Comparison of imaging methods used for dental implant osseous integration assessment

Two different imaging techniques used to determine bone tissue response to dental implants were compared. Dental implants were implanted into the maxillae of 18 pigs, which were sacrificed after 4, 8 and 12 weeks. Implants with surrounding bone tissue were retrieved for methyl methacrylate histology and contact radiography. On identical sections peri-implant bone density and bone implant contact (BIC) ratio were assessed with two different imaging methods. Evaluation of Giemsa eosin stained and contact radiographed sections showed direct osseous integration for all implants and both methods showed a strong correlation with correlation coefficient r = 0.930 (P < 0.0001) for peri-implant bone density and r = 0.817 (P < 0.0001) for bone implant contact ratio. While the two imaging methods showed moderate differences for peri-implant bone density there were significant differences between the BIC values determined. In general, contact radiography tends to underestimate BIC for approximately 4.5 % (P = 0.00003).     

Surface microstructure and cell biocompatibility of silicon-substituted hydroxyapatite coating on titanium substrate prepared by a biomimetic process

Silicon-substituted hydroxyapatite (Si-HA) coatings with 0.14 to 1.14 at.% Si on pure titanium were prepared by a biomimetic process. The microstructure characterization and the cell compatibility of the Si-HA coatings were studied in comparison with that of hydroxyapatite (HA) coating prepared in the same way. The prepared Si-HA coatings and HA coating were only partially crystallized or in nano-scaled crystals. The introduction of Si element in HA significantly reduced P and Ca content, but densified the coating. The atom ratio of Ca to (P + Si) in the Si-HA coatings was in a range of 1.61–1.73, increasing slightly with an increase in the Si content. FTIR results displayed that Si entered HA in a form of SiO₄ unit by substituting for PO₄ unit. The cell attachment test showed that the HA and Si-HA coatings exhibited better cell response than the uncoated titanium, but no difference was observed in the cell response between the HA coating and the Si-HA coatings. Both the HA coating and the Si-HA coatings demonstrated a significantly higher cell growth rate than the uncoated pure titanium (p < 0.05) in all incubation periods while the Si-HA coating exhibited a significantly higher cell growth rate than the HA coating (p < 0.05). Si-HA with 0.42 at.% Si presented the best cell biocompatibility in all of the incubation periods. It was suggested that the synthesis mode of HA and Si-HA coatings in a simulated body environment in the biomimetic process contribute significantly to good cell biocompatibility.     

Aerosol deposition of silicon-substituted hydroxyapatite coatings for biomedical applications

Silicon-substituted hydroxyapatite (Si-HA) coatings on commercially pure titanium (Ti) were prepared by aerosol deposition using Si-HA powders. Si-HA powders with the chemical formula Ca₁₀(PO₄)_6 − x(SiO₄)_x(OH)_2 − x, having silicon contents up to x = 0.5 (1.4 wt.%), were synthesized by solid-state reaction of Ca₂P₂O₇, CaCO₃, and SiO₂. The Si-HA powders were characterized by X-ray diffraction (XRD), X-ray fluorescence spectrometry, and Fourier transform infrared spectroscopy. The corresponding coatings were also analyzed by XRD, scanning electron microscopy, and electron probe microanalyzer. The results revealed that a single-phase Si-HA was obtained without any secondary phases such as α- or β-tricalcium phosphate for both the powders and the coatings. The Si-HA coating was about 5 µm thick, had a dense microstructure with no cracks or pores, and showed a high adhesion strength ranging from 28.4 to 32.1 MPa. In addition, the proliferation and alkaline phosphatase activity of MC3T3-E1 preosteoblast cells grown on the Si-HA coatings were significantly higher than those on the bare Ti and pure HA coating. These results revealed the stimulatory effects induced by silicon substitution on the cellular response to the HA coating.     

