Journal of Advanced Clinical & Research Insights (2016), 3, 215–219

R E V I E W A R T I LC E

Surface modifications of titanium implants – The new, the

old, and the never heard of options
Begum Fouziya1, M. A. Uthappa1, Deepthi Amara2, Nigel Tom1, Sharadha Byrappa1, Kiran Sunny1
1
Department of Prosthodontics, Coorg Institute of Dental Sciences, Virajpet, Kodagu, Karnataka, India, 2Department of Oral and Maxillofacial Surgery, Coorg
Institute of Dental Sciences, Virajpet, Kodagu, Karnataka, India

Keywords Abstract
Acid-etching, biomimetic, electrophoretic, Successful implant osseointegration requires an ideal biochemical environment for safe
laser, microroughness, nanotechnology,
integration into the jaw bone. To achieve better osseointegration, implant surface plays
osseointegration, sandblasting, sputter,
a vital role for the cellular level molecular interaction. Hence, various surface treatment
topography
options have been adopted as the latest course of action for the titanium (Ti) implants.
Correspondence This review throws a light on various methodologies of surface treatments and their
Dr. Begum Fouziya, Department of pursuance on Ti implants, also the different responses observed by various surface
Prosthodontics, Coorg Institute of Dental designs and coatings.
Sciences, Virajpet, Kodagu, Karnataka, India.
Phone: +91-8277772857.
E-mail: [email protected]

Received 1 October 2016;

Accepted 20 October 2016

doi: 10.15713/ins.jcri.142

Introduction only increases the implant stability while healing but also
improves the osseointegration by inducing bone formation.
In the past 20 years, the prosthetic rehabilitation option for patients Microroughness can be incorporated by threaded design
with partially and completely edentulous arch has been taken over by and by producing macroroughness on Ti surface. To amplify
dental implants. Clinical success of dental implant can be attributed the interlock formation between implant surface and the
to their early osseointegration. The beneficial combination of bone, microroughness within the range of 1-10 µm should be
biocompatibility, mechanical strength, and chemical stability of added. The microrough surface on implant surface attained
pure titanium (Ti) and Ti alloys is highly documented and hence by immersing it for few minutes in a mixture of concentrated
they can be used as standard materials in oral implantology. HCl and H2SO4 above 100°C. The rate of osseointegration is
Branemark et al. discovered the concept of osseointegration, which influenced by the surface profile in the nanometer range as it
changed the course of dentistry by introducing concept of oral helps in adsorption of protein and adhesion of osteoblastic cells.
implant in fixed treatment modality. Smooth surface and machined These methods use plasma spraying (PS), blasting with ceramic
Ti implants have been used successfully in the field of implantology particles, anodization, and acid-etching.[2,3]
for past 50 years. Such implants have been tested on animal models Implant surface quality has been classified by Albrektsson
by biochemical and histological evaluation, employing long term and Wennerberg into:
in vivo studies. Various surface modifications of implants which 1. Mechanical,
have been introduced are only to promote osseointegration with 2. Topographic, and
accelerated and stable bone formation.[1] 3. Physicochemical properties.

Surface roughness of dental implants Micron-scale surface topography and nanotechnology

Depending on the different surface treatments exposed altering the surface reactivity
onto the Ti, its surface roughness has been classified as Implant to bone integration may be determined by nanoscale
micro-, macro-, and nano-roughness. Surface roughness not and micron-scale parameters of implant surface texture. When
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Fouziya, et al. Implant surface treatments

