Figure 3.

Macro- and microstrucured titanium implants show excellent biomechanical integration into bone in long-term. This implant-to-bone strength is higher than within the adjacent cancellous bone leading to intra-bone fracture during explantation. Here, de novo bone formation (contact osteogenesis) is based on micro-mechanical interdigitation of the surface with the material surface. It is believed that nanostructure titanium surfaces accelerate the initial phase of osteointegration leading to early full weight bearing even in poor bone quality. In contrast, the “bone-bonding phenomenon” is based on a chemical interaction of collagen, from the adjacent bone interdigitating with the chemically active surface of the implant [46,140].