Surface Modification of Titanium Dental Implants

258 Pages·2023·7.473 MB·English

by  Karan Gulati

Surface Modification of Titanium Dental Implants
Karan Gulati
Editor
Surface Modification
of Titanium Dental Implants
Editor
Karan Gulati
School of Dentistry
The University of Queensland
Herston, QLD, Australia
ISBN 978-3-031-21564-3 ISBN 978-3-031-21565-0 (eBook)
https://doi.org/10.1007/978-3-031-21565-0
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Preface
This book aims to present advances in the surface modification of titanium dental
implants, from the macro and micro to nanoscale surface modifications, focusing on
advanced bioactive and nano-engineered dental implants. Through eight chapters,
the book covers a wide array of topics that provide an improved understanding of
the fabrication, bioactivity, therapy, and stability of modified titanium dental
implants. Overall, the book significantly contributes to the ever-changing field of
dental implants. From the basics of why the surface modification is needed to the
advanced state-of-the-art electrochemically anodized nanostructures fabricated on
implants, the book covers the domain of dental implants from a clinical, materials
science, and nano-engineering perspective.
The first chapter, “Titanium: The Ideal Dental Implant Material Choice”, details
the ideal characteristics of titanium that make it the most popular dental implant
material choice. While modern titanium-based dental implants provide optimum
treatment outcomes in healthy conditions, enhanced bioactivity and therapy are
needed to ensure long-term success in compromised patient conditions. The need to
modify the implant surface (especially in compromised conditions that present a
significant therapeutic challenge) is thoroughly reviewed in the chapter “Titanium
Dental Implants in Compromised Conditions: Need for Enhanced Bioactivity and
Therapy”. Advances in dental implants have evolved from macro- to micro- to
nanoscales. The chapter “Macro to Micro: Surface Modification of Titanium Dental
Implants” is devoted to various macro and microscale modifications performed on
titanium-based dental implants. The next generation of dental implants has con-
trolled nanotopography that augments the bioactivity and therapy toward achieving
timely integration and long-term success.
The fourth chapter, “Nano-scale Surface Modification of Dental Implants:
Fabrication”, compiles various nano-engineering tools and techniques that enable
effective nanoscale surface modification of titanium dental implants, focusing on
easy, scalable and cost-effective electrochemical anodization that fabricates con-
trolled nanotopographies on titanium implants. Titanium dioxide (or titania) nano-
tubes (like nanoscale test tubes) can be fabricated on dental implants via anodization
with excellent control over their dimensions. The nanotube-modified implants offer
v
vi Preface
various functionalities, including enhanced bioactivity and local therapy. The fifth
chapter, “From Micro to Nano: Surface Modification for Enhanced Bioactivity of
Titanium Dental Implants”, and the sixth chapter, “Local Therapy from Nano-
engineered Titanium Dental Implants”, categorically explain the strategies employed
to orchestrate implant integration and achieve tailored local therapy from anodized
nanotubular dental implants, respectively. The seventh chapter, “Mechanical
Stability of Anodized Nano-engineered Titanium Dental Implants”, focuses on the
mechanical stability considerations of anodized dental implants. Finally, the eighth
chapter, “Cytotoxicity, Corrosion and Electrochemical Stability of Titanium Dental
Implants”, presents the advances and challenges associated with the cytotoxicity
and corrosion of modified and nano-engineered dental implants. All chapters pres-
ent clinical translation challenges and recommend future directions to advance the
domain, ensuring long-term success, even in compromised patient conditions.
The book is interdisciplinary and will profoundly interest a broad audience,
including dentists, undergraduate/postgraduate/research students, academics, and
material/biomaterial scientists. Since the book describes cutting- edge nanotechnol-
ogy advances in dental implants, it will be valuable to entrepreneurs aiming to
understand the next generation of nano-engineered implants.
