Welcome to Dentium. If you want to know more detailed documentation in each case, please feel free to contact us by at

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3 Welcome to Dentium Dentium was founded in June Since the beginning, we have focused on the quality products and services. As a result, we have obtained a successful clinical results and excellent responses from the dental professionals in the world. Owing to accumulated experiences and our continuous efforts to improve products for more than 10 years until now, Dentium products have become very reliable and predictable. To show the reliability of our products, these documentation summaries are prepared with abstracts of some valuable clinical and experimental cases of Dentium dental implant system, bone graft material and surface treatment. We will continue to accumulate more documentation in collaboration with the universities and institutes around the world. If you want to know more detailed documentation in each case, please feel free to contact us by at biz@implantium.com. Sincerely Yours, Dentium Co., Ltd.

4 Contents Dental Implant Page 04 Bone Graft Material Page 14 Surface Treatment Page 29

5 Documentation Summaries - Dental Implant - CLINICAL Song, Dong-Wook 04 Comparative Analysis of Peri-implant Marginal bone Loss Based on Microthread Location: A 1- Year Prospective Study After Loading Kim, JY. 06 Paradigm shift of sinus lifting: success rate of consecutive 307 implants in 137 sinuses with sinus lifting and simultaneous placement up to 5-years Kang, Il-Hyun. 07 Retrospective study of survival rate of the Implantium Implant system Doh, Re-Mee 08 Retrospective study of the Implantium Implant with a SLA surface and internal connection with microthreads Chae, Gyung-Joon. 10 Analysis of Short-term Success Rate and Healing Patterns of Implantium Implant Hwang, Jung-Won. 12 Retrospective Study of Implantium Dental Implants: Clinical and Radiographic Results of 22 Months - Bone Graft Material - CLINICAL Kim, Young-Kyun. 14 Analysis of the healing process in sinus bone grafting using various grafting materials Bae, Ji-Hyun 15 Sinus bone graft using new alloplastic bone graft material(osteon) II : clinical evaluation Kim,Sun-Jong 16 Effects of 4 Different Alloplastic Materials on Bone Regeneration in Rabbit Calvarial Defects Kim, Su-Hwan. 18 Alveolar Bone Regeneration by Transplantation of Periodontal Ligament Stem Cells and Bone Marrow Stem Cells in a Canine Peri-Implant Defect Model; A Pilot Study Kim, Young-Kyun. 20 Clinical Evaluations of OSTEON as a New Alloplastic Material in Sinus Bone Grafting and its Effect on Bone Healing

6 Documentation Summaries EXPERIMENTAL Jeong, Ji-Yun. 23 Bone formation following dental implant placement with augmentation materials at dehiscence defects in dogs: pilot study Yang, JH. 24 The effects of alloplasts on peri-implant defects in dogs Um, Yoo-Jung. 26 Bone formation of newly developed biphasic calcium phosphate in rabbit calvarial defect model : A pilot study Yon, Je-Young. 28 Histometrical evaluation of biphasic calcium phosphate in surgically created 1-wall periodontal intrabony defects in dogs - Surface Treatment - EXPERIMENTAL Yoon, Heun-Joo. 29 Effects of Calcium-Phosphate Coating to SLA Surface Implants by the ionbeam-assisted Deposition Method on Self-contained Coronal Defect Healing in Dogs Kim, Hyeongil. Kim, Hyeongil The biocompatibility of SLA-treated titanium implants Enhanced Bone Forming Ability of SLA-Treated Ti Coated with a Calcium Phosphate thin film formed by E-Beam Evaporation Ahn, Sung-Joon 38 Comparison of Ultraviolet Light-Induced Photocatalytic Bactericidal Effect on modified Titanium Implant Surfaces Lee, In-Seop. 40 Industrial application of ion beam assisted deposition on medical implants Lee, In-Seop. 41 Formation of silver incorporated calcium phosphate film for medical applications Chae, Gyung-Joon. 42 Healing of surgically created circumferential gap around Nano-coating surface dental implants in dogs Li, Yan. 43 Incorporation of cytochrome C with thin calcium phosphated film formed by electron-beam evaporation

7 Comparative Analysis of Peri-Implant Marginal Bone Loss Based on Microthread Location: A 1-Year Prospective Study After Loading Dong-Wook Song, Dong-Won Lee, Chong-Kwan Kim, Kwang-Ho Park, and Ik-Sang Moon Department of Periodontology, Gangnam Severance Dental Hospital, College of Dentistry, Yonsei University, Seoul,Korea Department of Periodontology, College of Dentistry, Yonsei University Department of Oral and Maxillofacial Surgery, Gangnam Severance Dental Hospital, College of Dentistry, Yonsei University Background: The purpose of the present study was to investigate the short-term effects of microthread location on peri-implant marginal bone levels. Methods: Two types of implants, one with microthreads placed at the implant top (group A) and the other with micro-threads placed 0.5 mm below the implant top (group B), were placed adjacent to each other in the partially edentulous areas of 20 patients. In total, 40 implants were placed. Bone loss around each implant was analyzed after 1 year of functional loading, and gingival parameters (modified plaque index and modified sulcus bleeding index) of the peri-implant soft tissue were evaluated. Bone losses after loading and gingival parameters were compared using the paired t test. Results: The average bone loss was 0.16 (SD: 0.19) mm in group A and 0.30 (SD: 0.22) mm in group B after 1-year of functional loading. The paired t test revealed a significant difference in crestal bone loss between groups A and B in individual patients (P = 0.004). No significant differences were found between the two groups for the gingival parameters. Conclusions: Less peri-implant bone loss was observed around implants with microthreads placed at the implant top (group A) compared to those in which microthreads were placed below the top (group B). These results indicated that the microthreads acted to stabilize the peri-implant marginal bone, and their locations played an important role in the stabilization process. key words : Alveolar bone loss; dental implants; dental radiography; prospective studies. Fig 1. Schematic presentation of implants A) Implants in grooup A B)Implants in group B Dental Implant 04

8 Fig 2. Intraoral radio graphs of implants in groups A (a) and B A) At prosthesis delivery B) One year after functional loading to this study. Submitted Jun 9, 2009; accepted for publication July 16, 2009; Published by the J Periodontol on December Dental Implant

9 2008 (Poster presentations) 325. Topic Long-Term Studies Paradigm shift of sinus lifting: success rate of consecutive 307 implants in 137 sinuses with sinus lifting and simultaneous placement up to 5-years Kim JY, Kim JJ,Lee BK, Jeon JH, Kim MJ,Ahn KM Department of Oral and Maxillofacial Surgery. University of Ulsan, Asan Medical Center, Seoul. Department of Oral and Maxillofacial Surgery, Seoul National University, Seoul. Purpose: The aim of this prospective study was to evaluate the survival rate of installed implant in maxillary sinus which had been operated in 1-stage using xenogenic bone only irrespective of residual bone. Material and Methods: From 2003 to 2006, total 307 implants(implantium, Dentium Co., Korea) had been placed with simultaneous sinus lifting in 137 sinus(m:f=86:51). Same surgical protocol had been applied in all cases. Same brand implants with three different diameter(3.8mm, 4.3mm 4.8mm, same length(12mm) and Bio-Oss(Geistlich, Swiss) only graft had been performed. Second surgery was performed after 6 months and progressive loading had been applied for 2 months. Average follow-up months was 39.1±11.7. Clinical and radiographic examination was performed to evaluate the success rate according to Albreksson s criteria. Results: 41% of installed implants had been placed in the maxilla where the residual bone was less than 4mm. Only one implant was removed on the day of second surgery. Six implants out of 3 patients showed 2mm marginal bone loss. The cumulative survival rate was 99.7% and success rate was 97.4%. Case 1.(M/52 Jung,0 0) Residual bone : 4mm Simultaneous implntation with both sinus lifting Progressive loading Post OP 1 years Post OP 2 years Conclusion: Sinus lifting with simultaneous implant placement could be successfully performed to treat the atrophic maxilla in patients with less than 4mm residual bone using Implantium implant. Simultaneous implant installation with sinus lift can be a predictable treatment for patients having severely resorbed maxilla. One stage surgery reduces the surgical procedure and time for implant restoration and is more comfortable than the staged surgery. Dental Implant 06

