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A world-leading authority on dental implant surfaces, Prof. Ann Wennerberg, from the University of Gothenburg in Sweden, recently led a systematic review of 62 clinical studies in which she analysed a total of over 17,000 implants with at least ten years of follow-up. The study compared the long-term clinical outcomes of treatment with implants with different surfaces, including sandblasted, titanium plasma-sprayed, turned, sandblasted and acid-etched, and anodised. At the 2018 EAO congress in Vienna, Dental Tribune International met with Wennerberg to discuss her research and its findings.
Prof. Wennerberg, in your study, you compared five implant surfaces, including the TiUnite implant surface by Nobel Biocare. Could you please explain what TiUnite is exactly?
TiUnite is an anodised surface. An electrolytic bath is used to create those pores and those very typical structures on the implant surface. It is very easy on an image to detect that it is an anodised surface and not a blasted or etched one.
Nobel Biocare implants with a turned surface have been very well documented over the years. In this study, we were particularly interested in how TiUnite, which is relatively new, performs in the oral cavity. There had been some concerns that, because this surface has so many undercuts, that it may be difficult to clean and thus may harbour bacteria that may cause bone resorption over time.
What are the limitations of the TiUnite surface?
I do not know if there are any limitations. We do not have any proof that it causes more bone resorption or other problems, but I cannot say that it is absolutely impossible that it does. I have no idea how the implant would perform over the course of 25 or more years. As of now, we have not been able to confirm this concern though.
As for the financial aspect, of course, a lot of the major companies, which have spent a great deal on the development of these surfaces, expect some form of profit. Therefore, some implant systems are more expensive, but you quite often get more documented data on these systems compared with cheaper ones. Therefore, you know what you are buying. It may not be the case for every product, but generally speaking I think it is true.
During the Nobel Biocare symposium, which took place at the EAO congress on 12 October, you spoke about the next steps in surface technology. Where do you see innovation heading?
We are not at the point yet where we can talk about innovations, but from a research point of view, it might be possible that, at some point, you would be able to load surfaces with different substances when you want to treat a certain disease for example. For infections, you might load a surface with antibiotics or something else that the tissue would respond to in one way or another. There are some developments in this area already. I also think that in terms of topography we have come to a really good state of the art. Of course other areas, such as implant design, have not yet been investigated well enough and might also be of interest in the future.
In your opinion, what has been the biggest development in dental implantology throughout the decades?
That is a difficult question for me to answer [smiles] because there have been many developments. From a material standpoint, we now have better mechanical properties and better prosthetic solutions, and we are able to better compensate for misalignment. And then there are some things that have really improved over the last 30 years, but I would not say it happened in one big leap or anything; more like a step-by-step approach, which has been influenced by many players in the field that have provided us with very good clinical results. Overall, I think it is fantastic to have implants as a treatment option for patients.
Thank you very much for the interview.
Editorial note: The study, titled “Long-term clinical outcome of implants with different surface modifications”, is due to appear in an upcoming issue of the European Journal of Oral Implantology.