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| REVIEW ARTICLE |
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| Year : 2020 | Volume
: 11
| Issue : 2 | Page : 176-181 |
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Evaluation of osseintegration between traditional and modified hydrophilic titanium dental implants – Systematic analysis
Geeta Arya, Varun Kumar
Department of Prosthodontics and Oral Implantology, Seema Dental College and Hospital, Rishikesh, Uttarakhand, India
| Date of Submission | 17-Apr-2020 |
| Date of Acceptance | 04-Jul-2020 |
| Date of Web Publication | 16-Dec-2020 |
Correspondence Address:
Dr. Varun Kumar
Department of Prosthodontics and Oral Implantology, Seema Dental College and Hospital, Pashulok, Rishikesh, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/njms.NJMS_44_20
 Abstract | | |
The aim of the study was to conduct a systematic review to access the osseointegration between traditional and modified Hydrophilic Titanium Dental Implants for period of 10 years. PUBMed articles were searched from last ten years up to 15/12/2019 from which 24 studies included in this review. This systematic review compiles the data about osseintegration in hydrophilic titanium implants in human trials. It sheds light on the mechanism of integration of hydrophilic surfaces and numeric data to support the purpose of the review.
Keywords: Dental implants, hydrophilic titanium dental implants, osseointegration, systematic review
How to cite this article:
Arya G, Kumar V. Evaluation of osseintegration between traditional and modified hydrophilic titanium dental implants – Systematic analysis. Natl J Maxillofac Surg 2020;11:176-81 |
How to cite this URL:
Arya G, Kumar V. Evaluation of osseintegration between traditional and modified hydrophilic titanium dental implants – Systematic analysis. Natl J Maxillofac Surg [serial online] 2020 [cited 2021 Jan 26];11:176-81. Available from: https://www.njms.in/text.asp?2020/11/2/176/303507 |
| Introduction | |  |
Dental implants are root analogs that take the form of a root embedded in the bone tissue. The major factor that determines the success of dental implantation is osseointegration.[1] The texture and the properties of the implant surface determine the amount of bone-implant contact (BIC), in turn determining the osseointegration, implant stability, and longevity of the restoration.
A series of different techniques and materials have led to the constant evolution of implant surfaces, from smooth to micro rough, followed by nano rough to hydrophilic surfaces. Hydrophilic surfaces are the latest development in broad-spectrum implant surface characteristics. Most studies have found that hydrophilic surfaces tend to enhance the early stages of cell adhesion, proliferation, differentiation, and bone mineralization compared to hydrophobic surfaces.[2],[3] SLAactive, Photo-functionalized, and Electro-wetted implant surfaces are the hydrophilic surfaces that are commercially available.
Literature has lacked systematic studies of hydrophilic dental implants. We have taken this opportunity to conduct a systematic review of clinical trials conducted on hydrophilic titanium dental implants.
| Materials and Methods | | |
An electronic search was carried out on PubMed database with the following search terms-Hydrophilic Dental Implants, Modified Dental Implant Surfaces, Hydrophilic Dental Implant Surfaces, Hydrophilic Titanium Dental Implants.
The PRISMA guidelines by the Cochrane library for the formulation of the systematic review were followed.[4]
A total of 2071 articles were obtained on the PubMed database. The authors screened through the abstract and eliminated 981 duplicate articles. 1082 articles were screened from which 984 articles were eliminated. Through this method, 98 full-text articles were assessed for eligibility, of which 74 articles did not belong to the inclusion criteria of this review. A total of 24 articles were included in the study.
Inclusion criteria
- Articles published in thepast 10 years up to December 15, 2019
- Studies conducting human trials
- Studies using dental implants
- Studies using hydrophilic implant surfaces.
Exclusion criteria
- Any study published before 2009
- Studies using nondental implants
- In vitro and animal studies.
PICOT
The studies were included in the review following the picot research criteria as follows:
- Population-clinical trials conducted on adult humans of either sex
- Intervention-placement of endosseous root-form hydrophilic or modified wetted surface implants in the human jaw
- Control-patients without any implants or implants with surfaces other than hydrophilic surfaces
- Outcome-osseointegration of the hydrophilic implants to the bone
- Time-period from the insertion of implants to the osseointegration of the implants to the surrounding bone.
