Does incorporating zinc in titanium implant surfaces influence osseointegration? A systematic review.
BACKGROUND
Titanium implant surfaces have been modified to improve osseointegration; however, the evidence for incorporating zinc into titanium implants to improve new bone formation and osseointegration is not clear.


OBJECTIVE
The purpose of this systematic review was to assess the efficacy of treating titanium surfaces with zinc on the osseointegration of implants.


METHODS
The focused question addressed was, "Does incorporating zinc in titanium implant surfaces influence osseointegration?" Indexed databases were searched up to January 2016 using the key words "Bone to implant contact"; "implant"; "zinc"; "osseointegration." Letters to the editor, case reports/case series, historic reviews, and commentaries were excluded. The pattern of the review was customized to summarize the pertinent data.


RESULTS
Ten experimental studies were included, all of which were performed in animals (5 in rabbits, 4 in rodents, and 1 in goats). The number of titanium implants placed ranged from 10 to 78. The results from all studies showed that incorporating zinc into titanium implants enhanced new bone formation and/or bone-to-implant contact around implants. One study reported that zinc enhanced the removal torque on implants.


CONCLUSIONS
The current available evidence on adding zinc to titanium implants surfaces to enhance osseointegration remains unclear. Further investigation is necessary to assess its effectiveness and safety in humans and to establish a standard methodology and ideal compound for incorporating zinc ion into titanium implant surfaces in a clinical setting.
Postdoctoral Fellow, Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY. Electronic address: sergio_kellesarian@urmc.rochester.edu.
Sergio Varela
SV
Kellesarian
Assistant Professor, Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.
Michael
M
Yunker
Assistant Professor, Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Ravikumar
R
Ramakrishnaiah
Program Director, Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York.
Hans
H
Malmstrom
Graduate student, College of Health Sciences, Barry University, Miami Shores, Florida.
Tammy Varela
TV
Kellesarian
Graduate student, Department of Dentistry, Universidad Santa Maria, Caracas, Venezuela.
Vanessa
V
Ros Malignaggi
Postdoctoral Fellow, Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York.
Fawad
F
Javed
D003758:Dental Implantation, Endosseous / Q000295:instrumentation / Q000379:methods; D015921:Dental Implants; D006801:Humans; D016348:Osseointegration; D014025:Titanium; D015032:Zinc
D015921:Dental Implants; D014025:Titanium; D015032:Zinc