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ePaper created 2015-09-15, 12:06:46 | version 1.38.0
I case report Fig. 1_Implant #001 (SLA M-line) at 30× magnification: irregularities in the surface roughness are evident. Fig. 2_Implant #001 (SLA M-line) at 100× magnification: there are parts on the crestal implant body with sanding marks and no surface treatment. Fig. 3_Implant #001 (SLA M-line) at 300× magnification: structural defects due to blasting media and massive residue are evident. Fig. 4_Implant #002 (SBA M-line) at 30× magnification. Quality of implant surfaces and poor osseointegration Part II: Irregular surface roughness suspected of causing deficient osseointegration Authors_Drs Nikolaos Papagiannoulis, Andreas Sakkas & Adrian Kasaj, Germany 16 I implants3_2015 _Modern dental implantsaremadeofatitanium alloy or a combination of titanium and ceramic. Pure titanium implants are also still manufactured. Tita- nium induces bone on-growth through a direct bio- chemical interaction with bone tissue. The biological response of the organism is related to the formation of a titanium dioxide layer, as discovered by Per-Ing- var Brånemark and widely applied to orthopaedic treatment. Besides this natural response to titanium, a series ofotherfactorsenhancebonetissueon-growth,even ingrowth, as in porous tantalum implant surfaces. Surface roughness, macro- and microstructure, as well as pores and specific laser configurations, in- creasebone–implantcontact(BIC),offeringmoresur- faces for osseointegration and stability under occlu- sion.Alloftheseparametersareimportantcharacter- istics of implant surfaces. The rate and speed of os- seointegration,aswellasthetimeofloading,correlate withthetextureandqualitystructureofsuchsurfaces. Several studies claim, controversially, that in the first year after loading implants show a vertical bone loss of approximately 1 mm and another 0.2 mm for every year thereafter. Such claims, although they do not consider implant type and design, soft-tissue quality, operation protocol, abutment connection, etc.,havebeenacceptedastruenonethelessbythein- dustry. Currently, operators consider such findings not critical. The industry has had different responses to this problem. Some manufacturers focus on the abut- ment–implant connection, others on the crestal im- plantdesignorimplantcollarsurface,andyetothers on platform switching and crestal or sub-crestal im- plant placement. The elimination of microgaps, the improvement of peri-implant tissue quality and quantity through platform switching, the reduction of bone stress through reduced roughness crestally or specific laser-directed thread design partially solve the bone loss problem. Hybrid implants are the most recent trend in oral implantology. Manufacturers claim reduced bone stressandpressure,betterhygiene,long-termtissue stabilitythroughlackofinclinedthreads,abettertis- sue response, reduction of the risk of peri-implanti- tis, faster integration and many other all-in-one so- lutions. Fig. 1 Fig. 2 Fig. 3 Fig. 4