Osteointegration of bioactive glass-coated zirconia in healthy bone: an in vivo evaluation

Biological activity of titania coating prepared with zirconium oxychloride and titania on zirconia surface

Zirconia is recognized as a promising dental implant material because of its good biocompatibility, sufficient mechanical strength, minimal ion release and aesthetic effects similar to natural teeth. However, the limitations of inert surface of zirconia affect the long-term efficacy of zirconia implants. To enhance the osseointegration of zirconia implants, titania (TiO₂) coating is prepared on the zirconia surface by immersion in a mixed zirconium oxychloride (ZrOCl₂) and TiO₂ suspension in a water bath. The surface and longitudinal section morphology are observed by scanning electron microscopy (SEM). The chemical composition is evaluated through energy dispersive spectroscopy (EDS) and X-ray diffraction (XRD). The roughness and hydrophilicity of zirconia surface are also examined. A three-point bending test is conducted on the samples to explore the effect of this surface treatment on the mechanical strength of zirconia. Vickers hardness measurements are performed to evaluate the gradient change of the longitudinal section of the zirconia substrate. The MC3T3-E1 cells are seeded on zirconia discs, and a LIVE/DEAD double-staining test is conducted to detect the cytotoxicity of the TiO₂ coating. The cell morphology is studied through fluorescence microscope. The degrees of cell proliferation, mineralization and alkaline phosphatase (ALP) activity are calculated and compared. Detection of the mRNA expression of osteogenic differentiation-related markers is performed by RT-PCR. A TiO₂ coating is generated on the zirconia surface and significantly improves the surface roughness and hydrophilicity while not adversely affecting the mechanical strength of zirconia. The hardness of the zirconia substrate shows a gradient change. The TiO₂ coating can promote proliferation, spreading and osteogenic differentiation of MC3T3-E1 cells. These findings suggest that modifying the surface of zirconia with a TiO₂ coating may have a favourable osteogenic effect.

Oral Tissue Interactions and Cellular Response to Zirconia Implant-Prosthetic Components: A Critical Review

Background: Dental components manufactured with zirconia (ZrO₂) represent a significant percentage of the implant prosthetic market in dentistry. However, during the last few years, we have observed robust clinical and pre-clinical scientific investigations on zirconia both as a prosthetic and an implantable material. At the same time, we have witnessed consistent technical and manufacturing updates with regards to the applications of zirconia which appear to gradually clarify points which until recently were not well understood. Methods: This critical review evaluated the “state of the art” in relation to applications of this biomaterial in dental components and its interactions with oral tissues. Results: The physico-chemical and structural properties as well as the current surface treatment methodologies for ZrO₂ were explored. A critical investigation of the cellular response to this biomaterial was completed and the clinical implications discussed. Finally, surface treatments of ZrO₂ demonstrate that excellent osseointegration is possible and provide encouraging prospects for rapid bone adhesion. Furthermore, sophisticated surface treatment techniques and technologies are providing impressive oral soft tissue cell responses thus leading to superior biological seal. Conclusions: Dental devices manufactured from ZrO₂ are structurally and chemically stable with biocompatibility levels allowing for safe and long-term function in the oral environment.

An introduction of biological performance of zirconia with different surface characteristics: A review

Zirconia (ZrO₂) ceramic is widely used in dentistry as a clinical dental biomaterial. In this review, we are focusing on and summarizing the biological performance of zirconia under different surface characteristics. We have included an initial tissue cell attachment study on zirconia and bacterial adhesion on zirconia. Our results suggest that surface modifications applied on zirconia may change the interfacial surface characteristics e.g. surface roughness, surface free energy, and chemistry of zirconia. The modifications also result in advanced biological performance of zirconia, including enhanced tissue cell attachment and reduction of bacterial adhesion. The recent laboratory research has provided many interesting modification methods and showed clinically interesting and promising outcomes. A few of the outcomes are validated and have been applied in clinical dentistry.

Design of dental implants at materials level: An overview

Due to the excellent restoration of masticatory function, satisfaction on aesthetics and other superiorities, dental implants represent an effective method to resolve tooth losing and damaging. Current dental implant systems still have problems waiting to be addressed, and problems are centralized on the materials of implant bodies. This review aims to summarize major developments in the field of dental implant materials, starting with an overview on structures, procedures of dental implants and challenges of implant materials. Next, implant materials are examined in three categories, that is, metals, ceramics, and polymers, their mechanical properties, biocompatibility, and bioactivity are summarized. And as an important aspect, strategies of surface modification are also reviewed, along with some finite element analysis to guiding the research direction of implant materials. Finally, the conclusive remarks are outlined to provide an outlook on the future research directions and prospects of dental implants.

