DENTAL IMPLANT COATING : MATERIALS AND TECHNIQUES (A REVIEW)

Nowadays, dental implants provide a reliable treatment option in oral rehabilitation of

partially or fully edentulous patients. Dental implants have become a standard procedure for
single tooth replacement in the esthetic zone, providing many advantages but also challenges
in sophisticated patients (Smeets, 2016). Titanium (Ti) is the most widely used material for
dental implants due to ist minimal toxicity, resistance of corrosion, high mechanical resistance,
and biocompatibility.
Osseointegration consist of a series of bone modeling and remodeling processes. It has
actually been defined as the direct structural and functional connection between living bone
and the surface of an artificial implants (Xuereb, 2015). There are several theories about
osseointegration process, and one of the theories is that osseointegration started with the
presence of a layer of connective tissue or fibro-osseus ligament between the implant surface
and the adjacent bone. The presence of bone adjacent to the implant surface is determined by
the surgical technique and also by the implant material, design and surface texture.

1. Carbon Coatings
Demri et al (2009) and Junker et al (2012) have reported a trial of carbon coating
for titanium dental implants. Thin carbon film with a chemical composition of
Ti0.5O0.3C0.2 has been used to coat Ti implants. Carbon-coated implants were
reported to give good and stable chemical inertia between the carbon coating and the
etching agent used. Grabarczyk (2006) reported that carbon coating were also
hemocompatible, histocompatible, biostable, and chemically stable in vitro and in vivo.
The corrosion resistance of the carbon could be improved by plasma immersion ion
implantation and deposition or by direct carbon bonding. The direct carbon bonding
actually allows for osteoblast adhesion and proliferation at the surface of the nickel-
titanium shape memory alloy.

2. Biophosponate
Goto et al (2003) reported that biophosponates have special characteristic, they
have selective inhibition of osteoclasts, with an increase in bone quantity and increase
in osteoblasts activity. In a study by Yoshinari et al (2010), they found that
biophosponate immobilized on the surface of titanium implants and combined with
 hidroxyapatite coatings, provided a good osteogenic potential with no toxicity
manifested on the osteoblast.

3. Bone Stimulating Factors (BSF)

Bone stimulating factors are very important during the osseointegration process,
and by incoporating these components as coatings, the bone density in the peri-implant
area, together with the prosthesis biocompatibility, can be improved. A study by
Bensho et al (2009) reported that dental implants with BSFs coating provided
increasing bone strength at the bone-implant surface when compared to controls
withount BSFs coating.

4. Bioactive Glass and Bioactive Ceramics

Oshida et al (2010) reported that bioactive glass and ceramic (silicon dioxide)
as dental implants coating showed an increasing in osteoblasts formation, and had
same speed with dental implants with HA coating. The disadvantages of silicon
dioxide as implant coating is the limitation of use in load-bearing areas. Silica contents
above 60% weight would delaminate and crack during the implant insertion.

5. Hydroxyapatite (HA)
Many researches have been reported about hydroxyapatite effectiveness as
dental implant coating material. Hagi et al (2010) reported that cultures grown in HA
gave an increased alkaline phosphatase expression and parathyroid hormone (PTH)
response in the surrounding medium. It was assumed that with the presence of PTH,
there will be an increasing in osteoblast activity, followed by rapid bone modelling
around the implants. According to Oshida et al (2010), HA long-term prognosis is still
questionable, and more research about the behaviours of HA as implant coating
material needed. As the most used material as dental implant coating, HA still needed
to be investigated and optimized more, in order to make HA a great option for dental
implant coating material. One thing that still be a concern of HA is that HA does not
have long-acting release characteristic. Meanwhile, dental implants need osteoblast
activity for quite long time, so the osseointegration process can be fullfiled occured in
a short time. HA usually released and gone after several weeks post implant insertion,
although osseointegration still undergo, so there will be a period when osteoblast
working without the help form HA
Smeets, R., Stadlinger, B., Schwarz, F., Beck-Broichsitter, B., Jung, O., Precht, C., Kloss, F.,
Grobe, A., Heiland, M., Ebker, T., 2016, Impact of Dental Implant Surface Modifications on
Osseointegration, Hindawi Publishing.

Xuereb, M., Camilleri, J., Attard, N., 2015, Systematic Review of Current Dental Implant
Coating Materials and Novel Coating Techniques, The International Journal of Prosthodontics,
Vol 28(1) : 51-59.