Studies included in this systematic review as PRISMA format
Identification
- Records obtained through the PubMed database search, n = 2071
- Additional records identified through other sources, n = 0
- Records after duplicates were removed, n = 1082.
Screening
- Records screened, n = 1082
- Records excluded, n = 984.
Eligibility
- Full-text articles assessed for eligibility, n = 98
- Full-text articles excluded, n = 74.
Included
- Studies included in qualitative synthesis, n = 24.
| Observations and Result | | |
Twenty-four studies included in this review; thus, a total of 4498 implants were placed in 2037 patients of which 37 implants were lost.
Therefore, the cumulative survival rate was 99.18%. The studies included in the review are listed in [Table 1].
From these, seven studies observed the MBL (marginal bone loss) as listed in [Table 2] and 10 studies observed the ISQ (implant stability quotient) values as listed in [Table 3]. | Table 3: Descriptive statistics on maximum achieved implant stability quotient values over the last 10 years by hydrophilic implants
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| Discussion | | |
Osseointegration is the process by which the titanium implants fuse to the underlying bone. Many factors seem to influence the process of osseointegration, like host factors-quality and type of bone, surgical factors like the drilling procedure, and speed.[29] Mostly the quality of surface which contacts the bone determines the type and speed of osseointegration. The role of surface characteristics gained importance since the early 80s, Albrektsson et al.[30] further pioneered the concept of osseointegration by ascribing to surface properties a possible role for the biological response to an implant.[31] Many surface modifications have been done than the traditional machined surfaces of the titanium implants.
Hydrophilicity is nothing but wettability of a surface. Contact angle (CA) is the angle between the tangent line to a liquid drop's surface at the three-phase boundary and the horizontal solid's surface. In principle, the CA can range from 0° to 180°. Surfaces with water CAs lower than 90° are designated as hydrophilic, and those with CAs very close to 0° are superhydrophilic. Surfaces with water CAs above 90° are considered hydrophobic, and those with CAs above 150° are termed superhydrophobic.[32]
Lately, the most commonly used implant surfaces are the solution instead of air (SLA) surfaces, Sandblast and acid-etched surfaces, which are inherently hydrophobic. These SLA surfaces are hydrophilized by surface neutralization after acid etching is done in a contaminant-free, protective nitrogen environment, and the implants are finally stored in a neutral saline SLA active. Recent reviews highlight numerous in vitro, in vivo and clinical studies focusing on this hydrophilic surface.[24],[31],[32]
Hicklin et al.[15] describes the method to convert the hydrophilic implants (INICELL; Thommen medical AG) to super-hydrophilic by chairside conditioning procedure following the manufacturer's instructions that included wetting with 0.05M NaOH solution pH 12.24 using a dedicated applicator immediately prior to implant placement. It is observed that most manufacturers claim their implants to be super-hydrophilic and recommend the implant to be wetted by a special solution to increase its wettability and osseointegration. The purpose of the wetting could be to avoid the formation of the titanium oxide layer, which forms as soon as the implant is exposed to the atmosphere.
A recent study has revealed that time since surface preparation or aging can significantly reduce the osteoconductivity of implants.[33] This phenomenon, known as “biologic aging of titanium,”[34],[35] results from time-dependent loss of hydrophilicity and progressive accumulation of hydrocarbon impurities on titanium surfaces. Ultraviolet light treatment of titanium immediately before use, or photo-functionalization, has been found to counteract the biologic aging of titanium by regenerating hydrophilicity and removing hydrocarbon impurities. Indeed, the BIC of photo-functionalized implants is increased from 53% to nearly 100% in animal models.[36] Photo-functionalization of dental implants is rapid and simple to perform chairside immediately before placement. Various clinical studies have indicated that photo-functionalization may accelerate and enhance the osseointegration of dental implants.[37],[38],[39],[40]
Researchers have quantified the wettability of an implant surface by either the sessile drop method, where liquid drops are set on a surface and the CA is directly measured from the drop shape surface[31] and second, tensiometry, where CAs are measured indirectly according to the Wilhelmy balance technique,[32] where in the samples have to be fixed to an electro balance and the forces detected during continuous immersion and withdrawal of the samples into and from the wetting liquid allow the calculation of advancing and receding CAs, respectively. In general, dynamic CAs can be measured if there is a relative movement between the material and the wetting liquid. Without such a movement, static CAs can be analyzed.
