JOMI on CD-ROM (1997 © Quintessence Pub. Co.), 1997 Vol. 12, No.

1 (65 - 73): Osseointegration of Rough Acid-Etched Implants: One-Year Follo

Osseointegration of Rough Acid-Etched Implants:

One-Year Follow-up of Placement of 100 Minimatic
Implants
Dario De Leonardis, DDS/Arun K. Garg, DMD/Gabriele E. Pecora, MD, DDS/Sebastiano
Andreana, DDS

Between January 1992 and October 1992, 100 Minimatic screw implants made of titanium
alloy with rough acid-etched surfaces were placed in 63 consecutive partially edentulous
patients. At second-stage (uncovering) surgery performed after a 4- to 6-month healing period,
none of the implants showed any signs of mobility, peri-implant infection, or bone loss. After
an additional healing phase averaging 2 weeks, the patients were restored with fixed
prostheses. Patients were reexamined every 3 months for 1 year, with all 63 patients available
for evaluation during this period. Periapical radiographs were taken preoperatively,
immediately after surgery, and at 6 and 12 months after implantation. There were no signs of
peri-implant radiolucencies in any of the implants, and alveolar bone loss was less than 1 mm
on average 1 year after implantation. Based on Plaque Index, sulcular bleeding index, pocket
probing depth, attachment level, width of keratinized mucosa, and hand-tested mobility, 99
implants were considered successful and 1 (which developed peri-implant infection) was
considered a failure. Study results substantiate other reports that implants with a rough
surface can yield predictable good results.
(INT J ORAL MAXILLOFAC IMPLANTS 1997;12:65–73)
Key words: implant surface, Minimatic implant, osseointegration, rough acid-etched implant

C linical and experimental studies have shown that osseointegrated dental implants can provide a
predictable means of replacing teeth in partially and completely edentulous patients. The intimate
bone-implant contact is generally considered a prerequisite for successful long-lasting results. This
type of bone anchorage was first described by Brånemark et al1 with the use of titanium implants.
Later, this intimate bone-implant contact was found in undecalcified histologic sections by
Schroeder et al.2 This phenomenon is usually referred to as osseointegration.3
Among the initial factors considered necessary to achieve osseointegration were the macrostructure
of the implant (eg, cylindrical, threaded, screw design) and microstructure elements (eg, a smooth
surface, pure titanium material).4 In a 1986 review, Albrektsson et al5 noted that reports regarding the
majority of current implants, whose morphology and surface differed from that of standard Brånemark
implants (Nobel Biocare AB, Göteborg, Sweden), were not based on controlled clinical studies in which
reliable success rates could be determined. Thus, the authors concluded that the results of such implants
should be considered empirical or, at the very least, still in the experimental stage. Included were
titanium alloy (Ti-6Al-4V) implants and rough-surfaced implants such as those from ITI (International
Team for Oral Implantology, Institut Straumann, Waldenburg, Swit zerland).

In regard to implant design, Quirynen et al6 indirectly confirmed this assumption when they reported

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JOMI on CD-ROM (1997 © Quintessence Pub. Co.), 1997 Vol. 12, No. 1 (65 - 73): Osseointegration of Rough Acid-Etched Implants: One-Year Follo

that any changes in implant design may dramatically affect the status of peri-implant marginal bone. For
this reason, the authors emphasized that results obtained with one type of implant should not be assumed
to apply to another implant, even though the two implants might appear similar in design.
Concerning the importance of the surface characteristics of implants, initially the use of a smooth,
pure titanium surface was recommended.3,5 Since then, this assumption (based on empirical findings)
has gradually come under scrutiny. First, the biocompatibility of a given implant is determined by the
oxide layer that covers the surface and not by the pure metal of which the implant is made.7 A layer of
TiO 2 covers both pure titanium and Ti-6Al-4V implants. Because this oxide layer is also formed on
rough surfaces,8 a similar biocompatibility for smooth and rough surfaces can be assumed.

