BIO-MATERIALS IN IMPLANTS

BY,
DR.SIDDARTH SAS
Introduction
 The restoration of missing teeth is an important aspect of modern dentistry
 There is a demand for replacing missing teeth for esthetics and functional aspect
 Conventional methods of restoration includes R.P.D, F.P.D, C.D
 Each method have their own advantages and disadvantages
 Removal of Partial Denture one or more times per day – inconvenience to young
patients (it’s a major drawback)
 Bulky, un esthetic, complicate chewing – Removable Partial Denture.
 F.P.D seems to be more natural and convenient but they need adjacent teeth
preparation  secondary decay, irreversible pulpitis.
 Complete Denture-
 Bulky in nature- major drawback
 Structural variation of tissue- resorption
 Instability of denture.
 Loss of masticatory efficiency.
 Implants overcome all this drawbacks.
DENTAL IMPLANT
According to GPT, 1999

A prosthetic device of alloplastic material(s) implanted

into the oral tissues beneath the mucosal and/or
periosteal layer and on/or within the bone to provide
retention and support for a fixed or a removable
prosthesis; a substance that is placed into and/or upon
the jaw bone to support a fixed or removable prosthesis.

According to GPT, 2005

It is defined as a graft (a) insert which is set firmly /

deeply into the alveolar bone (which is prepared to the
insertion of crowns) to support a fixed / removable
prosthesis.
IMPLANT MATERIAL
Definition of implant material
It has been accepted that no foreign material placed with in a living
body is completely compatible. The only substances that conform
completely are those manufactured by the body itself (autogenous)
Other substance that is recognized as foreign
Initiates some type of reaction host – tissue response.

BIO MATERIAL
Definition of bio material
Any substance other than the drug that can be used for any period
of time as part of a system that treats, augments or replaces any
tissues, organ, or functions of the body.
 Classification of bio material
Classification of biomaterials according to their bioactivity
(Reaction)
1. Bio active eg., hydroxyapatite coating an a metallic
dental implants
2. Bio inert eg., alumina dental implants
3. Surface active bioglass
4. Bioresorbable
VARIOUS TYPES OF IMPLANTS
The implants may be classified based on their position & design
and materials used for it.
Classification based on implant position & design and their
properties
1. Sub periosteial
1. Unilateral
2. Bilateral
2. Transosteal (or) Staple bone implant (or) Mandibular staple
implant (or) Trans mandibular implant
3. Endosteal implant
3. Cylindrical cones (or) thin plates
4. Blade implant
5. Ramus frame implant
6. Root form implant
4. Epithelial implant (or) Sub dermal implant (or) intra mucosal
implant.
Classification based on materials used
1. Metallic
1. Titanium
2. Titanium alloy
3. Cobalt chromium
4. Molybdenum
5. Stainless Steel
2. Non metallic
6. Ceramics
7. Carbon
Classification based on bio activity
 Bio active implant
 Bio inert implant
 Bio glass implant
 Bio resorbable implant
How implant getting attached to bone
Retention of implant in the bone by two methods.
1. Mechanical – Osseointegration
1. Fibroosseous integration
2. Osseous integration
2. Chemical
Mechanical
 Mechanical inter locking between bone and implant
 Retention may be achieved by etching of the implant surface
(or) undercuts in the form of vents, slots, screws etc.,
 No chemical bond between bone and implant
 This kind of retention seen in inert metals like titanium used.
Chemical bonding
 Achieved by coating the implant surface with bio active
material e.g, Tricalcium phosphate, Hydroxy apatite.
 Chemical bond between ions on the implant surface and the
collagen of the bone.
OSSEIOINTEGRATION
Osseiointegration  Lattin word
Osseious  Bone
Integration  State of being complete whole

Definition of osseointegration (According to GPT)

