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Biomedical subjects

Tomas Albrektsson

Publications and source records attributed to Tomas Albrektsson.

At least 19 recordsLinked to original sources
PubMed2006

Stepwise introduction of a bone-conserving osseointegrated hip arthroplasty using RSA and a randomized study: II. Clinical proof of concept--40 patients followed for 2 years.

BACKGROUND: We have developed a bone-conserving commercially pure titanium hip replacement system using osseointegration principles: a metaphyseal loading proximal femoral component affixing into the retained neck and metaphysis only, leaving the femoral canal untouched. The acetabular cup closely fits a dual-geometry cavity, avoiding stress protection at the dome. PATIENTS AND METHODS: After extensive laboratory and clinical pilot trial investigations, the surface-engineered implants were submitted to a prospective randomized controlled clinical trial involving 40 patients (40 hips), in which they were compared to the cemented Spectron femoral component and cementless Trilogy cup as control implant. The following clinical measures were used to monitor progress at regular intervals for the first 2 postoperative years: radiostereometric analysis (RSA), Harris Hip Score, pain score, WOMAC, and SF-36. RESULTS: After 2 years of follow-up, no statistically significant differences were seen between the groups concerning rotation or translation along the cardinal axes. The patients receiving the Gothenburg osseointegrated titanium (GOT) system had significantly higher Harris Hip Score at 6 months, suggesting more rapid recovery. WOMAC, SF-36 and pain analysis were similar for the first 2 postoperative years. INTERPRETATION: Our RSA data suggest that osseointegration was achieved for all patients receiving the GOT hip system. This bone-conserving prosthesis may provide a good alternative, especially for young and active patients.

Acetabulum↗
PubMed2006

Oxidized, bioactive implants are rapidly and strongly integrated in bone. Part 1--experimental implants.

OBJECTIVES: The study presented was designed to investigate the speed and the strength of osseointegration of oxidized implants at early healing times in comparison which machined, turned implants. MATERIAL AND METHODS: Screw-shaped titanium implants were prepared and divided into two groups: magnesium ion incorporated, oxidized implants (Mg implants, n=10) and machined, turned implants (controls, n=10). Mg implants were prepared using micro-arc oxidation methods. Surface oxide properties of implants such as surface chemistry, oxide thickness, morphology/pore characteristics, crystal structures and roughness were characterized with various surface analytic techniques. Implants were inserted into the tibiae of ten New Zealand white rabbits. After a follow-up period of 3 and 6 weeks, removal torque (RTQ), osseointegration speed (DeltaRTQ/Deltahealing time) and integration strength of implants were measured. Bonding failure analysis of the bone-to-implant interface was performed. RESULTS: The speed the and strength of osseointegration of Mg implants were significantly more rapid and stronger than for turned implants at follow-up periods of 3 and 6 weeks. Bonding failure for Mg implants dominantly occurred within the bone tissue, whereas bonding failure for turned implants mainly occurred at the interface between implant and bone. CONCLUSIONS: Oxidized, bioactive implants are rapidly and strongly integrated in bone. The present results indicate that the rapid and strong integration of oxidized, bioactive Mg implants to bone may encompass immediate/early loading of clinical implants.

Animals↗
PubMed2006

Retrieved implants from irradiated sites in humans: a histologic/histomorphometric investigation of oral and craniofacial implants.

PURPOSE: The aim of this report was to quantitatively and qualitatively evaluate the tissue response to bone-anchored implants retrieved from irradiated sites in patients. MATERIALS AND METHODS: The material consists of 23 consecutively received Brånemark implants (Nobel Biocare AB, Göteborg, Sweden) placed in pre- or postoperatively irradiated sites. Twenty-two of the 23 implants were suitable for histologic evaluation of undecalcified sections in the light microscope. RESULTS: The oral implants with shorter time in situ demonstrated sparse bone to implant contact with mainly dense connective tissue in the interface. However, for implants with longer time in situ, high amounts of bone-implant contact and bone fill of threads were noted. The mean values of bone-implant contact and bone area within the thread were calculated to 40% (16-94) and 70% (13-96), respectively. The craniofacial implants, with the exception of two implants lined with a capsular formation, demonstrated mature and newly formed bone at the bone-implant interface. The mean value for bone-metal contact was calculated to 45 and 53% for two specimens. The mean value for bone area within the thread ranged from 65 to 88% for three specimens. CONCLUSION; The possibility to achieve bone anchorage of implants in irradiated tissue was supported by the findings in this study. However, due to limited material, conclusions with regard to radiation dose and bone tissue response to implants cannot be stated.

