured with the profilometer
osseous matter by suspending them them in plasticine. Measurements were with contact set point 0.1 mg, scan
upside down with a floating support in carried out at room temperature in air. profile in both up/down directions,
a cleaning bath and treating ultrasoni- AFM was operated in tapping mode with vertical range 100 mm, scan size
cally at 60°C, first 45 minutes in a 50% probes NSG01 (NT-MDT, Russia), with 1 mm, scan rate 0.07 Hz, filter order 2
vol Tergazyme (Sigma-Aldrich, Milan, silicon cantilevers coated with gold and (ie, 6118 data points), number of pro-
Italy) in deionized (DI) water, then nominal tip aspect ratio and apex radius files 200, step between profiles 5 mm.
20 minutes in acetone, 20 minutes in of 22° and 20 nm, respectively. The set The profilometer tip was a conical taper
ethanol, and 10 minutes in DI water, point was 60% of free amplitude oscilla- of synthetic diamond with terminal
and blowing dry with nitrogen. tion; acquired images were 2562 pixels diameter ;4 mm.

Image Treatment and Selected


Morphological Parameters
The analysis of the implant samples
(both pre- and post-) consisted of three
phases: morphological reconstruction
of 3D sample surfaces from profilom-
eter data, image processing, and statis-
tical analysis of the data. The 200
profilometer scans were assembled into
1 image of the whole 1 3 1 mm2 area
scanned, using an IGOR 6.2 (Wavemet-
rics, Lake Oswego, OR) procedure. For
image processing and analysis, we used
both the AFM program and the image
analysis program SPIP 2005 (Image
Metrology, Hørsholm, Denmark). For
both AFM and profilometer images,
before analysis, an offset plane fitting
the surfaces was removed. The images
obtained from the profilometer, which
have much elongated pixel size in
y-direction and lower resolution, have
been interpolated between adjacent pix-
els for better rendering (see Fig. 2, B).
During the AFM scans, occasion-
ally part of the image area saturated
overcoming the z-range of the instru-
Fig. 2. Typical morphological images used in the current work. A, Topographical map ob- ment and appeared artificially flat.
tained by AFM, with 256 3 256 pixels on a 90 3 90 mm2 area. B, Topographical map ob- When the saturated area was ,15% of
tained by the profilometer on implant Spline Twist MP-1 HA, where the AFM failed due to the the total, it was masked away and only
too high surface roughness, beyond the Z-range of AFM. C, Map of oscillation phase, the nonsaturated part was considered.
simultaneously acquired in the same AFM measurement of topographical map (A): images of When the saturated area was $15%,
these type, which provide a contrast based on the physical-chemical phase of the surface the image was rejected and a new mea-
have been used for postmeasurements to check the uniformity of the material (ie, to exclude
major bone contamination). D, Typical data set (subimage) used for extraction of the values of
surement was made. Only when it was
the selected parameters to be analyzed, for the case of profilometer data images (this image not possible to obtain five acceptable
comes from digital cropping of the red square in (B)). images in different regions among ten,
we moved to the profilometer.

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IMPLANT DENTISTRY / VOLUME 24, NUMBER 3 2015 251

Statistical Analysis due to the longer acquisition time and of 90 3 90 mm2 each. The pixel size
For each implant, the parameters large imaged area, a single image was was 0.618 3 5 mm2 for these images,
were assigned (N ¼ 5) different values obtained for each sample, and from pre- whereas for AFM ones (Fig. 2, C), it
from AFM images of equivalent re- defined positions inside the image (see was 0.352 3 0.352 mm2.
gions. When the profilometer was used, Fig. 2, B), we extracted five subregions For each parameter, mean and SD
were calculated for each implant in pre-
and post-conditions. To evaluate the
statistical significance of the differen-
ces, an analysis of variance (ANOVA)
was performed by Origin 8.0 (Origin-
Lab, Northampton, MA). Pair compar-
isons were carried out based on Tukey
test at significance levels a ¼ 0.05,
0.01, and 0.001.

RESULTS
On AFM scan, only two implants,
Spline Twist MP-1 HA and Pitt Easy
VTPS, saturated the Z-range. This
occurred both in post- and pre-conditions
and therefore was not due to surface
damage on testing. Typical images ob-
tained by AFM and 3D profilometer are
shown in Figure 2, A and B, respectively.
Only implant Spline Twist was
clearly damaged by the test. Soon after
the cleaning after the test, its coating
was partly removed showing macro-
scopic grooves visible by the naked eye
(Fig. 2, C). The effect is ascribed to
delamination probably enhanced by
air cavitation during the cleaning soni-
cation. Despite this macroscopic dam-
age, for the sake of completeness, we
carried out the characterization of post-
conditions also for this implant.
The main result is presented in
Figure 3, where the absolute values of
the four selected parameters are plotted
for both pre- (Fig. 3, A), post-condition
(Fig. 3, B) and again as a relative vari-
ation (Fig. 3, C). When looking at
Figure 3, A and B, the above consider-
ation about Z-range saturation occa-
sionally occurring in AFM for Spline
Twist and Pitt Easy VTPS can be better
understood by observing that the
respective Sq roughness were for both
implants higher than the others.
The raw data plotted have been
analyzed by ANOVA to assess the
Fig. 3. These bar plots graphically represent the values of the four selected surface param- possible statistical significance of the
eters (Sq, S10z, Srw, and Sdr, represented each with a bar of different color) on the ten implant differences. The comparisons between
types considered in this work. A, All samples in condition before, (B) all samples in condition
after, and (C) relative differences for each samples between precondition and postcondition.
each pair of implants, both in pre- and
For (A) and (B), the bar heights are the mean values, and the error bars correspond to 61 SD. post-conditions and between the same
For (C), only the differences between the mean values have been plotted. implant pre-vs-post conditions, have
been carried out. The results of all

