High-voltage electron microscopy and conventional transmission electron microscopy of the interface zone between bone and endosteal dental implants

Dental Implants

The goal of modern dentistry is to return patients to oral health in a predictable fashion. The partial and complete edentulous patient may be unable to recover normal function, esthetics, comfort, or speech with a traditional removable prosthesis. The patient’s function when wearing a denture may be reduced to one sixth of the level formerly experienced with natural dentition; however, an implant prosthesis may return the function to near-normal limits. The esthetics of the edentulous patient is affected as a result of muscle and bone atrophy. In order to replace a missing tooth, the development of materials science and technology improved the materials for implant application. Nowadays, titanium has become the most popular implant material due to its advantages. The first submerged implant placed by Strock was still functioning 40 years later. Recently, zirconia implants and innovative surface designs are being researched and practiced. In this chapter, these materials will be comparatively discussed through contemporary literature and research.

Osseointegration and current interpretations of the bone-implant interface

Complex physical and chemical interactions take place in the interface between the implant surface and bone. Various descriptions of the ultrastructural arrangement to various implant design features, ranging from solid and macroporous geometries to surface modifications on the micron-, submicron-, and nano- levels, have been put forward. Here, the current knowledge regarding structural organisation of the bone-implant interface is reviewed with a focus on solid devices, mainly metal (or alloy) intended for permanent anchorage in bone. Certain biomaterials that undergo surface and bulk degradation are also considered. The bone-implant interface is a heterogeneous zone consisting of mineralised, partially mineralised, and unmineralised areas. Within the meso-micro-nano-continuum, mineralised collagen fibrils form the structural basis of the bone-implant interface, in addition to accumulation of non-collagenous macromolecules such as osteopontin, bone sialoprotein, and osteocalcin. In the published literature, as many as eight distinct arrangements of the bone-implant interface ultrastructure have been described. The interpretation is influenced by the in vivo model and species-specific characteristics, healing time point(s), physico-chemical properties of the implant surface, implant geometry, sample preparation route(s) and associated artefacts, analytical technique(s) and their limitations, and non-compromised vs compromised local tissue conditions. The understanding of the ultrastructure of the interface under experimental conditions is rapidly evolving due to the introduction of novel techniques for sample preparation and analysis. Nevertheless, the current understanding of the interface zone in humans in relation to clinical implant performance is still hampered by the shortcomings of clinical methods for resolving the finer details of the bone-implant interface. STATEMENT OF SIGNIFICANCE: Being a hierarchical material by design, the overall strength of bone is governed by composition and structure. Understanding the structure of the bone-implant interface is essential in the development of novel bone repair materials and strategies, and their long-term success. Here, the current knowledge regarding the eventual structural organisation of the bone-implant interface is reviewed, with a focus on solid devices intended for permanent anchorage in bone, and certain biomaterials that undergo surface and bulk degradation. The bone-implant interface is a heterogeneous zone consisting of mineralised, partially mineralised, and unmineralised areas. Within the meso-micro-nano-continuum, mineralised collagen fibrils form the structural basis of the bone-implant interface, in addition to accumulation of non-collagenous macromolecules such as osteopontin, bone sialoprotein, and osteocalcin.

The effects of implant topography on osseointegration under estrogen deficiency induced osteoporotic conditions: Histomorphometric, transcriptional and ultrastructural analysis

Compromised bone quality and/or healing in osteoporosis are recognised risk factors for impaired dental implant osseointegration. This study examined the effects of (1) experimentally induced osteoporosis on titanium implant osseointegration and (2) the effect of modified implant surface topography on osseointegration under osteoporosis-like conditions. Machined and micro-roughened surface implants were placed into the maxillary first molar root socket of 64 ovariectomised and sham-operated Sprague-Dawley rats. Subsequent histological and SEM observations showed tissue maturation on the micro-rough surfaced implants in ovariectomised animals as early as 3days post-implantation. The degree of osseointegration was also significantly higher around the micro-rough implants in ovariectomised animals after 14days of healing although by day 28, similar levels of osseointegration were found for all test groups. The micro-rough implants significantly increased the early (day 3) gene expression of alkaline phosphatase, osteocalcin, receptor activator of nuclear factor kappa-B ligand and dentin matrix protein 1 in implant adherent cells. By day 7, the expression of inflammatory genes decreased while the expression of the osteogenic markers increased further although there were few statistically significant differences between the micro-rough and machined surfaces. Osteocyte morphology was also affected by estrogen deficiency with the size of the cells being reduced in trabecular bone. In conclusion, estrogen deficiency induced osteoporotic conditions negatively influenced the early osseointegration of machined implants while micro-rough implants compensated for these deleterious effects by enhancing osteogenic cell differentiation on the implant surface.