implant topography is altered by nanoscale alterations, it affects A maximum implant roughness of 1.5 µm is required to attain
the chemical reactivity, ionic, and biomolecular interactions maximum biologic response.[1,4]
between the implant and bone. Suggested advances are
increased wettability, modified protein adsorption, and latent Acid-etched surface
mineralization phenomenon.[2] Ti dental implant surface can also be roughened by etching with
strong acids such as HCl, H2SO4, HNO3, and HF. It produces
Different Surface Treatments micropits of 0.5-2 mm in diameter on Ti surfaces by immersing
implants for few minutes in a mixture consisting of concentrated
Classification HCl and H2SO4 which is heated above 100°C. Dual acid-etching
accelerates the osteoconductive process, by directly forming
• Subtractive treatments bone on the surface of the implant, through fibrin and osteogenic
• Machined cell attachment.
• Sandblasted The oxide layer on the Ti surface can be removed by acid-
• Acid-etched surface etching, and the roughness is dependent on the bulk of material,
• Dual acid-etching surface microstructure, acid, and soaking time.[6]
• Sandblasted and acid etched surface (SLA) When Ti reacts with fluoride ions, it forms soluble TiF4
• Laser treatment species. Fluoride-treated Ti surface produced surface roughness
• Additive treatments as well as favorable osseointegration.
• Anodization Chemical treatments also have the potential to improve
• Fluoride surface treatment implant anchorage in bone by rendering the implant surface
• Nanostructured surface bioactive. Nevertheless, mechanical properties of Ti can be
• Spraying plasma reduced by chemical treatments. For instance, acid-etching can
• Ti lead to hydrogen embrittlement of the Ti, creating microcracks
• Hydroxyapatite (HA). on its surface that could reduce the fatigue resistance of the
• Coating sol-gel implants.[5,7]
• Sputter deposition
• Electrophoretic deposition Dual acid-etched surface
• Biomimetic precipitation
• Drugs incorporated. By immersing Ti implants for few minutes in a mixture
of concentrated HCl, H2SO4 and heated above 100°C to
Machined surface (turned surface) produce microroughness on its surface and to enhance the
The presence of crease, crinkle, and splotch by the device used osteoconductive process through the fibrin and osteogenic cell
for the manufacturing on the surfaces of machined implants attachment, resulting in bone formation (dual acid-etching).
provides mechanical interlocking, and it has been documented Advantage of this technique is that it produces high
by scanning electron microscopic analysis. The morphology adhesion and enunciation of platelet and extracellular genes,
of non-treated implants (machined) enables the growth of which help in immigration of osteoblasts at the site and benefit
osteoblastic cells into the grooves on the surface, which is a osseointegration.[2,6]
disadvantage. The machined implant surface is considered to be
minimally rough. Machined implant surfaces have Sa values of Sandblasted and acid-etched surface (SLA)
0.3-1.0 µm. This feature requires a longer waiting time between It is done by a process of blasting (large grit 250-500 µm) and
surgery and implant loading.[4] by etching the implant surface with hydrochloric/sulfuric acid. It
produces microtexture and results superior bone assimilation as
Sandblasted surface related to the above-said methods.
Another approach for roughening the Ti surface consists blasting This procedure creates a new hydrophilic surface (SLActive)
the implants with hard ceramic particles. Different surface and allows the SLActive to maintain a chemically active surface.
roughness which produced on implant surface depends on the Anions also can be added, which are taken from acids such as
size of the ceramic. The surface roughness usually found to be fluoride ions (when etched with hydrofluoric acid) into the
anisotropic because of craters, ridges, and occasionally particles oxide layer.
enclosed on the surface. Studies have shown that SLActive implants produce a greater
Other ceramic particles which were used are alumina, Ti bone contact and stability at early healing phase (6 weeks) when
oxide, and calcium phosphate. Alumina (Al2O3) is frequently correlated with SLA implants and fasten healing times.[2,6,7]
used as a blasting material. These particles hamper the process of
osseointegration when released into the surrounding tissues, and Laser treatment
physiological environment may decrease the excellent corrosion The laser ablation technology develops microstructures on Ti
resistance of Ti implant.[5] implant surface which aids in osseointegration by increasing its

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Implant surface treatments Fouziya, et al.