10 Retrospective study of survival rate of the Implantium implant system Il-hyun Kang, Gyung-Joon Chae, Ui-Won Jung, Chan-Sung Kim, Kyoo-Sung Cho, Jung-Kiu Chai, Chong-Kwan Kim, Seong-Ho Choi Department of Dental Science, Graduate School, Yonsei University, Reasearch Institute for Periodontal Regeneration Purpose: The Implantium implant system is characterized by sand-blasting, acid etching, internal connection and micro-thread. Specially, sand-blased and acid-etched (SLA) surface stimulates bone cell differentiation and protein production, has large amounts of bone-to-implant contact, and results in large removal torque values in functional testing of the bone contact. The aim of this retrospective study is to evaluate the clinical use and its efficacy and to analyze the short term success rate of Implantium implant system. These results contribute to long term study and place reliance on Korean-made implant. Material and Methods: Eighty five patients received placement of Implantium implant system, total number of 233 implant for a period of 3 year 4 months (from November 2003 to March 2007). Results: The findings from the results were as follows; 1. From patterns and distributions of the patients, no differences among male and female patients, the peak distributions of the implants, a total number of implants are similar on maxilla and mandible. 33(14.16%) implants on anterior region, 200 (85.84%) implants on posterior region. 2. The reason of tooth loss was orderly periodontal problem (52.79%), caries (18.88%), congenital missing (1.29%), and others. 3. As failed implants were three, survival rate was 98.71% 4. The reasons of implant failure were infection, poor bone conditions and failure of osseo-integration. Table 1. Distribution of implants according to position Table 2. Implant survival rate of native bone & augmented bone Conclusion: The survival rate of Implantium implant was 98.71%. Based on the result of this study, Implantium implant has an excellent survival rate. Key words : Implant, Survival rate 07 Dental Implant

11 Retrospective study of the Implantium internal connection with microthreads implant with a SLA surface and Re-Mee Doh, DDS, MSD, Hong-Suk Moon, DDS, MSD, PhD, Jun-Sung Shim, DDS, MSD, PhD, Keun-Woo Lee, DDS, MSD, PhD * Graduate Student, Associate Professor, Professor, Department of Prosthodontics, College of Dentistry, Yonsei University Statement of problem: Since the introduction of the concept of osseointegration in dental implants, high long-term success rates have been achieved. Though the use of dental implants have increased dramatically, there are few studies on domestic implants with clinical and objective long-term data. Purpose: The aim of this retrospective study was to provide long-term data on the Implantium implant, which features a sandblasted and acid-etched surface and internal connection with microthreads. Material and Methods: 106 Implantium implants placed in 38 patients at Yonsei University Hospital were examined to determine the effect of various factors on implant success and marginal bone loss, through clinical and radiographic results during a6to 30 month period. Results: 1. Out of a total of 106 implants placed in 38 patients, one fixture was lost, resulting in a 99.1% cumulative survival rate. 2. Among the 96 implants which were observed throughout the study period, the survival rates were 97.0% in the maxilla and 100% in the mandible. The survival rate in the posterior regions was 98.9% and 100% in the anterior regions. 3. The mean bone loss during the first year after prosthesis placement was 0.17mm, while the mean annual bone loss after the first year was 0.04 mm, which was statistically less than during the first year (P <.05). 4. There was no significant difference in marginal bone loss according to age during the first year (P>.05), but after the first year, the mean annual bone loss in patients above 50 years was significantly greater (P <.05) compared with patients under 50 years. 5. No significant difference in marginal bone loss was found according to the following factors: gender, jaw, location in the arch, type of implant (submerged or non-submerged), presence of bone grafts, type of prostheses, and type of opposing dentition (P <.05). Conclusion: Based on these results, the sole factor influencing marginal bone loss was age, while factors such as gender, jaw, location in the arch, type of implant, presence of bone grafts, type of prostheses and type of opposing dentition had no significant effect on bone loss. In the present study, the success rate of the Implantium implant with a SLA surface and internal connection with microthreads was satisfactory up to a maximum 30 month period, and the marginal bone loss was in accord with the success criteria of dental implants. Keywords : Implantium, SLA surface, internal connection, survival rate, marginal bone loss Corresponding Author: Keun-Woo Lee Department of Prosthodontics, College of Dentistry, Yonsei University 250 Seongsanno, Seodaemun-gu, Seoul , Korea : kwlee@yuhs.ac Article history Revised August 8, 2008 / Last Revision October 23, 2008 / Accepted November 26, 2008 Dental Implant 08

12 Fig 1.Implantium Implant (Dentium Co., Seoul, Korea) Fig 2. Reference used to measure actual marginal bone loss. (a) junction between implant machined collar beved and rough surface (b) implant to marginal bone contact level (c) inter-thred distance of six threrads Table 1. Life table analysis showing cumulative survival rates Table 2. Survival rates according to respective region in arch and jaw Table 3. Marginal bone loss around implants according to observation period Table 4. Comparison of marginal bone loss between older and younger adults 09 Dental Implant

13 Analysis of Short-term Success Rate and Healing Patterns of Implantium Implant Gyung-Joon Chae, Sung-Min Chung, Ui-Won Jung, Kyoo-Sung Cho, Jung-Kyu Chai, Chong-Kwan Kim, Seong-Ho Choi, and Chang-Sung Kim 1 2 Department of Periodontology, College of Dentistry, Yonsei University, Reasearch Institute for Periodontal Regeneration, Dentium Co., Ltd. Purpose: This study analyzed the distribution of patients who had Implantium implant placed at Yonsei University Dental Hospital as well as the types of implant site for about 1-year recall check and the success rate. Specifically, a total of 164 implants were placed on 52 patients. Material and Methods: Using the patient s chart, 1)Patient Type and Implant Distribution 2) Condition of Bone in the Surgery Area, 3) Diameter and Length of Grafted Implants, and 4) Quantity of Previous Bone After the Grafting Operation Involving Maxillary Sinus Elevation and Guided Bone Regeneration were evaluated. The success rate was then examined for the implants investigated in each case. Oral cavity examination and radiological examination were performed on all patients; their medical history and smoking habits were also investigated. Patients with absolutely uncontrollable contraindications were not subjected to implant operation; instead, other methods were recommended for the recovery of lost teeth. Results: 1. Patients in their 40s and 50s made up 65% of all implant cases; the average number of implants was 4 for males and 2.7 for females. A total of 75 implants were used on the maxilla, whereas 89 were placed on the mandible. On the other hand, 19 implants were used in the anterior region, and 145 implants, in the posterior region. 2. Bone quality for the implant site was mostly Type (37.2%); bone quantity was Type C (61.7%). 3. Majority of the implants used had length of 10, 12 mm (85%) and regular diameter (48.8%). 4. A total of 30 implants were placed using advanced techniques, e.g., GBR, window opening, and osteotome technique. 5. Two implants were removed prior to prosthodontic treatment owing to osseointegraton failure. A success rate of 98.8% was recorded in the 15.2 month follow-up period, with marginal bone loss of 0.28 mm. Table 1. Localization of the 164 implants inserted Dental Implant 10

