Dental Implant Materials

Classifications, Osseointegration, Implant

Materials and Surface Treatments

Dr. Zeeshan Sheikh. DipDh, DDS, MSc, M.Perio, PhD, FRCDC

Clinical Scientist in Periodontics - Assistant Professor-Tenure Track
Applied Oral Sciences & Dental Clinical Sciences. Faculty of Dentistry-Dalhousie University
Faculty of Medicine-School of Biomedical Engineering (Cross-appointment)-Dalhousie University
Scientific Affiliate-Nova Scotia Health

FEBRUARY 10th, 2023

1
 PRESENTATION OUTLINE

• Classificationsand historical overview

of dental implants
• Osseointegration
• Dental implant materials
• Implant surface treatments
 LEARNING OBJECTIVES
• To gain familiarity with the basics of implant dentistry
• Understandthe three classifications of dental implants and
problems associated with early dental implants
• Understandthe term ‘Osseointegration’ and stages of
osteogenesis
• Understand the different materials used to produce dental
implants along with the associated benefits and limitations
• Be able to describe the rational behind surface modifications
 INTRODUCTION
• Dental implants are a prosthodontically driven treatment
to:
• Direct replacement of missing teeth
• Anchorage of a dental prosthesis.
• All the biologic, material and engineering principles that
govern the design and use of traditional dental prostheses
apply to implant supported restorations.
 CLASSIFICATIONS

A BRIEF HISTORY OF DENTAL IMPLANTS

• Subperiosteal (1935 to 1970’s)

• Transosseous (up to1970)
• Endosseous
 SUBPERIOSTEAL
• Subperiosteal (1935 to 1970’s)
• Directly on bone surface under gingival
tissues.
• Complicated surgical procedure
• Major flap + impression of alveolar bone
• “Implant”
(really “onplant”), a cast framework, similar to RPD
framework, fabricated from Cr-Co-Mo alloy
• Flap raised again at (7–10 days) for delivery of implant
• Prosthesis retained by framework trans-gingival projections
 SUBPERIOSTEAL
• Technique mainly for edentulous jaw - overdenture
• Nofusion to bone - Implant not accepted as part of the
body
• Treatment caused substantial bone loss – risk of
perforation of mandibular canal, maxillary sinus or
nasal cavity
• Infection,
often severe, plus epithelial downgrowth and
eventual implant encapsulation lead to failure
 TRANSOSSEOUS
• Goes through cortical wall twice
• Sitesprepared on inferior border of mandible for
stabilization of metal plate
• Screws placed through mandible for support and
stabilization of an over-denture
• Originally
plates and screws made of gold or semi-
noble alloys, more recently Ti or Ti alloys
• Prosthesisretained by framework trans-gingival
projections (screws)
 TRANSOSSEOUS

• Only for edentulous mandible to support over-denture

prosthesis
• Difficult surgical technique, some risk of nerve damage,
general anesthesia used
• Those fabricate from gold or base metal alloy, not accepted
as part of the body, foreign body reaction
 ENDOSSEOUS
• Only through cortical wall once
• Usedfor supporting single and multiple teeth restorations
and over dentures.
• Earlyendosseous implants used ‘blade’ designs and a
variety of materials including Cr-Co alloys, Ti alloys,
ceramics, along with a variety of surface treatments
• Earlyendosseous implants has similar biological problems
to the subperiosteal and transosseous implants
• Blade, Cylinder and Screw shapes used.
 WHAT HAPPENS WHEN BIOLOGICAL
TISSUES INTERACT WITH METALS?
• Pathological process
• Corrosion with products producing acute and/or chronic
inflammation which causes fibrous tissue encapsulation
(“marsupialization”) of implant as the human body walls
off offensive material
• OR

• Recognition as self
• Nocorrosion because of oxidized metal surface (called
“passivated surface oxide”)
Per-Ingvar Brånemark
1929 – 2014
• 1965Dr Brånemark placed the first
titanium dental implant
• Gösta Larsson of Gothenburg, Sweden, was the first patient to be treated with implants by
Professor Per-Ingvar Brånemark. That was in 1965. When Larsson passed away in 2006, he had

.
had his implants— still in place and fully functioning— for more than forty years

• The success of the implant was due

to “osseointegration”, a term coined
by Dr Brånemark.
 OSSEOINTEGRATION
• Osseointegration - A direct structural and functional
connection between ordered, living bone and the surface
of a load carrying implant without an intervening fibrous
tissue layer (biological).

• < 10 nm space between implant and bone.

