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Poor glycemic control negatively modulated the bone factors during healing, although T2DM, regardless of glycemic status, had no effect on implant stabilization.

Background and Objective The success rates of dental implants in low-density bone have been reported as a challenge, especially for early or immediate loading in the maxilla posterior area. Nanoscale architecture affects the roughness, surface area, surface energy of the implant and can enhance osseointegration. This study aimed to evaluate the implant-surface topography and biomechanical, histomorphometric, and histological bone responses to a new nanostructured hydroxyapatite surface placed in the iliac crest of sheep. Methods Ten female sheep (2–4 years) received 30 implants (n=10/group): HAnano ® coated (Epikut Plus ® , S.I.N. Implant System, Sao Paulo, SP, Brazil), SLActive (BLX ® , Straumann, Basel, Switzerland), and TiUnite (NobelActive ® , Nobel Biocare, Göteborg, Sweden) surfaces. Scanning electron microscopy with energy-dispersive spectroscopy evaluated the implant surface topography, the insertion torque value, and resonance frequency analysis evaluated the primary stability, bone-implant contact, and bone-area fraction occupancy were evaluated after 14 and 28 days after implant placement. Results The surface morphology was considerably comparable between the implant groups’; however, the TiUnite ® group presented a remarkable different surface. The SLActive ® and TiUnite ® groups presented an insertion torque average of 74 (±8.9) N/cm that was similar to that of HAnano ® 72 (±8.3) N/cm (p >0.05). The resonance frequency evaluated with Osstell ® /SmartPeg ® or Penguin ® /MulTipeg ® showed similar results when assessing implants from the same group. BIC and BAFO significantly increased (p<0.05) throughout the experimental periods to all groups, but BIC and BAFO values were similar among the implants at the same time point. After 4 weeks, bone-implant contact was higher than 80% of the total length analyzed. New bone occupies around 60% of analyzed area around the implants. Conclusion HAnano ® coated surface promoted comparable osseointegration as SLActive and TiUnite in the sheep model. The three tested surfaces showed comparable osseointegration at the early stages of low-density bone repair in the sheep model.

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This study evaluated the response of a nano‐hydroxyapatite coating implant through gene expression analysis (runt‐related transcription factor 2 (Runx2), alkaline phosphatase (Alp), osteopontin (Opn), osteocalcin (Oc), receptor activator of nuclear factor‐kappa B (Rank), receptor activator of nuclear factor‐kappa B ligand (Rank‐L), and osteoprotegerin (Opg)). Three‐dimensional evaluation (percent bone volume (BV/TV); percent intersection surface (BIC); bone surface/volume ratio (BS/BV); and total porosity (To.Po)) were also analyzed. Mini implants were surgically placed in tibias of both healthy and diabetic rats. The animals were euthanized at 7 and 30 days. Evaluating all factors the relative expression of Rank showed that NANO surface presented the best results at 7 days (diabetic rats). Furthermore the levels of Runx2, Alp, Oc, and Opn suggest an increase in osteoblasts proliferation, especially in early stages of osseointegration. %BIC in healthy and diabetic (7 days) depicted statistically significant differences for NANO group. BV/TV, BS/BV and To.Po demonstrated higher values for NANO group in all evaluated time point and irrespective of systemic condition, but BS/BV 30 days (healthy rat) and 7 and 30 days (diabetic rat). Microtomographic and gene expression analyses have shown the benefits of nano‐hydroxyapatite coated implants in promoting new bone formation in diabetic rats.