14 Table 2. Distribution of implants Table 3. Distribution of bone quality Table 4. Number of advanced techniques on the recipient site Conclusion: The results provided basic data on patient type, implant distribution, bone condition, and survival rate. Based on the results of this study, Implantium implant can be said to be applicable to various clinical situations. Keywords : Implantium implant, success rate. * This study was supported by a grant from Dentium Co., Ltd. in Dental Implant

15 Retrospective Study of Implantium Dental Implants: Clinical and Radiographic Results of 22 Months Jung-Won Hwang, DDS, MSD, PhD, Young-Kyun Kim, DDS, MSD, PhD Department of Prosthodontics and Oromaxillofacial Surgery, Dentistry, Seoul National University Bundang Hospital, Korea. 2 Purpose: Over the last years, growing attention has been paid to the several domestic implant systems. This study presents results of a clinical trial of Implantium implants followed up to 22 months. Material and Methods: Two hundred fifty-two Implantium implants were investigated which were placed in 119 patients between June 2003 and November The average follow-up period from implant placement was 10. 9months (SD 4.9) and mean loading period was 7.9months(SD 4.3). Survival rate of implants was evaluated. For the evaluation of marginal bone changes, only the implants in function and more than 12 months of follow-up period from installation were considered. Crestal bone loss of 118 implants was analyzed using linear radiographic measurements. Results: After the first surgical stage, there was no failures of implants. No implant was lost after prosthetic loading time. The crestal bone level after fixture installation and after 1 year was 0.16±0.30mm and 0.58±0.64mm, respectively. The marginal bone loss during first one year was 0.44±0.55mm. Reference point Fig 1. Distribution of implants according to type of prosthetic restoration Fig 2. Reference point of implant Table 1. Distribution of implants according to length and diameter Table 2. Life table analysis of implants Dental Implant 12

16 A B C D Fig 3. Crestal bone response in serveral cases after 1 year of loading. A) very favorable response. B) slight bone loss to the first microthread. C)Vertical and horizontal bony loss. D) horizontal bony loss. Table 3. Comparison of Marginal Bone Level After 1year Table 4. Marginal Bone Loss(A-B) After 1year Conclusion: The results obtained in this short-term retrospective study population revealed an excellent survival rate for Implantium implants KEY WORDS: endosseous dental implants, Implantium, retrospective analysis 13 Dental Implant

17 Analysis of the healing process in sinus bone grafting using various grafting materials Young-Kyun Kim, DDS, PhD, Pil-Young Yun, DDS, PhD, Su-Gwan Kim, DDS, PhD, and c a a b Sung-Chul Lim, MD, PhD SeongNam and GwangJu City, Korea SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL AND CHOSUN UNIVERSITY Objectives: The purpose of this study was to compare differences in the healing process in the sinus bone grafting using various grafting materials. Study design: Maxillary sinus bone grafts were divided into 4 groups according to the graft material used: group I, amixture of autogenous bone and BioOss (Osteohealth Co., Shirley, NY); group II, a mixture of BioOss and Orthoblast II (Greencross; Isotis); group III, BioOss only; and group IV, synthetic bone, Osteon (Genoss, Korea), only. To evaluate the healing status of the graft surgery, bone specimens were collected from the lateral sinus using a 2.0-mm trephine bur at 4 and 6 months after surgery. Histology of the bone specimens was prepared, and the percentage of newly formed bone fraction, lamellar bone/woven bone ratio (LB/WB), and newly formed bone/graft material ratio (NB/GM) were measured to indicate the suitability of the materials and the healing of the grafts. Results: The LB/WB ratio and NB/GM ratio were markedly increased at 6 months compared with the values at 4months. It was observed that good bone healing was achieved even for grafts of xenogeneic bone only or synthetic bone only. Cases grafted with a mixture of allogeneic and xenogeneic bone showed no great advantage regarding bone healing. Table 1. Summary of the histomorphometric study Conclusion: The results indicated that grafts of xenogeneic or synthetic bone can be effective for sinus bone grafting. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107: ) I. Autogenous bone+biooss II. BioOSS +Orthoblast II III. BioOSS IV. OSTEON 4 month 6 month Bone Graft Material 14

18 Sinus bone graft using new alloplastic bone graft material(osteon) II : clinical evaluation a b c Ji-Hyun Bae, DDS, PhD, Young-Kyun Kim, DDS, PhD, Su-Gwan Kim, DDS, PhD, d Pil-Young Yun, DDS, PhD, and Jae-Seung Kim, DDS, PhD, Seongnam, Gwangju, and Seoul, Korea SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL, CHOSUN UNIVERSITY, AND GUNGUK UNIVERSITY e Objectives: The objective of this study was to clinically evaluate the use of Osteon as a sinus bone graft material and to measure the loss of sinus bone graft volume and marginal bone loss around the implants. Study design: Thirty-two implants were placed in 16 patients after maxillary sinus bone grafting. In 7 patients,maxillary sinus bone graft was performed first and 15 implants were placed after 4 months; in 9 patients, 17implants were placed simultaneously with maxillary sinus bone grafting. Based on medical records and radiographs, intraoperative and postoperative complications were examined, and at 1 year after the placement of the upper fixture,the success rate of implants, peri-implant soft tissue condition, and the marginal bone loss were evaluated. Additionally, the sinus bone graft volume loss was evaluated by comparing the residual alveolar bone height of the preoperative maxillary sinus floor with that immediately after the operation and after 1 year. Results: Regarding intraoperative complications, perforation of the maxillary sinus membrane occurred in 6 cases (37.5%), and after surgery maxillary sinusitis developed in 2 cases. During the healing period, 1 implant failed in osseointegration. At the last follow-up observation, none of cases showed marginal bone loss of _1 mm and a 96.9% success rate was seen. The follow-up observation period after placement of the superstructure was months (average 15). Between the simultaneous placement group and the delayed placement group, marginal bone loss showed no statistically significant difference (P _.455). In the entire patient group, the volume of sinus bone graft loss did not correlate with marginal bone loss (P _.568). Preoperative alveolar bone height was mm (mean 4.64), postoperative alveolar bone height was mm (mean 17.67), and the alveolar bone height 1 year after the operation was mm (mean 16.78). Between the group with perforation of the maxillary sinus membrane and the group without, no difference in marginal bone loss was observed (P _.628). Additionally, no difference in the volume of sinus bone graft resorption between the two groups was observed (P _.970). Conclusion: It was concluded that Osteon is suitable for use in sinus graft application. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e14-e20 15 Bone Graft Material

