(2021) 21:207
Körmöczi et al. BMC Oral Healthhttps://doi.org/10.1186/s12903-021-01498-z

RESEARCH ARTICLE

Open Access

The early loading of different
surface‑modified implants: a randomized
clinical trial
Kinga Körmöczi1* , György Komlós1, Petra Papócsi1, Ferenc Horváth2 and Árpád Joób‑Fancsaly1

Abstract
Background: Various surface treatment options have been adopted with the aim to improve osseointegration,
reducing the overall treatment time. Implant stability of early loaded implants with different modified surfaces wascompared in the present study.
Methods: Patients were selected from the Department of Oro-Maxillofacial Surgery and Stomatology at Semmelweis
University. Patients randomly received SA (alumina sandblasted and acid-etched), NH (bioabsorbable apatite nano‑coating) or SLA (large-grit sandblasted and acid-etched) surface implants. Outcome measures were: implant success,
implant stability, and periodontal parameters. The implant stability was measured at the time of implant placement(primary stability) and six weeks after (prothesis delivery, secondary stability). Osstell and Periotest were applied totake all the measurements. The primary and secondary stability were compared in the three study groups Finally theperiimplant probing depth appearing after three months of loading was checked on 6 points around to the implantsupported prostheses. Shapiro–Wilk and Mann–Whitney tests were used for the comparison between the study
groups.
Results: A total of 75 implants with different length and diameter were inserted into various positions. One implantfailed spontaneously at the fourth week after implant placement. The survival rate was 98,7%. Comparing the primaryand secondary stability values, the data were significantly improved in every groups. The difference was the highest
in the NH group, however, this difference was not significant compared to the two other groups. Good periodontal
parameters were experienced in all the tested implants, independently by the groups.
Conclusions: With the limitation of the present study, all the implants showed improved stability six weeks after
implant placement. A trend of higher result was found for the NH group. Further studies with longer follow-up areneeded to confirm this preliminary results.
Trial registration: Current Controlled Trials ISRCTN13181677; the date of registration: 04/03/2021. Retrospectively
registered.
Keywords: Early loading, Surface modification, Sand-blasted/acid-etched surface, Hydroxyapatite surface*Correspondence: kormoczi.kinga@dent.semmelweis-univ.hu
1Oral and Maxillofacial Department, Faculty of Dentistry, Semmelweis
University, Mária str 52, 1085 Budapest, Hungary
Full list of author information is available at the end of the article

BackgroundThe direct integration of titanium implants into the bone
was first reported by Rudy et al. [20]. After various animal experiments, dental implants began to be used ineveryday dental practice from 1965 [4]. Osseointegration was firstly described in 1976 as the direct contact© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to theoriginal author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images orother third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of thislicence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. The Creative Commons Public Domain Dedication waiver (http://​creat​iveco​
mmons.​org/​publi​cdoma​in/​zero/1.​0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Körmöczi et al. BMC Oral Health(2021) 21:207

between machined surface implant and the surrounding bone at microscopy level. The observation of a directbone-implant contact (BIC), confirmed by Albrektsson
et al. with electron microscopy, was the most important discover in dental implantology [1]. Machined surface implants were characterized by low BIC therefore,
implant surface modifications were suggested to enhanceosseointegration, particularly in challenging clinical scenarios. The ideal form, utilized material, the biologicalindicator function of dental implant surfaces is a main
focus of basic research in implant dentistry [5, 7, 8, 12].
Dental implant surfaces can be defined by their roughness (Sa), chemical composition, and by the physicaland mechanical implant features. Surface roughnessof implants can be categorized into three basic levels:
minimally rough: 0.5–1 μm, moderately rough: 1–2 μm,
rough: greater than 2 μm [2]. Moderately rough surface,compared to the previously used rough and smoothsurfaces, has shown better clinical results by improving osseointegration, reducing the early failure rates [10,26]. The combined large-grit sand-blasted acid-etchedprocedure is still one of the most frequently used surfaces modifications, which creates micro-sized surface
elements of about 1.5 μm Ra value, showing a positive
influence on osseointegration in several studies [14, 16,17]. The effect of micrometer-sized structures on cells
has been clarified, and the protein layer formation ability of nanometer-sized structures has been proven in animal experiments, although the latter mechanism is still
unknown [12, 13, 22, 25]. Moreover, there remain some
unexplained questions related to the clinical effects ofcurrent surface structures on the surrounding bone [11,15, 27]. The osseointegration-stimulating effect of biological surface modifications (e.g., tricalcium phosphate andhydroxyapatite) has been frequently reported, however,
the application of nanometer-sized biomaterials onto theimplant surface is still under investigation [18, 19, 21].
The purpose to combine SLA surface with the osteoinductivity-features of hydroxyapatite (HA) is to takeadvantages of both processes. The hypothesis was that anano coating of HA turns the bioinert titanium implant
to be more hydrophilic (bioactive), making the implantable to overcome unfavorable conditions during undisturbed healing or earlier loading [23]. Previous investigations reported some failures using HA modified surface,
nevertheless, the bonding strength was too low (20–35 MPa) resulting in the HA detachment. The novel HA
coating was developed to be resorbable enhancing osseointegration process with no improved risk of implantfailure. In vivo preliminary researches showed encouraging short and long-term results [28].
The ultimate goal of surface development is to achieve
the quick, safe, and long-term formation of the secondary