Aged↗
PubMed2006

Histologic evaluation of Brånemark clinic oral implants retrieved from grafted sites.

PURPOSE: The aim of this report is to quantitatively and qualitatively describe the bone tissue response to Brånemark implants retrieved from grafted sites in patients. MATERIALS AND METHOD: The material consists of consecutively received Brånemark implants retrieved from grafted sites. Thirty-five of these implants, retrieved from 16 patients, were suitable for the histologic evaluation of undecalcified sections in the light microscope. RESULTS: The unloaded implants were mainly lined with soft tissue, and sparse bone-implant contact was observed only in some sections. The loaded implants, with the exception of one implant removed due to mobility, had mature and new bone-implant contact. Resorption of graft through cutting cone structures was detected. Cement lines were found separating bone-like tissue albeit no cellular content and bone tissue with detectable osteocytes. CONCLUSION: In this heterogeneous group of implants from grafted sites, the unloaded implants showed limited bone-implant contact. The autografts showed seemingly mixed viability as judged by the cell content in the osteocyte lacunae and cement lines separating areas with filled and empty lacunae.

Bone Transplantation↗
PubMed2005

The bone response of oxidized bioactive and non-bioactive titanium implants.

A number of experimental and clinical data on so-called oxidized implants have reported promising outcomes. However, little is investigated on the role of the surface oxide properties and osseointegration mechanism of the oxidized implant. Sul [On the Bone Response to Oxidized Titanium Implants: The role of microporous structure and chemical composition of the surface oxide in enhanced osseointegration (thesis). Göteborg: Department of Biomaterials/Handicap Research, University of Göteborg, Sweden; 2002; Biomaterials 2003; 24: 3893-3907] recently proposed two action mechanisms of osseointegration of oxidized implants, i.e. mechanical interlocking through bone growth in pores/other surface irregularities (1) and biochemical bonding (2). The aim of the present study is two-fold: (i) investigating the role of the implant surface chemistry on bone responses; (ii) investigating the validity of the biochemical bonding theory of the oxidized, bioactive bone implants with specific implant surface chemistry. Two groups of oxidized implants were prepared using micro arc oxidation process and were then inserted in rabbit bone. One group consisted of magnesium ion incorporated implants (MgTiO implant), the other consisted of TiO2 stoichiometry implants (TiO implant). Surface oxide properties of the implants were characterized with various surface analytic techniques. After 6 weeks of follow up, the mean peak values of removal torque of Mg implants dominated significantly over TiO implants (p < or = 0.0001). Bonding failure generally occurred in the bone away from the bone to implant interface for the MgTiO implant and mainly occurred at the bone to implant interface for the TiO implant that consisted mainly of TiO2 chemistry and significantly rougher surface as compared to the MgTiO implant. Between bone and the Mg- incorporated implant surface, ionic movements and ion concentrations gradient were detected. The current in vivo experimental data may provide positive evidence for the surface chemistry-mediated biochemical bonding theory of oxidized bioactive implants. However, the present study does not rule out potential synergy effects of the oxide thickness, micro-porous structure, crystal structure and surface roughness on improvements of bone responses to oxidized bioactive implants.

Absorbable Implants↗
PubMed2005

The impact of oral implants - past and future, 1966-2042.

This paper traces the history of oral implants, beginning with their early undocumented use in the mid-1960s. Although early experimentation with the Brånemark system of osseointegration was unsuccessful, significant improvements and scrupulous documentation of the 1970s led to their general acceptance. George Zarb spearheaded their introduction into North America and application of the osseointegration technique soon expanded to extraoral craniofacial prostheses and bone-anchored hearing aids.New possibilities, such as altered surface properties and the use of implants in grafted and irradiated bone are currently being explored, although commercial pressure to introduce new products before they are adequately tested is a cause for concern. The future will see bioactive surfaces and additives that stimulate bone growth. In fact, with the possibility of in vivo growth of new teeth, implants may become unnecessary.

