(US) Phone: (310) 273-2819

IMPLANOVA CERTIFICATION

WHY?

Implanova implants boast self-osteomizing and self-grafting features, supplemented with an extremely easy prosthetic attachment setup. For the practitioners to take advantage of these innovations, they need to learn and understand the design features that are responsible for these advantages. The practitioner is expected to know the basics of dental implant placement and restoration. This course will not cover the basic principles of dental implant placement or restoration. If Implanova implants are treated like other endosseous dental implants currently in market, their benefits cannot be appreciated.e. It’s easy.

HOW?

The Implanova Certification Course explains in detail the entire Implanova dental implant system and simplifies the selection of various implant sizes through use of charts and x-rays. The difference between surgical protocols and procedures for Implanova implants and conventional dental implant systems are explained using animated videos, x-rays, and photographs. Finally, the practitioner is shown the simplicity by which almost all anterior and posterior restorations can be performed using one of the abutment selections from this system. In addition, procedural photos and videos are used to show practitioners the numerous possibilities of the system.

A schedule of classes can be found in the Course Schedule section. You may register for classes by phone, email, or directly through our website.

These courses, which are about 2 hours in length, can be taken at the Implanova office at 9100 Wilshire Blvd Suite W448 in Beverly Hills, CA or by recorded webinar online. Two CE credit units will be awarded upon completion of the course and, upon answering a 20-qustion quiz, an Implanova Certified Dentist certificate will be issued.

 

COURSE SCHEDULE

TESTIMONIALS

CE Course – How To Make a Simple, Economical, Fixed Implant Supported Bridge
September 30, 2016

Beverly Hills, CA

What Do They Think About the Course?

“Great experience awesome course. Thank you.” — Dr. Patricia Bezad, DDS

“Very knowledgeable speaker. Great presentation.” — Dr. Sako Ohanesian, DDS

“Dr. Zadeh has found or created a prosthetic solution that simplifies and enhances all implant dentistry.” — Dr. Hellickson

______________________________________________________________________________________________________

September 25, 2016
Study Group
Orange County, CA

What Do They Think About the Course?

“This was a true learning experience. I’m eternally grateful, the materials covered and learned can be put into practice immediately. Thank you!” — V. Bechtol, DDS

“Dialog was engaging and helpful. Questions were problem based and evidence based.”

“Very good and easy to apply.” 

“Very good hands-on workshop”

 “Had a lot of experience and offered a lot of tips. Was very helpful and gave me confidence to place implants.”

“It is very informative, educational, especially for new dentists.”

 “Great course! Simple, straight-forward and easy to understand.”

 “Great introduction for me as a GPR. FRIDGE was very interesting and something I would like to come back to learn more.” 

 “Great lecturer, made the whole lecture informative and entertaining at the same time.” 

 “I really enjoyed this class with a small group of people. I will definitely recommend other dentists to attend this class if they want to learn more about implants.”

______________________________________________________________________________________________________

September 10, 2016
CE Course – How To Make a Simple, Economical, Fixed Implant Supported Bridge
New Jersey

What Do They Think About the Course?

“Dr. Zadeh is very approachable, very patient and very knowledgable about his subject.  I am excited to have an alternative to the expense and complications of a screw-retained appliance. This method fills a big gap between locators and fixed appliances. New technique for providing a great service for the patient.” — Dr. Cam Witt, Basking Ridge, NJ 

“Great interaction. Dr. Zadeh engaging teaching allows the audience to come with conclusions and clarify steps before proceeding. This becomes a very  clear course from start to finish.”

“Excellent. Very informative and concise.” — Dr. Sheldon Boruchow, PA

“Excellent course. Instructor shows great detail in explaining how to do simple and effective permanent bridges for implant patients. This method will help save patient and dentist thousands of dollars.”

FRIDGE

FRIDGE Videos

FRIDGE™ Friction Grip Bridge System

The FRIDGE™ – Friction Grip Bridge System was introduced by Implanova® as a revolutionary technique for creating a totally implant supported denture that is fixed for the patient but removable by the dentist. This system serves as a superior alternative to traditional fixed screw-retained process and eliminates the need for screws, cement, implant level impressions, jig verification, metal bar, or other components that create a hassle for the practitioner. The system also allows the practitioner to examine and clean the prosthesis and implants conveniently without having to spend hours of opening access holes and unscrewing screws to remove the prosthesis. Therefore, the FRIDGE™ system would considerably reduce the labor and expense involved with creating and maintaining implant-supported fixed dentures.

FRIDGE™ system works by virtue of stock, precision-machined titanium FRIDGE™ caps that engage with the abutment head when fully seated by way of friction, allowing it to sit tightly on the abutment and serve as a stable pick-up attachment for the prosthesis. When tapped in and fully seated, these FRIDGE™ caps would not be removable without the use of significant force. These FRIDGE™ caps are compatible with all Unibutments and select stock abutments. The design of the caps can correct up to 8 degrees of inherent non-parallelism when using straight Unibutments, and up to 20 degrees of non-parallelism when using angled Unibutments. As a result, your implants don’t need to be perfectly straight to use this system! Silicone washers and Delrin caps are also available for easy processing.

