The laser removes the titanium through sublimation moving along the surface of the implant and creating thousands of micrometrical pores regularly distributed and the same shape and size. The result is a clean, topographically controlled surface able to induce excellent osseointegration and to significantly reduce bacterial adhesion with a lesser risk of peri-implantitis.
Geass research has developed and patented Synthegra, the laser treated surface which acts in two ways: it fights periimplantitis and promotes osseointegration for long term success. In fact, Synthegra:
Synthegra technology has been patented to treat the entire implant body, regardless of the shape, diameter and length of the way and omny implants, the implant-prosthetic systems designed by Geass.
At the end of the Nineties, research for better performance led to the creation of new implant surfaces, characterized by a certain level of roughness in order to further stimulate osseointegration.
In many cases the effects that surface roughness can have on bacterial adhesion and the relative consequences to long term implant success were ignored.
Now, some years on, more and more cases which had used rough implants need reintervention, generating dissatisfaction both for the dentist as well as for the patient, a loss of time and an increase in costs.
The new challenge for an implant surface today is to answer two needs at the same time: reducing risks of infection which may prejudice implant survival and the promotion of long term osseointegration.
The most recent data (Mombelli 2012) states that this problem concerns about 20% of patients and 10% of implants, percentages which seem destined to increase over the next few years.
The use of laser technology makes it possible to create a geometrically controlled surface, characterized by thousands of niches each one the same as the others in terms of shape, dimension and distribution. The nature of the niches and the inter spacing is extremely smooth, a characteristic which obstacles bacterial adhesion. According to the classification of the surfaces of Albrektsson and Wennerberg, the Ra values inside and outside the niches correspond to those of the smoothest surfaces.
Synthegra has resulted in being smoother than the machined surface, recognized by clinical experience as the standard reference to reduce bacterial adhesion and the risk of periimplant infections.
To verify the reduction of bacterial adhesion on Synthegra, some studies were conducted in collaboration with the I.R.C.C.S. Galeazzi in Milan.
Evaluation of the quantity of bacterial biofilm
Initial experimentation in vitro was carried out to evaluate the quantity of bacterial biofilm on a sand-blasted surface and on Synthegra.
For the three species of bacteria analysed, the quantity of biofilm present on Synthegra is inferior to that on the sand-blasted surface and the reduction can be observed in:
- 79% for S. aureus
- 36% for P.aeruginosa
- 42% for P. gingivalis
Evaluation of the volume of the bacterial biofilm
The study of the bacterial biofilm was carried out in depth thanks to a specific method of confocal laser scanning microscopy, measuring the volume of the biofilm on the Synthegra surface as well as the sand-blasted one.
The measurements carried out indicate, for the three species analysed, a reduced volume of bacterial biofilm on Synthegra compared to the sand-blasted surface.
5 years after marketing the implant-prosthesis system way (2008), Geass has decided to gather the clinical data with a retrospective study aimed at evaluating the behaviour of way Milano with the Synthegra surface in the medium term.
The preliminary data confirms a high percentage of success and a low incidence of peri-implantitis.
Materials and methods
The study involved 4 dental clinics with over 800 way Milano implants inserted on 400 patients.
The patients included were treated consecutively from 2008 to 2013.
All the edentulia (single, partial and total) and all the prosthetic rehabilitation techniques with prosthetic loading at at least 12 months were considered.
Thanks to its extremely smooth nature, Synthegra is less attackable by bacteria and so reduces the risk of infection which may produce peri-implantitis.
Synthegra stimulates the formation of an extended coagulation of fibrin, which attracts the cells involved in bone healing and allows them to reach the surface of the implant. The topographical distribution and the dimensions of the niches favour their housing and the activity of the osteoblasts, determining effective osseointegration.
On the traditional rough surface, the fibrin filaments are able to adhere nearly exclusively to the peaks of the surface forming bridges between them. However, on Synthegra the fibrin manages to form well-developed lattices in the valleys too, favouring housing of the osteogenic cells directly on the implant surface.
Thanks to the elevated fibrin adhesion, Synthegra attracts a larger number of osteogenic cells and allows them to house themselves stably on the implant surface. This process activates the formation of bone directly in contact with the implant, determining a faster and more favorable osseointegration.
Even though it is a smooth surface, able to reduce bacterial adhesion, Synthegra favours osseointegration with its strong contact osteogenesis, as demonstrated by an in vivo study on sheep.
From the study, it results that already at 15 days the percentage of BIC (Bone Implant Contact) for Synthegra is greater than that of the machined surfaces and can be compared to that of the performing rough surfaces.
Synthegra, as well as guaranteeing a lesser risk for bacterial adhesion, ensures excellent ossoeintegration in a short time.