The influence of surface treatment on the implant roughness pattern
Identifieur interne : 002F74 ( Pmc/Corpus ); précédent : 002F73; suivant : 002F75The influence of surface treatment on the implant roughness pattern
Auteurs : Marcio Borges Rosa ; Tomas Albrektsson ; Carlos Eduardo Francischone ; Humberto Osvaldo Schwartz Filho ; Ann WennerbergSource :
- Journal of Applied Oral Science [ 1678-7757 ] ; 2012.
Abstract
An important parameter for the clinical success of dental implants is the formation of direct contact between the implant and surrounding bone, whose quality is directly influenced by the implant surface roughness. A screw-shaped design and a surface with an average roughness of Sa of 1-2 µm showed a better result. The combination of blasting and etching has been a commonly used surface treatment technique. The versatility of this type of treatment allows for a wide variation in the procedures in order to obtain the desired roughness.
To compare the roughness values and morphological characteristics of 04 brands of implants, using the same type of surface treatment. In addition, to compare the results among brands, in order to assess whether the type of treatment determines the values and the characteristics of implant surface roughness.
Three implants were purchased directly from each selected company in the market, i.e., 03 Brazilian companies (Biomet 3i of Brazil, Neodent and Titaniumfix) and 01 Korean company (Oneplant). The quantitative or numerical characterization of the roughness was performed using an interferometer. The qualitative analysis of the surface topography obtained with the treatment was analyzed using scanning electron microscopy images.
The evaluated implants showed a significant variation in roughness values: Sa for Oneplant was 1.01 µm; Titaniumfix reached 0.90 µm; implants from Neodent 0.67 µm, and Biomet 3i of Brazil 0.53 µm. Moreover, the SEM images showed very different patterns for the surfaces examined.
The surface treatment alone is not able to determine the roughness values and characteristics.
Url:
DOI: 10.1590/S1678-77572012000500010
PubMed: 23138742
PubMed Central: 3881788
Links to Exploration step
PMC:3881788Le document en format XML
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pattern</title>
<author><name sortKey="Rosa, Marcio Borges" sort="Rosa, Marcio Borges" uniqKey="Rosa M" first="Marcio Borges" last="Rosa">Marcio Borges Rosa</name>
<affiliation><nlm:aff id="aff01"> DDS, PhD student, Division of Implantology, Department of Post-Graduation, School of Dentistry, São Leopoldo Mandic University, Campinas, SP, Brazil.</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Albrektsson, Tomas" sort="Albrektsson, Tomas" uniqKey="Albrektsson T" first="Tomas" last="Albrektsson">Tomas Albrektsson</name>
<affiliation><nlm:aff id="aff02"> MD, PhD, ODhc Professor and Head, Department of Biomaterials, Gothenburg University, Gothenburg, Sweden.</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Francischone, Carlos Eduardo" sort="Francischone, Carlos Eduardo" uniqKey="Francischone C" first="Carlos Eduardo" last="Francischone">Carlos Eduardo Francischone</name>
<affiliation><nlm:aff id="aff03"> DDS, MS, PhD, Professor and Head, Department of Post-Graduation, Division of Implantology, School of Dentistry, São Leopoldo Mandic University, Campinas, SP, Brazil.</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Schwartz Filho, Humberto Osvaldo" sort="Schwartz Filho, Humberto Osvaldo" uniqKey="Schwartz Filho H" first="Humberto Osvaldo" last="Schwartz Filho">Humberto Osvaldo Schwartz Filho</name>
<affiliation><nlm:aff id="aff04"> DDS, MS, PhD, Department of Post-Graduation, Division of Implantology, School of Dentistry, University of Santo Amaro-UNISA, São Paulo, SP, Brazil.</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Wennerberg, Ann" sort="Wennerberg, Ann" uniqKey="Wennerberg A" first="Ann" last="Wennerberg">Ann Wennerberg</name>
<affiliation><nlm:aff id="aff05"> LDS, PhD, Professor and Head, Department of Prosthodontics, Malmö University, Malmö, Sweden.</nlm:aff>
</affiliation>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The influence of surface treatment on the implant roughness
pattern</title>
<author><name sortKey="Rosa, Marcio Borges" sort="Rosa, Marcio Borges" uniqKey="Rosa M" first="Marcio Borges" last="Rosa">Marcio Borges Rosa</name>