1. The apparent direct attachment connection of ossesous tissue to an
inert alloplastic material with out intervening connective tissue.
2. The process and resultant apparent direct connection of an
exogenous material’s surface and the host bone tissues, with out
intervening fibrous connective tissue present
3. The interface between alloplastic material and bone
Brane mark 1983 stated “ A direct bone anchorage to an implant body
which can provide foundation support to prosthesis, it has an ability to
transmit occlusal forces directly to bone.
In 1986 Carisson stated the Direct adaptation of bone implant without
any other inter mediate tissue, similar to tooth ankylosis
Ossciointegration - How it takes
1. Osteo conduction
2. Surface bone apposition
OSTEO CONDUCTION
Bone producing cells migrate along side the implant
surface through a connective tissue scaffolding (implants
surface design) form adjacent to implant.
Surface bone apposition  encouraged microscopic surface
ridges the osseointegration can also occur by use of bio
active material  stimulate formation of bong along
surface of implant.
SURFACE BONE A POSITION
“De no vo”  bone formation where in a mineralized
interfacial matrix is deposited along the implant surface.
The surface topography will determine the bond strength
of bone to the implant surface.
Mechanisum of osseiointegration
It is same a normal bone healing primary / secondary bone
healing.
Primary healing
To duplicate primary bone healing surgery should be performed in
on healthy bone
• Free from infection
• Free from necrotic tissue
• Area should be perfectly sterilized
Process of healing
 Initially blood present between fixture and bone  blood clot
forms
 Blood clot is transformed by the phagocytic cells such as
P.M.N.L, lymphoid cells and macrophages.
 Phagocytic activity increases during the times between 1st & 3rd
day after surgery
 Procallons formation (fibroblasts, fibrous tissue &
phagocytes)
 Procallus becomes dense Connective Tissue and
mesenchymal cell differentiate into osteoblasts and
fibroblsts  callus.
 Connective Tissue + osteoblasts  seen on tissue surface
 Osteogenic fiber formed by osteoblasts  potential to calcify
 Dense Connective Tissue forms fibro cartilagenous callus
(between fixture and the bone)
 New bone penetrates and new bone matrix called bone
callus.
Bone callus
1. Increase density
2. Hardness
 At this time prosthesis is attached to fixture with the
stimulation and bone remodeling.
 Haversian bone calcifies, becomes dense and homogeneous.
 Occlusal stress stimulate surrounding bone to model and
osseointegrated  fixtures can with stand masticating
function.
FACTORS AFFECTING OSSEIOINTEGRATION
1. Occlusal load
2. Bio compatibility of material
3. Implant design
4. Implant surface
5. Implant bed (surgical site)
6. Surgical technique
7. Infection control.
Bone to implant interface – 2 theories
8. Fibrosseous – weiss theory
9. Osseo integration (Branemark’s theory)
Fibrosseous theory
States that there is a fibroosseons ligament formed between
the implant and the bone and this ligament can be considered
as the equivalent of periodontal ligament.
 Presence of collagen fibers at bone & implant interface
 Peri implantal ligament with an osteogenic effect
 Early loading of implant.
Characteristics of osseiointegrated implant
1. Direct bone anchorage support fixed prosthesis
2. Surgically designed for full arch prosthesis using 6 fixtures 
Fornoto denture (or) Fully bone Anchored prosthesis
3. Cantilevered form 2nd pre molar
4. Bilateral cantilevered section are limited to
 10 mm on each side (maxilla)
 20 mm on each side (mandible)
5mm (min) adjacent to natural teeth
Length  longer anterior posterior depends on inferior
alveolar canal position.
Elimination of fulcrum rotations in FPD (using several
fixtures – shorter fixed segments)
Free standing FPD
Soft tissue interface

 Similar to gingiva around natural teeth

 Peri implant tissues firmly surround and mechanically attach

along the abutment surface

 J.E. surrounds abutment at crevice

 C.T. adapts to abutment surface beneath.

