MetAlive® bioadhesion is scientifically researched and numerous articles of the features of material and cell biology, as well as clinical indications, has been published. Find out why and how MetAlive® bioadhesion functions and how does faster healing benefit clinically.


MetAlive® bioadhesion - the solution for non-problematic wound healing

To understand why bioadhesion is important in achieving a proper healing as well as a long-term sustainable biological width, it’s important to review the following wound healing steps with the corresponding evidence of how MetAlive® bioadhesion effects it.

Wound healing steps

wound healing steps

Blood clotting

Within minutes of an injury, platelets (thrombocytes) aggregate at the injury site to form a fibrin clot. This clot acts to control active bleeding.


In the inflammatory phase, bacteria and debris are phagocytosed (eaten by cells) are removed while factors are released that cause the migration and division of cells involved in the proliferative phase.


The proliferative phase is characterized by angiogenesis, collagen deposition, granulated tissue formation, epithelialization, and wound contraction. Angiogenesis occurs whereby vascular endothelial cells form new blood vessels. Fibroplasia and granulating tissue formation occurs while fibroblasts grow and form a new provisional extracellular matrix (ECM) by excreting collagen and fibronectin. Concurrently, re-epithelialization of the epidermis occurs, in which epithelial cells proliferate and 'crawl' atop the wound bed, providing cover for the new tissue (in the case of skin and mucosal tissue).
In contraction, the wound is made smaller by the action of myofibroblasts, which establish a grip on the wound’s edge and contract themselves using a mechanism similar to that in smooth muscle cells. When the cells' role is close to complete, unnecessary cells undergo apoptosis (cell death).

Maturation and Remodeling

In the maturation and remodeling phase, collagen is remodeled and realigned along tension lines and cells that are no longer needed are removed by apoptosis.

Every wound is an open gateway for bacteria to enter the body and attack living tissue.

The cells’ natural defense system, or what we call an immune system, is triggered in response to the onslaught. If the microbial colony can invade the tissue and reach a critical mass, an infection has become reality. A number of treatments has been developed to prevent the infection from occurring and spreading in the body beyond control, including from simple procedures like cleaning and airing the wound to highly sophisticated systemic methods, like the use of antibiotics. The only certain way to prevent the wound from infecting is to let it close and heal completely. As long as the wound is open, the bacteria can, and will, attack through it. 

Some surgical wounds are by nature such that they are not allowed to close via the natural course. For example, long-term catheter wounds remain open because the tube inserted through the skin keeps the tissue from closing, until the catheter is removed. Dental implant abutments are clinically speaking nearly an equivalent situation. The purpose of the abutment surface is to create a sustainable biological seal between oral cavity and the rest of the body. In the ideal situation the gingival tissue will heal and create an intimate contact to the abutment surface, that of a sufficient width that can withstand the continuous bacterial attack. The weak point in the system is the lack of adhesion between the material surface and cells.

MetAlive® bioadhesion surface modification has for the first time created a bond between living cells and inorganic materials, metals and ceramics.

MetAlive® bioadhesion solves the problem of wound healing

Clinical implications of using MetAlive® bioadhesion surface modification 

 Wound healing process is the natures way of dealing with the trauma of implantation. Clinically, the advantages provided by MetAlive® bioadhesion surfaces improved wound healing are manifested in many ways. Some clinical effects have already been proven in clinical studies, such as faster healing, less bone resorption under the adhered gingival tissue, smaller sulcus and greater biological width. These effects were observed in dental implant abutment study and in a skin penetrating implant study.

It is expected that many other clinical benefits of MetAlive® bioadhesion are still uncovered, even though for some of which, there exists already indicative evidence. Reduction of infections is one of the most prominent effects to be studied in the next clincal trial.

The wound healing process is nature’s way of dealing with the trauma of an implantation. Clinically, the advantages provided by MetAlive® bioadhesion surfaces improve wound healing are manifested in many ways. Some clinical effects have already been proven in clinical studies, such as faster healing, less bone resorption under the adhered gingival tissue, smaller sulcus and greater biological width. These effects were observed in both a dental implant abutment study as well as a skin penetrating implant study.

It is expected that many other clinical benefits of MetAlive® bioadhesion are still to be uncovered, even though for some of which, there exists already indicative evidence. Reduction of infections is one of the most prominent effects to be studied in the next clinical trial.

How does MetAlive® bioadhesion work ?

In the following table & flow chart are listed the main, observable differences at the ultra histological, histological, clinical and mechanical level. In short, MetAlive® bioadhesion functions can be summarised by stating that MetAlive® bioadhesion enhances wound healing by allowing cells to adhere onto itself and thereby improve the healing process steps at every level and time span.

This chain of clinical events can be simplified to consist of:

clinical scheme

Comparison between traditional and MetAlive dental implant abutments


MetAlive® bioadhesion 

Ordinary titanium 

Immidiately after implantation

Specific protein adsorption

Non specific protein adsorption

0-3 days

Cell adhesion, faster spreading and proliferation, low inflammatory response, loose connective tissue with round cells at the interface.

Poor adhesion, slow spreading and proliferation, moderate inflammatory response, loose connective tissue with densely packed flat fibrous tissue around the material.

3-11 days 

Cell and tissue adhesion on MetAlive® bioadhesion. No encapsulation.

No adhesion of tissue. Encapsulation with dense fibrous tissue layer. 

11 days – 12 weeks

Measurable mechanical adhesion of tissue on MetAlive® bioadhesion. Histologically higher level of tissue contact. Clinically faster healing. Significantly reduced bone resorption during healing. Smaller depth of sulcus.