<affiliation><nlm:aff id="aff01"> DDS, PhD student, Division of Implantology, Department of Post-Graduation, School of Dentistry, São Leopoldo Mandic University, Campinas, SP, Brazil.</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Albrektsson, Tomas" sort="Albrektsson, Tomas" uniqKey="Albrektsson T" first="Tomas" last="Albrektsson">Tomas Albrektsson</name>
<affiliation><nlm:aff id="aff02"> MD, PhD, ODhc Professor and Head, Department of Biomaterials, Gothenburg University, Gothenburg, Sweden.</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Francischone, Carlos Eduardo" sort="Francischone, Carlos Eduardo" uniqKey="Francischone C" first="Carlos Eduardo" last="Francischone">Carlos Eduardo Francischone</name>
<affiliation><nlm:aff id="aff03"> DDS, MS, PhD, Professor and Head, Department of Post-Graduation, Division of Implantology, School of Dentistry, São Leopoldo Mandic University, Campinas, SP, Brazil.</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Schwartz Filho, Humberto Osvaldo" sort="Schwartz Filho, Humberto Osvaldo" uniqKey="Schwartz Filho H" first="Humberto Osvaldo" last="Schwartz Filho">Humberto Osvaldo Schwartz Filho</name>
<affiliation><nlm:aff id="aff04"> DDS, MS, PhD, Department of Post-Graduation, Division of Implantology, School of Dentistry, University of Santo Amaro-UNISA, São Paulo, SP, Brazil.</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Wennerberg, Ann" sort="Wennerberg, Ann" uniqKey="Wennerberg A" first="Ann" last="Wennerberg">Ann Wennerberg</name>
<affiliation><nlm:aff id="aff05"> LDS, PhD, Professor and Head, Department of Prosthodontics, Malmö University, Malmö, Sweden.</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">Journal of Applied Oral Science</title>
<idno type="ISSN">1678-7757</idno>
<idno type="eISSN">1678-7765</idno>
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<front><div type="abstract" xml:lang="en"><p>An important parameter for the clinical success of dental implants is the formation
of direct contact between the implant and surrounding bone, whose quality is directly
influenced by the implant surface roughness. A screw-shaped design and a surface with
an average roughness of Sa of 1-2 µm showed a better result. The combination of
blasting and etching has been a commonly used surface treatment technique. The
versatility of this type of treatment allows for a wide variation in the procedures
in order to obtain the desired roughness.</p>
<sec><title>Objectives</title>
<p>To compare the roughness values and morphological characteristics of 04 brands of
implants, using the same type of surface treatment. In addition, to compare the
results among brands, in order to assess whether the type of treatment determines
the values and the characteristics of implant surface roughness. </p>
</sec>
<sec><title>Material and methods</title>
<p>Three implants were purchased directly from each selected company in the market,
i.e., 03 Brazilian companies (Biomet 3i of Brazil, Neodent and Titaniumfix) and 01
Korean company (Oneplant). The quantitative or numerical characterization of the
roughness was performed using an interferometer. The qualitative analysis of the
surface topography obtained with the treatment was analyzed using scanning
electron microscopy images. </p>
</sec>
<sec><title>Results</title>
<p>The evaluated implants showed a significant variation in roughness values: Sa for
Oneplant was 1.01 µm; Titaniumfix reached 0.90 µm; implants from Neodent 0.67 µm,
and Biomet 3i of Brazil 0.53 µm. Moreover, the SEM images showed very different
patterns for the surfaces examined. </p>
</sec>
<sec><title>Conclusions</title>
<p>The surface treatment alone is not able to determine the roughness values and
characteristics.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Appl Oral Sci</journal-id>
<journal-id journal-id-type="iso-abbrev">J Appl Oral Sci</journal-id>
<journal-id journal-id-type="publisher-id">J. Appl. Oral. Sci.</journal-id>
<journal-title-group><journal-title>Journal of Applied Oral Science</journal-title>
</journal-title-group>
<issn pub-type="ppub">1678-7757</issn>
<issn pub-type="epub">1678-7765</issn>
<publisher><publisher-name>Faculdade de Odontologia de Bauru da Universidade de São
Paulo</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">23138742</article-id>