STATEMENT OF SIGNIFICANCE

Lower bone density, poor bone quality and osseous microstructural changes are all features characteristic of osteoporosis that may impair the osseointegration of dental implants. Using a clinically relevant trabecular bone model in the rat maxilla, we demonstrated histologically that the negative effects of surgically-induced osteoporosis on osseointegration could be ameliorated by the biomaterial's surface topography. Furthermore, gene expression analysis suggests this may be a result of enhanced osteogenic cell differentiation on the implant surface.

Proteomic analysis of bone proteins adsorbed onto the surface of titanium dioxide

Osseointegration is the structural and functional connection between bone tissues and implants such as titanium dioxide (TiO₂). The bone-TiO₂ interface is thought to contain proteoglycans. However, exhaustive analysis of the proteins in this layer has not been performed. In this study, we evaluated the bone protein adhered on the surface of TiO₂ comprehensively. Pig bone protein was extracted by sequential elutions with guanidine, 0.1 M EDTA, and again with guanidine. The proteins obtained from these extractions were allowed to adhere to an HPLC column packed with TiO₂ and were eluted with 0.2 M NaOH. The eluted proteins were identified by LC/MS/MS and included not only proteoglycans but also other proteins such as extracellular matrix proteins, enzymes, and growth factors. Calcium depositions were observed on TiO₂ particles incubated with bone proteins, guanidine-extracted proteins adhered to TiO₂ displayed significantly high amounts of calcium depositions.

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We identified bone proteins adhered on the surface of TiO₂.

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Chromatography was an useful tool for investigating the layer adhered on the TiO₂.

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The bone-TiO₂ interface contained not only proteoglycans but also other proteins.

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Some of the adhered proteins showed mineralization capacity.

Histological analysis of bone/heteroplastic implant interfaces in dog tibia

This work presents histological analysis of interfaces between bone and heteroplastic implants in dog tibias. The study was performed in four tibias (of four mongrel dogs) into which cylindrical implants were inserted. One ceramic (titania) implant and three grit-blasted titanium implants (with sandblasted and acid-corroded surfaces) were chosen for histological analysis of the implant surface/bone tissue interface. The implants remained in the tibias for eight months and none were loaded during this period. The animals were subsequently sacrificed and the samples were processed for analysis. Light microscope analysis revealed a large amount of osteoid tissue and proximity of osteoblasts and osteocytes to the implant surfaces. In addition, little or no fibrous tissue was observed between the bone and implant surfaces. The titanium implants presented better osseointegration than did the ceramic implant.

Enhanced bone integration of implants with increased surface roughness: a long term study in the sheep

OBJECTIVES

This study evaluated the quality and the remodeling of bone around commercially pure titanium implants after 3, 6, 12 and 18 month implantation periods in the sheep.

METHODS

Twelve animals were implanted in the cortico-trabecular areas of both femurs. Each femur received four implants with a rough surface (type 1) in the right femur and four with a smooth surface (type 2) in the left one. Bone blocks containing the implants were studied by histomorphometry on undecalcified specimens. The amount of bone around implants was measured (bone volume, fractional woven bone volume, bone thickness, contact interface) together with osteoblastic activity (mineral apposition rates, bone formation rates) and resorption activity (eroded surfaces).

RESULTS

No significant differences could be observed for the two types of implants between 3 and 6 months. At 12 and 18 months, bone volume and contact interface were still increasing and there was always a tendency for type 1 implants to be associated with higher values. On the contrary, mineral apposition rate, bone formation rates and eroded surfaces decreased in the referent area in contact with the implant; this phenomenon of 'return to the normal' was more evident with type 1 implants. The remodeling process appears to increase bone quality and bone-titanium interface around implants in long term periods.

