Comparing Surface Treatments in Dental Implants: SLA, RBM, and Beyond

As dental professionals, every implant decision affects the outcome. Selecting the features of your implant is a crucial step in determining how well and quickly osseointegration occurs. From SLA to RBM and other emerging nanotechnologies, each method dictates healing time, cellular response, and long-term performance.

This informative article compares the most clinically relevant implant surface treatments and outlines when to use them for the best results.

Understanding Implant Surface Technology

Why is Surface Texture Relevant?

The surface isn’t a passive element in dental implants but a biological interface. Its topography plays a significant role in protein adsorption, osteoblast adhesion, and early bone remodeling.

Current research has shown how microroughened surfaces increase bone-to-implant contact (BIC), especially during the healing window.

Going from Smooth to Microtextures

The first implant designs featured machined, smooth titanium that, although biocompatible, failed to promote predictable early bone anchorage. In contrast, modern roughened surfaces, like SLA and RBM, dramatically increase surface area and foster a stronger biological bond. Today, surface preparation is essential and integral to any high-performance implant system.

Sandblasted, Large-Grit, Acid-Etched (SLA)

How SLA Works

SLA implants are created by blasting the titanium with large-grit particles, followed by an acid-etching process to add microroughness. These steps result in a homogeneously textured surface, ideal for the desired osteoblast proliferation. While SLA surfaces are hydrophobic by default, new iterations incorporate hydrophilic properties that further improve their outcome.

Clinical Performance and Indications

SLA is one of the most studied surface types with consistently high success rates. It performs exceptionally well in moderate to dense bone (D1–D2), especially for immediate and early loading protocols. Moreover, its microroughness encourages rapid stabilization and is frequently selected for full-arch restoration or cases with tight schedules.

Contraindications and Limitations

SLA may require adjunctive protocols like under preparation or tapered implants to achieve primary stability in very soft bone (D4). It also demands excellent hygiene and surgical control to avoid contamination.

Resorbable Blast Media (RBM)

RBM Main Features

RBM-treated implants use biocompatible materials like calcium phosphate to blast the implant surface. The particles dissolve after the placement, leaving behind a clean but moderately rough texture. The absence of acid etching makes RBM a more conservative option that preserves the implant’s structural integrity.

Eligibility Criteria

RBM implants are often used to prioritize soft tissue response, particularly in the esthetic zone or thin gingival buccal biotypes. They can also offer great performance in patients with systemic sensitivity or in cases where minimizing foreign residues and contamination is essential.

Clinical Considerations

Achieving adequate primary stability may require implant design modifications or relayed loading on low-density bone, as RBM surfaces are less aggressive than SLA. Yet, their balanced roughness and surface purity make them a highly reliable alternative in long-term osseointegration.

Other Surface Innovations

Anodized Surfaces

Anodizing involves a controlled oxidation process of the titanium surface to create a thickened titanium oxide layer with nano-scale features. Products like our OPI - One Piece Implant fall under this category. These surfaces can accelerate early osseointegration while requiring a more precise and rigorous hygiene to avoid plaque accumulation.

Hydroxyapatite (HA) Coatings

HA is a highly biocompatible ceramic that mimics natural bone minerals. These coatings chemically bond with bone, enhancing early stability and fostering osteoblastic activity. Although older HA coatings had issues with delamination, current plasma-sprayed and nanocoated techniques have improved hydroxyapatite implants reliability and clinical success.

Nanostructured and Biomimetic Surfaces

Some emerging technologies include bioactive peptides, nano-etching, and hybrid surfaces that mimic bone at a microscopic level. Although there’s plenty of research and more long-term clinical data to gather on this subject, these modern surfaces promote angiogenesis and cellular signaling, potentially reducing healing time.

Clinical Decision-Making Based on Surface Treatment

Case Selection Guidelines

The first step is to match the surface treatment with the patient’s biological and anatomical profile. SLA surface implants are ideal for high-demand cases with dense bone and immediate loading, whether unitary or multiple. RBM is better suited for esthetic areas, soft bone quality, or medically compromised patients. On the other hand, it’s worth considering moderately rough or bioactive surfaces in grafted or regenerated sites to enhance early bone response.

Surgeon Experience and Workflow

The success of the treatment is tied to more than just surface type alone. Every case requires a comprehensive evaluation, rigorous planning, and the proper surgical technique, which includes the appropriate insertion torque and load management. When paired with digital planning and conservative approaches, the right surface can give you a biological advantage.

Surface Selection by Implant Type: Unitary, Multiple, All-on-4, and Zygomatic Applications

Following the Prosthetic Design

The implant’s surface should reflect the surgical indication and the prosthetic designs. As a result, implant selection also involves multidisciplinary work to discern the best alternative for each scenario.

Unitary Implants, especially in the anterior maxilla, benefit greatly from RBM surface features that offer excellent soft tissue compatibility, papilla preservation, and lower bacterial adhesion risk. This decreases the risk of contamination, gum recession, and transparencies in thin biotypes.

