S 7 - Surface Treatments of Dental Implants

SURFACE TREATMENTS OF
DENTAL IMPLANTS
DR. SOWMYA K
II MDS
DEPT OF PROSTHODONTICS
2
SYNOPSIS
• Introduction • Sand blasting

• Classification • Etching
• Plasma sprayed coating
• Various methods • Ion sputtering coating
• Conclusion • Anodization
• References • Biomimetic surface treatment
• Nano-silver coating
• Fluoride coating
• Photo functionalization
• Sol gel coatings
• Chitosan coating
• Growth factor coating
25/8/2021
3
INTRODUCTION
Why surface characteristics are important?
Bone implant
osseointegration stability
contact
25/8/2021 Contemporary implant dentistry – 3 rd edition – Carl E. Misch

4
SURFACE ROUGHNESS increases the

SURFACE surface area of the dental implant
ROUGHNESS
• to achieve higher initial implant
FACTORS AFFECTING stability by mechanical interlocking
INITIAL BONE FORMATION
• to maximize cell adhesion at the
HYDROPHILICITY surface to promote bone ingrowth
into the surface porosities.
Goyal et al (2012) observed that the increased roughness can simultaneously increase the surface
area of the implant and enhance osseointegration process.
25/8/2021
Article - Dental implants materials and surface treatments - Shariq Najeeb - Advanced Dental Biomaterials. DOI: https://doi.org/10.1016/B978-0-08-102476-8.00021-9
5
CLASSIFICATION
Based on the surface

roughness
Minimally rough Intermediately rough Rough

(0.5–1 µm) (1–2 µm) (2–3 µm)
25/8/2021
Article - Implant surface modifications: A review – Sreeharsha et al - International Journal of Applied Dental Sciences - 2020; 6(3): 334-338
6
Based on surface texture
Concave Convex
Additive treatments Subtractive treatments
(HA coating, titanium plasma spraying) (etching, blasting)
25/8/2021
Article - Status of surface treatment in endosseous implant: A literary overview – Gupta et al - Indian J Dent Res, 21(3), 2010
7
Based on the orientation of

surface irregularities
Isotropic surfaces Anisotropic surfaces
25/8/2021
8
Based on the method
Chemical Physical
(Surface coating ) (Mechanical surface alteration)
25/8/2021
9
SAND BLASTING
GRIT BLASTING
Creates roughness through pressurized particle projection
Commonly used
Roughness depends on • Al2O3
• Particle size • TiO2
IDEAL REQUIREMENTS
• Time of blasting • Hydroxyapatite
 Chemically stable
• Pressure • zro2
 Biocompatible
• Distance from the source of
 Should not hamper osseointegration.
particle to the implant
surface.
25/8/2021
Contemporary implant dentistry – 3 rd edition – Carl E. Misch
10
 It allows adhesion, proliferation and differentiation of osteoblasts.

 It has also been noticed that fibroblasts adhere to the surface with difficulty and hence could limit soft
tissue proliferation and increase bone formation.
Residual ceramic particles can detach from the implant surface and cause inflammation in the peri-
implant bone. So it is mandatory to do acid-etching following sand blasting.
Sandblasted, large grit , acid-etched implant surface (SLA)

Enhances osseointegration through greater bone-to-implant contact (BIC).
• Al2O3 particles & HCl and H2SO4

• Tricalcium phosphate & HF
25/8/2021
11
ACID ETCHING
Aids in cleaning the surface and attaining homogenous roughening.
Acid etched surfaces increase cell adhesion and bone formation, thus
Micropits enhancing the osseointegration.
0.5 to 2 µm
Roughness depends on Commonly used

• Concentration of the • Hydrochloric (HCl)
acidic solution • Hydrofluoric (HF)
• Time • Nitric (HNO3)
• Temperature • Sulphuric (H2SO4)
• Or a combination
25/8/2021
12
DUAL ACID ETCHING (DAE)
Immersion of Ti implants for several minutes in a mixture of concentrated HCl and

