The role of different scale ranges of implant surface topography on the stability of the bone-implant interface (2023)


Volume 34, Number 14,

Mayo 2013

, pages 3535-3546

Author links open the overlay panel, , ,


We attempt to decipher the effects of submicron topography and microtopography on bone union phenomena and endosseous interface stability.implants. To investigate this experimentally, we implanted individuallytitanium alloyImplants of different superficial topographical complexity in the femur of rats for 6, 9 or 12 days. All five surfaces have been polished, machined, double acid etched, and shot blasted and acid etched in two ways; Each type of surface has been further modified by the deposition ofNanocrystalsvonfootballphosphate for a total of 10 material groups (norte=10 for each time point; 300 implants in total). Where necessary, we subjected the bone-implant interface to a mechanical fracture test. We have found that even the smoothest surfaces, when modified with submicron crystals, can bond to bone. However, as the movement stress through the bone to the implant increased with healing time, such interfaces failed while others with submicron features superimposed on surfaces of increasing microtopographical complexity remained intact under stress. We show here that higher order topography in the micron or micron range is a prerequisite for long-term interface stability. We show that each of these topographic scale ranges represents a scale range found in natural bone tissue. What emerges from an analysis of our results is a new means by which biologically relevant criteria can be used to assess the importance ofimplant surfaceTopography in different scale ranges.


We have previously said that endosteal integration by contact osteogenesis involves three steps: osteoconduction, or recruitment and migration of osteogenic cells to the surface of the implant; bone formation on the surface of the implant; and peri-implant bone remodeling [1], [2]. However, contact osteogenesis can result in bone attachment to the implant surface if the implant has a surface topography with submicron physical undercuts [3]. This sequence mimics the events that occur at sites of natural bone remodeling where the surface left by resorption of active osteoclasts presents a nanotopographically complex surface with undercuts [3], [4]. We have also shown that topographically complex surfaces accelerate osteoconduction [5].

Bony union means the interlocking of the cement matrix of the bone with the properties of the underlying implant surface. However, bone healing is assessed by attempting to separate the bone from the implant. When the bone is attached to the implant surface, the force that breaks the pattern causes the bone to detach from the bone-implant interface [5], [6]. By this definition, bone union can be distinguished from the phenomenon of bone growth [7], which has been described as bone growth on implant surface features in the >100 micron size range. Indeed, in a study originally aimed to show that the bonding phenomenon is chemical in nature, surface topography changes in the micrometer range were observed in hydroxyapatite ceramic implants, suggesting that micromechanical interlocking contributed to the bonding mechanism [8]. In fact, it is salutary to emphasize that in natural bone remodeling, the cementum matrix invades the underlying resorbed bone surface to a depth of about one micron, which corresponds to the depth of penetration of the fibrous rim of the ruffled membrane of osteoclasts in the resorbed matrix. 9]. We therefore hypothesize that bone bonding could occur on surfaces with submicron topographical complexity in the absence of microtopography.

However, using the natural bone interface as a model, it is also evident that osteoclasts produce Howship lacunae, which are depressions excavated in the bone surface ranging in size from microns to hundreds of microns. The origin and extent of osteoclast resorption gaps have been studied for many decades following the pioneering studies of Boyde and colleagues [10]. Recently, the surface properties of osteoclast resorption gaps were compared to those of potential implant materials and showed significant similarity in the micron range [11]. Furthermore, Howship's lacunae form themselves on a bone surface with an even higher order topography, as can be seen from the strut-like morphology of the bony trabeculae in cancellous bone. Therefore, in natural bone remodeling, the bonding phenomenon is limited to submicron interlocking [3], however, the long-term physical stability of the interface between new and old bone, which is crucial for the stability of skeletal tissue, depends on the higher-order morphology properties. For this reason, we also hypothesize that the three-dimensional (3D) microtopographical surface design of the underlying implant is fundamental to maintaining the integrity of the bone/implant interface while peri-implant healing progresses and motion stress is transferred to the interface.

