|Year : 2022 | Volume
| Issue : 2 | Page : 21-26
Comparative evaluation of crestal bone level between alumina-blasted /acid –etched surface treated implant and calcium phosphate surface treated implant”- an in vivo study
Gattu Balram Pramod Kumar1, A Kalyan Chakravarthy2, Nukalamarri Om Brahma Prasad Chary3, Kukutla Sai Amulya4, Kumbham Kiran Babu5, Deepika Poleypally1
1 Postgraduate Student, Department of Oral and Maxillofacial Prosthodontics and Implantology, Meghna Institute of Dental Sciences, Nizamabad, India
2 Professor and HOD, Department of Oral and Maxillofacial Prosthodontics and Implantology, Meghna Institute of Dental Sciences, Nizamabad, India
3 Sr. Lecturer, Department of Oral and Maxillofacial Prosthodontics and Implantology, Meghna Institute of Dental Sciences, Nizamabad, India
4 Sr. Lecturer, Department of Oral and Maxillofacial Prosthodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
5 Senior Resident, Department of Oral and Maxillofacial Prosthodontics and Implantology, Government Dental College, Hyderabad, Telangana, India
|Date of Submission||06-May-2022|
|Date of Acceptance||27-May-2022|
|Date of Web Publication||28-Jun-2022|
Dr. Gattu Balram Pramod Kumar
Department of Oral and Maxillofacial Prosthodontics and Implantology, Meghna Institute of Dental Sciences, Nizamabad, Telangana
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study was to evaluate the crestal bone level between alumina-blasted/acid-etched (AB/AE) surface-treated implant and calcium phosphate surface-treated implant” based on the radiological examination.
Materials and Methods: An in vivo study was undertaken to evaluate the crestal bone loss on mesial and distal aspects of implants categorized into two groups with different surface treatments, Group A: AB/AE surface-treated implant and Group B: calcium phosphate surface-treated implant using standardized intraoral periapical at three different intervals, i.e., immediately after implant placement, at the end of 3, and 6 months after placing the implants. Statistical tests used were Student's unpaired t-test and ANOVA.
Results: The bone loss was measured, and values were recorded immediately after implant placement, 3, and 6 months of placement.
Conclusions: The use of calcium phosphate surface-treated implants minimizes crestal bone loss compared to AB/AE. This may increase the longevity of implants.
Keywords: Acid etched, calcium phosphate, crestal bone
|How to cite this article:|
Kumar GB, Chakravarthy A K, Chary NO, Amulya KS, Babu KK, Poleypally D. Comparative evaluation of crestal bone level between alumina-blasted /acid –etched surface treated implant and calcium phosphate surface treated implant”- an in vivo study. Int J Prev Clin Dent Res 2022;9:21-6
|How to cite this URL:|
Kumar GB, Chakravarthy A K, Chary NO, Amulya KS, Babu KK, Poleypally D. Comparative evaluation of crestal bone level between alumina-blasted /acid –etched surface treated implant and calcium phosphate surface treated implant”- an in vivo study. Int J Prev Clin Dent Res [serial online] 2022 [cited 2022 Aug 16];9:21-6. Available from: https://www.ijpcdr.org/text.asp?2022/9/2/21/348712
| Introduction|| |
Implants have become an integral facet of prosthodontic therapy for replacing single or multiple teeth and to reconstruct maxillofacial defects. However, to elicit proper biological response to dental implants with adequate mechanical properties has remained a challenge.
Implant success is strictly related to the osseointegration process. Modifications in titanium surfaces are achieved by either adding a coating consisting of different types of bioactive substances or by removing portions of the external layer with the use of blasting materials of different particle sizes or by the application of chemical treatments and/or by physical means which can thus bring benefits in terms of implant osseointegration.
The rate and quality of osseointegration in titanium implants are related to their surface properties. Surface composition, hydrophilicity, and roughness are parameters that may play a role in implant–tissue interaction and osseointegration.
The success of an implant depends directly on crestal bone resorption and it is one of the major determinant factors for the postoperative success of implants. Since bone level maintenance is one of the most important factors to be considered in implant prosthodontics, the postoperative evaluation of this bone is thus of great importance to a prosthodontist.
Various dental implants with different surface designs are being used for dental rehabilitation of patients. The purpose of this in vivo study was to evaluate and compare the crestal bone level between two different surface treated implant (alumina-blasted/acid-etched [AB/AE] surface-treated implant and calcium phosphate surface-treated implant) in the mandibular partially edentulous patient based on intraoral periapical (IOPA) radiograph analysis.
| Materials and Methods|| |
An in vivo study was undertaken to evaluate the crestal bone loss on the mesial and distal aspects of implants, using standardized IOPA radiographs by paralleling cone technique at three different intervals of time. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. A written informed consent was obtained from each participant. A total of 20 mandibular edentulous patients were selected based on the following inclusion and exclusion criteria:
Patients with an age group of 20–35-year-old categorized as American Society of Anesthesiologists (ASA1) with unilateral partially edentulous mandibular arch with a duration of 2–3 months having adequate bone width and height with D2 and D3 bone density and interocclusal distance of 8–12 mm were included in the study.