Electrospun poly(d,l-lactide)/gelatin/glass-ceramics tricomponent nanofibrous scaffold for bone tissue engineering

Electrospun scaffolds are emerging as extracellular matrix (ECM)mimicking structures for tissue engineering thanks to their nanofibrous architecture. For the development of suitable electrospun scaffolds for bone tissue engineering, the addition of inorganic components has been implemented with the aim to confer important bioactivity like osteoinduction, osteointegration, and cell adhesion to the scaffolds. In this context, we propose a tricomponent electrospun scaffold composed of poly(d,l-lactide), gelatin and RKKP glass-ceramics. The bioactive RKKP glass-ceramic system has attracted interest, due to the presence of ions such as La³⁺ and Ta⁵⁺ , which turned out to be valuable as growth supporting agents for bones. In this work, RKKP glass-ceramics were embedded inside the microfibers of electrospun scaffolds and the structural and biological properties were investigated. Our results showed that the glass-ceramic microparticles were uniformly distributed in the fibrous structure of the scaffold. Furthermore, the glass-ceramics promoted biomineralization of the scaffolds and improved cell viability and osteogenic differentiation. The mineralized layer formed on RKKP-containing scaffolds after incubation in simulated body fluid medium has been shown to be hydroxyapatite by Raman spectroscopy and X-ray diffraction. The results on differentiation studies of canine adipose-derived mesenchymal stem cells grown on the electrospun scaffolds suggest that on varying the content of RKKP in the scaffold, it is possible to drive the differentiation toward chondrogenic or osteogenic commitment. The presence of ions, like La³⁺ and Ta⁵⁺ , in the RKKP embedded polymeric composite scaffolds could play a role in supporting cell growth and promoting differentiation.

Bioactive coating of zirconia toughened alumina ceramic implants improves cancellous osseointegration

Bioactive coatings have the potential to improve the bony integration of mechanically loaded orthopedic ceramic implants. Using the concept of mimicking the natural bone surface, four different coatings of varying thickness on a zirconia toughened alumina (ZTA) ceramic implant were investigated regarding their osseointegration in a drill-hole model in sheep. The hypothesis that a bioactive coating of ZTA ceramics would facilitate cancellous bone integration was investigated. The bioactive coatings consisted of either a layer of covalently bound multi phosphonate molecules (chemical modification = CM), a nano hydoxyapatite coating (HA), or two different bioactive glass (BG) coatings in micrometer thickness, forming a hydroxyl-carbonate apatite layer on the implant surface in vivo (dip-coated 45S5 = DipBG; sol-gel 70S30C = SGBG). Coated surfaces were characterized by scanning electron microscopy and X-ray photoelectron spectroscopy. After 12 weeks, osseointegration was evaluated via mechanical push-out testing and histology. HA enhanced the maximum push-out force (HA: mean 3573.85 ± 1119.91 N; SGBG: mean 1691.57 ± 986.76 N; p = 0.046), adhesive shear strength (HA: mean 9.82 ± 2.89 MPA; SGBG: mean 4.57 ± 2.65 MPA; p = 0.025), and energy release rate (HA: mean 3821.95 ± 1474.13 J/mm²; SGBG: mean 1558.47 ± 923.47 J/mm²; p = 0.032) compared to SGBG. The implant-bone interfacial stiffness increased by CM compared to SGBG coating (CM: mean 6258.06 ± 603.80 N/mm; SGBG: mean 3565.57 ± 1705.31 n/mm; p = 0.038). Reduced mechanical osseointegration of SGBG coated implants could be explained histologically by a foreign body reaction surrounding the implants.