Tissue response to hafnium

The aim of the present experimental study was to evaluate the tissue response to hafnium (Hf) a reactive metal closely related to titanium (Ti) and zirconium (Zr). Hf has not been previously evaluated as implant material in a biologic environment. In a first experiment, 21 machined Hf non-threaded implants (test) and 21 similar Ti implants (control) were inserted in the abdominal wall of 21 rats. Animals were sacrificed after 8 days (6 rats), 6 (7 rats) and 12 weeks (8 rats). In a second experiment, 18 rabbits received 18 Hf and 18 Ti threaded implants in their tibiae, one implant in each tibia. The rabbits were sacrificed after 6, 12 and 24 weeks (6 animals/time interval). The bulk metal of the abdominal wall implants, embedded together with the surrounding tissue, was electrolytically dissolved and semithin (1 m) sections of the intact tissue–implant interface were evaluated by light microscopy (morphometry). Bone-implant contact and bone area within threads were evaluated in ground sections. In soft tissues, a fluid space containing predominantly monocytes/macrophages surrounded the abdominal implants at 8 days. At 6 and 12 weeks, a fibrous capsule, consisting of layers of macrophages and fibroblasts, surrounded the implants. Macrophages, including multinuclear giant cells, always formed the innermost layer in contact with the implant surface. No quantitative or qualitative difference in the tissue organization was detected between Ti and Hf implants. In rabbits, 6 weeks after insertion, the proximal two threads located within the cortical bone were filled with bone in contact with Hf and Ti. The distal threads contained bone marrow. After 12 and 24 weeks, mature bone was present in the proximal 3–4 implant threads. No statistically significant difference was found between Hf and Ti implants at any time periods. It is concluded that Hf is an interesting metal for biomedical applications in bone and soft tissue. © 2001 Kluwer Academic Publishers     

In vivo assessment of the effect of controlled high- and low-frequency mechanical loading on peri-implant bone healing

The aim of this study was to investigate the effect of controlled high- (HF) and low-frequency (LF) mechanical loading on peri-implant bone healing. Custom-made titanium implants were inserted in both tibiae of 69 adult Wistar rats. For every animal, one implant was loaded by compression through the axis of tibia (test), whereas the other one was unloaded (control). The test implants were randomly distributed among four groups receiving different loading regimes, which were determined by ex vivo calibration. Within the HF (40 Hz) or LF (2 Hz) loading category, the magnitudes were chosen as low- (LM) and high-magnitude (HM), respectively, leading to constant strain rate amplitudes for the two frequency groups. This resulted in the four loading regimes: (i) HF-LM (40 Hz–0.5 N); (ii) HF-HM (40 Hz–1 N); (iii) LF-LM (2 Hz–10 N); and (iv) LF-HM (2 Hz–20 N) loading. Loading was performed five times per week and lasted for one or four weeks. Tissue samples were processed for histology and histomorphometry (bone-to-implant contact, BIC; and peri-implant bone fraction, BF) at the cortical and medullar level. Data were analysed statistically with ANOVA and paired t-tests with the significance level set at 0.05. For the one-week experiments, an increased BF adjacent to the implant surface at the cortical level was exclusively induced by the LF-HM loading regime (2 Hz–20 N). Four weeks of loading resulted in a significant effect on BIC (and not on BF) in case of HF-LM loading (40 Hz–0.5 N) and LF-HM loading (2 Hz–20 N): BIC at the cortical level significantly increased under both loading regimes, whereas BIC at the medullar level was positively influenced only in case of HF-LM loading. Mechanical loading at both HF and LF affects osseointegration and peri-implant BF. Higher loading magnitudes (and accompanying elevated tissue strains) are required under LF loading to provoke a positive peri-implant bone response, compared with HF loading. A sustained period of loading at HF is needed to result in an overall enhanced osseointegration.     

Silicon-substituted hydroxyapatite composite coating by using vacuum-plasma spraying and its interaction with human serum albumin

The incorporation of silicon can improve the bioactivity of hydroxyapatite (HA). Silicon-substituted HA (Ca₁₀(PO₄)_6−x (SiO₄) _x (OH)_2−x , Si-HA) composite coatings on a bioactive titanium substrate were prepared by using a vacuum-plasma spraying method. The surface structure was characterized by using XRD, SEM, XRF, EDS and FTIR. The bond strength of the coating was investigated and XRD patterns showed that Ti/Si-HA coatings were similar to patterns seen for HA. The only different XRD pattern was a slight trend toward a smaller angle direction with an increase in the molar ratio of silicon. FTIR spectra showed that the most notable effect of silicon substitution was that –OH group decreased as the silicon content increased. XRD and EDS elemental analysis indicated that the content of silicon in the coating was consistent with the silicon-substituted hydroxyapatite used in spraying. A bioactive TiO₂ coating was formed on an etched surface of Ti, and the etching might improve the bond strength of the coatings. The interaction of the Ti/Si-HA coating with human serum albumin (HSA) was much greater than that of the Ti/HA coating. This might suggest that the incorporation of silicon in HA can lead to significant improvements in the bioactive performance of HA.     