Patients on medication known to interfere with wound and bone healing, smoking habits and alcoholism, with chronic localized periodontics adjacent to the edentulous area, having debilitating diseases or immunocompromised, and with parafunctional habits are excluded from the study.
Twenty patients were divided into two different groups based on the surface treatment as:
prior assessment of the patient's demographic data and medical and dental history, followed by clinical examination was performed. The assessment was done using IOPA radiograph, orthopantomograph, and cone-beam computed tomography (CT) to determine the bone height, width, and density.
Diagnostic impressions were made using irreversible hydrocolloid, casts were poured using type III dental stone, and the articulation was done. Interocclusal clearance was evaluated on the study models using a divider. Diagnostic wax-up was done using pattern wax. A putty index was prepared; autopolymerizing clear acrylic resin was used for the fabrication of a surgical guide. On the basis of clinical and radiographic findings, the implant size was selected. Crestal incision was given for full-thickness flap reflection, to expose the implant site. The implants were placed at the level of alveolar crest [Figure 1],[Figure 2],[Figure 3],[Figure 4]. A cover screw was placed to close the opened implant site. Then, both the buccal and lingual flaps were approximated with simple interrupted sutures using 4.0 vicryl absorbable suture material. The patient was prescribed antibiotics and analgesics for 1 week, postoperatively.
At 3–4-month interval, second-stage surgery was performed [Figure 5], and healing abutment was secured for about 10–14 days for the formation of the gingival contour. The suture was removed after 2 weeks. In later appointment, the healing abutment was removed, and close tray impression coping was placed on implant and implant level impression made with stock tray using single-stage impression technique [Figure 6]. An implant analog is secured to a close tray impression coping, and the cast was poured using a die stone. Now, the abutment was secured to an analog. Extraoral milling of the abutment is done using a milling machine to the desired height. Cement-retained porcelain-fused metal crowns with access holes were fabricated. Metal try-in was done and evaluated for proper fit and adaptation. A bisque trial was performed for the verification of high points and contacts. Permanent cementation was done using Type I glass ionomer cement. Interference-free occlusion is provided to prevent nonaxial forces on implants [Figure 7].
IOPA radiographs were made with parallel cone technique at baseline, 3rd, and 6th months. Radiographs were scanned using dual-lens scanner, and the images were inverted in VistaDent Database server (Digital cephalometric analyzing tool, version-4.2.1). The images were digitized in JPEG format and stored on a personal computer.
Two standard reference lines were used to measure crestal bone loss. Reference 1: Lowest point of marginal bone around the implant at the bone level Reference 2: the apical corner of the implant.
After the image was uploaded to the software, the edges were well defined [Figure 8] followed by the insertion of a Grid on the image to minimize the angulation errors [Figure 9]. Now with the help of Grid and well-defined margins, the height of the bone is measured adjacent to implant with the tool in the software (the angulation of the line should be 90° to standardize the measurement). After the images were uploaded into the software, the distances between two lines were measured with the ImageJ analysis tool (distance was measured to the nearest 0.01 mm in this software). Bone levels were measured on the mesial and distal aspects of the implants [Figure 10] and [Figure 11]. A positive value indicated a level coronal to the first reference line, and a negative value indicated a level apical to the first reference line. The readings were subjected for statistical analysis. All measurements were done by two examiners who were blinded to the methods used in the study. Measurements were repeated in case of any mismatch. This gives the measurement of the crestal bone loss around an implant with time.
| Results|| |
Measurements of the samples were obtained. Paired t-test was done to evaluate intragroup comparisons, an unpaired t-test was used to evaluate intergroup comparisons, and repeated measures for ANOVA were used to evaluate the changes at different intervals.