 Hanssion (1963) normal shaped epithelial cells attach to the

oxide layer with the glycoprotein layer and no inflammatory
cells are found around abutment.
Classification of material
Metals
Gold, stainless steel, cr-co alloy, titanium, tantalum etc,
Titanium & tantalum – most commonly used.

Metals with surface coatings

Titanium substructure sprayed with - plasma spraying
hydroxy apatite,
Titanium substructure sprayed with calcium phosphate
(CaPo4) ceramic coating

Ceramics
Bioactive
Non reactive
Other materials
Carbon (vitreous)
Porous aluminium silicate
Polymers and composites (under evaluation)
STAINLESS STEEL
 Iron based alloy (steel)  1.2% carbon
 Stainless steel 12-30% chromium
 3 types (based on composition)
 Ferritic
 Martenstic
 Austenitic steel
 Austenitic steel (surgical grade) is used here
 Iron 9120C to 394oC quenched  Austenitic steel obtained
heated
Composition
18 % chromium  Corrosion resistance
8% nickel  Stabilize austenitic form (may cause allergic
reaction)
0.03 to 0.05% carbon  hardness (it should not exceed)
Properties
 High strength and ductility (resistant to brittle #)
 Modulus of elasticity 28* 106 psi
Disadvantages
 Can’t be used in nickel sensitive patients
 Susceptible to pit and crevice corrosions
 Direct contact with dissimilar metal crown should be avoided
 prevent galvanism.
 Through the mechanical properties are suitable, it is not
corrosive resistant to the extent to be used in implant.

COBALT CHROMIUM MOLYBDENUM.

 Cast and annealed for custom made implant designs.
Composition
Cobalt  63%  continuous phase for bi - phasic properties.
Chromium  30%  corrosion resistance (oxide formation)
Molybdenum  5%  serve to stabilize the structure
Carbon traces  hardener
Manganese and nickel traces.
properties
 Out standing resistance to corrosion
 Tensile strength  95 .psi
 Modulus of elasticity  34*106psi
 It has very low ductility
 Properly fabricated  good bio compatibility
 Used in sub periosteal frame work.
Advantages
 Resistance to corrosion
 High modulus of elasticity
 Long term clinical success
Disadvantage
 Poor ductility of all implant alloys
 Excessive bending should be avoided #
The grater corrosive resistance and tissue compatibility over
come by titanium.
TITANIUM ITS ALLOYS(Ti-6Al-4Va)
 Most popular implant material using today
 Pure element with an atomic no 22
 Highly reactive
 Composition  pure titanium  99.9%
 Titanium alloys Titanium 90%, aluminium6%, vanadium 4%
 Traces of nitrogen, carbon and hydrogen.
 The titanium is highly reactive metal it oxidizes (passivates) on
contact with air/normal tissue fluids. This reactivity is
favourable for implant devices. Because it minimizes bio
corrosion.
 Titanium alloys can be classified as alpha, beta, and alpha
beta alloys.

Alpha alloy
 Highest strength best corrosion resistance pure titanium small
amounts of nitrogen and oxygen (CpT1)

Beta alloy
 Difficult to manufacture (vanadium + aluminium) not used for
implant.

Alpha beta alloys

 Most common alloys consisting of 6% of aluminium 4% of

vanadium (T1 & Al64Va)
 Tensile strength of about 120,000 psi
 Corrosion resistance
properties
 Material of choice because of inert, bio compatible nature with
excellent resistant corrosion.
 Density 4.5 gm/cm2  40 % lighter than steel
 Low specific gravity
 High heat resistance
 High strength compatible with S.S
 Very resistance to corrosion
 Ability to from stable oxides like Tio2
 Titanium – more ductility than titanium alloy endosteal blade
from implants.
 High dielectric property osseointegration.
Advantages
 Osseontegration
 Biodegradative products from alloy vanadium produce
favourable tissue response.
 High corrosive resistance.

