Best Surface Coatings for Immediate Implant Placement?

A couple of surfaces that have not been mentioned are the Ossean surface from Intra-Lock and the hydroxyapatite coatings. The hydroxyapatite coated implants were shown to promote faster osseointegration. The Ossean surface is impregnated with calcium phosphate to try to reduce the osteoclastic activity that happens in the first couple of weeks after implant placement by promoting an increase in osteoblastic activity sooner. This ia important for extraction and immediate placement protocols. If you want to take a closer look, you can see some of the research here: http://intra-lock.com/index.php?option=com_content&task=view&id=100&Itemid=162 Good luck! Carlos Boudet, DDS http://www.boudetdds.com

If you read the scientific literature for the past 25 years, you will see that almost all articles state that HA coatings are far superior to other surfaces especially with extraction and implant placement at the same time. Claims for other surfaces are marketing hype.

I completely agree with you. But you misunderstand the chemistry of the Ossean surface. It is, just like HA, a calcium phosphate material. The reason CaPO4 surfaces work so well is, when the surface starts to resorb, it releases free ionic calcium. This works as a signaling ion to ramp up osteoblast metabolism. The reason HA surfaces fell out of favor is that they tended to fracture and become infected. When it became possible to nanoimpregnate the titanium surface with highly resorbable calium phosphate, we started to measure dramatic increases in rate of bone bonding. Please refer to the new journal article: Coelho p, Granato R, Marin C, et al: Biomechanical Evaluation of Endosseous Implants at Early Implantation Times: A Study in Dogs. Journal Of Oral and Maxillofacial Surgery 68:1667-1675, 2010. The study demonstrates that there is a 500% increase in bone bonding within the first week as compared to Osseospeed and Nanotite. A game-changer with regard to early and immediately loaded implants. Hats off to the researchers at Intra-Lock International for their outstanding new engineering. RJM

You should check straumann sla-active, since it is a very well documented surface and it works really well. I use this surface in cases when Im in a really challenging situation such as: Imediate implants. Imediate loading. Poor bone cuality. Augmentation cases.

An aluminum oxide blasted, then acid-etched, 35 year old implant surface no longer moves me even if it is packaged in sterile saline. We have hit the wall with regard to genetic expression of osteoblasts on pure titanium surfaces. If your paradigm includes re-engineering the wound response, compression of the catabolic phase of bone, increasing bone-to-implant contact, maintenance of crestal bone, and enhancement of biotype, then it is time to start using a bioactive implant surface. Multiple studies around the world have shown that the fractal nanoimpreganated CaPO4 surface (Ossean, Intra-Lock International), is indeed the natural evolution of surface modifications that functions as a tool to control the biology of the osteotomy. Read the literature (as opposed to marketing hype) and then make a cogent decision as to the selection of a system that addresses so many of the traditional problem areas in oral implantology. I believe you will be very impressed. RJM

I’ve started reading………… Schwarz F, Sager M, Kadelka I, Ferrari D, Becker J. Influence of titanium implant surface characteristics on bone regeneration in dehiscence-type defects: an experimental study in dogs. J Clin Periodontol. 2010 May;37(5):466-73. Bornstein MM, Wittneben JG, Brägger U, Buser D. Early loading at 21 days of non-submerged titanium implants with a chemically modified sandblasted and acid-etched surface: 3-year results of a prospective study in the posterior mandible. J Periodontol. 2010 Jun;81(6):809. Lai HC, Zhuang LF, Liu X, Wieland M, Zhang ZY, Zhang ZY. The influence of surface energy on early adherent events of osteoblast on titanium substrates. J Biomed Mater Res A. 2010 Apr;93(1):289-96. Schätzle M, Männchen R, Balbach U, Hämmerle CH, Toutenburg H, Jung RE. Stability change of chemically modified sandblasted/acid-etched titanium palatal implants. A randomized-controlled clinical trial. Clin Oral Implants Res. 2009 May;20(5):489. Schwarz F, Herten M, Sager M, Wieland M, Dard M, Becker J. Histological and immunohistochemical analysis of initial and early subepithelial connective tissue attachment at chemically modified and conventional SLA titanium implants. A pilot study in dogs. Clin Oral Investig. 2007 Sep;11(3):245-55. Ferguson SJ, Broggini N, Wieland M, de Wild M, Rupp F, Geis-Gerstorfer J, Cochran DL, Buser D. Biomechanical evaluation of the interfacial strength of a chemically modified sandblasted and acid-etched titanium surface. J Biomed Mater Res A. 2006 Aug;78(2):291-7. …………But haven’t finished