30 EXTR

SUPPLEMENTARY PUBLICATIONS

Experimental Study of Bone Response to a

New Surface Treatment of Endosseous Titanium Implants

Antonio Sanz R., DDS
Periodontist, Adjunct Professor in Oral Implantology, and Director of the Postgrade in Oral Implantology, Odontology Faculty, University of Chile, Santiago, Chile.

Alejandro Oyarzun, DDS
Biochemical and Oral Biology Unit, Odontology Faculty, University of Chile, Santiago, Chile.

Daniel Farias, DDS, Ivan Diaz, DDS
Specialist in oral implantology, Odontology Faculty, Postgraduate School, University of Chile, Santiago, Chile.

There is a need to find ways of achieving better and more efficient osseointegration in poor bone qualities found in different jaw regions and to attempt to reduce the preload cicatrization period. Success in this area will make possible the placement of implants in sites (such as the posterior areas of the maxilla and the mandible) where it would be difficult or impossible to currently achieve sound osseointegration. 
Much of the current research is aimed at finding ways to modify the macrostructure as well as the microstructure of implants. These efforts may include the use of materials that could modify tissue response. The goal of obtaining an implant made with a biomaterial that will allow precise control of the superficial structure, absorption of protein, cellular adhesion, growth, and bone activation is noteworthy.
Different surface treatment of implants to improve their microstructure has been the goal of much experimental and clinical research during the last few years. Studies have demonstrated that the application of hydroxyapatite coatings increases the hardness of the bone-implant interface. Long-term outcomes for implants coated with hydroxyapatite are still under discussion. 
Another type of implant surface treatment involves increasing the superficial roughness. Scientific evidence accumulated over the last 10 years suggests that titanium implants with roughened surfaces achieve significantly improved anchorage in the bone than do implants with machined surfaces. The first attempt at increasing surface roughness was made almost two decades ago18 with the application of titanium plasma sprayed onto the surfaces of the implants. Results obtained with this surface have been very satisfactory, as studies have shown.
Other treatments designed to alter the surface morphology of implants include grit blasting with different sized particles of sand, glass, or aluminum oxide to create varying degrees of roughness and acid etching, which produces a uniformly rough texture over the entire implant surface. These techniques have also been used in combination with promising results. 
Recently, a new surface treatment called resorbable blast media (RBM) has been developed for application to implants. RBM involves blasting the implant with coarsely ground calcium phosphate (particle size, 180mm 3 425 mm), which gives the implant a coarse surface without leaving any residues. The calcium phosphate is a resorbable material that is not permanently imbedded into the surface of the implant primarily because of the passivation method used. The purpose of this study was to observe the biocompatibility of the RBM surface, analyze bone response, and make a topographical examination of the microstructure. 

MATERIALS AND METHODS.
Two one-year-old, white New Zealand rabbits weighing approximately 4 kg each received four commercially manufactured titanium implants (diameter, 4 mm; length, 10 mm) (Restore, Lifecore Biomedical, Chaska, MN) with surfaces treated with RBM. These implants were placed in the mid-face of each tibia (proximal metaphysis). The housing care and experimental protocol were in accordance with guidelines set by the University of Chile Institutional Animal Care and Use Committee. After a 16-week cicatrization period, the rabbits were killed. The implants and all surrounding bone tissue were recovered from the tibial area and fixed in 4% paraformaldehyde in 0.1 mol/L phosphate buffer (pH, 7.4) for seven days. Subsequently, the samples were dehydrated in ascending ethanols, including LR White hard grade resin (London Resin Co., Hants, UK). 
For microscopic observation, cuttings were made with diamond discs to a thickness of 100 mm. Their preparation was completed by abrasion to a thickness of 8 to 10 mm based on a method described by Donath.21 The cuttings were stained with methylene blue Azur II– basic fuchsin to observe their histology and take photographs with an Axioscop microscope (Carl Zeiss Inc., Thornwood, NY) on Kodak ASA 100 film (Eastman Kodak, Rochester, NY). 
The electron microscopy used to observe the characteristics of the microstructure of the RBM implants and to compare it with the surface of the machined implants was performed on a scanning electron microscope (DSM 940, Carl Zeiss Inc.). Observation of the sample was performed directly and without a gold bath because the implants reflect the ions of the scanning beam.

RESULTS.
Observation by Optic Microscopy.
Optic microscopy reveals bone formation in close contact with the titanium without intervening fibers. There is direct bone apposition in hollow areas in the surface of the implant. Bone tissue appears in the cortical area, completely filling the threads of the implant. In the medullary area, there is progress of bone tissue in relation to the surface of the implant, producing a type of cortical bone of a different thickness based on the degree of progress of the osteogenesis. In the areas closest to the cortical bone, greater thickness is seen than in the more distal areas. In the middle, there is bone marrow in contact with the bone in proliferation. At greater magnification, mature bone of the lamellar type is observed in the cortical area with a configuration of osteons within a clearly identifiable haversian system. There is no evidence of inflammatory cells or fibrous tissue.