Canada↗
PubMed2005

A study of 275 retrieved Brånemark oral implants.

The aim of this report was to describe the bone tissue response to Brånemark oral implants retrieved from patients. The material consisted of consecutively received Brånemark threaded oral implants and related patient data provided by clinicians. The implant samples were processed into undecalcified sections for evaluation under the light microscope. The analysis demonstrated a lower percentage of bone-to-implant contact for the unloaded implants as compared to the loaded implants. When the threads were divided into four different regions, the loaded implants had a lower percentage of bone-contacting length at the thread top as compared to the other three regions.

Adaptation, Psychological↗
PubMed2004

Titanium release from implants prepared with different surface roughness.

OBJECTIVES: There may be a risk of greater ion release for surface-enlarged implants than conventionally turned components. The major aim of the present paper was to investigate whether a correlation exists between ion release and a surface roughness relevant for today's commercial implants. Other aims were to compare ion release after two insertion times and concentration in bone tissue as a function of distance from the implant surface. MATERIAL AND METHODS: Lactic acid aqueous solution (pH=2.3) and phosphate-buffered saline were used for the in vitro investigation. For the in vivo investigation, synchrotron radiation X-ray fluorescence (SRXRF) spectroscopy and secondary ion mass spectroscopy (SIMS) were performed 12 weeks and 1 year after implantation in rabbit tibiae. RESULTS: The average height deviation (S(a)) was 0.7, 1.27, 1.43 and 2.21 microm, respectively, for the four surfaces investigated. No difference in ion release was found in vitro. In vivo, SRXRF demonstrated slightly higher values for the roughest surface up to a distance of 400 microm from the implant surface; thereafter no difference was found. SIMS demonstrated no difference in ion release for the roughest and smoothest surfaces, but slightly more titanium in bone tissue after 1 year than after 12 weeks. Titanium rapidly decreased with distance from the implant surface. CONCLUSION: At a level relevant for commercial oral implants, no correlation was found between increasing roughness and ion release, neither in vitro nor in vivo.

Air Abrasion, Dental↗
PubMed2003

Failure to induce supracrestal bone growth between and around partially inserted titanium implants using bone morphogenetic protein (BMP): an experimental study in dogs.

The effect of bone morphogenetic protein on supracrestal bone growth around partially inserted implants in a dog model is described. The lower premolar teeth (P1, P2, P3 and P4) were extracted on both sides of the mandible in six dogs. At a surgical exposure 12 weeks later, two 10-mm turned titanium implants were partially inserted, approximately 15 mm apart, in the areas of the P1 and P3 in each side of the mandible, allowing five threads to protrude from the bone crest. A titanium mesh was fastened to the coronal aspect of the two fixtures and the space beneath the mesh was filled with bone morphogenetic protein (S300 BMP) in combination with an insoluble bone matrix carrier, or with the carrier alone. The mesh was covered with an ePTFE membrane. Thus, a space for potential bone formation was created between the two implants. The surgical flaps were coronally positioned and secured with vertical mattress sutures. After 16 weeks of healing, biopsy specimens were retrieved and examined histologically. Bone was not formed around the protruding implants or in the created space between the implants in any case. The carrier was incompletely resorbed. We conclude that supracrestal bone growth beyond the crestal limit with or without BMP in such a large space as in this experimental design may not be possible.

Absorbable Implants↗
PubMed2003

Bone augmentation by means of a stiff occlusive titanium barrier.