Now read the article in Journal of Oral and Maxillofacial Surgery with regard to the contrast between early healing times of a chemically treated surface (Fluoride, Astra Tech) and a nanoimpregnated CaPO4 surface (Ossean, Intra-Lock International). A 500% increase in bone bonding, using Ossean, at the first week is a remarkable feat. Don't show me papers comparing original SLA to SLA in saline. Now compare it to new nanotechnology and realize these old surfaces can no longer compete with newer biotechnology. RJM

The first article listed in my post was a comparative one between modsla and calcium phosphate nano coated Ti surfaces........ Here it is again: Schwarz F, Sager M, Kadelka I, Ferrari D, Becker Influence of titanium implant surface characteristics on bone regeneration in dehiscence-type defects: an experimental study in dogs.J Clin Periodontol. 2010 May;37(5):466-73. OBJECTIVES: The aim of the present study was to compare bone regeneration in dehiscence-type defects at titanium implants with chemically modified sandblasted/acid-etched (modSLA) or dual acid-etched surfaces with a calcium phosphate nanometre particle modification (DCD/CaP. CONCLUSION: ModSLA implants may have a higher potential to support osseointegration in dehiscence-type defects than DCD/CaP implants. and another one........ Vignoletti F, Johansson C, Albrektsson T, De Sanctis M, San Roman F, Sanz M.Early healing of implants placed into fresh extraction sockets: an experimental study in the beagle dog. De novo bone formation. J Clin Periodontol. 2009 Mar;36(3):265-77. OBJECTIVES: Describe the early phases of tissue integration in implants placed into fresh extraction sockets and test whether a new implant surface nano-topography (DCD nano-particles, Nanotite) promotes early osseointegration when compared with minimally rough surface implants (DAE, Osseotite). CONCLUSION: Osseointegration occurred similarly at both implant groups, although the socket dimension appeared to influence bone healing. It is suggested that the enhanced nano-topography has a limited effect in the immediate implant surgical protocol. I really wish Ossean surface become a big breaktrough in oral implanthology. further scientifical studies have to prove it. Merry christmas.

Here is the problem with the papers you have cited. None of them reflects the chemistry of the Ossean surface. Just because you have calcium phosphate materials on the surface of an implant, it does not mean it will have the desired effect on osteoblasts and fibroblasts. In fact, the OTHER implant surface that is cited in the Journal of Oral and Maxilliofacial Surgery was the 3i nanotite surface. This is also a calcium phosphate surface but applied by a completely different process. It fared the WORST of the three surfaces tested, never getting past 20 Ncm of reverse torque to pullout even after 3 weeks compared with the Ossean 110 Ncm. So you see, you must read the literature carefully to understand how the chemistry of each different type of surface modification will affect metabolism of the target cells. The engineers at Intra-Lock got this one right. RJM

immediate implants are not successful! can you fill that void predictably-nope

There is more to this than surface. The thread design, pitch, occlusion, occlusal parafunction, patients systemic health, bone density, prosthetic design are just a few points to consider. One has to have a good understanding of this topic in order to be successful.

Surface coating plays a major role in Early loading (6 weeks) not immediate loading. We don't rely on the implant surface for immediate loading. There is no osseointegration during the first few weeks after implant placement. As Richard Hughes mentioned, other factors such as thickness of cortical bone, thread and macro-design, occlusion ,.. etc, are more important than surface coating . Bottom line; if you are considering immediate loading, focus on macro-design not micro-design.

