Biomaterials in Implants 63

DENTAL IMPLANT
Is defined as a prosthetic device of alloplastic material
implanted into the oral tissues beneath the mucosa or within the
bone to provide retention and support for fixed partial denture or
removable partial denture prosthesis.
Why do we prefer implant?
It is to restore function to the oral cavity.
The implant must be capable of carrying occlusal forces and
be able to transfer the occlusal stress to the adjacent bone in correct
orientation and magnitude such that tissue viability is maintained in
a physiological state.
HISTORY:
The origin of implant was as early as GREEKS and EGYPTIANS.
Albucasis de Condue (936-1013) attemted using OX bone to replace
missing teeth.
1809 Maggiolo- used gold roots to fix teeth by springs.
1887 Harris- used platinum post coated with lead.
1895 Bonwell- used iridium
1905 Scholl- used porcelain corrugated root implant.
1937 Venable, Strock, Beach- studied effect of metal on bone and
concluded

that

metals

produce

galvanic

corrosion when contacted with tissue fluids.

reaction

leading

to

Biomaterials in Implants 64

1952 Branemark- conducted extensive studies on titanium and its

implications in iplantology.
CLASSIFICATION:
Chemical point of view
Metals
Ceramics
Polymers.

Type of biologic response

Biotolerant

Metals
Co-Cr Alloys

Ceramics

Polymers
Polyethylence

Stainless steel

Polymethymethacrylate

zirconium

Polytetrafluroethylene
polyurethane

Bioinert

Aluminium
Commercially

oxide

pure titanium

Zirconium oxide

Titanium
alloy
Bioactive
Hydroxyappatite
Tricalcium
phosphate
fluroappatite
Bioglass
silicone.

&

C-

Biomaterials in Implants 65

Biomaterial:
Any substance other than a drug that can be used for any
period of time as part of system, that treats, augments or replaces
any tissue, organ or function of the body.
Biocompatibility:
Is defined as an appropriate response to a material within a
device for a specific clinical application.
Biotolerant:
Are materials those that are not necessarily rejected when
implanted into living tissue, but are not surrounded by a fibrous
layer in the form of a capsule.
Bioinert:
Are materials that allow close apposition of bone on their
surface, leading to contact Osteogenesis.
Bioactive:
Are materials that allow the formation of bone onto their
surface, but ion exchange with the host tissue leads to the formation
of chemical bond along the interface.
REQUIREMENTS FOR IMPLANT MATERIALS :
1. Physical and chemical properties:
Forces exerted on the implant material consist of tensile,
compressive

and

shear

components.

It

should

have

enough

Biomaterials in Implants 66

components for its longevity. Because bone can modify its structure
in response to forces exerted on it, the implant material and design
must be designed accordingly.
The mechanical properties of the metals can be altered by
heating for varying periods and alloying. But this leads to loss of
ductility. ADA recommends 8% ductility to minimize its brittle
fracture.
Ceramic materials are weak under shear forces because of
combination of low fracture strength and ductility causing it brittle.
2. Corrosion and Biodegradation:
Corrosion is a concern with metallic implants because the
implant protrude into the oral cavity where electrolyte and oxygen
compositions differ from that of tissue fluids. Also the PH can vary
in areas below plaque and within the oral cavity exposing the
implant to a wide range. Thus implant should be corrosion resistant.
Williams suggested three types of corrosion are relevant to dental
implants. They are galvanic corrosion
fretting corrosion
stress corrosion cracking.

Biomaterials in Implants 67

Galvanic corrosion:
Occurs when two dissimilar metallic materials are in contact
and are within an electrolyte resulting in current flow between the
two.
Plenk and Zitter stated that galvanic corrosion would be
greater for dental implants.
The passivity of oxide layers, which are characterized by
minimal dissolution rate and high regenerative power for titanium
would tend to decrease this type of corrosion.
Fretting corrosionOccurs when there is a micro motion and rubbing or
scratching contact within a corrosive environment, due to loss of
passive layer either by perforation or shear loading directed along
adjacent contact surfaces. This is shown to occur along implant
body/abutment/super structure interfaces.
Stress corrosion crackingThe combination of high magnitudes of applied mechanical
stress and exposure to a corrosive environment results in failure of
metallic materials by cracking which was presented by Williams as
S.C.C.