The study of osseointegration in the retrieved implants in the human trials revealed that the hydrophilic implants had a better bone to implant contact and better osseointegration than hydrophobic implants. Histology and histomorphometry[6],[8],[10] show that the hydrophilicity of hydrophilic implants during the early osseointegration period help the implant surface in neovascularization and thus the bone contact around the titanium implants is more when compared to other implants. Gene ontology was done in some of the studies suggest that a hydrophilic surface indeed improves early bone deposition around the implants through the expression of bone mimetic proteins such as osteoprotegrin.[5],[13]
Many additive morphology changes also have been done to the titanium implant surfaces to be able to osseointegrate better to the bone. Hydrogels,[41] crosslinked, have been engineered to coat on the implant surface, can act as a scaffold to deliver the biomimetic drugs like bone morphogenic proteins, antibiotics like amoxicillin. The results are improved osseointegration with bone due to increased wettability caused by the hydrogels.
This systematic review compiles the data about osseointegration in hydrophilic titanium implants in human trials. It sheds light on the mechanism of integration of hydrophilic surfaces as they have a positive impact on osseointegration. Given the limited data, the authors would like to conclude that hydrophilic implants offer better osseointegration as compared to other implants. The authors feel there is a need for more randomized clinical trials to support the findings from this review.
| Conclusion | | |
Total 4948 implants placed in 2037 patients in the studies included, in which almost all the implants osseointegrated and 37 were lost due to implant failure. The cumulative survival rate for the implants were 99.18%. It was observed that the hydrophilic implants showed higher ISQ values during the early osseointegration period, and then the ISQ values further increased in the duration of 3–6 months showing solid osseointegration of at least 2.25 times more.[22] The marginal bone loss also was considerably less for the hydrophilic implants as compared to the hydrophobic implants.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Branemark PI. The Osseointegration Book– From Calvarium to Calcaneus. USA: Quintessence Books; 2005. p. 24.  |
| 2. | Eriksson C, Nygren H, Ohlson K. Implantation of hydrophilic and hydrophobic titanium discs in rat tibia: Cellular reactions on the surfaces during the first 3 weeks in bone. Biomaterials 2004;25:4759-66. |
| 3. | Bornstein MM, Valderrama P, Jones AA, Wilson TG, Seibl R, Cochran DL. Bone apposition around two different sandblasted and acid-etched titanium implant surfaces: A histomorphometric study in canine mandibles. Clin Oral Implants Res 2008;19:233-41. |
| 4. | Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Int Med 2009;151:264-9. |
| 5. | Donos N, Hamlet S, Lang NP, Salvi GE, Huynh-Ba G, Bosshardt DD, et al. Gene expression profile of osseointegration of a hydrophilic compared with a hydrophobic microrough implant surface. Clin Oral Implants Res 2011;22:365-72. |
| 6. | Lang NP, Salvi GE, Huynh-Ba G, Ivanovski S, Donos N, Bosshardt DD. Early osseointegration to hydrophilic and hydrophobic implant surfaces in humans. Clin Oral Implants Res 2011;22:349-56. |
| 7. | Ivanovski S, Hamlet S, Salvi GE, Huynh-Ba G, Bosshardt DD, Lang NP, et al. Transcriptional profiling of osseointegration in humans Clin Oral Implants Res 2011;22:373-81. |
| 8. | Bosshardt DD, Salvi GE, Huynh-Ba G, Ivanovski S, Donos N, Lang NP. The role of bone debris in early healing adjacent to hydrophilic and hydrophobic implant surfaces in man. Clin Oral Implants Res 2011;22:357-64. |
