Cochran D L
Department of Periodontics, Dental School, The University of Texas Health Science Center at San Antonio, 78284-7894, USA.
J Periodontol. 1999 Dec;70(12):1523-39. doi: 10.1902/jop.1999.70.12.1523.
Endosseous dental implants are available with various surface characteristics ranging from relatively smooth machined surfaces to more roughened surfaces created by coatings, blasting by various substances, by acid treatments, or by combinations of the treatments. Studies characterizing these implants and surfaces include in vitro experimentation, animal studies, and human clinical trials. Both descriptive and functional testing of the bone-implant interface includes histomorphometrics and biomechanical testing such as torque removal values and push out/pull out strength. Using these assays to evaluate and compare different surfaces, the data demonstrate that rough implant surfaces have increased bone-to-implant contact and require greater forces to break the bone-implant interface compared to more smooth surfaces. The objective of this report was to evaluate publications of human clinical experiences evaluating implant use in patients and to determine if differences existed in success rates of implants with relatively smooth surfaces compared to implants having roughened implant surfaces. Human trials were reviewed to determine the clinical efficacy of implants under various clinical indications. Synopsis tables were constructed and the experiences segregated by implant surface characteristics. Meta-analyses were performed on all implants in all locations, on implants placed only in the maxilla or the mandible, and, finally, on implants placed in the maxilla compared to implants placed in the mandible. Evaluation of the data revealed that predictably high success rates can be achieved for implants with both rough and smooth titanium surfaces and for hydroxyapatite-coated implants. When studies were clustered by specific indications or patient populations, rough surfaced implants had significantly higher success rates compared to implants with more smooth surfaces except in the case of single tooth replacements where the success rates were comparable. In general, implants placed in the mandible had significantly higher success rates than implants placed in the maxilla. However, in the partially edentulous patient group, titanium implants with a rough surface had significantly higher success rates in the maxilla compared to the mandible and, in cases of single tooth replacement, success rates were similar in the maxilla and in the mandible as was the case for hydroxyapatite-coated implants. The documented advantage of implants with a roughened surface in animal and in vitro experiments has been demonstrated in clinical cases when studies were compared in which specific indications or patients were treated. Additionally, implants placed in the mandible have, in general, higher success rates than implants placed in the maxilla, with only a few exceptions noted. These data from human clinical experiences support the documented advantage of implants with a roughened surface in animal and in vitro experimentation and indicate that the magnitude of the advantage is significant for patient care.
骨内牙种植体具有各种表面特征，范围从相对光滑的机械加工表面到通过涂层、各种物质喷砂、酸处理或这些处理的组合产生的更粗糙表面。表征这些种植体和表面的研究包括体外实验、动物研究和人体临床试验。骨-种植体界面的描述性和功能性测试包括组织形态计量学和生物力学测试，如扭矩去除值和推出/拔出强度。使用这些测定法来评估和比较不同表面，数据表明与更光滑的表面相比，粗糙的种植体表面增加了骨与种植体的接触，并且需要更大的力来破坏骨-种植体界面。本报告的目的是评估评估患者使用种植体的人体临床经验的出版物，并确定与具有粗糙种植体表面的种植体相比，具有相对光滑表面的种植体在成功率上是否存在差异。对人体试验进行了审查，以确定种植体在各种临床适应症下的临床疗效。构建了概要表，并根据种植体表面特征对经验进行了分类。对所有部位的所有种植体、仅在上颌或下颌植入的种植体，最后对上颌植入的种植体与下颌植入的种植体进行了荟萃分析。对数据的评估表明，具有粗糙和光滑钛表面的种植体以及羟基磷灰石涂层种植体都可以实现可预测的高成功率。当按特定适应症或患者群体对研究进行聚类时，除了单颗牙替换的成功率相当外，粗糙表面的种植体与更光滑表面的种植体相比具有显著更高的成功率。一般来说，植入下颌的种植体比植入上颌的种植体成功率显著更高。然而，在部分牙列缺损患者组中，与下颌相比，上颌中具有粗糙表面的钛种植体成功率显著更高，并且在单颗牙替换的情况下，上颌和下颌的成功率相似，羟基磷灰石涂层种植体也是如此。当比较针对特定适应症或患者进行治疗的研究时，在临床病例中已经证明了在动物和体外实验中具有粗糙表面的种植体的记录优势。此外，一般来说，植入下颌的种植体比植入上颌的种植体成功率更高，仅注意到少数例外情况。这些来自人体临床经验的数据支持了在动物和体外实验中具有粗糙表面的种植体的记录优势，并表明该优势的程度对患者护理具有重要意义。