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252 SURFACE MICROSTRUCTURE OF DENTAL IMPLANTS BEFORE AND AFTER INSERTION  SALERNO ET AL

comparisons are shown in Figure 4. character with respect to the precondi- • The implants with the highest ampli-
Figure 4, A describes the comparison tion table (Fig. 4, A) have been pointed tude parameters are TLR3815 and
among all implants in precondition: out by plotting on gray background. Pitt Easy VTPS; the latter shows
“0” means not statistically different, Dark gray cells are most significant higher Z-amplitude features,
whereas the different degrees of “1,” corresponding to changes between 0s whereas the former keeps its surface
namely 1, 1*, and 1**, represent statis- and 1s, whereas light gray background parameters almost constant but for
tically different values with increasing points out only the minor differences S10z. Actually, these two implants
significance (P , 0.05, 0.01, and between different levels of 1. Finally, maintain their topography even after
0.001). The table cells at the intersec- we used the same table to also repre- the insertion into the bone.
tion of the same implant header have sent the possible change in character of • Pitt Easy Puretex and OT-F1 are
not been filled as they would all score each implant between pre- and post- the only implants that increment
0 (each implant in the same condition condition. For this purpose, this time their amplitude parameters on test-
of pre or post was not different to it- also, the diagonal line of cells, com- ing, and, to a lesser extent, also the
self). The four scores list the results of paring each implant with itself, has hybrid parameter. The reason is
comparison of the four parameters been filled. In some cases, the same probably that their surface was
considered here in the same order, that implant has undergone significant nanostructured during fabrication.
is, Sq, S10z, Srw, and Sdr, from left to changes (scores from 0 to 1, in dark • All implants exhibit through Sdr
right. gray). only minor variations in surface
In Figure 4, B, the comparison With the exception of implant area, even if the insertion has made
between the implants in postcondition Spline Twist MP-1 HA, which was the surface of implants Tri-Vent,
is reported. The subcells that changed in damaged by the test, we observed that: Pitt Easy Puretex, and Exp.#1
rather different from the preinser-
tion state.
• The topography of DT4013TI is
different from that of the previous
implants because it has lower val-
ues for all the surface parameters
but for Srw. Furthermore, this
implant does not change signifi-
cantly after insertion into the bone
even if a general decrease in the
values of the parameters appears.
• Tri-Vent shows the highest incre-
ment in Srw: obviously insertion
made its surface more folded in
the 3D space.
• All the three experimental im-
plants have similar topographic
properties, in both pre- and post-
condition.

DISCUSSION
Concerning the selected implant
types, because this work is a research
investigation without clinical part, we
Fig. 4. Table describing the results of ANOVA. A, The differences among all implants in
also included a blade vent type even if
precondition, whereas (B) represents the differences among all implants in postcondition. this design has never been proven
Additionally, in (B), also the changes in character of each implant with respect to precondition clinically usable.
have been pointed out, by means of different shades of gray: with dark gray cell background, Concerning the measurement
the samples that presented important changes in character have been stressed (ie, from 0 to 1 methods, previous studies addressing
or 1* or 1**, and vice-versa), whereas in light gray, the minor changes occurred have been surface damage used scanning electron
shown (from 1 to 1* or 1**, or vice-versa). In particular, for this comparison (between pre- microscopy and interferometry.26,27
condition and postcondition for each sample), note that in (B), also the differences of each
implant with itself have been considered (which correspond to the along bottom-left to top-
Despite the high quality of these works,
right diagonal, not showing in (A), where it would read all zero). The significance levels for we believe that a direct measurement of
differences within pre- and post-sets are as follows: *P , 0.05, **P , 0.01. 3D topography28 could better avoid
possible artifacts due to locally different