Therefore, in this work, we try to decipher the effects of submicron topography and microtopography on bone bonding and interface stability phenomena. To address this experimentally, we adopted the previously described method [5] by placing custom-made implants in rat femurs and subjecting the bone-implant interface to a mechanical fracture test. However, we did this throughout the healing period in the presence of implant candidate surfaces of different magnitudes of surface topography to distinguish between the respective biological roles of submicron topography in bone healing and bone healing. -Arrange the topography of the implant surface in interfacial stability, since the movement load increases transiently.

section cutouts


Three hundred custom-designed rectangular plates (1.3mm x 2.5mm x 4mm) were fabricated by Biomet3i (FL, USA) from titanium alloy (Ti6Al4V, abbreviated as Ti64). Each plate had a central hole in the long axis to allow for suture fixation in surgery and also to facilitate mechanical testing. This model, which we used in previous experiments [5], was modified by Nakamura et al. inspired. (1985) [6].

Individual groups of the complexity and topographical design of the modified implant surface were generated


The postoperative period was uneventful for all rats except one, which died on the first postoperative day (PO) and was excluded from the study. All remaining animals increased their walking activity over time after their recovery from surgery. Daily checks did not indicate that three rats suffered femoral fractures at any time post-operatively. They were observed only during harvest on days 6 (right femur - PL), 9 (left femur - GB/AE1) and 12 (right femur - DAE).


Our data clearly show that an additive submicron notched structure (DCD) on the PL and MC surfaces causes them to fuse with the bone. This addresses our first hypothesis; reported that the submicron features provided by DCD treatment on smooth surfaces as pits around and between which a cement line matrix was deposited as osteoblasts differentiated. We know that the cement layer arises from the secretion of non-collagenous proteins that mineralize rapidly [2].

(Video) How Does the Material and Surface Topography of an Interbody Fusion Device Affect B


The topography of the implant surface is multi-dimensional and can be described in terms of three distinct scale ranges, each resembling those observed at sites of remodeling in natural bone tissue. The indented submicron features on the implant surface provide a three-dimensional structure with which the cementitious matrix of the newly formed bone can interlock. Micron-scale features are analogous to those produced by single osteoclast resorption pits, while corresponding to those of higher order

expression of gratitude

The authors thank for the research support ofCanadian Institutes for Health Research (CIHR)jBiomet3i. The assistance of Susan Carter for animal care, Jian Wang for mechanical testing, Ross Towse for discussions of surface topography scale ranges, and Zeesy Powers for assistance with Fig. 9 are also greatly appreciated.


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    What are the requirements for osseointegration? ›

    Requirements for osseointegration

    Typically, this just requires a physically and mentally healthy person without diabetes or a circulatory system disease. Patients who undergo this surgery must stop smoking for 3 months prior to the surgery and will be disallowed to smoke immediately after the treatment as well.

    Is a direct structural and functional connection between ordered living bone and the surface of the load carrying implant? ›

    Osseointegration was originally defined as a direct structural and functional connection between ordered living bone and the surface of a load-carrying implant.

    What is the best implant type allowing osseointegration? ›

    Rough implant surfaces are believed to deliver better osseointegration compared with smooth surfaces however, results from different studies vary.

    How is osseointegration achieved? ›

    The processes of osseointegration involve an initial interlocking between alveolar bone and the implant body, and later, biological fixation through continuous bone apposition and remodeling toward the implant.

    How do you test for implant stability? ›

    There are several methods to measure primary implant stability. The most commonly used are RFA (Resonance Frequency Analysis), tactile feeling, torque test, and percussion test.

    What factors affect successful osseointegration? ›

    Osseointegration mainly depends on the quality and quantity of the available bone. Various factors influence the process of osseointegration which include biocompatibility of the implant material, surface topography of the implant, the surgical protocol followed and on the loading of the implants.

    What is the structure that acts like the bones and makes up the support system of the sponge? ›

    As we've seen, most sponges are supported by small bone-like spicules (usually tiny pointed structures made of calcium carbonate or silica) in the mesohyl. Spicules provide support for the body of the sponge, and may also deter predation.

    How is the structure of bone related to its function? ›

    The bone's hard crystal matrix of bone tissue gives it its rigid structure. The other 35 percent of bone is organic material, most of which is the fibrous protein, collagen. The collagen fibers are networked throughout bone tissue and provide it with flexibility and strength.

    What is the functional relationship of bone matrix and the storage of essential minerals? ›

    For one, the bone matrix acts as a reservoir for several minerals important to the functioning of the body, especially calcium and phosphorus. These minerals, incorporated into bone tissue, can be released back into the bloodstream to maintain levels needed to support physiological processes.

    What is the best primary stability for implant? ›

    Other studies found an increase in failure rates when implants installed with insertion torques ≤ 25 [19,20]. FRA indicated low primary stability when ISQ values are ≤ 45. Favorable implant stability is considered when ISQ values ≥65 [21].