Biomaterials in Implants 68

Lemons et als said that it may be respond for some dental

implant failures due to high concentration of fores in the area of
abutment- implant body interface.
Under

three

dimensional

finite

element

stress

analysis,

implant body design show a concentration of stresses at crest of the

bone support and cervical 1/3 rd of the implant interface area.
The corrosion resistance of synthetic polymers, depends not only on
their composition and structural form but also on the degree of
polymerization.
3. Toxicity:
Is related mainly to the biodegradation products particularly
those of higher atomic weight metals.
Factors to be considered
The amount dissolved by biodegradation per unit time.
The amount of material removed by metabolic activity per
unit time.
Quantities of solid particles and ions deposited in the tissue
and associated transfer to systemic system
IRON

CHROMIUM-NICKEL-BASED

STEEL)
Is an iron carbon alloy.
Cr- 18%

ALLOYS

(STAINLESS

Biomaterials in Implants 69

Ni- 8%
Fe-C 0.05%
Chromium imparts corrosion resistance, nickel to stabilize the
austenitic structure. The alloy is used in wrought and heat treated
condition which results in high strength and ductility, thus it is
resistant to brittle fracture. To improve its corrosion resistance
studies where conducted by surface treating the metal with 40%
nitric acid or by ion implantation method but no improvement was
seen.
Also it has galvanic potential resulting in galvanic corrosion
if contacted with Ti, Co, ZR or C implant biomaterials.
Advantages high strength
low cost
Ease of fabrication.

Disadvantages as nickel is present it cannot be used in patients allergic to it.

Susceptible to crevice and pitting corrosion.
Corrosion products are Fe, Cr, Ni, Mo which accumulate in
tissues surrounding implant and transported to different parts
of body.
COBALT- CHROMIUM- MOLYBDENUM ALLOY (VITALLIUM)

Biomaterials in Implants 70

Co- 63%
Cr- 30%
Mo- 5%
Traces of C, Mn, Ni.
It was introduced in 1930s by Venable.
These alloys are used in as- cast or cast and annealed
condition. Chromium provides corrosion resistance through the
oxide surface. Molybdenum provides strength and bulk corrosion
resistance.

Cobalt

provides

the

continuous

phase

for

basic

properties.
Advantages These alloys have high elastic modulus(4 times that of
compact bone) and resistance to corrosion.
Low cost and ease of fabrication.

Disadvantages Showed chronic inflammation with no epithelial attachment

and with fibrous encapsulation with mobility.
To improve inert materials in the form of aluminium oxide or
zirconium oxide were added to surface, but no effect was
observed.

POLYMERS AND COMPOSITES:

Biomaterials in Implants 71

First used in 1930s.

Made of PMMA, PTFE
These
monomers

are

simple

connected

and
by

recurrent
covalent

structural
bonds

units

formed

called
during

polymerization process.
They are complex molecules of high molecular weight but are
softer and more flexible.
Polymethoxy methylene is used as intramobile element in Ti
plasma sprayed or hydroxyl appatite coated implant which acts as
internal shock absorber.
It is placed between prosthesis and implant body to ensure
more uniform stress distribution along bone- implant interface.
COMPOSITES:
Biodegradable

polymers-

PVA,

POLYACTIDES,

CYANO

ACRYLATES are combined with calcium phosphate fibers.

They are used as plates, screws etc.
They are sensitive to sterilization.
Advantages Elastic modulus almost similar to that of the compact bone.

Disadvantages-

Biomaterials in Implants 72

Have inferior mechanical properties.

Lack of adhesion to living tissues.
Adverse immunologic reactions.
Sterilization by gamma radiation or ethyelene oxide gas.
Electrostatic properties are more thus attract more impurities.

CARBON:
Introduced in 1960s.
Advantages

It shows minimal response from host tissues.

Studies showed that morphology of bone- implant interface is

similar to that of hydroxyl appatite implant.

Carbon is inserted under physiological conditions. Modulus of

elasticity is almost equal to that of bone and dentin thus
transmitting adequate stress.

