Análisis de la capacidad de osteointegración de diferentes revestimientos de superficie de implantes dentales de titanio

Resum

Teeth, in addition to being considered indispensable organs for carrying out, among other functions, masticatory functions, are geometric structures that shape the facial profile and the esthetics of the smile, their morphology and absence conditioning not only a series of physiological functions, but also the personality of an individual. In the last fifty years, there have been great technological achievements in the replacement of missing teeth. Dental implantology has revolutionized clinical dental practice, to the point of becoming a routine act in dental cabinets, becoming, after five decades, a recognized therapeutic advance in the treatment of partial or total tooth loss. The technique is reliable and eliminates the use of fixed or removable prostheses, which invariably alter the adjacent supporting teeth after a short or medium period of time. The concept of osseointegration, introduced and defined by Brånemark in 1969, has undergone variations in terms of technique, devices to be implanted and design of the prostheses supported by the implanted devices. Current research is mainly focused on rectifying the surfaces of the implants that are in intimate contact with the peri-implant bone, surfaces that researchers and industry are trying to improve day by day, with the aim of shortening the osseointegration periods and also ensuring their stability and durability over time. In this Doctoral Thesis, which we present as a compendium of publications, to opt for the Degree of Doctor by the University of Alcalá de Henares, we carried out an extensive review of the scientific literature on the latest trends in titanium coatings, focusing on chitosan coatings, together with a meta-analysis that studied in depth the effectiveness of bioactive surfaces on the osseointegration of titanium dental implants. Experimentally, we investigated in a canine model the efficacy of chitosan-coated titanium dental implants in peri-implant bone remodeling, analyzing the results by computed microtomography. We found that chitosan-coated implants showed superior osseointegration compared to the control group. We also describe a novel method of surface coating with chitosan, which is clinically useful without the use of toxic surface intermediates. On the other hand, we investigated, in a minipig model, the osseointegration capacity of titanium surfaces treated with carboxyethylphosphonic acid and functionalized with BMP-7, finding a significant increase in the bone-impact contact surface, compared to the control group. The four articles (Appendices 1- 4) and the eleven complementary articles (Appendices 5.1- 5.11) presented, studied and evaluated, both the current knowledge and our research on the osseointegration capacity of different treatments, coatings and surface functionalizations of titanium dental implants, comparing the results with implants with a conventional etched surface, without any additional coating.