| 9. | Roccuzzo M, Wilson TG Jr., A prospective study of 3 weeks' loading of chemically modified titanium implants in the maxillary molar region: 1-year results. Int J Oral Maxillofac Implants 2009;24:65-72. |
| 10. | Iezzi G, Degidi M, Piattelli A, Shibli JA, Perrotti V. A histological and histomorphometrical evaluation of retrieved human implants with a wettable, highly hydrophilic, hierarchically microstructured surface: A retrospective analysis of 14 implants. Implant Dent 2013;22:138-42. |
| 11. | Hinkle RM, Rimer SR, Morgan MH, Zeman P. Loading of titanium implants with hydrophilic endosteal surface 3 weeks after insertion: Clinical and radiological outcome of a 12-month prospective clinical trial. J Oral Maxillofac Surg 2014;72:1495-502. |
| 12. | van Eekeren P, Said C, Tahmaseb A, Wismeijer D. Resonance frequency analysis of thermal acid-etched, hydrophilic implants during first 3 months of healing and osseointegration in an early-loading protocol. Int J Oral Maxillofac Implants 2015;30:843-50. |
| 13. | Dolanmaz D, Saglam M, Inan O, Dundar N, Alniacık G, Gursoy Trak B, et al. Monitoring bone morphogenetic protein-2 and-7, soluble receptor activator of nuclear factor-κB ligand and osteoprotegerin levels in the peri-implant sulcular fluid during the osseointegration of hydrophilic-modified sandblasted acid-etched and sandblasted acid-etched surface dental implants. J Periodontal Res 2015;50:62-73. |
| 14. | Gac OL, Grunder U. Six-year survival and early failure rate of 2918 implants with hydrophobic and hydrophilic enossal surfaces. Dent J (Basel) 2015;3:15-23. |
| 15. | Hicklin SP, Schneebeli E, Chappuis V, Janner SF, Buser D, Brägger U. Early loading of titanium dental implants with an intra-operatively conditioned hydrophilic implant surface after 21 days of healing. Clin Oral Implants Res 2016;27:875-83. |
| 16. | Hirota M, Ozawa T, Iwai T, Ogawa T, Tohnai I. Implant stability development of photofunctionalized implants placed in regular and complex cases: A case-control study. Int J Oral Maxillofac Implants 2016;31:676-86. |
| 17. | Degasperi W, Andersson P, Verrocchi D, Sennerby L. One-year clinical and radiographic results with a novel hydrophilic titanium dental implant. Clin Oral Implants Res 2014;16:511-9. |
| 18. | Şener-Yamaner ID, Yamaner G, Sertgöz A, Çanakçi CF, Özcan M. Marginal bone loss around early-loaded SLA and SLActive implants: Radiological follow-up evaluation up to 6.5 years. Implant Dent 2017;26:592-9. |
| 19. | Novellino MM, Sesma N, Zanardi PR, Laganá DC. Resonance frequency analysis of dental implants placed at the posterior maxilla varying the surface treatment only: A randomized clinical trial. Clin Implant Dent Relat Res 2017;19:770-5. |
| 20. | Makowiecki A, Botzenhart U, Seeliger J, Heinemann F, Biocev P, Dominiak M. A comparative study of the effectiveness of early and delayed loading of short tissue-level dental implants with hydrophilic surfaces placed in the posterior section of the mandible-A preliminary study. Ann Anat 2017;212:61-8. |
| 21. | Cabrera-Domínguez J, Castellanos-Cosano L, Torres-Lagares D, Machuca-Portillo G. A prospective case-control clinical study of titanium-zirconium alloy implants with a hydrophilic surface in patients with type 2 diabetes mellitus. Int J Oral Maxillofac Implants 2017;32:1135-44. |
| 22. | Rosen PS, Sahlin H, Seemann R, Rosen AS. A 1-7 year retrospective follow-up on consecutively placed 7-mm-long dental implants with an electrowetted surface. Int J Implant Dent 2018;4:24. |
| 23. | Siqueira RAC, Aparecida de Mattias Sartori I, Freitas Santos PG, Thiesen MJ, Gonçalves MC, Gasparini Kiatake Fontão FN. Resonance frequency analysis of dental implants with 2 types of surface treatment submitted to immediate loading: A prospective clinical study. Implant Dent 2018;27:282-7. |
