A histomorphometric study of two different threaded Commercially

Pure titanium implants

Dong-Hoo Han, Young-Sik Jeon, Jin Kim, Seon-Jae Kim.

Department of prosthodontics and oral pathology, College of dentistry, Yonsei University

ABSTARCT The purpose of this study was to compare surface roughness and bone formation
around two types of threaded commercially pure titanium implants manufactured by two
different companies. The experimental implants were AVANA(South Korea) while the
controls were Brnemark MK II (Nobel Biocare, Sweden).
To compare bone formation adjacent to newly product implant with Brnemark MK II implant,
surface roughness was measured by Accurate 1500M and histomorphometric analysis was done.
The results were as follows:
1. Measurement of surface roughness showed that AVANA implant had a slightly more
irregular surface compared with Brnemark MK II implant.
2. In the light microscopic studies, neither infiltration of inflammatory cells nor the giant cells
were observed on both groups.
3. In the light and fluorescent microscopic studies, the amount of osseointegration and the extent
and the timing of bone formation were similar.
4. There was no statistically significant difference between two groups in the average bone to
implant contacts. Brnemark implant; 67%(SD 23%), AVANA implant:70% (SD 16%).
Comparing with Brnemark implant, AVANA implant made of CP grade II titanium showed
similar good bone healing, formation and osseointegration.
The Journal of Korean Academy of Prosthodontics 1999;37(4)

Key words: implant, histomorphometric analysis, bone contact, surface roughness

INTRODUCTION
Since osseointegrated implant was performed

osseointegration without fibrousintegration

first in 1965, implant dentistry becomes

In addition, careful surgical procedure,

global phenomenon. Adell et al reported high

healthy bone tissue, loading condition, early

level of clinical performance on complete

stabilization, implant shape and proper

edentulous patients. Because recently even

surface treatment affect the osseointegration.

partially

The surface of implant depends on implant

edentulous

patients

are

also

indicated for the implant treatment, implant

manufacturing

dentistry becomes no more special but

treatment procedure. The most outer surface

general

modalities.

molecule layers is known as the most critical

Osseointegration is accepted as the most

factors for osseointegration. Since response

ideal healing condition for the stabilization of

of bone cells and oxidized layers of implant

endosseous implant through the past 30 years

occurs on small portion of molecular layer,

of studies and clinical experiences. The direct

the change of compositional factors at the

contact between bone tissue and implant,

molecular layer affects substantially the

however, does not occur on the whole

biological compatibility and osseointegration

interface but varies dependent on anatomical

of implant. Oxidized layers formed on

locations and bone quality. Albrektsson and

titanium

Jacobsson

of

properties of implant. Since the thickness of

osseointegration of implant at the compact

oxidized layer is affected by cutting methods

bone should be observed for success.

during implant manufacture, coolant types,

Carlsson et al, Gottlander et al, Weinlaender

surface roughness, and sterilization methods,

et al, Ettinger et al also assessed bone contact

similarity of shape and size does not provide

of implant in morphometric studies. Screw

the similar clinical outcome. And in contrast

type

slight dissimilarity of shape and size may

and

prosthodontic

suggested

plasma

spray

90~95%

coating

with

procedure

alloy

and

determined

substantially

surface

biological

hydroxyapatite or titanium powders were

produce

adopted to increase the bone contact surface

outcome. Osseointegrated implant makes

in titanium implant. Recently the change of

fixed prosthesis possible on edentulous jaw

bone formation depending on titanium

where traditionally removable prosthesis was

implants surface roughness and surface

indicated and natural tooth could be kept

treatment methods was studied very much.

sound

After the introduction of Brnemark implant,

advantages of implant over the conventional

many similar products were marketed. Use of

prosthodontic modalities long waiting time

titanium does not guarantee the perfect

from surgery to prosthesis loading and

and

dissimilar

untouched.

Despite

clinical

these

expensive fees hinder the availability of

implant by reducing the burden of fees. The

implant treatment from the public. Currently

purposes of this study are to compare the

major costs of fee for implant are instruments

surface roughness, osseointegration, and

and materials that are imported from foreign

bone formation of Brnemark MK implant

countries. Therefore, the development of

with those of domestic brand implant

domestic implant brand substituting foreign

AVANA.

brands may improve the availability of

MATERIALS AND METHODS

3 respective implants were selected randomly

on the 4 and 10 week, red fluorescent

from 10 Brnemark MK implants and 10

Alizarin Red S(Junsei Chemical Co., Japan)

AVANA

dimensional

on the 7 week, and bright yellow fluorescent

surface roughness and cross-sectional image

Oxytetracycline Hydrochloride(Terramycin,

were measured using Accura 1500M (Intec

Pfizer Co., South Korea) on the 13 week prior

Engineering Co., South Korea). Ra( mean

to 1 week of expiration of the 5 adult dogs

surface

were injected intravenously.

implants.

roughness),

Three

Rq(squared

mean

roughness), Rmax(the maximum height),

Rsk(distribution of wave) and Rku(peakness)

One adult dog was excluded from the study

were measured.