<article-id pub-id-type="pmc">3881788</article-id>
<article-id pub-id-type="doi">10.1590/S1678-77572012000500010</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject>
</subj-group>
</article-categories>
<title-group><article-title>The influence of surface treatment on the implant roughness
pattern</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>ROSA</surname>
<given-names>Marcio Borges</given-names>
</name>
<xref ref-type="aff" rid="aff01">1</xref>
<xref ref-type="corresp" rid="c01"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>ALBREKTSSON</surname>
<given-names>Tomas</given-names>
</name>
<xref ref-type="aff" rid="aff02">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>FRANCISCHONE</surname>
<given-names>Carlos Eduardo</given-names>
</name>
<xref ref-type="aff" rid="aff03">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>SCHWARTZ FILHO</surname>
<given-names>Humberto Osvaldo</given-names>
</name>
<xref ref-type="aff" rid="aff04">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>WENNERBERG</surname>
<given-names>Ann</given-names>
</name>
<xref ref-type="aff" rid="aff05">5</xref>
</contrib>
</contrib-group>
<aff id="aff01"><label>1</label>
DDS, PhD student, Division of Implantology, Department of Post-Graduation, School of Dentistry, São Leopoldo Mandic University, Campinas, SP, Brazil.</aff>
<aff id="aff02"><label>2</label>
MD, PhD, ODhc Professor and Head, Department of Biomaterials, Gothenburg University, Gothenburg, Sweden.</aff>
<aff id="aff03"><label>3</label>
DDS, MS, PhD, Professor and Head, Department of Post-Graduation, Division of Implantology, School of Dentistry, São Leopoldo Mandic University, Campinas, SP, Brazil.</aff>
<aff id="aff04"><label>4</label>
DDS, MS, PhD, Department of Post-Graduation, Division of Implantology, School of Dentistry, University of Santo Amaro-UNISA, São Paulo, SP, Brazil.</aff>
<aff id="aff05"><label>5</label>
LDS, PhD, Professor and Head, Department of Prosthodontics, Malmö University, Malmö, Sweden.</aff>
<author-notes><corresp id="c01"><bold>Corresponding address:</bold>
Marcio Borges Rosa - Av. do Contorno 4849, 4º
andar - 30110-035 - Belo Horizonte - MG - Phone: (31) 3284-2020 - e-mail:
<email>marcio@implantare.com.br</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><season>Sep-Oct</season>
<year>2012</year>
</pub-date>
<volume>20</volume>
<issue>5</issue>
<fpage>550</fpage>
<lpage>555</lpage>
<history><date date-type="received"><day>30</day>
<month>3</month>
<year>2012</year>
</date>
<date date-type="rev-recd"><day>18</day>
<month>7</month>
<year>2012</year>
</date>
<date date-type="accepted"><day>20</day>
<month>8</month>
<year>2012</year>
</date>
</history>
<permissions><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly
cited.</license-p>
</license>
</permissions>
<abstract><p>An important parameter for the clinical success of dental implants is the formation
of direct contact between the implant and surrounding bone, whose quality is directly
influenced by the implant surface roughness. A screw-shaped design and a surface with
an average roughness of Sa of 1-2 µm showed a better result. The combination of
blasting and etching has been a commonly used surface treatment technique. The
versatility of this type of treatment allows for a wide variation in the procedures
in order to obtain the desired roughness.</p>
<sec><title>Objectives</title>
<p>To compare the roughness values and morphological characteristics of 04 brands of
implants, using the same type of surface treatment. In addition, to compare the
results among brands, in order to assess whether the type of treatment determines
the values and the characteristics of implant surface roughness. </p>
</sec>
<sec><title>Material and methods</title>
<p>Three implants were purchased directly from each selected company in the market,
i.e., 03 Brazilian companies (Biomet 3i of Brazil, Neodent and Titaniumfix) and 01
Korean company (Oneplant). The quantitative or numerical characterization of the
roughness was performed using an interferometer. The qualitative analysis of the
surface topography obtained with the treatment was analyzed using scanning
electron microscopy images. </p>
</sec>
<sec><title>Results</title>
<p>The evaluated implants showed a significant variation in roughness values: Sa for