hardness, resistance to corrosion, and a large quality of purity Nanostructured surfaces for implant dentistry
with a definitive roughness and compact oxide layer. Biological Nowadays, only a fewer nanoscale surface changes have been
studies have figured out; the importance of laser ablation on used to upgrade bone responses of clinical dental implants. The
implant surface and chemical properties revealed that creased OsseoSpeed surface contains nanostructured details produced
surface of implant is necessary to adapt osteoblast cell attachment by TiO2 blasting followed by hydrofluoric acid treatment.
and control its direction of ingrowth. Most of the osteoblastic gene expression was checked in cells
The advantages of this technique are that there is no chemical attached to the nanoscale HF coated surface related to the
so better to use in manufacturing on routine basis. In vivo studies micron-scale surface. This nanotopography is related with the
have showed a symbolic escalation in torque removal, long-term elated levels of gene enunciation that reveal rapid osteoblastic
bonding to the bone, interface strength, and different fracture differentiation.
mechanisms.[8-10] IBAD or ion beam assisted deposition when used creates
a thin film of ions over the implant surface by discharge of the
Additive surface treatments chemical element of interest.[2,11]
Anodized surface or oxidized surface Peculiar approaches applicable to layer Ti implants are:
Anodization is a process by which oxide films are deposited on • PS
Ti implant surface by means of an electrochemical reaction. • Sputter deposition
In this process, Ti surface to be oxidized plays as anode in an • Sol-gel coating
electrochemical cell with diluted solution of acids acting as the • Electrophoretic deposition
electrolyte. • Biomimetic precipitation.
Micro- or nano-porous surfaces can be formed by
potentiostatic or galvanostatic anodization of Ti in strong
Roughening of Implant Surface by PS
acids (H2SO4, H3PO4, HNO3, and HF) at high current density
(200 A/m2) or potential (100 V). The result of the anodization is PS coating is an optimized way to achieve a surface topography
to thicken the oxide layer to more than 1000 nm on Ti. and morphology. The advantage of this technique is that these
The TiUnite surface (anodized surface) is a phosphate layers give implants a porous surface making easy for the bone
enriched and partially crystalline Ti oxide with wide opening on its to penetrate more easily. Bone to implant integration was found
surface. Anodized surfaces result in a strong reinforcement of the to be flashing and ultimate striking for rough surfaces within the
bone response in comparison to machined surfaces. Depending range of 50-400 µm. Ti and calcium phosphate (HA) can be
on the electrolyte distribution, various ions could be unified in the added to the surface by spraying plasma.
oxide layer, such as phosphorus, magnesium, and calcium. They
are basically amorphous with crystalline grains of anatase. Ti
At immediate implant placement, early molecular events
These particles when envisioned on the implants where they
of healing phase and osseointegration can be accentuated by
condense and fuse together on its surface design a film which
phosphorus-containing anodized surface.
measures about 30 µm thick. This layer must reach 40-50 µm
When an implant surface made of anodization and also by
thickness to be homogeneous, smooth, and rigid. Average
addition of calcium ions, it showed better osseointegration as
roughness of this layer should be around 7 µm, which increases
well as removal torques were increased.[6]
the surface area of the implant.[2]
Bone and implant interlocking through mechanical factors
which occurs due to growth of bone into those surface openings
HA coating
and provides biochemical bonding.
Modifications to the chemical composition of the Ti oxide HA is one of the materials that may form a direct and strong
layer with the incorporation of magnesium, calcium, sulfur, binding between the implant and bone tissue. Kay et al. showed
or phosphorus lead to an uplifted torque removal values in that for dental implant application, the coating of PSHA
comparison to other ions.[9] should be crystalline, and it offers compatible chemical and
mechanical properties. Thomas[9] demonstrated an elevated
Fluoride treatment bone formation and maturation around HA-layered implants
Ti implant surface showed to be very sensible to fluoride ions, in dogs when correlated with non-coated implants. Substrate
and it forms soluble TiF4 when treated in fluoride solutions. alloys when modified with HA-coated layer, it resulted in
This process on Ti heightens the osseointegration and uplifted increased corrosion resistance. The bone implant interface
osteoblastic differentiation when correlated with control revealed to be better formed than with other implant materials
samples (Ellingsen, 1995). Roughened implant surface by and with enhanced mineralization. As the surface area of bone
fluoride ion treatment also had a greater push-out forces and apposition to the implant increases, when related to uncoated
showed a significantly more advanced torque removal forces implants, which may accentuate the load bearing capacity and
than the control implants.[2] biochemical bonding.[2]