19 Effects of 4 Different Alloplastic Materials on Bone Regeneration in Rabbit Calvarial Defects 1,2 1 1,2 1,2 2 1,2 Sun-Jong Kim, Jin-Won Lim, Jae-Jun Ryu, Jin-Soo Ahn, In-ho Han and Sang-Wan Shin * 1 Dept of Advan Prosthodontics, Graduate School of Clinical Dentistry, 2 Instit Clinical Dental Research, Korea Univ, 80, Guro-Gu, Seoul , Korea (Received: Jan. 2nd, 2009; Accepted: Jan. 7th, 2009) Objectives: The purpose of this study was to compare bone regeneration in 8-mm defects in 8 New Zealand White rabbit calvaria using 4 different alloplastic bone substitutes. Materials and Methods: Four 8-mm calvarial defects were made in the parietal bone of each animal. The defects were filled with Bongros-HA (Bioalpha, Seongnam, Korea), micro macroporous biphasic calcium phosphate(mbcp, Biomatlante, France), Osteon (Dentium Co, Seoul, Korea) and Cerasorb (Curasan, Kleinsthei, Germany). Two animals died after surgery. Two rabbits were sacrificed after 4 weeks, and the other 4 were sacrificed after 8 weeks. Data analysis included the qualitative assessment of the calvarial specimens. Results and Discussion: Histomorphometric analysis was performed to quantify the amount of new bone within the defects. It was found that Osteon -treated defects had significantly more new bone after 8 weeks than all other groups. Osteon was an effective alloplastic bone substitute which showed reliable osseous healing of critical size defects in the rabbit calvarium. Conclusion: From the results of this study, it is suggested that HA and TCP alloplastic materials can be good bone substitutes for inducing new bone formation in rabbit calvaria in the early stage and that HA coated with TCP may have a better bone regeneration ability than HA, TCP or a mixture of HA and TCP. KEY WORDS: Bongros-HA, MBCP, Osteon, Cerasorb, critical size defect, rabbit model Table 1. Four groups of alloplastic materials used in this study Fig 1. Four different alloplastic materials were placed in the each defect. Fig 2. Histologic finding at 4 weeks after healing (x12).(a) BongrosHA, (b) MBCP, (c) Osteon and (d) Cerasorb Bone Graft Material 16

20 Fig 3. Histologic finding at 8 weeks after healing (x12). (a)bongros HA, (b)mbcp, (c) Osteon and (d)cerasorb. Table 2. Histomorphometric measurement of the percentages of newly formed bone. *p< Bone Graft Material

21 Alveolar Bone Regeneration by Transplantation of Periodontal Ligament Stem Cells and Bone Marrow Stem Cells in a Canine Peri-Implant Defect Model: A Pilot Study Su-Hwan Kim, Kyoung-Hwa Kim, Byoung-Moo Seo, Ki-Tae Koo, Tae-Il Kim, Yang-Jo Seol, Young Ku, In-Chul Rhyu, Chong-Pyoung Chung, and Yong-Moo Lee Department of Periodontology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea Department of Oral and Maxillofacial Surgery and Dental Research Institute, School of Dentistry, Seoul National University Background: The present study was undertaken to evaluate the potential of periodontal ligament stem cells (PDLSCs) and bone marrow SCs (BMSCs) on alveolar bone regeneration in a canine peri-implant defect model. Methods: Four adult, male beagle dogs were used in this study. Autologous BMSCs from the iliac crests and PDLSCs from extracted teeth were cultured. Three months after extraction, BMSC-and PDLSC-loaded hydroxyapatite/b-tricalcium phosphate (HA/TCP) (test groups) and cell-free HA/TCP (control group) were implanted in three rectangular, saddle-like peri-implant defects, respectively. The left side of the mandible was initially prepared, and after 8 weeks, the right side was also prepared. The animals were sacrificed after an 8-week healing period. Undecalcified ground sections were prepared. New bone formation and bone-toimplant contact (BIC) were measured histomorphometrically. BMSCs and PDLSCs were fluorescently labeled and traced. Results: Alveolar bone regeneration in surgically created periimplant saddle-like defects was more effective in test groups than the control group. The BMSC group had the highest new bone formation (34.99% and 40.17% at healing times of 8 and 16 weeks, respectively) followed by the PDLSC group (31.90% and 36.51%) and control group (23.13% and 28.36%), respectively. Test groups exhibited a significantly higher new bone formation than the control group at 8 weeks, but the same was true for only the BMSC group at 16 weeks (P <0.05). Fluorescently labeled cells were identified adjacent to HA/ TCP carriers and, partly, near connective tissues and osteoids. Conclusion: This study demonstrated the feasibility of using stem cell mediated bone regeneration to treat peri-implant defects. J Periodontol 2009;80: Fig 2. Characterization of canine PDLSCs. A) Cell clusters derived from PDL formed a single colony stained with 0.1% toluidine blue. B) Immunocytochemical staining showed that cultured PDLSCs expressed STRO-1 (CLSM). C) Immunocytochemical staining showed that cultured PDLSCs expressed CD146. Nuclei were stained with 30nMDAPI (CLSM). (Original magnification: A, x4.0: B. x400: C, x200) Fig 1. Surgical procedure. A)Three rectaangular, saddle-like, through defects were created. B)An implant was installed in the center of each defect. C)HA/TCP with or without cells was grafted. D) Collagen membranes were placed to cover the implants and defects. Bone screws secured the membranes in place. Bone Graft Material 18

22 Fig 3. Cells attached to HA/TCP. Arrows indicate attached cells. A) BMSCs. B) PDLSCs. (FE-SEM; original magnification x300) Fig 4. Photographs of the buccal-lingual histologic section at 8 weeks. A and B) BMSC group. C and D) PDLSC group. E and F) Control group. Asterisks indicate new bone formation around HA/TCP. (Basic fuchsin and methylene blue; original magnification; A, C, and E, x12.5;b,d,and F, x100.) Fig 5. Photographs of the buccal-lingual histologic section at 16 weeks. A and B) BMSC group. C and D) PDLSC group. E and F) Control group. Asterisks indicate new bone formation around HA/TCP. (Basic fuchsin and methylene blue; original magnification; A, C, and E, x12.5;b,d,and F, x100.) Fig 6. Cell tracking with CM-Dil labeling. CM-Dil-labeled cells appear red in the matrix and along the HA/TCP carrier. A) BMSC group at 8 weeks. B) PDLSC group at 8 weeks. C) BMSC group at 16 weeks. D) PDLSC group at 16 weeks. (CLSM; original magnification x200.) * udy. Submitted May 1, 2009; accepted for publication June 17, 2009; Published by the J Periodontol on November Bone Graft Material

23 Purpose: The objective of this study was to clinically evaluate the use of OSTEON as a sinus graft material and to measure the effect of healing at 4 and 6 months after surgery. Material and Methods: After sinus graft (Fig. 3) using OSTEON in 17 patients, bone specimens were collected from lateral sinus using 2.0-mm trephine bur at the time of 4 or 6 months after surgery. Histology of the bone specimens was prepared and the percentage of newly formed bone fraction, lamellar bone/woven bone ratio (LB/WB), and newly formed bone/graft material ratio (NB/GM) were measured to indicate the suitability of the materials and the successful healing of the graft. Results: The morphology of OSTEON was observed to be interconnected, with 77% porosity and a pore size of m.this observed architecture was suggested to be similar to human cancellous bone, with the interconnected porosity and pore size capable of providing space for bone cell ingrowth (Fig.1). After implantation, the mean percentage of newly formed bone fraction after 4 months and 6 months surgery was 40.6 and 51.9%, respectively (Table 1). Statistical analysis indicated no significant difference (p = 0.135) in the newly formed bone fraction between the two postoperative periods. As described in Table 1, the mean LB/WB ratio after 4 months and 6 months surgery was 0.14 and 0.45, respectively, with significant difference observed between the two postoperative periods (p = 0.027). Additionally, the mean NB/GM ratio after 4 months and 6 months surgery was 1.95 and 7.72, respectively, with significant difference observed between the two postoperative periods (p = 0.046). Bone Graft Material 20