    What are the best implants to avoid capsular contracture? ›

    Submuscular Implant Placement. By placing your implant under the chest muscle, Dr. Armijo can significantly lower your risk of capsular contracture. If you choose completely submuscular placement, you'll only face a 4 to 8% lifetime risk of capsular contracture.

    What is the best bone quality for implants? ›

    Bone Quality:

    Type 2 bone is the best bone for osseointegration of dental implants. It provides good cortical anchorage for primary stability, yet has better vascularity than Type 1 bone. Types 3 and 4 are soft bone textures with the least success in type 4 bone.

    What can cause osseointegration to fail? ›

    Early failure is failure to obtain osseointegration within several weeks or months after implant placement, mainly due to poor bone quality, necrosis of bone due to micro-trauma during surgery, bacterial infections around implants, lack of initial stability, immediate or early loading, smoking, or short-length implants ...

    What are the 4 phases of osseointegration? ›

    However, this concept can be transferred to bone healing and, in particular, to intraoral bone healing of an implant wound – haemostasis, the inflammatory phase, the proliferative phase and finally the remodelling phase.

    Can osseointegration be achieved without primary stability? ›

    Implant primary stability is not an absolute prerequisite to osseointegration; however, it has an effect on the implant survival rate.

    What is a strong indicator for implant failure? ›

    Clinically, failing dental implants are characterized by soft tissue inflammation, increased probing depths, increased mobility, and peri-implant radiolucency. Changes involve both the hard and soft tissues surrounding an implant.

    What are the different types of implant stability? ›

    Implant stability is one of the most important factors for successful implant treatment and seems to be crucial for osteointegration, especially for immediate loading. Primary stability is a mechanical phenomenon, while secondary stability is the result of a biological event (osteointegration)13.

    How you would know if an implant is a success or failure? ›

    Your dentist may recommend an X-ray to check your bone growth if your implant is mobile. An X-ray of a failed implant will probably show substantial loss of bone around the metal portion. Other signs your implant is compromised include pain, swelling, or infection.

    What are the three major reasons for failure of implants? ›

    Below are 7 of the main reasons why a dental implant can fail:
    • #1 Misalignment of The Implant: ...
    • #2 Poorly Taken Impressions. ...
    • #3 Peri-Implantitis And Other Infections. ...
    • #4 Failed Osseointegration. ...
    • #5 Nerve Damage. ...
    • #6 Failure of The Implant Itself. ...
    • #7 Foreign body rejection and Allergic reaction.

    What factors can improve the success of implants? ›

    Patients who have good oral hygiene and visit their dentist regularly are more likely to have successful dental implants. Additionally, patients who do not smoke and who have healthy gums are also more likely to have successful dental implants. Another important factor is the experience of the implant dentist.

    Which area of osseointegration has the highest success rate? ›

    According to the anatomical site of implant placements, the most favorable results were obtained in the posterior mandible and the less favorable results were obtained in the anterior maxilla.

    What bone provides support and stability? ›

    Short Bones

    A short bone is one that is cube-like in shape, being approximately equal in length, width, and thickness. The only short bones in the human skeleton are in the carpals of the wrists and the tarsals of the ankles. Short bones provide stability and support as well as some limited motion.

    What part of the body provides stabilization and connects bone to bone? ›

    Ligaments often connect two bones together, particularly in the joints: Like strong, firmly attached straps or ropes, they stabilize the joint or hold the ends of two bones together.

    What are the structures that stabilize and support a joint? ›

    Ligaments. Strong ligaments (tough, elastic bands of connective tissue) surround the joint to give support and limit the joint's movement. Ligaments connect bones together.

    How does the structure of bone affect its strength? ›

    Bone strength is determined by its material composition and structure. Bone must be stiff to resist deformation, thereby making loading possible, and it must also be flexible to absorb energy by deforming. Bones shorten and widen when compressed, and lengthen and narrow in tension.

    What is most responsible for bone structure? ›

    Osteoblasts. Osteoblasts are cuboidal cells that are located along the bone surface comprising 4–6% of the total resident bone cells and are largely known for their bone forming function [22].

    How does the structure of a bone make it strong? ›

    Bone is a living, growing tissue. It is made mostly of two materials: collagen (KOL-uh-juhn), a protein that provides a soft framework, and calcium (KAL-see-uhm), a mineral that adds strength and hardness. This combination makes bone strong and flexible enough to hold up under stress.