Read Misch's book "Contemporary Implant Dentistry". The definition of immediate load is placing an implant in function at any time during the first two weeks after placement. I also thought that micro-, nano-design had nothing to do with immediate load. I have completely changed my mind and consider all aspects of implant design to be important during this critical phase. Most immediate load failures occur within the first two weeks. If I can skip the catabolic phase and ramp up bone bonding from the first day, why wouldn't I consider a surface that gives me a 500% increase in early stability? This is precisely why I prefer the Ossean surface. Astoundingly, I also see crestal bone GROWTH in these cases, the opposite of what would expect to see in extraction/immediate placement. I would be happy to share radiographs of some of these for the skeptical clinicians. I will also make available the papers from the last two years that give the biology of it's interaction. RJM

I am not in accord with all the participants of this forum. the coating of an implant surface is not essential for a good and fast result in case of immediate or not immediate loading. essential is: the quality of osseous support the drawing of implant and the length the points of dura-madre contacts with the implant (one,two or three) etc. etc. The coating of an implant is purely somethig more, that is not essential for a better osseousholding. the same, more or less, can occur with oxidation treatment or a right sandblast. i would say tha all i said is fruit of my own,but not only, experience in in 30 years of implantology. best respect for the other opinions.

The problem with many of these forums is that they become a media for advertising. Drs. Miller and Boudet, what is your affiliation with Intra-lock? This whole discussion seems to be a rah rah for this company.

PS, is the DR. B who asked the original question actually Dr. Boudet? If so, I think Osseonews needs to get a better handle on who asks questions and what their true goals are. These forums should be for factual information, not advertising.

Hi Dr. Johnson, Thanks for your comment. Dr. Boudet did not ask the original question and manufacturers have no influence whatsoever on any forums as per our comment guidelines and strict editorial policies. OsseoNews is a completely third-party website with no affiliation to any manufacturer, dental "guru", or dental association. It is simply an open forum for intelligent discussion on dental implants for dentists, with over 70,000 monthly readers worldwide, which means quite a few Dr. "B.s"", and quite a few questions submitted each week from dentists worldwide that our editors needs to sift thru. Moreover, if you feel you disagree with any of the posts or facts presented in this post, you are free to post your comments and your view of the facts, even if they are disagreement with those of any other poster or any marketing material from any manufacturer. Our whole goal is to help facilitate open and honest communication on any topic related to dental implants. Those who are merely regurgitating marketing hype generally are shot down quite quickly in these forums, precisely because there is no outside influence. We merely ask that comments do not insult or attack individuals. In other words, ad hominem arguments are not accepted. Thanks for your understanding and continued support.

I have absolutely no afiliation or conflict of interest with the Intra-lock company. Dr. Johnson, you are barking up the wrong tree.

Tunnel Question Tunnel Answers MOST WORK QUITE WELL Oh from 95% to 98% really makes something better. There is more that the implant success than surface, Thread pitch,etc! What about Abutment and transmucosal zone. Many have one piece of the puzzel and many have two. Some have three Surface Transmucosal connection Abutment choice The purpose is for the restoration remember

Thank you for the clarification. Osseonews states to not post any links to websites, yet Dr. Boudet did so, to Intra-lock. Also, Dr. Miller is a co author on many of the Intra-lock research papers hence his intimate knowledge of the surface. I certainly appreciate getting the information about surface treatments as it is an interest of mine (I'm a Prosthodontist) but also agree with most of the other bloggers that surface treatments have come light years from the machined surface and all seem to work very well. There are other factors influencing bone retention such as internal morse tapers, coronal microthreads, marcrothread design and medializing the microgap. Also, why do we feel we have to be in such a hurry to immediately load an implant? There are times it's a great adjunct, primarily in edentulous jaws, but does 6 weeks really make a difference in the treatment to gain predictability? Thank you again to Osseonews and Dr. Boudet for the responses to my queries.