H2SO4 heated above 100°C.
• The dual acid-etched surface produces a microtexture rather than a macrotexture.
• Enhance the osteoconductive process through the attachment of fibrin and osteogenic cells, resulting
in bone formation directly on the surface of the implant.
Chou et al (2001) - A comparative study between a machined surface and those using HF and
HCl/H2SO4 (DAE) has shown the acid treated surface has greater resistance to reverse torque
removal and better osseointegration.
25/8/2021
Article - Dental implants materials and surface treatments - Shariq Najeeb - Advanced Dental Biomaterials. DOI: https://doi.org/10.1016/B978-0-08-102476-8.00021-9
13
ALKALINE ETCHING
4-5 M
sodium
hydroxide
sodium titanate
gel of 1 µm thick
600 0C 24
hours
(irregular
topography and
ample of open
porosity)
Titanium
implant
surface
If alkali treatment is done after acid etching, the resulting surface has increased porosity.
25/8/2021
Article - Surface Treatment of dental implants: A review - Gaurav Singh - Journal of Dental and Medical Sciences - Volume 17, Issue 2 Ver. 15 February. (2018), PP 49-
14
LASER ETCHING
NONCONTACT TREATMENT
No possible contamination with blasting media.
PROCESS – Using Nd: YAG laser, substrate material vaporizes and forms a crater.
Hsu et al (2007) - Better way of controlling the micro-topography of the implant surface and
this process enhances biocompatibility of the implant surface
Hallgren et al, demonstrated that the removal torque value was larger for the laser-
modified implant (52 Ncm) than the machined surface implant (35 Ncm) after 12 weeks of
healing.
25/8/2021
Article - Surface Treatment of dental implants: A review - Gaurav Singh - Journal of Dental and Medical Sciences - Volume 17, Issue 2 Ver. 15 February. (2018), PP 49-
15
PLASMA-SPRAYED SURFACES
Spraying molten metal on the titanium base
Increased surface Increases the Better

More BIC
roughness surface area osseointegration
 Titanium plasma spray

 HA spray
25/8/2021
Article - Influence of Implant Surfaces on Osseointegration - A.B. Novaes Jr. et al - Braz Dent J 21(6) 2010
16
TITANIUM PLASMA SPRAY (TPS)
• Process involves injecting titanium powder through a hot plasma torch.

• The molten titanium particles fuse and condense at the surface of the implant to produce a rough surface.
Increases the implant surface by 6 times (30- 50 μm deep)

25/8/2021
Article - Influence of Implant Surfaces on Osseointegration - A.B. Novaes Jr. et al - Braz Dent J 21(6) 2010
17
HA COATING
De Groot
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.
The thickness of 50-200 μm produces roughness of 7-24 μm
INDICATIONS
 For type 4 bone
 Fresh extraction sites
 Newly grafted sites
25/8/2021
18
ADVANTAGES
 Faster healing bone interface
 Increased gap healing between bone and implant
 Stronger interface than TPS
 Less corrosion of metal
Fouda et al (2009) reported that HA coated titanium implant could enhance the healing
period compared to the uncoated implants.
25/8/2021
19
DISADVANTAGES
 Delamination of coating leads to failure of implant
 Dissolution/fracture of HA coating results in failure
 Predisposes to plaque retention
Liu et al (2004) - the bonding strength of HA on titanium alloys decreased long hours of
immersion time in the simulated body fluids (SBF)
25/8/2021
20
VARIOUS METHODS OF HA COATING
Functionally graded coating
Antibiotic coating
Laser ablation coating
Pulsed laser deposition
25/8/2021
21
FUNCTIONALLY GRADED COATING

• Use of HA along with Ti6Al4V
• Mechanically strong, bio-inert and biocompatible.
LASER ABLATION TECHNIQUE

• To control the morphology of coating of HA (either crystalline or amorphous)
25/8/2021
22
ANTIBIOTIC COATING
 Gentamycin
 Tetracycline
• Local prophylactic agent along with systemic antibiotics in dental implant surgery.
• Functions as an antimicrobial agent.
• Removes the smear layer as well as endotoxins from the implant surface.
• It inhibits collagenase activity.
• Increases cell proliferation as well as attachment and bone healing.
25/8/2021
Article - Surface topography of dental implants: A review - Varun Dahiya - Journal of Dental Implants | Jan - Jun 2014 | Vol 4 | Issue 1
23
PULSED LASER DEPOSITION (PLD)