Page 2 of 8

stability allowing for early prosthetic loading [25]. Many
investigations and systematic reviews found that earlyloading did not negatively influence the osseointegration.
Soft and hard tissues were reported very stable aroundthe early loaded implants, similarly to conventional loading [9].
The aim of this randomized controlled trial was toinvestigate whether the implant surface characteristics
influence the osseointegration process, up to six weeks
after dental implant insertion.

Methods
Study design

A randomized prospective clinical trial was conducted at
the Department of Oro-Maxillofacial Surgery and Stomatology at Semmelweis University to evaluate the effectsof the SA (alumina sandblasted and acid-etched, Osstem
Implants, Seoul, South Korea), NH (bioabsorbable apatite nanocoating, Osstem Implants) or SLA (sandblasted,large-grit and acid-etched, Straumann, Basilea, Swiss)surface on secondary implant stability of early loaded
implants. Patients with good general health aged 18 orolder with at least one missing tooth and requiring an
implant supported fixed partial denture were includedin the study. Written informed consents were signedby all participants. The study was approved by National
Institute of Pharmacy and Nutrition (reference number:
OGYÉI/55,197/2019), all treatments were performed
according to Helsinki declaration (2013).
Inclusion criteria were: patients with an edentulous siterequiring implant supported fixed partial dentures, goodpatient’s compliance, good or moderate oral hygiene,
complete mucosal healing at the study site, previous
tooth extraction performed between two months and one
year prior to implant placement. Exclusion criteria were:general contraindications to oral surgery (i.e. non-controlled systematic diseases, chemo- and radiotherapy inthe head and neck region, previous and ongoing bisphosphonate or denosumab therapy), incomplete mucosal
healing at the study site, need for bone grafting, previous socket preservation or ridge augmentation, > 5 mm ofperiodontal pockets at adjacent teeth, poor oral hygiene,
smoking more than 10 cigarettes per day.
Clinical protocol

The medical and dental history of patients was registered. Before implant placement, all the necessary dental treatments were completed. The informed consent
was fulfilled and signed by each patient. To evaluate thequantity and quality of the bone a preoperative low-dosage Cone Beam Computer Tomography (CBCT) scan
was taken. All the surgical procedures were performedby three calibrated and experienced surgeons (ÁJF, GYK,

Körmöczi et al. BMC Oral Health(2021) 21:207

KK). Implants were placed under local anaesthesia (4 ml
Ultracain DS Forte, Sanofi Aventis, Paris, France). Then,a midcrestal incision was made continued in the intracrevicular sulcus of the adjacent teeth. In the first group(SA group) SA implants (Osstem implant were inserted.
This implant is featured with a surface sand blasted withaluminium oxide grains of 250–500 μm and etched withhydrochloric acid or sulphuric acid. The Ra value is 2.5–
3.0 μm. In the second group (NH group) NH implants(Osstem implant) were inserted. The characteristic of
this hydrophilic surface is that the sand-blasted surface iscovered with a 10 nm thick hydroxyapatite layer, which
has the ability of bio absorption in the human body.
The bonding strength of the HA layer is 75 MPa. The
Ra value is 2.5–3.0 μm. In the third group (SLA group)
SLA implants (Straumann implant) were inserted. The
Ra value is 1.42 μm. Implant osteotomy was performed
according to the manufacturers’ protocols. Implants ofdifferent lengths and diameters were chosen according topatients’ individual needs. All the implants were inserted
using a manual wrench torque and the healing abutments
were inserted. Wound closure was performed by simple
interrupted suture. A postoperative periapical radiograph was taken. Fourteen days after surgery, sutures
were removed. Six weeks after implant placement thepatients were controlled and the secondary stability wasmeasured. Three days after a definitive screw-retained
fixed partial denture was delivered. Three months after
definitive prothesis delivery clinical parameters wererecorded. After study completion, patients were enrolled
to a lifetime supportive therapy with visits every four to
six months.

