Integration of press-fit implants in cortical bone: a study on interface kinetics.

The early healing phase of hard tissue implants is important to their long-term success. Problems during this phase can result in a so-called primary biological failure. In 24 New Zealand white rabbits, the healing in cortical bone of noncoated TiAlV and cpTi cylinders and of TiAlV cylinders plasma-spray-coated with hydroxyapatite (HA) of fluorapatite (FA) was investigated histologically and histomorphometrically after 3, 7, 14, and 28 days. Histomorphometry consisted of bone contact measurements and the use of a new semi quantitative scoring system that discriminated various tissues in contact with the implant. The results demonstrated that the most important parameter in initial implant healing is the bone itself and not the characteristics of the implanted material. For all implants, healing was characterized by a sequence of hematoma formation, bone resorption, and new bone formation where the initial press-fit situation revealed more bone-implant contact than after 7 and 14 days. There were only minor differences between the implant types: the new bone formation directly on the implant surface was qualitatively histologically superior to the CaP-coated implants, but this could be confirmed with the scoring method only for the HA-coated implants. It is concluded that initial press-fit fixation in cortical bones is not an end situation; rather, what happens is that as a result of interface remodeling, early postoperatively implant integration in the bone will decrease temporarily prior to a subsequent phase of new bone formation.