because of death from upper respiratory

infection. On the 14 week, 4 adult dogs were

Ten respective 3.75mm wide and 10mm long

sacrificed and block sections of implant and

Brnemark MK implants(Nobel Biocare AB,

adjacent bone tissue were prepared. After

Sweden) as comparing group and AVANA

fixed in 70% ethyl alcohol for 1 week,

implants(South Korea) as experimental group

specimens of block sections were sectioned

were placed on the femurs of healthy 5 adult

into halves using diamond disk of Bone

dogs weighted about 15kgs after general

trimmer(Maruto Co., Japan) with sufficient

anesthesia with intravenous injection of

coolants. After submerged in Villanueva bone

3ml/kg

Pharmaceuticals,

stain solution for 3 days, dehydration was

South Korea). Incised wound was sutured

conducted by increasing concentration of

with

500mg

ethyl alcohol. Complete dehydration was

South

done in acetone solution. After treated with

Endobar(Hanlim
4-0

absorbable

Cefazolin(Yuhan

silk.

Pharmaceuticals,

Korea ) was injected intramuscularly to

polymethylmethacrylate

in

vacuum

and

prevent wound infection. To examine the

hardened for 40 days in 37 C, one half was

bone formation timing and the bone shape,

cut

green fluorescent Calcein(Sigma Co., USA)

cutter(Maruto Co., Japan), the other half was

in

200m

thickness

using

Crytal

cut in 200m thickness at the upper compact

and fluorescent microscopic examinations.

bone layer and lower spongy bone layer

Taking image magnified 20 times, Image-

along the axis of implant and polished into

Pro(Cybernetics Media, USA) were used to

30m thickness using Hard Tissue Grinding

measure the length of implant contacting

System (Maruto Co., Japan).

bone tissue to assess the bone contact

proportions of experimental implants and

Vano-S

research

microscope(Olympus,

comparing implants, respectively.

Japan) was used to conduct light microscopic

RESULTS
1. Surface roughness
Measurement of surface roughness showed that AVANA implant had a slightly more irregular
surface compared with Brnemark MK II implant(Table1, Fig 1a & 1b).
Table 1. Surface roughness (m)
MK II
MK II
MK II
AVANA
AVANA
AVANA

Ra
0.55
0.473
0.492
0.814
0.661
0.637

Rq
0.724
0.605
0.618
0.986
0.877
0.786

Rmax
4.37
3.36
3.07
5.07
14.03
4.29

Rsk
0.58
0.50
-0.03
-0.46
0.97
-0.07

Rku
3.88
3.05
2.60
2.68
14.98
2.50

2. Light microscopic studies

A. Comparing group
No bone loss or lower migration of

1/3 of implant interface at bone marrow also

epithelium was observed. Direct bone contact

were direct bone contact (fig 4a, 5a). In every

at the bone implant interface was found (fig

specimen, infiltration of neither inflammatory

3a). 30% of this contact was osteoid tissue.

cells nor giant cells was observed.

B. Experimental group
Distribution of bone tissue and osteoid tissue

some specimens, strand of fibrous tissue was

were similar to comparing groups(fig 6a, 7a).

observed on the lower part of implant (fig 8a).

No inflammatory tissue was observed. In

3. Fluorescent microscopic studies

A. Comparing group
At the compact bone area, new bones

and show the signs of lamella compaction

adjacent to implant have circulating pattern

having

green

and

yellow

bands.

The

boundaries between new bone and existent

formed prior to the 7 week and bone was

bone showed interface remodeling having red,

remodeled later. At bone marrow area, red,

green, and yellow bands (fig 3b). After

green and yellow band implying new bone

considering the injection timing of bone stain

was formed before 7 week were observed (fig

solution, new bone tissue at implant interface

4b, 5b).

B. Experimental group
Features similar to comparing group were observed. No difference of bone formation and bone
remodeling was noticed (fig 6b, 7b, 8b).

Title of figures
Fig. 3a, 3b.- Brnemark Mk implant in the

femoral diaphysis of a dog (longitudinal

femoral diaphysis of a dog (longitudinal

section, 40). The implant surface in close

section,40). Direct contact of lameller bone

contact with the bone marrow is covered by

to implant surface is observed in the cortical

bone trabeculae or is in contact with marrow

layer. In these areas, osteoid tissue

cells (apical portion).

Fig. 4a, 4b.- Brnemark Mk implant in the

Fig. 5a, 5b.- Brnemark Mk implant in the

femoral diaphysis of a dog (longitudinal

67%(SD 23%) for Brnemark implant and

section, 40).