In addition, Gotfredsen et al9 reported significantly better bone anchorage with TiO 2-blasted screw
implants compared with implants that were machined smooth. In a comparison of six different surface
structures, Wilke et al 10 reported that acid-treated screws with a rough surface required the highest
torque removal.
The purpose of the present study was to evaluate tissue integration of Minimatic (Minimatic Implant
Technology, Boca Raton, FL) Ti-6Al-4V implants with a rough acid-etched surface ( Figs 1a and 1b) and
a modified thread design with a flat surface facing the implant apex, which allowed for self-tapping of
the implant. The study period comprised the healing phase following implantation and 12-month
postoperative follow-up.
Material and Methods
Between January 1992 and October 1992, 100 Minimatic screw implants (3.75 mm in diameter and of
varying lengths) were placed in 63 consecutive partially edentulous patients (Table 1). Patients with
systemic (eg, uncontrolled diabetes, immune disorders, connective tissue disorders) or local (eg, patients
irradiated for cancer treatment, active untreated periodontal disease, areas of suppuration, smokers, close
proximity to vital anatomic structures) contraindications were excluded. Fifty-four of the implants were
placed in the mandible and 46 in the maxilla. All operations were performed by the same surgeon (DDL)
in a sterile environment (as sterile as can be obtained in a dental office) following standard protocol.
First-Stage Surgery. First-stage surgery consisted of (1) incision of the gingiva and mucoperiosteal
flap elevation, (2) drilling and countersinking procedures, (3) implant placement and cover screw
placement, and (4) soft tissue readaption and suturing. There were two major changes in the technique, as
described by Lekholm.11 First, the bone-tapping procedure was almost totally eliminated because of the
self-tapping design of the implant. The tapping procedure was used only for implants placed in the more
dense bone between the mental foramina. Second, it was not necessary to use an external cooling system
with a syringe because the drills used during the surgery were equipped with an internal channel for
saline flow (in addition to the external flow provided by the handpiece) and designed with four flutes.
The first gingival incision was made slightly lingually with respect to the midcrestal line, and a
mucoperiosteal flap was created. Bone drilling was performed by first using a round bur to mark the
implant site and make the initial entry into the cortical bone. Then, in sequence, five different drills were
used: the pilot drill, which was 2 mm in diameter; and then three spade drills, increasing in diameter from
2.5 mm to 3.0 mm to 3.5 mm; a countersinking of the coronal portion of the implant site was done. These
drilling procedures were done using copious irrigation of chilled saline to reduce the risk of thermal
damage to the bone with drilling speeds of 1,500 rpm.