| 24. | Ghazal SS, Huynh-Ba G, Aghaloo T, Dibart S, Froum S, O'Neal R, et al. A randomized, controlled, multicenter clinical study evaluating the crestal bone level change of SLActive bone level ø 3.3 mm implants compared to SLActive bone level ø 4.1 mm implants for single-tooth replacement. Int J Oral Maxillofac Implants 2019;34:708-18. |
| 25. | Puisys A, Schlee M, Linkevicius T, Petrakakis P, Tjaden A. Photoactivated implants: A tripleblinded, splitmouth, randomized controlled clinical trial on the resistance to removal torque at various healing intervals. Clin Oral Investig 2020;24:1789-99. Epub 2019 Sep 11. |
| 26. | Tallarico M, Baldini N, Martinolli M, Xhanari E, Kim YJ, Cervino G, et al. Do the new hydrophilic surface have any influence on early success rate and implant stability during osseointegration period? Four-month preliminary results from a split-mouth, randomized controlled trial. Eur J Dent 2019;13:95-101. |
| 27. | Velloso G, Moraschini V, Dos Santos Porto Barboza E. Hydrophilic modification of sandblasted and acid-etched implants improves stability during early healing: A human double-blind randomized controlled trial. Int J Oral Maxillofac Surg 2019;48:684-90. |
| 28. | Beena Kumary TP, Parihar AS, Mathew J, Sabu KI, Venkata SK, Babaji P. A clinical and radiographic evaluation of resonance frequency analysis of sand blasted acid etched (SAE) and chemical modified sae dental implants. J Int Soc Prev Community Dent 2019;9:55-9. |
| 29. | Gittens RA, Scheideler L, Rupp F, Hyzy SL, Geis-Gerstorfer J, Schwartz Z, et al. A review on the wettability of dental implant surfaces II: Biological and clinical aspects. Acta Biomater 2014;10:2907-18. |
| 30. | Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: A review and proposed criteria of success. Int J Oral Maxillofac Implants 1986;1:11-25. |
| 31. | Mittal KL, Good RJ. Contact angle, wettability and adhesion: Festschrift in honor of professor Robert J. Good. Utrecht, The Netherlands: VSP; 1993. |
| 32. | Rupp F, Scheideler L, Eichler M, Geis-Gerstorfer J. Wetting behavior of dental implants. Int J Oral Maxillofac Implants 2011;26:1256-66. |
| 33. | Aita H, Hori N, Takeuchi M, Suzuki T, Yamada M, Anpo M, et al. The effect of ultraviolet functionalization of titanium on integration with bone. Biomaterials 2009;30:1015-25. |
| 34. | Att W, Hori N, Takeuchi M, Ouyang J, Yang Y, Anpo M, et al. Time-dependent degradation of titanium osteoconductivity: An implication of biological aging of implant materials. Biomaterials 2009;30:5352-63. |
| 35. | Att W, Ogawa T. Biological aging of implantsurfaces and thei rresoration with ultraviolet light treatment: A novel understanding of osseointegration. Int J Oral Maxillofac Implants 2012:27:753-61. |
| 36. | Wang R, Hashimoto K, Fujishima A, Chikuni M, Kojima E, Kitamura A, et al. Light-induced amphiphilic surfaces. Nature 1997;388:431-2. |
| 37. | Ogawa T. Ultraviolet photofunctionalization of titanium implants. Oral Craniofac Tissue Eng 2012:2:151-8. |
| 38. | Funato A, Yamada M, Ogawa T. Success rate, healing time, and implant stability of photofunctionalized dental implants. Int J Oral Maxillofac Implants 2013;28:1261-71. |
| 39. | Suzuki S, Kobayashi H, Ogawa T. Implant stability change and osseointegration speed of immediately loaded photofunctionalized implants. Implant Dent 2013;22:481-90. |
| 40. | Rupp F, Haupt M, Klostermann H, Kim HS, Eichler M, Peetsch A, et al. Multifunctional nature of UV-irradiated nanocrystalline anatase thin films for biomedical applications. Acta Biomater 2010;6:4566-77. |
| 41. | Campbell DI, Duncan WJ. The effect of a keratin hydrogel coating on osseointegration: a histological comparison of coated and non-coated dental titanium implants in an ovine model. Int J Oral Maxillofac Implants 2014;13:159-64. |
[Table 1], [Table 2], [Table 3]
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