Metals with surface coatings

The term bio active  inorganic material that develop an adhered
bonded interface with bone eg., tricalcium phosphate,
hydroxyapatitie.
 The titanium substructures sprayed with
 plasma spraying, hydroxyapatite
 Calcium phosphate ceramic coating
Plasma spraying hydroxyapatite
 Improves quality of osseointegration
Procedure
 More ten droplets of titanium in plasma state are bombarded
against the implant surface with high velocity at tem. 15000oC
 Plasma stray will from a layer of 0.04 to 0.05 mm after
 Under microscopic examination, small inter connected pores
are found or plasma spray
Advantages
 Promotes bone growth
 Improves osseiointegration
Disadvantages
 May disrupt interfacial attachment
 Ion exchange reaction between the bioactive implant and the
surrounding body fluids  results in the formation of
biologically active carbonate appetite (CHAP) layer on the
implant that is chemically and crystallographically equivalent
to mineral plasma bone.
 Collagen formed is thus directly
Anchored onto the apatite - depecting
Complete osseo – intergration
CERAMICS
1. Bio active eg., hydroxy apatitite
2. Non reactive eg., bioglass, alumina sapphire.
 They are highly inert
 Bio compatible
 Moderately high modulus of elasticity
Disadvantage
 Low ductility
 Low tensile strength
Bio active by hydroxy apatite
 Calcium phosphate ceramic
 Natural mineral component of vertebrate of hard tissue
 It show direct bonding with bone similar to ankylosed tooth
 As alloplastic material to augment the high of resorbed alveolar
ridges.
The major advantage of there ceramic coatings is that they can
stimulate the adaptation of bone and they exhibit more bone
intimate bone to implant contact compared with metallic
surface.
Greater bone to implant integration hydroxyapatite coated
implants with values.

hydroxyapatite Titanium

17.1 %  7 days 1.2% – 7 days

75.9 %  3 months 45.7%  3 months

BIO GLASS
Surface active highly bio combatable
Sio2-CaO-Na2O-P2O5-MgO
Developed by L.Hench –1967.
Known to form a carbonated hydroxyapatite layer in vivo as a
result of their calcium and phosphorous content.
Formation of this layer initiated by migration of calcium,
phosphate, silica & sodium ions towards tissue as a result of
external ph changes.
Silica rich gel layer forms on the surface as elements are released
and lost.
This results in formation of calcium phosphorus layer that
simulates osteoblasts to proliferate.
These osteoblasts produce collagen fibrils that become
incorporated into the calcium phosphorus layer under later
anchored by the calcium phosphorus crystals.
Which forms strong bone bioglass interface
Bioglass – bio active material – stimulate the formation or
bone
This materials often used as grafting materials ridge
augmentation or bony defects than as coating materials for
metallic implants.
Even though they have osteoinductive ability bioglasses are
also very brittle, which makes them unsuitable for use as
stress bearing implant materials
 Fig - 2

Fig - 1
  The rationale for coating the hydroxyapatite on metal
surface
1. Fast bony adaptation
2. Reduced healing time

Advanced bio ceramics

 Composition similar to biological tissue
 Chemical bonding implant of bone
 Modulus of elasticity equal to that of bone
Disadvantage
 Bone tensile & shear strength
Non reactive ceramic
 Well tolerated by bone
 But not promote bone formation
 High strength
 Stiffness
 Hardness
 Abutment F.P.D. mouth
Carbon compounds
vitreous carbon were developed in 1975 to enhance bio
compatibility. Connective tissue interface between implant and
bone is comparable to that of periodontal ligament. These implants
were not very successful because they did not exhibit long term
clinical stability other carbon implants are
 Pyrolytic carbons
 Glassy carbons
 Vapour deposited carbons.

Polymers and composites

polymeric bio material have been used as implant material as
well as surface coating the various polymer which used include.
 Ultra high molecular weight polymers
 Poly tetra fluro ethylene
 Fibre reinforced polymers
the major dis advantages with these materials is their low
strength, high ductility.