CONCLUSIONS

The net bone quantity necessary to immobilize implants is obtained rapidly but the adapting process to mechanical strength can lead to a small but persistent increase in bone volume around implants. Although the differences between type 1 and type 2 implants were often small or statistically insignificant, the rougher type 1 implants seemed to be associated with stronger bone response.

Proteoglycans at the bone-implant interface

The widespread success of clinical implantology stems from bone's ability to form rigid, load-bearing connections to titanium and certain bioactive coatings. Adhesive biomolecules in the extracellular matrix are presumably responsible for much of the strength and stability of these junctures. Histochemical and spectroscopic analyses of retrievals have been supplemented by studies of osteoblastic cells cultured on implant materials and of the adsorption of biomolecules to titanium powder. These data have often been interpreted to suggest that proteoglycans permeate a thin, collagen-free zone at the most intimate contact points with implant surfaces. This conclusion has important implications for the development of surface modifications to enhance osseointegration. The evidence for proteoglycans at the interface, however, is somewhat less than compelling due to the lack of specificity of certain histochemical techniques and to possible sectioning artifacts. With this caveat in mind, we have devised a working model to explain certain observations of implant interfaces in light of the known physical and biological properties of bone proteoglycans. This model proposes that titanium surfaces accelerate osseointegration by causing the rapid degradation of a hyaluronan meshwork formed as part of the wound-healing response. It further suggests that the adhesive strength of the thin, collagen-free zone is provided by a bilayer of decorin proteoglycans held in tight association by their overlapping glycosaminoglycan chains.

Ultrastructural analyses of the attachment (bonding) zone between bone and implanted biomaterials

This report presents transmission electron and high voltage transmission electron microscopic observations of bone and associated remodeling tissues directly interfacing with endosteal dental implants. Undecalcified interfacial tissues were serially sectioned from mandibular samples encasing 60 implants placed into 30 dogs. Two-dimensional ultrastructural analyses and three-dimensional stereology showed that osteogenesis adjacent to dental implants is a dynamic interaction of osseous cells and a collagenous fiber matrix. This study showed that the interfacial bone consists of a mineralized collagen fiber matrix associated with an inorganic (hydroxylapatite) matrix. This study suggested that an unmineralized collagen fiber matrix initially is laid down directly at the implant surface, and that this matrix then is mineralized. Osteoblasts interacted with this matrix, eventually becoming encased within developing lacunae during the remodeling process. This process formed the cellular (osteocyte) aspects of the developed bone. Osteocyte processes extended through canaliculi directly to the implant surface. Apparently, these processes also were entrapped within canaliculi during the mineralization events. At times, these processes paralleled the implant surface. The bone-implant interfacial zone was primarily fibrillar (both mineralized and unmineralized) in morphology, with an electron-dense, ruthenium positive deposition. This electron-dense material was approximately 20 to 50 nanometers in thickness, and only this thin layer separated the remodeled mineralized bone from the implant.

A transmission electron microscopy examination of the interface between osteoblasts and metal biomaterials

Transmission electron microscopy was used to examine the interface between metal implant materials and bone cells. Specifically, neonatal rat calvaria osteoblasts were cultured on CoCrMo alloy and on 316L stainless steel discs (mechanically polished to a 0.3 micron finish) in Dulbecco's Modified Eagle Medium (supplemented with 10% fetal bovine serum, 50 micrograms/mL ascorbic acid, and 10 mM beta-glycerophosphate) under standard, sterile, cell culture conditions for 14 to 28 days. At the end of the prescribed time periods, the cells were fixed and embedded in resin before removing the metal substrates using an electrolytic dissolution technique and a 7% NaCl solution. Transmission electron microscopic examination of stained, ultrathin sections of the biological samples revealed an intact interface with microscopic details characteristic to the cell line and similar to those reported in the literature for animal and explant studies. The osteoblasts exhibited continuous contact and intimate apposition to both the CoCrMo and stainless steel substrate surfaces and grew in multilayered structures; an electron dense layer (composed of mucopolysaccharides and proteins) was observed at the surface of both substrates; collagen fibrils and mineralized foci were observed in the extracellular matrix interspersed among the multilayered osteoblasts.