Scanning Electron Microscopy.
The surface of the RBM implants as seen with a scanning electron microscope appears to be a coarse roughness that does not refract light except on the first three threads on which can be seen the machined titanium without surface treatment. In this area, the striae, characteristic of the implant turning process, can be distinguished. From the third thread onward, the surface of the implant is highly irregular and rough all over not only on the crest of the threads but also in the depressions between them. At higher magnification, the surface appears reticulated, with undermining and deformation of the metal remaining after impaction of the resorbable calcium phosphate material blasted under pressure on the surface of the implant. 

DISCUSSION.
The surface remaining after calcium phosphate blast application is irregular, extremely rough, and comparable to that obtained with other types of treatments, such as the sand form, the application of acids, or a combination of these two. The roughness of the implant surfaces favors distribution of stress, retention of the implants in the bone, and cellular response. An increase in bone response and in the resistance of the bone-implant interface has been reported with bone trabeculae growing perpendicular to the surface of the roughened implant. 
Studies have reported that adequate growth of bone in the interior of the pores or cavities left by the surface treatment requires that these must be approximately 100 mm in size. The growth of bone tissue into cavities of this size allows a mechanical interlocking of the implant with the bone. An increase in reverse torque values occurs in implants with pores between 10 mm and 40 mm. These pores do not allow maximum growth toward the inside of the bone. However, they do strengthen the mechanical union of the bone-implant interface. In vitro studies have also shown that the superficial roughness of the materials can influence cell function, matrix deposition, and mineralization. 
In terms of superficial roughness and pore size (2.5–4 mm), the RBM implants analyzed using scanning electron microscopy met the criteria, resulting in an improved boneimplant interface as described by various authors. Studies designed to measure the mechanical resistance of this type of surface appear to be absolutely necessary to support what has been described in relation to its microstructure. 
Using optic microscopy, there is evidence of direct apposition of bone tissue over the rough surface of this implant, just as was previously described by the authors in relation to other surfaces, such as commercially pure titanium, titanium plasma spray, and implants with a superficial coating of hydroxyapatite. In the cortical areas of the tibia, there is a complete filling of the implant threads, including anatomical repairs, with bone tissue appearing as mature bone of the lamellar type with haversian systems taking shape. In areas of spongy bone, there is bone apposition over the threads of the implant, surrounding them with a thin cortical bone of no more than 10–12 mm, bone tissue that grows at the expense of cortical areas and contact osteogenesis. This stretches toward the medullary area. This condition has also been described by Albrektsson and Johannsson25 in similar animal models and by Lederman, Schenk, and Buser in humans.
This bone property of growth over different surfaces is directly related to the mechanical rigidity of the substrate, its moistening ability, and the topography of the surface. The substrates with superficial tension greater than 30 dynes show greater bioadhesion; thus developing more points of insertion for cellular union. The property of greater moistening ability has been associated with rough implant surfaces. It is argued that it increases the points of initial fixation of the coagulum; thus avoiding its retraction and allowing greater bone contact with the implant. 
Scientific evidence accumulated during the last 10 years conclusively indicates that the rough surfaces of titanium implants offer a significantly improved anchor to the bone than machined titanium surfaces. Future lines of research in this field are absolutely essential to consolidate the new knowledge and to prepare the way for the development of implants that achieve more effective and lasting osseointegration, even in clinical situations of poor bone quality.

REFERENCES.

  1. Buser D, Schenk R, Steinemann S, et al. Influence of surface characteristics on bone integration of titanium implants: A histomorphogenic study in miniature pigs. J Biomed Mater Res. 1991;25:889–902.

  2. Gross U, Muller-Mai C, Fritz T, et al. Implant surface roughness and mode of load transmission influence periimplant bone structure. Adv Biomater. 1990;9: 303–308.

  3. Wilke H, Claes L, Steinemann S. The influence of various titanium surfaces on the interface shear strength between implants and bone. Advances in Biomaterials. 1990;9:309–314.

  4. Martin J, Schwartz Z, Hummert T, et al. Effect of titanium surface roughness on proliferation, differentiation and protein synthesis of human osteoblast-like cells. J Biomed Mater Res. 1995;29:389–401.

  5. Ledermann P, Schenk R, Buser D. Long lasting osseointegration of immediately loaded, bar connected TPS screw after 12 years of function: A histologic case report of a 95 year old patient. Int J Periodontics Restorative Dent. 1998;18:552-563.

  6. Ericsson I, Johansson CB, Bystedt H, et al. A histo-morphometric evaluation of to implant contact on machine-prepared and roughened titanium dental implants. Clinical Oral Implant Res. 1994;5:202–206.

  7. Gotfredsen K, Nimb L, Horting- Hansen E, et al. Histomorphometric and removal torque analysis for TiO2- blasted Titanium implants. An experimental study in dog. Clin Oral Implants Res. 1992;3:77–84.

