2. Introduction
• A dental implant is an artificial tooth root that takes the form of a screw. It
supports restorations resembling a tooth or a group of teeth. The efficiency
of an implant depends on its capacity to provide mechanical support,
withstand loads, cyclic loads (fatigue) and wear. On the biological front;
toxic, inflammatory, allergic reactions should not occur. Aspects like
osseointegration, osteolysis or bone remodelling has to be considered. Per-
Ingvar Brånemark, proposed that titanium (Ti) implants integrate such that
the bone is laid very close to the implant without any intervening
connective tissue. The major factor that determines the success of dental
implantation is osseointegration. (the titanium dioxide, TiO2, layer
permanently fuses with the bone) Geometrical design, the surface
treatment, and the surgical technique are also essential in evaluating the
performance of a specific implant.
3. Introduction
• The initial period of osseointegration of Titanium & its alloys is the critical
point for promoting the anchoring of dental implants. The implant/tissue
interface is influenced by numerous factors, including surface chemistry
and surface topography of the foreign material. Surface modifications have
been applied to metallic biomaterials on macroscopic, microscopic and
nano level in order to improve mechanical, chemical, and physical
properties such as wear resistance, corrosion resistance, biocompatibility
and surface energy. On the macroscopic level surface roughness influences
the mechanical properties of the titanium/bone interface, through
mechanical interlocking of the interface. Microrough surfaces enhances the
mechanical retention between two surfaces, by sandblasting, acid etching
shot peening, or laser peening method.
4. Mechanism of osseointegration
• Blood clot
• Clot transformed by phagocytes (1st to 3rd day)
• Procallus formation (containing immature fibroblasts and phagocytes)
• Dense connective tissue (differentiation of osteoblasts and
fibroblasts)
• Callus formation Fibrocartilagenous callus
• Bony callus (penetration and maturation)
5. Implant Biomaterials
• Biomaterials are those materials that are compatible with the living
tissues. Biocompatibility is dependent on the basic bulk and surface
properties and biomaterials. Materials used for fabrication of dental
implants can be categorized in two different ways:
1. Chemical basis - metals, ceramics
2. Biological basis - biodynamic materials: biotolerant, bioinert,
bioactive
6. Factors affecting implant biomaterial
1. Chemical factors
Three basic types of corrosion - General, pitting and crevice.
2. Surface Specific Factors The events at the Bone-Implant interface can be divided into
• The behavior of the implant material
• The host response
3. Electrical Factors
• Physiochemical methods
• Morphologic methods
• Biochemical methods
4. Mechanical Factors
• Modulus of elasticity
• Tensile or compressive forces
• Elongation
• Metallurgy
7. Metals and Alloys
• Titanium
• Cobalt-Chromium-Molybdenum Based Alloys
• Iron-Chromium-Nickel Based Alloys
• Other Metals and Alloys
8. Ceramics
• Ceramics are nonorganic, nonmetallic, nonpolymeric materials
manufactured by compacting and sintering at elevated temperatures.
They can be categorized according to tissue response as:
• Bioactive: Bioglass/Glass ceramic
• Bioresorbable: Calcium phosphate
• Bioinert: Alumina, zirconia and carbon
9. Ceramics
• Aluminum, Titanium and Zirconium Oxides
• Bioactive and Biodegradable Ceramics based on Calcium Phosphate
• Bioactive Ceramics
• Carbon and Carbon Silicon Compounds
• Bioactive Glass Ceramics
10. Polymers and Composites
• Biomedical Polymers The more inert polymeric biomaterials include
Polytetrafluroethylene (PTFE),
Polyethyleneterephthalate (PET),
Polymethylmethacrylate (PMMA),
Ultra high molecular weight polyethylene (UHMW-PE), Polypropylene
(PP),
Polysulfone (PSF) and
Polydimethyl siloxane (PDS) or Silicone rubber (SR)
11. Surface modifications of titanium implants
• Surface roughness has been identified as an important parameter for implants and its
capacity for being anchored in bone tissue.
• Commercially available implants have been categorized according to the roughness value
(Sa) into 4 groups by Albrektsson & Wennerberg in 2004 into-
o smooth (Sa < 0.5 μm)
o minimally rough (Sa = 0.5-1.0 μm)
o moderately rough (Sa = 1.0-2.0 μm)
o rough (Sa > 2.0 μm).
