Enhancement of Osseointegration by Generating a Dynamic Implant Surface
Preparations of autologous plasma rich in growth factors (PRGF) are used to promote healing and tissue regeneration. We seek to determine whether covering the titanium implant surface with this preparation could enhance osseointegration. The interaction of PRGF with the surface of titanium implants was examined by environmental scanning electron microscopy (ESEM). A total of 23 implants were placed in the tibiae and radii of 3 goats; 13 implants were inserted after covering the surface and filling the alveolus with PRGF, and 10 more implants were inserted following a conventional protocol and served as controls. Histomorphometric analysis of the bone-implant interface was performed after 8 weeks. Finally, 1391 implants were placed in 295 patients after bioactivating the surface with PRGF. Stability and implant survival were evaluated. The implant surface adsorbed the protein-rich material as shown by ESEM. In the animal study, osseointegration was enhanced when the surface was covered with PRGF as shown by histomorphometry (bone-implant contact: 51.28% ± 4.7% vs 21.89% ± 7.36%; P < .01). Finally, studies in patients showed that 99.6% of the implants treated with PRGF were well osseointegrated. Clinical use of this technique in oral implantology can improve the prognosis.Abstract
and 2. Figure 1. Visualization of the interface between the plasma rich in growth factors and the titanium surface of the implant (BTI, Vitoria, Spain). The surface boundary was directly visualized with an Electroscan 2020 environmental scanning electron microscope without previous specimen preparation (magnification ×6000). Figure 2. Visualization of the interface between the titanium surface of the implant and the developed fibrin-rich clot that remains in close contact with the microroughened surface of the BTI implant (Electroscan 2020, magnification ×6000).
Analysis of the effect of the plasma rich in growth factors on bone regeneration around a titanium implant in an animal model. Bone structure was examined histologically after 8 weeks. (A) A stained section shows the compact cortical structure of the bone surrounding the entire implant. (B) A typical section from a control implant where soft tissue has been lost from the apical portion during the biopsy. (C and D) Macroscopic views of similar treated and control implants, respectively.
Contributor Notes
Eduardo A. Anitua, DDS, MD, is in private practice in implantology and oral rehabilitation in Vitoria, Spain. Address correspondence to Dr Anitua at c/ San Antonio, 15-3°C, 01005 Vitoria, Spain (eduardoanitua@eduardoanitua.com).