24 Human bone OSTEON Fig 1. SEM morphology of OSTEON with interconnected pore structure (x120). The pore size is from 300 to 500 m, which is similar to human cancellous bone and the porous bone graft is beneficial to osteoblast cell ingrowth to OSTEON Fig 2. Cross-section view of OSTEON (left, x1000) and high magnification of OSTEON surface (right, x3000). The interconnected porous scaffold is comprised from biocompatible HA, while the surface is coated with bioresorbable -TCP. Fig 3. The window-forming bone was pushed-on to make the upper border of the graft site, and sinus membrane was elevated carefully. Panorama X-ray images before surgery Panorama X-ray images 7 month after surgery 21 Bone Graft Material

25 Table 1. Summary of the Histomorphometric Study Fig 4. Thickened, locally lamellar trabecular bone (closed asterisks) is seen around the resorbing implant material (open asterisks). H&E staining x40 (after 6 months) Conclusion: In this study, OSTEON, a new alloplastic material was clinically evaluated as a sinus graft material. The morphology was observed to be interconnected, with 77% porosity and a pore size of 300~500 m. No significant difference in the percentage of newly formed bone fraction was observed at 4 months and 6 months after grafting in 17 patients. However, significant differences in mean LB/WB ratio and the mean NB/GM ratio were observed after 4 months surgery. As confirmed by observations using the SEM, bone biopsy indicated more lamellar bone after 6 months surgery as compared to biopsy obtained after 4 months surgery. In this short-term study, it was concluded that OSTEON is suitable for use in sinus graft application since desirable time-dependent healing was demonstrated. Bone Graft Material 22

26 Purpose: Guided Bone Regeneration (GBR) has emerged as a treatment in the management of osseous defects associated with dental implants. But several studies have reported different degrees of success of guided bone regeneration, depending upon the type of barrier selected, presence or absence of an underlying graft material, types of graft material, feasibility of technique, and clinician s preference. The aim of the present study was to evaluate bone formation following dental implant placement with augmentation materials at dehiscence defects in dogs. Material and Methods: Standardized buccal dehiscence defects (3x5mm) were surgically 2 Mongrel dog s mandibles, each 8 SLA surface, 8 anodizing surface implants. Each buccal dehiscence defect received flap surgery only (no treatment, TM control), Cytoflex membrane only, Resolut XT membrane only, Resolut XT + Osteon. Animals were sacrificed at 8 weeks post-surgery and block sections were harvested for histologic analysis. Results: TM All experimental group resulted in higher bone formation than control. Resolut XT + Osteon group resulted appeared highest defect resolution. There was no difference between SLA and anodizing surface, nonresorbable and resorbable membrane. Fig1. Control:anodizing surface (8wk, x10) Fig2. Resolut XT : SLA surface (8wk, x10) TM Fig3. Resolut XT + OSTEON anodizing surface (8wk, x10) Conclusion: GBR results in rapid and clinically relevant bone closure on dehiscence defects of the dental implants. (J Korean Acad Periodontol 2008;38: ) KEY WORDS : dental implant; dehiscence defect; bone formation; GBR. 23 Bone Graft Material

27 2008 (Poster presentations) 218. Topic Tissue Augmentation and Tissue Engineering The effects of alloplasts on peri-implant defects in dogs Yang JH, Jung JY, Chae GJ, Jung UW, Jung SM, Lee IS, Cho KS, Choi SH Department of Periodontology, Oral Science Research Center, College of Dentistry, Yonsei University, Seoul Dentium, Seoul, Institute of Physics Applied Physics, and Atomic-Scale Surface Science Research Center, Yonsei University, Seoul. 2 3 Purpose: The objectives of this study were to evaluate the combined effect of ß-tricalcium Phosphate hydroxyapatite alloplasts(osteon ) and SLA surface dental implants(implantium ) placed in the surgically created two defects: circumferential and dehiscence gap. Material and Methods: In six mongrel dogs, all mandibular premolars and the first molar were extracted. After 8-weeks of healing period, submerged type implants were placed with circumferential cylinderical 2mm coronal defects and 3x5 mm dehiscence defects surgically created around the implants by using customized step drills. The defects were treated with 1 of the following 4 modalities: Control 1) No treatment on peri-implant circumferential defects, Control 2) No treatment on peri-implant dehiscence defects, Experimental group 1) Bone graft on peri-implant circumferential defects, Experimental group 2) Bone graft and resorbable membrane(gore Resolut XT ) applied on peri-implant dehiscence defects. The dogs were sacrified following an 8-weeks healing period, specimens were analyzed histologically and histomorphometrically. Fig 1. Bone circumferential defect preparation on implants Fig 2. Bone dehiscence defect preparation on implant buccal aspect Results: 1. Clinical findings During the postoperative period, healing was uneventful and implants were well-maintained. There were no signs of inflammation observed in the mucosa adjacent to the implants. 2. Histologic analysis The implant surface was covered with a bone layer as a base for intensive bone formation and remodeling. New bone formation was observed on peri-implant circumferential defects due to self contained gap. New bone formation was observed along the implant surface in the experimental group. Bone Graft Material 24

28 Fig 3. Histologic view of control group 1(Circumferential defect). 8 Wks A:magnification x 10, B: x 100, H.E staining. Fig 4. Histologic view of control group 2(Dehiscence defect). 8 Wks A:magnification x 10, B: x 20, H.E staining. Fig 5. Histologic view of experimental group 1{Circumferential defect, Implant + Bone(Osteon :HA+TCP)graft} 8 Wks A:magnification x 10, B: x 100, H.E staining. Fig 6. Histologic view of experimental group 2(Dehiscence defect) 8 Wks A:magnification x 10, B: x 20, H.E staining. 3. Histologic analysis The bone - to - implant contact (BIC) for Experimental group 1 showed higher value than control 1. Table 1. Bone to Implant contact Percentage(BIC %) in the Coronal 5mm of the Implant Control 1(No treatment, circumferential defect) Experimental 1(Circumferential Defect + Bone graft) Mean ( =4) Conclusion: The results suggests that ß-tricalcium phosphate hydroxyapatite alloplasts are effective on peri-implant defects of circumferential and dehiscence. * This research was supported by a grant(code #:08K ) from 'Center for Nanostructured Materials Technology' under '21st Century Frontier R&D Programs' of the Ministry of Education, Science and Technology, Korea 25 Bone Graft Material

29 Purpose: Biphasic calcium phosphates have been of great interest recently. Mixing adequate ratios of hydroxyapatite(ha) and beta-tricalcium phosphate ( -TCP) allowed to control the resorption rate without distorting its osteoconductive property. This study evaluated the bone formation effect of newly developed biphasic calcium phosphate (BCP) in calvarial defect of rabbits. Material and Methods: 6 male New Zealand rabbits were used. Four defects with 8mm in diameter were created on each animal. BCP with HA/ -TCP ratio of 7:3 and particle size of 0.5~1.0mm was used as the test group and bovine bone with 0.25~1.0mm particle size, as the control group. Both test and control group materials were randomly implanted in the calvarial defects and were covered with a polymer membrane. The animals were sacrificed after 12, 24, and 48 weeks of implantation under general euthanasia. Resin blocks were obtained and were stained by masson s trichrome for histological observation. Fig 1. Calvarial defect formation Fig 2. Bone material implantation Fig 3. Polymer membrane application Results: Overall results were uneventful without any defect exposure or inflammation. The amount of new bone formation and bone maturity increased with increase in healing period at both groups. New bone in test group was mostly formed along the material particle surrounded by osteoblasts, and observation of osteoblastic stream was also present. Bone maturity increased as it was closer stable bovine bone particles remaining even after 48 weeks, whereas considerable resorption took place in BCP. Almost total defect closure was observed in test group with new bone formation in the central part of the defect. However, limited new bone formation was observed in the control group. Bone Graft Material 26

