TiUnite implant surface – proven to perform

Enhanced osseointegration and stable bone levels

The surface for osseointegration

TiUnite is a unique implant surface that enhances osseointegration. Its ceramic-like properties and micropores ensure high osteoconductivity and fast anchorage of newly formed bone. Human histology six months after implant insertion shows bone anchored in the TiUnite pores (© Schüpbach Ltd, Switzerland).

TiUnite is a unique implant surface that enhances osseointegration – even under the most challenging conditions including soft bone and immediate loading.3, 11, 12, 14, 15, 16, 18 TiUnite is a thickened, moderately rough titanium oxide layer with high crystallinity and a high phosphorus content.19

Why TiUnite?

Predictable osseointegration with minimal failure rates

The TiUnite implant surface was first introduced on the Brånemark System in 2000. This shift from machined to TiUnite surface resulted in a clear decrease in early failures, especially in areas with poor bone density.1, 2

Immediately load your implants

TiUnite also allows for immediate loading protocols to be used more frequently and with superior outcomes.3 Additionally, implants with the TiUnite surface increase survival rates when used in revision surgeries.4

Short- and long-term success

TiUnite maintains implant stability immediately after placement with enhanced osseointegration and anchorage in surrounding bone.5, 6, 7 In the long term, it maintains marginal bone and soft tissue levels, maximizing functional endurance and esthetics.8, 9, 10

Scientific evidence

TiUnite is one of the most researched implant surfaces

TiUnite has been clinically documented in more than 275 publications on clinical studies and case series. In total, more than eleven million implants with TiUnite surface have been placed in patients across the world.

High stability in the critical healing phase

TiUnite maintains implant stability immediately after placement with enhanced osseointegration and anchorage in surrounding bone.5, 6, 7 This is particularly important in regions with soft bone and/or high occlusal loads as well as for immediate loading protocols.

Clinical experience of over 14 years

Very few implant systems can offer a wealth of long-term data that matches that of the original Brånemark System. Clinical studies are available with up to eleven-year follow-up data.8, 9, 10

Proven longevity with 10-year clinical data

The first three long-term studies indicate that implants with TiUnite surface maintain marginal bone, both in partially and fully edentulous cases, with cumulative survival rates of 97.1–99.2% after ten and more years – even when placed in fresh extraction wounds and immediately loaded.8, 9, 10, 20

Stable marginal bone levels over the long term

Implants with TiUnite surface demonstrate excellent crestal bone stability over the long term.8, 9, 10, 13 In a study on TiUnite, for example, mid-term change between one and five years is on average 0.0 mm; and long-term change between one and ten years is -0.3 mm (see figure on the left).9

Other key findings

High performance under the most challenging conditions, including soft bone and immediate loading.3, 11, 12, 14, 15, 16, 18

There are several structural similarities between gingiva and peri-implant tissue which provide protection for the underlying soft tissues and alveolar bone.17

Osseointegration

The beauty of osseointegration

A remarkable set of pictures display the beauty of osseonintegration as it has never been revealed before. Courtesy of Prof. Dr. Peter Schüpbach.

Download the TiUnite screensaver, to display these amazing microscopic images that are as beautiful as they are breathtaking.

Platelet attraction

The negatively charged TiUnite surface attracts blood proteins and inactive platelets immediately after implant insertion. Simultaneously, fibrils from the fibrin meshwork become visible.

Platelet activation

The platelets begin to swell and form pseudopodia. By releasing adenosine diphosphate (ADP), they get sticky and clump together, closing the injured blood vessels at the wound edges to stop the bleeding.

Hemostasis

The newly formed fibrin matrix allows the blood to clot. Activated platelets become embedded in the matrix and release granules full of enzymes and growth factors needed for wound healing and bone formation.

Blood clot

Blood cells, activated platelets and fibrin form a blood clot that adheres to the moderately rough TiUnite surface. It is crucial for contact osteogenesis that the blood clot remains attached to the surface.

Provisional matrix

Neutrophils and, later, macrophages, remove the blood clot during the first two days of wound healing. Osteogenic cells stream to the TiUnite surface and migrate to the front of the forming bone. Here, they turn into osteoblasts.

Contact osteogenesis

Newly formed bone spreads over the osteoconductive TiUnite surface and forms a thin band of woven bone deposited directly on and along the surface. This thin bone layer will grow by further bone apposition and turn into lamellar bone.

Bone anchorage

Bone forming osteoblasts attach to the TiUnite surface and cover the orifices of the open pores. They start to secrete the collagen matrix of woven bone directly into the pores and move away from the surface. This forms the collagenous bone matrix which will eventually mineralize.

Osteoconductive surface for new bone formation

Newly formed bone crosses the gap between local bone and implant by distance osteogenesis. When the bone reaches the TiUnite surface, it spreads over it by contact osteogenesis, characterized by woven bone deposited directly on and along the surface.

Osseointegration

Transmitted and polarized light shows early (four weeks) and ongoing (six months) bone formation by contact osteogenesis and final osseointegration.

Grooves

Grooves added to the threads of the implant promote initial bone formation. Bone grows in a spiral-like fashion along the grooves before spreading laterally over the entire TiUnite surface.

Bone fragments

During drilling bone fragments are generated and accumulate in the osteotomy, especially in the apical region. In this area, they serve as nuclei for bone formation by guiding osteogenic cells through the wound and towards the TiUnite surface.

Testimonials

Prof. Bertil Friberg from the Brånemark Clinic in Sweden explains why he likes TiUnite.

Prof. Bertil Friberg, Brånemark Clinic, Sweden

"The TiUnite surface has improved our results, especially in grafted bone and in bone of low density. It has, without question, significantly reduced our early failure rate as well."