Oneplant was 1.01 µm; Titaniumfix reached 0.90 µm; implants from Neodent 0.67 µm,
and Biomet 3i of Brazil 0.53 µm. Moreover, the SEM images showed very different
patterns for the surfaces examined. </p>
</sec>
<sec><title>Conclusions</title>
<p>The surface treatment alone is not able to determine the roughness values and
characteristics.</p>
</sec>
</abstract>
<kwd-group><kwd>Surface treatments</kwd>
<kwd>Blasting</kwd>
<kwd>Acid etched</kwd>
<kwd>Dental implants</kwd>
<kwd>Osseointegration</kwd>
</kwd-group>
</article-meta>
</front>
<body><sec><title>INTRODUCTION</title>
<p>Since the discovery of osseointegration by Brånemark, the placement of titanium implants
has been established as the treatment of choice for replacing missing teeth, thereby
improving the patients' quality of life<sup><xref ref-type="bibr" rid="r13">13</xref>
,<xref ref-type="bibr" rid="r18">18</xref>
</sup>
.</p>
<p>An important parameter for the clinical success of dental implants is the formation of
direct contact between the implant and surrounding bone<sup><xref ref-type="bibr" rid="r14">14</xref>
</sup>
. The quality of the bone-implant interface is directly
influenced by the implant surface roughness<sup><xref ref-type="bibr" rid="r01">1</xref>
,<xref ref-type="bibr" rid="r09">9</xref>
,<xref ref-type="bibr" rid="r10">10</xref>
,<xref ref-type="bibr" rid="r23">23</xref>
-<xref ref-type="bibr" rid="r25">25</xref>
</sup>
which, since the early 1980s, has been identified as one
of the six factors that are particularly important for incorporating the implant into
the bone<sup><xref ref-type="bibr" rid="r01">1</xref>
</sup>
.</p>
<p>Both morphology and surface roughness influence cell proliferation and differentiation,
extracellular matrix synthesis, local production factors, and even cell shape<sup><xref ref-type="bibr" rid="r04">4</xref>
,<xref ref-type="bibr" rid="r10">10</xref>
</sup>
. Furthermore, the shape of the cell regulates its growth, gene
expression, protein secretion, differentiation, and apoptosis<sup><xref ref-type="bibr" rid="r07">7</xref>
</sup>
. Therefore, osteoblast adherence on implant surfaces is
not sufficient for achieving osseointegration, much less for improving it, but it is
necessary, particularly to enable the cell to receive the signals to induce its
proliferation<sup><xref ref-type="bibr" rid="r10">10</xref>
</sup>
. In addition,
roughness not only facilitates the retention of osteogenic cells, but also allows them
to migrate to the implant surface by osseoconductivity<sup><xref ref-type="bibr" rid="r06">6</xref>
</sup>
. Faster and stronger bone formation provides greater
stability during the repair process, allowing for even faster implant loading<sup><xref ref-type="bibr" rid="r23">23</xref>
-<xref ref-type="bibr" rid="r25">25</xref>
</sup>
. Oral implant surfaces have structures that are measurable on a
macrometric scale in millimeters (mm), micrometric in micrometers (µm), and nanometric
in nanometers (nm)<sup><xref ref-type="bibr" rid="r02">2</xref>
,<xref ref-type="bibr" rid="r03">3</xref>
,<xref ref-type="bibr" rid="r18">18</xref>
,<xref ref-type="bibr" rid="r22">22</xref>
-<xref ref-type="bibr" rid="r24">24</xref>
</sup>
. How these
structures influence repair has been the subject of various publications and studies in
recent years<sup><xref ref-type="bibr" rid="r02">2</xref>
,<xref ref-type="bibr" rid="r07">7</xref>
,<xref ref-type="bibr" rid="r08">8</xref>
,<xref ref-type="bibr" rid="r11">11</xref>
,<xref ref-type="bibr" rid="r13">13</xref>
,<xref ref-type="bibr" rid="r17">17</xref>
,<xref ref-type="bibr" rid="r21">21</xref>
,<xref ref-type="bibr" rid="r24">24</xref>
</sup>
.</p>
<p>Until now, certainties have been limited to the influence of implant design and surface
roughness on the micrometric scale. A screw-shaped design and a surface with an average
roughness of S<sub>a</sub>
of 1-2 µm have shown better results<sup><xref ref-type="bibr" rid="r02">2</xref>
,<xref ref-type="bibr" rid="r10">10</xref>
,<xref ref-type="bibr" rid="r24">24</xref>
,<xref ref-type="bibr" rid="r25">25</xref>
</sup>
. Studies have
shown that titanium implants with the proper roughness can improve bone-implant
contact<sup><xref ref-type="bibr" rid="r29">29</xref>
</sup>
, while also increasing
the removal torque values<sup><xref ref-type="bibr" rid="r21">21</xref>
