title: Osseointegration of Zirconia in the Presence of Multinucleated Giant Cells.
abstract: BACKGROUND
  Current strategies to reduce medical device-associated infections propose zirconia as a potential implant material which may limit bacterial adhesion. Because multinucleated giant cells (MNGCs) have been detected on these implant surfaces, concerns have been raised regarding tissue integration.
  
  
  OBJECTIVE
  The present study examined the presence of MNGCs and their subsequent effect upon tissue integration. Surface-modified implants made of yttria-stabilized (TZP) and alumina-toughened zirconia (ATZ) were compared with commercially pure titanium (Ti).
  
  
  METHODS
  Seven miniature pigs received three implants on either side of the maxilla. After healing periods of 4 and 8 weeks, the tissue response at the implant surfaces was characterized according to three specific parameters: bone-to-implant contact (BIC), MNGC-to-implant contact (MIC), and the peri-implant bone density (BD).
  
  
  RESULTS
  Despite being present on all tested implant surfaces, MNGCs were not associated with an inflammatory cell infiltrate or with fibrous encapsulation. MNGCs were less numerous on the Ti implants (range: 3.9-5.2%) compared with the ceramic implants (range: 17.6-30.3%, p < .0001). Even though the values of newly formed bone and pristine bone in direct contact with the implant surfaces were high at 4 weeks (tBIC: Ti = 82.3%, TZP = 64.3%, ATZ = 70%), a negative correlation was observed between the presence of MNGCs and newly formed bone at the implant surface (p < .001). Interestingly, the newly formed peri-implant bone density, defined as the percentage of new bone area inside the screw threads (nBD), was not diminished by the presence of MNGCs.
  
  
  CONCLUSIONS
  Differences in the presence of MNGCs and the BIC parameters between Ti and the ceramic implants appear to be a local cellular phenomenon which is restricted to the implant-bone marrow interface and do not affect the peri-implant bone formation. Factors triggering MNGC differentiation and their persistence in response to biomaterial surface need to be investigated in future studies.
authors.affiliation: Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Vivianne
authors.initials: V
authors.lastname: Chappuis
authors.affiliation: Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Yeliz
authors.initials: Y
authors.lastname: Cavusoglu
authors.affiliation: Laboratory of Oral Cell Biology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Gruber
authors.affiliation: Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Kuchler
authors.affiliation: Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Buser
authors.affiliation: Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland.
authors.forename: Dieter D
authors.initials: DD
authors.lastname: Bosshardt
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001672:Biocompatible Materials; D015519:Bone Density; D002516:Ceramics; D003758:Dental Implantation, Endosseous / Q000379:methods; D015921:Dental Implants; D017267:Dental Prosthesis Design; D015726:Giant Cells / Q000502:physiology*; D016348:Osseointegration / Q000502:physiology*; D013552:Swine; D013556:Swine, Miniature; D014025:Titanium; D014945:Wound Healing / Q000502:physiology; D015040:Zirconium
chemical_list: D001672:Biocompatible Materials; D015921:Dental Implants; D015040:Zirconium; D014025:Titanium; C028541:zirconium oxide
keywords: biomaterials; endosseous dental implantation; giant cells; macrophages; osteogenesis; surface chemistry; titanium; zirconium oxide