Bone-metal interface in osseointegration

Abstract

D ental implants have been used clinically for more than 30 years with a variety of implant materials and different designs, and with poorly described surface properties and surface structures, without the benefit of scientific: experience and investigation. Furthermore, clinical follow-up of the patients has been of unacceptably poor quality with inadequately defined success criteria. In a recently published article, American, Japanese, and European dental implant systems were evaluated against a strictly defined success protocol.’ The conclusions were alarming. Of all the currently used dental implants, only two passed the defined success criteria: the Small transosteal implant2 and the Branemark osseointegrated screw.3 In addition, a few directly bone-anchored systems including the IMZ implant (Friedrichsfeld BmBh, Mannheim, Germany) of commerical pure CP titanium, the IT1 CP titanium screw (Inst. Straumann, Waldenburg, Switzerland),5 and the Frailit-Tubingen aluminum oxide implant6 (Friedrichsfeld BmBh) were investigated scientifically with promising results. However, they were not followed up for an adequate time period, which Albrektsson et al.’ defined as minimally 10 years. Commonly used dental implants including blade-vents, subperiosteal implants, or the Core-Vent system (CoreVent Corp.., Encino, Calif.) were found to be poorly investigated or with unacceptable clinical results. The clinical success achieved with the Brinemark osseointegrated, titanium screw is based on a meticulous method of follow-up and a thorough scientific examination of relevant background factors of a functioning dental implant. Many articles have been published in refereed journals on various aspects of the implantation procedure and the clinical results of the Brinemark screw.3’7 An essential reason for the observed clinical success is the interface that is established between oral hard and soft tissues and the Brinemark implant. The present article reviews important implant parameters determining the bone-metal interface reactions used around an inserted titanium screw. The concept of