30 Fig 4. Higher magnification of test group presenting new bone with osteoblastic stream (arrow) around BCP particle (x100, Masson s trichrome) Fig 5. Higher magnification of test group showing bone bridging (arrow) between newly formed bone (x100, Masson s trichrome) 12 weeks 12 weeks 24 weeks 24 weeks 48 weeks Fig 6. Histological section of control (bovine bone) at 12,24,48 weeks 48 weeks Fig 7. Histological section of test group (BCP) at 12,24,48 weeks Conclusion: Within the limits of the study, the present study reveals the newly developed BCP to be a good osteoconductive material. However, further studies are needed to be conducted in a different study model with a larger sample size. (J Korean Acad Periodontol 2008;38:163~170) KEY WORDS : Hydroxyapatite; beta-tricalcium phosphate; bone graft; calvarial defect. 27 Bone Graft Material

31 Purpose: The aim of this study was to evaluate biphasic calcium phosphate applied in surgically created 1-wall periodontal intrabony defects in dogs by histometircal analysis. Material and Methods: Critical sized (4mm X 4mm), on wall periodontal intrabony defects were surgically produced at the proximal aspect of mandibular premolars in either right and left jaw quadrants in four canines. The control group was treated with debridement alone, and experimental group was treated with debridement and biphasic calcium phosphate application. The healing processes were histologically and histometrically observed after 8 weeks. Results: In biphasic calcium phosphate group, more new bone and cementum formation, less epithelium and connective tissue attachment were observed compared to other groups. But there was statistical significance. Table 1. Histometric Results of Biphasic Calcium Phosphate and Control Group1 Fig 1. Schematic diagram depicting the landmarks and parameters used in the hostometric analysis, CEJ:cemento-enamel junction, aje:apical extent of junctional epithellum, cnc:coronal extent of newly formed cementum, cnb:coronal extent of newly formed bone, DF:dental floor,ea:epithelial attachment,cta:connective tissue attachment, BH:bone height, CR:cementum regeneration, DH: defect height Conclusion: Though the statistically significant difference could not be found, it seemed that there was more new bone and cementum formation with applying biphasic calcium phosphate in 1-wall intrabony defects in dogs by preventing junctional epithelium migration. (J Korean Acad Periodontal 2008;38: ) Fig 2. Control 8 weeks ( x40,h-e) Fig 3. Biohasic calcium phosphate8 weeks (x40,h-e) KEY WORDS : biphasic calcium phosphate, alloplastic materials, 1-wall defect. Bone Graft Material 28

32 Effects of Calcium-Phosphate Coating to SLA Surface Implants by the ion-beam assisted Deposition Method on Self-contained Coronal Defect Healing in Dogs Heun-Joo Yoon, Ji-Eun Song, Yoo-Jung Um, Gyung Joon Chae, Sung-Min Chung, In Seop Lee, 1 1 1,4 Ui-Won Jung, Chang-Sung Kim, and Seong-Ho Choi Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, 134 Shinchon-Dong, Seodaemun-gu, Seoul , Korea. Dentium Co., Seoul, Korea. Institute of Physics & Applied Physics, Atomic-scale Surface Science Research Center, Yonsei University, Seoul, Korea Abstract: The aim of this study was to evaluate the healing of self-contained coronal defects on a sand-blasted, large- grit, acid-etched (SLA) surface implant, which had calcium-phosphate (CaP) coating applied by ion beam-assisted deposition (IBAD). We also evaluated the effect of heating the coating to different temperatures. The HA-coated SLA implants exhibited a slightly larger bone healing capacity in the self-contained coronal defect than SLA implants, indicating that combining SLA surface implants and an HA coating by IBAD method had synergistic effects on bone healing. There was no difference in the healing capacity between 350 C and 450 C heat treatment of coating layer. Materials and methods: 1. Implant preparation Commercially pour titanium screw-type dental implants with a diameter of 3.4 mm and length of 10 mm were used. All implants were blasted with Al2O3 particles and divided into 3 groups. As-blasted implants were used for control group. The implants of experiment group 1and 2 were coated with CaP applied by the IBAD method and heat treatment was conducted at 350 C and 450 C. The samples were processed with 500-nm thick CaP films. Details of the coating procedures employed in this study have been described previously [25] ; Figure 1 shows the SEM micrographs of the resulting surface. 2. Animals Four male mongrel dogs, aged 18 to 24 months and weighing approximately 30 kg, were used. All of them had intact dentition and a healthy periodontium. Animal selection, management, and preparation as well as the surgical protocol followed the routine procedure approved by the Animal Care and Use Committee, Yonsei Medical Center, Seoul, Korea. 3. Experimental Design Titanium implants were divided according to their surface. The control group was implants with an SLA surface only. Experimental group 1 had an SLA surface and HA coating applied by IBAD after a 350 C heat treatment of the coating layer. Experimental group 2 had an SLA surface and HA coating applied by IBAD after a 450 C heat treatment of the coating layer. 4. Surgical protocol The implants (Implantium, Dentium, KOREA) were placed after a healing period of 8 weeks using the same surgical conditions. An incision was made at the crest of the ridge and full thickness flaps were carefully reflected on the buccal and lingual aspects. The edentulous ridge was flattened with a ridge contouring bur. Three non-submerged type implants (3.4 mm diameter, 10.0 mm length) were placed on the left side of the mandible. Implant osteotomy was performed at 800 rpm and circumferential defects of 2.0mm were surgically created around the implant with a customized paralleled step drill. The implant was then placed without tapping to obtain good initial stability. The flaps were closed with the 5-0 resorbable sutures. 29 Surface Treatment

33 Postoperative care was similar for both extraction and implantation. The sutures were removed after 7 to 10 days and a soft diet was provided throughout the study period. The dogs were sacrificed after 12 weeks by anesthesia overdose. Block sections, including segments with implants, were preserved and fixed in 10 % neutral buffered formalin. Results: 1.Clinical observations During the postoperative period, healing was uneventful and implants were well maintained. There were no sign of inflammation in the mucosa adjacent to the implants. 2. Histological Observations Examination revealed that the defect was incompletely filled with the bone in the control group (Figure 1). In the coronal portion of the defect, the lateral border of the newly formed bone was not in contact with the implant surface. A dense layer of connective tissue was observed in the space and in direct contact with the implant surface. On the other hand, the defect was healed and filled with new bone in both experimental groups (Figure 2, 3). This newly formed bone presented many osteocytes and showed good integration with the osteoblasts lining the implant surface. Fig 1. Scanning electron microscopy(sem) photographs (a) SLA surface (b) SLA surface with HA coating applied by the IBAD method Fig 2. SClinical photograph representing the experiment. 2.0mm circumferential gaps were prepared around the implants Fig 3. Histologic view of the control group. (a) Overall view. The defect adjacent implant Exhibited incomplete bone filling (magnification x10). (b) The connective tissue occupied the region between the implant and the mineralized tissue (magnification x20) Surface Treatment 30