Our philosophy of the definition of osseointegration is about to change to one where osseointegration can be viewed as an immediate state occurring instantly at time of implant placement and where immediate loading protocols will become a normality because of the positive stimulative effect of directed loading. This will/is developing due to a combination of macro and micro design features as well as from nano bioactive surface experimentation. I would refer you to the commentaries made by Dr. Ulrich Joos et.al. where they make what some would feel are highly radical statements but which are supported in their research. c/f Head and Face Medicine Sept, 2005 They state: 1. only a few hours is the time that is necessary for osteoblast adhesion to occur on artificial substrates when the peri-implant tissue receives an optimal mechanical environment. 2.load related bone reaction at the implant interface may in combination with substrate effects be responsible for an immediate osseointegration state. The authors emphasize that the principal requirement for this success is the establishment of high immediate bone interface contact. There are many implant designs currently available that can develop this type of excellent primary fixation. However other improvements will eventually come about and design and surface features of implants will continue to evolve as will our understanding of how bone biology interacts with newer and better implants.

I fully agree that intimate bone contact is one of principal requirements for immediate loading (this not automatically the same as a high insertion torque). In this big market many scientific battles are fought, numbers are thrown on a daily base to the dentists, many of them conflicting or biased. The amount of literature is so big that you can pubmed enough articles to almost support any idea you want to promote. As a dentist you need to be very critical to choose from the literature and implement the results in your daily implant routine. Let's be honest, every dentist or oral surgeon placing implants on a regular base does have 98% success for already over 15-20 years. When I started placing implants in 1998 all the materials which are the foundation of the success that implants have now, were already on the market. While the prosthetics became tremendously better (CAD-CAM, Zr, Intra-orally scan impressions), it's actually a sad story that the screw is just as good as we had in the 90's, only the marketing around it got improved.

I see that a bunch of postings have been removed from this thread. Kudos to the folks at Osseonews for finally standing up to the marketers posting on this site. Let's continue with the scientific statements in this section. It's nice to see that some clinicans are beginning to recognize that high insertion torque does NOT equate with higher initial stability. We are in the process of publishing a paper that compares a single tapered implant model with three different thread modifications. One with no apical vent, one with a classic "self-tapping" vent evident on most systems, and one with modified "self-cutting" threads (New York University Department of Biomaterials and Biomimetics). Measurements clearly show that the implant design with the LOWEST final seating torque actually had the BEST resistance to displacement. Another indication that highly compressive designs are NOT the best for early and immediate load. Next is osteoblast attachment. This is regulated by the speed of attachment of vitronectin and fibronectin. This will depend on the hydrophilicity of the implant surface. Osteoblasts then attach to these compounds. However, simple attachment does not mean immediate synthesis of type I collagen and production of provisional matrix. This requires a favorable biological interface that eliminates the inflammatory cascade. CaPO4 nanoimpregnated surfaces have been shown to ramp up MAP kinase production in osteoblasts within the first 5 minutes (up to 500% faster than acid-etched surfaces alone). Last is the statement that implants are 98.6% successful. This is the last and greatest myth perpetrated by implant companies. While lecturers on the podium use this statistic to make their system look good relative to the competition, when you get the same clinicians to open up that evening, you will find that the true statisitics are actually in the low 90's. Time for everyone to "man up" and show a little intellectual honesty here instead of trying to look good to their colleagues. Let me start: In my survival table over the past 15 years, I have a 91% success rate, which includes my early AND late failures. What say you. RJM

Failure usually happens between the moment the implant is placed and the bone is healed. Therefore, if healing happens way faster, you reduce your chances of failure. (wether or not you load early your implant). That's why the paper Dr Miller mentions, showing the quasi "obscene" superiority of intra-lock implant 1 week post op is very interesting. Looks like something positive is happening at the implant/bone interface as soon as the implant is placed....

I like aggressively threaded implants such as Nobelactive and MIS. I usually get primary stability with fewer failures..but this is what works in my hands. Whichever implants you use, make sure you know what the manufacturer's recommendations are on the torque and uses of the implant. Good luck.

Immediate placement - high primary stability and generally dependant on macro design, aggressive threading, self-tapping, and proper apical cutting edges. Immediate loading - This doesn't really mean immediate occlusal loading, but rather out of occlusion immediate temporaries (or early temps, within two weeks) for beautiful aesthetic temps and emergence profile. Soft tissue contours happen during this time. Highly dependent on micro and surface features, such as Calcium Phosphate, hydrophilic surface properties, and presence of biologic signaling such as CGF bone, etc. as well as initial torque and primary stability to prevent implant failure from micro movement.