The Effect of Zirconium Dioxide Implant Surface Characteristics on Osseous Healing in Diabetes: An Experimental Pilot Study in Pigs

Objectives: To assess the effect of Zirconium dioxide (ZrO2-ZLA) surface characteristics on osseointegration in diabetes as compared to commercially available pure titanium implant surfaces Ti-SLA and Ti-SLActive.
Methods: Six female 12 months old Guangxi Bama mini-pigs were used in the study. The pigs were divided into two groups: Healthy (H) control and Diabetic (D) groups, containing three animals in each group. Lower incisors were removed and left to heal at least for 3 months prior to the diabetic induction. Experimental diabetes were induced by multiple single dosage of streptozotocin (STZ) dissolved in saline (1g/10ml) at a dose of 90mg/Kg and administrated to the pigs IV via an ear vein. Diabetic status was confirmed at 3 months following the induction. Three different implants (ZLA, SLA and SLActive, Strauamnn, Bazel, Switzerland) were placed at each side of the mandible. The animals were sacrificed at 6 weeks of healing and the specimens were collected for u-CT, histology and histomorphometric analyses.
Results: Histology of the ear veins in the healthy and diabetic animals was examined, showing plaque (AGEs- related) formation in the lumens and discontinuity of the endothelial cells in the diabetic animal group. The diabetic animals demonstrated less new bone formation and osseointegration in total compared to the healthy animals, The SLActive surface promoted higher new bone formation than the other implant surfaces in both healthy and diabetic condition. The amount of newly formed bone and osseointegration between the SLA and ZrO2 surface were similar to each other in both healthy and diabetic groups.
Conclusions: Diabetic condition (type-I like) compromised the osseous healing capacity, however the SLActive surface was shown to counteract the effect of the systemic condition. The ZrO2 surface demonstrated less new bone formation and osseointegration in the diabetic condition as compared to the SLActive surface, however its performance was comparable to the SLA surface.