  8. Brunette D. The effects of implant surface topography on the behavior of cells. Int J Oral Maxillofac Implants. 1988;3:231–246.

  9. Bobyn J, Pilliar R, Cameron H, et al. The optimum pore size for the fixation of porous-surface metal implants by the ingrowth of bone. Clin Orthop. 1980;150: 263–270.

  10. Hay D, Moreno E. Differential adsorption and chemical affinities for apatitic surfaces. J Dent Res. 1979;58:930–942.

  11. Lausmaa J, Mattson L, Rolander U, et al. Chemical composition and morphology of titanium surface oxides. In: Williams J, Nichols M, Zingg W, eds. Biomedical Materials. Pittsburgh: Materials Research Society; 1986:351–359.

  12. Sanz A, Farias D, Diaz I, et al. Estudio experimental de la respuesta osea frente a tres diferentes superficies de implantes de titanio Cp, Ha y Tps. REVISTA DEL Ilustre Consejo General de Odontologos y Estomatologos de Espana. RCOE 1998 Vol. 3;3: 221–226.

  13. Baier R. Surface properties influencing biological adhesion. In: Manly R, ed. Adhesion in Biological Systems. New York: Academic Press, 1970:115–148.

  14. Boyan BD, Hummert T, Kieswetter K, et al. Role of material surfaces in regulating bone and cartilage cell response. Biomaterials. 1996;17:137–146.

  15. Harris A. Tissue culture cells on deformable substrata: Biomechanical implications. J Biomech Eng. 1982;106:19–24.

  16. Harris A. Traction and its relations to contraction in tissue cell locomotion. In: Bellairs R, Curtis A, Dunn C, eds. Cell Behavior. Cambridge: Cambridge University Press, 1982:109–135.

  17. Sanz A, Farias D, Diaz I, et al. Estudio experimental de la fuerza de torque de remosion de implantes de Titanio cp, Ha, TPS, y RBM. J Periodoncia y Osteointegracion. (in press)

  18. Schroder A, Pohjer O, Sutter F. Gewebereaktion auf ein titanholzylinderimplanta mit titanspritzchichtoberflache. Schweitz Moonaatsschhr Zahnheilkd. 1976;86:713–722.

  19. Babbush C, Kent J, Misiek D. Titanium plasma sprayed (TPS) screw implants for the reconstruction of the edentulouos mandible. J Oral Maxillofacial Surgery. 1986;44:274–282.

  20. Buser D, Mericske-Stern R, Bernard J, et al. Long-term evaluation of non submerged ITI implants. Part 1: 8-year life table analysis of a prospective multicenter study with 2359 implants. Clin Oral Implants Res. 1997;8:161–172.

  21. Donath K, Breuner C. A method for the study on undecalcified bones and teeth with attached soft tissue. J Oral Pathol. 1982;11:318–325.

  22. Wong M, Eulenberger J, Schenk R, et al. Effect of surface topology on the osseointegration of implant materials in trabecular bone. J Biomed Mater Res. 1995;29:1567–1575.

  23. Martin JY, Schwarttz Z, Hummert TW, et al. Effect of titanium surface roughness on proliferation, differentiation and protein synthesis of human osteoblast-like cells (MG63). J Biomater Res. 1995;29:389–401.

  24. Breme J, Wadewitz V, Furbacher B. Production and mechanical properties of porous sintered specimens of the implant alloy TiAl5Fe2. Advances in Biomaterials. 1990;9:63–68.

  25. Albrektsson T, Johanson C. Quantified bone tissue reaction in various metallic materials with reference to the so-called osseointegration concept. In: Davies JE, ed. The Bone Biomaterial Interface. Toronto: Toronto University Press; 1991:357–363.

  26. Wong M, Eulenberger J, Schenk R, et al. Effect of surface topology on the osseointegration of implant material in trabecular bone. J Biomed Mater Res. 1995;29:1567–1575.

Article Link:  

http://www.implantoloji.info/articles/16/1/Experimental-Study-of-Bone-Response-to-a-New-Surface-Treatment-of-Endosseous-Titanium-Implants/Page1.html

 

EXPERIMENTAL STUDY OF BONE RESPONSE

Experimental Study of Bone Response to a New Surface Treatment of Endosseous Titanium Implants

Antonio Sanz R., DDS
Periodontist, Adjunct Professor in Oral Implantology, and Director of the Postgrade in Oral Implantology, Odontology Faculty, University of Chile, Santiago, Chile.

Alejandro Oyarzun, DDS
Biochemical and Oral Biology Unit, Odontology Faculty, University of Chile, Santiago, Chile.

Daniel Farias, DDS, Ivan Diaz, DDS
Specialist in oral implantology, Odontology Faculty, Postgraduate School, University of Chile, Santiago, Chile.

