Critical Reviews in Oral Biology & Medicine, Vol 7, 329-345, Copyright © 1996 by International & American Associations for Dental Research
The role of implant surface characteristics in the healing of bone
K. Kieswetter, Z. Schwartz, D. D. Dean and B. D. Boyan
OsteoBiologics, Inc., San Antonio, Texas, USA.
The surface of an implant determines its ultimate ability to integrate into
the surrounding tissue. The composite effect of surface energy,
composition, roughness, and topography plays a major role during the
initial phases of the biological response to the implant, such as protein
adsorption and cellular adherence, as well as during the later and more
chronic phases of the response. For bone, the successful incorporation (and
hence rigid fixation) of an alloplastic material within the surrounding
bony bed is called osteointegration. The exact surface characteristics
necessary for optimal osteointegration, however, remain to be elucidated.
This review will focus on how surface characteristics, such as composition
and roughness, affect cellular response to an implant material. Data from
two different culture systems suggest that these characteristics play a
significant role in the recruitment and maturation of cells along relevant
differentiation pathways. In the case of osteointegration, if the implant
surface is inappropriate or less than optimal, cells will be unable to
produce the appropriate complement of autocrine and paracrine factors
required for adequate stimulation of osteogenesis at the implant site. In
contrast, if the surface is appropriate, cells at the implant surface will
stimulate interactions between cells at the surface and those in distal
tissues. This, in turn, will initiate a timely sequence of events which
include cell proliferation, differentiation, matrix synthesis, and local
factor production, thereby resulting in the successful incorporation of the
implant into the surrounding bony tissue.
