Titanium Surface Modification Techniques to Enhance Osteoblasts and Bone Formation for Dental Implants: A Narrative Review on Current Advances
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Titanium Surface Modification Techniques and Their Effects on Osteoblasts and Bone Formation In Vitro and In Vivo
3.1.1. Subtraction Technique
Sandblasting
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- Surface Properties of Sandblasted Titanium
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- In Vitro Studies of Sandblasting
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- In Vivo Studies of Sandblasting
Author, Year | Study Design | Method | Outcome |
---|---|---|---|
Gotfredsen et al., 1995 [25] | In vivo | Test group 1. TiO2-blasted implants 2. TiO2-blasted implants with HA coating Control group Machine implants | TiO2-blasted implants had higher removal torque values than machined implants, indicating stronger anchorage. |
Ivanoff et al., 2001 [26] | In vivo | Test group TiO2-blasted implants Control group Turned implants | TiO2-blasted implants had higher BIC compared to turned implants. |
Citeau et al., 2005 [20] | In vitro | Test group 1. Tipassiv group (Tipassiv) 2. BCP grid-blasted titanium discs (Tiblast) Control group Mirror-polished titanium discs (Tipolish) | On Tiblast samples, MC3T3- E1 cells had a round shape, displayed dorsal microvilli, but exhibited only a few cytoplasmic extensions. |
Gil et al., 2021 [24] | In vivo | Test group 1. Sandblasting with residual alumina 2. Sandblasting without alumina (due to cleaning process) Control group As-received lathed cut titanium samples | TiO2-blasted implant with HA coating showed higher percentage of BIC after 4 and 6 weeks of implantation. |
Acid Etching
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- Surface Properties of SLA-treated Titanium
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- In Vitro Studies of SLA
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- In Vivo Studies of SLA
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- SLActive
Anodization
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- Surface Properties of Anodized Titanium
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- In Vitro Studies of Anodization
- -
- In Vivo Studies of Anodization
Laser Radiation
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- Surface Properties of Laser-Radiated Titanium
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- In Vitro Studies of Laser Radiation
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- In Vivo Studies of Laser Radiation
3.1.2. Additive Techniques
HA Implant Coating
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- Mechanical and Chemical Properties of HA-coated Titanium
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- In Vitro Studies of HA Coating
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- In Vivo Studies of HA Coating
Author, Year | Study Design | Method | Outcome |
---|---|---|---|
Hermida et al., 2005 [65] | In vivo | Test group Porous titanium surface with HA coating. Control group Porous titanium surface without a solution deposited coating. | HA coated implants showed significantly higher bone ingrowth compared to non-coated implants at both 6 and 12 weeks. |
Zagury et al., 2007 [67] | In vivo | Test group HA coated implants Control group Titanium–aluminum–vanadium (TiAlV) alloy implants | No significant difference in the percentage of BIC between HA-coated and titanium alloy implants. Histomorphometric analyses showed no statistically significant differences in osseointegration between the two groups. |
Park et al., 2013 [61] | In vitro In vivo | Test group HA coating on titanium discs Control group Control group with uncoated titanium implants | In vitro - Higher ALP activity on HA-coated discs compared to titanium discs - Faster cell migration observed on HA-coated discs In vivo - Higher BIC percentage in HA-coated implants - Significantly increased height of bone regeneration in the HA-coated group |
Jing et al., 2015 [62] | In vitro | Test group HA coating with MAO Process Control group Uncoating titanium | - Histomorphometry indicated enhanced bone ingrowth in the HA-coated group. - The HA-coated group exhibited significantly higher maximum pull-out force at the bone-implant interface at 4, 12, and 24 weeks post-implantation. - HA-coated specimens showed improved BIC and mechanical performance compared to uncoated specimens. |
Suwanprateeb et al., 2018 [59] | In vitro In vivo | Test group Coating sol with calcium to phosphorus molar ratios (Ca/P) of 1.67 using ammonium hydrogen Control group Uncoating titanium | In vitro - Osteoblast proliferation was significantly higher in the coated group compared to the uncoated group at day 14 and day 21. - Cell calcification increased significantly at days 14 and 21 in the coated group compared to the uncoated group In vivo The torques were approximately 2 times greater in the coated group in all timepoints |