Multiple implant restorations, particularly posterior units subjected to high occlusal forces, benefit from SLA-treated surfaces as they provide superior early stability.

All-on-4 and All-on-6 full-arch protocols, where immediate loading is crucial, SLA surfaces are the gold standard due to their high bone-to-implant contact and ability to quickly stabilize in D1-D2 bone. These implants also benefit from SLA microroughness that helps secure primary fixation in high insertion torque and tilted distal implants.

Implants that rely primarily on cortical bone, such as the zygomatic implants, also benefit greatly from RBM and SLA options, providing additional bone-to-implant contact and supporting biological integration at the crestal and sinus contact zones.

The role of Surface Chemistry and Wettability

Beyond the topography of the implant’s surface, the chemical composition and wettability of the surface dramatically influence early cellular behavior. Hydrophilic surfaces attract blood, proteins, and other biomarkers more efficiently, allowing an enhanced clot stability and increasing the recruitment speed of osteogenic cells.

Considering that early osteogenic activity is critical for primary stability, it’s clear that surface treatments like SLA provide a chemically modified substrate that allows higher wettability and promotes better performance in immediate placement cases.

On the other hand, RBM surface treatment provides an exceptionally clean and biocompatible contact area that supports and fosters positive cell response.

Clinicians should consider both aspects of the spectrum, the physical and chemical natures of implant surfaces, to achieve the best outcomes, especially when working in sites with compromised healing potential.

Maintenance and Long-Term Stability of Treated Surfaces

After a complete osseointegration, the clinical focus shifts to preserving peri-implant health. Different surface textures have distinct tendencies for biofilm retention.

SLA and other rough surface treatments may be more prone to plaque accumulation if the patient has poor compliance or systemic factors that may affect oral hygiene, requiring a strict hygiene protocol followed by regular checkups. In those cases, RBM or other smoother hybrid surface treatments may offer a slight maintenance advantage.

Either way, every patient requires regular follow-up visits, specialized professional cleaning protocols, and constant hygiene education to achieve long-term implant success.

The GDT Perspective

At GDT Dental Implants, we offer SLA and RBM surface technologies across our dental implant collection. Whether you’re working with dense cortical bone with the GDT Spiral SLA-treated implant or facing soft-tissue esthetic zone with the GDT RBM Spiral implant, the system allows for strategic pairing of the surface technology with the clinical environment.

Frequently Asked Questions (FAQs)

Which surface is better for immediate loading protocols?

Most clinicians typically prefer SAL due to its enhanced microroughness and superior early bone anchorage.

Are RBM implants as effective as SLA?

Yes. Clinical studies show RBM and SLA implants with similar long-term survival rates when placed under the appropriate conditions.

Can SLA be used in soft bone?

Yes! With the appropriate conditions and preparation, you can use SLA implants in most cases. However, soft bone sites may require surgical adjustments like underpreparation and tapered implant geometry to achieve primary stability.

Are nano-treated implants superior to SLA or RBM?

Not yet. At least not conclusively. While early results are promising, these new technologies require more peer-reviewed, long-term data before making clinical recommendations.

The Takeaway

Implant surface treatment is a decision that directly impacts your implant cases. Choosing between SLA, RBM, and other options requires clinical insight, patient evaluation, and a clear understanding of how each surface interacts and behaves with different bone qualities.

However, when used with the appropriate technique and product support, you’re more than equipped to deliver reliable, science-driven outcomes across numerous cases and levels of complexity.

References

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2. Buser, D., Janner, S. F., Wittneben, J. G., Brägger, U., Ramseier, C. A., & Salvi, G. E. (2012). 10-year survival and success rates of 511 titanium implants with a sandblasted and acid-etched surface: a retrospective study in 303 partially edentulous patients. Clinical implant dentistry and related research, 14(6), 839–851. https://doi.org/10.1111/j.1708-8208.2012.00456.x

3. Rupp, F., Gittens, R. A., Scheideler, L., Marmur, A., Boyan, B. D., Schwartz, Z., & Geis-Gerstorfer, J. (2014). A review on the wettability of dental implant surfaces I: theoretical and experimental aspects. Acta biomaterialia, 10(7), 2894–2906. https://doi.org/10.1016/j.actbio.2014.02.040

4. Smeets, R., Stadlinger, B., Schwarz, F., Beck-Broichsitter, B., Jung, O., Precht, C., Kloss, F., Gröbe, A., Heiland, M., & Ebker, T. (2016). Impact of Dental Implant Surface Modifications on Osseointegration. BioMed research international, 2016, 6285620. https://doi.org/10.1155/2016/6285620

5. Dhaliwal, J. S., Abd Rahman, N. A., Ming, L. C., Dhaliwal, S. K. S., Knights, J., & Albuquerque Junior, R. F. (2021). Microbial Biofilm Decontamination on Dental Implant Surfaces: A Mini Review. Frontiers in cellular and infection microbiology, 11, 736186. https://doi.org/10.3389/fcimb.2021.736186