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During placement, the implant was carefully handled to avoid contact with other materials and
contaminants. As previously stated, the need for bone site threading (ie, tapping) was almost totally
eliminated. Tapping was only applied when the compact structure of the bony walls at the implant site
made it absolutely necessary. The implant was brought into the recipient site with the plastic cap of the
sterile vial containing the implant still in place. The cap was removed, and the final fitting (ie, screwing)
of the implant was competed with a hand wrench. The mucoperiosteal flap was readapted and tightly
sutured, thus minimizing a pathway for infection.
Healing Phase. During the initial healing phase (2 to 3 weeks), patients were instructed not to chew
or brush in the surgical area, with chemical control of dental plaque maintained by the use of
chlorhexidine digluconate (0.12%, twice a day for 1 minute) (Dentosan Mese, Pagni Raffaello, Firenze,
Italy). System antibiotics (1 g of amoxicillin and 250 g of clavulanic acid [Neoduplamox, Procter &
Gamble, Rome, Italy] twice a day) were administered for 7 days. The sutures were removed between 7
and 10 days after surgery. Follow-up visits were scheduled for 14 and 21 days after surgery, and then on
a monthly basis until the 4- to 6-month healing phase was completed.
Second-Stage Surgery. Timing of second-stage surgery was based on implant location (ie, maxilla
or anterior or posterior mandible). During the uncovering procedure, a mixed-thickness flap (full
thickness on and immediately around the implant; partial thickness in the adjacent areas) was made to
provide complete view and instrumental access to the implant and peri-implant bone.
Special care was taken to augment (and not reduce) as much as possible the width of peri-implant
keratinized mucosa. If the implant was surrounded by mobile alveolar mucosa, a free gingival grafting
technique was performed to increase keratinized tissue. At the time of second-stage surgery, this was
accomplished at seven sites: six in the distal mandible region; and one in the distal maxillary region.
In addition, an attempt was made in all patients to reduce the height of peri-implant soft tissues
covering the implant to approximately 3 mm using an apically positioned flap procedure. Special care
was taken not to excessively reduce the soft tissues around implants located in the maxillary anterior
region, where critical esthetic demands sometimes required leaving a residual pocket deeper than 3 mm
If, at this time, the implant did not show any signs of mobility and the appearance and consistency of
the peri-implant bone were normal (ie, no indications of infection or bone loss), a healing screw
(appropriate for the condition of the soft tissue and the prosthetic needs of the implant) was placed. After
an additional soft tissue healing phase of approximately 2 weeks, a custom tray was fabricated, the final
impression was made using square pick-up impression copings, and prosthesis fabrication was
completed. Thirty implants were restored with single crowns, and the remaining 70 implants served as
abutments for 33 implant-supported prostheses (Table 2).
Postoperative Follow-up Visits. After the prosthetic phase of treatment, all patients were enrolled in
a maintenance program with follow-up visits scheduled every 3 months. During these visits, oral hygiene
was checked, plaque was removed using a rubber cup and polishing paste, and, if necessary, the patient
was again informed and educated as to the importance of proper home care oral hygiene procedures.
Periapical radiographs were taken by the same operator (DDL) preoperatively, immediately after
surgery, at the time of the uncovering procedure (4 or 6 months following implantation), and 12 months
following surgery. The radiographs were obtained with the long-cone technique, using Rinn film holders
and an adhesive millimeter grid (X-ray Grid, General X-ray, Monte Carlo, Monaco). The radiographs
were evaluated for the presence of peri-implant radiolucencies, and the level of the alveolar bone around

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the implants was assessed (DDL). The distance between the implant shoulder and the first visible bone
contact (DIB) was measured at the mesial and distal aspect of each implant (Fig 2). Based on the
collected data, each implant was classified as either successful or failed according to the criteria of
Albrektsson et al.5
Twelve months after implantation, all 63 patients were available for evaluation, and the 100 implants
were assessed using the following clinical indexes: Plaque Index (PI), sulcular bleeding index (SBI),
probing depth (PD) of pocket, distance between the UCLA abutment shoulder and mucosal margin
(DSM), attachment level (AL), width of keratinized mucosa (WKM), and hand-tested mobility.
The PI was determined on the mesial, buccal, distal, and lingual surfaces of the implant with the
following scores applied based on the amount of plaque present: 0 indicated no plaque was detected; 1
meant that plaque was recognized only by running a probe across the smooth marginal surface of the
implant; 2 meant that plaque could be seen by the naked eye; and 3 indicated that there was an abundance
of soft matter present.12
The SBI was assessed at the same surface areas as those used for the PI, with the following scores
based on the amount of bleeding present: 0 indicated no bleeding when a periodontal probe was passed
along the gingival margin adjacent to the implant; 1 meant that only isolated bleeding was visible; 2
meant that blood formed a confluent red line on the margin; and 3 indicated the presence of heavy or
profuse bleeding.
The PD of the pocket was measured to the nearest millimeter with a Hu-Friedy PGF-GFS periodontal
probe (Hu-Friedy, Chicago, IL) at the same surface areas as those used for the PI and SBI.
The DSM was measured to the nearest millimeter, with measurements taken with the same probe at
the same surfaces. For a subgingival abutment shoulder, the measurement was recorded as a negative
value. The UCLA abutments used in this study were all plastic castable abutments. Prior to casting, the
abutments were prepared by placing the shoulder in three possible locations (positions): slightly
subgingival for anterior esthetically demanding implants; at the level of the gingival margin as it
appeared on the master cast if esthetics were not critical; or supragingival for posteriorly located implants.
The AL was calculated for each site by adding the PD and the DSM (Fig 3). The WKM was
measured in millimeters midbuccally and midlingually for implants located in the mandible, and
midbuccally for implants in the maxilla. Implant mobility was tested manually.
Results
Clinical Observations. During the first 3 days after first-stage surgery, patients usually reported only
minor discomfort. Moderate pain and swelling were noted, but there were no signs of infection with any
of the implants during the healing phase.
At the time of second-stage surgery (ie, uncovering procedure), all 100 implants appeared stable
without any detectable mobility, and they exhibited healthy, well-mineralized peri-implant bone.
Periapical radiographs taken at that time showed good appearance of the peri-implant bone, intimate
bone-implant contact, and no signs of peri-implant radiolucencies. All implants were in a favorable
prosthetic position and received ceramometal UCLA abutments and cemented restorations.
Nine months after implantation, one patient reported moderate pain at the site of one mandibular
implant that had already been restored. Clinical examination revealed peri-implant infection with
increased PD, along with bleeding and mild suppuration. Periapical radiographs clearly demonstrated