,<xref ref-type="bibr" rid="r29">29</xref>
</sup>
. On the other hand, increasing the
surface roughness to the level of surfaces treated with plasma spray titanium,
S<sub>a</sub>
above 2 µm, elicits a prejudiced and non-reinforced bone
response<sup><xref ref-type="bibr" rid="r10">10</xref>
,<xref ref-type="bibr" rid="r23">23</xref>
-<xref ref-type="bibr" rid="r25">25</xref>
</sup>
.</p>
<p>As a result, over the past 20 years, a large number of implant systems with different
surface topographies have been introduced<sup><xref ref-type="bibr" rid="r19">19</xref>
</sup>
. Oral implants are an example of the close link between research and
industry, since the laboratory findings often become clinical applications. However, any
change in the implant morphology, i.e., in its design, causes changes in the topography
at the micrometric level and vice versa. Likewise, chemical changes cause physical
changes and vice versa<sup><xref ref-type="bibr" rid="r23">23</xref>
-<xref ref-type="bibr" rid="r25">25</xref>
</sup>
. There are many types of surface
treatments on the market. In general, all seek to alter the previously machined surface
roughness, increasing it to levels considered optimal. A combination of blasting,
followed by acid etching, has been a technique commonly used for surface treatment in
recent years<sup><xref ref-type="bibr" rid="r24">24</xref>
</sup>
. The main reason for
the combination of methods is that hypothetically, blasting reaches an optimal roughness
and mechanical fixation, while acid etching smooths the peaks and can add a high
frequency component to the implant surface, with a potential importance for protein
adherence, which is considered important during the early bone healing process<sup><xref ref-type="bibr" rid="r24">24</xref>
</sup>
.</p>
<p>The surface characteristics obtained with blasting deformation depend on the type of
particle used, its hardness, size, and impact velocity. The blasting process, usually
performed with titanium (TiO<sub>2</sub>
) or alumina (Al<sub>2</sub>
O<sub>3</sub>
)
particles, allows for good control of the size of the resulting micro cavities. Some
remaining particles may however, become embedded and contaminate the implant
surface<sup><xref ref-type="bibr" rid="r10">10</xref>
</sup>
.</p>
<p>Acid etching removes a few atomic layers from the deformed surface, part of the residual
surface stress, and reduces the possibility of surface contamination by particles left
over from the blasting process, because it also acts in cleaning the surface. These
processes create micro cavities overlapping the pre-blasted rough surface.</p>
<p>Each manufacturer has its own method of acid etching with regard to temperature,
concentration of acids, and exposure time. In general, there is dual acid etching, which
is carried out by first immersing the implants in solutions of
HCl+H<sub>2</sub>
SO<sub>4</sub>
, HNO<sub>3</sub>
+HF, or HNO<sub>3</sub>
. Thereafter,
the implant is again immersed in an aqueous solution of HNO<sub>3</sub>
to stabilize the
titanium oxide layer<sup><xref ref-type="bibr" rid="r10">10</xref>
,<xref ref-type="bibr" rid="r24">24</xref>
</sup>
.</p>
<p>The versatility of this type of treatment allows for a wide variation in the procedures
to obtain the desired roughness. On the other hand, this characteristic can produce
significantly different surfaces. Consequently, it is very important to characterize the
surfaces to obtain the values envisioned by the proposed treatments. According to
Wennerberg and Albrektsson<sup><xref ref-type="bibr" rid="r23">23</xref>
</sup>
(2000), a
light interferometer is a safe and effective way to measure the roughness of
screw-shaped implants.</p>
<p>This aim of this study was to characterize the surfaces, by means of using a light
interferometer and scanning electron microscopy (SEM), of implants from four companies:
3 Brazilian and 1 Korean, which use blasting and acid etching treatments. The results
were compared among the 4 companies.</p>
</sec>
<sec sec-type="materials|methods"><title>MATERIAL AND METHODS</title>
<p>In accordance with this study design, three implants from each company would be
analyzed<sup><xref ref-type="bibr" rid="r16">16</xref>
</sup>
. Therefore, 03
implants were purchased from each of the following 3 Brazilian companies, namely Biomet