Material processing of hydroxyapatite and titanium alloy (HA/Ti) composite as implant materials using powder metallurgy: A review

The bio-active and biodegradable properties of hydroxyapatite (HA) make this material a preferred candidate for implants such as bone replacement in replacing natural tissues damaged by diseases and accidents. However, the low mechanical strength of HA hinders its application. Combining HA with a biocompatible material with a higher mechanical strength, such as a titanium (Ti) alloy, to form a composite has been of interest to researchers. A HA/Ti composite would possess characteristics essential to modern implant materials, such as bio-inertness, a low Young’s modulus, and high biocompatibility. However, there are issues in the material processing, such as the rheological behavior, stress-shielding, diffusion mechanism and compatibility between the two phases. This paper reviews the HA and Ti alloy interactions under various conditions, in vitro and in vivo tests for HA/Ti composites, and common powder metallurgy processes for HA/Ti composites (e.g., pressing and sintering, isostatic pressing, plasma spraying, and metal injection molding).     

A novel in vivo method for quantifying the interfacial biochemical bond strength of bone implants

Quantifying the in vivo interfacial biochemical bond strength of bone implants is a biological challenge. We have developed a new and novel in vivo method to identify an interfacial biochemical bond in bone implants and to measure its bonding strength. This method, named biochemical bond measurement (BBM), involves a combination of the implant devices to measure true interfacial bond strength and surface property controls, and thus enables the contributions of mechanical interlocking and biochemical bonding to be distinguished from the measured strength values. We applied the BBM method to a rabbit model, and observed great differences in bone integration between the oxygen (control group) and magnesium (test group) plasma immersion ion-implanted titanium implants (0.046 versus 0.086 MPa, n=10, p=0.005). The biochemical bond in the test implants resulted in superior interfacial behaviour of the implants to bone: (i) close contact to approximately 2 μm thin amorphous interfacial tissue, (ii) pronounced mineralization of the interfacial tissue, (iii) rapid bone healing in contact, and (iv) strong integration to bone. The BBM method can be applied to in vivo experimental models not only to validate the presence of a biochemical bond at the bone–implant interface but also to measure the relative quantity of biochemical bond strength. The present study may provide new avenues for better understanding the role of a biochemical bond involved in the integration of bone implants.     

不同孔隙率锶磷灰石陶瓷体内异位成骨能力的比较

采用健康兔的骨髓组织,体外培养,诱导分化为成骨细胞,分别与孔径约为450～700μm、孔隙率分别为50%、60%、70%的Sr-HA以及孔隙率为70%的纯羟磷灰石陶瓷体复合,自体回植到兔背脊肌内.同时以未复合细胞的相同孔隙率的陶瓷材料作为对照,植入后4周、12周和24周取材,行四环素荧光染色观察,定量计算各组陶瓷材料新骨的形成量和速度,比较不同孔隙率锶磷灰石陶瓷材料的异位成骨能力.结果表明,复合成骨细胞的各组陶瓷在植入兔背脊肌内4周后均有新骨形成,随着植入时间的延长,骨组织的数量不断增加;孔隙率为70%的Sr-HA陶瓷和HA陶瓷的新骨形成数量和速度明显优于低孔隙率的Sr-HA陶瓷.四环素荧光标记还显示未复合成骨细胞的Sr-HA陶瓷和HA陶瓷孔隙内也有荧光沉积.Sr-HA多孔陶瓷是较理想的骨组织工程支架材料,成骨细胞复合Sr-HA陶瓷用于骨缺损的修复,具有广阔的临床应用前景.     

