Department of Periodontology, SNU Chung, Jae-eun. Quality of dental implants

Size: px

Start display at page:

Download "Department of Periodontology, SNU Chung, Jae-eun. Quality of dental implants"

Osborn Lynch
5 years ago
Views:

Challenges in Implantology Surface configuration of Implant Department of Periodontology, SNU Chung, Jae-eun Improve Techniques Improve Tools Implants in market Quality of dental implants Quality of

Substantial number of claims made by different manufacturers on alleged superiority due to design and characteristics are not based on sound and long-term clinical scientific research Jokstad et al.

1 Challenges in Implantology Surface configuration of Implant Department of Periodontology, SNU Chung, Jae-eun Improve Techniques Improve Tools Implants in market Quality of dental implants Quality of dental implants Revolutionary implant Nano-technology Accelerate osseointegration Promote osseointegration Speed up osseointegrarion Osteoconductive The latest advancement in implant dentistry Substantial number of claims made by different manufacturers on alleged superiority due to design and characteristics are not based on sound and long-term clinical scientific research Jokstad et al. Int Dent J 2003;53: Race for the surface IONS Surface Characteristics ti Topography+Chemistry POLYSACCARIDES IMMUNOGLOBULIN PROTEINS FIBROBLASTS CHONDROBLASTS Endosseous Surface Surface Biomimetic Healing Topography Chemistry Approach OSTEOBLASTS 1

Mechanism of Endosseous healing Endosseous Healing Surface Surface Biomimetic Topography Chemistry Approach

Osteogenesis Contact Osteogenesis Bone approximating the implant surface Cortical bone Osseointegration of

novo bone formation (Cement line matrix) Osteoconduction in Contact Osteogenesis Blood cells Osteoconduction

COIR 2000;11:530-539 Nygren et al. J Lab Clin Med 1997;129:35-46 Broberg et al.

2 Mechanism of Endosseous healing Endosseous Healing Surface Surface Biomimetic Topography Chemistry Approach Distance osteogenesis Contact osteogenesis Osborn & Newesely, Biomaterials 1980;1: Distance Osteogenesis Contact Osteogenesis Bone approximating the implant surface Cortical bone Osseointegration of Machined implant Bone apposition to the implant surface In poor quality bone, Surface Osteoconduction De novo bone formation (Cement line matrix) Osteoconduction in Contact Osteogenesis Blood cells Osteoconduction in Contact Osteogenesis Fibrin : The transitory matrix GP IIb/IIIa Rc DAE Machined Park & Davies. COIR 2000;11: Nygren et al. J Lab Clin Med 1997;129:35-46 Broberg et al. J Lab Clin Med 2002;139: Bromberek et al. Exp Cell Res 2002;275: Graves et al. Connective Tissue Res 1989;23: Daives. Anat Rec 1996;245:

De novo Bone Formation in Contact Osteogenesis Bone implant interface Interfacial matrix De novo Bone Formation in Contact Osteogenesis Bone/Implant interface In vitro modeling Thickness of

Anat Rec 1996;245:526-445 Macrostructure Endosseous Surface Surface Biomimetic Healing Topography Chemistry Approach Thread implant Maximize initial contact Improve initial stability Enlarge implant

Microstructure Evaluation Resolution level of surface roughness Form Waviness Roughness Smooth? Kasemo et al. Adv Dent Res 1999;13:11-19 Quantitative Evlaluation Where to evaluate?

3 De novo Bone Formation in Contact Osteogenesis Bone implant interface Interfacial matrix De novo Bone Formation in Contact Osteogenesis Bone/Implant interface In vitro modeling Thickness of Interfacial tissue SS > Mobile Ti > Stable Ti Steflik et al. J Biomed Mater Res 1998;39: Davies. J Dent Edu 2003;67: Albrektsson & Hansson. Biomateirals 1986;7: Davies. Anat Rec 1996;245: Macrostructure Endosseous Surface Surface Biomimetic Healing Topography Chemistry Approach Thread implant Maximize initial contact Improve initial stability Enlarge implant surface area Favor dissipation of interfacial stress Microthread Abrahamsson & Berglundh. Clin Implant Dent Relat Res 2006;8: Microstructure Evaluation Methods of evaluation Rough? Microstructure Evaluation Resolution level of surface roughness Form Waviness Roughness Smooth? Kasemo et al. Adv Dent Res 1999;13:11-19 Quantitative Evlaluation Where to evaluate? Top Mechanical Contact Profilometer Optical Profiling (Confocal Laser Scanning Microscopy) Scanning Probe Microscope Flank Valley 9 points : 3Flanks 3Tops 3Valleys Wennerberg & Albrektsson. Int J Oral Maxillofac Imp 2000;15: Wennerberg & Albrektsson. Int J Oral Maxillofac Imp 2000;15:

Microstructure Evaluation Microsturcture Surface Parameter Isotropic? Anisotropic?

et al. Instrument and measurement techniques of 3d surface topography.

Smooth V10d30p V3d30p H22d30p H10d30p H10d39p H3d30p H3d7p Epi Att( μm ) 248 304 319 121

I Biomed Mater Res 1990;24:1203-1219 Effect of Surface Characteristics Surface Roughness

Cell Adhesion Cell Proliferation Cell Differentiation Matrix Production Abrahamsson et al.

4 Microstructure Evaluation Microsturcture Surface Parameter Isotropic? Anisotropic? 2-D vs 3-D Height R a Space R q S a S q S m S cx S tr Hybird Δ q S Δq S dr Direc -tion Dong et al. Instrument and measurement techniques of 3d surface topography. Penton Press, 1994:3-63 Surf. Smooth V10d30p V3d30p H22d30p H10d30p H10d39p H3d30p H3d7p Epi Att( μm ) Chehroudi et al. I Biomed Mater Res 1990;24: Effect of Surface Characteristics Surface Roughness Protein Adsorption Platelet Activation 4 weeks healing Surface Chemistry Surface Energy Cell Adhesion Cell Proliferation Cell Differentiation Matrix Production Abrahamsson et al. Clin Oral Imp Res 2004;15: Protein adsorption Platelet activation DAE 320 Grit Machined Polished Machined Acid Etching DAE Acid Etching + Blasting Sela et al. Clin Oral Impl Res 2007;18: Park et al. Biomaterials 2001;22:

ALP : early marker of OB diff Osteocalcin : late marker of OB diff Type I collagen :

Sandblasting (Al 2 O 3 ) Acid etching (1%HF+30%NitricAcid) Orsini et al.

Turned Sa = 0.20 μm Cbfa1 UMR Cbfa1 RCOB Blasted with 63-90μm particles Sa = 0.

30 μm Blasted with 180-300 μm particles Sa = 1.38 μm BSPⅡ UMR BSPⅡ RCOB Mustafa et al.

J Dent Res 2003;82:372-376 OB/FB response OB/FB response Sb, Ra=5.70 μm 09 mm, Ra=1.

5 ALP : early marker of OB diff Osteocalcin : late marker of OB diff Type I collagen : indicator of synthetic capacity Runx-2(Cbfα-1), Osterix Osteoblast response Sandblasting (Al 2 O 3 ) Acid etching (1%HF+30%NitricAcid) Orsini et al. Int J Oral Maxillofac Impl 2000;15: Osteoblast response Osteoblast response Turned Sa = 0.20 μm Cbfa1 UMR Cbfa1 RCOB Blasted with 63-90μm particles Sa = 0.72 μm Blasted with μm particles Sa = 1.30 μm Blasted with μm particles Sa = 1.38 μm BSPⅡ UMR BSPⅡ RCOB Mustafa et al. Clin Oral Impl Res 2001;12: Schneider et al. J Dent Res 2003;82: OB/FB response OB/FB response Sb, Ra=5.70 μm 09 mm, Ra=1.12 μm SLA, Ra=3.00 μm Thermanox, Ra=0.04 μm Rat Calvaria OB Human Gingival FB Osteoblast Fibroblast Kunzler et al. Biomaterials 2007;29: Kunzler et al. Biomaterials 2007;29:

OXIDE LAYER OXIDE LAYER 2-17nm Thickness

6 Titanium Oxide Layer IONS Corrosion Resistance Passivation ability POLYSACCARIDES Amorphous Homogenous Endosseous Surface Surface Biomimetic Healing Topography Chemistry Approach IMMUNOGLOBULIN PROTEINS FIBROBLASTS OXIDE LAYER OXIDE LAYER 2-17nm Thickness Crystalline CHONDROBLASTS OSTEOBLASTS Tengval et al. Clin Mater 1992;9: Chemically modified titanium oxides Fluoride Fluoride Fluoride TiO 2 grit blasting Grit blasting + HF Grit blasting + Etching Grit blasting + Etching + Rinsing(N 2 ) + NaCl Control Fluoride-mod 1mo 3mo Masaki et al. Clin Oral Impl Res 2005;16: Ellingsen et al. Int J Oral Maxillofac Impl 2004;19:

Fluoride Actin Non-modified BIC % = 34.21% Fluoride-modified BIC % = 55.

Biomaterials 2006;27:926-936 Agents for Biomimetic Approach Bioceramics HA, Calcium phosphate phases HOW to coat implant surface with Ca-P?

glucosamine + N-acetyl glucosamin Avila et al. Implant Dent 2009;18:17-26 Janet et al.

7 Fluoride Actin Non-modified BIC % = 34.21% Fluoride-modified BIC % = 55.45% Collagen Osteopontin Osteocalcin BSP Endosseous Healing Surface Surface Biomimetic Topography Chemistry Approach BMP Cooper et al. Biomaterials 2006;27: Agents for Biomimetic Approach Bioceramics HA, Calcium phosphate phases HOW to coat implant surface with Ca-P? Plasma Spraying BMP, RGD Type 1 Collagen Biomimetic Coating (Simulated Body Fluid) Fluoride Ca 10 PO 4 (OH)2 Bio ACTIVE Implant for chemical BONDING Chitosan : glucosamine + N-acetyl glucosamin Avila et al. Implant Dent 2009;18:17-26 Janet et al. Perio ;41: Biomimetic Coating of Ca-P Biomimetic Coating of Ca-P OCP BCA BCA OCP BCA SBF0 SBF1 SBF2 SBF3 Closer structure to bone mineral than plasma sprayed HA coating Barrère et al. Bone 1999;25Supp:107s-111s Modification of SBF Different mineral phase Solubility & Attachment of bone marrow stromal cell Wang et al. Biomaterials 2004;25:

Bioactive Protein - BMP Bioactive Protein - RGD HOW to immobilize BMPs on titanium surface?

amorphous layer of Ca-P Subsequent growth of thick crystalline lattice work SBF with Mg 2+ Supersaturated Ca-P + BMP Ti disk coated

OB-like cell 8wks, Ti_RGD 8wks, Ti SYPRO Ruby protein blot staining Liu et al. Tissue eng 2004;10:101-108 Kroese-Deutman et al.

8 Bioactive Protein - BMP Bioactive Protein - RGD HOW to immobilize BMPs on titanium surface? Arg-Gly-Asp (RGD) Rh-BMP2 Ti6Al4V plate Use Allyamine Incorporation BMP into biomimetic Ca-P Alkaline phophatase activity Thin amorphous layer of Ca-P Subsequent growth of thick crystalline lattice work SBF with Mg 2+ Supersaturated Ca-P + BMP Ti disk coated with 100M RGD in PBS Implanted in Rat calvaria 2,4,8 weeks, evaluaion In ECM proteins High affinity for integrin Adhesion of OB-like cell 8wks, Ti_RGD 8wks, Ti SYPRO Ruby protein blot staining Liu et al. Tissue eng 2004;10: Kroese-Deutman et al. Tissue Eng 2005;11:186 Comment Implant in Suboptimal condition Faster osseointegration Stronger bone-implant interface Surface roughness Surface chemistry Biomimetic approach 경청해주셔서감사합니다 8

9 Effect of Surface?? Ivanoff et al. COIR 2001;12:

10 10

Technion, Institute of Technology- Israel

Technion, Institute of Technology- Israel Micro surface Micro surface T.A.G Dental implant surface treatment is a result of extensive experience and research which resulted in obtaining the best biological response. The success and safety of dental