Femtosecond Laser Fabrication of Engineered Functional Surfaces Based on Biodegradable Polymer and Biopolymer/Ceramic Composite Thin Films

Surface functionalization introduced by precisely-defined surface structures depended on the surface texture and quality. Laser treatment is an advanced, non-contact technique for improving the biomaterials surface characteristics. In this study, femtosecond laser modification was applied to fabricate diverse structures on biodegradable polymer thin films and their ceramic blends. The influences of key laser processing parameters like laser energy and a number of applied laser pulses (N) over laser-treated surfaces were investigated. The modification of surface roughness was determined by atomic force microscopy (AFM). The surface roughness (R_rms) increased from approximately 0.5 to nearly 3 µm. The roughness changed with increasing laser energy and a number of applied laser pulses (N). The induced morphologies with different laser parameters were compared via Scanning electron microscopy (SEM) and confocal microscopy analysis. The chemical composition of exposed surfaces was examined by FTIR, X-ray photoelectron spectroscopy (XPS), and XRD analysis. This work illustrates the capacity of the laser microstructuring method for surface functionalization with possible applications in improvement of cellular attachment and orientation. Cells exhibited an extended shape along laser-modified surface zones compared to non-structured areas and demonstrated parallel alignment to the created structures. We examined laser-material interaction, microstructural outgrowth, and surface-treatment effect. By comparing the experimental results, it can be summarized that considerable processing quality can be obtained with femtosecond laser structuring.

Surface Modification Techniques for Zirconia-Based Bioceramics: A Review

Zirconia is gaining interest as a ceramic biomaterial for implant applications due to its biocompatibility and desirable mechanical properties. At present, zirconia-based bioceramics is often seen in the applications of hip replacement and dental implants. This article briefly reviews different surface modification techniques that have been applied to zirconia such as polishing, sandblasting, acid etching, biofunctionalization, coating, laser treatment, and ultraviolet light treatment. The potential of surface modification to make zirconia a successful implant material in the future is highly dependent on the establishment of successful in vitro and in vivo studies. Hence, further effort should be made in order to deepen the understanding of tissue response to implant and tissue regeneration process.

Bioactive Glasses and Glass-Ceramics for Healthcare Applications in Bone Regeneration and Tissue Engineering

The discovery of bioactive glasses (BGs) in the late 1960s by Larry Hench et al. was driven by the need for implant materials with an ability to bond to living tissues, which were intended to replace inert metal and plastic implants that were not well tolerated by the body. Among a number of tested compositions, the one that later became designated by the well-known trademark of 45S5 Bioglass® excelled in its ability to bond to bone and soft tissues. Bonding to living tissues was mediated through the formation of an interfacial bone-like hydroxyapatite layer when the bioglass was put in contact with biological fluids in vivo. This feature represented a remarkable milestone, and has inspired many other investigations aiming at further exploring the in vitro and in vivo performances of this and other related BG compositions. This paradigmatic example of a target-oriented research is certainly one of the most valuable contributions that one can learn from Larry Hench. Such a goal-oriented approach needs to be continuously stimulated, aiming at finding out better performing materials to overcome the limitations of the existing ones, including the 45S5 Bioglass®. Its well-known that its main limitations include: (i) the high pH environment that is created by its high sodium content could turn it cytotoxic; (ii) and the poor sintering ability makes the fabrication of porous three-dimensional (3D) scaffolds difficult. All of these relevant features strongly depend on a number of interrelated factors that need to be well compromised. The selected chemical composition strongly determines the glass structure, the biocompatibility, the degradation rate, and the ease of processing (scaffolds fabrication and sintering). This manuscript presents a first general appraisal of the scientific output in the interrelated areas of bioactive glasses and glass-ceramics, scaffolds, implant coatings, and tissue engineering. Then, it gives an overview of the critical issues that need to be considered when developing bioactive glasses for healthcare applications. The aim is to provide knowledge-based tools towards guiding young researchers in the design of new bioactive glass compositions, taking into account the desired functional properties.

Synthesis and Characterization of β-Tricalcium Phosphate Derived From Haliotis sp. Shells

PURPOSE

To develop a methodology for the synthesis of β-tricalcium phosphate (β-TCP, Ca3(PO4)2) from the shell of Haliotis sp. (abalone shell) and to verify its characterization and biocompatibility.

MATERIALS AND METHODS

Calcium oxide (CaO) was synthesized from abalone shell by sintering and was suspended in distilled water to prepare calcium hydroxide (Ca(OH)2). For the synthesis of calcium carbonate (CaCO3), carbon dioxide was used to infuse Ca(OH)2 at pH 7.4. CaCO3 was reacted with phosphoric acid at pH 6.0 to obtain dicalcium phosphate (CaHPO4). Subsequently, β-TCP was synthesized by a chemical reaction between CaHPO4 and CaO at 950°C to 1100°C for 3 hours. Fourier transform infrared spectroscopy (FT-IR) and x-ray diffraction (XRD) was performed to verify the physiochemical characteristics of the composite synthesized from abalone shell.