It has already been shown that occlusive titanium barriers have osteoconductive properties. These barriers, however, cover only a limited surface area and have only been used in animal experiments. The aim of this study was to evaluate bone neogenesis under a pre-shaped titanium barrier placed over the top of the rabbit skull and the top of highly resorbed edentulous upper-jaw bone in patients. Computed tomography (CT) scans made it possible to pre-shape the titanium barrier according to individual bone shape in human experiments. On the rabbit skull, tissue augmentation of up to 6 mm 1 year after barrier placement was observed, while the original thickness of skull bone was on average between 1.5 and 2.5 mm. The bone, which remained histologically immature for 1 year, grew systematically along the titanium surface, illustrating its osteoconductivity. Even after removal of the barrier, on average, 75.3 and 59.4% of the newly created tissue volume was maintained after 3 and 9 months, respectively. Clinical observations on 10 consecutive patients showed that, in those (5/10) in which the barrier remained unexposed for several months, an increase of the jawbone height and width of up to 16 mm could be observed when the barrier was removed after 12-18 months. As in the rabbits at barrier removal, the bone demonstrated a limited degree of mineralization as ascertained from biopsies. This newly formed osteoid tissue allowed the insertion of 33 screw-shaped titanium implants which in most cases (30/33) successfully osseointegrated to support a fixed prosthesis. The surrounding marginal bone level remained stable even up to 5 years after implant placement. Both animal and clinical data demonstrate that guided bone neogenesis under a subperiosteally placed titanium barrier can reach large volumes.

Adult↗
PubMed2003

Long-term results of a cementless knee prosthesis with a metal-backed patellar component: clinical and radiological follow-up with histology from retrieved components.

Aseptic loosening of cemented knee arthroplasties has encouraged development of uncemented fixation. The Miller-Galante I (MG I) prosthesis was designed to achieve permanent stability through ingrowth into a titanium fiber mesh. Thirty-five knees in 30 patients with MG I knee replacements have been followed clinically and radiologically with a mean follow-up of 12 years. Twenty knees were revised with a mean follow-up of 5 years. Patellofemoral problems, especially avulsion of the polyethylene from the metal-backed patella and in some cases severe metallosis, have been the main reason for revision. Metal-backed patellar component should be avoided. In addition, instability has been a problem. However, the fixation of the components has been excellent, with a high degree of osseous ingrowth displayed at histological analysis of retrieved components. The clinical and radiological results after revision are in most cases good, despite the femoral component having been left in situ.

Arthroplasty, Replacement, Knee↗
PubMed2002

Characteristics of the surface oxides on turned and electrochemically oxidized pure titanium implants up to dielectric breakdown: the oxide thickness, micropore configurations, surface roughness, crystal structure and chemical composition.

Titanium implants have been used widely and successfully for various types of bone-anchored reconstructions. It is believed that properties of oxide films covering titanium implant surfaces are of crucial importance for a successful osseointegration, in particular at compromized bone sites. The aim of the present study is to investigate the surface properties of anodic oxides formed on commercially pure (c.p.) titanium screw implants as well as to study 'native' oxides on turned c.p. titanium implants. Anodic oxides were prepared by galvanostatic mode in CH3COOH up to the high forming voltage of dielectric breakdown and spark formation. The oxide thicknesses, measured with Auger electron spectroscopy (AES), were in the range of about 200-1000 nm. Barrier and porous structures dominated the surface morphology of the anodic film. Quantitative morphometric analyses of the micropore structures were performed using an image analysis system on scanning electron microscopy (SEM) negatives. The pore sizes were < or = 8 microm in diameter and had 1.27-2.1 microm2 opening area. The porosity was in the range of 12.7-24.4%. The surface roughness was in the range of 0.96-1.03 microm (Sa), measured with TopScan 3D. The crystal structures of the titanium oxide were amorphous, anatase, and a mixtures of anatase and rutile type, as analyzed with thin-film X-ray diffractometry (TF-XRD) and Raman spectroscopy. The chemical compositions consisted mainly of TiO2, characterized with X-ray photoelectron spectroscopy (XPS). The native (thermal) oxide on turned implants was 17.4 nm (+/- 6.2) thick and amorphous. Its chemical composition was TiO2. The surface roughness had an average height deviation of 0.83 microm (Sa). The present results are needed to elucidate the influence of the oxide properties on the biological reaction. The results of animal studies using the presently characterized surface oxides on titanium implants will be published separately.

Crystallography, X-Ray↗
PubMed2002

Qualitative and quantitative observations of bone tissue reactions to anodised implants.

