Periodontal-type measurements associated with hydroxyapatite-coated and non-HA-coated implants: uncovering to 36 months.

BACKGROUND While the use of hydroxyapatite (HA)-coated endosseous dental implants has gained in popularity over the past 10 years, the short-term and long-term predictability and indications for their use remain highly controversial. Some reports suggest that the HA coating may separate from the substructure, undergo dissolution in tissue fluids, and/or contribute to rapid osseous breakdown around the implant. Other reports, however, relate favorable responses to HA-coated implants, which include rapid bone adaptation to the HA, greater stability at uncovering, and increased coronal bone growth. These contradictions may be related to differences in chemical composition of the HA on the implant surface. Most clinicians and researchers may agree that long-term, independent, scientific clinical studies are needed to compare HA-coated and non-HA-coated (titanium-alloy and CP-titanium) implants under the same conditions. Concerns appear in the literature that HA-coated implants experience greater breakdown because they are more susceptible to bacterial colonization due to their roughness and hydrophilicity. Some studies suggest that specific putative periodontal pathogens may adhere to the HA, thereby predisposing the implant to greater peri-implantitis than that experienced by non-HA implants. METHODS A total of 32 clinical research centers, located in various geographic regions of the United States, were selected to participate in a comprehensive clinical study. More than 2,900 HA-coated and non-HA implants were randomized as to location within one of three jaw regions--maxillary anterior, mandibular anterior, and mandibular posterior--and followed for 36 months. It can be assumed that in each of these jaw regions, the conditions associated with both implant surface types would be similar enough to permit meaningful comparisons of periodontal-type measurements that have not previously been reported. Periodontal-type measurements (gingiva, plaque, suppuration, and calculus indices; probing depth; attachment levels; recession; and keratinized tissue width) for each aspect of each implant (mesial, facial, distal, and lingual) were recorded at 3, 6, 9, 12, 18, 24, and 36 months following implant uncovering. The implant was considered the experimental unit for analysis using generalized estimating equation and repeated measure methods. Data for the four aspects of each implant, as well as measurements over time, were all clustered in the unit of analysis. RESULTS The percentages of implants with zeros recorded for the indices was remarkably similar for both HA-coated and non-HA implants. While statistically significant differences were found for some of the measurements associated with HA-coated and non-HA implants under certain conditions, these differences were too small to be considered clinically significant. CONCLUSIONS Overall, there was no clinically significant difference between the periodontal-type measurements for HA-coated and non-HA-coated implants followed for a period from 3 through 36 months. The concerns about HA-coated implants being associated with adverse periodontal responses for the HA chemical composition included in this study appear to be unfounded for a period of clinical performance up to 36 months.