Osseointegration behavior of novel Ti–Nb–Zr–Ta–Si alloy for dental implants: an in vivo study

This study aimed to evaluate the effects of Ti–Nb–Zr–Ta–Si alloy implants on mineral apposition rate and new BIC contact in rabbits. Twelve Ti–Nb–Zr–Ta–Si alloy implants were fabricated and placed into the right femur sites in six rabbits, and commercially pure titanium implants were used as controls in the left femur. Tetracycline and alizarin red were administered 3 weeks and 1 week before euthanization, respectively. At 4 weeks and 8 weeks after implantation, animals were euthanized, respectively. Surface characterization and implant-bone contact surface analysis were performed by using a scanning electron microscope and an energy dispersive X-ray detector. Mineral apposition rate was evaluated using a confocal laser scanning microscope. Toluidine blue staining was performed on undecalcified sections for histology and histomorphology evaluation. Scanning electron microscope and histomorphology observation revealed a direct contact between implants and bone of all groups. After a healing period of 4 weeks, Ti–Nb–Zr–Ta–Si alloy implants showed significantly higher mineral apposition rate compared to commercially pure titanium implants (P?<?0.05), whereas there was no significant difference between Ti–Nb–Zr–Ta–Si alloy implants and commercially pure titanium implants (P?>?0.05) at 8 weeks. No significant difference of bone-to-implant contact was observed between Ti–Nb–Zr–Ta–Si alloy implants and commercially pure titanium implants implants after a healing period of 4 weeks and 8 weeks. This study showed that Ti–Nb–Zr–Ta–Si alloy implants could establish a close direct contact comparedto commercially pure titanium implants implants, improved mineral matrix apposition rate, and may someday be an alternative as a material for dental implants.     

A new way of incorporating silicon in hydroxyapatite (Si-HA) as thin films

Bioactive silicon-containing hydroxyapatite (Si-HA) thin films that can be used as coatings for bone tissue replacement have been developed. A magnetron co-sputtering technique was used to deposit Si-HA films up to 700 nm thick on titanium substrates, with a silicon level up to 1.2 wt%. X-ray diffraction demonstrated that annealing transformed the as-deposited Si-HA films which were amorphous, into a crystalline HA structure. A human osteoblast-like (HOB) cell model was used to determine the biocompatibility of these films. HOB cells were seen to attach and grow well on the Si-HA films, and the metabolic activity of HOB cells on these films was observed to increase with culture time. Furthermore, mineralisation of the cell layers was observed after 8 weeks of culture. Based on the present findings, Si-HA of different film compositions demonstrate bioactive properties in-vitro, and indicate the potential as biocoatings for a wide variety of medical implants including load-bearing applications such as the femoral stem of hip replacement implants.     

Biomechanical evaluation of cell-loaded and cell-free hydroxyapatite implants for the reconstruction of segmental bone defects

Porous hydroxyapatite (HA) scaffoldings are currently used in tissue engineering for bone reconstruction. When this osteoconductive biomaterial is combined with osteoprogenitor cells, it acquires osteoinductive features which accelerate and improve bone formation in vivo. The aim of our study was to assess the mechanical properties of HA–bone complexes undergoing indentation tests, and relate stiffness to composition and structure as examined by micro X-ray. To this purpose, 35-mm tibia diaphyseal resections were performed in sheep. Gaps were filled using porous HA cylinders. Implants were loaded with autologous bone marrow stromal cells (BMSC); cell-free cylinders were used as control. After 8 weeks, bone tissue was found within the internal macropores of cell-loaded HA carriers, and in control implants, bone formation was mostly limited to the outer surface. As assessed by indentation testing the stiffness values of bone–HA composites were halfway between those of HA scaffoldings and tibia bone. Cell-loaded implants were stiffer than cell-free ones. In a cell-loaded implant we also analyzed the variation of stiffness along the main axis of the tibia.     

The biological seal of the implant–soft tissue interface evaluated in a tissue-engineered oral mucosal model

For dental implants, it is vital that an initial soft tissue seal is achieved as this helps to stabilize and preserve the peri-implant tissues during the restorative stages following placement. The study of the implant–soft tissue interface is usually undertaken in animal models. We have developed an in vitro three-dimensional tissue-engineered oral mucosal model (3D OMM), which lends itself to the study of the implant–soft tissue interface as it has been shown that cells from the three-dimensional OMM attach onto titanium (Ti) surfaces forming a biological seal (BS). This study compares the quality of the BS achieved using the three-dimensional OMM for four types of Ti surfaces: polished, machined, sandblasted and anodized (TiUnite). The BS was evaluated quantitatively by permeability and cell attachment tests. Tritiated water (HTO) was used as the tracing agent for the permeability test. At the end of the permeability test, the Ti discs were removed from the three-dimensional OMM and an Alamar Blue assay was used for the measurement of residual cells attached to the Ti discs. The penetration of the HTO through the BS for the four types of Ti surfaces was not significantly different, and there was no significant difference in the viability of residual cells that attached to the Ti surfaces. The BS of the tissue-engineered oral mucosa around the four types of Ti surface topographies was not significantly different.     

