Abstract
Various treatments have been used to change both the topography and chemistry of titanium surfaces, aiming to enhance tissue response and reduce healing times of endosseous implants. Most studies to date focused on bone healing around dental implants occurring later during the healing cascade. However, the impact of the initial inflammatory response in the surgical wound site on the success and healing time of dental implants is crucial for implant integration and success, yet it is still poorly understood. The purpose of this study was to investigate the effect of titanium surface hydrophilicity on the response of human neutrophils by monitoring oxygen radical production, which was measured as chemiluminescence activity. Materials and Methods: Neutrophils were isolated from human donors’ blood buffy coats using the double sucrose gradient method. Neutrophils were exposed to both hydrophilic and hydrophobic titanium surfaces with identical topographies in the presence and absence of human serum. This resulted in six experimental groups including two different implant surfaces, with and without exposure to human serum, and two control groups including an active control with cells alone and a passive control with no cells. Two samples from each group were fixed and analyzed by SEM. Comparisons between surface treatments for differences in chemiluminescence values were performed using analysis of variance ANOVA. Results and Conclusion: In the absence of exposure to serum, there was no significant difference noted between the reaction of neutrophils to hydrophilic and hydrophobic surfaces. However, there was a significant reduction in the mean and active chemiluminescence activity of neutrophils to serum-coated hydrophilic titanium surfaces than to serum-coated hydrophobic titanium surfaces. This suggests that surface hydrophilicity promotes enhanced adsorption of serum proteins, which leads to decreased provocation of initial immune cells and reduction of local oxygen radical production during wound healing. This can help explain the faster osseointegration demonstrated by hydrophilic titanium implants.
Highlights
Dental rehabilitation of edentulous or partially edentulous patients with fixed prostheses supported by titanium implants is well accepted and documented in extended clinical trials [1,2]
The results suggested that the explanation behind clinically-observed healing superiority of the chemically-modified moderately rough (CMR) surface implants might begin at the response of initial inflammatory cells coming into contact with the implant surface
The reaction of neutrophils to moderately rough (MR) and CMR surfaces suggests that these surfaces, overall, provoke minimal reaction from human inflammatory cells, which could be favorable during the healing period leading to osseointegration
Summary
Dental rehabilitation of edentulous or partially edentulous patients with fixed prostheses supported by titanium implants is well accepted and documented in extended clinical trials [1,2]. Rough surfaces have been shown in a number of in vitro and in vivo reports to enhance the growth of osteoblasts and increase torque removal forces when compared to smoother machined surfaces [5,7,8,9,10]. Osteoblasts demonstrated increased osteocalcin and local growth factor production when exposed to hydrophilic titanium surfaces when compared to hydrophobic surfaces [21]. Clinical recommendations for shorter loading protocols were adjusted to be at three to four weeks instead of the standard six to eight weeks. This resulted in a significantly reduced implant therapy time [22,23]
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