Page 3 of 8

Fig. 1 Measuring of the primary stability immediately after implant
insertion with the Periotest

Outcome measures

The primary outcome measures were implant failure andthe implant stability. Implant was judge as failed in caseof loss of osseointegration for any reason. The implantstability was measured at baseline (primary implant stability) and 6 weeks after implant placement (secondary
stability), by using the Periotest (Medizintechnik Gulden,
Modautal, Germany) and the Osstell ISQ module (W&H,
Bürmoos, Austria). The Periotest utililizes an electricallydriven tapping head, which percusses the implant and theobtained Periotest Value (PTV) indicates implant stability based on the parameters of repercussion (Fig. 1). The
Osstell (ISQ) device measures by a resonance frequency
analysis while using a special transducer. The device generates oscillation in the transducer via the piezoelectriceffect, thus the index is given by the interactions of theimplant and the quiver (Fig. 2). After gaining all the data
we compared the primary and secondary stability values
and registered the differences.

Fig. 2 Measuring of the primary stability immediately after implant
insertion with the Osstell

Secondary outcome measures were the following:
periimplant probing depth evaluated three months
after the definitive prosthesis delivery. Six points

Körmöczi et al. BMC Oral Health(2021) 21:207

around the implants were measured (three measuring
points on the buccal side and three on the oral side).
Statistical analysis

A computer generated randomization scheme was used
to allocate patients in three different groups (SA—20
patients, NH—20 patients, SLA—20 patients). Randomization codes were secured in an opaque envelope. An
external assessor, not previously involved in the study,
prepared all the envelopes.
Data were presented as mean standard deviation andmedian. A Shapiro–Wilk test was used for testing thenormality of the data. The presence of a significant difference between the examined groups (implant stability)
was revealed with the Mann–Whitney and Kruskal–Wallis test. Fischer Exact Probability Test or Chi-Square test
were performed to assess unbalance between groups andto evaluate dichotomous outcomes. All statistical comparisons were two-tailed and conducted at the 0.05 levelof significance. The implant was used as the statisticalunit of analysis.

Results
Of the original 60 enrolled patients seven patients were
dropped out. In the SA group four patients were dropped
out due to did not come at the planned visits for reasons
not related to the present research. Three patients were
dropped out in the SLA group due to did not attend thefollow up visits for reasons not related to the present
research. No patient was dropped out in the NH group.
Finally, a total of 75 implants (SA 16, NH 39, SLA 20)
were inserted into various positions (6 front, 26 premolar, and 43 molar) in 53 patients (35 women, mean age
44 years and 18 men, mean age 53 years). Ten percent ofparticipants were light smokers (less than 10 cigarettes
per day).
In the SA group 6 3.5 mm diameter implants, 8
4.0 mm diameter implants and 2 4.5 diameter implants
were inserted. The implant length was 7 mm in 2 cases,
8.5 mm in 4 cases, 10 mm in 6 cases and 11.5 mm in 4
cases. Implants were placed in various positions according to patients’ individual needs (2 front, 6 premolar and
8 molar).
In the NH group 17 3.5 mm diameter implants, 20
4.0 mm diameter implants and 1 4.5 diameter implants
were inserted. The implant length was 8.5 mm in 7 cases,
10 mm in 25 cases and 11.5 mm in 6 cases. Implants wereplaced in various positions according to patients’ individual needs (2 front, 12 premolar and 25 molar).
In the SLA group 10 3.3 mm diameter implants and 10
4.1 mm diameter implants were inserted. The implant
length was 8 mm in 3 cases and 10 mm in 17 cases.