Based on the scale of the features, the surface roughness of implants can be divided into-
Macro
Micro
Nano
12. Methods for evaluation of Surface Roughness
• 1) Mechanical Contact Profilometers
• 2) Optical Profiling Instruments
Focus Detection Systems
Confocal Laser Scanning Microscopy
White Light Interferometer
• 3) Scanning Probe Microscopes
13. Classification of Surface treatment
• Classification -1
Ablative/Subtractive processes: Grit Blasting, Acid Etching, Anodization, Laser peening
Additive processes: Plasma Spraying, Electrophoretic Deposition, Sol Gel coating, Biomimetic precipitation
• Classification -2
Based on texture obtained, the implant surface can be divided as:
Concave texture: mainly by additive treatments like hydroxyapatite coating and titanium plasma spraying.
Convex texture: mainly by subtractive treatment like etching and blasting
• Classification -3
Based on the orientation of surface irregularities, implant surfaces are divided as:
Isotropic surfaces: have the same topography independent of measuring direction.
Anisotropic surfaces: have clear directionality and differ considerably in roughness.
• Classification -4
Physicochemical: modification of surface energy, surface charge and surface composition to improve the
boneimplant interface.
Morphological: alteration of surface morphology and roughness to influence cell and tissue response to
implants
Biochemical: increased biochemical interaction of implant with bone
14. Macro-Surface Modifications
• Implant design and topography
• Thread shape
• Thread depth
• Thread width
• Thread pitch
• Thread helix angle
• Amount of force
• Favorable force
• Crestal module
• Rough or Smooth neck
• Microthreads
• Machined surface
15. Implant design and topography
• Thread shape is determined by the
thread thickness and thread face
angle. Available shapes V-shape,
square shape, buttress, reverse
buttress and spiral.
• Thread shape determines the face
angle.
• Face angle is the angle between
the face of a thread and a plane
perpendicular to the long axis of
the implant.
16. • Thread depth is defined as the
distance from the tip of the
thread to the body of the
implant.
• Thread width is the distance in
the same axial plane between
the coronal most and the apical
most part at the tip of a single
thread
17. • Thread pitch
The distance from the center of the thread to the center of the next thread,
measured parallel to the axis of a screw. In implants with equal length, the
smaller the pitch the more threads there are. In a single-threaded screw,
lead is equal to pitch, however in a double threaded screw, lead is double the
pitch and in a triple-threaded lead is triple the pitch. An implant with double
threads would insert twice as fast the single threaded and the triple
threaded would only need a third of the required time for a single thread
• Thread helix angle
Constant pitch of 0.8mm. The double and triple threaded implants had twice
and triple the thread helix of the single-threaded implant, respectively.
According to FEA study, the implant stability appeared to be the single-
threaded one. The triple threaded was found to be the least stable.
18. • Amount of force
Functional occlusal loading on an implant triggers the remodeling of
the surrounding alveolar bone. A mild load induces a bone remodeling
response and reactive woven bone production. However, excessive
load result in microfractures which in turn causes osteoclastogenesis
• Favorable forces
Three types of loads are generated at the interface --compressive,
tensile and shear forces. An ideal implant design should provide a
balance between compressive and tensile forces while minimizing
shear force generation.
19. • Crestal Module
The neck of the implant is called crest module In this area the bone density is
thicker and therefore helpful to achieve implant primary stability. If loading on a
particular bone increases, the bone will remodel to become stronger. If the loading
on a bone decreases, the bone will become weaker because no stimulus is present.
• Rough or Smooth neck
Originally crest module was always smooth. The use of a smooth neck on rough
implants --decreases plaque retention because the coronal portion of the implant
was not embedded in bone. When the smooth portion of the implant is placed
under the bone crest, increased shear forces are created resulting in marginal bone
loss and eventually more pocket formation. When an implant with a smooth neck is
selected, it should be placed over the bone crest.
20. • Micro threads
Recently, the concept of microthreads in the crestal portion has been
introduced to maintain marginal bone and soft tissues around the
implants. In presence of a smooth neck, negligible forces are
transmitted to the marginal bone leading to its resorption. The
presence of retentive elements at the implant neck will dissipate some
forces leading to the maintenance of the crestal bone height
accordingly to Wolff’s law. fMicrothreaded implants increase bone
stress at the crestal portion when compared with smooth neck
implants.