RESULTS

FT-IR and XRD results showed that β-TCP was successfully synthesized from abalone shell. The synthesized β-TCP did not affect cell viability of either normal human oral keratinocytes or osteoblastic MG-63 cells. These data indicate that β-TCP synthesized from abalone shell is biologically safe.

CONCLUSIONS

β-TCP (Ca3(PO4)2) synthesized from abalone shell can be used as a potential source of bone grafting material.

Osseointegration of zirconia dental implants in animal investigations: A systematic review and meta-analysis

OBJECTIVE

To determine the osseointegration rate of zirconium dioxide (ZrO₂) dental implants in preclinical investigations.

DATA

Data on the osseointegration rate was extracted considering the bone to implant contact (BIC), removal torque analysis (RTQ) and push-in tests. Meta analyses were conducted using multilevel multivariable mixed-effects linear regression models. The Šidák method was used in case of multiple testing.

SOURCES

An electronic screening of the literature (MEDLINE/Pubmed, Cochrane Library and Embase) and a supplementary manual search were performed. Animal investigations with a minimum sample size of 3 units evaluating implants made of zirconia (ZrO₂) or its composites (ZrO₂>50vol.%) were included.

STUDY SELECTION

The search provided 4577 articles, and finally 54 investigations were included and analyzed. Fifty-two studies included implants made from zirconia, 4 zirconia composite implants and 37 titanium implants. In total, 3435 implants were installed in 954 animals.

CONCLUSIONS

No significant influence of the evaluated bulk materials on the outcomes of interest could be detected. When comparing different animal models, significant differences for the evaluated variables could be found. These results might be of interest for the design of further animal investigations.

Is zirconia a viable alternative to titanium for oral implant? A critical review

PURPOSE

Titanium based implant systems, though considered as the gold standard for rehabilitation of edentulous spaces, have been criticized for many inherent flaws. The onset of hypersensitivity reactions, biocompatibility issues, and an unaesthetic gray hue have raised demands for more aesthetic and tissue compatible material for implant fabrication. Zirconia is emerging as a promising alternative to conventional Titanium based implant systems for oral rehabilitation with superior biological, aesthetics, mechanical and optical properties. This review aims to critically analyze and review the credibility of Zirconia implants as an alternative to Titanium for prosthetic rehabilitation.

STUDY SELECTION

The literature search for articles written in the English language in PubMed and Cochrane Library database from 1990 till December 2016. The following search terms were utilized for data search: "zirconia implants" NOT "abutment", "zirconia implants" AND "titanium implants" AND "osseointegration", "zirconia implants" AND compatibility.

RESULTS

The number of potential relevant articles selected were 47. All the human in vivo clinical, in vitro, animals' studies were included and discussed under the following subheadings: Chemical composition, structure and phases; Physical and mechanical properties; Aesthetic and optical properties; Osseointegration and biocompatibility; Surface modifications; Peri-implant tissue compatibility, inflammation and soft tissue healing, and long-term prognosis.

CONCLUSIONS

Zirconia implants are a promising alternative to titanium with a superior soft-tissue response, biocompatibility, and aesthetics with comparable osseointegration. However, further long-term longitudinal and comparative clinical trials are required to validate zirconia as a viable alternative to the titanium implant.

Combined effect of magnesia and zirconia on the bioactivity of calcium silicate ceramics at C\S ratio less than unity

This paper describes the effect of magnesia in the presence of zirconia on the bioactivity, microstructure and physico-mechanical properties of calcium silicate composition adjusted at calcia/silica ratio(C/S) of 0.5. A mixture from calcium carbonate and silica was conducted at C/S of 0.5. 20wt.% of magnesia and 5-25wt.% of ZrO₂ were added. Each mixture was mixed with ethanol in a planetary ball mill, dried, formed and fired at a temperature of 1325±5°C. Phase composition, FE-SEM, and physico-mechanical properties of the fired specimens were determined and explained. The in vitro bioactivities of these specimens were investigated by analysis of their abilities to form apatite in the simulated body fluid (SBF) for a short time (7days) using SEM-EDS. The findings indicated that the surface of the specimens containing 5 and 15wt.% ZrO₂ were completely covered by single and multilayered hydroxyapatite (HA) precipitate typical to "cauliflower" morphology, respectively. The surface of the specimen containing 25wt.% ZrO₂ did not cover, but there are some scattered HA precipitate. The differences among the results were rationalized based on the phase composition. Vickers hardness and fracture toughness of the specimens of highly promised bioactivity were 2.32-2.57GPa and 1.80-1.50MPa. m^1/2, respectively. The properties of these specimens are similar to the properties of human cortical bone. Consequently, these composites might be used as bone implant materials.