Disadvantages

More susceptible to fracture under tensile stress.

Low compressive strength. So require a large surface area to

resist fracture.

CERAMICS:
These are inorganic, non-metallioc, non- polymeric materials
manufactured by compacting and sintering at elevated temperatures
which are either bioinert or bioactive.

Biomaterials in Implants 73

Bioinert- aluminium oxide, zirconium oxide.

They can withstand high compressive strength and elastic
modulus is high.

These materials are bioinet with no evidence of

ion release or immune reactions invivo and are not bioactive as they
donot promote bone formation. They have high strength, stiffness
and

hardness

so

function

as

subperiosteal

or

transperiosteal

implants. Used as root form, endosteal plate form and pin type
dental implants. The compressive strength exceeds 3-5 times that of
compact bone.
Advantages Low thermal and electrical conductivity.
Low biodegradation.
Low reaction with bone.

Disadvantages Exposure to steam sterilization results in tear strength.

Scratches or notches may induce fracture sites.
Chemical solution will have residues.

Bioactive-

hydroxyapatite,

tricalcium

phosphate,

bioglass,

fluroappatite.
The synthetic type of material calcium phosphate are most
successful for grafting and augmentation of bone. They are non

Biomaterials in Implants 74

immunogenic and biocompatible with host tissues. These are used

most commonly as bone graft in granular or block form to srve as a
template for new bone formation. These promote and achieve a
direct bond between implant and hard tissues, hence known as
bioactive. Hydroxyapatite, tricalcium phosphate released calcium
and phosphate ions to surrounding tissues over a period of time.
Studies showed that tricalcium phosphate is resorbed more rapidly
than

hydroxyapatite

resulting

in

breakdown

of

material

and

replacement by mesenchymal cells.

Physical properties- the use of calcium phosphate as coating
materials for metallic implants is directly related to their
1. Form of the product- block or particle.
2. Porosity dense, macroporous and microporous.
3. crystallinity- crystalline and amorphous.
The more crystalline hydroxyapatite coating is the more
resistant it is to clinical dissolution. A minimum of 50% crystalline
nature is optimal in implant coating.
The

major

advantage

of ceramic

coatings

is

that

they

stimulate adaptation of bone and form a more intimate bone- implant

contact when compared with metallic surface.

Biomaterials in Implants 75

Non resorbable, bioinert ceramics with satisfactory load

bearing

capability

are

limited

to

dense,

monocrystalline

and

polycrystalline Al, Zr, or TiO2 ceramics.

The longest resorption rate occurred with dense, nonporous
hydroxyapatite type as osteoclasts attack only the surface and
cannot penetrate the nonporous material. The porous materials also
provide additional regions for tissue ingrowth and integration,
minimizing the interfacial motion.
Chemical properties are related to calcium, phosphate ratio,
elemental impurities like carbonates and PH of surrounding region.
These coatings

are mostly applied by plasma

spraying(50-70

microns thickness), small size crystalline hydroxyapatite ceramic

powder particles.
Impurities like carbonate, decrease in PH are more prone to
resorption. They are non conductors of heat and electricity.
BioglassAre classified as bioactive because they stimulate bone
formation. They are often used as grafting materials for ridge
augmentation or bony defects than as coating materials for metallic
implants, because

It is a dense ceramic material made from CaO, Na2O, P2O5,

SiO2 and MgO.

Biomaterials in Implants 76

Due to the local PH changes near bioglass surface, Na, Ca,

PO4 ions get dissolved.

Hydrogen ions from local tissue fluid replace the lost Na ions
in bioglass.

At the surface, a silica rich gel forms because of the selective

dissolution of elements.

Si depletion is followed by migration of Ca, PO4 ions to Si

gel surface both from bioglass and tissue fluids to form a
calcium- phosphate layer.

Sufficient concentration of phosphorous is present at the

surface, osteoblasts proliferate producing collagen fibrils that
become incorporated into calcium- phorous gel and are
anchored by them.