21. Machined surface
• Lathing, Milling, Threading
Machined implant surfaces are characterized by more grooves and valleys which
provide mechanical resistance through bone interlocking.
Properties of machined surface depends upon manufacturing tools, tool pressure,
bulk material, thickness and temperature choice of lubricant and machining speed .
Typical Sa values for machined surfaces are 0.3-1.0 μm.
The surface oxide consists of a 2-10 nm thick mostly amorphous layer of TiO2
Disadvantage
osteoblastic cells are rugophillic
they grow along the grooves existing in the surface
Hence a long waiting time (3-6 months )
26. Sandblasting
• Small grits in chosen shape and size are forced across implant surfaces by compressed air
that creates a crater. Surface roughness is dependent on the bulk material, the particle
material, (size, shape, speed density), duration of blasting, air pressure, and distance
between the source of the particles and implant surface. Blasting media Alumina (Al2O3)
or silica (SiO2) Surfaces blasted with 25 μm particles were rougher than machined
surface and smoother than 75 μm and 250 μm blasted surfaces.
• Typical Sa values range from 0.5-2.0 μm
• Goals of sand blasting:
1) Cleaning the implant surface and increasing its bioactivity.
2) Roughening surfaces to increase effective/functional surface area.
3) Accelerate osteoblasts adhesion and proliferation
4) Producing beneficial surface compressive residual stress.
5) Exhibiting higher surface energy, higher surface chemical and physical activities.
Enhancing fatigue strength, fatigue life, due to compressive residual stress.
27.
28. Grit blasting
• Surface of the implant is bombarded with hard dry particle or
particles suspended in a liquid, through a nozzle at high velocity by
means of compressed air. Roughness produced on the surface of Ti
depends upon the size of the particle. Blasting material must be
chemically stable and biocompatible and must not hamper
osseointegration. Ceramic particles such as alumina, silica, Titanium
oxide, calcium phosphate particles are used. Blasting media is
embedded in the implant surface. Residue particles have been
released into the surrounding tissues and interfered with
osseointegration.
29. Shot peening
• Modified method of grit blasting but has more controlled peening
power, intensity and direction. It is a cold working process in which
the surface of a part is bombarded with small spherical media called
„shot‟. It is used primarily for introducing compressive stresses in the
material‟s surface. Depends greatly on the size of the particle used.
Alumina particles in the size (25-75 μm) -- surface roughness (0.5-1.5
μm) Particles of size (200-600 μm) -- roughness (2-6 μm) Glass
particles of size (150-230 μm) -- smooth surface with Ra value of 1.36
μm
30. Acid-etching
• Immersing it in strong acids (e.g., nitric acid, hydrochloric acid,
hydrofluoric acid, sulfuric acid, and their mixtures) for a given period
of time, creates a micro-roughness of 0.5–3 μm. The surface is pitted
by removal of grains and grain boundaries of the implant surface. It
also cleans the implant surface, e.g., removes deposits. The typical Sa
values are 0.3-1.0 μm
31.
32. Dual acid-etched technique
• Immersion for several minutes in a mixture of concentrated HCl and
H2SO4 heated above 100 °C can be employed to produce a micro
rough surface. This enhances the osteoconductive process through
the attachment of fibrin and osteogenic cells, resulting in bone
formation directly on the surface of the implant.
33. Sandblasted and acid etched surface (SLA)
• SLA – (Buser) Sand blasted, Large grit, Acid etched. SLA combines
sandblasting and acid-etching. In SLA protocol, the titanium dental
implant surface is first sandblasted with large grits 250 - 500 μm,
making the surface grossly rough. Then, the implant is acid-etched by
HCL/H2SO4. Acid etching leads to micro texturing and cleaning.
34.
35. Other Chemical Treatments
• Solvent cleaning
Removes oils, greases and fatty surface contaminants remaining after
manufacturing process. Organic solvents (aliphatic hydrocarbons,
alcohols, ketones or chlorinated hydrocarbons), surface active
detergents and alkaline cleaning solutions.
36. • Alkaline etching
Treatment of titanium in 4-5 M sodium hydroxide at 600°C for 24 hours
produce sodium titanate gel of 1 μm thick, with an irregular
topography and a high degree of open porosity. Boiling alkali solution
(0.2 M sodium hydroxide, 1400°C for 5 hours) produce a high density of
nanoscale pits on the titanium. When the alkali treatment is preceded
by etching in hydrochloric acid/sulfuric acid, porosity of the final
surface is found to increase.