Page 4 of 8

Table 1 Baseline patients’ and implants’ characteristics
SA(n = 16)NH(n = 39)SLA(n = 20)

P value

Smoking patients

1

Maxillary implants

4

3

0

0

9

14

Mandible implants

12

0.002

30

6

Frontal position
Premolar area

2

2

2

6

12

8

Molar area

8

25

10

3.5/3.3 mm d
­ iametera

6

17

10

4.0/4.1 mm diameter

8

20

10

4.5 mm diameter

2

1

0

7 mm l­engtha

2

0

0

8.5/8 mm length

4

7

3

10 mm length

6

25

17

11.5 mm length

4

6

0

a

0.73

0.49

0.23

Osstem and Straumann respectively

Implants were placed in various positions according topatients’ individual needs (2 front, 8 premolar and 10
molar). (Table 1).
According to the baseline characteristics of thepatients and the implants only in case of the implant
location in the jaws a significant difference is shown.
As a background the patients’ individual needs fordental implant rehabilitation could stand. Since thedifference between the primary and secondary stability
was measured in this study this value is not influences
the results.
Implant successHowever, the primary stability values were suitable(PTV = − 4; ISQ = 67) one NH implant failed spontaneously due to improper surgical technique at the fourthweek after implant placement. No implants failed in theother groups. The difference was not statistically different(p = 0.99).
Implant stability

The mean Periotest and Osstell ISQ data of SA, NH and
SLA surface-modified implants were reported in the
Table 2 (implant placement, baseline) and 3 (prothesis
delivery). (Tables 2, 3).
Primary and secondary stability values were compared in each group. Both ISQ values were significantly
increased in every groups. However, in case of the PTV
values only in the SLA group was a significant change.
In the NH and SA groups the results were approaching
towards to significance (Tables 4, 5, 6).
Analyzing the three implant surfaces for differencein primary and secondary stability values we found noKörmöczi et al. BMC Oral Health(2021) 21:207

Page 5 of 8

Table 2 Mean primary stability immediately after implant placement
Primary stability
SLA

PTV (mean ± SD)

ISQ (mean ± SD)− 4.75 (± 0.967; median = − 5)SA

− 5.23 (± 1.166; median = − 5)NH

− 4.49 (± 1.802; median = − 5)

PTV, periotest value; ISQ, implant stability quotient; SD, standard deviation

Table 3 Mean secondary stability immediately at the definitive
prosthesis delivery
Secondary PTV (mean ± SD)
stability

ISQ (mean ± SD)

SLA− 5.35 (± 0.745;
median = − 5)67.85 (± 9.906;
median = 69.50)− 5.10 (± 1.410;
median = − 5)64.10 (± 19.793; median = 66)

SANH− 5.38 (± 0.957;
median = − 5)63.44 (± 16.789; median = 65)

PTV, periotest value; ISQ, implant stability quotient; SD, standard deviation

65.95 (± 9.897; median = 68.5)

55.69 (± 15.782; median = 48)

59.11 (± 19.523; median = 65)

significant results with either measuring method (ISQ—p = 0,338; Periotest—p = 0,946). (Table 7).
Although the differences between primary and secondary implant stability was higher in the NH group with
the ISQ measuring method and in the SA group with the
PTV measuring method, there were no significant differences between the three study groups.
Clinical measurements

Periimplant probing depth yielded favorable outcomesin each implant. No pockets > 5 mm were detected; soft
tissue conditions were optimal around every inserted

Table 4 Difference of secondary and primary stability values in SA groupSAPTV (mean ± SD)

ISQ (mean ± SD)

Primary stability− 5.23 (± 1.166; median = -5)

57.56 (± 16.240; median = 54,50)

1.13 (± 2.13)

5.88 (± 7.42)

Secondary stability
Difference
P value− 5.38 (± 0.957; median = − 5)
0.408

63.44 (± 16.789; median = 65)
0.009

Table 5 Difference of secondary and primary stability values in NH group
NH
Primary stability
Secondary stability

PTV (mean ± SD)− 4.59 (± 1.802; median = − 5)

− 5.10 (± 1.410; median = − 5)

ISQ (mean ± SD)
58.08 (± 19.526; median = 65)

64.10 (± 19.793; median = 66)

Difference

0.76 (± 1.89)

6.03 (± 17.93)

P value

0.045

0.001

Table 6 Difference of secondary and primary stability values in SLA group
SLA

PTV (mean ± SD)

Primary stability− 4.75 (± 0.967; median = -5)

Secondary stability− 5.35 (± 0.745; median = − 5)