Research projects focusing on biomaterials related factors; the bulk implant material, the macro-design of the implant and the microsurface roughness are routinely being conducted at our laboratories. In this study, we have investigated the bone tissue reactions to turned commercially pure (c.p.) titanium implants with various thicknesses of the oxide films after 6 weeks of insertion in rabbit bone. The control c.p. titanium implants had an oxide thickness of 17-200 nm while the test implants revealed an oxide thickness between 600 and 1000 nm. Routine histological investigations of the tissue reactions around the implants and enzyme histochemical detections of alkaline and acid phosphatase activities demonstrated similar findings around both the control and test implants. In general, the histomorphometrical parameters (bone to implant contact and newly formed bone) revealed significant quantitative differences between the control and test implants. The test implants demonstrated a greater bone response histomorphometrically than control implants and the osteoconductivity was more pronounced around the test implant surfaces. The parameters that differed between the implant surfaces, i.e. the oxide thickness, the pore size distribution, the porosity and the crystallinity of the surface oxides may represent factors that have an influence on the histomorphometrical results indicated by a stronger bone tissue response to the test implant surfaces, with an oxide thickness of more than 600 nm.

Acid Phosphatase↗
PubMed2002

Resonance frequency and removal torque analysis of implants with turned and anodized surface oxides.

The present experimental study was designed to address two issues. The first was to investigate whether oxide properties of titanium implants influenced bone tissue responses after an in vivo implantation time of six weeks. If such a result was found, the second aim was to investigate which oxide properties are involved in such bone tissue responses. Screw-shaped implants with a wide range of oxide properties were prepared by electrochemical oxidation methods, where the oxide thickness varied in the range of 200 nm to 1000 nm. The surface morphology was prepared in two substantially different ways, i.e. barrier and porous oxide film structures. The micropore structure revealed pore sizes of 8 microm in diameter, with a range in opening area from 1.27 microm 2 to 2.1 microm 2. Porosity ranged from 12.7% to 24.4%. The crystal structures of the titanium oxide were amorphous, anatase and a mixture of anatase and rutile type. The chemical compositions consisted mainly of TiO2. Surface roughness ranged from 0.96 microm to 1.03 microm (Sa). Each group of test samples showed its own, defined status with respect to these various parameters. The oxide properties of turned commercially pure titanium implants were used in the control group, which was characterized by an oxide thickness of 17.4 +/- 6.2 nm, amorphous type in crystallinity, TiO2 in chemical composition, and a surface roughness of 0.83 microm (Sa). Bone tissue responses were evaluated by resonance frequency measurements and removal torque tests that were undertaken six weeks after implant insertion in rabbit tibia. Implants that had an oxide thickness of approximately 600, 800 and 1000 nm demonstrated significantly stronger bone responses in the evaluation of removal torque values than did implants that had an oxide thickness of approximately 17 and 200 nm (P < 0.05). However, there were no difference between implants with oxide thicknesses of 17 and 200 nm (P = 0.99). It was concluded that oxide properties of titanium implants, which include oxide thickness, micropore configurations and crystal structures, greatly influence the bone tissue response in the evaluation of removal torque values. However, it is not fully understood whether these oxide properties influence the bone tissue response separately or synergistically.

Animals↗
PubMed2002

Dog model for study of supracrestal bone apposition around partially inserted implants.

A dog model for study of supracrestal bone growth around partially inserted implants is described. The mandibular premolar teeth (P1, P2, P3 and P4) were extracted on both sides of the mandible in four dogs. At a surgical exposure 12 weeks later, two 10 mm titanium implants were partially inserted on each side, 15 mm apart, in the areas of the P1 and the P3 so that five threads protruded from the bone crest. A titanium mesh was fastened to the coronal aspect of the two fixtures and covered with an ePTFE membrane. Thus, a space for potential bone formation was created between the two implants. The surgical flaps were coronally positioned and secured with vertical mattress sutures. After 12 weeks of healing, biopsy specimens were retrieved and examined histologically. In three of the four dogs under study, the partially inserted implants had integrated and the intended large wound spaces had been created around the noninserted parts of the implants. However, bone was not formed around the protruding implants. Accordingly, this experimental model may prove useful for future studies on the use of various procedures that hypothetically may enhance bone formation.