Biological evaluation of the effect of magnetron sputtered Ca/P coatings on osteoblast-like cells in vitro

A rat bone marrow cell culture was used to evaluate the osteogenic potential of amorphous and crystalline thin calcium phosphate (Ca/P) coatings. The coatings were deposited on titanium discs using a radiofrequency magnetron sputter procedure. Amorphous and crystalline plasma spray Ca/P coated and noncoated titanium discs served as reference material. The cellular behavior was analyzed with quantitative (attachment and proliferation rates) and qualitative (scanning electron microscopy) techniques. No significant differences were found in cell attachment and proliferation rates between the various materials. Scanning electron microscopy showed extracellular matrix formation after 18 days of culture on amorphous plasma-sprayed and the two types of magnetron sputtered coatings. Furthermore, no severe degradation of the magnetron sputtered coatings was observed. They even appeared to induce apatite formation. On basis of the results, we conclude that magnetron sputtering appears to be a promising method to manufacture bioactive ceramic coatings.

Transmission electron and high-voltage electron microscopy of osteocyte cellular processes extending to the dental implant surface

Examination of the morphology of osteocytes within the bone supporting endosteal dental implants was performed using conventional transmission and high-voltage transmission electron microscopy (HVEM). The in vivo dog model used 72 implants inserted into the premolar region of 18 experimental animals. Forty-eight implants in 12 dogs were used as anterior abutments for fixed bridges for periods up to 12 months. The mineralized matrix of the supporting bone was either directly apposed to the implant surface or was separated from the implant by a narrow region of unmineralized matrix. Osteocytes were routinely observed to be closely associated with the bone-implant interface, as well as at a distance from the implant. Osteocytes were found to extend cellular processes directly to the implant surface through canaliculi. The osteocyte processes contained microfilaments. The three-dimensional capabilities of HVEM elucidated the nature of these cell processes at the point of exit from the osteocyte, as the processes extended through the mineralized matrix, and as the processes terminated at the implant interface. This report suggests that avenues of communication may exist between the implant and the osseous cells, providing intriguing hypotheses regarding biomechanical forces and osteogenesis at the implant interface. Furthermore, an electron-dense deposit was observed upon the inner confines of the canalicular wall, upon the outer aspects of the osteocyte lacuna, and upon the outer aspect of the bone interfacing the implant.

Osteoblast activity at the dental implant-bone interface: transmission electron microscopic and high voltage electron microscopic observations

The purpose of this report is to present transmission electron microscopic and high voltage transmission electron microscopic (HVEM) observations of a longitudinal investigation examining the activities of osteoblasts and associated tissues apposing titanium and alumina oxide ceramic endosteal dental implants. The HVEM permitted 3-dimensional stereologic observations. All observations were obtained from undecalcified interfacial tissues from this in vivo experimental dog model using commercially available implants placed into the mandible. Two similar implants were placed in both sides of the mandible, with implants in 12 of the 18 dogs supporting fixed bridges for either 6 or 12 months. From the study, we observed that a mineralized matrix exists in direct apposition to the implant. Since bone does not interface the entire length of the implant, other interfacial zones were found to exist which consisted of unmineralized tissues. In such zones, we observed that osteoblasts were routinely found directly at the implant interface to the mandibular bone. These interfacial tissues included unmineralized collagen fibers, proteinaceous material, a finely fibrillar matrix, and the osteoblasts. This study has reinforced the concept that the oral tissue-dental implant interface is a dynamic zone consisting of remodeling activities of the osseous cells and extracellular matrices.

The epithelial attachment and the dental junctional epithelium: ultrastructural features in porcine molars

The region of epithelial apposition with a tooth surface is the site of an unusual stratified integument, the junctional epithelium, which combines tight attachment to the tooth, cell turnover, tissue permeability, and epithelial versatility into the first line of defense against periodontal destruction by oral pathogens. To better understand the structure and function of the junctional epithelium we have reviewed its developmental and cell biology, and undertaken a multidisciplinary analysis of its composition in the pig, an omnivore whose dietary and dental development and occlusion patterns are similar to the human condition, and which, because of its size, is more readily amenable to experimental manipulation. The porcine junctional epithelium was also compared with this well-described epithelium in the rat. Morphological analyses by light microscopy and scanning and transmission electron microscopy showed the porcine junctional epithelium and epithelial attachment were similar to that in the rat except that apically, extracellular matrix lamellae associated with the internal basal lamina were more complex, and more coronally there was extensive layering of a dental cuticle-like material. Biochemical analysis of the porcine junctional epithelium by dissociative extraction and SDS-PAGE revealed the presence of some proteins not present in gingival epithelium. Together, these studies show that the porcine junctional epithelium has predictable morphological and biochemical features which establish the pig as an advantageous model to study the basic and clinical biology of this unique epithelium.

