SURFACE MODIFICATIONS OF TITANIUM IMPLANTS

SURFACE MODIFICATIONS OF TITANIUM

IMPLANTS
Surface roughness has been identified as an important parameter for implants and its capacity for
being anchored in bone tissue. It is important to acknowledge that the surface chemistry and
surface phase composition of the implant surface will change by altering the surface roughness.
Commercially available implants have been categorized according to the roughness value (Sa)
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into 4 groups by Albrektsson & Wennerberg in 2004 into-

 smooth (Sa < 0.5 μm)

 minimally rough (Sa = 0.5-1.0 μm)
 moderately rough (Sa = 1.0-2.0 μm)
 rough (Sa > 2.0 μm).

The Sa value represents the mean height of peaks and pits of the surface, while another important
parameter is Sdr, which represents the developed surface area compared to a perfect flat area.
With a larger surface area a larger contact to the bone tissue could be obtained. For Sa
measurements different factors will affect the outcome result as the type of equipment used, the
area of analysis, the filtering process of the raw data, the cut-off values as well as where on the
implant the measurements are performed.

Surface roughness

The role of surface topography has been the interesting area of investigation in implant dentistry
for several years. Response of the tissues to the implant is largely controlled by the nature and
texture of the surface of the implant. Compared to smooth surfaces, textured implants surfaces
exhibit more surface area for integrating with bone via osseointegration process. Textured
surface also allows ingrowth of the tissues.

Several types of implant surface textures are currently available for clinical use. Some of these
have the ability to enhance and direct the growth of bone and achieve osseointegration when
implanted in osseous sites. Most implant systems of this category are based on the fact that bone

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tissue can adapt to surface irregularities in the 1 – 100 micron range, and that altering the surface
topography of an implant can greatly improve its stability.

Primary aim of the surface texturing or treating the implant surface is to enhance cellular activity
and improve bone apposition. Studies using endosseous dental implants in human clinical trials
indicated that rough surfaces integrate better with the bone than those materials with relatively
smooth surfaces. With few animal studies, low success rates were observed when implantation
was done in the posterior maxilla (with cancellous bone) as compared to denser bone elsewhere
in the mouth. When the bone volume and the quality are poor, an implant with greater surface
roughness is indicated.

Based on the scale of the features, the surface roughness of implants can be divided into-

 Macro
 Micro
 Nano

Macro modifications: Dental implants have a surface roughness in the range of millimetres to
microns. Because the size of the topography is large (roughness more than 10 µm), it is directly
related to implant geometry, (example: threaded screw, solid body press-fit designs and/or
sintered bead technologies). Screw threaded implants are designed to achieve a compressive
loading of the surrounding cortical or cancellous bone (Fig.10). Sintering technologies are used
to create mesh or sintered beads on the surface of the implant to facilitate the growth of bone.
Macro-sized topographies with high rough surfaces help in initial implant stability and provide
volumetric spaces for growth of bone. However, high surface roughness may result in an
increase in ionic leakage as well as peri-implantitis.

Fig 10: Implant surface

design

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Micro modifications: Dental implants have a surface roughness in the range of 1 – 10 µm.
Microsurface roughness attempts to enhance the osteoconduction (in-migration of new bone)
through changes in surface topography, and osteoinduction (new bone differentiation) along the
implant surface by utilizing implant as a vehicle for local delivery of bioactive agents (adhesion
matrix or growth factor such as BMP).

Implant surfaces with microtopographies have shown greater percentage of bone-to-implant

contact when compared with machined or polished titanium surfaces. Improved bone bonding
and accelerated bone formation appears to be possible with roughened surfaces modified with
certain acid treatments. Sandblasted and acid-etched surfaces have shown improved bone
apposition in histomorphometric analyses. These studies indicate that surface modification
improves osseointegration of the implant surface with the bone and suggests a synergistic
mechanism to enhance bone formation by a combination of macro and micro modifications of
the implant surface (Fig.11).

Fig 11: Micro surface modifications

and the resultant surface
topographies

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Nano modifications: Physical approach by compaction of nanoparticles (such as titanium

dioxide), molecular self-assembly method, chemical modification by acid/alkaline treatment or
peroxidation, nanoparticle deposition (such as sol-gel and discrete crystalline deposition) have
been used to create nanotopographies on the implant surfaces. Nano-sized topographic profiles
on the implant surface may play a role in the adsorption of proteins, adhesion of osteoblasts and
thus affect the rate of osseointegration (Fig.12). Acid etching of the grit blasted implant surface
increases the surface roughness by creating a nanotopography that allows bone ingrowth. One of
the drawbacks of the nanotopographies is the reproducibility in the roughness values.