Herston, QLD, Australia Karan Gulati
Contents
Titanium: The Ideal Dental Implant Material Choice . . . . . . . . . . . . . . . . 1
Himanshu Arora
Titanium Dental Implants in Compromised Conditions:
Need for Enhanced Bioactivity and Therapy . . . . . . . . . . . . . . . . . . . . . . . . 23
Necla Asli Kocak-Oztug and Ece Irem Ravali
Macro to Micro: Surface Modification of Titanium Dental Implants . . . . 61
Yifan Zhang, Shuai Li, Ye Lin, Ping Di, and Yan Liu
Nano-scale Surface Modification of Dental Implants: Fabrication . . . . . . 83
Ruben del Olmo, Mateusz Czerwiński, Ana Santos-Coquillat,
Vikas Dubey, Sanjay J. Dhoble, and Marta Michalska-Domańska
From Micro to Nano: Surface Modification for Enhanced
Bioactivity of Titanium Dental Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Tianqi Guo, Sašo Ivanovski, and Karan Gulati
Local Therapy from Nano-engineered Titanium Dental Implants . . . . . . . 153
Anjana Jayasree, Sašo Ivanovski, and Karan Gulati
Mechanical Stability of Anodized Nano- engineered
Titanium Dental Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Divya Chopra and Karan Gulati
Cytotoxicity, Corrosion and Electrochemical Stability
of Titanium Dental Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Tianqi Guo, Jean-Claude Scimeca, Sašo Ivanovski, Elise Verron,
and Karan Gulati
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
vii
Titanium: The Ideal Dental Implant
Material Choice
Himanshu Arora
Abbreviations
Å Angstrom
cpTi Commercially pure titanium
GPa Gigapascal
HA Hydroxyapatite
MPa Megapascal
PEEK Polyether ether ketone
Ti-6Al-4V Titanium aluminium vanadium alloy
TiZr Titanium zirconium alloy
ZrO Zirconium oxide
2
1 Introduction
The relationship between edentulism and dentistry is as long as dentistry itself.
Since then, dentists worldwide have been busy finding novel ways to limit or restore
edentulism. Edentulism, whether partial or complete, has seen an increasing trend
in the last few decades, with reports estimating around 120 million Americans are
missing at least one tooth and approximately 35 million are completely edentulous
(American College of Prosthodontists, 2022). Consequences of partial or complete
edentulism range from functional, esthetic, physical, and psychological limitations
affecting the overall oral health related quality of life. Various treatment options
have evolved to solve this health crisis over the past few centuries with oral
H. Arora (*)
School of Dentistry, The University of Queensland, Herston, QLD, Australia
e-mail: [email protected]
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 1
K. Gulati (ed.), Surface Modification of Titanium Dental Implants,
https://doi.org/10.1007/978-3-031-21565-0_1
2 H. Arora
implantology the latest addition to this list of options. Till date no treatment option
is complete. Each treatment option must compete with the natural dentition in per-
formance and long- term success. This drives the current research and advances in
oral implantology to find the best performing dental implant.
Dental implant is defined as a prosthetic device made of alloplastic material(s)
implanted into the oral tissues beneath the mucosal and/or periosteal layer and on or
within the bone to provide retention and support for a fixed or removable dental
prosthesis; a substance that is placed into and/or on the jawbone to support a fixed
or removable dental prosthesis (The Glossary of Prosthodontic Terms: Ninth
Edition, 2017). Major advances have occurred over the last few decades in the clini-
cal use of oral and maxillofacial implants. Latest statistics on the use of dental
implants reveal that, in the United States alone, an estimated 5 million implants are
placed annually, and a total of 15–20 million implants are placed worldwide (Misch
& Misch, 2015). Dental implants are currently used to replace missing teeth, rebuild
the craniofacial skeleton, provide anchorage during orthodontic treatments, and
even aid in new bone formation in the process of distraction osteogenesis.
In modern dentistry, the dental implant is the one of the best tooth replacement
options for nearly all situations where a tooth is missing or is failing. The primary
reason for this is the extremely high success rate achieved with dental implants.
Saving teeth at all costs is no longer the norm because of the unpredictability of the
longevity of heroic dentistry. In other words, preserving bone and tissue regenera-
tion are now considered to be more important than trying to prolong tooth retention
(Massa & Von Fraunhofer, 2021).