There is a need to find ways of achieving better and more efficient osseointegration in poor bone qualities found in different jaw regions and to attempt to reduce the preload cicatrization period. Success in this area will make possible the placement of implants in sites (such as the posterior areas of the maxilla and the mandible) where it would be difficult or impossible to currently achieve sound osseointegration. 
Much of the current research is aimed at finding ways to modify the macrostructure as well as the microstructure of implants. These efforts may include the use of materials that could modify tissue response. The goal of obtaining an implant made with a biomaterial that will allow precise control of the superficial structure, absorption of protein, cellular adhesion, growth, and bone activation is noteworthy.
Different surface treatment of implants to improve their microstructure has been the goal of much experimental and clinical research during the last few years. Studies have demonstrated that the application of hydroxyapatite coatings increases the hardness of the bone-implant interface. Long-term outcomes for implants coated with hydroxyapatite are still under discussion. 
Another type of implant surface treatment involves increasing the superficial roughness. Scientific evidence accumulated over the last 10 years suggests that titanium implants with roughened surfaces achieve significantly improved anchorage in the bone than do implants with machined surfaces. The first attempt at increasing surface roughness was made almost two decades ago18 with the application of titanium plasma sprayed onto the surfaces of the implants. Results obtained with this surface have been very satisfactory, as studies have shown.
Other treatments designed to alter the surface morphology of implants include grit blasting with different sized particles of sand, glass, or aluminum oxide to create varying degrees of roughness and acid etching, which produces a uniformly rough texture over the entire implant surface. These techniques have also been used in combination with promising results. 
Recently, a new surface treatment called resorbable blast media (RBM) has been developed for application to implants. RBM involves blasting the implant with coarsely ground calcium phosphate (particle size, 180mm 3 425 mm), which gives the implant a coarse surface without leaving any residues. The calcium phosphate is a resorbable material that is not permanently imbedded into the surface of the implant primarily because of the passivation method used. The purpose of this study was to observe the biocompatibility of the RBM surface, analyze bone response, and make a topographical examination of the microstructure. 

MATERIALS AND METHODS.
Two one-year-old, white New Zealand rabbits weighing approximately 4 kg each received four commercially manufactured titanium implants (diameter, 4 mm; length, 10 mm) (Restore, Lifecore Biomedical, Chaska, MN) with surfaces treated with RBM. These implants were placed in the mid-face of each tibia (proximal metaphysis). The housing care and experimental protocol were in accordance with guidelines set by the University of Chile Institutional Animal Care and Use Committee. After a 16-week cicatrization period, the rabbits were killed. The implants and all surrounding bone tissue were recovered from the tibial area and fixed in 4% paraformaldehyde in 0.1 mol/L phosphate buffer (pH, 7.4) for seven days. Subsequently, the samples were dehydrated in ascending ethanols, including LR White hard grade resin (London Resin Co., Hants, UK). 
For microscopic observation, cuttings were made with diamond discs to a thickness of 100 mm. Their preparation was completed by abrasion to a thickness of 8 to 10 mm based on a method described by Donath.21 The cuttings were stained with methylene blue Azur II– basic fuchsin to observe their histology and take photographs with an Axioscop microscope (Carl Zeiss Inc., Thornwood, NY) on Kodak ASA 100 film (Eastman Kodak, Rochester, NY). 
The electron microscopy used to observe the characteristics of the microstructure of the RBM implants and to compare it with the surface of the machined implants was performed on a scanning electron microscope (DSM 940, Carl Zeiss Inc.). Observation of the sample was performed directly and without a gold bath because the implants reflect the ions of the scanning beam.

RESULTS.
Observation by Optic Microscopy.
Optic microscopy reveals bone formation in close contact with the titanium without intervening fibers. There is direct bone apposition in hollow areas in the surface of the implant. Bone tissue appears in the cortical area, completely filling the threads of the implant. In the medullary area, there is progress of bone tissue in relation to the surface of the implant, producing a type of cortical bone of a different thickness based on the degree of progress of the osteogenesis. In the areas closest to the cortical bone, greater thickness is seen than in the more distal areas. In the middle, there is bone marrow in contact with the bone in proliferation. At greater magnification, mature bone of the lamellar type is observed in the cortical area with a configuration of osteons within a clearly identifiable haversian system. There is no evidence of inflammatory cells or fibrous tissue.

Scanning Electron Microscopy.
The surface of the RBM implants as seen with a scanning electron microscope appears to be a coarse roughness that does not refract light except on the first three threads on which can be seen the machined titanium without surface treatment. In this area, the striae, characteristic of the implant turning process, can be distinguished. From the third thread onward, the surface of the implant is highly irregular and rough all over not only on the crest of the threads but also in the depressions between them. At higher magnification, the surface appears reticulated, with undermining and deformation of the metal remaining after impaction of the resorbable calcium phosphate material blasted under pressure on the surface of the implant. 