34 Fig 4. Histologic view of the experimental group 1. (a) Overall view (magnification x10). (b) The surgically produced defect was healed and filled with new bone in experimental group 1 (magnification x 20) Fig 5. Histologic view of the experimental group 2. (a) Overall view (magnification x10). (b) The surgically produced defect was healed and filled with new bone in experimental group 2 (magnification x 20) Conclusion: In conclusion, on the self-contained coronal defect in dogs, combining an SLA surface and HA coating applied by the IBAD method has synergistic effects on bone healing. However, within the limits of this study, a 350 C heat treatment and 450 C heat treatment do not have different healing capacities when using this method. Submitted Jan 13, 2009; accepted for publication May 14, 2009; Published by the IOP Publishing August 11, Surface Treatment

35 Purpose: Since there is a lack of systematic studies on the SLA implant surface, the aim of this study is to investigate the efficacy of the newly developed SLA surface treatment technique. Material and Methods: The titanium implant surface was sandblasted with large grits and acid etched (SLA) to increase the implant surface for osseointegration. The topography of the titanium surface was investigated with scanning electron microscopy (SEM) and a profilometer. The biological behavior of the specimens was evaluated through the in vitro cell-surface interaction and in vivo animal tests with rabbits. In the clinical study, the marginal bone loss around implants was measured from radiographs taken with a standardized guiding device. The average evaluation period was 15.2 months. Results: The SLA implant demonstrated uniform small micro pits (1 2 m in diameter). The values of average roughness (Ra) and maximum height (Rt) were 1.19 and respectively after sandblasting and the acid-etching treatment. In the cell-surface interaction study, the human osteoblast cells grew well in vitro. The in vivo evaluation of the SLA implant placed in rabbit tibia showed good bone-to-implant contact (BIC) with a mean value of 29% in total length of the implant. In the short-term clinical study, SLA implants demonstrated good clinical performance, maintaining good crestal bone height. Fig 1.SEM topography of SLA surface Fig 2.SEM image of osteoblasts on the SLA surface after seven days of incubation (x700) Surface Treatment 32

36 Fig 3.Histological image of new bone apposition over the implant surface at four weeks Fig 4.Bone formation along the SLA surface from the cortical bone to the apex Fig 5. Clinical radiography after one year of loading. (A) Single case and (B) multiple cases Conclusion: The surface treated by sandblasting and then acid etching(sla)had beneficial effects on the biocompatibility and bone formation around the Ti implant. Although there was a slight decrease in the roughness value after the acid-etching treatment following sandblasting, it developed more uniform small micro pits (1-2 m in diameter) and sharp-edged peaks on the sandblasted surface. The SLA surface showed good biocompatibility with both in vitro cell response and in vivo animal study. Based on the short-term clinical results, the SLA implant used in this study showed an excellent survival rate (98.7%)with an average marginal bone loss of 0.28mm over a period of 15.2 months. A long-term clinical study is required in future work. 33 Surface Treatment

37 Enhanced Bone Forming Ability of SLA-Treated Ti Coated with a Calcium Phosphate thin film formed by E-Beam Evaporation Hyeongil Kim1, Seong-Ho Choi, Sung-Min Chung, Long-Hao Li and In-Seop Lee , Restorative Dentistry, School of Dental Medicine, University at Buffalo, NY 14214, USA Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul , Korea Dentium Clinic Implantium Institute, Seoul , Korea Atomic-Scale Surface Science Research Center, Yonsei University, Seoul , Korea Purpose: This study is aimed at forming a thin Ca-P coating layer on the SLA-treated titanium surface without altering the topography of SLA and thus having synergic effects of SLA topography with an active Ca-P coating layer. Material and Methods: A. Sample Preparation Ti specimens with grade IV were sandblasted using alumina particles and then acid etched by hydrochloric acid for SLA Treatment. The thickness of the deposited calcium phosphate layer was measured by a surface profiler. And evaporants of calcium phosphate were prepared by sintering the mixed powder of hydroxyapatite and calcium oxide. B. Characterization of Ca-P film Dissolution behavior was investigated by measuring the amount of dissolved phosphate ions with ion chromatography by immersing the coated Ti disks in 1ml deionized water at 37 C for different periods of soaking time. C. Cell attachment test Human osteosarcoma (Saos-2) cells were obtained from American Type Culture Collection. The stained cells were Dissolved by 0.5%SDS, and then the absorbance was measured at 619nm using ELISA reader. D. Animal Study Rabbit tibia model & Miniature pig model were used for the animal study. Screw-shaped Ti implants with dimensions of 4.0mm in length, 3.4 mm in diameter and 0.75mm in pitch height. The histological morphology was observed using optical microscopy. Results: The Ca-P coated implants improved bone formation greatly compared with uncoated SLA implants. New bone grew well on the portion of the cortical bone in only 4 weeks, and in most cases, it grew down to the hollowed region of the rabbit tibia bone. The positive effect of the Ca-P film was proven further by studies with a large animal of the miniature pig model. And during the post operative period, healing was uneventful and implants were well maintained. In addition, there were no signs of inflammation observed in the mucosa adjacent to the implants. Surface Treatment 34

38 Table 1. Roughness values of SLA Ti and coated Ti. Fig 1. SEM morphologies of (A) SLA Ti and (B) coated Ti. Fig 2. Dissolution behavior of Ca-P film in a deionized water solution at 37 C for various periods of immersion time. Fig 3. SEM image of Ca-P coating immersed in deionized water for (A) 1 day, (B) 3 days, (C) 8 days and (D) 15 days. The upper-right corner in (C) in the high magnification image. 35 Surface Treatment

39 Fig 4. X-ray different (XRD) patterns of coated Ti after immersion in deionized water for various soaking periods. Fig 5. Apatite formation of coated Ti after soking in DPBS for a 1h(A) and 1 day(b). Fig 6. Histological view of SLA Ti (A), (B), and coated Ti implant (C), (D) with a healing period of 4 weeks in the rabbit tibia model. Surface Treatment 36

40 Fig 7. Histological view of SLA Ti (A) and the coated Ti implant (B) with a healing period of 8 weeks in the miniature pig model. Fig 8. Number of Saos-2 cells after culturing for 4h. Asterisk ( ) indicates a statistically significant difference (Ρ< 0.05). Conclusion: A uniform and dense Ca-P thin film was coated on the SLA surface without changing the original morphology of the SLA surface. The newly developed Ca-P coated SLA-Ti implant showed higher cell adhesion, and greatly improved bone forming ability in both rabbit and the large animal of the miniature pig model. 37 Surface Treatment

41 Purpose: Titanium dioxide (TiO ), photocatalyst, is known to decompose various organic compounds under ultraviolet(uv) illumination by generating various rdicals, which is useful for killing bacteria. The purpose of the present study was to evlaluate the photocatalystic bactericial effectd of vaiously treated titanium surfaces on Septococcus sanguins SL1. Material and Methods: Specimens were fabricated from grade 4 commercially pure titnium, 10mm diameter and 2mm in thickness. Threre different surfaces were prepared: anodized (AO) at 270 BV. head-treatd(ht) and mechined (MA). Surface analysis was performed using confical laser scanning microscope, scanning electron microsopy nd thin-film X-ray-diffractometry. The antibacterial activities were assessed by comparing adhesin and survival rates of S sanguinis on various surfaces under UV illumination. Results: The AO surface was rougher than the HT and MA surfaces. The AO surface showed TiO peaks of anatase structure, while the HT anatase structure, while the HT surface showed TiO peaks of rutile structure in x-ray diffractometry. HT and AO surfaces showed significantly decreased bacterial adhesion under UV illumination (AO and HT > control, AO> MA). In addiition, bacterial adhesion decreased more signigicantly with extended UV illumination time. With respect to survival rates of bacteriam, AO and HT showed a significant reduction over time compared to MA. The photocatalytic bacteriidal effect was maximal on te AO titanium, followd by HT and MA. Surface Treatment 38

