A role for surface topography in creating and maintaining bone at titanium endosseous implants

Statement of problem. A variety of claims are made regarding the effects of surface topography on implant osseointegration. Many in vivo and in vitro experimental observations have key limitations in their interpretations. Purpose. This review considers the major claims made concerning the effects of commercially pure (cp) titanium implant surface topography on osseointegration. Important findings of consensus are highlighted, and, existing controversies are revealed. Material and methods. This review considers many of the research publications listed in MEDLINE and presented in biomedical research publications and textbooks. Results. Implant surface topography is not well defined in the marketplace or consistently reported among experimental studies. Many in vitro evaluations art. not predictive of or correlated with in vivo outcomes. In some culture models, increased surface topography positively affects pro-osteogenic cellular activities. Animal models reveal modest increases in bone-to-implant contact and increases in the biomechanical interlock of the implant with bone for implants of increased surface topography. Existing information fails to define increased surface topography as a risk factor for peri-implant inflammation. Conclusion. Increased cp titanium implant surface topography improves the bone-to-implant contact and the mechanical properties of the enhanced interface. Growing clinical evidence for increased bone-to-implant: contact at altered cp titanium implants confirms the temporally limited observations made in preclinical studies. In the absence of controlled comparative clinical trials, the aggregate experimental evidence supports the use of cp titanium implants with increased surface topography.