One of the main reasons for the high success rate of dental implants is their abil-
ity to integrate with bone in the oral environment (Misch, 2008). The goal of place-
ment of endosseous dental implants is to achieve osseointegration of the bone with
the implant in order to support a prosthesis (Brånemark et al., 1983; Branemark
et al., 1977). The physical, chemical, and biological properties of dental implant
materials along with their surface characteristics are key factors in their success
(Binon, 2000; Buser et al., 1991). A wide variety of materials has been used for
these implants, but only a few promote osseointegration and biointegration (Weiss
& Weiss, 2001). Titanium and titanium alloys have been the most widely used of
these materials. This chapter will look into the historical aspect of dental implant
materials, drawing comparisons with the modern-day contemporary materials in an
attempt to arrive to a conclusion ‘why titanium is the most suitable dental implant
material?’.
2 Osseointegration
The godfather of modern implants was a Swedish physician and anatomical and
experimental biologist named Per-Ingvar Branemark. He studied bone healing
response and regeneration in the 1950s and in order to observe the functioning of
bone marrow in vivo, he used titanium to make a chamber that could be inserted into
Titanium: The Ideal Dental Implant Material Choice 3
Fig. 1 Radiographic
image of the original
titanium screw placed in
rabbit
tibial bone by
P. I. Branemark showing
the integration of the
implant with bone that led
to discovery of
osseointegration.
(Albrektsson et al., 2017)
rabbit legs to allow microscopic visualization of vital processes (Fig. 1). After a few
months-long series of investigations, he sought to retrieve the chamber for reuse and
found to his annoyance that it could not be removed from the rabbit bone
(Branemark, 1983).
Branemark reportedly was not struck by the significance of this turn of events
until sometime after 1960, when he accepted a professorship in the Department of
Anatomy at Gothenburg University. There, using an adaptation of the titanium
chamber placed in the upper arms of human volunteers, he and his team investigated
the workings and structure of human blood cells under a number of conditions. This
work yielded a great deal of information about the nature of blood, and it showed
the researchers that the titanium serving as lens casings appeared uniquely compat-
ible with the human soft tissue and skin, provoking no adverse immunological reac-
tions. At this point, Branemark began to contemplate using titanium for medical
applications (Albrektsson et al., 2017).
As this understanding advanced, Branemark believed it necessary to coin a new
term to refer to the in-growth of the bone into the threads and crevices of titanium.
He finally settled upon “osseointegration,” derived from the Latin words os (bone)
and integro (to renew) (Branemark et al., 1977). The first and the most important
event that occurs when an implant is placed in host tissue is surface adsorption of
proteins. The amount, composition, and conformational changes of the adsorbed
proteins influence the entire biological response to the material, including antigenic
response, attachment, and growth of cells.
The host response to implants placed in bone involves a series of cell and matrix
events, ideally culminating in tissue healing that is as normal as possible and that
ultimately leads to intimate apposition of bone to the biomaterial, i.e. an operative
definition of osseointegration. For this intimate contact to occur, gaps that initially
exist between bone and implant at surgery must be filled initially by a blood clot,
and bone damaged during preparation of the implant site must be repaired (Szmukler-
Moncler et al., 1998). The material used to construct oral implants plays a major
role in the host response and has been one of the most researched topics in the field
of oral implantology.
4 H. Arora
3 Materials for Endosseous Dental Implants
Today, the goal of the placement of endosseous implants is to achieve osseointegra-
tion at the surface of the implant. Osseointegration, as defined by Branemark, is the
direct contact of the loaded implant material with living bone (Brånemark et al.,
1983) (Fig. 2). The concept of osseointegration has been developed largely from the
work of Branemark and was introduced in 1982 after several decades of animal
work and at least a decade of work in humans (Fenton, 1992; Albrektsson et al.,
2017). This concept represented a fundamental shift away from the prevailing
dogma of the time.
Previously, implant materials were sought which would act as inert substances,
usually eliciting a fibrous encapsulation around them (Lemons, 1990). However, by
definition, osseointegration demands the absence of a fibrous layer (Meffert et al.,
1992), and implies that the biological response of the bone is not one of inertness
toward a foreign material but rather one of integration of the material with the bone
as if it were part of the body. By today’s standards, the presence of a fibrous layer
between bone and implant indicates failure of the implant (Albrektsson et al., 2017;
Buser et al., 2017). In spite of these definitions, there is still controversy about what
osseointegration really represents. For some, osseointegration does not represent an
Fig. 2 Histological photomicrograph showing a direct contact between a titanium screw/implant
(black) and bone tissue using hematoxylin-eosin staining technique. (Albrektsson et al., 2017)