Fig 12: Nano topographies play a

role in adhesion of osteoblasts

Primary goal of current strategies is to provide an enhanced osseous stability through micro and
nanosurface features. These strategies can be divided into those that attempt to enhance bone
ingrowth (e.g. osteoconduction), through changes in surface topography (e.g. surface roughness)
and the biological means to manipulate the type of cells that grow onto the implant surface.

METHODS FOR EVALUATION OF SURFACE ROUGHNESS

There are 3 major groups of instruments that can supply quantitative and qualitative data for
surface topographic evaluations: mechanical contact profilometers, optical profiling instruments,
and scanning probe microscopes.

1. Mechanical Contact Profilometers

The principle of mechanical contact profilometers (contact stylus instruments) is that a pick-up
with a stylus is traversed over the surface at a constant velocity. Most mechanical contact
profilometers use a diamond tip as a stylus. The tip, attached to a cantilever, is drawn across the
surface in the X direction (Fig.13).

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Vertical movements of the cantilever are registered in an analog or digital signal, and a profile of
the surface is recorded. Standard tips for mechanical profilometers are often produced with a
radius of 2 or 10 μm and an angle of 60 or 90 degrees. Naturally, this will determine the smallest
pits the tip can enter and the steepest slopes that may be measured. The tip is always in contact
with the sample and is therefore exposed to wear and contamination.
Inspection in a light microscope before measurement is recommended. For 3-dimensional (3-D)
images, after one scan is performed, the tip moves back to its starting point, and the cantilever is
indexed in the Y direction before another scan is made. The step in the Y direction can be set
from 1 to several μm. In implant research, contact profilometers have been used almost
exclusively for cylinder and flat sample investigations in dental related research and for
roughness evaluations of experimental and retrieved orthopedic implants. However, the design of
the implant can determine which instrument can be used and where the measurements can be
performed. Discs and cylinders can be measured with a mechanical contact profilometer, while
only selected parts of a screw design can be measured with this method.

Fig 13: Mechanical contact

profilometer

When screw-type dental implants have been evaluated with a contact profilometer, there is
generally no information given about precisely which regions of the screws were actually
measured. However, the measurements must refer to some areas without threads, since a
mechanical contact profilometer cannot evaluate threaded regions, which is a serious
shortcoming with that method in implant evaluations. The hardness of the implant material is

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another factor that needs to be considered. If the material is too soft, the surface will be damaged
from the load applied on the tip. This is a drawback for all contact systems. Typically applied
loads for mechanical contact instruments are in the milligram range, while for atomic force
microscopy (AFM), the typical load is in the microgram range.

Advantages-
These instruments generally have a large horizontal measuring range (typical 100 x 100 mm) and
a vertical range up to 8 mm. They are suitable for evaluating large, rough areas, eg, blade-type
implants, and for measurements of deviation in form, for example, in relation to wear.

Disadvantages-
Mechanical contact profilometers cannot be used for nondestructive evaluations of screw-type
dental implants, since the tip cannot evaluate threaded parts. Surface roughness may differ
significantly at different locations of an implant.

2. Optical Profiling Instruments

There is a wide range of different optical instruments. Because they are non-contacting, these
methods are attractive in biomaterial research since many biomaterials have soft and vulnerable
surfaces. Optical instruments are generally faster and have better resolution than mechanical
contact instruments. As was the case for mechanical contact profilometers, optical instruments
have been used mainly in experimental studies evaluating discs or cylinders. For topographic
characterization of oral implants, the most applicable methods are the following three-

Focus Detection Systems- These systems use a light beam as an optical stylus about 1 μm in
diameter. The light beam is scanned over the surface by moving the sample, the light beam, or
the objective. The focus is determined by detecting the light intensity. The beam size, the
numerical aperture, and the wavelength of the illuminating light determine the lateral resolution,
which is normally 1 to 1.5 μm, while maximum vertical resolution is about 5 nm. The maximum
vertical measuring range is approximately 500 μm, and the maximum lateral measuring range

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could be as high as 300 x 300 mm. Surface irregularities with slopes exceeding 15° are difficult
to measure because of scattering of the reflected light.