DISCUSSION.
The surface remaining after calcium phosphate blast application is irregular, extremely rough, and comparable to that obtained with other types of treatments, such as the sand form, the application of acids, or a combination of these two. The roughness of the implant surfaces favors distribution of stress, retention of the implants in the bone, and cellular response. An increase in bone response and in the resistance of the bone-implant interface has been reported with bone trabeculae growing perpendicular to the surface of the roughened implant. 
Studies have reported that adequate growth of bone in the interior of the pores or cavities left by the surface treatment requires that these must be approximately 100 mm in size. The growth of bone tissue into cavities of this size allows a mechanical interlocking of the implant with the bone. An increase in reverse torque values occurs in implants with pores between 10 mm and 40 mm. These pores do not allow maximum growth toward the inside of the bone. However, they do strengthen the mechanical union of the bone-implant interface. In vitro studies have also shown that the superficial roughness of the materials can influence cell function, matrix deposition, and mineralization. 
In terms of superficial roughness and pore size (2.5–4 mm), the RBM implants analyzed using scanning electron microscopy met the criteria, resulting in an improved boneimplant interface as described by various authors. Studies designed to measure the mechanical resistance of this type of surface appear to be absolutely necessary to support what has been described in relation to its microstructure. 
Using optic microscopy, there is evidence of direct apposition of bone tissue over the rough surface of this implant, just as was previously described by the authors in relation to other surfaces, such as commercially pure titanium, titanium plasma spray, and implants with a superficial coating of hydroxyapatite. In the cortical areas of the tibia, there is a complete filling of the implant threads, including anatomical repairs, with bone tissue appearing as mature bone of the lamellar type with haversian systems taking shape. In areas of spongy bone, there is bone apposition over the threads of the implant, surrounding them with a thin cortical bone of no more than 10–12 mm, bone tissue that grows at the expense of cortical areas and contact osteogenesis. This stretches toward the medullary area. This condition has also been described by Albrektsson and Johannsson25 in similar animal models and by Lederman, Schenk, and Buser in humans.
This bone property of growth over different surfaces is directly related to the mechanical rigidity of the substrate, its moistening ability, and the topography of the surface. The substrates with superficial tension greater than 30 dynes show greater bioadhesion; thus developing more points of insertion for cellular union. The property of greater moistening ability has been associated with rough implant surfaces. It is argued that it increases the points of initial fixation of the coagulum; thus avoiding its retraction and allowing greater bone contact with the implant. 
Scientific evidence accumulated during the last 10 years conclusively indicates that the rough surfaces of titanium implants offer a significantly improved anchor to the bone than machined titanium surfaces. 
Future lines of research in this field are absolutely essential to consolidate the new knowledge and to prepare the way for the development of implants that achieve more effective and lasting osseointegration, even in clinical situations of poor bone quality.

REFERENCES.

  1. Buser D, Schenk R, Steinemann S, et al. Influence of surface characteristics on bone integration of titanium implants: A histomorphogenic study in miniature pigs. J Biomed Mater Res. 1991;25:889–902.

  2. Gross U, Muller-Mai C, Fritz T, et al. Implant surface roughness and mode of load transmission influence periimplant bone structure. Adv Biomater. 1990;9: 303–308.

  3. Wilke H, Claes L, Steinemann S. The influence of various titanium surfaces on the interface shear strength between implants and bone. Advances in Biomaterials. 1990;9:309–314.

  4. Martin J, Schwartz Z, Hummert T, et al. Effect of titanium surface roughness on proliferation, differentiation and protein synthesis of human osteoblast-like cells. J Biomed Mater Res. 1995;29:389–401.

  5. Ledermann P, Schenk R, Buser D. Long lasting osseointegration of immediately loaded, bar connected TPS screw after 12 years of function: A histologic case report of a 95 year old patient. Int J Periodontics Restorative Dent. 1998;18:552-563.

  6. Ericsson I, Johansson CB, Bystedt H, et al. A histo-morphometric evaluation of to implant contact on machine-prepared and roughened titanium dental implants. Clinical Oral Implant Res. 1994;5:202–206.

  7. Gotfredsen K, Nimb L, Horting- Hansen E, et al. Histomorphometric and removal torque analysis for TiO2- blasted Titanium implants. An experimental study in dog. Clin Oral Implants Res. 1992;3:77–84.

  8. Brunette D. The effects of implant surface topography on the behavior of cells. Int J Oral Maxillofac Implants. 1988;3:231–246.

  9. Bobyn J, Pilliar R, Cameron H, et al. The optimum pore size for the fixation of porous-surface metal implants by the ingrowth of bone. Clin Orthop. 1980;150: 263–270.

  10. Hay D, Moreno E. Differential adsorption and chemical affinities for apatitic surfaces. J Dent Res. 1979;58:930–942.

  11. Lausmaa J, Mattson L, Rolander U, et al. Chemical composition and morphology of titanium surface oxides. In: Williams J, Nichols M, Zingg W, eds. Biomedical Materials. Pittsburgh: Materials Research Society; 1986:351–359.

  12. Sanz A, Farias D, Diaz I, et al. Estudio experimental de la respuesta osea frente a tres diferentes superficies de implantes de titanio Cp, Ha y Tps. REVISTA DEL Ilustre Consejo General de Odontologos y Estomatologos de Espana. RCOE 1998 Vol. 3;3: 221–226.

  13. Baier R. Surface properties influencing biological adhesion. In: Manly R, ed. Adhesion in Biological Systems. New York: Academic Press, 1970:115–148.