37. • Passivation treatments
For obtaining a uniformly oxidized surface to improve corrosion
resistance. Immersion of titanium for a minimum of 30 minutes in 20-
40 vol% solution of nitric acid at room temperature. After passivation,
surface of the implant should be neutralized, thoroughly rinsed and
dried. Nitric acid passivation has no major influence on the overall
surface topography of titanium surfaces. In addition to nitric acid
passivation, heating in air at 400- 600 °C or ageing in boiling deionized
water for several hours can be used as an alternative passivation
treatments (heat treatment) .
38. Electrochemical treatments
• Anodic oxidation
Produces roughness, porosity and chemical composition for improved
biocompatibility. The anodic oxide can have interconnected pores (0.5–2 μm
in diameter) and intermediate roughness (0.60–1.00 μm). In addition, anodic
oxide can be flat layer or tubular and can have amorphous or anatase phase.
Titanium can be anodically oxidized in a) acid (sulphuric acid and b) non-acid
electrolytes like a) sodium phosphate and isopropyl phosphate in ethylene
glycol, b) ammonium pentaborate, and c) calcium acetate and calcium
glycerophosphate. Calcium and phosphorus are deposited on the titanium
oxide during anodization from a bath containing calcium acetate and
glycerophosphate and are useful for the formation of HA. The oxides usually
grow at the rate of 1.5 – 3 nm/V (also called as growth constant) in the
various electrolytes.
39.
40. • Biocoat (colour anodization)
Titanium is immersed into an electrolyte and connected as an anode leading to the
formation of an oxide film at the surface.
• Biodize (alkaline grey anodization)
Similar to the Biocoat however the specific electrolyte allows the formation of thicker TiO2
layers in the range of micrometers.
• Biobright (electropolishing)
Titanium is immersed into an electrolyte and is connected as an anode leading to the
dissolution of the titanium material.
• Innosurf
Modification of the Biobright process. The removed layer of titanium is in the range of 5 to
30 micrometers. The thickness of the layer to be dissolved depends on the starting
roughness of the material. Electropolishing eliminates surface contaminants.
41. Electrophoresis
• Electrophoretic deposition (EPD) HA powders dispersed in a suitable solvent and coatings are obtained by
applying voltages of the order of 20- 200V. The coating density is improved by a further sintering at 600°C or
above. Using this method, small particles as well as large particles can be deposited.
• Advantages Simplicity and low cost Ability to coat with uniform thickness, wide range of thicknesses,
complex shapes Ease of chemical composition control.
• Disadvantage -- Post-coating sintering at about 800°C.
• Mechanism -- Two steps.
1 st
the migration of particles (which acquire positive charge) under the influence of an electric field applied to a
stable colloidal suspension.
2 nd
deposition on the metallic substrate.
Driving force of the deposition process is the applied electric field. Depending on the mode and sequence of
voltage applied, the electrophoretic deposition can be carried out at i) constant voltage or ii) dynamic voltage.
42. • Electrochemical cathodic deposition Calcium phosphate coatings are
formed on the titanium cathode from a bath containing dissolved
calcium and phosphorus compounds. Concentrations of calcium and
phosphorus in the electrolyte, pH of the electrolyte, cathodic current
density, time, processing temperature and pressure are the
parameters influencing the type of calcium phosphate deposit.
• Pulsed electrochemical deposition produce CaP coatings on porous
titanium substrates under milder conditions (pH 4.4, 25°C) but post-
treatment with sintering under vacuum at high temperatures
between 300 and 800°C was required.
• Galvanostatic technique was used to produce HA
43. Laser Treatments
• Laser is an micromachining tool to produce a 3-D structure at micrometer and
nanometer level. Generates short pulses of light, of single wavelength, providing energy
focused on one spot.
Advantages
• Rapid andextremely clean
• Suitable for the selective modification of surfaces.
• Allows the generation of complex microstructures with high resolution.
• No chemical treatments are done.
Only the valley and parts of the flank of the implant threads is laser treated while the
remaining part was left as machined.
Flank portion (smooth surface) to minimize the incidence of peri-implantitis. High risk to
expose to the microorganism and plaque.
Valley part of the implant threads has the rougher surface.