KrF
laser
Involves three main steps:
1. Ablation of the target material

2. Formation of a highly energetic plume
3. The growth of the film on the substrate.
25/8/2021
24
ION-SPUTTERING COATING
A thin layer (0.5-3 µm) of Calcium/Phosphate will be coated onto an implant substrate.
PROCESS - Directing a beam of ion onto an HA block that is vaporized to create plasma and then
recondensing this plasma onto the implant.
- Provide greater - Time consuming

control of the
coating's properties.
- Produces amorphous
coatings
- Improved adhesion
between the
substrate and the - Ca/P ration of the
coating. coating is higher than
of synthetic HA.
25/8/2021
25
ANODIZATION
Produces a micro / nano porous oxide layer on the Ti surface.
This process involves passing a current through the implant as the anode with an acid as
the electrolyte to form the surface oxide.
Depends on,
 Phosphoric acid
• Current density
 Nitric acid
• Concentration and composition of the acids used in
 Sulfuric acid
the electrolyte solution
 Hydrofluoric acid
• The temperature
25/8/2021
Article - Effects of Surface Charges on Dental Implants: Past, Present, and Future - Yan Guo et al - International Journal of Biomaterials Volume 2012, 381535, 5
26
Sul et al (2002), analyzed the resonance frequency and removal torque of implants with
turned and anodized surface oxides.
Studies have demonstrated increased bone response with higher biomechanical and
histological values for anodized surfaces compared with machined ones.
25/8/2021
27
NANOSILVER
Silver nanoparticles act against Gram-negative bacteria
• Nanoparticles of size 1–10 nm adheres to the cell membrane of bacteria and effects
permeability and respiration.
• SNPs enters bacteria interacts with sulfur- and phosphorus-containing compounds like DNA.
• SNPs emit silver ions, which will have an additional contribution to the bactericidal effect.
SNPs are doped over implant surface in concentration of 0.05 ppm by Tollens reaction.
25/8/2021
28
Zhao et al, AgNPs were inserted on surface of Ti implants by

a technique which also involves silver nitrate immersion and
ultraviolet radiation. Study shows that during initial days
planktonic bacteria was inhibited and bacteria adhesion was
prevented for 30 days due to AgNPs coating.
25/8/2021
29
BIOMIMETIC SURFACE TREATMENT
Potential bioactive agents
Ideal requirements
• It should be able to bring about differentiation of cell for bone formation
• It should not delaminate
• Easy to manufacture
• Affordable
• Chemically stable
• Non-immunogenic
25/8/2021
30
• Recombinant human bone morphogenetic protein-2 (rhBMP-2) is reported to act as a

bone-modulating agent for uses in dentistry
• Biphosphonate assimilated on surface of titanium implants has shown increased bone

density around implant
25/8/2021
31
FLUORIDE TREATMENT
Titanium
implant
surface
Titanium Better
tetrafluoride
osseo-
TiF4 integration
Fluoride
ions
25/8/2021
32
PHOTO FUNCTIONALIZATION
• UV treatment of dental implant surfaces enhances bioactivity and osseointegration by altering

the titanium dioxide on the surface.
• By promoting interactions of cells and proteins to the implant on a molecular level, UV light is
believed to enhance the osteoconductivity.
25/8/2021
33
SOL-GEL COATINGS
• A liquid with a specific composition (i.e., the Sol) is converted into a solid gel phase.
• Thin coatings can be deposited onto a surface by dip- or spin coating techniques.
• The procedure makes it possible to produce coatings of Ti, HA or combination of both.
25/8/2021
Article - In vitro analysis of the influence of surface treatment of dental implants on primary stability - Carla et al - Braz Oral Res., (São Paulo) 2012 Jul-Aug;26(4):313-7
34
SIMVASTATIN
Induce the expression of bone morphogenetic protein (BMP) 2 messenger ribonucleic acid
that might promote bone formation.
Yang et al. (2010) showed that simvastatin-loaded porous implant surfaces promote accelerated
osteogenic differentiation of preosteoblasts, which have the potential to improve the nature of
osseointegration
25/8/2021
35
GROWTH FACTOR COATING
• The implant surface can be coated with osteogenesis stimulating agents to accelerate
angiogenesis and bone formation around implants.
 Bone morphogenetic proteins (BMPs)

 Transforming growth factor b1 (TGF-b1)
 Vascular endothelial growth factors (VEGFs)
 Platelet-derived growth factors (PDGFs)
 Insulin-like growth factors (IGFs).
25/8/2021
Article - In vitro analysis of the influence of surface treatment of dental implants on primary stability - Carla et al - Braz Oral Res.,
(São Paulo) 2012 Jul-Aug;26(4):313-7
36
CHITOSAN COATING
• Provides adhesion and proliferation of human gingival fibroblast cells.
• It showed a high level of cytocompatibility while preventing the growth of the P. gingivalis
bacteria.
25/8/2021
37
ZIRCONIA IMPLANTS
25/8/2021
38
CONCLUSION
Surface characteristics is one of the key factor in achieving primary stability and for better
osseo-integration. Therefore, it is necessary for a clinician to know the various
modification methods of implant surface treatments for the long term success.
25/8/2021
REFERENCES
• Contemporary implant dentistry – 3rd edition – Carl E. Misch