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signs of bone resorption in the crestal region. The patient was treated with systemic antibiotic (250 mg of
metronidazole three times a day) for 7 days, and the peri-implant pocket was locally irrigated with
tetracycline hydrochloride solution once a day for 10 days. All signs of inflammation disappeared within
7 days of treatment.
Radiographic Evaluation. Radiographs were obtained of 99 implants (62 patients). One implant
could not be properly evaluated. There were no signs of continuous peri-implant radiolucencies. Changes
in alveolar bone height (calculated as the difference between the implant shoulder and the first visible
DIB) were measured on the mesial and distal aspect of the implant at times T0 (day of implantation), T1
(immediately prior to the uncovering procedure; ie, 4 months after implantation in the mandible and 6
months in the maxilla), and T2 (12 months after implantation). Between T0 and T2, a mean bone
resorption of 0.80 mm was noted in the mandible and 0.76 mm in the maxilla. The mean overall DIB
value for the 99 implants was 0.78 mm.
Clinical Indexes. Twelve months after the initial surgery, all 63 patients were available for
evaluation of their implants. Only one patient, as previously described, developed any negative clinical
symptoms. The 63 patients were assessed according to PI, SBI, PD, DSM, AL, WKM, and implant
mobility.
PI. Most of the patients demonstrated excellent oral hygiene. The PI scores of 100 implants
(measured on four surfaces for a total of 400 sites) were 0 on 330 surfaces (82.5%), 1 on 46 surfaces
(11.5%), and 2 on 24 surfaces (6.0%). There were no PI scores of 3. The mean PI value was 0.27.
SBI. The peri-implant soft tissues appeared healthy in the majority of patients. As with the PI,
measurements were made on four surfaces for a total of 400 sites. A score of 0 was registered for 328
surfaces (82.0%), 1 for 44 surfaces (11.0%), and 2 for 28 surfaces (7.0%). There were no SBI scores of 3.
The mean SBI value was 0.25.
PD. The PD of the pocket, as measured on four surfaces for a total of 400 sites, ranged from 1 to 6
mm. Of the 400 sites, 89.0% had a PD less than or equal to 3 mm: the PD for 20 surfaces (5.0%) was 1
mm; for 144 surfaces (36.0%), 2 mm; and for 192 surfaces (48.0%), 3 mm. Thirty-two surfaces (8.0%)
had a PD of 4 mm. Three percent of the sites (12 surfaces) had a PD of 5 mm or more, including the
implant that developed peri-implant infection. The mean PD value was 2.68 mm.
DSM. The DSM was also measured on four surfaces for a total of 400 sites. The DSM ranged
between –2 mm and +2 mm. Forty sites (10.0%) had a DSM of –2 mm, and 92 sites (23.0%) had a DSM
of –1 mm. The negative scores (indicating a subgingival abutment shoulder) were mostly recorded in
anterior maxillary implants (where the crown margins were placed slightly into the peri-implant sulcus
for esthetic reasons) or in sites directly adjacent to natural teeth. One hundred eighty sites (45.0%) had a
DSM of 0 mm, 72 sites (18.0%) had a DSM of 1 mm, and 16 sites (4.0%) had a DSM of 2 mm. The
mean DSM value was –0.17 mm.
AL. The clinical AL was calculated on four surfaces for a total of 400 sites by adding the PD and the
DSM values, resulting in scores ranging from 1 to 6 mm. Ninety-one percent of the examined surfaces
showed an AL of 3 mm or less: 48 surfaces (12.0%) had an AL of 1 mm, 148 surfaces (37.0%) had an
AL of 2 mm, and 168 surfaces (42.0%) had an AL of 3 mm. Twenty-four surfaces (6.0%) had an AL of 4
mm, and 12 surfaces (3.0%) had an AL equal to or greater than 5 mm. The mean AL value was 2.51 mm.
WKM. The WKM was evaluated and measured on 154 surfaces in 54 mandibular implants (both on

