国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (3): 281-295.doi: 10.7518/gjkq.2025060

• 专家笔谈 •    

氧化锆种植体的表面修饰及其对骨整合的影响

余杰1(),刘劲松2()   

  1. 1.温州医科大学口腔医学院·附属口腔医院综合科 温州 325027
    2.温州医科大学口腔医学院·附属口腔医院修复科 温州 325027
  • 收稿日期:2024-10-12 修回日期:2025-02-02 出版日期:2025-05-01 发布日期:2025-04-30
  • 通讯作者: 刘劲松
  • 作者简介:余杰，副主任医师，硕士，Email：735385443@qq.com|余杰，硕士，温州医科大学附属口腔医院口腔综合科副主任医师。浙江省口腔医学会口腔黏膜病（中西医结合、罕见病）专业委员会副主任委员，浙江省医师协会中西医结合医师分会委员。擅长牙体牙髓病和口腔黏膜病的诊疗。主持省市级科技项目2项，在各级专业期刊发表学术论文10余篇。|刘劲松，温州医科大学附属口腔医院主任医师/教授，博士生导师。国际牙医师学院Fellow，浙江省高层次卫生创新人才培养对象，浙江省151人才，中华口腔医学会口腔美学专业委员会常务委员，中华口腔医学会口腔修复专业委员会委员，浙江省口腔医学会口腔修复专业委员会副主任委员、浙江省老年口腔医学专业委员会副主任委员。擅长固定义齿、复杂活动义齿及种植义齿修复。主持国家自然科学基金面上项目4项、省级课题4项，以第一/通信作者发表文章60余篇，H指数20，获得省科技进步奖1项，浙江省卫生健康委员会科技奖1项。
  • 基金资助:
    国家自然科学基金(80220039)

Surface modification of zirconia implants to promote bone integration

Jie Yu1(),Jinsong Liu2()   

  1. 1.Dept. of General Dentistry, Institute of Stomatology, Affiliated Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325027, China
    2.Dept. of Prosthodontics, Institute of Stomatology, Affiliated Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325027, China
  • Received:2024-10-12 Revised:2025-02-02 Online:2025-05-01 Published:2025-04-30
  • Contact: Jinsong Liu
  • Supported by:
    National Natural Science Foundation of China(80220039)

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摘要：

氧化锆种植体因其颜色类似天然牙齿，美学效果优良且具有适当的机械性能以及理想的生物相容性，可以减少种植体周围的炎症反应，成为替代钛种植体的可能选择。然而，与钛相比，未经处理的氧化锆表面具有生物惰性，导致其骨整合有限。由于表面特性在蛋白质的吸附、黏附、增殖和成骨相关细胞的分化中起着至关重要的作用，因此许多表面修饰被用于增强氧化锆的表面生物活性。本文综述了氧化锆种植体的各种表面修饰及其对骨整合的影响，并总结了几种表面改性方法的优缺点。

关键词: 表面改性, 骨整合, 氧化锆, 种植体

Abstract:

Zirconia implants are considered as promising alternatives to titanium implants because of their tooth-like color that can simulate the appearance of natural teeth, appropriate mechanical properties, and biocompatibility, which reduce peri-implant inflammatory reactions. However, an untreated zirconia surface is bio-inert, which results in limited osseointegration compared with titanium. Considering that surface characteristics play an essential role in the adsorption of protein, adhesion, proliferation, and differentiation of osteogenesis-related cells, numerous surface modifications are applied to enhance the surface bioactivity of zirconia. In this review, various surface modifications of zirconia implants and their effects on osseointegration were comprehensively summarized. Meanwhile, the advantages and disadvantages of se-veral surface modifications were discussed.

Key words: surface modification, osseointegration, zirconia, dental implant

中图分类号: 

  • R783.1

表 1

表面形貌修饰"

方法特征参考文献
喷砂改善粗糙度，低成本，颗粒污染，造成微裂纹[18-25]
酸蚀清除杂质，改变化学成分[28-37]
喷砂-酸蚀提高粗糙度，清除杂质[38-46]
SIE纳米多孔，可选择性[47-50]
激光光纤激光一种稳定的高能光束，波长短，没有空间波动[59-62]
CO2激光低频率和小光子能量，表面氧化和易碎边缘[63-66]
YAG激光更短的波长聚焦在更小的光斑上[67-70]
飞秒激光增加表面粗糙度，减少残余元素的存在[71-76]

表 2

表面化学修饰"

方法特征参考文献
紫外光处理增强表面亲水性，降低表面碳含量[77-84]
自组装自主过程，易于设置，低成本，良好的细胞反应[85-87]
生物功能化将生物分子（蛋白质、酶、肽等）接枝于表面[88-94]
离子注入镁涂层改善细胞行为[95-101]