Animals↗
PubMed2002

Bone reactions to oxidized titanium implants with electrochemical anion sulphuric acid and phosphoric acid incorporation.

BACKGROUND: The importance of the surface properties of implants for a successful osseointegration has been emphasized. It is generally known that bone response to implant surfaces is considerably related to the various surface properties. PURPOSE: The purpose of this study was to investigate bone tissue reactions to multifactorial biocompatibility of the surface oxide of electrochemically oxidized titanium implants. The ultimate objective was to improve surface quality, resulting in enhancement of clinical outcomes of osseointegrated implants. MATERIALS AND METHODS: Three different surface types of commercially pure titanium (c.p. Ti) implants were prepared. Turned implants were used for controls and test implants were prepared by the micro arc oxidation (MAO) method, either in sulphuric acid (S implants) or in phosphoric acid (P implants). Implants were inserted in the femur and tibia of 10 mature New Zealand White rabbits. The bone response was evaluated by biomechanical tests, histology, and histomorphometry. The follow-up time was 6 weeks. RESULTS: The mean peak values of the removal torque showed significant differences between control and test S implants (p =.022) but showed no significant differences between control and test P implants (p =.195) or between test S and test P implants (p =.457). In addition, the histomorphometric comparisons of the bone-to-metal contact around entire implants demonstrated 186% increase in S implants (p =.028) and 232% increase in P implants (p =.028) compared with the paired control groups. Quantification of the bone area in the threads did not show any significant differences. CONCLUSIONS: The present results suggest that the primary mode of action in strong bone response to S implants is mechanical interlocking, and to P implants, it is biochemical interaction. It is possible that the phosphate groups in the titanium oxide of P implants provide potential chemical bonding sites for calcium ions and hydroxyapatite of the bone matrix during biologic mineralization. key words: bone responses, histomorphometry, oxidized implants, removal torque test, surface oxide properties

Animals↗
PubMedDate not supplied

Influence of the microgap in the peri-implant hard and soft tissues: a histomorphometric study in dogs.

PURPOSE: The purpose of this study was to examine the dimensions and relationships of the peri-implant tissues surrounding osseointegrated 2-stage implants placed at different depths in bone. MATERIALS AND METHODS: Twenty-four implants were placed in the mandibles of 4 mongrel dogs. A modification of the surgical protocol was introduced so that in group I, implants remained 1 mm above the bone crest, in group II, implants were placed level with the bone crest; and group III implants were countersunk to approximately 1 mm below the bone crest. After 3 months, abutment operations were carried out with the placement of 3-mm standard abutments. Following a healing period of 3 months the dogs were sacrificed. A total of 20 implants were available for histometric analysis. Non-decalcified sections were evaluated for the dimensions of the junctional epithelium, connective tissue band, marginal bone level, and bone-to-metal contact. RESULTS: Histologic observations showed a mucosal barrier consisting of keratinized oral epithelium continuous with a thin junctional epithelium facing the implant and abutment surface. Junctional epithelium showed a mean of 1.67 mm for group 1, 1.93 mm for group II, and 2.78 mm for group III. These values were not statistically different. The band of connective tissue had a mean of 1.13 mm for group 1, 0.92 mm for group II, and 1.60 mm for group III. These values were not statistically different, except for group II versus group III. Bone level had a mean of 2.50 mm for group 1, 2.30 mm for group II, and 1.60 mm for group III. These differences were significant between groups I and III. The surface of bone contact along the implant (BMC%) showed mean values of 46.8% in group 1, 53.7% in group II, and 49.0% in group III (no significant differences among the 3 groups). DISCUSSION: There was a clear tendency of the epithelium and connective tissue to be longer the deeper the implants were placed, although those differences were not statistically significant. Bone loss was smaller for group III (countersink group). This is not in accordance with recent articles which have stated that bone will maintain its biologic width. CONCLUSIONS: When the microgap between implants and abutments was placed deeper in the bone, additional bone loss did not result.

Alveolar Bone Loss↗