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IMPLANT DENTISTRY / VOLUME 24, NUMBER 3 2015 253

surface chemistry and optical constants. data analysis.31,32 The more stringent is internally folded. With our selection,
AFM in particular provides higher res- instrumental limitations are lateral and we tried to provide a significant picture
olution and thus higher accuracy. How- vertical size windows and the respective of the implant surfaces.
ever, in both profilometry and AFM, resolutions.33,34 On this topic, Wenner- For the measurements in postcon-
one has geometrical constraints due to berg13 published a guide with best pro- dition, it was important to ensure that
the physical tip-sample contact, which cedures including techniques for data all contaminants, including bone frag-
restricted the analyzed region of the im- filtering. For example, calculation of ments and soft tissues, were removed
plants. It was not possible to reach the the fast Fourier transform has been rec- from the implant surface. For this
recessed regions within the screw ognized important to evaluate the tex- purpose, we sonicated with Terga-
thread where the probe holder would ture to be combined with the spatial zyme, an enzymatic detergent based
contact instead of the tip (Fig. 1, D), parameters through the hybrid parame- on protease that removes organic re-
so we only assessed the screw top (or ters.33–35 Overall, a common opinion is siduals. To independently cross-check
blade sidewall). spread that AFM, now becoming com- the efficacy of the cleaning, we exam-
When we used the profilometer mon also in dentistry, can be the golden ined the AFM phase images. In fact,
instead of the AFM, the Z-range standard for evaluation of micro/ different materials often present dif-
increased from 15 mm to 100 mm at nanotopography.36,37 ferent viscoelastic properties and thus
the expense of resolution. The step The parameters, mathematically different AFM probe oscillation.
between lines of the profilometer image defined, have been selected from more However, in our measurements of
was 5 mm different from the AFM im- than 20 similarly available roughness postsurfaces, no major regions with
ages with isotropic pixel size z350 nm. parameters.35–38 We selected at least 1 different contrast have been identified
In fact, even along the fast scan axis of parameter from the three different clas- (see Fig. 2, C). We conclude that most
the profilometer, the sampling can be as ses of amplitude (Z), spatial (XY), and bone residuals had been successfully
fine as 100 nm, whereas the resolution hybrid parameters (combining both Z removed, and the surfaces measured
depends on the tip size, which we esti- and XY directions). Usually, more after test represented the bare implant
mated to be z500 nm, giving for the emphasis is given in industrial field to surface without overcoating residuals
profilometer effective pixel an y:x amplitude parameters as Sq or Sa. These of contaminants.
aspect ratio z10. quantities define the deviation of the According to the tables in Figure 4,
The lack of statistical validity in surface from a perfectly flat and smooth different groups of statistically different
our experiment due to no use of repli- one in which case they should be both implants can be assigned in both pre-
cates for each implant (N ¼ 1) is of no zero. However, Sq and Sa do not and post-conditions for the various pa-
concern because we did not aim to describe the texture, that is, how the Z rameters. If one identifies these groups
assess what type of implant would per- heights are distributed on the surface. with letters in alphabetical order corre-
form best, but we used different im- For example, a sinusoidal profile with sponding to decreasing parameter val-
plants to test our method towards the different period will present the same ues, it appears that in preconditions, for
general goal. For the same reason, even root mean square (RMS) as long as peak Sq, group A is formed by Spline Twist
if for insertion of the blade implant no and valley Z values are the same. The only, while group B is formed by TLR
reproducible method (as the dynamo- periodicity on the XY plane is described and Pitt Easy VTPS, and group C con-
metric key) was used but the skill of instead by the spatial parameters, like tains all the other implants. The same
the trained operator, the limited repro- the wavelength from analysis in the fre- grouping holds for S10z, an amplitude
ducibility did not affect our goal. quency space. Finally, because a surface parameter also describing the rough-
The biological effects of the surface is always expanding in the 3D space, ness. For Srw, instead (texture) the
micro-/nano-morphology of implants obviously the different dimensions are group with Spline Twist is C (lowest
are not yet fully understood.10–13,29 Fur- combined. Thus, the actual surface area values level), which also contains Pitt
thermore, whereas 2D surface charac- depends on both the number of its up- Easy VTPS. At the opposite level,
terization follows established down envelopes (texture) and on how group A is only formed by TLR,
standards,30 this is not true for 3D large these envelopes are (RMS). The whereas all the other implants belong
equivalents, which makes a common ratio of actual area to projected area to the intermediate level, group B. For
language for description of results from plays an important role in all interfacial Sdr, again Spline Twist scores alone as
different laboratories difficult.5,10,30 So phenomena dominating chemical sys- group A and only another group is there
far, only the combination of different tems (where reactions occur at the (B) containing all the other implants.
techniques has shown useful results in boundaries between species) or some In postconditions, the group rank-
evaluation of implant surfaces.12,14 physical (eg, heat radiation) and biolog- ings both for Sq (amplitude) and Sdr
MacDonald31 observed that while ical phenomena (biochemical interface (hybrid) do not change with respect to
investigating different implant surfaces, processes with exchange of, eg, hor- preconditions. On the contrary, for S10z,
the results were significantly different mones or electrical signals). The actual group A contains Spline Twist only,
depending on the technique. This has surface area also correlates with the while only another group B exist: in this
been ascribed to the inappropriateness fractal dimension of the surface33,38,39 case, the TLR and Pitt Easy have been
of both measurement techniques and because it is higher when the surface “flattened” by the test to the same level

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254 SURFACE MICROSTRUCTURE OF DENTAL IMPLANTS BEFORE AND AFTER INSERTION  SALERNO ET AL

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