3i of Brazil (São Paulo, SP, Brazil); Neodent (Curitiba, PR, Brazil) and Titaniumfix
(São José dos Campos, SP, Brazil); and 01 implant from the Korean Oneplant Company
(Seoul, Korea).</p>
<p>The implant surfaces were evaluated using a light interferometer (MicroXAM<sup>TM</sup>
,
Phaseshift, Tucson, AZ, USA), which, according to Wennerberg and Albrektsson<sup><xref ref-type="bibr" rid="r23">23</xref>
</sup>
(2000) is recommended for evaluating the
roughness of implants with threads at the micrometer level. A 50X magnification and 0.62
zoom were used, and the measured area was 264x200µm. The mean height of the measurements
varied between 80 µm and 100 µm. The maximum resolution of this technique is 0.30 µm
horizontally and 0.05 µm vertically.</p>
<p>To evaluate an implant surface, three measurements are taken in different areas, i.e.,
the tops, valleys, and flanks of the threads (<xref ref-type="fig" rid="f01">Figure
1</xref>
) totaling nine measurements for each unit. In addition, a minimum of three
samples were evaluated for each implant<sup><xref ref-type="bibr" rid="r16">16</xref>
</sup>
.</p>
<fig id="f01" orientation="portrait" position="float"><label>Figure 1</label>
<caption><p>Red: top; green: flank; orange: valley</p>
</caption>
<graphic xlink:href="jaos-20-05-0550-g01"></graphic>
</fig>
<p>The undulations from the machining process and the shape are considered separately to
adequately describe the roughness obtained with the treatment. A standard filtering
process, with a 50X50 µm Gaussian filter was used to make the separation and evaluate
the micrometric roughness (<xref ref-type="fig" rid="f02">Figure 2</xref>
). Surfascan
software (Somicronic Instrument, Lyon, France) was used for this purpose, which also
provides visual images and numerical descriptions.</p>
<fig id="f02" orientation="portrait" position="float"><label>Figure 2</label>
<caption><p>a, b and c: Filter sequence in which the undulations and shapes have been
removed</p>
<p>Note: a: Nanotite original; b: Nanotite 50X50 μm Gaussian filter; c: Nanotite
50X50 μm Gaussian filter low pass<xref ref-type="bibr" rid="r18">18</xref>
</p>
</caption>
<graphic xlink:href="jaos-20-05-0550-g02"></graphic>
</fig>
<p>The following parameters were used for the numerical description of the surface
topography, which should preferably be in 3D:</p>
<p>S<sub>a</sub>
: represented the arithmetic mean of the roughness area from the mean
plane.</p>
<p>S<sub>ds</sub>
: represented the density, i.e., the number of peaks per unit of area.</p>
<p>S<sub>dr</sub>
: hybrid parameter that represented the ratio between the developed
surface area and a flat reference area.</p>
<p>According to Albrektsson and Wennerberg<sup><xref ref-type="bibr" rid="r02">2</xref>
</sup>
(2004) implants can be divided into four different categories,
depending on the surface roughness measured by the value of S<sub>a</sub>
: smooth
(S<sub>a</sub>
<0.5 µm); minimally rough (S<sub>a</sub>
between 0.5-1.0 µm),
moderately rough (S<sub>a</sub>
between 1.0-2.0 µm); rough (S<sub>a</sub>
>2.0
µm).</p>
<p>Images were also captured by scanning electron microscopy on the top, flank and valley
of the threads, with magnifications at 65X, 350X, 1,000X, 3.000X and 5.000X. The purpose
of these images was to allow a qualitative analysis of the changes obtained by the
surface treatment, as well as to visualize the roughness characteristics and check the
maintenance of the standard throughout the entire implant body.</p>
<sec><title>Statistical evaluation</title>
<p>The implants were evaluated for significant differences in surface topography at the
micrometric level. The statistical analyses were performed with the software GraphPad
Prism 5.0 (GraphPad Software, San Diego, CA, USA). The data was analyzed by one-way
ANOVA (Kruskall-Wallis test) with the significance level set at p<0.05, and the
application of the Dunn's multiple comparisons test.</p>
</sec>
</sec>
<sec sec-type="results"><title>RESULTS</title>
<p>The evaluated implants showed a significant variation in roughness values: Sa for
Oneplant was 1.01 µm; Titaniumfix reached 0.90 µm; implants from Neodent 0.67 µm, and
Biomet 3i of Brazil 0.53 µm. Moreover, the SEM images showed very different patterns for
the surfaces examined (<xref ref-type="table" rid="t01">Table 1</xref>
).</p>