The mean values of crestal bone level in the mesial side at baseline, 3 months, and 6 months were 12.7 (1.33), 12.6 (1.4), and 12.6 (1.3), respectively, and the difference was not statistically significant with P = 0.892. The mean values of crestal bone level in the distal side at baseline, 3, and 6 months were 12.7 (1.49), 12.4 (1.6), and 12.3 (1.6), respectively, and the difference was not statistically significant with P = 0.422 [Table 1].
|Table 1: Comparison of crestal bone level in mesial and distal sides at various intervals among Capo4.touareg.os|
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The mean values of crestal bone level in the mesial side at baseline, 3, and 6 months were 11.2 (1.9), 10.9 (1.2), and 10.8 (1.5), respectively, and the difference was not statistically significant with P = 0.292. The mean values of crestal bone level in the distal side at baseline, 3, and 6 months were 11.2 (1.9), 10.6 (1.5), and 10.3 (1.6), respectively, and the difference was statistically significant with p [Table 2].
|Table 2: Comparison of crestal bone level in mesial and distal sides at various intervals among acid-etched touareg-s|
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The mean values at baseline among Group 2 and Group 1 were 12.73 (1.49) and 11.23 (1.94), respectively, and the result was statistically not significant with P = 0.067. The mean values at 3 months among Group 2 and Group 1 were 12.42 (1.61) and 10.62 (1.47), respectively, and the result was statistically significant with P = 0.017. The mean values at 6 months among Group 2 and Group 1 were 12.33 (1.6) and 10.29 (1.60), respectively, and the result was statistically significant with P = 0.010 [Table 3].
|Table 3: Comparison of crestal bone level in distal side at various intervals among study groups|
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The mean values at baseline among Group 2 and Group 1 were 12.7 (1.33) and 11.2 (1.91), respectively, and the result was statistically not significant with P = 0.06. The mean values at 3 months among Group 2 and Group 1 were 12.56 (1.40) and 10.9 (1.19), respectively, and the result was statistically significant with P = 0.011. The mean values at 6 months among Group 2 and Group 1 were 12.62 (1.26) and 10.85 (1.49), respectively, and the result was statistically significant with P = 0.010 [Table 4].
|Table 4: Independent t-test was done to assess the crestal bone level on the mesial side|
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| Discussion|| |
The use of endosteal implants for dental rehabilitation of patients represents one of the most technologically advanced forms of dentistry available today. The long-term preservation of crestal bone height around osseointegrated implants is often used as a primary success criterion for different implant systems. The radiographic evaluation of bone forms a very important and viable means of detecting health and stability of bone around the peri-implant hard tissue. A decrease of crestal bone level indicates that the implant is loosening its bony anchorage.
The implant surface has been identified as one of the six important factors for implant anchorage in bone, there have been remarkable efforts to improve surface design, as evidenced by the extensive number of studies published since the 1980s. Modifying an implant surface include chemical or physical alterations. Incorporating inorganic phases into the titanium oxide layer, such as calcium phosphate, has been shown to provide higher levels of early biomechanical fixations and bone-to-implant contact (BIC) percentage values compared with as turned, or grit-blast/AE, surfaces.
Doe et al. conducted a study and observed higher amounts of new bone formation and osseointegration around calcium-modified AE pure titanium implant. Interestingly, more bone formation was observed around loaded implants than nonloaded implants. Furthermore, calcium-modified AE pure titanium implants had no significant toxicity by the accumulation of metal ions. Hence suggesting that calcium-modified AE pure titanium is a suitable biomaterial for implantation with superior biocompatibility, stability, and biosafety.
Yoshinari et al. studied the solubility of calcium phosphate coatings. Results indicate that rapid, homogeneous, and comparatively low-temperature heating, such as defocused infrared radiation, controls Ca-P solubility, and ensures the adherence of the coatings to the substrate.
Chen et al. through a study concluded that compared with the Sand blast, Large grit, Acid-etch SLA implant, the CaP implant with tetracalcium phosphate (TTCP) improved the early osteointegration of the BIC at 1-month postoperation. SLA and CaP implants all showed good osseointegration through micro-CT analysis (1–6 months). Study findings suggest the CaP anchoring Ti surface demonstrated improvement in the early stages of osseointegration and thus shows the potential clinical benefits of TTCP anchoring on Ti surfaces in bone-level solutions.
Duckworth et al. described that the periapical radiographs have minimal distortion when they are well angulated by applying the standardized projection geometry. In addition, the exposure dose of periapical radiography is extremely low compared to that of other modalities. Furthermore, the standardized periapical radiographs probably provide the highest reliability and reproducibility in terms of linear measuring distance.,,
Limitations of the study included
- Only ideal cases with adequate bone volume and normal bone contour, ideal soft-tissue thickness were selected for the study
- Bone loss was measured only on the mesial and distal sides of the implants. For more predictable results, total bone loss including that on buccal and lingual sides should also be measured
- Small sample sizes and short observational periods were also the limitations of our study.
| Conclusions|| |
This study has evaluated the effect of AB/AE and calcium phosphate surface-treated implants on crestal bone loss within the 6-month follow-up period. Finally, this study concludes the use of calcium phosphate surface-treated implants minimizes crestal bone loss compared to AB/AE. This may increase the longevity of implants.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]
[Table 1], [Table 2], [Table 3], [Table 4]