44. • Laser Peening
• no contact, no media and contamination free. High intensity (5-15
GW/cm2) nanosecond pulses (10-30ns) of laser light beam (3- 5mm
width) striking the ablative layers generate short-lived plasma which
causes a shock wave to travel into the implant. The shock wave
induces compressive residual stress that penetrates beneath the
surface and strengthens the implant, resulting in improvements in
fatigue life and retarding in stress corrosion cracking occurrence. The
average surface roughness of the laser treated acid-etched implant
was 2.28 μm
45. Thermal treatments
• Commercially pure titanium can be thermally annealed up to 1000°C
to form oxide layer composed of anatase and rutile structures of
TiO2. The titanium oxide that is formed on the surface is crack-free
and uniformly rough. Average roughness when the titanium is
annealed at 600 °C and 650 °C for 48 hours was 0.90 and 1.30 μm,
respectively. Average roughness of untreated sample was 0.08 μm.
Thermal treatment at 600°C and 650°C for 48 hours is considered
appropriate for implanted materials.
46. Plasma spraying
• Titanium Plasma Spray (TPS)
A gas plasma stream is first created by having an electrical arc between
a finger-type tungsten cathode and a nozzle-type copper anode inside
the plasma torch. Inject titanium powders into a plasma torch at high
temperature. The titanium particles are projected on to the surface of
the implants where they condense and fuse together, forming a film
about 30μm thick. The thickness must reach 40-50μm to be uniform.
TPS coating has an average roughness of around 7μm.
47. Electrophoretic Deposition
• Colloidal particles such as hydroxyapatite nanoprecipitates which are suspended
in a liquid medium migrate under the influence of an electric field and are
deposited onto a counter charged electrode. The coating is simply formed by
pressure exerted by the potential difference between the electrodes. EPD can
produce HA coatings ranging from 500μm thick.
Advantages
• Low cost and simple methodology
• Produces coatings of variable thicknesses
• High deposition rate
• Ability to coat irregularly shaped or porous objects
Disadvantages
• Need for post deposition heat treatment to increase the density of the coating.
(1200˚C)
48. Sol-gel coated implants
• Deposits thin coatings with homogenous chemical composition onto
substrates with large dimensions and complex design. A system that
joins both materials has the mechanical advantages of the underlying
(metallic) substrate and biological affinity of HA.
Advantages
• simple and low cost procedure
• high mechanical strength and toughness of titanium alloys
49. Ultrasonic spray pyrolysis
• Group of processes for particle production which are based on precursor atomization,
aerosol transport through a temperature and atmosphere regulated reactor.
• Used in the production of nanopowders.
• Particle morphology is the result of droplet size (1-100μm), precursor concentration,
operating temperature and evaporation rate.
• Inside the furnace, the following steps are assumed to be taking place
1. Evaporation of the solvent
2. 2. Diffusion of solutes
3. 3. Precipitation
4. 4. Decomposition
5. 5. Densification
Three main process steps (aerosol generation, thermal decomposition, nanopowder
collection).
50. Nano-Surface Modifications
• Organic nanoscale self-assembled monolayers
Involves adsorption and self-assembly of single layers of molecules on a
substrate. Molecular self-assembly of alkane phosphate SAMs on metal
oxides like TiO2 and Al2O3. The hydrophilicity of these alkane
phosphate SAMs can be modified with a hydroxy-terminated end
group. When smooth and rough titanium surfaces coated with hydroxy-
terminated (hydrophilic) and methyl-terminated (hydrophobic) alkane
phosphate SAMs were exposed to human fibroblasts, more fibroblasts
were found on smooth surface. Surface wettability was much less
important than surface roughness.
51. Hydrogels on Titanium Surface
• A hydrogel is a network of polymer chains that swell in aqueous solution. It
is composed of long polymer chains connected by cross-links. The cross-
links may be biodegradable or non-biodegradable and are formed by ionic
interactions between polyelectrolyte chains. Cross-linking of polymer
molecules or polymerization can be achieved by photopolymerization,
changes in temperature, radiation, self-assembly, or cross-linking enzymes.
Hydrogels undergo responsive swelling by absorbing solvent when placed
in an aqueous solution (solvation). Swollen hydrogels can absorb many
times their own weight in water and can switch between swollen and
collapsed forms (Fig.29). Properties of hydrogels are high biocompatibility,
biodegradability, and ability to incorporate biomolecular cues (due to high
permeability for oxygen, nutrients, and water-soluble metabolites).