Kusha et al., 2019 [63] | In vivo | Test group Fourteen other implants were coated with HA using electrochemical deposition Control group Al2O3 grit-blasted surfaces | - Increase in ISQ in the coated group - Decrease in PTV in the coated group |
Oliveira et al., 2020 [66] | In vivo | Test group DAE (Double acid-etched) NANO (nano-hydroxyapatite coated) Control group Machine surface | - NANO surface implants showed higher gene expression levels of Runx2, Alp, Oc, and Opn, indicating increased osteoblast proliferation, especially in early osseointegration stages. - NANO group demonstrated higher percent bone volume (BV/TV), bone surface/volume ratio (BS/BV), and lower total porosity (To.Po) across all evaluated timepoints and systemic conditions. |
Wang et al., 2021 [60] | In vitro In vivo | Test group Ti-M-H1; a titanium sample coated with nano-structured HA using MAO and steam-hydrothermal treatment (SHT) Control group Pure titanium | In vitro - Ti-M-H1 promoted osteoblast adhesion, spreading, and proliferation (validated by MTT assay). - Increased ALP, collagen secretion, ECM mineralization in Ti-M-H1. - Induced higher expression of osteogenic-related genes such as BMP-2, COL1, OCN, and RUNX2 in Ti-M-H1. In vivo Higher bone-to-implant interface and dendrite attraction were observed in Ti-M-H1, promoting osseointegration. |
Chitosan Implant Coating
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- Chemical Properties of Chitosan-Coated Titanium
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- In Vitro Studies of Chitosan Coating
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- In Vivo Studies of Chitosan Coating
Author, Year | Study Design | Method | Outcome |
---|---|---|---|
Kung et al., 2011 [75] | In vivo | Test group - Implants wrapped with Col-I membrane containing 450 kDa chitosan - Implants wrapped with Col-I membrane containing 750 kDa chitosan Control group - Implants wrapped with plain Col-I membrane | - Strong positive staining for osteopontin and ALP indicated active bone formation in chitosan-coated group. - Chitosan–collagen composites induced new bone formation around the titanium implants in rats - Slight increase in bone parameters for the 750 kDa chitosan group compared to the 450 kDa group, though not statistically significant. |
Takanche et al. 2018 [74] | In vitro In vivo | Test group Ch-GNP/c-myb-coated Ti implants Control group Pure titanium | In vitro - Increased expression of EphB4 and ephrinB2 suggested promotion of osteoblast differentiation and osteoclast suppression. - Ch-GNPs/c-myb promoted osteogenesis and inhibited osteoclastogenesis in MC-3T3 E1 cells. In vivo - Ch-GNP/c-myb-coated Ti implants increased bone volume and density in ovariectomized rat mandibles. - Immunohistochemical analysis showed upregulation of bone morphogenic proteins and osteoprotegerin. - Enhanced osseointegration of dental implants was observed via micro-computed tomography |
Zhang et al., 2020 [73] | In vitro In vivo | Test group - Porous titanium implants without any coating. - Porous titanium implants with a CSHA composite coating. Control group - Dense titanium implants without any coating. | In vitro - Porous titanium implants supported better osteoblast adhesion and proliferation compared to dense titanium. - Porous titanium implants with CSHA coating showed improved higher ALP activity. In vivo Increased trabecular bone thickness and new bone tissue formation in implant pores were observed over time. |
López-Valverdeb et al., 2021 [76] | In vivo | Test group - Melatonin test group (MtG) - Chitosan test group (ChG) | Chitosan- and melatonin-coated titanium dental implants did not significantly affect peri-implant bone density (BD) when compared to the control group with a conventional etched surface. |
3.2. Commercialized Dental Implants and Their Clinical Outcomes in Healthy Population
3.2.1. Turned (Machined) Surface
3.2.2. HA-Coated Surface
3.2.3. Sandblasted Surface
3.2.4. Acid-Etched Surface
3.2.5. SLA-Treated Surface
3.2.6. Anodized Surface
3.2.7. Laser-Radiated Surface
Surface Modification | Implant Systems | Clinical Performance | |
---|---|---|---|
Survival Rate | Success Rate | ||
1.Turned surface | Brånemark System®, Southern Implant System® (Nobel Biocare, Kloten, Switzerland) | Maxillary 5 years; 89% 10 years; 81% 15 year; 78% Mandibular 5 years; 97% 10 years; 95% 15 year; 86% [77]. | N/A |