A histological and histomorphometrical evaluation of screw-type calciumphosphate (Ca-P) coated implants; an in vivo experiment in maxillary cancellous bone of goats

The bone response to different calcium phosphate (Ca-P) coated implants was evaluated in a goat animal model. Two types of plasma spray coatings were applied to a commercially pure titanium (cpTi) tapered, conical screw-design implant (BioComp^®); hydroxyapatite (HA-PS) and a dual coating, consisting of FA and HA (FA/HA-PS). In addition an amorphous RF magnetron sputter coating (Ca-P-a) and uncoated implants were investigated. Forty-eight implants were inserted in the maxilla of 12 adult female goats. After implantation periods of 3 and 6 months, the bone implant interface was evaluated histologically and histomorphometrically. After both implantation periods all plasma spray coated implants were maintained. On the other hand three Ca-P-a and two cpTi implants were lost. Histological examination revealed a better bone response to both plasma spray coated implants. Histomorphometrical evaluation confirmed this finding. At 3 and 6 months significantly higher percentages of bone contact (p<0.001, ANOVA) were measured for both plasma spray coated implants than for the cpTi and Ca-P-a implants, while no significant difference (p<0.05) existed between both implantation periods. Degradation of both plasma spray coatings was observed. Supported by the results, it is concluded that, although Ca-P coatings can improve the performance of dental implants, the presence of a Ca-P coating is not the only important factor for bone healing around implants placed in low density trabecular bone.     

Effect of biological implant surface coatings on bone formation, applying collagen, proteoglycans, glycosaminoglycans and growth factors

Objectives The aim of the present study was to evaluate six different implant surface coatings with respect to bone formation. Being major structural components of the extracellular matrix, collagen, the non-collagenous components decorin/chondroitin sulphate (CS) and the growth factors TGF-β1/BMP-4 served in different combinations as coatings of experimental titanium implants. Materials and methods Eight miniature pigs received each six implants in the mandible. The implant design showed two circular recesses along the length axis. Three, four, five and six weeks after implant placement, the animals were sacrificed in groups of two. Bone-implant contact (BIC) was evaluated along the outer implant surface and within the recesses. Bone volume was determined by synchrotron radiation micro computed tomography (SRμCT) for one implant of each surface state, 6 weeks after placement. Results At each week of observation, collagen/CS or collagen/CS/BMP-4 coated implants showed the highest BIC of all surface states. This was statistically significant at week five (p = 0.030, p = 0.040) and six (p = 0.025, p = 0.005). SRμCT measurements determined the highest bone volume for a collagen/CS coated implant. Conclusion The results indicate that collagen/CS and collagen/CS/BMP-4 lead to a higher degree of bone formation compared to other ECM components.     

Histomorphometric and histologic evaluation of titanium–zirconium (<Emphasis Type="Italic">a</Emphasis>TiZr) implants with anodized surfaces

The choice of implant surface has a significant influence on osseointegration. Modification of TiZr surface by anodization is reported to have the potential to modulate the osteoblast cell behaviour favouring more rapid bone formation. The aim of this study is to investigate the effect of anodizing the surface of TiZr discs with respect to osseointegration after four weeks implantation in sheep femurs. Titanium (Ti) and TiZr discs were anodized in an electrolyte containing dl-α-glycerophosphate and calcium acetate at 300 V. The surface characteristics were analyzed by scanning electron microscopy, electron dispersive spectroscopy, atomic force microscopy and goniometry. Forty implant discs with thickness of 1.5 and 10 mm diameter (10 of each-titanium, titanium–zirconium, anodized titanium and anodized titanium–zirconium) were placed in the femoral condyles of 10 sheep. Histomorphometric and histologic analysis were performed 4 weeks after implantation. The anodized implants displayed hydrophilic, porous, nano-to-micrometer scale roughened surfaces. Energy dispersive spectroscopy analysis revealed calcium and phosphorous incorporation into the surface of both titanium and titanium–zirconium after anodization. Histologically there was new bone apposition on all implanted discs, slightly more pronounced on anodised discs. The percentage bone-to-implant contact measurements of anodized implants were higher than machined/unmodified implants but there was no significant difference between the two groups with anodized surfaces (P > 0.05, n = 10). The present histomorphometric and histological findings confirm that surface modification of titanium–zirconium by anodization is similar to anodised titanium enhances early osseointegration compared to machined implant surfaces.     

