title: The role of bone debris in early healing adjacent to hydrophilic and hydrophobic implant surfaces in man.
abstract: OBJECTIVE
  To evaluate morphologically and morphometrically the sequential healing and osseointegration events at moderately rough implant surfaces with and without chemical modification. Particularly the role of bone debris in initiating bone formation was emphasized.
  
  
  METHODS
  Solid, screw-type cylindrical titanium implants (SSI) (n=49), 4 mm long and 2.8 mm wide, with either chemically modified (SLActive(®)) or sandblasted and acid-etched (SLA(®)) surface configurations were surgically installed in the retromolar region of 28 human volunteers. After 7, 14, 28 and 42 days of submerged healing, the devices were retrieved with a trephine. Histologic ground sections were prepared and histomorphometrically analyzed. Linear measurements determined fractions of old bone (OBIC), new bone (NBIC), soft tissue (ST) and bone debris (BD) in contact with the SSI surfaces.
  
  
  RESULTS
  Healing was uneventful at all installation sites. Sixty-one percent of all devices were suitable for morphometric analyses. All implant surfaces were partially coated with bone debris and new bone formation was observed as early as 7 days after installation. There was a gradual increase in NBIC, whereas OBIC, ST and BD progressively decreased over time. NBIC after 2 and 4 weeks was higher on SLActive(®) than on SLA(®) surfaces, albeit statistically not significant. The BD : ST ratio changed significantly from 7 to 42 days (from 50 : 50 to 10 : 90 for SLActive(®); from 38: 62 to 10 : 90 for SLA(®)) (Fisher's exact test, P<0.01).
  
  
  CONCLUSIONS
  Both SLActive(®) and SLA(®) devices became progressively osseointegrated, while old bone on the device surface was gradually resorbed. The decrease in BD : ST ratio suggests that bone debris, created during implant installation and adhering to moderately rough surfaces, significantly contributed to the initiation of bone deposition and mediated the connection between the old bone and the new bone on the implant surface.
authors.affiliation: Department of Periodontology, School of Dental Medicine, University of Berne, Berne, Switzerland. dieter.bosshardt@zmk.unibe.ch
authors.forename: Dieter D
authors.initials: DD
authors.lastname: Bosshardt
authors.forename: Giovanni E
authors.initials: GE
authors.lastname: Salvi
authors.forename: Guy
authors.initials: G
authors.lastname: Huynh-Ba
authors.forename: Saso
authors.initials: S
authors.lastname: Ivanovski
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Donos
authors.forename: Niklaus P
authors.initials: NP
authors.lastname: Lang
mesh_terms: D001854:Bone Marrow Cells; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D017267:Dental Prosthesis Design; D006801:Humans; D057927:Hydrophobic and Hydrophilic Interactions; D016348:Osseointegration; D010006:Osteoblasts / Q000166:cytology; D010010:Osteoclasts / Q000166:cytology; D016369:Smear Layer; D018709:Statistics, Nonparametric; D013499:Surface Properties; D013997:Time Factors
chemical_list: D015921:Dental Implants