Morphology of the bone that supports endosteal dental implants. Transmission electron microscopic and high voltage electron microscopic observations

The morphologic features of the bone-dental implant interface were investigated using an in vivo dog model. The undecalcified bone and associated support tissues were serially sectioned and examined with both conventional and high voltage transmission electron microscopy. A varied morphologic appearance of the tissues supporting clinically and radiographically appearing integrated implants was observed. Osteoblasts were observed at the implant interface, and osteocytes were routinely seen encased within lacunae extremely close to the implant surface. Often these osteocytes extended cellular projections to the implant surface. The variable tissue types observed were suggestive of healthy lamellar and appositional type mineralization patterns adjacent to the implants.

Osteogenesis at the dental implant interface: high-voltage electron microscopic and conventional transmission electron microscopic observations

The osteogenesis of mandibular bone to endosteal dental implants was examined using an in vivo dog model. One half of the implants examined were unloaded implants, with the remaining one half prosthodontically loaded for 6 months. Undecalcified mandibular implant samples were examined with both high-voltage electron microscopy (HVEM) stereology and routine transmission electron microscopy. The osseous interface to integrated implants was shown to vary in its morphology. Mineralized bone was observed directly apposing the implant, often separated from the implant by an electron-dense deposit of approximately 50 nm. Within this densely mineralized matrix, osteocytes were routinely observed. Adjacent areas were shown to contain slightly wider zones of either a less dense mineralized matrix or, alternatively, unmineralized tissue. Other zones consisted of wider unmineralized matrices containing collagen fibers and osteoblasts. These latter zones were consistent with the appearance of an appositional type of bone growth. Because bone is a dynamic, actively remodeling tissue, a varied morphology of the support tissues to dental implant is not unexpected. Areas of mature bone interfacing with successfully integrated implants were demonstrated, as well as areas adjacent to the mature bone that were undergoing remodeling or mineralization. This study has also shown that HVEM stereology is a valuable research tool to investigate the oral tissue interface with dental implants.

Local stimulation of new bone formation by prostaglandin E1: quantitative histomorphometry and comparison of delivery by minipumps and controlled-release pellets

E-series prostaglandins (PGE) given systematically or locally in vivo can have powerful anabolic effects on bone. The comparative dose-response relationships from PGE1 given by osmotic minipump or controlled-release pellet on periosteal and intracortical bone envelopes were determined. Graded doses of PGE1 were delivered by osmotic minipump (0.0 to 16.7 mg PGE1/week) or controlled-release pellet (0.0 to 16.7 mg PGE1/week) to the lateral mandibular surface of adult dogs (2-5 years old). PGE1 was given for three weeks and tissues were collected for histology and histomorphometry one week later. At sites of maximal response, there were dose-related increases in the periosteal surface with new bone formation, average new bone thickness, maximum thickness, and new bone area. Subperiosteal bone formation was greater for comparable doses when PGE1 was delivered by minipumps. The proliferation of new bone at those sites treated with the pellets was greatest with the 8.3 mg PGE1/week/three week treatment. Periosteal bone formation did not appear to be preceded by a resorption phase, indicating that PGE1 treatment stimulated bone modeling in the formation mode. The new bone consisted of woven bone, particularly at sites with high accretion rates, and primary lamellar bone. There were some dose-related changes in intracortical remodeling indices including increases in cortical porosity, single and double-labeled surface, numbers of formation, reversal and resorption osteons, radial closure rate, and surface- and volume-referent bone formation rates. Increases in the bone formation rates indicate that PGE1 increased the recruitment of osteoblasts. Increases in the mineral appositional rate, observed at a higher dose, indicates that PGE1 stimulated bone production at the cellular level.(ABSTRACT TRUNCATED AT 250 WORDS)