ISQ (mean ± SD)
65.95 (± 9.897; median = 68.50)

67.85 (± 9.906; median = 69.50)

Difference

0.6 (± 0.94)

1.9 (± 3.96)

P value

0.002

0.001

Körmöczi et al. BMC Oral Health(2021) 21:207

Page 6 of 8

Table 7 Difference between primary and secondary stability in the three examined groups
PTV (mean ± SD)

ISQ (mean ± SD)

SA

NH

SLA

Difference

1.13(± 2.13)

0.76(± 1.89)

0.6 (± 0.94)

P value

0.946

SA

NH

SLA

5.88(± 7.42)

6.03(± 17.93)

1.9 (± 3.96)

0.338

Table 8 Measurements of the gingival sulcus depth, three months after the implant placement
Periimplantprobing depth

Buccal 1 average
value

Buccal 2 average
value

Buccal 3 average
value

Oral 1 average
value

Oral 2 average
value

Oral 3 averagevalue

3 Months after
implant place‑ment

0,69 (± 0.53,
median = 1)

0,63 (± 0.598,
median = 1)

0,77 (± 0.598,
median = 1)

0,71 (± 0.825,
median = 1)

0,71 (± 0.667,
median = 1)

0,86 (± 0.55,
median = 1)

implant. In general, periimplant probing depth was
smaller on the buccal surfaces. Higher than average
probing depths were detected in two aspects of theoral surface. The highest average value was registeredat the the disto-oral surface (0.86). The lowest average
probing depth was recorded on the mid-buccal surface(0.63). (Table 8).

Discussion
The present randomized trial was aimed to investigate
whether the implant surface characteristics influence theosseointegration process up to six weeks healing. The
result of the present study showed a significant differenceof the implant stability from the baseline to 6 weeks after
insertion. There was significant difference in each study
groups between the changes of primary and secondary stability values. The values increased after six weeks.
However, no differences were found between the tested
group, even if a trend of a better result could be referedto the NH implants. In a systematic review Huthayfa andcolleagues after investigate 1.137 study, reported that incomparison hydrophilic surface implants to sandblasted,
acid-etched surface implants there was no significant
effect on improving implant stability [3].
Based on the literature, moderately rough surface could
increase the clinical outcome after dental implant placement by facilitating osseointegration [10, 27]. Although
the NH and SA surfaces showed a higher roughness (Ra
2–3 μm) compared to the SLA surface, the results ofthe present research were similar. It could be concluded
that all the three groups could be safely used in case ofearly loading protocol, when the recommended primary
implant stability could be achieved during insertion.
In the present research, in all the tested implants
primary implant stability statistically increased. The

increase of the implant stability was the lowest in case of
SLA group and the highest in case of NH group.
The main limitations of the present research are thesort follow-up period and the small sample size, due toa sample size calculation was not performed. Further
research should be conducted to better evaluate the osseointegration process at its most critical period. Usually,
the value of the primary stability of the inserted implants
decreases after two weeks and it approaches its originalvalue after fourth to sixth weeks [6]. At this point, thesecondary stability emerges. Presumably, the physiological processes are positively influenced by the different
modified surfaces during the first two weeks after dental implant insertion. In a randomized control trial, it
was resulted that in case of new hydrophilic surface, theprimary stability values significantly increased after two
weeks of implant insertion. [24]In the present study the primary stability was the highest in case of SLA group. The primary stability is not
influenced by the implant surface. Possible explanations
were related to the implant macro design, the drilling
protocol and the bone characteristics. In the present
study there was no significant difference between the secondary stability results. The implants were inserted into
different quality of bone (D1–D3). The results show thatafter six weeks of healing good secondary stability could
be achieved, allowing for safe early loading protocol withall of these type of surface modifications and in case of
D3 bone quality as well. Further research should be conducted in D4 bone quality to evaluate the clinical outcomes even in poor bone quality.
After three months of prothesis delivery good softtissue integration and stably of the attached mucosa wasrecorded. The rates of the periimplant probing depths
were higher on the oral surfaces. This can be explainedby the fact that the oral surfaces of the teeth are more

Körmöczi et al. BMC Oral Health(2021) 21:207

difficult to brush and clean. This observation reflects how
important the frequent recalls and the proper motivation
are to achieve long-term success and to prevent the formation of periimplantitis.