Dr. Thomas Müller-Hotop from Germany explains why he uses TiUnite for all indications.

Dr. Thomas Müller-Hotop, Germany

"Ever since the TiUnite surface became available, we have used it for all indications in our dental office. We see major benefits in advanced indications such as immediate implant placement, immediate loading and implant placement in soft bone conditions."

Dr. Javier Alández from Spain explains why the immediate function protocol with TiUnite implants is predictable.

Dr. Javier Alández, Spain

"Recently, we have conducted a retrospective study using Immediate Function. Based on the results of a six-year follow-up, we can conclude that the Immediate Function protocol with TiUnite implants is predictable and we can expect a high success rate."

References

Balshi SF, Wolfinger GJ, Balshi TJ. Analysis of 164 titanium oxide surface implants in completely edentulous arches for fixed prosthesis anchorage using the pterygomaxillary region. Int J Oral Maxillofac Implants. 2005; 20:946-52

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Olsson M, Stenport V, Jemt T. Incidence of first implant failure. A retro-prospective study on 10 719 implant operations in 8 528 treated patients during a 28-years period of time at one specialist clinic. submitted 2014.

Rocci A, Rocci M, Rocci C, Scoccia A, Gargari M, Martignoni M, Gottlow J, Sennerby L. Immediate loading of Brånemark System TiUnite and machined-surface implants in the posterior mandible: a randomized open-ended clinical trial. Int J Oral Maxillofac Implants. 2013 May-Jun;28(3):891-5. doi: 10.11607/jomi.2397

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Alsaadi G, Quirynen M, van Steenberghe D. The importance of implant surface characteristics in the replacement of failed implants. Int J Oral Maxillofac Implants. 2006; 21:270-74

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Glauser R, Portmann M, Ruhstaller P, Lundgren AK, Hämmerle CH, Gottlow J. Stability measurements of immediately loaded machined and oxidized implants in the posterior maxilla. A comparative clinical study using resonance frequency analysis. Applied Osseointegration Research 2001; 2:27-9

Zechner W, Tangl S, Furst G, Tepper G, Thams U, Mailath G, Watzek G. Osseous healing characteristics of three different implant types. Clin Oral Implants Res 2003; 14:150-7

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Ivanoff CJ, Widmark G, Johansson C, Wennerberg A. Histologic evaluation of bone response to oxidized and turned titanium micro-implants in human jawbone. Int J Oral Maxillofac Implants 2003; 18:341-8

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Degidi M, Nardi D, Piattelli A. 10-Year Follow-Up of Immediately Loaded Implants with TiUnite Porous Anodized Surface. Clin Implant Dent Relat Res 2012; 14(6):828-38

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Östman PO, Hellman M, Sennerby L. Ten years later. Results from a prospective single-centre clinical study on 121 oxidized (TiUnite) Brånemark implants in 46 patients. Clin Implant Dent Relat Res 2012 Dec; 14(6):852-60

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10 Glauser R. Eleven-year results of implants with an oxidized surface placed predominantly in soft bone and subjected to immediate occlusal loading. Clin Oral Impl Res 2012; 23 suppl 7;140-1

11 Kolinski ML, Cherry JE, McAllister BS, Parrish KD, Pumphrey DW, Schroering RL. Evaluation of a Variable-Thread Tapered Implant in Extraction Sites With Immediate Temporization: A 3-Year Multi-Center Clinical Study. J Periodontol 2014; 85: 386-394

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12 Marzola R, Scotti R, Fazi G, Schincaglia GP. Immediate loading of two implants supporting a ball attachment-retained mandibular overdenture a prospective clinical study. Clin Implant Dent Relat Res 2007; 9:136-43

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13 Nickenig H, Wichmann M, Schlegel K, Nkenke E, Eitner S. Radiographic evaluation of marginal bone levels adjacent to parallelscrew cylinder machined-neck implants and rough-surfaced micro-threaded implants using digitized panoramic radiographs. Clin Oral Impl Res 2009; 20:550-4

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14 Arnhart C, Kielbassa AM, Martinez-de Fuentes R, Goldstein M, Jackowski J, Lorenzoni M, Maiorana C, Mericske-Stern R, Pozzi A, Rompen E, Sanz M, Strub JR. Comparison of variable-thread tapered implant designs to a standard tapered implant design after immediate loading. A 3-year multicentre randomised controlled trial. Eur J Oral Implantol 2012; 5: 123-136

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15 Glauser R. Implants with an Oxidized Surface Placed Predominately in Soft Bone Quality and Subjected to Immediate Occlusal Loading: Results from a 7-Year Clinical Follow-Up. Clin Implant Dent Relat Res 2013; 15: 322-331.

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16 Liddelow G and Henry P. The immediately loaded single implant-retained mandibular overdenture: a 36-month prospective study. Int J Prosthodont 2010; 23:13-21

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17 Schüpbach P, Glauser R. The defense architecture of the human periimplant mucosa: a histological study. J Prosthet Dent 2007; 97(6 Suppl):15-25

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18 Mura P. Immediate Loading of Tapered Implants Placed in Postextraction Sockets: Retrospective Analysis of the 5-Year Clinical Outcome. Clin Implant Dent Relat Res 2012; 14: 565-574

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19 Hall J, Lausmaa J. Properties of a new porous oxide surface on titanium implants. Applied Osseointegration Research 2000; 1: 5-8

20 Mozzati M, Gallesio G, Del Fabbro M. Long-term (9-12 years) outcomes of titanium implants with an oxidized surface: a retrospective investigation on 209 implants. J Oral Implantol. 2013 Oct 31. [Epub ahead of print]

Read on PubMed