42 Conclusions: The photo-induced bactericidal efficacy of TiO films is dependent on their surface characteristics. Int J Oral Maxillofac Implants 2011; 26:39-44 Key words: ammtjas. photocatlytic bactericila effectr, rutile, titanium dioxidem ultravlet illuminuation 39 Surface Treatment

43 Purpose: In the present study, calcium phosphate was coated on titanium dental implant by IBAD, the properties of the thin films were analyzed, and the biological effects of the coatings on bone and soft tissue response were evaluated. Material and Methods: Each rabbit received four implants of two different treatments either as-machined surface, or as-blasted surface, or calcium phosphate coating on machined surface. The implants were grit blasted with TiO2 particles for blasted surface. The two implants with identically treated surfaces were inserted in the same leg 10 mm apart. After 12 weeks post implantation,the distal implants of each condition were unscrewed with a torque gauge instrument, and the proximal ones were preserved for the histomorphometric study. Results: The average bond strength of the as-deposited film is higher than other vacuum processed coatings. Biological evaluation showed that the calcium phosphate coatings promote more osteoblasts and fibroblasts to proliferate. The thin calcium phosphate coatings on the machined implants required a higher removal torque (48.5±5.4 Ncm), approximately 1.5 times than the as-machined ones (32.3±2.91 Ncm). Calcium phosphate coated implants showed slightly higher removal torque force than sandblasted implants (47.3±5.8 Ncm), but no statistical difference was obtained between the two materials. Fig 1.Bonding strength of coating layers according to coating methods Fig 2. Removal torque force Conclusion: In vivo experiments demonstrated that calcium phosphate coating on implants could improve bone-to-metal contact and removal torque force between bone and implant surfaces. Surface Treatment 40

44 Purpose: In this study, electron beam evaporation of hydroxyapatite with simultaneous bombardments of Ar ion beam was employed to deposit thin calcium phosphate films with the various Ca/P ratios. Also, silver incorporated calcium phosphate coating layer was created for antimicrobial effects. Material and Methods: Thin calcium phosphate films were deposited on the Ti substrates by electron-beam evaporation. Silver ion was introduced through immersion of calcium phosphate coated samples in 0.4 M AgNO3 solution. Results: Silver incorporated calcium phosphate films were formed by immersing calcium phosphate coated samples in 0.4 M AgNO3 for 30 min, and the Ag doped surface was almost 100% effective in reducing bacteria on contact with respect to controls. Table 1.Antimicrobial test rresults by shake flask method (CFULcolony forming unit) Fig 1.XPS spectra for (a)the as-deposited and (b)after 30 min immersion in 0.4M AgN03. Conclusion: Silver incorporated calcium phosphate coating layer had effect on antibiosis. 41 Surface Treatment

45 Healing of surgically created circumferential gap around Nano-coating surface dental implants in dogs Gyung-Joon Chae, Ui-Won Jung, Sung-Min Jung, In-Seop Lee, Kyoo-Sung Cho1, Chong-Kwan Kim, Seong-Ho Choi,* 1. Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea. 2. Institute of Physics & Applied Physics, and Atomic-scale Surface Science Research Center, Yonsei University, Seoul, Korea. 3. Dentium *Correspondence to : Seong-Ho Choi, Dept. of Periodontology, Yonsei University, dental hospital 134 shinchon-dong, Seodaemun-gu, Seoul Korea shchoi726@yumc.yonsei.ac.kr Purpose: The development and expanded use of dental implants has been increased. The implant stability and osseointegration are important factors in the success of treatment. Pure titanium and its alloys are the most commonly used materials for dental implants. Hydroxyapatite (HA), one of the calcium phosphate, has been studied for biomedical applications since it has similarity in chemistry with inorganic components of human bone and its biocompatibility. HA coating can be applied on metal implants by numerous methods. Of several coating methods, ion beam-assisted deposition has shown to promise. Material and Methods: This study was to compare the healing response of various nano-coating HA surface implants placed in surgically created circumferential gaps 12 weeks postplacement. In Four mongrel dogs, all mandible premolars and the first molar were extracted and four kinds of implants were placed. 2mm circumferential defects around the implants were made surgically with a customized drill. Groups were divided according to the fixture surfaces. The dogs were sacrificed following a 12 week healing period. Specimens were analyzed histologically and histomorphometrically. Results: The defect fills were much higher in the experimental groups. The bone-to-implant contact (BIC) and the bone density for experimental groups calcium phosphate coating implants with heat treatment- were also higher than the control group. In the control group, the coronal part showed minimal bone fill and osseointegration. Table 1.Bone- to Implant Contact Table 2.Bone Density Conclusion: Within the scope of this study, calcium phosphate coating may improve the bone response and the calcium phosphate coating may therefore be suitable in implant design with complex surface geometries. Key words: Dental implant, BIC, surface treatment, HA, animal study Surface Treatment 42

46 Purpose: In the present study, cytochrome C (cyt C) was incorporated with the thin calcium phosphate films formed on titanium by electron-beam evaporation during the formation of cyt C-apatite composite layer in Dulbecco's Phosphate buffered saline (DPBS) solution containing cyt C. And, the cyt C-apatite composite layer was evaluated. Material and Methods: Thin calcium phosphate films were deposited on the substrates to a thickness of 500 nm by electron-beam evaporation. Three different surface were calcium phosphate coating on machined surface, heated to 700 in air (M700), calcium phosphate coating on anodized surface, heated to 450 in air (A450), and calcium phosphate coating on anodized surface, heat to 350 in vacuum (A350). Cyt C (Sigma Chemicals, USA. 40 g/ml) was added to the DPBS solution to prepare the DPBSC solution. The samples with different surface finish were immersed in 2.0 ml of the DPBSC solution at 37 for 2 days. The surfaces were analyzed using X-ray photoelectron spectroscopy (XPS, PHI 5700) with Al K X-rays. The cyt C concentration of the DPBSC solution after immersion of the samples was measured using the BCA (Micro BCA protein assay kit, Pierce Biotechnology Inc, USA) method. Results: Cytochrome C (cyt C) was immobilized on the thin calcium phosphate films formed by electron-beam evaporation in the form of cyt C-apatite composite layer. Considering the protein quantitative assay based on the BCA method and SEM observations, it is confirmed that a thin newapatite layer incorporated with cyt C was formed on all the three groups of samples. There is a burst release within 1 day, and the amount of released cyt C almost reached to one-half of that released for 10 days. Fig1. Amount of cyt C incorporated with each disk of different sample Fig2. SEM micrographs of A350 surface after immersion in DPBSC solution for 2 days at 37 Conclusion: Cyt C-apatite composite layer was successfully formed on thin calcium phosphate film when immersed in DPBSC solution, and Sample A350 loaded with the maximum amount of cyt C. The release of cyt C from the cyt C-apatite composite layer continued at least 10 days. 43 Surface Treatment

47