    What are the four components of the structural and functional unit of compact bone tissue? ›

    To wrap it all up, osteons are structural and functional units of compact bone. Every osteon is made up of a central canal (which contains nerves and blood vessels), perforating canals, lamellae (configurations of bone matrix), and osteocyte-containing lacunae (holes).

    What factors determine where bone matrix is to be remodeled? ›

    Abstract. Bone remodeling is thought to be regulated by many factors including nutritional status, humoral factors, and biomechanical stress.

    What are the major components of the matrix in bone tissue and importance to bone tissue? ›

    Bone matrix (also known as osteoid) consists of about 33% organic matter (mostly Type I collagen) and 67% inorganic matter (calcium phosphate, mostly hydroxyapatite crystals). The osteoblasts occur as simple, epithelial-like layer at the developing bone surface.

    What does implant stability depend on? ›

    Extent of implant stability may also depend on the situation of surrounding tissues [3, 12]. Bone quantity and quality, implant geometry, and surgical technique adopted are also among the predominant clinical factors that affect primary stability [13].

    What does implant stability mean? ›

    In clinical practice, implant stability measurements (ISQ) are used as an indirect indicator to determine the time frame for practical implant loading and as a prognostic indicator for possible implant failure.

    What is the best implant surface? ›

    Study comparing types of dental implant surfaces

    The study showed that implants with the anodized surface showed the best survival rate (98.5%) with at least 10 years' follow-up.

    Can exercise make capsular contracture worse? ›

    Some surgeons or medical professionals recommend additional techniques for minimizing your risk of getting capsular contracture: Avoid vigorous activity for the first several weeks of your recovery. Strenuous exercise can increase your blood pressure, raise your heart rate and cause bleeding around your new implants.

    What vitamins prevent capsular contracture? ›

    Omega-3 supplementation may prevent capsular contracture: Study.

    What happens if you don't correct capsular contracture? ›

    Capsular contracture can cause chronic pain and distortion in the shape of the breast, and it can make the breast rise higher on the chest.

    How can you tell if you have enough bone for an implant? ›

    How is bone evaluated before implant placement? A clinical examination of your mouth and radiographs will allow your dentist to assess the bone. In some cases, cone beam computed tomography (CBCT) will be prescribed to evaluate and measure the amount of bone in the jaw.

    Which type of bone has the highest rate of implant failure? ›

    Studies have reported that implants fail in the maxilla more than the mandible9-13. Furthermore, the maxillary anterior region exhibited the highest rate of implant failure. Factors contributing to higher implant failure in the maxillary arch compared to mandibular arch are not yet understood14,15.

    How do you prevent bone loss with implants? ›

    A dental implant is surgically placed into your gum and jaw bone. Then, once it has healed, it transmits the force of everyday chewing, smiling, and biting into your jaw bone. This prevents the bone from deteriorating further, and can actually strengthen it.

    Which is a leading cause of dental implant failure? ›

    The most frequent and avoidable cause of dental implant failure is infection. At any moment over the course of implant therapy, a bacterial infection that results in implant failures can happen. Peri-implantitis is a term used to describe an inflammatory response with bone loss in the soft tissues surrounding implants.

    How many months for implant osseointegration? ›

    The reason for this is that the dental implant must “osseointegrate” with your jaw bone and bond to it permanently. This process can take 3-6 months or longer.

    How do you know if osseointegration has failed? ›

    We listed the signs you should watch out for after getting dental implants.
    • Severe Pain and Discomfort. ...
    • Gum Recession around the Implant. ...
    • Difficulty While Chewing and Biting. ...
    • Shifting and Loose Implant. ...
    • Swollen Gums. ...
    • Implant Micro-Movements. ...
    • Sudden Allergic Reactions. ...
    • Teeth Grinding.
    Dec 16, 2019

    What is necessary for osseointegration to be successful? ›

    The primary factor for success at the time of placement is achieving primary stability. Any micromotion during initial phases of bone healing will cause a lack of integration. Failure is most often caused by overloading due to transmucosal forces of removable appliance over the implant site.

    What factors increase osseointegration? ›

    Thus, osseointegration depends on the material used in the implant, the machining conditions, the surface finish, the type of bone that receives the implant, the surgical technique, design of the prosthesis and the patient care.

