PMC:2871132 / 251012-259321 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/2871132","sourcedb":"PMC","sourceid":"2871132","source_url":"http://www.ncbi.nlm.nih.gov/pmc/2871132","text":"5.9. Bioengineering and Biomaterial-Integrated Implant System\nWith the aforementioned supportive technologies, surfaces of dental and orthopedic implants have been remarkably advanced. These applications can include not only ordinal implant system but also miniaturized implants, as well as customized implants. Dental implant therapy has been one of the most significant advances in dentistry in the past 25 years. The computer and medical worlds are both working hard to develop smaller and smaller components. Using a precise, controlled, minimally invasive surgical (MIS) technique, the mini dental implants (MDI) are placed into the jawbone. The heads of the implants protrude from the gum tissue and provide a strong, solid foundation for securing the dentures. It is a one-step procedure that involves minimally invasive surgery, no sutures, and none of the typical months of healing. Advantages associated with the MDI are (1) it can provide immediate stabilization of a dental prosthetic appliance after a minimally invasive procedure. (2) It can be used in cases where traditional implants are impractical, or when a different type of anchorage system is needed. (3) Healing time required for mini-implant placement is typically shorter than that associated with conventional 2-stage implant placement and the accompanying aggressive surgical procedure. According the clinical reports, a biometric analysis of 1,029 MDI min-implants, five months to eight years in vivo showed that the MDI mini-implant system can be implemented for long-term prosthesis stabilization, and delivers a consistent level of implant success [451].\nIn addition to the aforementioned miniature implants, an immediate loading, as well as customized implants, have been receiving attention recently. Conventionally, a dental implant patient is required to have two-stages of treatment consisting of two dental appointments five to six months apart. Recently, a single stage treatment has received attention. Placing an implant immediately or shortly after tooth extraction offers several advantages for the patient as well as for the clinician. These advantages include shorter treatment time, less bone sorption, fewer surgical sessions, easier definition of the implant position, and better opportunities for osseointegration because of the healing potential of the fresh extraction site [452–455]. Titanium bar (particularly the portions in direct contact to connective tissue and bony tissue) is machined to have the exact shape of the root portion of the extracted tooth of the patient. The expected outcome of this method is a perfect mechanical retention, and therefore an ideal osseointegration can be achieved. This is called a custom (or customized) implant, which is fabricated by the electro-discharge machining (EDM) technique.\nPrefabricated dental implant can be further machined to replicate the extracted tooth and machined implant (whose shape is exactly same as the patient’s extracted tooth) can be prepared within a relatively short operation time and can be placed within one hour to the patient. Since the root shape of the placed implant is exactly same as the extracted tooth’s root form, the follow-up reaction including osseointegration is expected shorter and placed implant’s retention force can be achieved within a relatively short time.\nElectron-beam machining (EBM) is a machining process where high-velocity electrons (in the range of 50 to 200 kV to accelerate electrons to 200,000 km/s) are directed toward a work piece, creating heat and vaporizing the material. Electromagnetic lenses are used to direct the electron beam, by means of deflection, into a vacuum. The electrons strike the top layer of the work piece, removing material, and then become trapped in some layer beneath the surface. Applications of this process are annealing, metal removal, and welding. EBM can be used for very accurate cutting of a wide variety of metals. Surface finish is better and kerf width is narrower than those for other thermal cutting processes. The process is similar to laser-beam machining, but because EBM requires a vacuum, it is not used as frequently as laser-beam machining [456]. In addition to the immediate placement of dental implants, another concept has been introduced. Techniques such as stereoscopic lithography and computer-assisted design and manufacture (CAD/CAM) have been successfully used with computer-numerized control milling to manufacture customized titanium implants for single-stage reconstruction of the maxilla, hemimandible, and dentition without the use of composite flap over after the removal of tumors [457]. Nishimura et al. [458] applied this concept to dental implants to fabricate the individual and splinted customized abutments for all restoration of implants in partially edentulous patients. It was claimed that complicated clinical problems such as angulation, alignment, and position can be solved. However, with this technique, the peri-implant soft tissues are allowed to heal 2 to 3 weeks, so that at least two dental appointments are required.\nMany oral implant companies (about 25 companies are currently marketing 100 different dental implant systems) have recently launched new products with claimed unique, and sometimes bioactive surfaces [459,460]. The focus has shifted from surface roughness to surface chemistry and a combination of chemical manipulations on the porous structure. To properly explain the claims for new surfaces, it is essential to summarize current opinions on bone anchorage, with emphasis on the potentials for biochemical bonding. There were two ways of implant anchorage or retention: mechanical and bioactive [459,460].\nRecent research has further redefined the retention means of dental implants into the terminology of osseointegration versus biointegration. When examining the interface at a higher magnification level, Sundgren et al. [30] showed that unimplanted Ti surfaces have a surface oxide (TiO2) with a thickness of about 35 nm. During an implantation period of eight years, the thickness of this layer was reported to increase by a factor of 10. Furthermore, calcium, phosphorous, and carbon were identified as components of the oxide layer, with the phosphorous strongly bound to oxygen, indicating the presence of phosphorous groups in the metal oxide layer. Many retrospective studies on retrieved implants, as well as clinical reports, confirm the aforementioned important evidence (1) surface titanium oxide film grows during the implantation period, and (2) calcium, phosphorous, carbon, hydroxyl ions, proteins, etc. are incorporated in an ever-growing surface oxide even inside the human biological environments [460,461]. Numerous in vitro studies, (e.g., [461]) on treated or untreated titanium surfaces were covered and to some extent were incorporated with Ca and P ions when such surfaces were immersed in SBF (simulated body fluid). Additionally, we know that bone and blood cells are rugophilia, hence in order not only to accommodate for the bone growth, but also to facilitate such cells adhesion and spreading, titanium surfaces need to be textured to accomplish and show appropriate roughness [462]. Furthermore, gradient functional concept (GFC) on materials and structures has been receiving special attention not only in industrial applications, but in dental as well as medical fields [462]. Particularly, when such structures and concepts are about to be applied to implants, its importance becomes more clinically crucial. For example, the majority of implant mass should be strong and tough, so that occlusal force can be smoothly transferred from the placed implant to the receiving hard tissue [462]. However, the surface needs to be engineered to exhibit some extent of roughness. From such macro-structural changes from bulk core to the porous case, again the structural integrity should be maintained. The GFC can also be applied for the purpose of having a chemical (compositional) gradient. Ca-, P-enrichment is not needed in the interior materials of the implants. Some other modifications related to chemical dressing or conditioning can also be utilized for achieving gradient functionality on chemical alternations on surfaces as well as near-surface zones 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