DENTAL IMPLANT MATERIALS
WHY TITANIUM AND TITANIUM ALLOYS?
• Titanium is a common, non noble metal that is corrosion
resistant due to its passive oxide surface.
• Titanium
dioxide (TiO2) surface provides a stable interface on
which mineralizing bone matrix can be deposited
• Lowdensity and modulus compared to other base metals,
Important with respect to stress environment in bone
• Withdecades of clinical success and innovation, titanium
implants have become one of the most successful medical
devices in all of medicine with long-term success rates of 94-
97%.
 COMMERCIALLY PURE TITANIUM

• 4 grades available which vary according to the oxygen

(0.18 to 0.40 wt%) and iron (0.20 to 0.50 wt%)

• Grade 4 most common dental implant material

COMMERCIALLY PURE TITANIUM

Modulus of Elasticity ~ 100GPa

 Grade 5 Titanium Alloy

• Also known as Ti6Al4V, Ti-6Al-4V or Ti 6-4 is the most

commonly used alloy.
• It is significantly stronger than commercially pure titanium
while having the same stiffness and thermal properties.
 TITANIUM - ZIRCONIUM ALLOY

• Roxolid® is a metal alloy composed of 15 % zirconium and 85%

titanium. The combination of these two metals leads to a
material with a higher tensile and fatigue strength than
comparable titanium implants
 ZIRCONIA DENTAL IMPLANTS

Two piece zirconia dental implant

One piece zirconia dental implant
 ZIRCONIA DENTAL IMPLANTS

• Have been used since 1987

• Similar bone to implant contact when compared to Ti implants
• Several risk factors when using zirconia implants
 ZIRCONIA DENTAL IMPLANTS

• Some zirconia dental implants cannot

heal under the gums because of their
“one-piece” design, meaning that they
do not have a removable abutment but
one that is fixed to the implant.
• When Zirconia is adjusted, micro cracks
form and can cause fractures
• One piece Zirconia implant crowns can
only be cemented.
One piece zirconia dental implant
 ZIRCONIA DENTAL IMPLANTS

Zirconia implants with a small diameter (<4mm) are prone to fracture

 OVERALL IMPLANT DESIGN AND
GEOMETRY

• Goal is to optimize implant fixation:

withstand occlusal stresses and in
turn appropriately transfer these
stresses to the supporting tissues
• Threaded design
• Increased surface area
• Primary stability
 TWO WAYS TO ACHIEVE INTEGRATION
• Distance Osteogenesis
• Contact Osteogenesis
• Basic ‘Tenets’ Common to Both:
• 1. Bone matrix is synthesized by only one cell: the osteoblast
• 2.
Bone can only be deposited by laying down matrix on a pre-
existing solid surface
• 3.
Bone matrix mineralizes and has no inherent capacity to
“grow”
 IMPLANT SURFACE TREATMENTS
• Surface treatments designed to
• Increase speed of osseointegration
• Increase bone coverage
• Facilitate soft tissue attachment
• Osseoconductive: to enhance in-migration of new
bone
• Ossseoinductive: to manipulate the types of cells
which contact surface
 IMPLANT SURFACE TREATMENTS
• PHYSICAL MODIFICATIONS
• Increasing roughness
• Porosity (micro, macro)
• “Nanoscale” features
• CHEMICAL MODIFICATIONS
• Oxide changes
• Surface “doping” (potentially linked to physical processes)
• CaP coatings
30um
• Firstimplants had
a machined
surface which was
‘smooth’
compared to later
technologies.
• Healing 16-24
weeks
 5000X SEM IMAGES

Osseotite TiOblast (Ti-

(acid etched) dioxide blasted)

SLA (Titanium TiUnite

plasma sprayed) (electrochemically
etched)
 TIOBLAST (ASTRA TECH)
• Created by grit blasting with TiO2
• Irregular Surfaces with Pits and
Depressions
• No material added
• No risk of contamination
• No release of material
 OSSEOTITE (3I / BIOMET)
• Dual Acid etched surface (HCl/H2SO4)
• Roughness: 0.5-2 um
• Pore Size: 1-3 um
• Reported Healing Time of 8 weeks
TIUNITE (NOBELBIOCARE)

• Roughness: ~1.4 µm, Pore Size: 1-5 µm

• Controlled increase in TiO2 layer from
coronal (1-2 µm) to apical (7-10µm)
portion
• anodized (acid etch + electricity)
SLACTIVE STRAUMANN
• Sand blasted-Large grit-Acid etched
(SLA)
• HCl + H2SO4 above 100°C
• A conditioning process to produce an
active hydroylated layer that forms
following contact with water
• Roughness: 1.2-1.8 µm
• Implant survival rate in immediate
loading after 10 years: 98.2%
• Estimated Healing Time of 3-4 weeks
Thank you