**Ricardo Trindade 1,\*, Tomas Albrektsson 2,3, Silvia Galli 3, Zdenka Prgomet 4, Pentti Tengvall <sup>2</sup> and Ann Wennerberg <sup>1</sup>**


Received: 20 May 2019; Accepted: 5 June 2019; Published: 7 June 2019

**Abstract:** Osseointegration is likely the result of an immunologically driven bone reaction to materials such as titanium. Osseointegration has resulted in the clinical possibility to anchor oral implants in jaw bone tissue. However, the mechanisms behind bony anchorage are not fully understood and complications over a longer period of time have been reported. The current study aims at exploring possible differences between copper (Cu) and polyetheretherketone (PEEK) materials that do not osseointegrate, with osseointegrating cp titanium as control. The implants were placed in rabbit tibia and selected immune markers were evaluated at 10 and 28 days of follow-up. Cu and PEEK demonstrated at both time points a higher immune activation than cp titanium. Cu demonstrated distance osteogenesis due to a maintained proinflammatory environment over time, and PEEK failed to osseointegrate due to an immunologically defined preferential adipose tissue formation on its surface. The here presented results suggest the description of two different mechanisms for failed osseointegration, both of which are correlated to the immune system.

**Keywords:** biomaterial; bone; osseointegration; immune; implant; healing; titanium; PEEK; Cu
