[The role of surface roughness in promoting osteointegration]

Scientific evidence that has been gathered in the past 20 years established that certain endosseous dental implants--primarily screw-type implants made of commercially pure titanium can be successfully utilized as anchorage for dental prostheses. In recent years, an effort has been made to simplify the surgical procedure, in order to modify clinical treatment modalities. One of the trends is to increasingly utilize microrough titanium implants. Roughened implant surfaces have a long history in implant dentistry, and the most prominent surface is titanium plasma-sprayed (TPS). In recent years new implant surfaces have emerged, so-called microrough titanium surfaces produced with reducing techniques such as grit-blasting with Al2O3 or TiO2 particles, sandblasting and acid-etching, or acid-etching alone. These different titanium surfaces have been tested in numerous in-vivo studies utilizing different animal models. Summarizing the results of these studies, it can be concluded that there is currently sufficient evidence that titanium implants with a microrough surfaces achieve a faster bone integration, a higher percentage of Bone implant Contact (BIC), and a higher resistance to shear documented with higher Removal Torque Values (RTV) when compared with titanium implants with a polished or machined surface. In order to understand the mechanism through which surface roughness modulates its effects mentioned above, recent studies used in-vitro experimental methods to study cell response to implant surface topography. These studies have shown that osteoblasts are sensitive to surface roughness, exhibiting decreased proliferation and a more differentiated phenotype on rougher surfaces. PGE2 production is enhanced on rough surfaces, as is the production of TGF beta 1, suggesting that surface roughness can mediate autocrine and paracrine regulation of osteogenesis. Moreover, surface roughness was found to modulate the effect of systemic hormones like 1,25-(OH)2D3 on osteoblasts. The clinical advantages of implants with rough surface were observed in recently conducted clinical trials. It was found, in humans, that roughened titanium implants need shorter healing period before loading, 6-8 (SLA and Osseotite respectively) weeks instead of 12 weeks. The clinical advantages of shorter healing periods are obvious. Moreover, it was found that certain roughened implants can be used in shorter sizes (6-8 mm) then accepted today. The utilization of shorter implants offers the avoidance of extensive surgical procedures such as nerve lateralization in the mandible or sinus grafting in the maxilla. However, sufficient long term documentation is still lacking, and the predictability of such modalities has yet to be examined in long term prospective clinical trials.