Comparison of surface modified zirconia implants with commercially available zirconium and titanium implants: a histological study in pigs

INTRODUCTION

New biomaterials and their various surface modifications should undergo in vitro and in vivo evaluation before clinical trials. The objective of our in vivo study was to evaluate the biocompatibility of newly created zirconium implant surfaces after implantation in the lower jaw of pigs and compare the osseointegration of these dental implants with commercially available zirconium and titanium implants.

MATERIALS AND METHODS

After a healing period of 12 weeks, a histological analysis of the soft and hard tissues and a histomorphometric analysis of the bone-implant contact (BIC) were performed.

RESULTS

The implant surfaces showed an intimate connection to the adjacent bone for all tested implants. The 3 newly created zirconium implant surfaces achieved a BIC of 45% on average in comparison with a BIC of 56% from the reference zirconium implants and 35% from titanium implants. Furthermore, the new zirconium implants had a better attachment to gingival and bone tissues in the range of implant necks as compared with the reference implants.

CONCLUSION

The results suggest that the new implants comparably osseointegrate within the healing period, and they have a good in vivo biocompatibility.

An overview of chitin or chitosan/nano ceramic composite scaffolds for bone tissue engineering

Chitin and chitosan based nanocomposite scaffolds have been widely used for bone tissue engineering. These chitin and chitosan based scaffolds were reinforced with nanocomponents viz Hydroxyapatite (HAp), Bioglass ceramic (BGC), Silicon dioxide (SiO₂), Titanium dioxide (TiO₂) and Zirconium oxide (ZrO₂) to develop nanocomposite scaffolds. Plenty of works have been reported on the applications and characteristics of the nanoceramic composites however, compiling the work done in this field and presenting it in a single article is a thrust area. This review is written with an aim to fill this gap and focus on the preparations and applications of chitin or chitosan/nHAp, chitin or chitosan/nBGC, chitin or chitosan/nSiO₂, chitin or chitosan/nTiO₂ and chitin or chitosan/nZrO₂ in the field of bone tissue engineering in detail. Many reports so far exemplify the importance of ceramics in bone regeneration. The effect of nanoceramics over native ceramics in developing composites, its role in osteogenesis etc. are the gist of this review.

Comparison of in vitro and in vivo bioactivity: cuttlefish-bone-derived hydroxyapatite and synthetic hydroxyapatite granules as a bone graft substitute

Bone reconstruction in clinical settings often requires bone substitutes. Hydroxyapatite (HAp) is a widely used bone substitute due to its osteoconductive properties and bone bonding ability. The aim of this study was to evaluate HAp granules derived from cuttlefish bone (CB-HAp) as a substitute biomaterial for bone grafts. In this study, HAp granules were prepared from raw CB by using a hydrothermal reaction. The formation of HAp from CB was confirmed by scanning electron microscopy and x-ray diffraction analysis. The bioactivity of the CB-HAp granules was evaluated both in vitro and in vivo. Our results show that CB-HAp is non-toxic and that CB-HAp granules supported improved cell adhesion, proliferation and differentiation compared to stoichiometric synthetic HAp granules. Furthermore, in vivo bone defect healing experiments show that the formation of bone with CB-HAp is higher than that with pure HAp. These results show that CB-HAp granules have excellent potential for use as a bone graft material.

Porous Alumina/Zirconia Composite Scaffold with Bioactive Glass 58S33C Coating

Strong and tough, macroporous alumina/zirconia composites are superior to alumina scaffolds but still biologically inert to bone tissue, leading to poor tissue ingrowth and osteointegration. One way to solve this problem is applying a bioactive coating onto the pore walls of the macroporous composites. In this study, macroporous alumina/zirconia (20vol%) composites (scaffolds) were prepared by a vacuum infiltration method involving the use of strained (10%) compacts of the expanded polystyrene (EPS) beads (typically 1-2.8 mm in diameter). A bioactive glass (58S33C) coating (~ 20 μm) was applied on the pore walls of the macroporous composites by slurry dip coating and sintering at 1200 oC for 1 hour. A top or outer bioactive glass (58S33C) thin layer (< 10 μm) was further applied by sol dip coating and sintering at a low temperature (< 800 °C). The bioactive glass-coated macroporous alumina/zirconia composites had well interconnected pores, relatively large pore sizes (1-2 mm), medium porosities (60-66%), high compressive strengths (7.52 – 5.42 MPa), and high bioactivity (with an apatite layer formed within 24 hours in the simulated body fluid). The combination of the strong and ultrafine (if not nano-structured) macroporous scaffolds with the multiple or graded bioactive coatings represented a new generation of bone substitutes or permanent scaffolds for bone tissue regeneration.