70%(SD

16%)

for

AVANA

implant,

respectively. Wilcoxon rank test showed that

4. Histomorphometric studies

there

was

no

statistically

significant

The average bone contact proportion was

difference between two groups (p>0.05)

DISCUSSIONS
Some studies regarding implant surface

than Wennerberg et als study regarding

roughness reported that the rougher surface is

screw type implant such as 3I(3I implant

beneficial to better bone formation. Irregular

innovations, FL, USA) and Impla-Med. Since

surface, however, may result in the worse

surface roughness indices, however, were

bone formation. The increased surface may

developed in mechanical engineering field

increase the possibility of the release of ions.

and there is no evidence supporting the

And the rough surface reduces the early

application of the roughness indices for the

stabilization of implant. In perspective of

assessment of implant in biological field, the

long term implant function, controversies are

value of indices should be interpreted as the

still open about the ideal implant surface

reflection of the level of precision of cutting

roughness. It is known that types of

surface

procedures. Fluorochrome labeling procedure

roughness, localized magnitude of surface

is used to investigate the calcification tissue

roughness

reflecting

as

well

as

simple

surface

the

timing,

direction

and

roughness also affect the bone formation. The

magnitude of bone remodeling. As Alizarin

current

Red S, Calcein, and tetracycline are known to

studys

Branemark

surface

implant

was

roughness
lower

of
than

have

property

of

combining

with

Wennerbergs studys. In particular, the

biologically active ion such as calcium and

difference of Rmax was substantial. In strict

makes the newly formed bone illuminate

sense, Rmax in this study is different from Rt

yellow fluorescence without affecting the

in

the

speed of bone formation, those are the major

maximum height of screw and bone, while Rt

chemicals in fluorescent studies. Alizarin Red

is the perpendicular height between the peak

S, however, is used prior to the sacrifice of

and the bottom of roughness curve which

experiment animals because of its possibility

disadvantageously reflects any scratch and

of bone formation hindrance. In fluorescent

dust on the surface. In the current study,

microscopic

AVANA implants surface is rougher and

Brnemark and AVANA was found. This is

more irregular than Brnemark MK II

partly due to the short 14 weeks observation

implants but it is smoother and more regular

period which is early healing period after

Wennerbergs

study.

Rmax

is

studies,

no

difference

of

implant surgery. All specimens showing red,

conducted on implants without prosthesis

green and yellow band at new bone on

loading, the value of bone contact proportion

interface present the evidence of lamella

probably is different from the normal

compaction until 14 weeks. Red fluorescent

prosthesis loading in clinical situations.

band by Alizarin Red S injected at the 7 week

Ettinger et al compared bone contact

implied that new bone formed before the 7

proportion of horizontal and perpendicular

week. Light microscopic studies showed

section from the identical specimen and

direct contact at the compact bone implant

found the huge difference of bone contact

interface and no signs of inflammation.

proportion. They argued that bone contact

Albrektsson and Jacobsson reported that

proportion should be observed dynamically

osseointegration occurs at the compact bone

and three dimensionally and it should be

better and at least 90~95% of direct bone

interpreted as only one time point value from

contact required for implant seems too high.

the continuously changing values.

On later study, bone contact varied from 27

through 69% (average 53%) after the 6 week

Since bone remodeling continues once

of surgery. The current study conducted on

implant is under stress, long-term observation

adult dogs femurs examined bone contact

until the removal of implant could be the

proportion at cortical

really meaningful quantitative analysis. Light

bone, which is 67%

for Brnemark and 70% for AVANA.

microscope

used in previous studies to

Direct comparison with previous other

measure

studies could be problematic because of the

overestimate the bone contact proportion than

variation of experimental animal types,

real.

anatomical locations, and observation time

microradiographic

periods among studies. Since measurements

accurate measurement of real bone contact

in the current laboratory situation were

proportion are expected.

the

bone

Further

contact

researches
technique

possibly
evaluating
regarding

CONCLUSION
To compare bone formation adjacent to

that AVANA implant had a slightly more

domestic AVANA implant with Brnemark

irregular surface than Branemark MK II

MK II implant, surface roughness was

implant.

and

2. In the light microscopic studies, neither

histomorphometric analysis. The results were

infiltration of inflammatory cells nor the

as follows:

giant cells were observed on both groups.

measured

using

Accurate

1500M

3. In the light and fluorescent microscopic

1. Measurement of surface roughness showed

studies, the amount of osseointegration and

the extent and the timing of bone

in the average bone contact proportions

formation were similar.

(p>0.05).

4. The average bone contact proportion was

Comparing

with

Brnemark

implant,

67%(SD 23%) for Brnemark implant and

AVANA implant showed similar good bone

70%(SD 16%) for AVANA implant,

healing, bone formation and osseointegration

respectively. There was no statistically

at the laboratory experiment using 5 adult

significant difference between two groups

dogs.

REFERENCES
1. Albtrktsson, T., and Jacobsson, M.
Bone-met-al interface in

clones, Int. J. Oral Maxillofac.

Implants, 1992; 7: 168-175.

osseointegration, J. Prosthet.Dent.,
1987; 57 : 597-607.

4. Brunski, J. B., Moccia, A. F., Jr.,

Pollack, S. R., Korostoff, E., and

2. Albrektsson T, Lekholm U:

Trachtenberg, D.I,:The influence of

Osseointegration: Current state of

functional use of endosseous dental

the art, in Berman C (ed):

implants on the tissue-implant

Osseointegrtion. Philadelpia, WB

interface: I. Histological aspects, J.

Saunders, 1989, pp 537-554

Dent. Res., 1979; 58:1953-1969.

3. Binon, P.P., Weir, D. J., and marshal

S. J Surface analysis of an original
Brnemark implant and three related