A multi-scaled hybrid orthopedic implant: bone ECM-shaped Sr-HA nanofibers on the microporous walls of a macroporous titanium scaffold

We report here, for the first time, a novel multi-scaled hybrid orthopedic implant material consisting of a macroporous Ti scaffold, whose macropores' walls have a microporous titania layer which is fully covered with nanofibers of Sr-doped hydroxyapatite (Sr-HA). The microporous titania layer is formed on and within the Ti scaffold by micro-arc oxidation, which firmly binds to the Ti substrate and contains Ca2+, Sr2+ and PO4(3-) ions. It is then hydrothermally treated to form Sr-HA nanofibers. During the hydrothermal treatment, Sr-HA nanoprisms nucleate from Ca0.5Sr0.5TiO3 pre-formed on the TiO2 and grow in length to nanofibers at the expense of Ca2+, Sr2+ and PO4(3-) ions that migrate from the TiO2. These Sr-HA nanofibers construct a network structure similar to the hierarchical organization of bone extracellular matrix (ECM), and the resulting nanofibrous surface displays a firm adhesion to substrate, superhydrophilicity and apatite-inducing ability. The induced apatite prefers to nucleate on the basal-faceted surfaces of Sr-HA nanofibers. The nanofiber-walled scaffold has a great potential for load-bearing orthotopic use.     

Pulsed laser deposition of silicon-substituted hydroxyapatite coatings

Thin films of Si-substituted hydroxyapatite (Si-HA) were deposited on Si and Ti substrates by pulsed laser deposition (PLD), in the presence of a water vapour atmosphere. The PLD ablation targets were made with different mixtures of commercial carbonated HA and Si powder, in order to produce the Si-HA thin films. The physicochemical properties of the coatings and the incorporation of the Si into the HA structure was studied by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS). The Si atoms were successfully incorporated into the HA structure, and were found to be in the form of SiO₄⁴⁻ groups, principally displacing carbonate groups off the HA structure.     

The effect of biological environment on the surface of titanium and plasma-sprayed layer of hydroxylapatite

The solubility of titanium samples with different surface coatings, i.e., hydroxylapatite (HA) powders, a two-layer coating of ZrO₅+HA on a titanium substrate in solution and of tooth implants after long-term functioning in the human organism, was studied. A minimum difference in solubility of titanium samples with different surface finishes (polished or grit blasted) was established. For the HA powders and coatings, the lowest solubility was observed with a coarse-grained HA–B powder and a coating made of that powder. Clinical tests of tooth implants after long implantation times were performed. A titanium implant (implantation 12 y), a titanium implant with a two-layer coating of ZrO₅+HA–A (implantation time 4 y) and a titanium implant with a two-layer coating of Al₅O₃+3% TiO₂)+ HA–A (implantation time 6 y) were studied. The results show that the titanium surface and HA–A layers were dissolved. Nevertheless, after 6 y implantation, total removal of HA–A coating from that part of implant set into the bone, was not observed.     

Osseointegration of bioactive microarc oxidized amorphous phase/TiO2 nanocrystals composited coatings on titanium after implantation into rabbit tibia

The amorphous phase/TiO₂ nanocrystals (APTN) composited coatings were prepared on Ti implants for biomedical applications. The Ti implants without and with the APTN composited coatings both do not cause any adverse effects after implantation into the rabbit tibia. The osseointegration of Ti implants after covering the APTN coatings is improved pronouncedly, greatly increasing the interface bonding strength between the implants and newly formed bones. In addition, it is interesting that the newly formed bone tissues appear in the micro-pores of the APTN coatings, promoting the interface bonding between the implants and new bones by the mechanical interlock. Moreover, the Ti implant with the APTN coatings formed at higher applied voltage exhibit higher shear strength and displacement during the pushing out experiment probably due to its better osseointegration.