2. HA coating | Calcitek Integral® and Omnilock® (Zimmer, IN, USA), HA-coated (BioHorizons, Birmingham, AL, USA) | The overall percentage survival rate ranging from 93.2% to 98.5% over periods of 4 to 8 years [78] | N/A |
3. Grit-blasting | MTX® and Inclusive® Tapered Implants (Zimmer, IN, USA) | 100% survival rate [79] | N/A |
4. Acid-etching | Osseotite® and NanoTite® (Zimmer, IN, USA) | The survival rate of 92.9% for dental implants with acid-etched surfaces over a follow-up period of at least 17 years [80] | N/A |
5. SLA surface | SLA® and SLActive® (Straumann, Basel, Switzerland), TiOblast® (Dentsply Sirona, NC, USA) | 10-year implant survival rate of 98.8% [81] | 10-year implant success rate of 97.0% [79]. |
6. Anodization | TiUnite® Brånemark System (Nobel Biocare, Göteborg, Sweden) | The cumulative survival rate (CSR) ranging from 96.6% to 99.2% [82] | N/A |
7. Laser microtextured surface | Laser-Lok® (BioHorizons, Birmingham, AL, USA) | The cumulative survival rate (CSR) of 98% in short implants [84] | N/A |
3.3. Commercialized Dental Implants and Their Clinical Outcomes in Compromised Patients
4. Current Limitations and Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author, Year | Study Design | Method | Outcome |
---|---|---|---|
Orsini et al., 2000 [29] | In vitro | Test group SLA commercially pure TiAl6V4 implants Control group Machined commercially pure TiAl6V4 implants | Irregular cellular morphology and more pseudopodi for attachment in SLA-treated implants. |
Li et al., 2002 [35] | In vivo | Test group SLA implant Control group MA (Machined acid-etch) | - Removal torque values (RTVs): RTVs of the SLA-surfaced implants were about 30% higher than those of the MA-surfaced implants, except at week 4 where the difference was not statistically significant. - Bone anchorage: The SLA surface achieved better bone anchorage than the MA surface. |
Ramaglia et al., 2011 [33] | In vitro | Test group SLA-treated titanium disk Control group Smooth titanium disk | - SLA titanium surfaces promoted more mature osteoblastic phenotype in SaOS-2 cells compared to smooth surfaces. - Increased deposition of collagen I and expression of α2-β1 integrin receptor were observed on SLA surfaces. - SaOS-2 cells showed better adhesion, proliferation, and expression of bone differentiation markers on SLA-treated titanium disk. |
Kim et al., 2015 [34] | In vitro In vivo | Test group - SLA group - ANO group - Modi-ANO group Control group Machined Titanium | In vitro The Modi-ANO group had the highest initial cell adhesion compared to SLA and ANO groups. In vivo - The Modi-ANO Ti implants had higher BIC (74.20%) compared to the machined (33.58%), SLA (58.47%), and ANO Ti (59.62%) implants. - The Modi-ANO implants showed better bone growth inside the screw threads of the implant than the other types. |
Ortega et al., 2019 [36] | In vivo | Test group - SLA Titanium Dental implant (SA) Control group - Oxidized Titanium Dental Implants (OS) | - Both SA and OS implant surfaces showed good bone response and significant new bone formation after 12 weeks. - SA implants had a slightly higher BIC than OS implants, but the difference was not statistically significant. |
Author, Year | Study Design | Method | Outcome |
---|---|---|---|
Sul et al., 2002 [47] | In vivo | Test group - Group II: non-porous barrier structure; anodized up to 100 V; oxide thickness of approximately 202 nm. - Group III: porous structure, anodized up to 200 V; oxide thickness of approximately 608 nm. - Group IV: porous structure; anodized up to 280 V; oxide thickness of approximately 805 nm. - Group V: porous structure; anodized up to 380 V; oxide thickness of approximately 998 nm Control group Group I: non-porous barrier structure; turned surface implants; oxide film of approximately 17 nm | Removal torque (RT) values increased with oxide thickness, with significant differences between Group I and Groups III–V. Statistically significant differences in RT values when comparing Group II with Groups III–V Oxide properties, including thickness, micropore configurations, and crystal structures, significantly influence bone tissue response. No significant differences in RFA values among all groups after six weeks of implantation |
Rodrigrez et al., 2003 [46] | In vitro | Test group - Anodized Ti surfaces treated with an electrolyte mixture for anodization. - Anodized Ti surfaces followed by a 2-h hydrothermal treatment. - Anodized Ti surfaces followed by a 4-h hydrothermal treatment Control group Control Ti surfaces without any treatment | Osteocalcin production was significantly higher on anodized and hydrothermally treated surfaces compared to the control. Osteoblasts on hydrothermally treated surfaces showed higher protein production than on the anodized surfaces. Anodized surfaces were porous, while hydrothermally treated surfaces had needle-like crystals rich in calcium and phosphorus. |