  14. Boyan BD, Hummert T, Kieswetter K, et al. Role of material surfaces in regulating bone and cartilage cell response. Biomaterials. 1996;17:137–146.

  15. Harris A. Tissue culture cells on deformable substrata: Biomechanical implications. J Biomech Eng. 1982;106:19–24.

  16. Harris A. Traction and its relations to contraction in tissue cell locomotion. In: Bellairs R, Curtis A, Dunn C, eds. Cell Behavior. Cambridge: Cambridge University Press, 1982:109–135.

  17. Sanz A, Farias D, Diaz I, et al. Estudio experimental de la fuerza de torque de remosion de implantes de Titanio cp, Ha, TPS, y RBM. J Periodoncia y Osteointegracion. (in press)

  18. Schroder A, Pohjer O, Sutter F. Gewebereaktion auf ein titanholzylinderimplanta mit titanspritzchichtoberflache. Schweitz Moonaatsschhr Zahnheilkd. 1976;86:713–722.

  19. Babbush C, Kent J, Misiek D. Titanium plasma sprayed (TPS) screw implants for the reconstruction of the edentulouos mandible. J Oral Maxillofacial Surgery. 1986;44:274–282.

  20. Buser D, Mericske-Stern R, Bernard J, et al. Long-term evaluation of non submerged ITI implants. Part 1: 8-year life table analysis of a prospective multicenter study with 2359 implants. Clin Oral Implants Res. 1997;8:161–172.

  21. Donath K, Breuner C. A method for the study on undecalcified bones and teeth with attached soft tissue. J Oral Pathol. 1982;11:318–325.

  22. Wong M, Eulenberger J, Schenk R, et al. Effect of surface topology on the osseointegration of implant materials in trabecular bone. J Biomed Mater Res. 1995;29:1567–1575.

  23. Martin JY, Schwarttz Z, Hummert TW, et al. Effect of titanium surface roughness on proliferation, differentiation and protein synthesis of human osteoblast-like cells (MG63). J Biomater Res. 1995;29:389–401.

  24. Breme J, Wadewitz V, Furbacher B. Production and mechanical properties of porous sintered specimens of the implant alloy TiAl5Fe2. Advances in Biomaterials. 1990;9:63–68.

  25. Albrektsson T, Johanson C. Quantified bone tissue reaction in various metallic materials with reference to the so-called osseointegration concept. In: Davies JE, ed. The Bone Biomaterial Interface. Toronto: Toronto University Press; 1991:357–363.

  26. Wong M, Eulenberger J, Schenk R, et al. Effect of surface topology on the osseointegration of implant material in trabecular bone. J Biomed Mater Res. 1995;29:1567–1575.

Article Link:  http://www.implantoloji.info/articles/16/1/Experimental-Study-of-Bone-Response-to-a-New-Surface-Treatment-of-Endosseous-Titanium-Implants/Page1.html

MICROMOVEMENTS AT THE IMPLANT-ABUTMENT INTERFACE:

MEASUREMENT, CAUSES, AND CONSEQUENCES

MICROMOVEMENTS AT THE IMPLANT-ABUTMENT INTERFACE:

MEASUREMENT, CAUSES, & CONSEQUENCES

Zipprich, Holger/ Weigl, Paul / Lange, Bodo / Lauer, Hans-Christoph

Abstract

Most of two-component or multi-component implant systems use an implant-abutment connection with a clearance fit. The clinical impact is assumed as high according to the following factors:

  • Implant systems consisting of two or several components are much more widespread than single component systems because they offer a number of well-known clinical and technical advantages.

  • Unconnected crowns in the posterior region are more susceptible to technical failure of the implant-abutment interface.

  • Crestally or subcrestally placed implant-abutment interfaces are frequently subjected to crestal bone resorption following abutment connection.

This in-vitro study examined the dynamic behaviour of different designs of implant-abutment connections. Abutments were loaded at an angle of 30° with a force of up to 200 N. The distance of the point of force application from the implant platform was 8 mm; the gradation of the force was 0.3 N/ms. The interface of the implant-abutment connection was examined and measured radiologically using a professional high speed digital camera (1,000 images per second).

The results showed that, under simulated clinical conditions, complex mechanisms are responsible for the presence or absence of a micro-motion. All implant-abutment connections with a clearance fit exhibit a micro-motion (implant systems: SIC®; Replace Select®; Camlog®; XIVE®; Straumann synOkta®; Bego-Semados®; Straumann massive conical abutment®). Precision conical connections (implant systems: Ankylos®; Astra Tech®) show no micro-motion.

The potential clinical relevance of these results can at this point only be derived from theoretical considerations. Presumably, the pumping effect caused by the micro-motion plays an important role for crestal bone resorption. It is assumed that the bone is contaminated with liquid contained in the implant.