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Fouziya, et al. Implant surface treatments

Sol-gel coated implants Ti implants engrossed in pamidronate or zoledronate showed a

This approach shows a straightforward and inexpensive method noticeable escalation in bone contact area. However, the major
to apply thin layers with homologous chemical distribution disadvantage will be present in the grafting and slow discharge of
onto substrates with complex design and bigger dimension. antiresorptive drugs on the surface of Ti implant.
The advantage of this technique over bioactive ceramics is that
Simvastatin
it increases toughness of Ti alloys, biological affinity of HA,
and mechanical strength. Layering Ti implants HA which is a Simvastatin could improve the enunciation of bone
bioactive material, result in accentuated early bone formation morphogenetic protein 2 mRNA that might promote bone
during healing face and improves implant bone integration.[2] formation. Clinical studies reported that statin use is associated
with increased bone mineral density.
Sputter deposition
Antibiotic coating
Sputtering is a process, in which high-energy ions are discharged
in a vacuum chamber to change the surface texture of a Ti Antibacterial coatings on the surface of implants provide
implant surface. antibacterial activity to the implants themselves and serve as a
possible way to prevent surgical site infections associated with
Radio frequency sputtering implants.
Gentamicin in combination with HA when layered onto
This procedure involves the formation of thin films of CaP
the surface; it will behave like a local prophylactic agent.
coatings on Ti implants. The choice of this technique could be
Tetracycline-HCl treatment can be used as practical and efficient
due to formation of strong adhesive link/bond between the Ti
chemical method for decontamination and detoxification of
and CaP ratio, and it also depends on crystallinity of the layered
harmed surface of implants.
CaP.
Further, it hinders collagenase activity, accentuates
proliferation of cells as well as attachment and bone healing.
Magnetron sputtering
Tetracycline also enhances blood clot formation and its
This process sustains the bioactivity of the coated HA by attachment and retention on the implant surface during the early
maintaining mechanical qualities of Ti. There will be formation healing phase and thus it accentuates osseointegration.[2]
of the TiO2 layer at the bone and implant interface which
establishes the strong bond due to the outwardly diffused Ti into
the HA layer.[2] Conclusion
The endosseous dental implant has become a scientifically
Biomimetic calcium phosphate coatings accepted and well-documented treatment for fully and partially
In this method, Ti implant surface will have PSHA coating, which edentulous patients because of their good biocompatibility and
is inspired by the natural process of ion mineralization. There mechanical properties. The complex consequence of surface
is surface modification by condensation of calcium phosphate energy, composition, roughness, and surface texture of implant
apatite crystals onto the surface of implants from simulated body disposes its capacity to osseointegrate.
fluids formed a coating at room temperature. These surface modifications have encouraged the success
It has been shown that such biomimetic coatings are more rate of the implant therapy, in patients with poor quality of bone,
soluble in physiological fluids and resorbable by osteoclastic cells and have notably decreased the healing period even though
such as dentin materials than high-temperature coatings such as exact role of surface alterations has not understood. However,
PSHA.[11] the development of these surfaces has been empirical, requiring
numerous in vitro and in vivo tests. Most of these tests were
not standardized, using different surfaces, cell populations,
Biologically Active Drugs Incorporated Dental or animal models. Moreover, correlative clinical studies with
Implants various implant surfaces are notable achieved. The future of
Incorporation of some osteogenic and antiresorptive drugs, dental implantology should aspire at establishing surfaces with
such as bisphosphonate onto the implant surface, can be used standardized surface chemistry of a Ti dental implant which
appropriately in clinical cases with inadequate bone support.[2] implies to be assuring to enhance osseointegration.

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