    What is the difference between primary stability and secondary stability implants? ›

    Primary stability comes from mechanical engagement with cortical bone. Secondary stability is developed from regeneration and remodeling of the bone and tissue around the implant after insertion and affected by the primary stability, bone formation and remodelling.

    What is a dental implant without primary stability? ›

    Lack of primary stability occurs when the mineralization of the bone is diminished, and the bone provides insufficient anchorage. A second clinical situation where lack of primary stability may result is the placement of an implant in an immediate extraction socket (a space larger than the implant itself).

    What is a contraindication for osseointegration? ›

    Indications and Contraindications

    Exclusion criteria include skeletal immaturity, active infection, peripheral arterial disease, diabetes mellitus, current chemotherapy or immunosuppressant drug use, active smoking status, osteoporosis, metabolic bone disease, or untreated skin disease of the residual limb.

    What are the requirements for orthopaedic implants? ›

    The main requirements demanded for orthopedic implants are: high biocompatibility with no causation of inflammatory or toxicity for the human body, appropriate mechanical, tribological, and surface properties and economically feasible manufacturing and processing.

    What are the basic requirements of implant materials? ›

    Tensile, compressive and shear strength: An implant material should have high tensile and compressive strength to prevent fractures and improve functional stability. Improved stress transfer from the implant to bone is reported interfacial shear strength is increased, and lower stresses in the implant.

    What is the failure rate of osseointegration? ›

    The overall success rate was 98.12%. Failure was recorded with an overall failure rate of 1.88% (Table 4 and Figure 1). Success rates range from 95.52% for implants placed in the anterior maxilla to 98.90% in those inserted in the posterior mandible.

    Is osseointegration primary or secondary stability? ›

    Secondary stability or osseointegration rather depends on implant surface microdesign, surface composition, and biological bone quality. Conical implant designs as well as extended implant threads aim to increase primary stability especially in spongy D4 bone like in the maxillary side region.

    Do implants always need bone graft? ›

    Do All Dental Implants Require Bone Grafting? Some people are hesitant to replace their missing teeth with dental implants for fear of undergoing bone grafting. But the truth is that not all dental implants require bone grafting. Your dentist will analyze your jawbone to determine if a bone graft is necessary.

    Can I get implants if I have no bone? ›

    If no bone exists, it's impossible to place an implant. Every dental implant needs just as much bone to support it as you would for a natural tooth. This is why bone grafting is so essential after tooth loss!

    What makes you not a candidate for dental implants? ›

    Age limitations for dental implants are explained earlier, and teenagers without complete jawbone growth are the sole candidates considered unsuitable for dental implants. Anyone who is 70 would have attained total jawbone growth several years earlier.

    Which is most critical or most common for implant failure? ›

    The most frequent and avoidable cause of dental implant failure is infection. At any moment over the course of implant therapy, a bacterial infection that results in implant failures can happen. Peri-implantitis is a term used to describe an inflammatory response with bone loss in the soft tissues surrounding implants.

    What is the most commonly used implant design? ›

    Today, the most commonly used implant design is a tapered screw, with a moderately rough implant surface, thus facilitating one-stage surgical procedures and allowing for immediate or early loading protocols.

    What is the ideal property of a medical implant? ›

    Ideally, they should have biomechanical properties comparable to those of autogenous tissues without any adverse effects. The principal requirements of all medical implants are corrosion resistance, biocompatibility, bio-adhesion, biofunctionality, processability and availability.

    What are the three parts of an implant? ›

    Unlike dentures or bridges, dental implants are a permanent solution that provides a natural-looking and functioning replacement tooth. The three main parts of dental implants are the implant, the abutment, and the crown.


    1. Bone care approach for long term implant success with PrimeTaper EV
    (Dentsply Sirona)
    2. Dr. Jan Gottlow: Implant osseointegration stability and loading. At the Osstell Scientific Symposium
    3. Webinar: Scientific background for research and development of dental implants | Alpha-Bio Tec.
    (Alpha-Bio Tec. Dental Implants)
    4. Implant Treatment Planning By Dr Soni Prasad
    (Dr. Uvoh Onoriobe)
    5. What should you do? Bone Loss around Implants and Screw Loosenings - GF014
    (Jaz Gulati - Protrusive Dental Podcast)
    6. A Novel Implant Surface for Accelerated Bone Healing
    (MIS Implants Technologies Ltd.)


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