Conclusion
With the limitation of the present research, all the tested
implants showed improved stability six weeks after
implant placement. A trend of higher result was found
for the NH group. Further studies with longer follow-up
and sample size are needed to confirm this preliminary
results.
Abbrevitations
BIC: Bone-implant contact; HA: Hydroxyapatite; ISQ: Implant stability quotient;
NH: Nano-hydroxyapaptite; PTV: Periotest value; SA: Sandblasted and acidached; SD: Standard deviation; SLA: Sand-blasted large grit acid-etched.
Authors’ contributions
ÁJ planned and developed the research. ÁJ, KK, GK performed the surgeries,
registered the data and wrote the manuscript. FH and PP made the statisticalanalysis from the registered data. All authors read and approved the final
manuscript.
Funding
The authors declare there was no funding in the design of the study and col‑lections, analysis, and interpretation of data and in writing the manuscript.
Availability of data and materials
The datasets used and/or analysed during the current study are available fromthe corresponding author (Kinga Körmöczi, kormoczi.kinga@dent.semmel‑
weis-univ.hu) on reasonable request.

Declarations
Ethics approval and consent to participate
The necessary ethical approval for our prospective study has been consented
by the National Institute of Pharmacy and Nutrition, Medical General Depart‑
ment, Medical Research Council (reference number: OGYÉI/55197/2019; dateof registration: 12.09.2019). Participants gave written informed consent toparticipate.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1
Oral and Maxillofacial Department, Faculty of Dentistry, Semmelweis Uni‑
versity, Mária str 52, 1085 Budapest, Hungary. 2 Department of Public Health,
Faculty of Medicine, Semmelweis University, Nagyvárad Sqr. 4. 13th Floor,
1089 Budapest, Hungary.
Received: 3 September 2020 Accepted: 8 March 2021

References
1. Albrektsson T, Brånemark PI, Hansson HA, Lindström J. Osseointegrated
titanium implants. Acta Orthop Scand. 1981;52:55–170.

Page 7 of 8

2.