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the buccal and lingual surfaces) and 46 maxillary implants (only on the buccal surface). The WKM
ranged from 0 to 12 mm. Four surfaces (2.6%) had a WKM of 0 and were localized within mobile,
nonkeratinized mucosa. All other sites revealed a WKM presence of 1 mm or greater. Eleven surfaces
(7.1%) were 1 mm, 43 surfaces (28.0%) were 2 mm, 49 surfaces (31.8%) were 3 mm, and 47 surfaces
(30.5%) were 4 mm or greater.
Mobility. Clinically, all 100 implants showed stable anchorage in bone without any detectable
mobility based on manual testing.
Overview of Results. Table 3 summarizes the minimum, maximum, mean, and standard deviations
of the radiographic and clinical indexes used to evaluate the 100 implants at 1-year follow-up after im-
plantation.
Discussion
Other authors have noted that the efficacy of any new implant system must be based on its own merits,
that success cannot be asserted by extrapolating data from other similar implants.13 Any alterations in
material or design, even if minimal, can have a significant impact on the clinical function of the implant.
Thus, the present study was performed to clinically evaluate the outcome of an implant already available
for clinical usage but lacking in published scientific data.

According to Albrektsson et al,5 a 15% implant failure rate 5 years after implantation should be
considered the lower acceptable limit for any implant system. Thus, this 1-year study should be
considered preliminary, with an extended follow-up needed to provide more comprehensive long-term
information on the Minimatic implants.

Implant failure can be divided into early and late failures.14 Early failures occur during the first 6
months after implantation, during the healing phase. The typical clinical signs of such failures, often
noted just prior to second-stage surgery, are peri-implant bed infection associated with detectable implant
mobility. Early failures are usually the result of improper surgical technique (eg, overheating of the bone
site during drilling), lack of primary stability of the implant, or contamination of the recipient site. They
may also be caused by premature occlusal loading during the healing phase.
In the present study, there were no early failures of the 100 implants. This may be the result of the
surgical protocol followed during implantation, in which special care was taken to prevent contamination
of the implant and the recipient site. In addition, it is possible that the combination of both internal and
external irrigation may have provided a lower temperature, helping to keep the bone status within the
tolerance limit during the drilling procedure.
After an appropriate healing phase (ranging from 4 to 6 months) and at the time of second-stage
(uncovering) surgery, all of the implants showed healthy peri-implant soft tissue, normal peri-implant
bone tissue, and stable bony anchorage, indicating clinical evidence of achieved osseointegration. The
radiographs showed an intimate bone-implant relationship and no evidence of peri-implant
radiolucencies. Thus, all 100 implants were considered suitable to function as abutments for fixed
restorations.

