Comparison Between Micro- and Micro-Nano Surface Texturization in the Initial Osseointegration Process: An Experimental In Vitro and In Vivo Preclinical Study

Background: The physicochemical changes of the surface aim to improve cell adhesion, proliferation, and differentiation, that is, better biological interaction with the cells and, consequently, with the peri-implant tissues. In the present study, implants with the same macrogeometry were compared in vitro and in vivo, but with two different surfaces: micro-rough and a new micro-nano-rough surface. Materials and Methods: A total of 90 implants were used, 10 of which were used for in vitro surface characterization (n = 5 per group) through scanning electron microscopy (SEM), atomic force microscopy (AFM), and surface roughness measurements. For in vivo tests, 80 implants (n = 40 per group) were used in 20 rabbits (n = 2 implants per tibia). Two experimental groups were created: a control group, where the implants had a surface treated by sandblasting with titanium oxide microparticles, and a test group, where the implants were sandblasted using the same process as the previous group plus acid conditioned. The implant stability quotient (ISQ) was measured by resonance frequency (initially and at both euthanasia times). Animals were euthanized 3 and 5 weeks after implantation (n = 10 animals per time). Ten samples from each group at each time point were evaluated by removal torque (RTv). Another ten samples from each group were evaluated histologically and histomorphometrically, measuring the percentage of bone-to-implant contact (%BIC) and the bone area fraction occupancy (%BAFO). Results: In vitro, it was possible to observe a more homogeneous surface for the test group compared to the control group. ISQ values showed statistical differences at both 3 and 5 weeks (test > control). For RTv, the values were: 44.5 +/- 4.25 Ncm (control group) and 48.6 +/- 3.17 Ncm (test group) for the time of 3 weeks; 64.3 +/- 4.50 Ncm (control group) and 76.1 +/- 4.18 Ncm (test group) at 5 weeks. The %BIC and %BAFO values measured in both groups and at both times did not show significant differences (p > 0.05). Conclusions: The higher removal torque and ISQ values presented in the samples from the test group compared to the control group indicate that there was an acceleration in the mineralization process of the newly formed bone matrix.