Dental Implants – the tangible differences

How do grades of titanium, as well as their processing and surfaces, impact strength, osseointegration, restorative ease, and success rates?

Dr Mike Norton wrote ‘Dentists rely on the word of manufacturers’ that implants are manufactured to a high standard- ‘often this is not the case’

Titanium

Discovered in Cornwall, Great Britain, by William Gregor in 1791 and named by Martin Heinrich Klaproth after the Titans of Greek mythology titanium is a chemical element with the symbol Ti and atomic number 22. It has a silver colour, low density, and high strength and is resistant to corrosion in seawater and chlorine.

Titanium Grading

A simple grading system describes the purity levels of titanium and can be summarised as:

• Grade 1: carries the highest impurity level.
• Grade 2: is the choice for watch manufacturing.
• Grade 3: is used in industrial and commercial applications.
• Grade 4: is used in marine sectors and by many implant manufacturers.
• Grade 5 alloy: Titanium with 6% aluminium, 4% vanadium, 0.25% iron and 0.2% oxygen.
• Grade 23 alloy: is a higher purity version of Grade 5 titanium alloy.

The importance of Ti alloy for greater loading.

Masa & Braunitzer reported that ‘titanium alloy is 60% stronger than Grade 4 Titanium making it more suitable for orthopaedic and dental implant applications’

Grade 23 (Ti 6AL-4V ELI)

Grade 23 titanium Alloy provides the best combination of high strength, lightweight, good corrosion resistance, and high toughness.

Dental Implant Fractures are increasingly noted.

In the last 5 years, Implant Store has supplied many implant or implant screw removal kits to UK practices. In every case, the system in use was either grade 3 or grade 4 titanium. See article on implant screw removal. In the same period Implant Store supplied a grade 24 produced system Bioner TopDM) which at the time of writing has delivered zero implant or screw fractures.

These issues were typically, but not only limited to molar cases.

1. Aesthetic advantage. Using a system produced in Grade 23 alloy means a narrower implant can be placed with the same loading potential as a wider one.
2. Molar advantage. Sometimes even a 5mm wide implant has a narrow neck, increasing the probability of fractures. Producing such a system in grade 4 increases this two-fold. Employing an angled restoration on such a system creates a threefold risk of fracture with loading concentrated onto the weakest area around the collar or screw.

The Importance of a rough surface

Dental Implant manufacturers enhance osseointegration by employing various processes to create a macro, micro and nano surface to improve the bone-to-implant contact (BIC) area. Surface roughness is typically created by bombarding the surface with aluminium oxide, titanium oxide, calcium phosphate and biphasic calcium phosphates. This process creates what is known as an SLA surface (Sandblasted, Large grit, Acid-etch) and creates a rough titanium oxide layer that enhances osseointegration (fusion with bone).

The importance of a clean implant

Machining and SLA process impurities are reported as significant factors in poor healing and implant failure.

Dr Dirk U. Duddeck, Head of Research at the CleanImplant Foundation reports “many implants of inferior quality are contaminated with residues from the production and packaging process’. He acknowledged that ‘some companies set themselves apart and meet the quality demands of users and patients‘.

Independently owned Spanish manufacturer, Bioner has embraced this concept and eliminated surface impurities with its patented Bioetch* process. When applied to Grade 23 Titanium alloy dental implant surfaces this advancement creates macro and micro-textured surfaces without SLA blasting. The surface is shown to favour the osseointegration by stimulating osseointegration and shortening loading time.

Examined under the electron microscope, a rough honeycomb surface is observed, more regular in pattern than on other implant surfaces.

Even without SLA rocessing the average roughness of the Bioner TopDM Dental Implant is 1.3 microns – well within the scale recognized by international literature.

Unique technical breakthrough.

Dr Duddeck also observed that ‘obtaining a macro- and micro-textured surface…by etching alone without sandblasting is highly desirable from a biological point of view’.

Bioetch* is ‘the only surface on a commercially available implant to offer this combination of macro and micro-texture without sandblasting. The authors concluded that the Bioner process ‘can be considered a unique breakthrough‘

UPGRADE TO BIONER TOPDM

A free trial of the Bioner TopDM Implants with its patented Bioetch* surface is available from Implant Store where you can also browse complimentary Dental Implant Surgical Tools and the UK’s widest range of independent Regenerative Products.

ask@implant-store.co.uk I ask@regen-store.co.uk

www.restore-surgical.co.uk

*Trade Mark, Bioner SA.