Late failures occur during the maintenance phase following successful osseointegration.14 The main
clinical symptoms are pain, bleeding on probing, peri-implant infection with suppuration, and increased
probing depth (PD). Such a pathologic condition is thought to be plaque-induced15,16 and is defined as

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peri-implantitis. In the present study, one mandibular implant of the 100 placed showed signs of
peri-implantitis 9 months after implantation while already bearing the fixed restoration. The implant
showed no signs of mobility, while radiographs demonstrated signs of bone resorption in the crestal
region.
Based on the concept of osseointegration, implants are considered failures if any mobility is detected;
this parameter has often been regarded as a key factor in determining implant success.3,5,17,18 Implant
mobility is a clear sign of early failure but is a less reliable indicator of late failure when peri-implant
infection is present, and loss of firm bone anchorage appears very late because of the remaining ankylosis
in the apical portion of the implant body. All implants in the present study demonstrated stable bone
anchorage during follow-up, and no mobility was detected when manually assessed. This excellent
outcome could be related to the self-tapping design of the implant. Other authors19 have already noted
the importance of primary immobility of the implant in the adjacent vital bone during the initial healing
period.
The Plaque Index (PI) is a good parameter for evaluating patient participation in the maintenance
protocol. In the present study, the mean PLI was 0.27, indicating adequate home care. Similar results
have been reported in other studies.14,20-23 Health of the peri-implant mucosa is best evaluated by the
sulcular bleeding index (SBI). At examination, the peri-implant soft tissue of the patients in the present
study was found to be generally healthy with little tendency to bleed, reflected by the low mean SBI
value of 0.25. An increasing PD seems to be a characteristic sign of failing implant secondary to
peri-implant infection.12,24 In the present study, 89.0% of the examined sites showed a PD ranging
between 1 and 3 mm, with only 3% equal to or greater than 5 mm. The mean PD of 2.68 mm is similar to
results reported by other authors.14,20,22,23
A reference point on the implant abutment complex may be defined to evaluate the attachment level
(AL) of peri-implant soft tissues, similar to evaluating the cementoenamel junction of natural teeth.14 In
the present study, the reference point was fixed at the shoulder of the abutment, which was screw-secured
at the implant head. The mean distance between the abutment shoulder and the mucosal margin (DSM)
was –0.17 mm with a mean AL of 2.51 mm. Considering that approximately 30 of the 100 implants were
in critical esthetic locations, the mean DSM indicates that any gingival recession was minimal and that
there was good acceptance by the marginal tissue.
Because of the lack of controlled clinical studies, the role of keratinized mucosa width (WKM) in the
maintenance of peri-implant health has yet to be defined. While some authors tend to minimize its
significance,25,26 others believe it to be much more important.17 Although the importance of WKM has
not been clearly demonstrated, author preference is to have passage of the transmucosal abutment
through keratinized tissue. This was attained in 95.0% of the examined surfaces, the result of paying
particular attention to maintaining as much keratinized tissue as possible during second-stage surgery
through an apically repositioned flap and, when needed, by increasing that tissue with a free gingival
graft.

Similar results were obtained by Buser et al14 with nonsubmerged implants; in other studies20-22
with submerged implants, the WKM varied between 20% and 65%. These variations in outcome may be
caused by differences in operative approaches during the first- and, especially, second-stage surgeries,
when some keratinized tissue may have been sacrificed to gain access to the implants for abutment
placement.

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Continuous peri-implant radiolucency is considered a sign of implant failure.3,5 Of the 99 implants

assessed radiographically at times T0 (implantation), T1 (uncovering procedure), and T2 (12 months
after implantation), none showed any signs of such radiolucencies. This substantiated the results of our
clinical assessment.
Crestal bone height and its changes over time, as measured on radiographs, has also been considered
an important parameter for assessing implant success in long-term longitudinal studies.4,27 In the present
study, the implant shoulder was used as the reference point for measuring the distance to the first visible
bone contact on the mesial and distal surface of the implant (DIB). During implantation, the attempt was
always made to place the implant shoulder at the same level of the bone crest. Assuming that this was
successfully accomplished, the mean DIB value of 0.78 mm 12 months following implantation would
indicate a mean bone loss of 0.78 mm. This finding is in agreement with that of other authors.20
However, such calculations need to be interpreted with caution because differences in sink depth at the
time of implant placement may influence the position of the bone crest from the beginning. Nevertheless,
it is useful to establish a baseline at the 1-year postoperative examination for subsequent long-term
follow-up of the bone crest level and to better understand the trend of peri-implant bone behavior.
Several studies have shown that the long-term prognosis of dental implants strongly depends on the
degree of tissue integration during the first year following implantation.17,28 In the present study, 99
implants were considered successfully integrated 1 year after implantation. The remaining one implant
developed peri-implant infection 9 months into the study and was treated with systemic and local
antibiotics. The future of this implant is questionable and presently under continuing scrutiny.