On the possibility of silicon nitride as a ceramic for structural orthopaedic implants. Part I: processing, microstructure, mechanical properties, cytotoxicity

Notwithstanding the good combination of mechanical and tribological properties, the suitability of silicon nitride for application as prosthesis in bone reconstruction or in articular joints replacements is still controversial. This study aims to design and produce three different silicon nitride-based ceramics and to test the materials. In this Part I the microstructure and mechanical properties evidence outstanding characteristics and the cytotoxicity studies confirm that all the materials are extremely inert and biocompatible. In Part II, the wear performance and the wettability and chemical stability against different aqueous media and physiological solutions are investigated and discussed.

Biomaterials for orthopedics: A roughness analysis by atomic force microscopy

We conducted an AFM analysis of roughness on 7 materials widely used in bone reconstruction. Roughness was evaluated by measuring Root Mean Square (RMS) values and RMS/average height (AH) ratio, in different dimensional ranges, varying from 100 microns square to a few hundreds of nanometers. The results showed that Titanium presented a lower roughness than the other materials analyzed, frequently reaching statistical significance. On the contrary, bioactive materials, such as hydroxyapatite (HA) and bioactive glasses, demonstrated an overall higher roughness. In particular, this study focuses attention on AP40 and especially RKKP, which proved to have a significant higher roughness at low dimensional ranges. This determines a large increase in surface area, which is strongly connected with osteoblast adhesion and growth and to protein absorption. Therefore, the biointegration properties of bioactive glasses can also be given as answer in terms of surface structures in which chemical composition can influence directly the biological system (e.g. with chemical exchanges and development of specific surface electrical charge) and indirectly, via the properties induced on tribological behavior that expresses itself during the smoothing of the surfaces. We also test two new bioactive glasses, RBP1 and RBP2, with a chemical composition similar to AP40, but with some significant small additions and substitutions of components, in order to make preliminary considerations on their potential role in orthopedics.

X-ray micro-diffraction analysis of reconstructed bone at Zr prosthetic surface with sub-micrometre spatial resolution

The purpose of the present investigation is to demonstrate the power of the x-ray micro-diffraction technique in biological studies. In particular the reported experiment concerns the study of the interface between a Zr prosthetic device implanted in a rat femur and the newly-formed bone, with a spatial resolution of 0.5 microm. The obtained results give interesting information on the Zr deformation and on the crystallographic phase, the grain size and the orientation of the new bone. Moreover the study reveals a marked difference in the structure of the reconstructed bone with respect to the native bone, which cannot be appreciated with other techniques.

Osteointegration of bioactive glass-coated and uncoated zirconia in osteopenic bone: Anin vivo experimental study

In elderly and osteoporotic patients an age-related loss of osteoinductivity could be the biological cause of implant failure regardless of the high quality of the implanted device. yttria stabilized tetragonal zirconia (YSTZ), either coated with the bioactive glass named RKKP bioglaze (RKKP) or uncoated, was implanted in the distal femurs of sham-operated and ovariectomized female rats. Animals were sacrificed at 30 and 60 days. Histomorphometry and microhardness tests were performed to assess osteointegration rate as well as bone quality around the implants. Significant decreases (p < 0.0005) in trabecular bone volume, BV/TV (41%), trabecular bone surface BS/TV (33%), trabecular thickness Tb.Th (20%), and trabecular number Tb.N (32%), together with a significant increase in trabecular separation Tb.Sp (184%), were found for the osteopenic rats compared with the sham-operated rats. At both experimental times the RKKP coating ensured a better osteointegration rate with higher AI values than the uncoated YSTZ, even when osteopenic rats were used (48% at 30 days and 12% at 60 days). No differences were observed at the bone-biomaterial interfaces for either material when comparing sham-operated with osteopenic rats. The present results demonstrate that the RKKP bioactive glass used as a coating ensures a high osteointegration rate even in osteoporotic bone, which is already visible from postoperative day 30 and is still apparent on day 60.