Ann Wennerberg: On macro-, micro- and nanoscopic aspects of osseointegration

Implant design and implant surface structures have evolved over time and today various versions are available. Dr Wennerberg reviews the evolution of implant surface structures from the orignal Branemark machined Titanium designs to recent nanostructured surfaces, and discusses perceived or proven advantages and disadavantages. In unselected patient groups the differences between machined and moderately rough (average height deviation 1.5 to 2 ym) surfaces regarding implant success rates are not significant. The new surfaces such as TiUnite however seem to show advantages in situations such as compromised bone quality, under immediate loading protocols, in posterior sites, in the maxilla and with short implants. Disadvantages can be higher risk of plaque accumulation and inflammatory response in peri-implant tissues. Dr Wennerberg summarizes that in comparison to rough surfaces, moderately rough surfaces do not present an increased marginal bone loss and that newer nanostructured surfaces seem to perform as good as moderately rough surfaces but not better. Dr Wennerberg concludes that the search for the optimal implant design and surface topograpy continues.