<table-wrap id="t01" orientation="portrait" position="float"><label>Table 1</label>
<caption><p>Numerical description of the surface at a micrometer level</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr align="center" style="background-color:#CCCCCC"><td rowspan="1" colspan="1"></td>
<td rowspan="1" colspan="1"><bold>Sa µm</bold>
</td>
<td rowspan="1" colspan="1"><bold>Sds/mm<sup>2</sup>
</bold>
</td>
<td rowspan="1" colspan="1"><bold>Sdr%</bold>
</td>
</tr>
</thead>
<tbody><tr><td rowspan="1" colspan="1">Oneplant</td>
<td align="center" rowspan="1" colspan="1">1.01±0.20</td>
<td align="center" rowspan="1" colspan="1">168,931±21,201</td>
<td align="center" rowspan="1" colspan="1">73.20±37.28</td>
</tr>
<tr style="background-color:#CCCCCC"><td rowspan="1" colspan="1">Titaniumfix</td>
<td align="center" rowspan="1" colspan="1">0.90±0.23</td>
<td align="center" rowspan="1" colspan="1">164.673±10,265</td>
<td align="center" rowspan="1" colspan="1">57.08±27.10</td>
</tr>
<tr><td rowspan="1" colspan="1">Neodent EX</td>
<td align="center" rowspan="1" colspan="1">0.67±0.16</td>
<td align="center" rowspan="1" colspan="1">155.725±15,727</td>
<td align="center" rowspan="1" colspan="1">52.33±48.12</td>
</tr>
<tr style="background-color:#CCCCCC"><td rowspan="1" colspan="1">3i Bonelike CM</td>
<td align="center" rowspan="1" colspan="1">0.53±0.12</td>
<td align="center" rowspan="1" colspan="1">174.539±30,456</td>
<td align="center" rowspan="1" colspan="1">40.20±41.56</td>
</tr>
</tbody>
</table>
</table-wrap>
<p><xref ref-type="fig" rid="f03">Figure 3</xref>
shows the interferometer and SEM images
for the implants in this group:</p>
<fig id="f03" orientation="portrait" position="float"><label>Figure 3</label>
<caption><p>Interferometer images (left) and scanning electron microscopy (SEM) images 3,000X
magnification (right). Note: A and B Neodent; C and D Titaniumfix; E and F 3i
Biomet; G and H Oneplant</p>
</caption>
<graphic xlink:href="jaos-20-05-0550-g03"></graphic>
</fig>
</sec>
<sec sec-type="discussion"><title>DISCUSSION</title>
<p>When implants first began to be manufactured in developing countries, such as Brazil and
Korea, the majority of the companies adopted models and surface treatments of well-known
implants. Since then, no independent assessment has been made of the quality of the
implant surfaces, by means of characterizing the roughness obtained, and their clinical
performance.</p>
<p>Among the evaluated parameters, the most important are as follows: S<sub>a</sub>
, which
represent the arithmetic mean, in 3D, for the height of the peaks and valleys of surface
roughness; S<sub>ds, </sub>
which represents the density of peaks <italic>per</italic>
unit area; and finally, S<sub>dr</sub>
, which is the intersection of the first two
parameters and represents the surface enlargement<sup><xref ref-type="bibr" rid="r02">2</xref>
,<xref ref-type="bibr" rid="r03">3</xref>
,<xref ref-type="bibr" rid="r12">12</xref>
,<xref ref-type="bibr" rid="r23">23</xref>
</sup>
. The analysis of these
factors, and prior knowledge of their influence on the repair process, makes it easier
to signal the behavior of a given surface. There is strong scientific evidence about the
importance of S<sub>a</sub>
in the healing process<sup><xref ref-type="bibr" rid="r02">2</xref>
,<xref ref-type="bibr" rid="r10">10</xref>
,<xref ref-type="bibr" rid="r25">25</xref>
,<xref ref-type="bibr" rid="r29">29</xref>
</sup>
.</p>
<p>The type of titanium used needs to be added to these variables because its hardness
directly affects the roughness obtained with the treatment. In other words, the same
treatment can produce different roughness patterns in different grades of
titanium<sup><xref ref-type="bibr" rid="r10">10</xref>
,<xref ref-type="bibr" rid="r23">23</xref>
</sup>
.</p>
<p>For this group of implants, with the same type of treatment - blasting and acid etching
- different results were found. The Oneplant, from Korea showed a S<sub>a </sub>
value of
1.01 µm. All of the Brazilian implants presented S<sub>a</sub>
values of less than 1.0
µm, with the Titaniumfix reaching 0.90 µm, while those from Neodent presented a mean of
0.67 µm. Moreover, the Bonelike implants from Biomet 3i of Brazil, which uses titanium
alloy (Ti<sub>6</sub>
Al<sub>4</sub>
V), presented S<sub>a</sub>
values of only 0.53 µm.