 Thin tissue remnants obwervable on removed healing abutments. 

No adhesion. No tissue remnants observable on removed abutments.

Beyond 12 weeks

New adhesion on permanent abutment with MetAlive® bioadhesion

Histologically greater biological width or amount of contact between the abutment and the tissue. 

No adhesion. 



Healing phases

MetAlive® bioadhesion

Ordinary titanium

Blood clotting

Selective proteins are adsorbed onto MetAlive® bioadhesion surface from the blood. This happens within seconds after the implantation. The nanotexture of MetAlive® bioadhesion offers specific binding sites for the proteins.

Proteins also adsorp on the traditional polished surfaces which however have no binding sites to offer, nor are selectively adsorbed.Tissues natural inflammatory defence mechanisms take action agains bacteria and debris. 


Inflammatory cells also identify if the foreign body present is friendly or hostile. MetAlive® bioadhesion surface is considered a friendly material as it is made of pure titanium oxide, the most biocompatible synthetic material on earth, and it has the extra advantage of having the adsorbed protein layer on it. 

Titanium, its alloys and Zirconium ceramics as such are highly biocompatible materials. The lack of adhesion however leaves the cells experiencing relative movement between the cells and material surface leading to irritation.


Cells begin to proliferate directly onto the MetAlive® bioadhesion surface, which has binding proteins adhered to it. In cell culture studies fibroblasts and epithelial cells spread and attach faster to MetAlive® bioadhesion surface than to ordinary polished titanium material. This process begins within minutes from the implantation (REF). An intact, thin, new fibrous tissue layer is formed creating the next level of defence against microbial attacks. In other words, MetAlive® bioadhesion helps the cells to close the wound and prevent further attack by microbes. Within three days a markedly improved wound healing has occurred. (REF)

Cells are not able to spread and attach to ordinary abutment surfaces properly. Thus the blood clot is replaced by new intact tissue at a slower rate while the inflammatory reaction remains stronger. The movement between the abutment surface and the cells further irritates the tissue and increases the inflammatory and foreign body reaction against the abutment. Therefore tissues are not in proper contact with the abutment, the gap stays open and microbes have an open passageway to the wound. The tissues react by starting to form a dense fibrous encapsulation against the foreign body present.


At this point MetAlive® bioadhesion offers a continuous improved adhesion for the connective tissue and epithelium. Significantly reduced bone resorption and increased contact surface area together with a mechanically measurable adhesion level keeps the gingival tissue healthy and biological width at its maximum level.

With the help of chlorhexidine, proper cleaning and continuous monitoring for most abutments all goes well and the tissue wins the battle against microbia, regardless of the surface that does not achieve proper closure.
With any luck, the abutment has now healed without any complications.

In long term however 10-40% of all implants are reported to develop peri-implantitis and other complications.

MetAlive® bioadhesion - bioactive nanotechnology

2 millimeters             2millimeters

The MetAlive® bioadhesion surface improves the spreading of cells over the surface of the abutment. Each light point in the two pictures is in fact a single cell seen under the fluorescent light microscope. The MetAlive® bioadhesion surface on the left shows a much more rapid and even spreading of cells over the entire surface to the ordinary medical grade titanium, (on the right picture) whereby the cells have not spread anywhere from the seeded area.

0,1 mm                      01 mm 

(0,1 mm = 100 micrometers)

Right after the implantation, the cells come in contact with the MetAlive® bioadhesion surface and start dividing, spreading and covering the complete surface of the abutment. This image shows how individual cells have formed a continuous layer of cells on the MetAlive® bioadhesion surface after just 1 day post seeding. In other words, the beginnings of intact healed tissue have been formed.

 0,07 mm                   007 mm

(0,07 mm = 70 micrometers)

Cellular structures on the MetAlive® bioadhesion surface seen under scanning electron microscope at a magnification of 5000x. Each cell sits on the surface and is connected via tenticles and other organels to it, which forms the basis for closing the wound at the abutment interface. The length bar at the top of the picture is approximately equal to the size of a single cell. The sample is from an animal experiment in subcutaneous tissue. Even after removal of the sample from the tissue, cells remain in abundant quantities on the surface of the implant.

0,05 mm                   005 mm 

(0,05 mm = 50 micrometers)

Scanning electron microscopic images showing how cells can sit on the MetAlive® bioadhesion surface, spread and flatten on it at different stages of a wound healing process. This process is faster and more widespread on the MetAlive® bioadhesion surface than on other medically used materials.

0,002 mm                 0002 mm

(0,002mm = 2 micrometers)

This is a transmission electron microscopic image of the internal structure of a single human skin cell, called fibroblast which is sitting on th MetAlive® bioadhesion surface (black material on top). The thin lines right next to the MetAlive® bioadhesion surface are cell membranes. This type of close contact with adhesion mechanisms visible can only be seen with MetAlive® bioadhesion while other abutment materials are not adhered with the cells, leading to a clear gap between the two. The magnification of the image is showing an area of approx 10 square micrometers, which is equivalent to about 1/100.000 of mm2.

0,00002 mm                000002 mm

(0,00002mm = 29 nanometers)

The MetAlive® bioadhesion surface as seen under Atomic Force Microscopy. The unique patented nanotopography of MetAlive® bioadhesion improves the protein adsorption from tissue fluids in seconds after the implantation has taken place. This difference leads to the cells’ ability to recognize the MetAlive® bioadhesion surface as a friendly surface and allowing intimate contact with it. The drawn image represents a protein sitting on the pores on the MetAlive® bioadhesion surface. The magnification of this image is showing an area of approximately 2 square micrometers, which is equivalent to 1/500.000 of a mm2.