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Figure 13.2. Microphotograph of an immediately
loaded implant after 9 months in function. The histological
evaluation showed a bone-to-implant contact of 93%
and a densifi cation of the surrounding bone. The marginal
bone level is coronal to the fi rst implant thread.
surface, which improves the affi nity to react
with phosphates, which in turn will make the
surface attractive to calcium phosphate nucleation.
Thus calcifi cation and bone growth can
start soon after implantation. Signifi cantly
more bone-to-implant contact and signifi -
cantly higher removal torque values were seen
for the fl uoride modifi ed implant compared
to the non-modifi ed control after 1–3 months
of healing in rabbit tibial bone (Ellingsen
et al. 2004). Increased bone-to-implant
contact to the fl uoride modifi ed implant was
also reported after 2 weeks of healing in a dog
model (Berglundh et al. 2007). Clinical documentation
is limited to short-term interim
reports (e.g., Stanford et al. 2006).
The SLActive TM surface (Straumann) shows
hydrophilic properties, whereas the conventional
SLA surface is hydrophobic. The
Chapter 13 The Implant Design and Biological Response 229
increased wettability is accomplished by
storing the implants in glass ampoules containing
isotonic NaCl solution following the
acid-etching procedure. The purpose is to
protect the pure Ti surface from contamination
with carbonates and organic components
occurring in the atmosphere and thus maintain
a chemically clean and reactive surface.
Buser et al. (2004) found increased bone-toimplant
contact during early healing (2–4
weeks) in mini-pigs when comparing the
SLActive TM surface to that of SLA. Test and
control implants had the same microtopography.
An immunohistochemical study in dogs
(Schwartz et al. 2007) also found signifi cantly
more bone-to-implant contact at SLActive TM
implants during early healing (1–28 days). A
removal torque study in mini-pigs (Ferguson
et al. 2006) showed that the SLActive TM
surface was more effective in enhancing the
interfacial shear strength of implants in comparison
with the conventional SLA surface
during early stages of bone healing (2–8
weeks).
Originally, the TiUnite® implants were
packed in glass ampoules and the implant
surface had hydrophilic properties. Later, the
package was changed and the surface became
hydrophobic. It should be noted that all oxidized
study implants used in the cited references
above (Glauser et al. 2003; Rocci et al.
2003a, 2003b; Schüpbach et al. 2005) were
packed in glass ampoules and had hydrophilic
properties.
The Neoss Bimodal TM surface is created
through blasting in two steps. First, the
threaded portion is blasted with ZrO 2 particles
(100–300 µm). Then the full length of the
implant is blasted with Ti-based particles
(75–150 µm). The implants are delivered in
glass ampoules. The surface shows hydrophilic
properties. Sennerby et al. (2008) found bone
formation directly on the bimodal surface
after 3 and 6 weeks of healing in rabbits.
Andersson et al. (2008) reported a survival
rate of 98.1% for 102 Neoss implants in 44
consecutively treated patients (two-stage procedure)
with a mean bone loss of 0.7 mm
after 1 year in function.