Link to article:

The paper has been published in the German journal: Implantologie. (Vol. 15,2007 Issue 1, p. 31-46)

Article Link:

https://www.moi.uni-frankfurt.de/xrayvideo/index_en.php

A PROSPECTIVE, MULTICENTER, 4-YEAR STUDY

OF THE ACE SURGICAL RESORBABLE BLAST MEDIA IMPLANT

A Prospective, Multicenter, 4-Year Study of the ACE Surgical Resorbable Blast Media Implant

Aron Gonshor, PhD, DDS, Gerald Goveia, DMD, Emmanouil Sotirakis, DDS

1. Aron Gonshor, PhD, DDS, is in private practice and is a lecturer at McGill University, Oral and Maxillofacial Surgery, Montreal, Canada. Address correspondence to Dr Gonshor at McGill University, Oral and Maxillofacial Surgery, 4980 Glencairn Avenue, Montreal, Quebec, Canada H3W 2B2 ( arongonshor@hotmail.com)

2. Gerald Goveia, DMD, is in private maxillofacial practice in Brockton, MA

3. Emmanuel Sotirakis, DDS, is in private general dental practice in Athens, Greece

Article Citation:​ 
Aron Gonshor, PhD, DDS, Gerald Goveia, DMD, Emmanouil Sotirakis, DDS, A Prospective, Multicenter, 4-Year Study of the ACE Surgical Resorbable Blast Media Implant, Journal of Oral Implantology. 2003;29(4):174-180.

Abstract

This article reports on the 50-month results of the evaluation of the ACE Surgical resorbable blast media (RBM) dental implant. There were 1077 implants placed in 348 patients: 950 in the mandible and 127 in the maxilla. A total of 78.6 percnt; of the implants were used to support anterior, mandibular, bar-retained overdentures. The 3.75- to 4.00-mm-diameter implant was used in 91.1 percnt; of cases, with the remainder being 3.3 mm (2.2 %) or 4.75 mm (6.7 %). The implants of 10-, 13-, and 15-mm lengths were used in almost equal amounts in the mandible, maxilla, and anterior or posterior aspects of either jaw. There were 7 failures, all in the mandible and before stage 2 surgery. The overall implant success rate in this 50-month interim report is 99.3 % in the mandible and 100 % for the maxilla. There was no discernible crestal bone loss during the study period. No differences in bone response were seen in RBM implants with roughened surfaces on the entire implant, up to the collar, or up to the first 2 threads below the collar.

Article Link:  chrome-extension://oemmndcbldboiebfnladdacbdfmadadm/http://www.joionline.org/doi/pdf/10.1563/1548-1336%282003%29029%3C0174%3AAPMSOT%3E2.3.CO%3B2

BONE RESPONSE TO MACHINED AND RESORBABLE BLAST MATERIAL TITANIUM IMPLANTS:

AN EXPERIMENTAL STUDY IN RABBITS

Bone response to machined and resorbable blast material titanium implants: an experimental study in rabbits.

Piattelli M1, Scarano A, Paolantonio M, Iezzi G, Petrone G, Piattelli A.

Abstract

The aim of the present study was a comparison of implants’ responses to a machined surface and to a surface sandblasted with hydroxyapatite (HA) particles (resorbable blast material [RBM]). Threaded machined and RBM, grade 3, commercially pure, titanium,

screw-shaped inplants were used in this study. Twenty-four New Zealand white mature male rabbits were used. The inplants were inserted into the articular femoral knee joint according to a previously described technique. Each rabbit received 2 inplants, 1 test (RBM) and 1 control (machined). A total of 48 implants (24 control and 24 test) were inserted. The rabbits were anesthetized with intramuscular injections of fluanisone (0.7 mg/ kg body weight) and diazepam (1.5 mg/kg b.wt.), and local anesthesia was given using 1 mL of 2% lidocaine/adrenalin solution. Two rabbits died in the postoperative course. Four animals were euthanatized with an overdose of intravenous pentobarbital after 1, 2, 3, and 4 weeks; 6 rabbits were euthanatized after 8 weeks. A total of 44 implants were retrieved. The specimens were processed with the Precise 1 Automated System to obtain thin ground sections. A total of 3 slides were obtained for each implant. The slides were stained with acid and basic fuchsin and toluidine blue. The slides were observed in normal transmitted light under a Leitz Laborlux microscope, and histomorphometric analysis was performed. With the machined implants, it was possible to observe the presence of bone trabeculae near the implant surface at low magnification. At higher magnification many actively secreting alkaline phosphatasepositive (ALP+) osteoblasts were observed. In many areas, a not yet mineralized matrix was present. After 4 to 8 weeks, mature bone appeared in direct contact with the implant surface, but in many areas a not yet mineralized osteoid matrix was interposed between the mineralized bone and implant surface. In the RBM implants, many ALP+ osteoblasts were present and in direct contact with the implant surface. In other areas of the implant perimeter it was possible to observe the formation of an osteoid matrix directly on the implant surface. Mature bone with few marrow spaces was present after 4 to 8 weeks. Beginning in the third week, a statistically significant difference (P < .001) was found in the bone-implant contact percentages in machined and RBM implants. It must be stressed that these results have been obtained in a passive, nonloaded situation.