表 3

氧化锆表面涂层"

涂层材料特征参考文献
生物玻璃优异的生物活性和骨导电性[104-109]
磷酸钙减轻骨吸收，增加初始骨结合强度[110-119]
二氧化硅涂层各向同性微图案，诱导成骨细胞早期排列[120-121]
纳米结构涂层提供纳米级的粗糙度，促进整合素聚集，药物递送[122-127]

表 4

不同氧化锆表面改性下的粗糙度和BIC值"

表面处理

出版

年份

动物

模型

种植位置随访/周表面粗糙度/μm平均BIC/%参考文献
项目测量值
机械加工2019大鼠上颌骨3Sa3.2358.10[46]
机械加工2016小型猪

上颌骨

下颌骨

16

16

Ra0.18

62.4

66.9

[37]

机械加工

粗加工

等离子体处理

粗等离子体处理

2014兔胫骨4Ra

0.54

1.98

0.54

1.99

58.26

56.93

70.87

72.27

[132]
机械加工2012猪颅骨12——67.1[17]
机械加工2010兔胫骨6——26[16]
粗加工2009兔股骨/胫骨3Ra1.2495[109]

机械加工

粗加工

2009大鼠股骨4Ra

0.13

0.36

46.6

59.4

[133]
机械加工2008羊骨盆8——75[134]
喷砂2017小型猪下颌骨12——46[10]
喷砂2012兔股骨12——41.35[24]
喷砂2012小型猪前颅底16Sa

0.3

1.7

3.0

61.4

79.3

48.4

[19]
酸蚀2017小型猪下颌骨12——61[10]
酸蚀2016小型猪

上颌骨

下颌骨

16

16

Ra0.59

88.8

92.5

[44]
喷砂-酸蚀2019大鼠上颌骨3Sa351.8080.39[46]
喷砂-酸蚀2016小型猪下颌骨8Ra0.2586.24[45]
喷砂-酸蚀2013大鼠股骨4Ra0.9533.5[44]
SIE2013兔股骨6——75.01[47]

垂直光纤激光

水平光纤激光

垂直YVO4激光

水平YVO4激光

2013大鼠胫骨4Sa

1.84

1.84

1.44

1.44

64.9

49

39.8

17.5

[60]
YAG激光2014大鼠胫骨4Sa3.3333.92[70]
飞秒激光2014兔胫骨4——47.5[53]
飞秒激光2014狗下颌骨12.8——

未加载57.6

即刻负载65.0

[55]
飞秒激光2013狗下颌骨12Sa8.9

未加载48

即刻负载78

[56]
激光改性2012兔股骨12——43.86[24]
紫外光2019大鼠上颌骨3Sa3.0950.32[46]
喷砂酸蚀+紫外光2019大鼠上颌骨3Sa32285.87[46]

羟磷灰石涂层（浸渍）

羟磷灰石涂层（溅射）

2009兔股骨/胫骨3——95[109]

微结构

纳米表面改性磷酸钙

纳米表面改性磷酸钙

2009兔股骨6Ra

1.0

1.0

1.0

68.6

64.5

69.7

[47]
RKKP2002大鼠股骨8.5Ra0.3774[107]

表 5

氧化锆表面改性的优缺点"

表面改性优点缺点
喷砂微粗糙度，氧化锆表面均匀、温和的各向异性磨损颗粒污染，微裂纹与相变
酸蚀均匀粗糙度，消除杂质改变化学成分，降低抗弯强度
喷砂-酸蚀提高粗糙度，消除杂质不可控性，污染
SIE表面化学性质保持不变，纳米尺度和微观粗糙度操作复杂，孔隙直径不受控制
光纤激光稳定高能光束波长短，无空间波动
CO2激光低频率、小光子能量表面氧化和边缘脆弱
YAG激光波长较短聚焦于较小的光斑
飞秒激光可以得到具有规则几何形状的微槽，精度高、损伤小基底损坏，造成氧化锆老化
紫外光处理将氧化锆表面由疏水性转变为亲水性改变机械性能和变色
自组装易于设置，产生革命性新成果的潜力巨大潜在毒性，生物学效应不明确
生物功能化接枝生物分子能增强氧化锆的生物活性生物分子与氧化锆表面的黏附力较弱
离子注入高纯度、低损伤基底损坏，表面污染
生物玻璃涂层可严格控制孔隙率形成裂纹，界面附着力不足
磷酸钙涂层与骨头相似的矿物成分涂层分离
二氧化硅涂层可得到各向同性的微图案结构涂层分离，影响表面硅烷密度
纳米结构涂层可获得纳米级的粗糙度，药物递送涂层与基底的附着力较弱
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