Albrektsson T, Wennerberg A. Oral implant surfaces: reviewfocusing
on topographic and chemical responses to them. Int J Prosthodont.
2004;17:536–43.
3. Almassari HNS, Ma Y, Dan Z, Ting Z, Cheng Y, Wu X. Implant stability
and survival rates of a hydrophilic versus a conventional sandblasted,
acid-etched implant surface: systematic review and meta-analysis. J
Am Dent Assoc. 2020;151(6):444–53.
4. Branemark PI. Osseointegration and its experimental background. J
Prosthet Dent. 1983;50(3):399–410.
5. Buser D, Broggini N, Wieland M, Schenk RK, Denzer AJ, Cochran DL,
Hoffmann B, Lussi A, Steinemann SG. Enhanced bone apposition to achemically modified SLA titanium surface. J Dent Res. 2004;7:529–33.
6. Buser D, Schenk RK. Osseointegration: a reality. Periodontol.
2000;1998(17):22–35.
7. Cochran DL. A comparison of endosseus dental implant surface. J Peri‑
odontal. 1999;70:1523–39.
8. De Assis AF, Beloti MM, Crippa EG, Oliveira PT, Morra M, Roza AL. Devel‑
opment of the osteoblastic phenothype in human alveolar bonederived cells grown on a collagen type I-coated titanium surface. Clin
Oral Impl Res. 2009;20:240–6.
9. Eliasson A, Blomqvist F, Wenneberg A, Johansson A. A retrospective
analysis of early and delayed loading of full-arch madibular prothesis
using three different implant systems: clinicalresults with up to 5 yearsof loading. Clin Implant Dent Relat Res. 2009;11:134–48.
10. Gaggl A, Schultes G, Rainer H, Kärcher H. Histological and histomor‑
phometric results of implantation of dental implants by early and lateimplantation. Mund Kiefer Gesichtschir. 2000;4(5):278–84.
11. Joób-Fancsaly Á. Fogászati implantátumok felületi morfológiájának
vizsgálata, Doktori értekezlet, 2004.
12. Joób-Fancsaly Á, Karacs A, Pető G, Körmöczi K, Bogdán S, Huszár
T. Effects of a nano-structured surface layer on titanium implants
for osteoblast proliferation activity. Acta Polytechnica Hungarica.
2016;13:7–25.
13. Joób-Fancsaly A, Divinyi T, Fazekas A, Daroczi C, Karacs A, Peto G.
Pulsed laser-induced micro- and nanosized morphology and composi‑tion of titanium dental implants. Smart Mater Struct. 2002;11:819–24.
14. Karacs A, Joób FÁ, Divinyi T, Pető G, Kovách G. Morphological and ani‑
mal study of titanium dental implant surface induced by blasting andhigh intensíty pulsed Nd-glass laser. Mater Sci Eng C. 2003;23:431–5.
15. Kasemo B, Gold J. Implant surface and interface processes. Adv Dent
Res. 1999;13:8–20.
16. Khang W, Feldman S, Hawley CE, Gunsolley J. A multi-center study
comparing and acid-etched and machined-surfaced implants in vari‑
ous bone. Periodontol. 2001;17:1384–90.
17. Kim MJ, Yun PY, Chang NH, Kim YK. The long-term evaluation of the
prognosis of implants with acid-etched surfaces sandblasted withalumina: a retrospective clinical study. Maxillofac Plast Reconstr Surg.
2020;42:10–3.
18. Kiss G, Sebők B, Szabó JP, Joób-Fancsaly Á, Gy S. Surface analytical stud‑ies of maxillofacial implants: influence of the pre-operational treatment
and the human body on the surface properties of retrieved implants. J
Cranofac Surg. 2014;25(1062):1067.
19. Ogawa K, Miyaji H, Kato A, Kosen Y, Momose T, Yoshida T, Nishida E,
Miyata S, Murakami S, Takita H, Fugetsu B, Sugaya T, Kawanami M.
Periodontal tissue engineering by nano beta-tricalcium phosphate
scaffold and fibroblast growth factor-2 in one-wall infrabony defects ofdogs. J Periodontal Res. 2016;51:758–65.
20. Rudy RJ, Levi PA, Bonacci FJ, Weisgold AS, Engler-Hamm D. Intraosse‑
ous anchorage of dental protheses: an early 20th century contribution.
Compend Contin Educ Dent. 2008;29(4):220–2.
21. Schopper C, Moser D, Goriwoda W, Ziya-Ghazvini F, Spassova E,
Lagogiannis G, Auterith A, Ewers R. The effect of three different calcium
phosphate implant coatings on bone deposition and coating resorp‑
tion: a long-term histological study in sheep. Clin Oral Implants Res.
2005;16:357–68.
22. Sousa JCM, Sordi MB, Kanazawa M, Ravindran S, et al. Nano-scale modi‑
fication of titanium implant surface to enhance osseointegration. Acta
Biomaterialia. 2019;94:112–31.
23. Strnad Z, Strnad J, Povysil C, Urban K. Effect of plasma sprayedhydroxyapatite coating on osteoconductivity of commertially puretitanium implants. Int J Oral Maxillofac Implants. 2000;15:4.

Körmöczi et al. BMC Oral Health(2021) 21:207

24. Tallarico M, Baldini N, Gatti F, Martinolli M, Xhanari E, Meloni MS,
Cervino G, Immacolata LA. Role of new hydrophillic surfaces on early
success rate and implant stability: 1-year post-loading results of amulticenter, split-mouth, randomizel controlled trial. Eur J Dent. 2020.
https://​doi.​org/​10.​1055/s-​0040-​17139​52.
25. Weszl M, Tóth KL, Kientzl I, Nagy P, Pammer D, Pelyhe L, Vrana Nihal E,
Scharnweber D, Wolf-Brandstetter C, Joób-Fancsaly Á, et al. Investiga‑
tion of the mechanical and chemical characteristics of nanotubularand nano-pitted anodic films on grade 2 titanium dental implantmaterials. Mater Sci Eng C Mater Biol Appl. 2017;78:69–78.
26. Wennerberg A, Albrektsson T, Andersson B. Design and surface char‑acteristics of 13 commercially available oral implant systems. Int J Oral
Maxillof Implants. 1993;8:622–33.

Page 8 of 8

27. Wennerberg A, Albrektsson T, Jimbo R. Implant Surface and their
Biological and Clinical Impact. Berlin: Springer; 2015.
28. Woo-jung K, Wook-jin K, Kyung-won HA, hyun-mann K. nano coatingof hydroxyapatie crystals improves osseointergration of titanium
fixtures with poor initial fixation. Presented the 22th annual scientificmeeting of European Assosiation Of Osseointegration. 25–27 Sept.
2014, Rome, Italy.

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