Zhu et al., 2004 [43] | In vitro | Group 1: pretreated Ti as a control (G-1); Group 2: pretreated Ti and anodized in 0.2 m H3PO4 till 200 V (G-2); Group 3: pretreated Ti and anodized in 0.2 m H3PO4 till 300 V (G-3); Group 4: pretreated Ti and anodized in 0.2 m H3PO4 till 350 V (G-4); Group 5: pretreated Ti and anodized in 0.03 m Ca-GP and 0.15 m CA till 140 V (G-5); Group 6: pretreated Ti and anodized in 0.03 m Ca-GP and 0.15 m CA till 200 V (G-6); Group 7: pretreated Ti and anodized in 0.03 m Ca-GP and 0.15 m CA till 260 V (G-7); Group 8: pretreated Ti and anodized in 0.03 m Ca-GP and 0.15 m CA till 300 V (G-8) (Ca-GP = calcium glycerophosphate, CA = calcium acetate) | Cells on anodized titanium surfaces exhibit a range of morphologies, including polygonal and polarized shapes. The number of fully spread cells is higher on anodized surfaces than on the control, indicating improved cell spreading. SaOS-2 cells cultured on anodized titanium surfaces showed no cytotoxicity and an increase in adhesion and proliferation. No statistical difference of ALP activity was found between the control and anodized surfaces. |
Yao et al., 2008 [44] | In vitro | Test group 1. Anodized titanium (nanoparticle structure) 0.5% HF/10 V/20 min 2. Anodized titanium (nanotube-like structure) 0.5 HF/20 V/20 min Control group Unanodized titanium | Osteoblasts secreted and deposited more calcium onto anodized titanium surfaces possessing nanotubes compared to unanodized titanium. |
Li et al., 2014 [40] | In vitro | Test group 1. Anodization was performed at 10 V for 1 h 1 M NaF solution (nano tube 70 nm) 2. Anodization was performed at 20 V for 20 min 1 M NaF solution (nano pore 25 nm) Control group Commercially pure Ti | Osteoblasts cultured on the anodized Ti surface exhibited a polygonal shape with many filopodia extending in all directions. Cell proliferation was about twofold on the anodized surface as compared to that on the polished surface. |
Sakshi et al., 2019 [45] | In vitro | Test Group - Anodized specimens at 108 V in electrolyte A (A 108 V). - Anodized specimens at 180 V in electrolyte A (A 180 V). - Anodized specimens at 108 V in electrolyte B (B 108 V). - Anodized specimens at 180 V in electrolyte B (B 180 V) (Electrolyte A = 3.5 M sulfuric acid, 0.1875 M phosphoric acid, 0.75 M hydrogen peroxide, and 0.25 M oxalic acid; Electrolyte B = 5.6 M sulfuric acid) Control group Commercially pure titanium (CPTi) non-anodized specimens | ALP and osteocalcin assays revealed trends of early differentiation and maturation for phosphorus-incorporated oxides. Phosphorus incorporation into anodized titanium surfaces led to earlier osteoblast differentiation and maturation compared to non-phosphorus-containing surfaces. The combination of phosphorus incorporation, anatase phase oxide, low surface pore density, and high surface roughness resulted in the highest mineralization levels. |
Author, Year | Study Design | Method | Outcome |
---|---|---|---|
Veiko et al., 2021 [53] | In vitro | Investigated cell behavior on three different laser-induced surface reliefs: open grooves (OG), grid (G), and close grooves (CG) | - Quantitative analysis showed the highest cell proliferation on the OG relief with 266,500 cells/sample on day 20. - The OG relief was found to be the most conducive for osteogenic differentiation, with the highest ALP activity and osteocalcin expression. |
Veiko et al., 2022 [54] | In vivo | Test group I-topography (irregular structure) S-topography (slots) G-topography (µ-rooms-shaped grooves). Control group Machine surface | G-topography showed the highest BIC parameter and contained the highest number of mature osteocytes. Histological analysis indicated the best secondary stability and osseointegration for G-topography. |
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Tuikampee, S.; Chaijareenont, P.; Rungsiyakull, P.; Yavirach, A. Titanium Surface Modification Techniques to Enhance Osteoblasts and Bone Formation for Dental Implants: A Narrative Review on Current Advances. Metals 2024, 14, 515. https://doi.org/10.3390/met14050515
Tuikampee S, Chaijareenont P, Rungsiyakull P, Yavirach A. Titanium Surface Modification Techniques to Enhance Osteoblasts and Bone Formation for Dental Implants: A Narrative Review on Current Advances. Metals. 2024; 14(5):515. https://doi.org/10.3390/met14050515
Chicago/Turabian StyleTuikampee, Sivakorn, Pisaisit Chaijareenont, Pimduen Rungsiyakull, and Apichai Yavirach. 2024. "Titanium Surface Modification Techniques to Enhance Osteoblasts and Bone Formation for Dental Implants: A Narrative Review on Current Advances" Metals 14, no. 5: 515. https://doi.org/10.3390/met14050515