티타늄 임플란트의 표면처리가 골유착에 미치는 영향에 관한 조직형태계측학적 연구
A histomorphometric study on the effect of surface treatment on the osseointegration
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연구목적: 임플란트를 이용한 수복의 임상적인 성공에 중요한 역할을 하는 초기 골유착의 향상을 위해 티타늄의 표면 거칠기 조절과 함께 생체활성도를 가진 표면으로 변화시키는 방법에 관한 연구가 이루어지고 있다. 표면 거칠기의 적절한 증가는 조골세포의 활동을 증가시키고 골과 임플란트의 접촉과 유지를 촉진시킨다고 보고되고 있고 또한 알칼리와 열처리를 통하여 생체 활성 표면을 얻을 수 있는 것으로 보고되고 있다. 이에 본 연구에서는 알칼리 및 열을 이용한 티타늄 표면 처리가 골유착에 어떤 영향을 미치는지 알아보고자 하였다. 연구재료 및 방법: 기계절삭된 임플란트를 대조군으로 하여 (1군), 5 M NaOH 용액에 처리한 임플란트를 대기 중에서 열처리한 군 (2군)과 진공에서 열처리한 군 (3군)으로 분류하였다. 알칼리와 열처리를 시행한 임플란트들의 표면 특성을 관찰하고 가토에 식립하여 치유 기간에 따라서 조직학적 및 조직형태계측학적으로 비교하고 EPMA (Electron Probe Micro Analyzer)를 이용하여 치유 기간 별 골성분의 변화를 분석하였다. 결과 및 결론: 대기 중에서 열처리한 2군이 통계적으로 유의하게 (P < .05) 증가된 표면 거칠기를 보였다. 이렇게 만들어진 임플란트를 가토에 식립하여 조직형태계측학적 분석을 시행한 결과 골-임플란트 접촉율은 전반적으로 치유기간이 경과하면서 증가하는 것으로 나타났으며 2군과 3군에서 통계적 분석결과 치유기간 간에 유의한 차이가 관찰되었고 (P < .05), 골-임플란트 면적율 (BA) 또한 골 임플란트 접촉율과 비슷한 양상을 보였으며 통계적 분석결과 2군에서만 치유기간별로 통계적으로 유의한 차이가 관찰되었다 (P <. 05). 치유 기간별로 임플란트 주변 골에서 칼륨 (K), 인 (P), 칼슘 (Ca), 티타늄 (Ti)의 분포를 EPMA로 보았을 때 빈도의 편향은 관찰되지 않았으며 2군과 3군에서 초기에 칼슘과 인이 증가되는 것이 관찰되었다. 이상의 결과로 볼 때 알칼리 및 대기 중에서 열처리로 표면 처리된 임플란트의 사용은 초기에 안정된 골유착에 도움을 주며 임플란트 식립 후 기능까지의 시간을 감소시킬 것으로 사료된다.
Abstract
Statement of problem: Many studies have been conducted to improve the primary stability of implants by providing bioactive surfaces via surface treatments. Increase of surface roughness may increase osteoblast activity and promote stronger bonding between bone and implant surface and it has been reported that bioactive surface or titanium can beobtained through alkali and heat treatment. Purpose: The purpose of this study was to evaluate the stability of alkali and heat treated implants via histomorphometric analysis. Material and methods: Specimens were divided into three groups; group 1 was the control group with machined surface, the other groups were treated for 24 hours in 5 M NaOH solution and heat treated for 1 hour at 600℃ in the atmosphere (group 2) and vacuum (group 3) conditions respectively. Surface characteristics were analyzed and fixtures were implanted into rabbits. The specimens were histologically and histomorphometrically compared according to healing periods and change in bone composition were analyzed with EPMA (Electron Probe Micro Analyzer). Results: 1. Groups treated with alkali and heat showed increase of oxidization layer and Na ions. Groups 2 which was heat treated in atmosphere showed significant increase of surface roughness (P < .05). 2. Histomorphometric analysis showed significant increase in BIC (bone to implant contact) according to increase in healing period and there was significant increases in groups 2 and 3 (P < .05). 3. BA(bone area) ratio showed similar results as contact ratio, but according to statistical analysis there was significant increase according to increase in healing period in group 2 only (P < .05). 4. EPMA analysis revealed no difference in gradation of bone composition of K, P, Ca, Ti in surrounding bone of implants according to healing periods but groups 2 and 3 showed increase of Ca and P in the initial stages. Conclusion: From the results above, it can be considered that alkali and heat treated implants in the atmosphere have advantages in osseointegration in early stages and may decrease the time interval between implantation and functional adaptation.
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