The reaction of peri-implant tissues to titanium alloy and apatite-coated implants during the healing phase.

Abstract

Oral implantation has been a controversial dental therapeutic procedure. Many implant materials and designs are presently in progress of study to evaluate the long term response of peri-implant tissues, together with anticipated loading considerations. The purpose of this examination was to make clear whether a fibrous layer would form between bone and Titanium alloy and apatite-coated Titanium implants under stressed and unstressed conditions, during the healing phase after implantation. The in vivo evaluation of 10 implants were made on two dogs. The upper 2nd and 3rd and lower 3rd and 4th premolar teeth were extracted and the sockets allowed to heal for 3 months. The implants in the unstressed condition were completely submerged, and in the stressed condition they were left with their top 2 mm above the surface of the bone, so that after suturing the top of the implant was exposed to the oral environment. After the postoperative healing phase of 3 months, the animals were killed and the specimens were prepared for histological, SEM examinations and EDX analysis of the interface zone between bone and the implants. Histological examination showed a direct contact between the apatite-coated implant and new bone, so that the implant became anchored to bone without an intervening soft tissue layer and a similar result was obtained between the Titanium implant and bone in the unstressed condition. However the high magnification electron micrographs showed a thin connective tissue between the bead-blasted surface of the Titanium implant and bone, and this peri-implant tissue could be detached from the implant. In the stressed condition, a thin layer of fibrous tissue was interposed between the Titanium implant and bone. The high magnification electromicroscopical views of the interface zone between the bone and these implants showed coarse fiber bundles developed perpendicular to the Titanium surface and their terminal ends were confluent with the rugged Titanium surface presumably as a result of micro-movement during the 3 months healing phase. In this study, an adequate space for a development of fibro-anchorage was about 20-200 microns in width. If occlusal stresses were within permissible range in healing period, the relative motion of the implant and bone was then optimal for the formation of a fibro-anchorage. It could be suggested that an ideal stress transfer from the Titanium implant to bone might be achieved by this fibro-anchorage.