This strong bonding layer has shown to be 100-200 micron

thick

i.e

10

times

thicker

than

layers

hydroxyapatite.
Advantages

Excellent biocompatibility

Minimum thermal and electrical conductivity.

Elastic modulus similar to bone.

Disadvantages

Low tensile strength and shear strength.

formed

in

Biomaterials in Implants 77

Variable soluability.

TITANIUM AND ITS ALLOYS:

It is the material of choice for dental implants. At room
temperature

it

is

hexagonal

close

packed

(-

phase)

lattice

configuration and when exposed to high temperatures of 883 C

becomes body centered cubic lattice( - phase).
Modulus of elasticity is 5 times greater than bone.
It is very reactive element. It reacts with oxygen at room
temperature

and

form

surface

oxide

layer(TiO2,

TiO3)

in

milliseconds. TiO2 is more stable and exists in three crystalline

forms.
1. Brookite (orthorhombic)
2. Anatase

Tetragonal

3. Rutile
of these rutile is commonly formed. Thus it decreases corrosion.
Ti- 6Al- 4V Alloy
Its modulus of elasticity is 5.6 times greater than that of compact
bone.
Its strength is 60% greater than pure Ti.
Adverse effects:

Biomaterials in Implants 78

Increase in Ti concentration was found in both peri implant

tissues and parenchymal organs mainly lung and to lesser extent in
liver, kidney, spleen.
The emerging techniques to cast Ti and Ti alloys remain
limited for dental implant applications because of high melting
point of elements and ability for absorption of O2, N2, H2 which
cause metallic embrittlement. Hence a high vaccum or ultra pure
protective gas atmosphere is required for Ti castings.
SELECTING AN IMPLANT MATERIAL:
Because of the absence of different implant materials the
factor to be considered are Strength of the material
Type of bone
implant design
Surface finish
Biomechanical considerations.

StrengthDepending on the area of placement- posterior area is high

load zone Cp Ti grade IV can be used.
Use of narrow implants and history of parafunctional habits are
more prone to fracture.
Type of bone-

Biomaterials in Implants 79

Type I

homogenous compact bone

Type II

thick layer of compact bone surrounding core of dense

trabacular bone.
Type III

thin layer of cortical bone surrounding core of

dense

trabacular bone.
Type IV

composed of thin layer of cortical bone with core of low

density trabacular bone.

Surface finishHydroxyapatite coated implants stimulate bone growth and
greater bone implant integration.
Gottlander and Alberktson in 1991 examined bone- implant
contact area for both hydroxyapatite and Cp Ti implants at 6 weeks
and 12 months. It was observed that
6 WEEKS

12 MONTHS

HA

65%

53%

Ti

59%

75%

Titanium plasma sprayed:

Porous surface of titanium obtained by plasma spraying
powder form of molten droplets. At high temperatures of 15000 C,
an argon plasma is associated with nozzle to provide high velocity
of 600 m/ second to molten particles of Ti powder(0.05-0.1mm)
diameter are projected onto a metal or alloy substrate upto a

Biomaterials in Implants 80

thickness of 0.04- 0.05 mm.

Microscopically it showed round or

irregular pores which are connected to each other.

Hydroxyapatite coating:
A powdered crystalline HA is introduced and melted by hot,
high velocity region of plasma gun and propelled onto the metal
implant.
The plasma spraying technique alters the nature of crystalline
powder resulting in deposition of resorbable amorphous phase.
Biomechanical considerations:

A material is said to be biocompatible if it is capable of

existing in harmony with surrounding environment. Tissue
response to Ti implant is good.

Mechanisim.

There would be migration and differentiation of bone forming

cells to the implant surface known as osteoconduction.

Mineralization of interfacial matrix- denovo bone formation.

Over a long term stability of implant is given by bone

remodeling at the bone- implant interface.

Also there would be formation of biological seal. after

implantation, the gingival epitheliuym cells, similar
natural tooth crevicular and junctional epithelial zones.

to

Biomaterials in Implants 81

CONCLUSION:
The success of any implant depends on site of implantation,
tissue trauma during surgery, motion of implant tissue interface and
also the material used, its surface finish and properties.

Porous and featured coatings

Passivating Coatings

Biomaterials in Implants 82