Some authors27 have stated that to attain clinical results similar to those yielded by Brånemark im
plants when other implant systems are used, it would be desirable that the latter had a smooth surface
closely resembling that of the Brånemark system. The same authors rejected the Swede-Vent implant
from their clinical trial because it had, besides some surface contaminant, a rougher surface than that of
one of the standard Brånemark implants, which was probably the result of a different machining
procedure and an acid-etched finish. However, other authors have reported significant superiority in
achieving direct bone-implant contact when using implants with a rough surface compared with those
with a smooth surface.29-31 The results of our study, in which a success rate of 99% was attained 1 year
after implantation using screw implants with a rough (acid-etched) surface and a modified thread design,
substantiate these findings. Such implants, when used in conjunction with appropriate techniques, can
become osseointegrated and yield predictable good results.
Summary
The data relative to the 1-year follow-up of 100 Minimatic screw implants made of titanium alloy with
rough acid-etched surfaces are presented. After a healing period of 4 to 6 months, at the time of
second-stage surgery, none of the implants showed signs of mobility, infection, or bone loss. Treatment
consisted of fixed prostheses. Twelve months after im plantation, all 63 of the patients were available for
evaluation, and the 100 implants were assessed using the following clinical indexes: Plaque Index;
sulcular bleeding index; probing depth; attachment level; distance between the UCLA abutment shoulder
and mucosal margin; width of keratinized mucosa; and hand-tested mobility. Periapical radiographs were
taken preoperatively, immediately after surgery, at the time of the uncovering procedure, and 12 months
following surgery. Based on these indexes, 99 implants were considered successful, and 1 (which
developed peri-implant infection) was considered a failure. The results of the present study support the

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opinion that implants with a rough acid-etched surface allow for reliable tissue integration and yield
predictable results.

Dario De Leonardis

Clinical Assistant Professor, Center for Dental

Implants, Department of Oral and Maxillofacial
Surgery, University of Miami, School of Medicine,
Miami, Florida; Private Practice, Rome, Italy.

Arun K. Garg

Associate Professor of Surgery, Department of

Oral and Maxillofacial Surgery, University of
Miami, School of Medicine, Miami, Florida.

Gabriele E. Pecora

Associate Clinical Professor, Department of Oral

and Maxillofacial Surgery, State University of New
York at Buffalo, Buffalo, New York; Adjunct
Associate Professor of Endodontics, University of
Pennsylvania, Philadelphia, Pennsylvania.

Sebastiano Andreana

Research Associate, Departments of

Periodontology and Oral Biology, State University
of New York at Buffalo, School of Dental Medicine,
Buffalo, New York.

Footnotes 9
FIGURES

Figure 1a-b

Figs. 1a and 1b Photomicrographs of scanning electron microscopy of the rough acid-etched

surface of the titanium alloy Minimatic implant at magnification ×75.0 (left) and 226 (right).

Figure 2

Fig. 2 Measurement of DIB as the distance between the first visible bone-implant contact and
the implant shoulder

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Figure 3

Fig. 3 Clinical attachment level (AL) is calculated by adding the probing depth (PD) to the
distance between the UCLA abutment shoulder and the mucosal margin (DSM).

TABLES

Table 1

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Table 2

Table 3

Osseointegration of Rough Acid-Etched Implants: One-Year Follow-up of Plac

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