52. Titanium Nanotubes
• A nanotube is a tube-like structure at the nanometerscale (10-9 m).
Contain at least two layers, or more measuring about 3– 30 nm in outer
diameter. Bilayered nanotubes were closed at both ends. Chemical
synthesis of titanium dioxide (TiO2) nanotubes by anodization technique.
The thickness and structure of the oxide layers formed (amorphous or
crystalline) depends on the applied potential between the electrodes,
duration of anodization process, and the chemical composition of
electrolyte used. Depending on the anodizing conditions, the crystal
structure can be anatase, a mixture of anatase and rutile, or rutile A
completely different growth morphology leading to self-organized and
ordered nanotubular, nanoporous structures of TiO2 has been obtained
when electrolytes containing fluoride ions and suitable anodization
conditions were used. These nanotube-like pores possess higher surface
energy and wettability compared to un-anodized titanium.
54. 1. Bioactive glass coatings
• silica-based bioactive glasses are slowly resorbing synthetic
osteoconductive materials which are able to form strong chemical bond
with bone. The coating withstands an external stress of 47MPa, and
adequate for load bearing application. Double glass coating -- to solve the
problem of differences in thermal expansion coefficients. Application of a
ground layer prepared from inert glass with a thermal expansion
coefficient close to that of Ti6Al4V provided good adhesion to the
substrate. Ground coating in combination with more surface reactive glass
coatings , embedded with hydroxyapatite and/or bioactive glass particles
or a sol-gel-derived silica coating, Reactive plasma spraying or processing
with infra-red laser have also been attempted to create bioactive glass
coatings on titanium and its alloys. Titanium implants coated with bioactive
glass (BAG) were integrated into host bone without a connective tissue
capsule and greater osseointegration and high removal torque in
comparison to the control uncoated titanium implants.
55. 2. Hydroxyapatite (HA) Coating
• HA osseointegrates faster and stronger than untreated titanium so it is
coated on the surface of titanium implants. The resulting composite
material combines the mechanical advantages of titanium and superior
bioactivity and biocompatibility of HA. HA is usually coated onto the
surface of a titanium dental implant through plasma spraying, ion beam
assisted deposition. All these techniques require sophisticated and
expensive equipment and involve the use of high temperatures.
Biomimetic processes overcomes the above problems. HA coating has two
major advantages.
• 1. Faster osseointegration leads to earlier stabilization of the implant in
surrounding bone.
• 2. Stronger bonding between implant and bone extends the functional life
of the prosthesis
56. 3. Calcium-Phosphate Coating
• Accelerates bone formation around the implant and produces
effective osseointegration. Various processes available -- chemical,
electrochemical and physical – ion beam dynamic mixing technique
(IBDM), Radio- frequency magnetron sputter technique, biomimetic
deposition, electrochemical deposition are a few examples
57. 4. Titanium Nitride Coatings
• Treatment is known as Plasma nitriding or PVD coating with TiN.
Titanium nitride has high surface hardness and mechanical strength.
Titanium nitriding increases corrosion resistance and surface
hardness of the exposed implant surfaces. Methods of titanium
nitriding -- gas nitriding, plasma nitriding by plasma diffusion
treatment, plasma-assisted chemical vapour deposition, pulsed DC
reactive magnetron sputtering and closed field unbalanced
magnetron sputter ion plating
58. 5. Fluoride treatment
• Titanium is very reactive to fluoride ions, forming soluble TiF4. The
chemical treatment of titanium in fluoride solutions enhances the
osseointegration of dental implants.
59. 6. Biologically active drugs
• Bisphosphate-- improve implant osseointegration and they are
antiresorptive agents.
• Simvastatin -- induces bone morphogenetic protein (BMP) that
promotes bone formation.
• Antibacterial coatings provides antibacterial activity to the implants.
a) Gentamycin local prophylactic agent
b) Tetracycline-HCl decontamination and detoxification of
contaminated implant surfaces.
60. Conclusion
• Despite conflicting reports regarding the effect of and micro- and/or
nanotopography on the osseointegration of dental implants, the
prevailing philosophy is that they may significantly influence the bone
growth and attachment to implant surfaces and ultimately improve
the success of dental implants and the rapid return to function. The
exact role of surface chemistry and topography on the early events of
the osseointegration of dental implants remain poorly understood.
These techniques have greatly influenced the quality of clinical
service in implant prosthodontics.
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