Location, date Presenter name Implant surface Location, date Presenter name 348 Library_Implant surface - Materials_August 2012

Implant surface External surface The external surface of an implant body is the facade of an implant, including its macro and micro surface shape and texture. To create the desired surface topography, various surface treatments may be used: machining polishing acid-etching grit-blasting anodizing Macro: treatment visible with eyes (grooves, threads etc.) Micro: treatment providing a microscopically roughened surface Acid-etched implant: External surface of an implant body that has been modified by the chemical action of an acidic medium. The subtractive surface is intended to enhance osseointegration. Grit-blasted surface: Modification of an implant or other surface through the application of sand, aluminum oxide, or other abrasive material by intense air pressure. See also: Rough implant surface; Sandblasted implant surface.

Implant surface Titanium / Titanium Oxide Commercially pure, grade 4 Ti consists of more than 99% pure Ti A 100% pure form is not available or economical Ti is immediately oxidized upon exposure to air (TiO2) resulting in an approximate 4 nm oxide layer (called natural passivation layer) TiO2 layer is responsible for the relative inertness, corrosion resistance and biocompatibility of the material Should the oxide layer be removed, the natural passivation layer is rapidly reformed TiOxide adsorbs proteins from biologic fluids

Implant surface Titanium grades There are a number of grades of commercially pure (unalloyed) titanium as identified in ASTM B265 (Grade 1, 2, 3, 4 and 7). Each grade has a different amount of impurity content (Grade 1 has lowest impurities).  ASTM Grade AlloyComposition Min. Tensile(KSI) 1 Unalloyed Ti ("Pure") 35A 35 2 Unalloyed Ti ("Pure") 50A 50 3 Unalloyed Ti ("Pure") 65A 65 4 Unalloyed Ti ("Pure") 80A 80 5 Ti-6Al-4V 130 6 Ti-5Al-2.5Sn 120 7 Ti-0.15Pd 9 Ti-3Al-2.5V 90 Nobel Biocare implants are manufactured from the strongest grade of pure titanium.

Implant surface Cold-working process Definition: The deformation of a metallic material at a specific temperature and rate that results in strain-hardening.

Implant surface TiUnite® TiUnite surface treatment and implant manufacturing premises The TiUnite surface is produced by a specific electrochemical manufacturing process, with which the natural surface Titanium-Oxide layer is being thickened.

Implant surface TiUnite® results in fast, predictable osseointegration Pre-clinical and clinical studies have shown that the speed of osseointegration is enhanced in comparison to a machined surface.1 SEM image of the TiUnite surface showing pores in the 1–10µm range. Osteoblast anchored in the pores of a TiUnite surface. TiUnite stimulates rapid bone growth by osseoconduction directly on and along the implant surface. The osseoconductive properties result in a higher bone-to-implant contact already during the early phases of healing and contribute to faster integration of the implant in the surrounding bone. Further pre-clinical and clinical studies have shown that the speed of osseointegration is enhanced in comparison to a machined surface1-6: 1 Degidi M et al. Histological evaluation of a human immediately loaded titanium implant with a porous anodized surface. Clin Implant Dent Relat Res 2002;4:110-114 2 Huang YH et al. Bone formation at titanium porous oxide (TiUnite) oral implants in type IV bone. Clin Oral Impl Res 2005;16:105-111 3 Ivanoff CJ et al. Histological evaluation of bone response to oxidized and turned titanium micro-implants in human jawbone. Int J Oral Maxillofacial Implants 2003; 3:341-348 4 Rocci A et al. Histology of retrieved immediately and early loaded oxidized implants. Light microscopic observations after 5 to 9 months of loading in the posterior mandible of 5 cases. Clin Implant Dent Relat Res 2003;12(suppl 1):88-98 5 Schüpbach P et al. The human bone-oxidized titanium implant interface: a microscopic, scanning electron microscopic, back-scatter scanning electron microscopic, and energy-dispersive X-ray study of clinically retrieved implants. Clin Implant Dent Relat Res 2005;7(suppl 1):36-43 6 Zechner W et al. Osseous healing characteristics of three different implant types. A histological and histomorphometric study in mini-pigs. Clin Oral Implants Res 2003;14:150-157 1 Ivanoff CJ et al. Histological evaluation of bone response to oxidized and turned titanium micro-implants in human jawbone. Int J Oral Maxillofacial Implants 2003; 3:341-348

Implant surface TiUnite® results in fast, predictable osseointegration TiUnite shortens time at risk after implant insertion due to faster osseointegration. Bone reaction to TiUnite implant surface. The bone is following the implant threads. The mechanical stability of the implant can be maintained at a higher level throughout the critical healing phase. (Zechner 2003, Glauser 2001, Ivanoff 2003, Huang 2003, Rocci 2003, Schüpbach 2005)

Implant surface Progression of osseointegration 1 week 2 weeks 4 weeks

Implant surface TiUnite® TiUnite allows for soft tissue attachment. Esthetics and long-term function of dental implants relies on stable soft tissues around the dental implant or abutment. The mucosal seal constitutes a protective barrier that prevents oral bacteria and their products from penetrating into the soft tissues and alveolar bone. Collagen fibrils directed towards the TiUnite surface. Connective tissue fibres anchored in TiUnite pore. TiUnite® New dimension (2005), Nobel Biocare AG

Implant surface TiUnite® implant surface and osseointegration Primary & secondary stability – principle scheme Overall stability - combined Stability / Osseointegration Secondary stability - biological Primary stability - mechanical Time

Implant surface TiUnite® - Biomaterial Surgical protocol Primary stability – 35 Ncm Glauser R, Portmann M, Ruhstaller P, Lundgren AK, Hammerle CH, Gottlow J. Stability measurements of immediately loaded machined and oxidized implants in the posterior maxilla. A comparative clinical study using resonance frequency analysis. Appl Osseointegration Res 2001;2:27-29 RFA = Resonance frequency analysis = measurement for osseointegration stability 0 (Zero) = day of implant insertion, primary stability Thanks to the faster and stronger osseointegration achieved with TiUnite implants, the mechanical stability can be maintained at a higher level throughout the healing phase compared to machined implants. This allows an immediate loading of the implants.

Implant surface Grooves Bone is formed more rapidly inside the groove Hall J, Miranda-Burgos P, Sennerby L. Stimulation of directed bone growth at oxidized titanium implants by macroscopic grooves: an in vivo study. Clin Implant Dent Relat Res 2005;7 Suppl 1:S76-82.

Implant surface TiUnite® Groovy Three-dimensional reconstructions by micro-computed tomography illustrating the rapid osseointegration of TiUnite® implants with a groove at the thread flank. The images show large amounts of bone in the threaded area already after 7 days (left picture) and 14 days (right picture) of healing in the rabbit bone.

Implants, surgical kit and drill protocol TiUnite® TiUnite “all the way up” (textured collar) Machined (non-textured collar) TiUnite to collar Grooves on collar Grooves – Proven to increase the rate of osseointegration No grooves Included cover screw Cover screw not included

Implants, surgical kit and drill protocol Machined vs. textured collar perform similar A controlled, clinical radiographic follow-up of implants with machined vs. textured collar has demonstrated minimal changes in crestal bone levels during healing and under functional loading for the implant with textured collar. Nickenig HJ, Wichmann M, Schlegel KA, Nkenke E, Eitner S. Radiographic evaluation of marginal bone levels adjacent to parallel-screw cylinder machined-neck implants and rough-surfaced micro threaded implants using digitized panoramic radiographs. Clin Oral Implants Res 2009;20(6):550-554.