• Article - Status of surface treatment in endosseous implant: A literary overview – Gupta
et al - Indian J Dent Res, 21(3), 2010
• Article - Surface Treatment of dental implants: A review - Gaurav Singh - Journal of
Dental and Medical Sciences - Volume 17, Issue 2 Ver. 15 February. (2018), PP 49-53
• Article - Dental implants materials and surface treatments - Shariq Najeeb - Advanced
Dental Biomaterials. DOI: https://doi.org/10.1016/B978-0-08-102476-8.00021-9
• Article - Surface topography of dental implants: A review - Varun Dahiya - Journal of
Dental Implants | Jan - Jun 2014 | Vol 4 | Issue 1
• Article - Implant surface modifications: A review – Sreeharsha et al - International
Journal of Applied Dental Sciences - 2020; 6(3): 334-338
• Article - Surface Modifications and Their Effects on Titanium Dental Implants - Jemat et
al - BioMed Research International Volume 2015, Article ID 791725, 11 pages
• Article - Influence of Implant Surfaces on Osseointegration - A.B. Novaes Jr. et al - Braz
Dent J 21(6) 2010
• Article - Effects of Surface Charges on Dental Implants: Past, Present, and Future - Yan
Guo et al - International Journal of Biomaterials Volume 2012, Article ID 381535, 5 pages
• Article - In vitro analysis of the influence of surface treatment of dental implants on
primary stability - Carla et al - Braz Oral Res., (São Paulo) 2012 Jul-Aug;26(4):313-7
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S 7 - Surface Treatments of Dental Implants

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SURFACE TREATMENTS OF

• Introduction • Sand blasting

Why surface characteristics are important?

25/8/2021 Contemporary implant dentistry – 3 rd edition – Carl E. Misch

SURFACE ROUGHNESS increases the

Based on the surface

Minimally rough Intermediately rough Rough

Based on surface texture

Based on the orientation of

Isotropic surfaces Anisotropic surfaces

Based on the method

Creates roughness through pressurized particle projection

 It allows adhesion, proliferation and differentiation of osteoblasts.

Sandblasted, large grit , acid-etched implant surface (SLA)

• Al2O3 particles & HCl and H2SO4

Aids in cleaning the surface and attaining homogenous roughening.

Roughness depends on Commonly used

DUAL ACID ETCHING (DAE)

Immersion of Ti implants for several minutes in a mixture of concentrated HCl and

• The dual acid-etched surface produces a microtexture rather than a macrotexture.

Spraying molten metal on the titanium base

Increased surface Increases the Better

 Titanium plasma spray

TITANIUM PLASMA SPRAY (TPS)

• Process involves injecting titanium powder through a hot plasma torch.

Increases the implant surface by 6 times (30- 50 μm deep)

The thickness of 50-200 μm produces roughness of 7-24 μm

VARIOUS METHODS OF HA COATING

Functionally graded coating

Laser ablation coating

Pulsed laser deposition

FUNCTIONALLY GRADED COATING

LASER ABLATION TECHNIQUE

PULSED LASER DEPOSITION (PLD)

Involves three main steps:

1. Ablation of the target material

- Provide greater - Time consuming

Produces a micro / nano porous oxide layer on the Ti surface.

Silver nanoparticles act against Gram-negative bacteria

Zhao et al, AgNPs were inserted on surface of Ti implants by

BIOMIMETIC SURFACE TREATMENT

Potential bioactive agents

• Recombinant human bone morphogenetic protein-2 (rhBMP-2) is reported to act as a

• Biphosphonate assimilated on surface of titanium implants has shown increased bone

• UV treatment of dental implant surfaces enhances bioactivity and osseointegration by altering

• The procedure makes it possible to produce coatings of Ti, HA or combination of both.

GROWTH FACTOR COATING

 Bone morphogenetic proteins (BMPs)

• Provides adhesion and proliferation of human gingival fibroblast cells.

• Contemporary implant dentistry – 3rd edition – Carl E. Misch

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