Confocal Laser Scanning Microscopy- A specially designed focus detection system that
employs confocal laser scanning microscopy (CLSM). The reflected light and the XYZ position
of the laser spot (He-Ne) are measured simultaneously. The system adjusts the focus point by
point, independently of previous measures, which reduces integration errors. Two pinholes
reduce the light entering the detector from out-of-focus details, resulting in fine vertical
resolution. Furthermore, the CLSM technique is also less prone to overevaluation of surface
roughness. It has a maximal measuring area of 2 x 2 mm and maximal vertical range of 108 μm.
The vertical resolution is 6 nm and the lateral resolution is 0.6 μm. Maximal slopes of surface
irregularities that can be measured are 30°. The accuracy and reliability of this instrument were
evaluated, and it was found to be well suited to topographic characterization of oral implants and
other biomaterials (Fig.14).

Fig 14: Confocal Laser Scanning

microscope

White Light Interferometer- A light beam is separated into 2 beams; one is reflected from a
reference plane and the other is reflected from the surface of the sample to be measured. Surface
irregularities will cause phase changes in the reflected light; some waves cancel each other out,
while others augment each other. The dark and light fringes are then no longer straight and
equally spaced (as they are for optically flat surfaces). The degree of fringe modulation is
proportional to the surface height. Each point of the surface is measured independently of the

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previous measure, reducing integration errors. Some commercially available systems have a
maximum lateral measuring range (depending on magnification objectives) of 200 x 200 μm and
a maximal vertical range of 2 mm. The vertical resolution is about 0.1 nm, and the horizontal
resolution is about 0.4 μm.

3. Scanning Probe Microscopes

Scanning probe microscopes (SPM) measure the interaction between a sharp tip and the sample
surface. The tip is attached to a cantilever, and the vertical movement of the cantilever during
surface scanning is registered. The method uses a very fine tip (radius of 6 to 60 nm), which is
drawn over the surface at constant speed and pressure. A tapping mode is also available in which
the tip oscillates above the surface, just touching the surface at the bottom of its swing. The
position of the tip is monitored by a detection system. The typical measuring range is 100 x 100
μm, and the maximum vertical range is about 6 μm. The vertical resolution is very fine, down to
the picometer level, and the horizontal resolution is claimed to be about 100 pm (Fig.14, Fig.15).

Advantages-
Because of the very high resolution of this technique, structures as fine as a protein molecule
can be visualized and characterized. The relationship between surface roughness and biologic
processes can be studied. Measurements can be performed in air or in liquid.

Disadvantages-
The measuring area and especially the maximum measuring range in the vertical direction are
too small for many implant surfaces. This means that measurements are not always possible or at
least that the measured area has to be very selective, implying that the measurement may not be
representative for the overall surface roughness. In addition, the threaded part of dental implants
cannot be evaluated in a non-destructive manner, making this technique unsuitable for evaluating
the most commonly used types of oral implants.

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Fig 14: Schematic

drawing showing the
areas of a threaded
implant that need to be
measured.

Fig 15: Two different profiles-

numerically and visually. Area
measurement of the same
sample includes all features
and identification of the
surface structure. A dip in the
profile represents a pit or a
trough.

Properties of major types of measuring instruments

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Classification -1

 Ablative/Subtractive processes-

Eg: Grit Blasting, Acid Etching, Anodisation, Laser peening

 Additive processes-

Eg: Plasma Spraying, Electrophoretic Deposition, Sol Gel coating, Biomimetic precipitation

Classification -2

Based on texture obtained, the implant surface can be divided as:

 Concave texture: mainly by additive treatments like hydroxyapatite coating and titanium plasma
spraying.
 Convex texture: mainly by subtractive treatment like etching and blasting

Classification -3

Based on the orientation of surface irregularities, implant surfaces are divided as:

 Isotropic surfaces: have the same topography independent of measuring direction.

 Anisotropic surfaces: have clear directionality and differ considerably in roughness.

Classification -4

 Physicochemical: modification of surface energy, surface charge and surface

composition to improve the bone-implant interface.
 Morphological: alteration of surface morphology and roughness to influence cell and
tissue response to implants
 Biochemical: increased biochemical interaction of implant with bone

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