In this particular case, the influence of the titanium alloy hardness on the low
roughness should be highlighted, irrespective of which treatment would be appropriate
for the materials to produce the desired roughness, and not the opposite.</p>
<p>When evaluating the S<sub>dr</sub>
to compare the surface enlargement, different values
were also found: Oneplant had an S<sub>dr</sub>
value of 73.20%; while Titaniumfix
showed 57.08%; Neodent a S<sub>dr</sub>
value of 52.33%; and Bonelike CM, a S<sub>dr
</sub>
value of 40.20%, bearing in mind that an S<sub>dr</sub>
value of about 50%
promotes strong bone formation<sup><xref ref-type="bibr" rid="r26">26</xref>
-<xref ref-type="bibr" rid="r28">28</xref>
</sup>
.</p>
<p>For comparison, the SLA implants from Straumann, with the same type of treatment, an
extensive scientific documentation and good clinical performance have shown a
S<sub>a</sub>
value of 1.53 µm and a S<sub>dr</sub>
value of 74.52%<sup><xref ref-type="bibr" rid="r22">22</xref>
</sup>
.</p>
<p>The long-term clinical results obtained with minimally or moderately rough implants have
been shown to be very similar under normal conditions<sup><xref ref-type="bibr" rid="r05">5</xref>
</sup>
. Moreover, when placed under adverse conditions, such as
in bone grafts and type IV bone or for short implants, among others, comparative studies
have shown a significant superiority of the implants with a moderately rough
surface<sup><xref ref-type="bibr" rid="r12">12</xref>
,<xref ref-type="bibr" rid="r14">14</xref>
,<xref ref-type="bibr" rid="r15">15</xref>
</sup>
.</p>
<p>Thus, using an implant without knowing its real roughness, the bone repair can be weaker
than expected, which is highly undesirable, especially in critical cases, where more is
expected of the surface properties of the implants.</p>
<p>In the literature, the surface topography of blasted and etched surfaces varies greatly
because of the different measuring equipment and evaluation techniques, but mainly
because the blasting and etching procedures may differ as well. In blasting, the types
of particles used, along with the size and impact velocity, are directly responsible for
the results. In acid etching, the type of acid, exposure time, and temperature are
essential factors for surface characterization<sup><xref ref-type="bibr" rid="r10">10</xref>
</sup>
. However, in the vast majority of studies, blasted and etched
implants are moderately rough, between 1.0-2.0 µm, which is considered ideal and shows
better results<sup><xref ref-type="bibr" rid="r02">2</xref>
,<xref ref-type="bibr" rid="r10">10</xref>
,<xref ref-type="bibr" rid="r24">24</xref>
,<xref ref-type="bibr" rid="r25">25</xref>
</sup>
.</p>
<p>When analyzing the SEM images, it is quite clear how the same type of treatment may lead
to surfaces with very different characteristics, and therefore, the need for clinical
studies that prove the efficiency of each surface obtained, must be reinforced.</p>
<p>Further clinical studies are needed to show the factors that these differences may
really represent. However, similar surface treatments do not necessarily lead to the
same results. According to Wennerberg and Albrektsson<sup><xref ref-type="bibr" rid="r24">24</xref>
,<xref ref-type="bibr" rid="r25">25</xref>
</sup>
(2009, 2010)
even the roughness of a machined surface, as well as blasted, acid etched and anodized
surfaces, may vary considerably. They also point out that many studies and companies
leave out the surface topographic characterization in the false belief that their
treatment alone will determine the roughness of this surface<sup><xref ref-type="bibr" rid="r24">24</xref>
</sup>
.</p>
<p>When the surface topography is altered, its chemical and/or physical characteristics can
change at the same time, even accidentally<sup><xref ref-type="bibr" rid="r24">24</xref>
</sup>
. Often, there are no short, medium, and long-term studies to
evaluate the effects of these changes on the repair processes and longevity of implant
osseointegration. This occurs mainly in implants, such as those from Brazilian companies
that use surface treatments established by other companies, but do not conduct clinical
studies to evaluate their clinical performance. It is not practicable to endorse the
results of other implants only because they have the same type of surface treatment.</p>
</sec>
<sec sec-type="conclusions"><title>CONCLUSION</title>
<p>The results, with a significant variation in roughness values among the implants with
the same type of surface treatment showed that the characterization of the surface of
each implant is very important for a real evaluation of the obtained results.</p>
<p>Therefore, even if established treatments are used on the surface of these implants, it
is very important that each company conducts its own laboratory and clinical experiments
to validate them.</p>
</sec>
</body>
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